Journal of the International AIDS Society最新文献

{"title":"Impact of male peer-led outreach on uptake of HIV testing among male partners of pregnant women in Uganda: a randomized trial","authors":"Faith Naddunga,&nbsp;Michelle A. Bulterys,&nbsp;Agnes Nakyanzi,&nbsp;Deborah Donnell,&nbsp;Juliet Kyomugisha,&nbsp;Juliet E. Birungi,&nbsp;Paul Ssendiwala,&nbsp;Rogers Nsubuga,&nbsp;Timothy R. Muwonge,&nbsp;Joshua Musinguzi,&nbsp;Sue Peacock,&nbsp;Connie L. Celum,&nbsp;Andrew Mujugira,&nbsp;Monisha Sharma","doi":"10.1002/jia2.26440","DOIUrl":"https://doi.org/10.1002/jia2.26440","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Male partner HIV testing and engagement in antenatal care (ANC) is associated with improved clinical outcomes for men, pregnant women and infants. However, testing rates remain low among male partners of pregnant women receiving ANC in Africa. We evaluated the impact of male peer outreach to increase HIV testing among partners of pregnant women in Uganda.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a randomized trial in Kampala, Uganda, enrolling an equal number of pregnant women with and without HIV from public ANC clinics who were randomized 1:1 to intervention or standard-of-care (SOC) with delayed intervention after 1 month. (ClinicalTrials.gov ID, NCT05388084). The intervention consisted of male peer counsellors calling male partners of consenting pregnant women and inviting them to test for HIV. In the SOC, pregnant women received an invitation letter to deliver to their partners for fast-track HIV testing, per national guidelines. We conducted an intention-to-treat analysis using modified Poisson regression, comparing the proportion of male partners tested for HIV by month 1 across arms overall and by female's HIV status. A secondary analysis compared the proportion tested for HIV by 3 months after both arms received the intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between May 2022 and March 2023, we enrolled 150 pregnant women (76 in intervention, 74 in SOC). At 1 month, 18% more males in the intervention arm tested for HIV compared to SOC (32% vs. 14%; risk difference [RD] = 0.18; 95% confidence interval [CI]: 0.05–0.31). This association remained significant after stratifying by female HIV status. HIV testing was 22% higher among male partners of HIV-negative women in the intervention arm compared to SOC (46% vs. 24%; RD = 0.22; 95% CI: 0.004–0.430) and 15% higher among partners of pregnant women with HIV (18% vs. 3%; RD = 0.15; 95% CI: 0.02–0.28). At 3 months, 50% (38/76) of male partners tested in the intervention versus 35% (26/74) in the SOC/delayed intervention (RD = 0.15; 95% CI: −0.01 to 0.31).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Male peer outreach is a promising intervention to increase knowledge of HIV status among partners of pregnant women. Additional support is needed to increase HIV testing among partners of women with HIV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26440","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing post-tuberculosis sequelae among people living with HIV: an unmet need","authors":"Vidya Mave,&nbsp;Samyra R. Cox,&nbsp;Akshay N. Gupte,&nbsp;Jonathan E. Golub","doi":"10.1002/jia2.26439","DOIUrl":"https://doi.org/10.1002/jia2.26439","url":null,"abstract":"&lt;p&gt;In 2023, an estimated 10.8 million people fell ill with tuberculosis (TB) and 662,000 (6%) of them were living with HIV. Over the same period, an estimated 1.1 million people died with TB, and HIV co-infection contributed to an additional 161,000 TB-related deaths [&lt;span&gt;1&lt;/span&gt;]. Since 2010, global TB incidence and related mortality have been gradually declining due to increased access to new diagnostics and expanding treatment options. However, there is growing evidence that TB survivors experience excess morbidity and mortality even after successfully completing treatment. We must begin focusing more on caring for the 155 million TB survivors worldwide who are struggling with the aftermath of TB disease [&lt;span&gt;2&lt;/span&gt;]. The post-TB sequelae that these survivors experience include TB recurrence, lung disease, cardiovascular disease, mental health issues and an overall decline in quality of life [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Screening TB survivors for recurrent TB could lead to major reductions in TB transmission and improvements in patient outcomes, particularly in high HIV-prevalence countries which tend to have higher rates of TB recurrence [&lt;span&gt;4&lt;/span&gt;]. Recent evidence suggests that periodic screening for TB survivors is a high-yield approach for active case finding. The Targeted Universal Testing for TB study in South Africa found a new TB diagnosis among 12% of people with recent prior TB—higher than what was found among people living with HIV and among close contacts of people with TB in the study [&lt;span&gt;5&lt;/span&gt;]. However, so