PrEP Up!: Understanding PrEP stigma to improve uptake among men who have sex with men

项目摘要/摘要 在危地马拉，男男性行为者(MSM)感染艾滋病毒的比例不成比例。而国家层面 成人HIV感染率不到1.0%，最新的MSM流行率估计为10.5%。这 艾滋病毒的巨大差距表明，目前的预防战略是不够的。暴露前预防 (PREP)每日服用替诺福韦/恩曲他滨，安全地提供高水平的预防艾滋病毒感染 这是正确的，并扩大了艾滋病毒预防版图。全球PrEP的吸收速度慢于预期， 然而，男男性行为者(MSM)对PrEP的接受度只有58%。 需要基于对社会背景的情景理解的创新、量身定制的方法，以及 潜在使用者的生活经历1、2.在男男性接触者中，与艾滋病毒和艾滋病有关的多种程度的交叉污名 性取向可以阻止PrEP的启动1-14.PrEP耻辱，包括对PrEP使用者的负面刻板印象 因为患有艾滋病毒和/或不负责任和滥交，也极大地抑制了PrEP的可接受性和 上涨11，13-24。需要对PrEP耻辱的水平和表现进行更多的研究，以了解全球PrEP 推广工作。移动健康(MHealth)干预，特别是智能手机应用程序(App)，可以 用来减轻耻辱。智能手机的可访问性、可负担性、灵活性和匿名性使其成为 吸引男男性接触者和解决PrEP耻辱的极具吸引力的媒介。此外，智能手机的干预 解决交通物流、污名和保密等问题，所有这些都是进行性行为的障碍 危地马拉男男性接触者中的卫生服务6-9。虽然仍是一个新领域，但早期证据，包括我们的工作 团队认为，智能手机应用程序可以通过以下方式解决作为MSM健康促进障碍的污名问题 提供信息和培养社会支持25-30。我们的社区研究伙伴Colectivo Amigos Contra el Sida(CAS)，于2016年1月在拉丁美洲开设了第一家以社区为基础的PrEP诊所，目前 现在计划扩大覆盖范围。这种扩展产生了对PrEP障碍信息的迫切需求 可接受性和接受性，以及探索男男性接触者生活中PrEP污名的独特机会。建议数 R21旨在评估耻辱在PrEP可接受性中的作用，以指导mHealth PrEP推广的设计 通过与北卡罗来纳大学和中科院开展研究能力建设的双向进程，制定战略。在目标1中，我们将 使用混合调查方法确定男男性行为者中PrEP污名与PrEP可接受性之间的关系 方法：研究方法。我们将进行定性的深度访谈(n=20)和结构化调查(n=200)，以 获取有关备考可接受性、PrEP污名以及智能手机使用和偏好的多个视角。为了达到目标 2，我们将评估危地马拉的男男性接触者如何在在线讨论中互动并交换社会支持 通过在线焦点小组讨论与PrEP有关的问题。对于目标3，我们将评估促进 接受并参与智能手机应用程序以获取PrEP。在这些讨论中，我们将评估 为应用程序分发和应用程序内的组件提供最佳渠道和消息传递，以促进参与度。

Project Summary/Abstract Men who have sex with men (MSM) are disproportionately affected by HIV in Guatemala. While national level adult HIV prevalence is less than 1.0%, the most recent prevalence estimate among MSM is 10.5%. This dramatic HIV disparity suggests that current prevention strategies are not sufficient. Pre-Exposure Prophylaxis (PrEP) with daily tenofovir/emtricitabine safely provides high levels of protection against HIV infection if taken correctly and has expanded the HIV prevention landscape. Global PrEP uptake has been slower than expected, however, and PrEP acceptability among men who have sex with men (MSM) is only 58%1. Promoting PrEP requires innovative, tailored approaches grounded in contextualized understanding of the social context and lived experiences of potential users1,2. Among MSM, multiple levels of intersecting stigma related to HIV and sexual orientation can deter PrEP initiation1–14. PrEP stigma, which includes negative stereotypes of PrEP users as having HIV and/or being irresponsible and promiscuous, also greatly inhibits PrEP acceptability and uptake11,13–24. More research on levels and manifestations of PrEP stigma are needed to inform global PrEP promotion efforts. Mobile Health (mHealth) interventions, in particular smartphone applications (apps), can be used to mitigate stigma. The accessibility, affordability, flexibility, and anonymity of smartphones make them a highly appealing medium for engaging MSM and addressing PrEP stigma. Further, smartphone interventions address issues such as transportation logistics, stigma, and confidentiality, all of which are barriers to sexual health services among MSM in Guatemala6–9. While still a nascent field, early evidence, including work by our team, suggests that smartphone apps can address stigma as a barrier to health promotion among MSM by providing information and cultivating social support25–30. Our community research partner, Colectivo Amigos Contra el SIDA (CAS), opened the first community-based PrEP clinic in Latin America in January 2016 and is now planning to scale up coverage. This scale up creates a crucial need for information on barriers to PrEP acceptability and uptake and a unique opportunity to explore PrEP stigma in the lives of MSM. The proposed R21 aims to assess the role of stigma in PrEP acceptability to inform the design of mHealth PrEP promotion strategies through a bidirectional process of research capacity building with UNC and CAS. In Aim 1, we will determine the association between PrEP stigma and PrEP acceptability among MSM using a mixed methods approach. We will conduct qualitative in-depth interviews (n=20) and a structured survey (n=200) to obtain multiple perspectives on PreP acceptability, PrEP stigma, and smartphone use and preferences. For Aim 2, we will assess how MSM in Guatemala interact in online discussions and exchange social support related to PrEP through online focus groups discussions. For Aim 3, we will evaluate strategies to promote uptake of and engagement with a smartphone app for PrEP uptake. In these discussions we will assess optimal channels and messaging for app dissemination and components within the app to promote engagement.