Pre-exposure prophylaxis awareness, acceptability and potential stigma among medical and non-medical clinic staff in methadone treatment settings in northern New Jersey: The key role of non-medical staff in enhancing HIV prevention.
Pre-exposure prophylaxis awareness, acceptability and potential stigma among medical and non-medical clinic staff in methadone treatment settings in northern New Jersey: The key role of non-medical staff in enhancing HIV prevention.
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DOI：
10.1016/j.jsat.2021.108371
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发表时间：
2021-10
影响因子：
3.9
通讯作者：
Mumba M
中科院分区：
文献类型：
--
作者：
Jaiswal J;Dunlap K;Griffin M;Cox A;Singer SN;Hascher K;LoSchiavo C;Walters SM;Mumba M
需要在因性与毒品混合、出售/交易性行为和/或注射毒品而使用毒品的人群中预防艾滋病毒。暴露前预防（PrEP）是一种极其有效的生物医学艾滋病毒预防策略，但在最需要艾滋病毒预防的社区，包括PWUD，使用率仍然很低。先前的研究发现，提供者不太愿意给PWUD开PrEP，但PWUD表达了高水平的PrEP接受度。需要更多的研究来了解提供药物使用治疗服务的人如何看待PrEP，以最大限度地提高这种生物医学预防策略。该研究对新泽西州北部城市两家美沙酮诊所的29名工作人员进行了半结构化访谈。工作人员包括医务人员、美沙酮顾问、摄入协调员、前台工作人员、实验室技术人员、保安人员和行政/领导人员。所有工作人员都认识到在其患者群体中预防艾滋病毒的必要性，但大多数人要么不知道PrEP，要么不熟悉其目的和工作方式。与咨询师和其他工作人员相比，医疗服务提供者更有可能掌握一些PrEP知识，但前者在很大程度上没有深入的知识。在那些熟悉PrEP的人中，许多人将PrEP与艾滋病毒药物混淆，因为特鲁瓦达是研究时唯一获得fda批准的PrEP。大约一半的参与者明确表示支持PrEP，而另一半则对艾滋病毒、性行为和药物不信任持混合或消极态度。正面和负面的看法都包含污名化的因素。由于患者与非医务人员（如前台工作人员、实验室技术人员等）的互动频繁，所有工作人员，而不仅仅是医务人员，都应该了解PrEP并轻松地讨论它，以促进与患者就艾滋病毒预防进行知情的、不带偏见的对话。预防措施教育应具体解决艾滋病毒和与性有关的污名，因为即使对预防措施的积极看法也可能包含污名化因素。
HIV prevention is needed among people who use drugs (PWUD) due to mixing sex and drugs, selling/trading sex, and/or injecting drugs. Pre-exposure prophylaxis (PrEP) is an extremely effective biomedical HIV prevention strategy, but uptake remains low among communities most in need of HIV prevention, including PWUD. Previous studies have found that providers are less willing to prescribe PrEP to PWUD, yet PWUD express high levels of PrEP acceptance. More research is needed to understand how people who provide substance use treatment services think about PrEP to maximize this biomedical prevention strategy. The study conducted semistructured interviews with 29 staff members in two methadone clinic settings in urban northern New Jersey. Staff members included medical providers, methadone counselors, intake coordinators, front desk staff, lab technicians, security guards, and administrative/leadership personnel. All staff recognized the need for HIV prevention among their patient populations, but most were either unaware of PrEP or unfamiliar with its purpose and how it works. Medical providers were more likely to have some PrEP knowledge in comparison to counselors and other staff, but the former largely did not have in-depth knowledge. Among those familiar with PrEP, many confused PrEP with HIV medication, as Truvada was the only FDA-approved PrEP at the time of the study. About half of participants expressed clear support for PrEP, while the other half expressed mixed or negative attitudes related to HIV, sexual behavior, and mistrust of the medication. Both the positive and negative perceptions entailed stigmatizing elements. Due to patients’ frequent interactions with non–medical staff (e.g., front desk staff, lab technicians, etc.), all staff, not only medical personnel, should be aware of PrEP and comfortable discussing it to foster well-informed, nonjudgmental conversations about HIV prevention with patients. PrEP education should specifically address HIV and sexual-related stigma, as even positive perceptions of PrEP may entail stigmatizing elements.
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