Haider Mohammad Rifat, Sarwar Golam, Wang Liyuan, Khan Md Sharful Islam, Brown Monique J, Hansen Nathan, Gibbs Jeremy J
Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA.
Department of Health Policy and Management College of Public Health, University of Georgia, 100 Foster Rd Wright Hall 301B, Athens, GA, 30602, USA.
AIDS Behav. 2025 Sep 12. doi: 10.1007/s10461-025-04870-0.
Georgia has one of the highest HIV diagnosis rates in the U.S., yet only 33% of Pre-Exposure Prophylaxis (PrEP) users in the Deep South live there. This study aims to determine the potential mediational role of internalized homonegativity and attitudes towards PrEP between gay community connectedness and PrEP use among men who have sex with men (MSM) living in Georgia. Participants (N = 121) completed an online survey in June 2020. PrEP use (yes/no) was defined by the question "the last time you had sex, were you taking PrEP, like Truvada?" The study also used the "8-item Identification and Involvement with the Gay Community scale", "9-item internalized homophobia scale", and a "3-item PrEP attitude scale". Path analysis was performed using Stata 17.0. After adjusting for sociodemographic characteristics, positive associations were observed between attitudes towards PrEP and PrEP use (β = 0.11; p = < 0.001), and gay community connectedness (GCC) and PrEP attitudes (β = 0.17, p < 0.001). Conversely, negative associations were found between GCC and internalized homonegativity (β=-0.71, p < 0.001), and internalized homonegativity and PrEP use (β=-.01, p = 0.031). GCC was not significantly associated with PrEP use (β=-.01; p = 0.196). However, the indirect effects of GCC on PrEP use through PrEP attitudes (β = 0.01, p < 0.001) and internalized homonegativity (β = 0.02, p = 0.041) were statistically significant. These findings indicate that PrEP attitudes and internalized homonegativity mediate the relationship between GCC and PrEP use among MSM. Thus, improving attitudes toward PrEP and reducing internalized homonegativity through fostering GCC among MSM may improve PrEP use and persistence.
佐治亚州是美国艾滋病毒诊断率最高的地区之一，但美国最南部地区只有33%的暴露前预防（PrEP）使用者居住在该州。本研究旨在确定内化的同性恋消极观念以及对PrEP的态度在居住于佐治亚州的男男性行为者（MSM）的同性恋群体联结与PrEP使用之间可能起到的中介作用。参与者（N = 121）于2020年6月完成了一项在线调查。PrEP使用情况（是/否）由问题“你上次发生性行为时，是否在服用像舒发泰这样的PrEP？”来界定。该研究还使用了“8项同性恋群体认同与参与量表”、“9项内化恐同症量表”以及“3项PrEP态度量表”。使用Stata 17.0进行路径分析。在对社会人口学特征进行调整后，观察到对PrEP的态度与PrEP使用之间存在正相关（β = 0.11；p = < 0.001），以及同性恋群体联结（GCC）与PrEP态度之间存在正相关（β = 0.17，p < 0.001）。相反，发现GCC与内化的同性恋消极观念之间存在负相关（β = -0.71，p < 0.001），以及内化的同性恋消极观念与PrEP使用之间存在负相关（β = -0.01，p = 0.031）。GCC与PrEP使用之间无显著关联（β = -0.01；p = 0.196）。然而，GCC通过PrEP态度（β = 0.01，p < 0.001）和内化的同性恋消极观念（β = 0.02，p = 0.041）对PrEP使用产生的间接效应具有统计学意义。这些发现表明，PrEP态度和内化的同性恋消极观念在MSM的GCC与PrEP使用之间起到中介作用。因此，通过在MSM中促进GCC来改善对PrEP的态度并减少内化的同性恋消极观念，可能会提高PrEP的使用和持续性。
