The Pre-Exposure Prophylaxis (PrEP)-Stigma Paradox: Learning from Canada's First Wave of PrEP Users
The Pre-Exposure Prophylaxis (PrEP)-Stigma Paradox: Learning from Canada's First Wave of PrEP Users
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DOI：
10.1089/apc.2017.0153
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发表时间：
2017-11-29
影响因子：
4.9
通讯作者：
Tan, Darrell H. S.
中科院分区：
文献类型：
--
作者：
Grace, Daniel;Jollimore, Jody;Tan, Darrell H. S.
随着每日口服富马酸替诺福韦二吡呋酯和基于恩曲他滨的暴露前预防 (PrEP) 在加拿大的出现，人们开始质疑这种 HIV 预防工具对男同性恋社交和性生活的影响。我们对多伦多的 16 名男同性恋者进行了小型焦点小组和个人定性访谈，他们是第一波加拿大 PrEP 用户的一部分。作为示范项目的一部分，参与者接受了至少一年的 PrEP（2014 年 11 月至 2016 年 6 月）。这些参与者在 2016 年 2 月获得加拿大卫生部监管部门批准之前就接受了 PrEP。参与者的平均年龄为 37.6 岁（SD 11.02）； 94% 完成了中等教育，69% 是白人。在男性关于 PrEP 使用的三个重叠领域的描述中，性别耻辱成为一个复杂的主题：（1）与 PrEP 相关的耻辱，包括对朋友、家人和性伴侣隐瞒和耻辱的讨论；（2）PrEP 作为一种被认为对抗 HIV 相关耻辱的工具，一些男性表示他们不再与性伴侣讨论 HIV 状况；（3）PrEP 作为阐明结构性耻辱的工具，被认为是揭露与性和性伴侣有关的耻辱。性。对于一些参与者来说，PrEP 可以解放性行为，并自称恢复正常、令人兴奋、愉快的性行为，不再依赖安全套的使用。矛盾的是，一些男性表示，PrEP 的使用既让他们在社交和性网络中经历了耻辱反应，同时也帮助消除了与艾滋病毒、性行为以及与感染艾滋病毒的男同性恋者发生性行为有关的耻辱、羞耻和恐惧。
With the emergence of daily oral tenofovir disoproxil fumarate and emtricitabine-based pre-exposure prophylaxis (PrEP) use in Canada, questions have emerged concerning the impacts of this HIV prevention tool on gay men's social and sexual lives. We conducted small focus groups and individual qualitative interviews with 16 gay men in Toronto who were part of the first wave' of Canadian PrEP users. Participants were on PrEP for at least one year as part of a demonstration project (November 2014-June 2016). These participants accessed PrEP before regulatory approval by Health Canada in February 2016. The mean age of participants was 37.6 years (SD 11.02); 94% completed secondary education, and 69% were white. Sex-stigma emerged as a complex theme in men's accounts of PrEP use across three overlapping domains: (1) PrEP-related stigma, including discussions of concealment and stigma from friends, family, and sexual partners, (2) PrEP as a perceived tool for combating HIV-related stigma, where some men said that they no longer discussed HIV status with sexual partners, and (3) PrEP as illuminating structural stigma, where it was attributed to unmasking stigma related to sex and sexuality. For some participants, PrEP has allowed for liberating sex and a self-described return to normalcynormal, exciting, pleasurable sex that was no longer reliant on condom use. Paradoxically, some men said that PrEP use both led them to experience stigmatizing reactions within their social and sexual networks, while also helping to remove stigma, shame, and fear related to HIV, sexuality, and sex with gay men living with HIV.