The perspectives of street-involved youth who use drugs regarding the acceptability and feasibility of HIV pre-exposure prophylaxis: a qualitative study.
The perspectives of street-involved youth who use drugs regarding the acceptability and feasibility of HIV pre-exposure prophylaxis: a qualitative study.
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街头吸毒青少年对艾滋病毒暴露前预防的可接受性和可行性的看法：一项定性研究。
DOI：
10.1080/09540121.2022.2085868
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发表时间：
2023
期刊：
影响因子：
1.7
通讯作者：
McNeil,Ryan
中科院分区：
文献类型：
--
作者：
Dahlby,Lucia;Boyd,Jade;Knight,Rod;Philbin,Morgan;Small,Will;Kerr,Thomas;McNeil,Ryan
街头吸毒青少年 (YWUD) 感染艾滋病毒的风险较高，是艾滋病毒预防措施（包括暴露前预防 (PrEP)）的关键人群。然而，对于这一多重边缘化人群中 PrEP 的接受和坚持的可接受性和可行性，我们知之甚少。对 24 名参与街头的 YWUD（17-24 岁）进行了半结构化定性访谈，以考察他们对 PrEP 的看法；通过加拿大温哥华的一项纵向前瞻性队列研究招募了青少年。尽管参与了与艾滋病毒相关的危险行为，但青年人对 PrEP 仍表现出高度的矛盾心理。这种矛盾心理是由对艾滋病毒传播的误解造成的，包括污蔑艾滋病毒传播和个人卫生之间的联系。这种误解导致参与者制定了对预防艾滋病毒传播无效的策略。参与者对自己被列为 PrEP 的“关键人群”提出质疑，这限制了他们对 PrEP 的接受和坚持的热情。与会者还强调，更广泛的社会结构不平等（例如，住房脆弱性、贫困）产生与艾滋病毒相关的风险，可能会破坏 PrEP 的持续使用。研究结果表明，需要制定量身定制的实施策略来提高 PrEP 的可接受性，包括有针对性的教育和反耻辱干预措施，以提高对艾滋病毒传播的认识。干预措施还应针对结构性不平等，以充分解决艾滋病毒风险和 PrEP 矛盾心理。
Street-involved youth who use drugs (YWUD) face an elevated risk of HIV acquisition and represent a key population for HIV prevention initiatives, including pre-exposure prophylaxis (PrEP). However, little is known regarding the acceptability and feasibility of PrEP uptake and adherence among this multiply-marginalized population. Semi-structured qualitative interviews were conducted with 24 street-involved YWUD (ages 17-24) to examine their perspectives toward PrEP; youth were recruited through a longitudinal prospective cohort study in Vancouver, Canada. Youth reported high levels of ambivalence toward PrEP despite engagement in HIV-related risk behaviors. This ambivalence was driven by misperceptions regarding HIV transmission, including stigmatizing associations between HIV transmission and personal hygiene. Such misperceptions led participants to enact strategies that were ineffective in preventing HIV transmission. Participants contested their inclusion as a “key population” for PrEP, which limited their enthusiasm for PrEP uptake and adherence. Participants also highlighted that wider social-structural inequities (e.g., housing vulnerability, poverty) that produced HIV-related risks were likely to undermine sustained PrEP use. Findings demonstrate the need for tailored implementation strategies to increase PrEP acceptability, including targeted education and anti-stigma interventions to increase awareness about HIV transmission. Interventions should also target structural inequities in order to fully address HIV risk and PrEP ambivalence.