Multilevel Factors Impacting PrEP Engagement Among Young Gay Men and Young Transgender Women in Thailand: A Qualitative Analysis.

IF 2.2 Q3 INFECTIOUS DISEASES Journal of the International Association of Providers of AIDS Care Pub Date : 2023-01-01 DOI:10.1177/23259582231188221

Peter A Newman, Suchon Tepjan, Kangwan Fongkaew, Pakorn Akkakanjanasupar, Jan Willem de Lind van Wijngaarden, Nuttapon Chonwanarat

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Abstract

Half of new HIV infections in Thailand are among young people, the majority of whom are young gay and other men who have sex with men (YMSM) and young transgender women (YTGW). Amid low pre-exposure prophylaxis (PrEP) coverage, we explored practice-based factors that impact PrEP engagement among YMSM and YTGW. In 2018, we conducted 4 focus group discussions with 20 YMSM and 5 YTGW, and 22 in-depth interviews (5 in 2022) with healthcare providers (HCPs), community-based organization (CBO)/nongovernmental organization (NGO) staff, and peer educators. The inclusion of PrEP in universal healthcare coverage, including YMSM and YTGW, is a substantial facilitator of PrEP use; however, systemic barriers at microsocial (lack of communication about PrEP from HCPs, teachers, parents), mesosocial (healthcare-service fragmentation, lack of PrEP-competent HCPs), and macrosocial levels (annual quotas on free HIV-testing, HIV- and sexual-stigma) constrain and disincentivize adolescents' engagement with PrEP. National scale-up of youth-friendly and LGBT-affirmative CBO/NGO clinics, HCP training, and tailored programs to support adolescents' adherence may promote PrEP engagement among YMSM and YTGW in Thailand.

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影响泰国年轻男同性恋和年轻跨性别女性PrEP参与的多层次因素:定性分析。

泰国新增艾滋病毒感染者中有一半是年轻人，其中大多数是年轻男同性恋者和其他男男性行为者(YMSM)以及年轻变性女性(YTGW)。在暴露前预防(PrEP)覆盖率较低的情况下，我们探讨了影响YMSM和YTGW中PrEP参与的基于实践的因素。在2018年，我们与20名男青年和5名女青年进行了4次焦点小组讨论，并与医疗保健提供者(HCPs)、社区组织(CBO)/非政府组织(NGO)工作人员和同伴教育者进行了22次深度访谈(2022年为5次)。将预防措施纳入全民医疗保险，包括青年男性和青少年妇女保健，是预防措施使用的重要促进因素;然而，在微观社会(卫生保健服务提供者、教师和家长缺乏关于预防措施的沟通)、中社会(医疗保健服务分散、缺乏有能力预防措施的卫生保健提供者)和宏观社会层面(免费艾滋病毒检测、艾滋病毒和性污名的年度配额)上的系统性障碍，限制和抑制了青少年参与预防措施。量身定制的方案支持青少年坚持，可能会促进泰国青年男性和青少年女性的PrEP参与。

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