Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Soc Sci Med. 2024 Dec;363:117493. doi: 10.1016/j.socscimed.2024.117493. Epub 2024 Nov 9.
Sexual stigma, mental health disorders, and socioeconomic disparities present important yet incompletely understood barriers to PrEP adoption among gay men and other men who have sex with men (MSM). This study examines how these factors interact and affect PrEP uptake, adherence, and persistence among MSM.
Data from the 2018 and 2019 American Men's Internet Survey cycles, involving 6907 adult MSM eligible for PrEP, were analyzed. We assessed sexual stigma heterogeneity among this group using latent class analysis and investigated individual relationships between i) stigma class membership, ii) mental distress, and PrEP engagement (past-year use, adherence, and persistence) using Poisson regression with a robust error variance, considering potential variations based on poverty status. The combined associations of sexual stigma and mental distress with PrEP engagement was evaluated using inverse probability weighting.
Four distinct sexual stigma classes were identified, each exhibiting varied associations with PrEP engagement. Associations with mental distress lost statistical significance after adjusting for confounders. However, having both mental distress and sexual stigma was associated with lower past-year PrEP use, with the strongest association observed for those with anticipated healthcare stigma class membership and mental distress (aPR 0.53 [95% CI: 0.37, 0.76]). Sexual stigma accompanied by mental distress was also associated with significantly increased poor PrEP adherence, particularly among those with family and general social stigma class membership (aPR 2.31 [95% CI: 1.08, 4.97]).
Psychosocial factors exert synergistic impacts on PrEP engagement among MSM. Tailored interventions addressing these subtleties may effectively optimize PrEP uptake and improve consistency of use among MSM.
性污名、心理健康障碍和社会经济差距是男同性恋者和其他男男性行为者（MSM）中接受 PrEP 治疗的重要但尚未完全理解的障碍。本研究探讨了这些因素如何相互作用并影响 MSM 中 PrEP 的采用、依从性和持久性。
分析了 2018 年和 2019 年美国男性互联网调查周期中 6907 名符合 PrEP 条件的成年 MSM 的数据。我们使用潜在类别分析评估了该组中的性污名异质性，并使用具有稳健误差方差的泊松回归调查了个体之间的关系：i）污名类别成员，ii）心理健康和 PrEP 参与（过去一年的使用、依从性和持久性），考虑到贫困状况的潜在变化。使用逆概率加权法评估性污名和心理健康与 PrEP 参与的综合关联。
确定了四个不同的性污名类别，每个类别与 PrEP 参与的关联各不相同。在调整混杂因素后，与心理健康的关联失去了统计学意义。然而，同时存在心理健康和性污名与过去一年 PrEP 使用率较低相关，与预期医疗保健污名类别成员和心理健康相关的关联最强（调整后比值比[aPR]0.53[95%置信区间：0.37,0.76]）。伴有心理健康的性污名也与 PrEP 依从性差显著相关，尤其是那些具有家庭和一般社会污名类别的人（aPR2.31[95%CI：1.08,4.97]）。
心理社会因素对 MSM 中 PrEP 的参与产生协同影响。针对这些细微差别的量身定制的干预措施可能会有效地优化 MSM 中 PrEP 的采用，并提高使用的一致性。
