Introduction

The US Military is experiencing a rise in HIV infections among gay and bisexual men (GBM) serving on active duty, yet little is known about this population’s uptake of pre-exposure prophylaxis (PrEP), an evidence-based intervention for HIV prevention. This mixed methods study examines the facilitators and barriers to PrEP access and uptake among active duty GBM.

Methods

Active duty GBM were recruited using respondent-driven sampling (2017 and 2018). Participants (n = 93) answered quantitative survey questions on PrEP interest and accessibility. Another set of participants (n = 10) discussed their PrEP experiences in qualitative interviews. We conducted descriptive and bivariate analyses of quantitative data, while qualitative data were analyzed using structural and descriptive coding techniques.

Results

Approximately 71% of active duty GBM indicated interest in accessing PrEP. A greater proportion of those who disclosed (vs. did not disclose) their sexual orientation to their military doctor discussed (p < 0.001) or accessed (p = 0.017) PrEP. The following qualitative themes emerged: (1) providers’ negative views and knowledge gaps related to PrEP; (2) lack of a systems approach to PrEP access; (3) confidentiality concerns; and (4) reliance on peer networks for PrEP guidance and support.

Conclusions

Study results indicate that active duty GBM are interested in and want to discuss PrEP with their military doctors, but gaps in providers’ PrEP-related knowledge and skills, as well as mistrust in the military health care system, remain.

Policy Implications

A system-wide approach that addresses confidentiality concerns and removes procedural barriers to PrEP access is recommended to improve PrEP uptake in this population.

中文翻译：

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“这有点像现在最大的难题是我们能否获得 PrEP？”：现役男同性恋和双性恋男性采用 PrEP 的促进因素和障碍

介绍

美国军队现役男同性恋和双性恋男性 (GBM) 的艾滋病毒感染率正在上升，但人们对这一人群接受暴露前预防 (PrEP) 的情况知之甚少，这是一种基于证据的艾滋病毒预防干预措施。这项混合方法研究探讨了现役 GBM 获取和采用 PrEP 的促进因素和障碍。

方法

现役 GBM 是通过受访者驱动抽样（2017 年和 2018 年）招募的。参与者 ( n  = 93) 回答了有关 PrEP 兴趣和可及性的定量调查问题。另一组参与者 ( n  = 10) 在定性访谈中讨论了他们的 PrEP 经验。我们对定量数据进行描述性和双变量分析，同时使用结构和描述性编码技术对定性数据进行分析。

结果

大约 71% 的现役 GBM 表示有兴趣获得 PrEP。向军医透露（与未透露）性取向的人中，有更大比例的人讨论过（p  < 0.001）或访问过（p  = 0.017）PrEP。出现了以下定性主题：(1) 提供者对 PrEP 的负面看法和知识差距；(2) 缺乏获取 PrEP 的系统方法；(3) 保密问题；(4) 依靠同行网络提供 PrEP 指导和支持。

结论

研究结果表明，现役 GBM 有兴趣并希望与军医讨论 PrEP，但提供者在 PrEP 相关知识和技能方面的差距以及对军队医疗保健系统的不信任仍然存在。

政策影响

建议采用全系统方法来解决保密问题并消除 PrEP 获取的程序障碍，以提高该人群的 PrEP 采用率。