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

项目总结/摘要 在危地马拉，男男性行为者（MSM）受到艾滋病毒的影响不成比例。虽然国家一级 成人艾滋病毒感染率低于1.0%，最近估计男男性行为者感染率为10.5%。这 艾滋病毒感染率的巨大差异表明，目前的预防战略是不够的。暴露前预防 （PrEP）与每日替诺福韦/恩曲他滨安全地提供了高水平的保护，防止艾滋病毒感染，如果采取 正确地，并扩大了艾滋病毒预防的范围。全球PrEP吸收速度低于预期， 然而，PrEP在男男性行为者（MSM）中的可接受性仅为58%。推广PrEP 需要基于对社会背景的背景化理解的创新、量身定制的方法， 潜在用户的体验。在男男性行为者中，与艾滋病毒有关的多重交叉污名， 性取向可以阻止PrEP启动。PrEP污名，其中包括PrEP用户的负面刻板印象 作为艾滋病毒和/或不负责任和滥交，也大大抑制了PrEP的可接受性， 摄取。需要对PrEP污名的水平和表现进行更多研究，以告知全球PrEP 促进努力。移动的健康（mHealth）干预措施，特别是智能手机应用程序（app），可以 用于减轻耻辱感。智能手机的可访问性、可负担性、灵活性和匿名性使其成为 非常吸引人的媒介，用于吸引MSM并解决PrEP耻辱。此外，智能手机干预 解决运输物流、耻辱和保密等问题，所有这些都是性行为的障碍。 危地马拉男男性行为者的保健服务。虽然这仍然是一个新兴领域，但早期的证据，包括我们的工作， 研究小组认为，智能手机应用程序可以通过以下方式解决男男性接触者健康促进的障碍： 提供信息和培养社会支持。我们的社区研究合作伙伴，Colectivo Amigos Contra el SIDA（CAS）于2016年1月在拉丁美洲开设了第一家社区PrEP诊所， 现在正计划扩大覆盖范围这种规模的扩大创造了对PrEP障碍信息的迫切需求 可接受性和吸收和一个独特的机会，探索在MSM的生活PrEP耻辱。拟议 R21旨在评估耻辱在PrEP可接受性中的作用，以告知mHealth PrEP推广的设计 通过与中国科学院和中国科学院的双向研究能力建设进程，在目标1中，我们 确定PrEP耻辱和PrEP可接受性之间的关联MSM使用混合 方法论。我们将进行定性深入访谈（n=20）和结构化调查（n=200）， 获得关于PreP可接受性，PrEP耻辱以及智能手机使用和偏好的多个观点。为宗旨 2，我们将评估危地马拉的MSM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相关。对于目标3，我们将评估促进 采用和参与智能手机应用程序进行PrEP摄取。在这些讨论中，我们将评估 应用程序传播的最佳渠道和消息传递以及应用程序中的组件，以促进参与。

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%. Promoting PrEP requires innovative, tailored approaches grounded in contextualized understanding of the social context and lived experiences of potential users. Among MSM, multiple levels of intersecting stigma related to HIV and sexual orientation can deter PrEP initiation. PrEP stigma, which includes negative stereotypes of PrEP users as having HIV and/or being irresponsible and promiscuous, also greatly inhibits PrEP acceptability and uptake. 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 Guatemala. 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 support. 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.