학술논문
The perspectives of street-involved youth who use drugs regarding the acceptability and feasibility of HIV pre-exposure prophylaxis: a qualitative study.
Document Type
Academic Journal
Author
Dahlby L; British Columbia Centre on Substance Use, Vancouver, BC, Canada.; Boyd J; British Columbia Centre on Substance Use, Vancouver, BC, Canada.; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.; Knight R; British Columbia Centre on Substance Use, Vancouver, BC, Canada.; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.; Philbin M; Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.; Small W; British Columbia Centre on Substance Use, Vancouver, BC, Canada.; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.; Kerr T; British Columbia Centre on Substance Use, Vancouver, BC, Canada.; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.; McNeil R; British Columbia Centre on Substance Use, Vancouver, BC, Canada.; Yale School of Medicine (Internal Medicine), New Haven, CT, USA.
Source
Publisher: Informa Healthcare Country of Publication: England NLM ID: 8915313 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1360-0451 (Electronic) Linking ISSN: 09540121 NLM ISO Abbreviation: AIDS Care Subsets: MEDLINE
Subject
Language
English
Abstract
Street-involved youth who use drugs (YWUD) face an elevated risk of HIV acquisition and represent a key population for HIV prevention initiatives, including pre-exposure prophylaxis (PrEP). However, little is known regarding the acceptability and feasibility of PrEP uptake and adherence among this multiply-marginalized population. Semi-structured qualitative interviews were conducted with 24 street-involved YWUD (ages 17-24) to examine their perspectives toward PrEP; youth were recruited through a longitudinal prospective cohort study in Vancouver, Canada. Youth reported high levels of ambivalence toward PrEP despite engagement in HIV-related risk behaviors. This ambivalence was driven by misperceptions regarding HIV transmission, including stigmatizing associations between HIV transmission and personal hygiene. Such misperceptions led participants to enact strategies that were ineffective in preventing HIV transmission. Participants contested their inclusion as a "key population" for PrEP, which limited their enthusiasm for PrEP uptake and adherence. Participants also highlighted that wider social-structural inequities (e.g., housing vulnerability, poverty) that produced HIV-related risks were likely to undermine sustained PrEP use. Findings demonstrate the need for tailored implementation strategies to increase PrEP acceptability, including targeted education and anti-stigma interventions to increase awareness about HIV transmission. Interventions should also target structural inequities in order to fully address HIV risk and PrEP ambivalence.