Individual & joint associations of sexual stigma and mental distress with PrEP uptake, adherence and persistence among US gay and bisexual men.

Autor: Onwubiko UN; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States. Electronic address: udodirim.onwubiko@emory.edu., Murray SM; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States., Rao A; Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States., Chamberlain AT; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States., Sanchez TH; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States., Benkeser D; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States., Holland DP; Fulton County Board of Health, Atlanta, GA, United States; Division of Infectious Disease, School of Medicine, Emory University, Atlanta, GA, United States., Jenness SM; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States., Baral SD; Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States.
Jazyk: angličtina
Zdroj: Social science & medicine (1982) [Soc Sci Med] 2024 Dec; Vol. 363, pp. 117493. Date of Electronic Publication: 2024 Nov 09.
DOI: 10.1016/j.socscimed.2024.117493
Abstrakt: Background: Sexual stigma, mental health disorders, and socioeconomic disparities present important yet incompletely understood barriers to PrEP adoption among gay men and other men who have sex with men (MSM). This study examines how these factors interact and affect PrEP uptake, adherence, and persistence among MSM.
Methods: Data from the 2018 and 2019 American Men's Internet Survey cycles, involving 6907 adult MSM eligible for PrEP, were analyzed. We assessed sexual stigma heterogeneity among this group using latent class analysis and investigated individual relationships between i) stigma class membership, ii) mental distress, and PrEP engagement (past-year use, adherence, and persistence) using Poisson regression with a robust error variance, considering potential variations based on poverty status. The combined associations of sexual stigma and mental distress with PrEP engagement was evaluated using inverse probability weighting.
Results: Four distinct sexual stigma classes were identified, each exhibiting varied associations with PrEP engagement. Associations with mental distress lost statistical significance after adjusting for confounders. However, having both mental distress and sexual stigma was associated with lower past-year PrEP use, with the strongest association observed for those with anticipated healthcare stigma class membership and mental distress (aPR 0.53 [95% CI: 0.37, 0.76]). Sexual stigma accompanied by mental distress was also associated with significantly increased poor PrEP adherence, particularly among those with family and general social stigma class membership (aPR 2.31 [95% CI: 1.08, 4.97]).
Conclusions: Psychosocial factors exert synergistic impacts on PrEP engagement among MSM. Tailored interventions addressing these subtleties may effectively optimize PrEP uptake and improve consistency of use among MSM.
Competing Interests: Declaration of competing interest The authors have no relevant financial or non-financial interests to disclose.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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