Storholm Erik D, Randazzo Jessica, Hong Chenglin, Siconolfi Daniel E, Nacht Carrie L, Lee Sarita D, Wagner Glenn J
School of Public Health, San Diego State University, 5500 Campanile Drive, Hepner Hall 114E, San Diego, CA, 92182-4162, USA.
RAND Behavioral and Policy Sciences, Santa Monica, CA, USA.
AIDS Behav. 2025 Jun 24. doi: 10.1007/s10461-025-04802-y.
Cisgender sexual minority men (SMM) report intimate partner violence (IPV) at rates comparable to or higher than heterosexual cisgender women, often linked to increased HIV risk. This study explores the relationship between IPV perpetration and pre-exposure prophylaxis (PrEP), considering the potential mediating effects of sexual orientation related minority stress and PrEP stigma. Utilizing baseline data from the Empowering Relationships and Opportunities for Safety (EROS) cohort, this cross-sectional study examined survey data from partnered cisgender SMM in the U.S. Through online and community recruitment, participants were assessed for IPV perpetration using a validated measure, while internalized homonegativity and related stigma were evaluated through standardized scales. Current PrEP use was assessed through self-report and confirmed through dried blood spot assays. Of the 500 participants, 125 (25%) reported IPV perpetration, with perpetration of identity-related IPV (e.g., threatening to out a partner to family or coworkers; telling partner to act straight) significantly higher among non-PrEP users; mean number of identity-related IPV perpetration items endorsed was 0.21 (SD = 0.53) among non-PrEP users compared to 0.02 (SD = 0.14) among PrEP users. Perpetration of identity-related IPV was positively correlated with internalized homonegativity (r =.19, p <.001), experienced sexual orientation discrimination (r =.15, p <.01), and PrEP stigma (r =.14, p <.001). A logistic regression mediation analysis found that, separately, internalized homonegativity (OR = 0.97, 95% CI [0.94-0.99]) and PrEP stigma (OR = 0.48, 95% CI [0.40, 0.57]) had significant associations with PrEP use, and that each mediated the relationship between perpetration of identity-related IPV and PrEP use as demonstrated by their significant indirect effects (OR = 0.88, 95% CI [0.78, 0.98] and (OR = 0.77, 95% CI [0.60, 0.98], respectively). The study underscores internalized homonegativity and PrEP stigma as critical mediators of the relationship between perpetration of identity-related IPV and PrEP use among SMM. Findings call for interventions aimed at reducing internalized homonegativity, PrEP stigma and enhancing PrEP access while addressing IPV dynamics. Future research should further delineate these pathways to inform culturally sensitive interventions promoting health equity among SMM.
顺性别性少数男性（SMM）报告亲密伴侣暴力（IPV）的比例与异性恋顺性别女性相当或更高，这通常与艾滋病毒感染风险增加有关。本研究探讨了IPV实施与暴露前预防（PrEP）之间的关系，同时考虑了性取向相关的少数群体压力和PrEP污名化的潜在中介作用。利用“增强关系与安全机会”（EROS）队列的基线数据，这项横断面研究调查了美国有伴侣的顺性别SMM的调查数据。通过在线和社区招募，使用经过验证的测量方法评估参与者的IPV实施情况，同时通过标准化量表评估内化的同性恋消极态度和相关污名。通过自我报告评估当前PrEP的使用情况，并通过干血斑检测进行确认。在500名参与者中，125人（25%）报告实施了IPV，在未使用PrEP的人群中，与身份相关的IPV（例如，威胁向家人或同事暴露伴侣身份；要求伴侣表现得异性化）实施情况明显更高；未使用PrEP的人群中认可的与身份相关的IPV实施项目的平均数量为0.21（标准差=0.53），而使用PrEP的人群中为0.02（标准差=0.14）。与身份相关的IPV实施与内化的同性恋消极态度（r=0.19，p<0.001）、经历的性取向歧视（r=0.15，p<0.01）和PrEP污名（r=0.14，p<0.001）呈正相关。逻辑回归中介分析发现，内化的同性恋消极态度（OR=0.97，95%置信区间[0.94-0.99]）和PrEP污名（OR=0.48，95%置信区间[0.40，0.57]）分别与PrEP使用有显著关联，并且如它们显著的间接效应所示，二者都介导了与身份相关的IPV实施与PrEP使用之间的关系（OR分别为0.88，95%置信区间[0.78，0.98]和OR=0.77，95%置信区间[0.60，0.98]）。该研究强调内化的同性恋消极态度和PrEP污名是SMM中与身份相关的IPV实施与PrEP使用之间关系的关键中介因素。研究结果呼吁采取干预措施，旨在减少内化的同性恋消极态度、PrEP污名，在解决IPV动态问题的同时增加PrEP的可及性。未来的研究应进一步阐明这些途径，为促进SMM健康公平的文化敏感干预措施提供信息。
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