Considering Stigma in the Provision of HIV Pre-Exposure Prophylaxis: Reflections from Current Prescribers
Considering Stigma in the Provision of HIV Pre-Exposure Prophylaxis: Reflections from Current Prescribers
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DOI：
10.1089/apc.2018.0166
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发表时间：
2019-02-01
影响因子：
4.9
通讯作者：
Dovidio, John F.
中科院分区：
文献类型：
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作者：
Calabrese, Sarah K.;Tekeste, Mehrit;Dovidio, John F.
迫切需要努力查明和解决艾滋病毒暴露前预防（PrEP）获取方面的社会不公平现象。我们调查了早期采用PrEP处方者的信念，即耻辱感如何导致PrEP在医疗保健中的获取差异，并探讨了PrEP服务提供背景下的潜在干预策略。美国的PrEP开处方者是通过专业网络和参与者推荐招募的。定性访谈进行，转录和主题分析。参与者（n = 18）主要为男性（72%）；白人（39%）或亚洲人（33%）；异性恋者（56%）。大多数在美国东北部（67%）或南部（22%）；是医生（94%）；专门研究艾滋病毒/传染病（89%）。参与者描述了阻碍PrEP获取的多种形式的结构和人际耻辱。处方PrEP的要求被认为是对医疗不信任和/或卫生素养低的人群的一种威慑。只有在回应病人的要求时才讨论PrEP等实践规范被视为偏袒更有特权的群体。当被问及个人持有的偏见时，与年龄有关的刻板印象是最容易被承认的，包括认为老年人性生活不活跃，不愿意讨论性。参与者批评那些在临床实践中选择不开PrEP的提供者，特别是那些决定反映与无安全套性行为相关的个人价值观或与患者沟通性行为的不适的提供者。建议的解决方案包括在患者中标准化PrEP服务提供和增加文化能力培训。从早期采用的提供者的精选样本中获得的这些早期见解阐明了耻辱可能损害关键人群获得PrEP的机制和卫生保健系统内相应的干预点。
Efforts to identify and address social inequities in HIV pre-exposure prophylaxis (PrEP) access are urgently needed. We investigated early-adopting PrEP prescribers' beliefs about how stigma contributes to PrEP access disparities in health care and explored potential intervention strategies within the context of PrEP service delivery. US-based PrEP prescribers were recruited through professional networks and participant referrals. Qualitative interviews were conducted, transcribed, and thematically analyzed. Participants (n = 18) were primarily male (72%); white (39%) or Asian (33%); and heterosexual (56%). Most practiced in the Northeastern (67%) or Southern (22%) United States; were physicians (94%); and specialized in HIV/infectious disease (89%). Participants described multiple forms of structural and interpersonal stigma impeding PrEP access. The requirement that PrEP be prescribed was a perceived deterrent for populations with medical mistrust and/or low health literacy. Practice norms such as discussing PrEP only in response to patient requests were seen as favoring more privileged groups. When probed about personally held biases, age-related stereotypes were the most readily acknowledged, including assumptions about older adults being sexually inactive and uncomfortable discussing sex. Participants criticized providers who chose not to prescribe PrEP within their clinical practice, particularly those whose decision reflected personal values related to condomless sex or discomfort communicating about sex with their patients. Suggested solutions included standardizing PrEP service delivery across patients and increasing cultural competence training. These early insights from a select sample of early-adopting providers illuminate mechanisms through which stigma could compromise PrEP access for key populations and corresponding points of intervention within the health care system.