Understanding the factors that influence intentions to discuss long-acting injectable pre-exposure prophylaxis (LAI-PrEP) with healthcare providers among Black and Hispanic gay and bisexual men is an important area of prevention research. A good example is the study of factors influencing the intention of Black and Hispanic homosexual and bisexual males aged 18–34 years in Texas to discuss LAI-PrEP with their healthcare providers gives useful information; however, several statistical limitations should be acknowledged.1 In example, the use of a Poisson regression model for prevalence ratios may be inappropriate for rare events. When the outcome rate is high, this model may limit the interpretation of the results. Although the intention to discuss LAI-PrEP rate was >63.5%, interpreting the prevalence rate may be challenging. As a result, using logistic regression for binary outcomes would make the results easier to interpret. Another disadvantage is the use of cross-sectional data, which makes it difficult to identify causal correlations between factors and intention to discuss LAI-PrEP. According to the Theory of Planned Behavior model, attitudes, social norms, and perceived behavioral control all influence intention to act, although these factors can alter over time. Cross-sectional data make it impossible to determine whether factors such as skepticism in the medical system or human immunodeficiency virus (HIV) risk are responsible for decreased intentions. Importantly, the absence of longitudinal data further limits the ability to assess how these intentions and influencing factors evolve over time. Longitudinal research would help us better understand the direction of these associations and how they develop over time. Poisson regression may not adequately represent relevance in high-intention outcomes, further underscoring the appropriateness of logistic regression for clearer interpretation. Another problem to consider is the impact of internalized homophobia and medical skepticism on health-seeking behavior. The findings imply that these characteristics are associated with a decreased inclination to discuss LAI-PrEP, highlighting broader societal concerns, particularly among discriminated populations. However, the majority of the assessments of both categories in this study were based on self-reported data from participants, which could be influenced by social desirability or misrecognition. Reliance on self-reported measures can introduce significant bias, reinforcing the need for validation strategies in the future work. Future research in this area should consider complementing quantitative surveys with qualitative methodologies, such as in-depth interviews of focus groups, to require a better understanding of how these aspects manifest in interactions with healthcare professionals. Such an approach may also help capture dimensions of generalized stigma that self-report scales may overlook. Looking forward, efforts to promote LAI-PrEP discussions and uptake should emphasize both behavioral and structural interventions. Future research could use qualitative methodologies, such as in-depth interviews or focus groups, to acquire a better understanding of how these aspects manifest in interactions with healthcare professionals. For future directions, research could focus on intervention strategies aimed at addressing attitudinal barriers and reducing discrimination in healthcare settings, such as developing targeted education programs for healthcare providers about the HIV prevention needs and concerns of gay and bisexual, Black, and Hispanic men.2,3 Furthermore, investigating the effect of geosocial apps in disseminating information about LAI-PrEP may provide new avenues for reaching high-risk individuals where they are most active. Systemic barriers to boosting LAI-PrEP use could be identified by taking into account healthcare system elements such as health insurance coverage and service access. Reaching out to audiences at numerous levels, both individually and throughout the healthcare system, would be a crucial strategy for promoting LAI-PrEP use among this vulnerable demographic. Structural barriers also remain an important consideration, as shown in the P18 Cohort Study, which found that healthcare system obstacles and insurance limitations binder PrEP uptake among young sexual minority men.4 Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Daungsupawong et al. (Thu,) studied this question.
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