far, the World Health Organization has only made a conditional recommendation for post-TB screening due to limited evidence [&lt;span&gt;6&lt;/span&gt;]. To help address this gap, results are forthcoming from the first active case-finding trial targeting TB survivors and their household contacts, TB Aftermath [&lt;span&gt;7&lt;/span&gt;]. More work is needed to optimize post-TB screening so that it can be effective in a range of settings, including among people living with HIV. A priority is to identify post-TB screening algorithms that are low-cost but accurate and deployable in both clinic and community contexts, as well as efficient strategies that target the highest-risk groups for TB recurrence, without deepening TB and HIV-related stigma.&lt;/p&gt;&lt;p&gt;Comorbidities and non-TB conditions affecting people with TB during TB treatment almost always persist beyond TB, and some of these conditions first develop as TB treatment concludes. Screening for and treating non-TB conditions is, thus, necessary as early as possible to reduce post-TB morbidity and mortality. Identifying optimal care strategies for multi-morbidities during and after completion of TB treatment, including maintaining continued care and treatment of HIV, is also critical to optimize health outcomes. However, more research on the longer-term health outcomes of TB beyond 24 months of follow-up would help identify interventions and resources that national programmes need to man","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26439","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143689638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community leadership is key to effective HIV service engagement for female sex workers in Africa","authors":"Primrose Matambanadzo,&nbsp;Lilian Otiso,&nbsp;Sibonile Kavhaza,&nbsp;Parinita Bhattacharjee,&nbsp;Frances M. Cowan","doi":"10.1002/jia2.26425","DOIUrl":"https://doi.org/10.1002/jia2.26425","url":null,"abstract":"&lt;p&gt;Although overall HIV incidence has declined across sub-Saharan Africa since 2010, HIV incidence among female sex workers is nine times higher than among cisgender women [&lt;span&gt;1&lt;/span&gt;]. Young women who sell sex are particularly vulnerable. Women who sell sex do so in the context of discrimination and intense stigma, exacerbated by the criminalization of sex work [&lt;span&gt;2&lt;/span&gt;]. Despite impressive population-level gains in treatment cascade engagement, antiretroviral therapy (ART) coverage and rates of viral suppression have remained lower among African female sex workers than in the general population [&lt;span&gt;3&lt;/span&gt;]. Addressing female sex workers’ specific HIV prevention and treatment needs remains central to a comprehensive HIV response and remains one of UNAIDS central pillars for “ending AIDS by 2030.”&lt;/p&gt;&lt;p&gt;Community-led, person-centred prevention and treatment services that address contextually important barriers to service engagement, while considering sex workers’ heterogeneity and multiple intersecting vulnerabilities, remain essential [&lt;span&gt;4&lt;/span&gt;]. Community empowerment approaches seek to build social cohesion, psychological and financial resilience, and facilitate sex workers’ ability to work collaboratively towards shared goals, enabling them to prioritize and address the specific challenges they face including barriers to uptake of, and engagement in, HIV services. There is compelling evidence that community empowerment of female sex workers increases the impact of programmes in Asia [&lt;span&gt;5&lt;/span&gt;] and South America [&lt;span&gt;6&lt;/span&gt;] where sex worker-led programmes are estimated to have averted hundreds of thousands of HIV infections among female sex workers and the general population. Evidence of impact is building in Africa, where community-led approaches have more recently been introduced, resulting in increased effective coverage of HIV services [&lt;span&gt;7, 8&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Community empowerment is a process which takes time and resources to develop in any population, but possibly more so among sex workers who are marginalized, stigmatized and may be distrustful. It necessitates moving from providing services &lt;i&gt;for the community&lt;/i&gt; to services being led and provided &lt;i&gt;by the community&lt;/i&gt; [&lt;span&gt;6&lt;/span&gt;]. For example, sex worker provision of services &lt;i&gt;for the community&lt;/i&gt; might include mobilizing communities to engage with HIV services, deliver health education, distribute condom and HIV self-test kits; whereas when &lt;i&gt;sex workers lead&lt;/i&gt; the service provision, they receive funding directly to commission and monitor the quality of health services, they design and implement both health (e.g. community delivery of pre-exposure prophylaxis (PrEP) or ART to ensure effective community coverage) and social programmes (e.g. violence mitigation or savings schemes) [&lt;span&gt;9&lt;/span&gt;]. The UNAIDS Strategy for 2021–2025 states that 30% of key population programmes, including those for sex workers, should be community-led by ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26425","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143564867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comorbidities and HIV-related factors associated with mental health symptoms and unhealthy substance use among older adults living with HIV in low- and middle-income countries: a cross-sectional study","authors":"Jeremy L. Ross,&nbsp;Dhanushi Rupasinghe,&nbsp;Thida Chanyachukul,&nbsp;Brenda Crabtree Ramírez,&nbsp;Gad Murenzi,&nbsp;Edith Kwobah,&nbsp;Fiona Mureithi,&nbsp;Albert Minga,&nbsp;Ivan Marbaniang,&nbsp;Hugo Perazzo,&nbsp;Angela Parcesepe,&nbsp;Suzanne Goodrich,&nbsp;Cleophas Chimbetete,&nbsp;Ephrem Mensah,&nbsp;Fernanda Maruri,&nbsp;Dung Thi Hoai Nguyen,&nbsp;Alvaro López-Iñiguez,&nbsp;Kathryn Lancaster,&nbsp;Helen Byakwaga,&nbsp;Mpho Tlali,&nbsp;Marie K. Plaisy,&nbsp;Smita Nimkar,&nbsp;Rodrigo Moreira,&nbsp;Kathryn Anastos,&nbsp;Aggrey Semeere,&nbsp;Gilles Wandeler,&nbsp;Antoine Jaquet,&nbsp;Annette Sohn,&nbsp;the Sentinel Research Network of the International epidemiology Databases to Evaluate AIDS","doi":"10.1002/jia2.26434","DOIUrl":"https://doi.org/10.1002/jia2.26434","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;People with HIV (PWH) are vulnerable to mental health and substance use disorders (MSDs), but the extent to which these are associated with other non-communicable diseases in ageing PWH populations remains poorly documented. We assessed comorbidities associated with symptoms of MSD among PWH ≥40 years in the Sentinel Research Network (SRN) of the International epidemiology Database to Evaluate AIDS (IeDEA).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Baseline data collected between June 2020 and September 2022, from 10 HIV clinics in Asia, Latin America and Africa contributing to the SRN, were analysed. Symptoms of MSDs and comorbidities were assessed using standardized questionnaires, anthropometric and laboratory tests, including weight, height, blood pressure, glucose, lipids, chronic viral hepatitis and liver transient elastography. HIV viral load, CD4 count and additional routine clinical data were accessed from participant interview or medical records. HIV and non-HIV clinical associations of mental illness symptoms and unhealthy substance use were analysed using logistic regression. Mental illness symptoms were defined as moderate-to-severe depressive symptoms (PHQ-9 score &gt;9), moderate-to-severe anxiety symptoms (GAD-7 &gt;9) or probable post-traumatic stress disorder (PCL-5 &gt;32). Unhealthy substance use was defined as ASSIST score &gt;3, or AUDIT ≥7 for women (≥8 for men).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Of 2614 participants assessed at baseline study visits, 57% were female, median age was 50 years, median CD4 was 548 cells/mm&lt;sup&gt;3&lt;/sup&gt; and 86% had HIV viral load &lt;1000 copies/ml. Overall, 19% had mental illness symptoms, 15% unhealthy substance use, 49% BMI &gt;25 kg/m&lt;sup&gt;2&lt;/sup&gt;, 38% hypertension, 15% type 2 diabetes, 35% dyslipidaemia, 34% liver disease and 23% history of tuberculosis. BMI &gt;25 and dyslipidaemia were found in 54% and 40% of those with mental illness symptoms compared to 49% and 34% of those without. Mental illness symptoms were not significantly associated with the clinical factors assessed. Unhealthy substance use was more likely among those with dyslipidaemia (OR 1.55, CI 1.16−2.09, &lt;i&gt;p&lt;/i&gt; = 0.003), and less likely in those with BMI &gt;25 (OR 0.48, CI 0.30−0.77, &lt;i&gt;p&lt;/i&gt; = 0.009).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Improved integration of MSD and comorbidity services in HIV clinical settings, and further research on the association between MSD and comorbidities, and care integration among older PWH in low-middle-income countries,","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26434","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143554242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socio-economic status and adherence to HIV preventive and therapeutic interventions: exploring the mediating role of food insecurity among men who have sex with men and transgender and non-binary persons from Brazil","authors":"Paula M. Luz,&nbsp;Thiago S. Torres,&nbsp;Victor C. Matos,&nbsp;Giovanna G. Costa,&nbsp;Brenda Hoagland,&nbsp;Cristina Pimenta,&nbsp;Marcos Benedetti,&nbsp;Beatriz Grinsztejn,&nbsp;Valdilea G. Veloso","doi":"10.1002/jia2.26432","DOIUrl":"https://doi.org/10.1002/jia2.26432","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Brazil offers free-of-charge antiretroviral therapy (ART) for people living with HIV (PLWH) as well as oral pre-exposure prophylaxis (PrEP) through its national health system. Adherence to ART and to PrEP is essential to achieving the expected benefits of virologic suppression and prevention of HIV acquisition, respectively. Brazil has experienced worsening social inequalities, exacerbated by the COVID-19 pandemic, leading to increases in food insecurity especially among vulnerable populations. We explored whether food insecurity mediated the association of socio-economic status on adherence to ART/PrEP.