Factores relacionados al interés e intención al uso de profilaxis preexposición al VIH en hombres gay y/o bisexuales, Colombia

Resumen

Introducción: la profilaxis preexposición al VIH (PrEP) ha demostrado disminuir la incidencia del VIH, pero su adopción en Colombia es aún incipiente. Para avanzar en la implementación de la PrEP como intervención de salud pública es necesario conocer el interés de las poblaciones en riesgo de VIH y los factores que facilitarían su uso. Objetivo: identificar los factores relacionados con el interés e intención de tomar PrEP en hombres gay/bisexuales. Metodología: estudio transversal analítico en una muestra no probabilística en ciudades principales de Colombia. Se exploraron las características sociodemográficas, conocimiento, motivaciones, habilidades conductuales y factores psicosociales, se utilizaron modelos logísticos para estimar la relación de estos factores con el interés y la intención de usar la PrEP. Resultados y conclusiones: participaron 552 hombres gay/bisexuales, 301 (54 %) reclutados en línea y 251 en persona. Solo el 40 % de la muestra sabía de la existencia de PrEP. 57.4 % (IC95%:54.9%-62.4%) reportaron interés e 52.9 % (IC95%: 48.5%-57.3%) intención de usar PrEP. El interés y la intención de usar la PrEP se relacionaron con actitudes y normas positivas hacia PrEP, así como con mayores habilidades relacionadas con servicios de PrEP. El estigma hacia la PrEP y los síntomas depresivos se relacionaron con menor interés e intención. Los resultados sugieren la necesidad de fomentar la información sobre PrEP, especialmente en poblaciones con más desventajas sociales y que experimentan más estigma, al igual que desarrollar intervenciones comunitarias que apoyen las motivaciones y las habilidades para usar la PrEP.

Palabras clave:

Profilaxis preexposición

actitud

intención

minorías sexuales y de género

VIH

Pre-Exposure Prophylaxis

Attitude

Intention

Sexual and Gender Minorities

HIV

Profilaxia Pré-Exposição

Atitude

Intenção

Minorias Sexuais e de Gênero

HIV

Citas

Anderson PL, Glidden D V, Liu A, Buchbinder S, Lama JR, Guanira JV, et al. Emtricitabine-Tenofovir Concentrations and Pre-Exposure Prophylaxis Efficacy in Men Who Have Sex with Men. Sci Transl Med [Internet]. 2012; 4(151):151ra125-151ra125. Disponible en: https://doi.org/10.1126%2Fscitranslmed.3004006

Fonner VA, Dalglish SL, Kennedy CE, Baggaley R, O’Reilly KR, Koechlin FM, et al. Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS [Internet]. 2016; 30(12):1973-83. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4949005/

Ravasi G, Grinsztejn B, Baruch R, Guanira JV, Luque R, Cáceres CF, et al. Towards a fair consideration of PrEP as part of combination HIV prevention in Latin America. Journal of the International AIDS Society [Internet]. 2016; 19:21113.Disponible en: https://doi.org/10.7448/IAS.19.7.21113

Organización Panamericana de la Salud. Profilaxis Previa a la Exposición (PrEP) [Internet]. PAHO. 2021 [citado 9 de junio de 2022]. Disponible en: https://www.paho.org/es/temas/prevencion-combinada-infeccion-por-vih/profilaxisprevia-exposicion-prep

Silva Torres T, Konda K, Vega-Ramirez EH, Elorreaga Reyes OA, Diaz-Sosa D, Hoagland B, et al. Awareness and factors associated with willingness to use Pre-exposure prophylaxis (PrEP) in Brazil, Mexico and Peru: an online survey among men who have sex with men (MSM) (Preprint). JMIR Public Health Surveill [Internet]. 2019; 5(2):e13771. Disponible en: https://publichealth.jmir.org/2019/2/e13771

Ministerio de Salud y Protección Social. Acta No 01 de 2019. Sesión Ordinaria. 28, 29, 30 y 31 de enero de 2019. En:Comisión Revisora. Sala Especializada de Moléculas Nuevas NIyMB. 2019.

