PrEP 耻辱感、PrEP 自信心与 PrEP 坚持之间的关系：预期的 HIV 耻辱的条件间接效应。

IF 2.9 3区医学 Q3 IMMUNOLOGY

JAIDS Journal of Acquired Immune Deficiency Syndromes Pub Date : 2024-10-01 DOI:10.1097/qai.0000000000003474

Ibrahim Yigit,Henna Budhwani,Crissi B Rainer,Kristina Claude,Kathryn E Muessig,Lisa B Hightow-Weidman

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引用次数: 0

摘要

背景研究表明，暴露前预防疗法（PrEP）的污名化与艾滋病预防效果不佳（包括 PrEP 的坚持率）有关。然而，人们对 PrEP 耻辱感影响 PrEP 坚持率的机制，尤其是对性与性别少数群体（SGM）青年的影响机制的了解仍然有限。在这项研究中，我们旨在调查 PrEP 耻辱感通过 PrEP 信心对坚持 PrEP 的间接影响，以及预期 HIV 耻辱感的调节作用。方法参与者包括 235 名 SGM 青年，出生时性别为男性，年龄在 16-24 岁之间，自我报告 HIV 阴性，拥有来自 "准备、保护、emPowered "随机对照试验的有效 PrEP 处方。参与者是在 2019 年至 2021 年期间从美国的 9 家诊所招募的。结果我们发现了显著的间接效应，表明 PrEP 耻辱感与 PrEP 信心呈负相关，这反过来又导致了每月和每周的最佳 PrEP 坚持率（间接效应：B = -0.11, 标准误差 [SE] = 0.05, CI: [-0.244 to -0.032]；B = -0.09, SE = 0.04, CI: [-0.191 to -0.014]）。预期的艾滋病污名化对这些间接效应起到了调节作用（B = -0.11，SE = 0.08，CI：[-0.315 至 -0.001]；B = -0.09，SE = 0.06，CI：[-0.245 至 -0.001]），这表明条件间接效应在预期的艾滋病污名化程度较高时显著，而在程度较低时不显著。结论研究结果表明，SGM 青年在接受 PrEP 治疗时，如果预期会受到 HIV 耻辱，那么 PrEP 耻辱就会对 PrEP 信心产生复合效应，从而导致次优的依从性。针对 PrEP 和 HIV 耻辱的交叉性以及增强信心的干预措施可以提高 PrEP 的坚持率，尤其是在 SGM 青年中。

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Associations Between PrEP Stigma, PrEP Confidence, and PrEP Adherence: Conditional Indirect Effects of Anticipated HIV Stigma.

BACKGROUND Research has linked stigma surrounding preexposure prophylaxis (PrEP) to poor HIV prevention outcomes, including PrEP adherence. However, there remains a limited understanding of the mechanisms through which PrEP stigma affects PrEP adherence, specifically among sexual and gender minority (SGM) youth. In this study, we aimed to investigate the indirect effect of PrEP stigma on PrEP adherence through PrEP confidence and the moderating role of anticipated HIV stigma. METHODS Participants included 235 SGM youth, assigned male sex at birth, aged 16-24, and self-reported HIV-negative, with an active PrEP prescription from the Prepared, Protected, emPowered randomized controlled trial. Participants were recruited from 9 clinics in the United States between 2019 and 2021. Using baseline data, we tested cross-sectional indirect and conditional indirect effects using the Statistical Package for the Social Sciences Process with confidence intervals and 2000 resamples. RESULTS We found significant indirect effects, suggesting that PrEP stigma was negatively associated with PrEP confidence, which in turn resulted in both monthly and weekly optimal PrEP adherence (Indirect effects: B = -0.11, Standard Error [SE] = 0.05, CI: [-0.244 to -0.032]; B = -0.09, SE = 0.04, CI: [-0.191 to -0.014], respectively). Anticipated HIV stigma moderated these indirect effects (B = -0.11, SE = 0.08, CI: [-0.315 to -0.001]; B = -0.09, SE = 0.06, CI: [-0.245 to -0.001], respectively), suggesting that the conditional indirect effects were significant at high but not low levels of anticipated HIV stigma. CONCLUSION Results suggest that SGM youth who are on PrEP anticipating HIV stigma experience a compounding effect of PrEP stigma on PrEP confidence, consequently leading to suboptimal adherence. Interventions addressing the intersectionality of PrEP and HIV stigmas and enhancing confidence could improve PrEP adherence, particularly among SGM youth.

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来源期刊

JAIDS Journal of Acquired Immune Deficiency Syndromes 医学-传染病学

CiteScore

5.80

自引率

5.60%

发文量

490

审稿时长

3-6 weeks

期刊介绍： JAIDS: Journal of Acquired Immune Deficiency Syndromes seeks to end the HIV epidemic by presenting important new science across all disciplines that advance our understanding of the biology, treatment and prevention of HIV infection worldwide. JAIDS: Journal of Acquired Immune Deficiency Syndromes is the trusted, interdisciplinary resource for HIV- and AIDS-related information with a strong focus on basic and translational science, clinical science, and epidemiology and prevention. Co-edited by the foremost leaders in clinical virology, molecular biology, and epidemiology, JAIDS publishes vital information on the advances in diagnosis and treatment of HIV infections, as well as the latest research in the development of therapeutics and vaccine approaches. This ground-breaking journal brings together rigorously peer-reviewed articles, reviews of current research, results of clinical trials, and epidemiologic reports from around the world.