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Adult men who have sex with men (MSM) and transgender and non-binary persons (TGNB) living in Brazil (May−September/2021) voluntarily participated in a cross-sectional online study advertised on dating apps and social media. Participants living with HIV reporting ART use and participants with HIV-negative status reporting daily oral PrEP use were eligible for the analysis. Self-report of ART adherence was measured by the WebAd-Q instrument (3-items/past week) plus a visual analogue scale. Self-report of PrEP adherence was measured by the number of days the person took PrEP in the past week. The 8-item Brazilian Scale of Food Insecurity (EBIA) was used to measure food insecurity (higher scores indicate more severe food insecurity). Two structural equation models were used to assess the direct and indirect effects of variables on ART adherence among PLWH and on PrEP adherence among people using PrEP.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In total, 1230 PLWH were using ART, and 991 individuals with HIV-negative status were using daily oral PrEP. The median age of PLWH was 37 years (HIV negative: 34 years), most were cismen (98%). More PLWH reported moderate/severe food insecurity (21.7%; HIV negative: 12.9%). Self-report of ART adherence (measured by WebAd-Q, past 7 days) was 55.7% (PrEP adherence: 93.3%). In the two models, socio-economic status had an effect on adherence that was mediated through food insecurity: higher socio-economic status was associated with lower food insecurity, and higher food insecurity was associated with lower adherence.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Our findings suggest that the provision of socio-economic support could help PLWH and people at higher vulnerability to HIV acquisition by improving their adherence to ART or PrEP, and ultimately populations through decreased HIV transmissions.&lt;/p&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26432","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143554241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"We will not end AIDS: addressing the anti-rights movements","authors":"Allan Maleche,&nbsp;Wame Jallow,&nbsp;Jerop Limo,&nbsp;Timothy Wafula,&nbsp;Solomon Wambua","doi":"10.1002/jia2.26429","DOIUrl":"https://doi.org/10.1002/jia2.26429","url":null,"abstract":"&lt;p&gt;In 2015, global leaders made an ambitious commitment to end the AIDS epidemic under the 2030 Agenda for Sustainable Development, through political will, investments and rights-based approaches [&lt;span&gt;1&lt;/span&gt;]. On Zero Discrimination Day 2025, we sound the alarm on the growing wave of anti-rights and anti-gender movements that now threaten to roll back of these gains, putting millions of lives at risk. Anti-gender movements refer to organized efforts aimed at opposing gender equality and the rights of marginalized groups, particularly those advocating for sexual and reproductive health rights and the rights of LGBTIQ+ communities. These movements often target policies and programmes that promote gender inclusivity, comprehensive sexuality education and equal access to healthcare, using narratives that reject evolving gender norms and human rights frameworks.&lt;/p&gt;&lt;p&gt;The UNAIDS 2024 report emphasized that the global momentum in ending AIDS hinges on sustained political and financial investments [&lt;span&gt;2&lt;/span&gt;]. It highlighted the need to protect human rights, warning that any backtracking will undermine gains in the HIV response. This echoes the Global Commission on HIV and the Law (2012) [&lt;span&gt;3&lt;/span&gt;] and the UN Secretary-General's report (2016) [&lt;span&gt;4&lt;/span&gt;], which both reaffirmed that access to HIV services must be ensured for marginalized populations, including people living with HIV, young women in sub-Saharan Africa, sex workers, men who have sex with men (MSM), transgender people and people who inject drugs.&lt;/p&gt;&lt;p&gt;However, despite it being an established fact that rights-based strategies are important in ending HIV, 2024 witnessed merciless backlash on those rights. Conservative governments around the world are increasingly posing a threat to human rights, with suppression of human rights defenders, and universal human rights principles and laws being attacked and undermined by these governments.