Ministerio de Salud y Protección Social. Resolución 2292 de 2021 [Internet]. Colombia: Minsalud; 2021. p. 62. Disponible en: https://www.minsalud.gov.co/Normatividad_Nuevo/Resolución No. 2292 de 2021.pdf

Ministerio de Salud y Protección Social. Profilaxis Preexposición al VIH (PrEP). Lineamiento para la implementación de la PrEP en Colombia [Internet]. Colombia: Minsalud; 2023. https://prep-colombia.org/wp-content/uploads/2023/07/Lineamiento-PrEP_FINAL_Junio2023.pdf

Martínez-Cajas J, Alvarado-Llano B, Martínez-Buitrago E, Torres-Isasiga J, Arrivillaga, M, Camargo, P, et al. AC-2020-12-1420.R1 – HIV care providers’ familiarity, concerns, and attitudes about HIV PrEP in Colombia: insights from the PrEP-Col-Study. AIDS Care [Internet]. 2022; 34(11):1428-1434. https://doi.org/10.1080/09540121.2022.2029813

Arrivillaga M, Gómez SA, Mueses HF, Alvarado B, Martínez BE, Camargo-Plazas P, et al. Facilitadores y recomendaciones de proveedores de salud para la implementación de la Profilaxis Pre-Exposición en clínicas de VIH en Colombia. “Estudio PPrE-Colombia”. Revista Gerencia y Políticas de Salud [Internet]. 2022; 21:1-27. Disponible en: https://revistas.javeriana.edu.co/files-articulos/RGPS/21%20(2022)/54570443003/index.html

Bolívar-Rocha MC, Arrivillaga M, Camargo-Plazas P, Torres-Isasiga J, Hurtado-Quiñones L, Gómez-Peñaloza S, et al.Organizational factors related to the implementation of HIV-PrEP: A qualitative exploration with healthcare managers and providers working in HIV clinics in Colombia. Sex Gend Divers Soc Serv [Internet]. 2024; 1–26. https://doi.org/10.1080/10538720.2023.2291088

Coelho LE, Torres TS, Veloso VG, Grinsztejn B, Jalil EM, Wilson EC, et al. The Prevalence of HIV Among Men Who Have Sex With Men (MSM) and Young MSM in Latin America and the Caribbean: A Systematic Review [published correction appears in AIDS Behav. 2021 Jul 26]. AIDS Behav [Internet]. 2021; 25(10):3223-3237. Disponible en: https://doi.org/10.1007/s10461-021-03180-5

Fisher JD, Fisher WA, Bryan AD, Misovich SJ. Information-motivation-behavioral skills model - Based HIV risk behavior change intervention for inner-city high school youth. Heal Psychol. 2002;21(2):177-86.

Shrestha R, Altice FL, Huedo-Medina TB, Karki P, Copenhaver M. Willingness to Use Pre-Exposure Prophylaxis (PrEP):An Empirical Test of the Information-Motivation-Behavioral Skills (IMB) Model among High-Risk Drug Users in Treatment. AIDS Behav [Internet]. 2017; 21(5):1299-308. Disponible en: https://pubmed.ncbi.nlm.nih.gov/27990587/

Knox J, Kutner BA, Shiau S, Winterhalter FS, Wu Y, Hirsch-Moverman Y, et al. Assessing the Information-Motivation-Behavioral Skills Model to Predict Pre-exposure Prophylaxis Adherence Among Black Men Who have Sex with Men and Transgender Women in a Community Setting in New York City. AIDS Behav [Internet]. 2022; 26(7):2494-502.Disponible en: https://link.springer.com/article/10.1007/s10461-022-03588-7

Walsh JL. Applying the Information–Motivation–Behavioral Skills Model to Understand PrEP Intentions and Use Among Men Who Have Sex with Men. AIDS Behav [Internet]. 2019; 23(7):1904-16. Disponible en: http://link.springer.com/10.1007/s10461-018-2371-3

Dubov A, Altice FL, Fraenkel L. An Information–Motivation–Behavioral Skills Model of PrEP Uptake. AIDS Behav [Internet]. 2018; 22(11):3603-16. Disponible en: https://doi.org/10.1007/s10461-018-2095-418. Mueses-Marín HF, Alvarado-Llano B, Torres-Isasiga J, Camargo-Plazas P, Bolívar-Rocha MC, Galindo-Orrego X, et al.Scales to Assess Knowledge, Motivation, and Self-Efficacy for HIV PrEP in Colombian MSM: PrEP-COL Study. AIDS Res Treat [Internet]. 2021; 1-11. Disponible en: https://www.hindawi.com/journals/art/2021/4789971/

