| Objective: To understand the status of stigma in Men who have sex with Men(MSM)partcipating in pre-exposure prophylaxis(Pr EP)and its influencing factors,as well as the association between stigma and Pr EP adherence and condomless anal intercourse(CAI).Methods: A cohort of 1023 baseline HIV-negative high-risk MSM populations with Pr EP was established in Shenyang,Beijing,Shenzhen,and Chongqing.The participants were followed up for a period of one year,with an average outpatient follow-up every 3 months.At each follow-up,fill out an online self-filled questionnaire to collect the sociodemographic and behavioral characteristics of the respondents,and use the SelfStigma Scale-Short(SSS-S)to measure the stigma of the participants.Logistic regression was used to analyze the stigma and its influencing factors of MSM participating in Pr EP at baseline;the generalized estimating equation(GEE)was used to longitudinally analyze the impact of stigma on medication compliance and CAI of MSM participating in Pr EP.Results: From October 2018 to November 2019,a total of 1,222 MSM were screened,of which 1,023 eligible survey subjects were enrolled,and a total of 797.25 person-years of follow-up were completed.In the baseline survey,84.9%(869/1023)of the participants were older than 24 years old;about 50% of the participants each chose the daily medication method(510/1023)and the event-driven medication method(513/1023).);The research subjects were mainly from the Beijing and Shenyang sites,and the survey subjects at the two sites accounted for 44.1%(452/1023)and 34.5%(353/1023)of the total enrolled persons;most of the subjects were Han nationality 90%(991/ 1023);81.23%(831/1023)of respondents who self-reported that they have a university degree or higher;67.2%(687/1023)of participants who have a monthly income of more than 6000 yuan and above,97.6%(998/1023)of the participants who identified as male,78.5%(803/1023)of participants’ homosexual orientation were 78.5%(803/1023),and 93.0%(951/1023)had a sense of stigma.Chi-square analysis results showed: sexual role(P=0.01);anal bleeding in the past 3 months(P=0.03);previous abuse or bullying in childhood or adolescence(P=0.05);in previous relationships with male partners,there were differences in the experience of limiting each other’s relationship with others(P=0.03)and different levels of stigma;multivariate logistic regression shows that the sex-role is "0"(vs.sex role of "1")(a OR=0.42,95%CI: 0.19-0.94,P=0.034)and sex-role of "0.5"(vs.sex role of "1")are negatively correlated with stigma(a OR=0.30,95%CI: 0.14-0.63),P=0.01);the previous cold war with a male partner was positively correlated with the presence of stigma(a OR=2.48,95%CI: 1.25-3.34,P=0.04).The analysis of the generalized estimating equation showed that there was no statistically significant correlation between the stigma(vs.non-stigma)and Pr EP adherence(a OR=0.98,95%CI: 0.82-1.19,P=0.867).After adjusting for age,income,education level,way of taking medication,and different sites,the results of the generalized estimation equation analysis showed that the stigma(vs.nonstigma)was still not statistically related to adherence(a OR=0.96,95%CI: 0.79-1.16,P=0.645);the analysis of the generalized estimation equation shows that the stigma(vs.non-stigma)is statistically associated with CAI(OR=1.30,95%CI: 1.13-1.50,P<0.001).Besides,after adjusting for age,education level,income,and the number of sexual partners,the results of the multivariate generalized estimation equation show that there is an independent statistical association between stigma(vs.non-stigma)and CAI(a OR=1.19,95%CI: 1.03-1.38,P=0.017).Conclusion: The stigma of MSM participating in Pr EP is serious,and the cold war with sexual partners is an independent influencing factor.Stigma does not reduce the medication compliance of MSM participating in Pr EP,and stigma increases the CAI behavior of MSM participating in Pr EP.Intervention is needed to interfere with the stigma of MSM taking Pr EP to reduce the occurrence of high-risk sexual behaviors. |
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