&lt;/p&gt;&lt;p&gt;Most troubling of these trends is the increased criminalization and exclusion of LGBTIQ+ people from healthcare services. In Kenya, for instance, a 2023 Supreme Court decision enabled the registration of the National Gay and Lesbian Human Rights Commission—a landmark victory for human rights [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;But instead of promoting progress, political and religious leaders utilized the ruling to fuel public outrage, which led to a rise in violence towards the LGBTIQ+ community, closures of health service organizations (mainly drop-in centres led by MSM) and interruption of outreach initiatives to key population communities.&lt;/p&gt;&lt;p&gt;Uganda took it a step further. The passing of the Anti-Homosexuality Act in 2024 effectively criminalized LGBTIQ+ livelihoods, with disastrous consequences for HIV prevention and treatment. East African civil society groups warned that such laws push people underground, where they cannot access basic health services [&lt;span&gt;6&lt;/span&gt;]. Ghana followed the same route with a similar bill, which was not sig","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26429","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143513853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid development of an online tracker to communicate the human impact of abruptly halting PEPFAR support","authors":"Brooke E. Nichols,&nbsp;Elvin H. Geng,&nbsp;Eric Moakley,&nbsp;Andrew N. Phillips,&nbsp;Jeffrey W. Imai-Eaton,&nbsp;John Stover,&nbsp;Edinah Mudimu,&nbsp;Anna Grimsrud","doi":"10.1002/jia2.26433","DOIUrl":"https://doi.org/10.1002/jia2.26433","url":null,"abstract":"&lt;p&gt;On 24 January 2025, the global HIV community was confronted with the abrupt announcement that the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), a programme with longstanding bipartisan support, would be paused for 90 days following an executive order to halt all foreign aid [&lt;span&gt;1, 2&lt;/span&gt;]. For the over 20 million individuals worldwide receiving HIV treatment through PEPFAR-supported programmes, the potential consequences were severe and immediate. As the public health community sought mechanisms to respond, an accurate, quantitative and science-based understanding of the potential magnitude of this pause was urgently needed. Systematic quantification of the potential impacts would allow the public health community to plan harm reduction strategies, advocate for policy responses and effectively communicate the severity of the situation to stakeholders, including government officials, civil society leaders, media outlets and advocacy groups.&lt;/p&gt;&lt;p&gt;To provide a rapid assessment, we undertook a near real-time modelling effort. We leveraged existing modelling work, publicly available data and expert consensus to generate projections. Complex mathematical modelling typically requires weeks to generate robust projections, limiting its utility for real-time decision-making. Our focus was on answering the most pressing question—the potential health consequences of this funding pause—using the most parsimonious model possible.&lt;/p&gt;&lt;p&gt;To facilitate accessibility and dissemination, we collaborated with a product development expert to translate these calculations into an interactive website, now available at https://pepfar.impactcounter.com/. The site launched on 28 January 2025, 4 days after the funding freeze was announced [&lt;span&gt;10&lt;/span&gt;]. The platform provides an intuitive tool for users to quickly understand the potential consequences of the PEPFAR funding freeze.&lt;/p&gt;&lt;p&gt;As the tool gained visibility and traction, we continued to refine the modelled estimates through additional expert review. Members of the HIV modelling community, including those affiliated with the HIV Modelling Consortium, independently assessed the calculations, refined assumptions and incorporated the latest available data. This collaborative process ensured that the estimates remained as accurate and reliable as possible while maintaining clarity in communication.&lt;/p&gt;&lt;p&gt;The current estimates on adult deaths presented on the website are informed by detailed modelling projections from five well-established HIV mathematical models [&lt;span&gt;11&lt;/span&gt;]. We used estimates from Jewell et al. on the number of excess deaths expected to occur over a 1-year time horizon associated with complete ART service disruptions over a 90-day period—as a reduction in ART is what specifically drives short-term mortality. This number was multiplied by the percent of HIV programmes funded by PEPFAR (47%) [&lt;span&gt;12&lt;/span&gt;]. We assumed a linear distribution of deaths over the year, resulting","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26433","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge as resistance: advancing global health in challenging times","authors":"Marlène Bras,&nbsp;the Editors of the Journal of the International AIDS Society","doi":"10.1002/jia2.26430","DOIUrl":"https://doi.org/10.1002/jia2.26430","url":null,"abstract":"&lt;p&gt;These are extraordinary times, with daily assaults on public health principles. The sudden de-funding of life-saving programmes like PEPFAR poses existential threats to achieving the goals of effective control of the HIV epidemic, which had been predicated on increasing testing, engagement in care, and uptake of evidence-based treatment and prevention. The censorship of terms related to sex, gender, diversity, equity, and inclusion in public health reports and scientific publications is chilling and negates decades of thoughtful scholarship that has demonstrated the relevance of these issues in the lived experiences and health outcomes of people affected by HIV.