Wilton J, Kain T, Fowler S, Hart TA, Grennan T, Maxwell J, et al. Use of an HIV-risk screening tool to identify optimal candidates for PrEP scale-up among men who have sex with men in Toronto, Canada: Disconnect between objective and subjective HIV risk. J Int AIDS Soc [Internet]. 2016; 19(1). Disponible en: http://dx.doi.org/10.7448/IAS.19.1.20777

Mueses-Marín HF, Montaño D, Galindo J, Alvarado-Llano B, Martínez-Cajas J. Psychometric properties and validity of the Center for Epidemiological Studies Depression Scale (CES-D) in a population attending an HIV clinic in Cali,Colombia. Biomedica [Internet]. 2019; 39(1):33-45. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31021545/

Alvarado B, Mueses HF, Galindo J, Martínez-Cajas JL. Application of the “syndemics” theory to explain unprotected sex and transactional sex: A cross-sectional study in men who have sex with men (MSM), transgender women, and non-MSM in Colombia. Biomedica [Internet]. 2020; 40(2):391-403. Diponible en: https://www.redalyc.org/journal/843/84364615016/84364615016.pdf

Fullerton AS. A conceptual framework for ordered logistic regression models. Sociol Methods Res [Internet]. 2009;38(2):306-347. Disponible en: https://journals.sagepub.com/doi/10.1177/0049124109346162

Mueses-Marín HF, Tello-Bolívar IC, Galindo-Orrego MI, Galindo-Quintero J. Perceptions about sexual risk, HIV and HIVtesting in Cali, Colombia. Colomb Med (Cali) [Internet]. 2018; 49(2):139-147. Disponible en: https://colombiamedica.univalle.edu.co/index.php/comedica/article/view/3897

Camargo-Plazas P, Peralta-Ardila MdP, Mueses HF, Alvarado-Llano BE, Gómez Peñaloza SA, Martínez-Cajas JL. La adopción de prep como estrategia de prevención del VIH en Colombia: Análisis secundario de datos cualitativos. New Trends in Qualitative Research (NTQR) [Internet]. 2023; 18:e896. Disponible en: https://publi.ludomedia.org/index.php/ntqr/article/view/896

Bolívar MC, Gomez-Peñaloza SA, Camargo-Plazas P, Peralta-Ardila MdP, Mueses-Marín HF, et al. Barriers and facilitators to HIV pre-exposure prophylaxis uptake among transgender women in Colombia: A qualitative analysis using the COM-B model. PLOS Glob Public Health, 2023; 3(9):e0001395. Disponible en: https://doi.org/10.1371/journal.pgph.000139526. Sun Z, Gu Q, Dai Y, Zou H, Agins B, Chen Q, et al. Increasing awareness of HIV pre-exposure prophylaxis (PrEP) and willingness to use HIV PrEP among men who have sex with men: a systematic review and meta-analysis of global data. J Int AIDS Soc [Internet]. 2022; 25(3):e25883. Disponible en: https://doi.org/10.1002/jia2.25883

Pinto RM, Berringer KR, Melendez R, Mmeje O. Improving PrEP Implementation Through Multilevel Interventions: A Synthesis of the Literature. AIDS Behav [Internet]. 22:3681-3691. Disponible en: https://doi.org/10.1007/s10461-018-2184-4

Narváez Ochoa MA, Arrivillaga M. Intención de uso de la profilaxis pre-exposición (PrEP) de hombres que tienen sexo con hombres en Colombia. Bogotá: Pontificia Universidad Javeriana; 2021.

