Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
MLM Center for Health Education and Equity Consulting Services, Jackson, MD, USA.
Womens Health (Lond). 2024 Jan-Dec;20:17455057241296905. doi: 10.1177/17455057241296905.
BACKGROUND: Stigma and lack of social support are barriers to HIV prevention, especially among cisgender Black women in the United States. While HIV pre-exposure prophylaxis (PrEP) can decrease HIV transmission, PrEP initiation and adherence remains low among Black women, especially in the U.S. South. OBJECTIVES: The purpose of this study was to characterize experiences with stigma and social support among PrEP-naïve and PrEP-experienced Black cisgender women in Mississippi. DESIGN: Qualitative study in which semi-structured interviews and focus groups were conducted. METHODS: We purposively recruited PrEP-naïve cisgender Black women who met PrEP indications to participate in focus groups and all PrEP-experienced cisgender Black women at a sexual health clinic in Jackson, Mississippi to participate in one-on-one semi-structured interviews. Inductive thematic analysis was used to analyze focus group and interview transcripts. RESULTS: A total of 37 PrEP-naïve Black cisgender women participated across 6 focus groups and 8 PrEP-experienced cisgender Black women completed semi-structured interviews. Four themes were identified: (1) the intersection of gendered racism, discrimination, and HIV stigma, (2) enacted and anticipated PrEP stigma, (3) stigma mitigation strategies and PrEP adherence, and (4) social support's role in PrEP initiation and adherence. PrEP-naïve and -experienced Black women discussed the negative consequence that sexual stigmatization and gendered racism has on HIV testing. PrEP-naïve Black women discussed how HIV stigma decreases PrEP initiation. Conversely, PrEP-experienced Black women were able to identify strategies they utilized to mitigate stigma. PrEP-experienced Black women discussed how differing levels of social support impact their PrEP use. CONCLUSION: Improving social support and stigma mitigation strategies could help improve PrEP initiation and adherence among cisgender Black women at-risk of acquiring HIV in the U.S. South. Educating communities on PrEP, and training providers on stigma-mitigating strategies when serving Black women in the U.S. South who are seeking HIV prevention is paramount.
背景：污名化和缺乏社会支持是预防艾滋病的障碍，尤其是在美国的跨性别黑人女性中。虽然 HIV 暴露前预防 (PrEP) 可以降低 HIV 传播，但 PrEP 的起始和坚持率仍然很低，尤其是在美国南部的黑人女性中。
目的：本研究旨在描述密西西比州 PrEP 初治和经验丰富的黑人跨性别女性在污名和社会支持方面的经历。
设计：采用半结构式访谈和焦点小组进行定性研究。
方法：我们有目的地招募了符合 PrEP 指征的 PrEP 初治的黑人跨性别女性参加焦点小组，以及密西西比州杰克逊市一家性健康诊所中所有 PrEP 经验丰富的黑人跨性别女性参加一对一的半结构式访谈。采用归纳主题分析对焦点小组和访谈记录进行分析。
结果：共有 37 名 PrEP 初治的黑人跨性别女性参加了 6 个焦点小组，8 名 PrEP 经验丰富的黑人跨性别女性完成了半结构式访谈。确定了 4 个主题：（1）性别种族主义、歧视和 HIV 污名的交叉，（2）实施和预期的 PrEP 污名，（3）污名缓解策略和 PrEP 坚持，（4）社会支持在 PrEP 起始和坚持中的作用。PrEP 初治和经验丰富的黑人女性讨论了性污名化和性别种族主义对 HIV 检测的负面影响。PrEP 初治的黑人女性讨论了 HIV 污名如何降低 PrEP 的起始率。相反，PrEP 经验丰富的黑人女性能够确定她们用来减轻污名的策略。PrEP 经验丰富的黑人女性讨论了不同程度的社会支持如何影响她们对 PrEP 的使用。
结论：改善社会支持和污名缓解策略可能有助于提高美国南部有 HIV 感染风险的跨性别黑人女性的 PrEP 起始和坚持率。在向美国南部寻求 HIV 预防的黑人女性提供 PrEP 教育，并培训服务提供者使用污名缓解策略至关重要。
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