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

PrEP Up！：了解 PrEP 耻辱以提高男男性行为者的接受度

• 批准号: 9914144
• 负责人: CLARE L BARRINGTON
• 金额: $ 16.94万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-15 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9914144
• 关键词: AIDS prevention; Address; Adherence; Adult; Affect; Applied Research; Awareness; Brazil; Cellular Phone; Central America; Cities; Client; Clinic; Clinical Trials; Communities; Country; Development; Ecuador; Ensure; Faculty; Focus Groups; Guatemala; HIV; HIV Infections; Health; Health Promotion; Health Services; Intervention; Interview; Knowledge; Latin America; Latin American; Logistics; Mediating; Methods; Participant; Persons; Peru; Prevalence; Prevention strategy; Process; Randomized; Research; Role; Sampling; Series; Services; Sex Orientation; Sexual Health; Social Environment; Social support; Stereotyping; Structure; Students; Surveys; Technology; Tenofovir; Transportation; Work; base; care providers; care systems; control trial; cost effective; design; emtricitabine; experience; flexibility; improved; innovation; insight; mHealth; men; men who have sex with men; personalized approach; pre-exposure prophylaxis; preference; recruit; scale up; smartphone Application; social; social stigma; uptake; virtual

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.

项目摘要/摘要 与男性发生性关系的男性（MSM）受到危地马拉艾滋病毒的影响不成比例。而国家一级 成人HIV患病率小于1.0％，MSM的最新患病率估计为10.5％。这 戏剧性的HIV差异表明，当前的预防策略还不够。暴露前预防 （PREP）每天使用Tenofovir/Emtricitabine安全地提供高水平的针对HIV感染的保护 正确地扩大了HIV预防景观。全球准备吸收比预期的要慢， 但是，与男性发生性关系（MSM）的男性的准备可接受性仅为58％。促进准备 需要以情境化对社会环境的理解为基础的创新，量身定制的方法和 潜在用户的生活经验。在MSM中，多个与HIV相关的相交污名和 性取向可以阻止准备启动。准备污名，其中包括准备用户的负面刻板印象 因为患有艾滋病毒和/或不负责任和滥交，也极大地抑制了准备的可接受性和 吸收。需要更多地研究准备污名的水平和表现形式，以告知全球准备 促进工作。移动健康（MHealth）干预措施，特别是智能手机应用程序（应用程序），可以是 用于减轻污名。智能手机的可访问性，可及性，灵活性和匿名性使其成为 吸引MSM和应对PREP污名的高度吸引人的媒介。此外，智能手机干预措施 解决了运输后勤，污名和机密性等问题，所有这些都是性的障碍 危地马拉MSM中的卫生服务。虽然仍然是一个新生的领域，但早期证据，包括我们的工作 团队建议，智能手机应用程序可以将污名化为MSM中健康促进的障碍 提供信息并培养社会支持。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个基于社区的预科诊所 现在计划扩大覆盖范围。这个规模提高了对准备障碍的信息至关重要的需求 可接受性和吸收，也是探索MSM生活中预科污名的独特机会。提议 R21旨在评估污名在可接受性中的作用，以告知MHealth Prep促销的设计 通过与UNC和CAS建立研究能力的双向过程的策略。在AIM 1中，我们将 使用混合 方法方法。我们将进行定性的深入访谈（n = 20）和结构化调查（n = 200） 获得有关可接受性，准备污名以及智能手机使用和偏好的多种观点。目的 2，我们将评估危地马拉的MSM如何在在线讨论中进行互动和交换社会支持 通过在线焦点小组讨论与准备有关。对于AIM 3，我们将评估策略以促进 吸收并与智能手机应用程序进行互动，以进行准备。在这些讨论中，我们将评估 应用程序传播和应用程序中的最佳渠道和消息传递，以促进参与度。