Hillis A, Germain J, Hope V, McVeigh J, Van Hout MC. Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Men Who Have Sex with Men (MSM): A Scoping Review on PrEP Service Delivery and Programming. AIDS Behav [Internet].2020; 24(11):3056-70. Disponible en: https://doi.org/10.1007/s10461-020-02855-9

Farthing H, Rodriguez A, Armstrong M, Iyengar S, Nigh E, Potter JN, et al. Discomfort discussing HIV/AIDS and lack of awareness are barriers to partner-to-partner pre-exposure prophylaxis education. Int J STD AIDS [Internet]. 2019;30(2):147–53. Disponible en:https://pubmed.ncbi.nlm.nih.gov/30301426/

Alvarado BE, Martínez-Cajas JL, Mueses HF, Correa Sánchez D, Adam BD, Hart TA. Adaptation and Pilot Evaluation of an Intervention Addressing the Sexual Health Needs of Gay Men Living with HIV Infection in Colombia. Am J Mens Health [Internet]. 2021; 15(1). Disponible en:https://pubmed.ncbi.nlm.nih.gov/33511900/

Hart TA, Noor SW, Skakoon-Sparling S, Lazkani SN, Gardner S, Leahy B, et al. GPS: A Randomized Controlled Trial of Sexual Health Counseling for Gay and Bisexual Men Living With HIV. Behav Ther [Internet]. 2021; 52(1):1-14.Disponible en: https://pubmed.ncbi.nlm.nih.gov/33483108/

Mauldin RL, Rawwad TA, Amith M, Kuhns LM, Schneider JA, Fujimoto K. Community-clinic linkages for promoting HIV prevention: organizational networks for PrEP client referrals and collaborations. AIDS Care [Internet]. 2022;34(3):340-348. Dipsonible en: https://pubmed.ncbi.nlm.nih.gov/34085893/

Jackson-Gibson M, Ezema AU, Orero W, et al. Facilitators and barriers to HIV pre-exposure prophylaxis (PrEP) uptake through a community-based intervention strategy among adolescent girls and young women in Seme Sub-County, Kisumu,Kenya. BMC Public Health [Internet]. 2021; 21(1):1284. Disponible en: https://doi.org/10.1186/s12889-021-11335-1

Huang Y, Tian R, Zhou Z, Xu J, Agins B, Zou H, et al. HIV Pre-Exposure Prophylaxis Use on a Global Scale Among Men Who Have Sex with Men: A Systematic Review and Meta-Analysis. AIDS Patient Care STDS [Internet]. 2023; 37(4):159-191. Disponible en: https://doi.org/10.1089/apc.2022.0198

36. Biello KB, Oldenburg CE, Mitty A, Closson EF, Mayer KH, Safren SA, et al. The “Safe Sex” Conundrum: Anticipated Stigma From Sexual Partners as a Barrier to PrEP Use Among Substance Using MSM Engaging in Transactional Sex. AIDS Behav [Internet]. 2017; 21: 300-306. Disponible en: https://doi.org/10.1007/s10461-016-1466-y

Fujimoto K, Wang P, Flash CA, Kuhns LM, Zhao Y, Amith M, & Schneider JA. Network modeling of PrEP uptake on referral networks and health venue utilization among young men who have sex with men. AIDS Behav [Internet].2019; 23(7):1698-1707. Disponible en: https://doi.org/10.1007/s10461-018-2327-7

Knight R, Small W, Carson A, Shoveller J. Complex and Conflicting Social Norms: Implications for Implementation of Future HIV Pre-Exposure Prophylaxis (PrEP) Interventions in Vancouver, Canada. PLoS ONE [Internet]. 2016; 11(1):e0146513. Disponible en: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0146513

Brooks RA, Landrian A, Nieto O, Fehrenbacher A. Experiences of Anticipated and Enacted Pre-exposure Prophylaxis (PrEP) Stigma Among Latino MSM in Los Angeles. AIDS Behav [Internet]. 2019; 23:1964-1973. Disponible en: https://doi.org/10.1007/s10461-019-02397-9

Howell J, Deane-King J, Maguire R. Factors Associated with PrEP Stigma Among Gay, Bisexual, and Other Men Who Have Sex with Men (gbMSM): A Systematic Review. Journal of Homosexuality [Internet]. 2024; 1-30. https://doi.org/10.1080/00918369.2024.2326891

Meanley S, Connochie D, Choi SK, Bonett S, Flores DD, Bauermeister JA. Assessing the Role of Gay Community Attachment, Stigma, and PrEP Stereotypes on Young Men Who Have Sex with Men’s PrEP Uptake. AIDS Behav[Internet]. 2021; 25(6):1761-76. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33211207/

