The role of stigma and medical mistrust in the routine health care engagement of black men who have sex with men.
The role of stigma and medical mistrust in the routine health care engagement of black men who have sex with men.
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DOI：
10.2105/ajph.2014.302322
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发表时间：
2015-02
影响因子：
12.7
通讯作者：
Cherry C
中科院分区：
文献类型：
--
作者：
Eaton LA;Driffin DD;Kegler C;Smith H;Conway-Washington C;White D;Cherry C
尽管所有种族和性风险群体都有艾滋病毒感染的记录，但在美国，与男性发生性关系的黑人男性（BMSM）受艾滋病毒影响最大。目前，相当重视实施和使用生物医学艾滋病毒预防，以减缓艾滋病毒在这一群体中的流行;然而，使用生物医学预防需要参与常规医疗护理----这一必要性尚未得到满足。为了更好地了解这一缺陷，我们调查了544名BMSM（2012年），以评估医疗保健相关的耻辱，全球医疗不信任和个人对医疗保健提供者的信任与从事医疗保健的关系。我们使用广义线性模型和中介分析来评估数据（2013年完成）。29%的参与者报告说，他们经历过来自医疗保健提供者的种族/性取向耻辱，48%的人报告说，他们对医疗机构感到不信任。在广义线性模型中，我们发现，在HIV阴性的BMSM中，那些经历了更大的耻辱和全球医疗不信任的人有更长的时间间隔，从上次体检。此外，全球医疗不信任中介耻辱和参与护理之间的关系。在HIV阳性的BMSM中，经历来自卫生保健提供者的耻辱也与自上次HIV护理预约以来的时间间隔较长有关。迫切需要采取干预措施，支持提高对BMSM性健康需求的认识。不解决心理社会障碍将阻碍生物医学预防方面取得进展，并最终削弱我们实施这些技术的能力。
Although HIV infections are documented among all race and sexual risk groups, black men who have sex with men (BMSM) are the most affected by HIV in the US. Currently, there is considerable emphasis on the implementation and use of biomedical HIV prevention to slow the HIV epidemic among this group; however, use of biomedical prevention requires engagement in routine medical care – a necessity that has not been met. In order to better understand this shortcoming, we surveyed 544 BMSM (in 2012) to assess how health care related stigma, global medical mistrust, and personal trust in health care provider relate to engaging in medical care. We used generalized linear modeling and mediation analyses to assess data (completed in 2013). Twenty nine percent of participants reported experiencing race/sexual orientation stigma from heath care providers and 48% reported feelings of mistrust towards medical establishments. In generalized linear modeling we found that, among HIV negative BMSM, those who experienced greater stigma and global medical mistrust had longer gaps in time since last medical exam. Furthermore, global medical mistrust mediated the relationship between stigma and engagement in care. Among HIV positive BMSM, experiencing stigma from health care providers was also associated with longer gaps in time since last HIV care appointment. Interventions that support the development of greater awareness around the sexual health needs of BMSM are desperately needed. Failure to address psychosocial deterrents will stymie progress made in biomedical prevention and, ultimately, cripple our ability to implement these technologies.