Elevated HIV Prevalence and Correlates of PrEP Use Among a Community Sample of Black Men Who Have Sex With Men.
Elevated HIV Prevalence and Correlates of PrEP Use Among a Community Sample of Black Men Who Have Sex With Men.
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与男性发生性关系的社区样本中，艾滋病毒的患病率高和准备使用的相关性。
DOI：
10.1097/qai.0000000000001822
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发表时间：
2018-11-01
期刊：
影响因子：
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通讯作者：
POWER Study Team
中科院分区：
文献类型：
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作者：
Eaton LA;Matthews DD;Bukowski LA;Friedman MR;Chandler CJ;Whitfield DL;Sang JM;Stall RD;POWER Study Team
男男性行为黑人 (BMSM) 中艾滋病毒的流行需要公共卫生部门的紧急关注。暴露前预防 (PrEP) 是预防 HIV 的一种非常有效的选择，但 BMSM 社区样本中 PrEP 使用的特点尚不清楚。 2014 年、2015 年、2016 年和 2017 年在美国六个城市的黑人同性恋骄傲活动中进行了一系列横断面调查评估（N = 4,184 BMSM 报告 HIV 阴性/不确定状态）和 HIV 检测。BMSM 自我报告当前 PrEP 使用情况（每 3 名参与者中的 1 名）的 HIV 患病率高于 BMSM 未自我报告当前 PrEP 使用情况（每 5 名参与者中的 1 名）的 HIV 患病率（32.3%， N=103/319 对比 20.0%，N=639/3,193，aOR=1.68，95%CI=1.31–2.15)。报告当前 PrEP 使用情况的 BMSM (N=380) 更有可能报告有更多的男性性伴侣 (aOR=1.02, 95%CI=1.01–1.03)、STI 诊断 (aOR=2.44, 95%CI=1.88–3.16) 和兴奋剂药物使用 (aOR=2.05, 95%CI=1.21–3.47)。与 BMSM 未报告相比 当前 PrEP 使用情况（N=3,804）。 PrEP 使用率从 4.7% (2014 年) 增加到 15.5% (2017 年) (aOR=1.19, 95%CI=1.13–1.25)。在 PrEP 用户中，无力承担医疗保险费用与 HIV 检测呈阳性相关（aOR=2.10，95%CI=1.24–3.56）。报告 PrEP 使用情况的 BMSM 中 HIV 感染率高令人担忧。然而，它并不挑战 PrEP 本身的功效，而是挑战周围预防方案的采用，包括行为风险降低支持、性传播感染治疗和药物依从性咨询。需要进一步研究来了解充分有效的 PrEP 的障碍，以指导操作和行为干预措施，缩小事件感染的差距。
The HIV epidemic among Black men who have sex with men (BMSM) demands urgent public health attention. Pre-Exposure Prophylaxis (PrEP) is a highly efficacious option for preventing HIV, but characteristics of PrEP use among community samples of BMSM are not well-understood. A serial cross-sectional survey assessment (N=4,184 BMSM reporting HIV negative/unsure status) and HIV testing were conducted at Black Gay Pride events in six US cities in 2014, 2015, 2016, and 2017. HIV prevalence was higher among BMSM self-reporting current PrEP use (1 out of 3 participants) than BMSM not self-reporting current PrEP use (1 out of 5 participants) (32.3%, N=103/319 vs. 20.0%, N=639/3,193, aOR=1.68, 95%CI=1.31–2.15). BMSM reporting current PrEP use (N=380) were more likely to report having a greater number of male sex partners (aOR=1.02, 95%CI=1.01–1.03), a STI diagnosis (aOR=2.44, 95%CI=1.88–3.16), and stimulant drug use (aOR=2.05, 95%CI=1.21–3.47) when compared to BMSM not reporting current PrEP use (N=3,804). PrEP use increased from 4.7% (2014) to 15.5% (2017) (aOR=1.19, 95%CI=1.13–1.25). Among PrEP users, inability to afford health care coverage was associated with testing HIV positive (aOR=2.10, 95%CI=1.24–3.56). The high prevalence of HIV infection among BMSM reporting PrEP use is concerning. It does not, however, challenge the efficacy of PrEP itself but rather the uptake of the surrounding preventative package including behavioral risk reduction support, STI treatment, and medication adherence counseling. Further research to understand barriers to fully effective PrEP are needed in order to guide operational and behavioral interventions that close the gap on incident infection.