Babel RA, Wang P, Alessi EJ, Raymond HF, Wei C. Stigma, HIV Risk, and Access to HIV Prevention and Treatment Services Among Men Who have Sex with Men (MSM) in the United States: A Scoping Review. AIDS Behav [Internet].2021; 25(11):3574-3604. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33866444/

Card KG, Hawkins BW, Mortazavi L, Gregory A, Ng KH, Lachowsky NJ. Stigma, the Media, and Pre-exposure Prophylaxis for HIV Prevention: Observations for Enhancing Knowledge Translation and Resisting Stigma in the Canadian Context.AIDS Behav [Internet]. 2019; 23(7):1877-1887. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30390190/

Keene LC, Dehlin JM, Pickett J, Berringer KR, Little I, Tsang A, et al. 6#PrEP4Love: success and stigma following release of the first sex-positive PrEP public health campaign. Cult Health Sex [Internet]. 2021;23(3):397-413. Disponible en: https://doi.org/10.1080/13691058.2020.1715482

Calabrese SK, Tekeste M, Mayer KH, Magnus M, Krakower D, Kershaw T, et al. Considering Stigma in the Provision of HIV Pre-Exposure Prophylaxis: Reflections from Current Prescribers. AIDS Patient Care STDS [Internet]. 2019;33(2):79-88. Disponible en: https://doi.org/10.1089/apc.2018.0166

Patrick R, Jain J, Harvey-Vera A, Semple SJ, Rangel G, et al. Perceived barriers to pre-exposure prophylaxis use among HIV-negative men who have sex with men in Tijuana, Mexico: A latent class analysis. PLoS ONE [Internet]. 2019;14(8):e0221558. https://doi.org/10.1371/journal.pone.0221558

Aguilera-Mijares S, Martínez-Davalos A, Bautista-Arredondo S, Vermandere H. The Preexposure Prophylaxis Care Continuum Among Mexican Men Who Have Sex With Men and Transwomen: A Qualitative Study. Sex Transm Dis [Internet]. 2023; 50(8):512-517. Disponible en: https://doi.org/10.1097/olq.0000000000001759

48. Miller SJ, Harrison SE, Sanasi-Bhola K. A Scoping Review Investigating Relationships between Depression, Anxiety, and the PrEP Care Continuum in the United States. Int J Environ Res Public Health [Internet]. 2021; 18(21):11431. Disponible en: https://doi.org/10.3390/ijerph182111431

Wolff C, Alvarado R, Wolff M. Prevalencia, factores de riesgo y manejo de la depresión en pacientes con infección por VIH: Revisión de la literatura. Rev Chilena Infectol [Internet]. 2010; 27(1):65-74. Disponible en: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0716-10182010000100011&lng=es&nrm=iso&tlng=n

Krakower D, Maloney KM, Powell VE, Levine K, Grasso C, Melbourne K, et al. Patterns and clinical consequences of discontinuing HIV preexposure prophylaxis during primary care. J Int AIDS Soc [Internet]. 2019; 22(2):e25250.Disponible en: http://onlinelibrary.wiley.com/doi/10.1002/jia2.25250/full

Colson PW, Franks J, Wu Y, Winterhalter FS, Knox J, Ortega H, et al. Adherence to Pre-exposure Prophylaxis in Black Men Who Have Sex with Men and Transgender Women in a Community Setting in Harlem, NY. AIDS Behav [Internet].2020; 24(12):3436-3455. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32385678/

Parsons JT, Rendina HJ, Lassiter JM, Whitfield THF, Starks TJ, Grov C. Uptake of HIV pre-exposure prophylaxis (PrEP) in a national cohort of gay and bisexual men in the United States: The Motivational PrEP Cascade. J Acquir Immune Defic Syndr [Internet]. 2017; 74(3):285. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5315535/

Fondo Colombiano de Enfermedades de Alto costo. VIH Sida en Colombia, retos y apuestas en salud [Internet]. Cuenta de Alto Costo. 2020. Disponible en: https://cuentadealtocosto.org/site/vih/vih-sida-en-colombia-retos-y-apuestas-en-salud/