加拿大白人、黑人和原住民男性在艾滋病毒暴露前预防（PrEP）认知和使用方面的种族差异：对“我准备好了”全国艾滋病毒自我检测研究数据的分析
Racial disparities in HIV pre-exposure prophylaxis (PrEP) awareness and uptake among white, Black, and Indigenous men in Canada: Analysis of data from the I'm Ready national HIV self-testing study.
作者信息
Ajiboye Wale, Tharao Wangari, Owino Maureen, Soje Lena, Tian Jason M Lo Hog, Ly Amy, Piyesis Margaret Kisikaw, McLeod Albert, Fleury Mathew, McBain Kristin, Massaquoi Notisha, Mosugu Tegan, Swidrovich Jaris, Tan Darrell H S, Nelson LaRon, Rourke Sean B
机构信息
MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada.
Women's Health in Women's Hands Community Health Centre, Toronto, ON, Canada.
出版信息
Can J Public Health. 2025 Apr;116(2):243-253. doi: 10.17269/s41997-025-01009-5. Epub 2025 Mar 19.
OBJECTIVES
Black and Indigenous men in Canada continue to experience significant and disproportionate burden of new HIV infection. The purpose of this study was to understand racial differences in PrEP awareness and use, and PrEP cascade among white, Black, and Indigenous men in Canada with the intention to provide evidence for immediate action in our publicly funded health care system.
METHODS
We performed a secondary analysis (n = 4294) of cross-sectional data from the I'm Ready national HIV self-testing research program launched in June 2021 and running through December 2023. Binary logistic regression was used to assess racial differences in PrEP awareness and uptake. A proposed PrEP cascade was developed using the data on awareness, uptake, and retention in PrEP care.
RESULTS
Black participants (OR = 0.34, CI 0.29, 0.39), who are gbMSM (OR = 0.27, CI 0.21, 0.35), aged 18-45 (OR = 0.35, CI 0.30, 0.40), living in urban (OR = 0.41, CI 0.33, 0.51) or rural areas (OR = 0.33, CI 0.26, 0.44), and who are PrEP-eligible (OR = 0.34, CI 0.28, 0.40), were less likely to be aware of PrEP than white participants. Indigenous participants (OR = 0.57, CI 0.44, 0.75), aged 18-45 (OR = 0.57, CI 0.43, 0.75), living in rural communities (OR = 0.15, CI 0.25, 0.57), and who are PrEP-eligible (OR = 0.62, CI 0.46, 0.83), were less likely to be aware of PrEP than white participants. For PrEP uptake, Black participants (OR = 0.61, CI 0.46, 0.82), aged 18-45 (OR = 0.59, CI 0.44, 0.80), living in rural communities (OR = 0.44, CI 0.23, 0.84), and PrEP-eligible (OR = 0.62, CI 0.46, 0.85), were less likely to be on PrEP than white participants. Also, Indigenous men living in urban areas were more likely to be on PrEP than white participants (OR = 1.65, CI 1.01, 2.69).
CONCLUSION
Community-based and public health interventions are immediately needed to increase PrEP awareness, access, and uptake for Black and Indigenous communities in Canada.
目的
加拿大的黑人男性和原住民男性仍然承受着新感染艾滋病毒的巨大且不成比例的负担。本研究的目的是了解加拿大白人、黑人及原住民男性在暴露前预防（PrEP）知晓率、使用率以及PrEP连续过程中的种族差异，以便为我们公共资助的医疗保健系统立即采取行动提供证据。
方法
我们对2021年6月启动并持续至2023年12月的“我准备好了”全国艾滋病毒自我检测研究项目的横断面数据进行了二次分析（n = 4294）。采用二元逻辑回归评估PrEP知晓率和接受率方面的种族差异。利用PrEP护理方面的知晓率、接受率和留存率数据制定了一个拟议的PrEP连续过程。
结果
黑人参与者（比值比[OR]=0.34，置信区间[CI]0.29，0.39），即男同性恋、双性恋及其他男男性行为者（gbMSM，OR = 0.27，CI 0.21，0.35），年龄在18 - 45岁（OR = 0.35，CI 0.30，0.40），生活在城市（OR = 0.41，CI 0.33，0.51）或农村地区（OR = 0.33，CI 0.26，0.44），且符合PrEP条件（OR = 0.34，CI 0.28，0.40），他们知晓PrEP的可能性低于白人参与者。原住民参与者（OR = 0.57，CI 0.44，0.75），年龄在18 - 45岁（OR = 0.57，CI 0.43，0.75），生活在农村社区（OR = 0.15，CI 0.25，0.57），且符合PrEP条件（OR = �.62，CI 0.46，0.83），他们知晓PrEP的可能性低于白人参与者。在PrEP接受率方面，黑人参与者（OR = 0.61，CI 0.46，0.82），年龄在18 - 45岁（OR = 0.59，CI 0.44，0.80），生活在农村社区（OR = 0.44，CI 0.23，0.84），且符合PrEP条件（OR = 0.62，CI 0.46，0.85），他们接受PrEP的可能性低于白人参与者。此外，生活在城市地区的原住民男性比白人参与者更有可能接受PrEP（OR = 1.65，CI 1.01，2.69）。
结论
加拿大迫切需要基于社区和公共卫生的干预措施，以提高黑人及原住民社区对PrEP的知晓率、可及性和接受率。
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