&lt;/p&gt;&lt;p&gt;The leadership of IAS – the International AIDS Society – has expressed deep concern over the rhetoric surrounding funding cuts, which has misrepresented the use of international development support and needlessly further stigmatized vulnerable populations. As editors of the &lt;i&gt;Journal of the International AIDS Society&lt;/i&gt;, we affirm that the journal will not change our mission nor our standards for evidence-driven and person-centred reporting. We recognize that programmes funded with public money should be subject to government review. However, the acute pause in US funding for global health, along with statements and policy shifts targeting key populations, represent unprecedented attacks on initiatives that have saved millions of lives and prevented millions of new HIV acquisitions.&lt;/p&gt;&lt;p&gt;JIAS will continue to welcome research that is of interest to our diverse readership, can inform the development of effective strategies to decrease HIV transmission, and improve the health and wellbeing of people living with HIV across the globe. Our core principles continue to include an understanding that sex and gender are distinct, and that rigorous science respects the diversity of human experience.&lt;/p&gt;&lt;p&gt;As researchers, clinicians and public health practitioners, we must respond to the challenges posed by recent policy measures while also documenting their intended and unintended consequences. JIAS welcomes submissions that present empirical data, model potential outcomes of resource constraints and policy shifts or highlight best practices and innovative solutions that address current challenges.&lt;/p&gt;&lt;p&gt;We have received requests from authors of manuscripts under peer review to have their names removed or manuscripts withdrawn from further consideration in order to comply with the US administration's recent executive orders. Although we are very concerned about this, we will respect author requests in agreement with our policy on authorship changes.&lt;/p&gt;&lt;p&gt;This is a difficult time, but the global struggle to address the HIV epidemic has faced and overcome existential challenges before. We feel that the best way to counter misinformation is to continue to generate and disseminate new knowledge that provides a compelling, evidence-based narrative. While an instinctive response to such an un","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26430","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"By executive order: The likely deadly consequences associated with a 90-day pause in PEPFAR funding","authors":"Khai Hoan Tram,&nbsp;Jirair Ratevosian,&nbsp;Chris Beyrer","doi":"10.1002/jia2.26431","DOIUrl":"https://doi.org/10.1002/jia2.26431","url":null,"abstract":"&lt;p&gt;On 20 January 2025, the first day of his second term in office, President Donald Trump issued an executive order instating a 90-day pause on new U.S. foreign assistance, pending a review for alignment with U.S. foreign policy. Four days later, the U.S. State Department issued a “stop order” directive, expanding the pause to include a freeze on all foreign aid programmes, including the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) [&lt;span&gt;1&lt;/span&gt;]. By 1 February, PEPFAR received a limited waiver for life-saving HIV care and treatment services and prevention programmes to prevent vertical transmission [&lt;span&gt;2&lt;/span&gt;]. While this waiver signalled hope to millions, it did not release immediate funding to implementing partners, prolonging confusion and disruption on the ground [&lt;span&gt;3, 4&lt;/span&gt;]. Ongoing uncertainty around PEPFAR funding has interfered with critical HIV programmes that rely on long-term planning, making it impossible to operate effectively and sustain life-saving services.&lt;/p&gt;&lt;p&gt;First announced under President George W. Bush in 2003 and reauthorized regularly since with bipartisan support in Congress, PEPFAR has been critical not only in the global response against the HIV epidemic but also in strengthening overall health systems in over 50 countries worldwide [&lt;span&gt;5&lt;/span&gt;]. Over the past 21 years, PEPFAR has supported antiretroviral treatment (ART) for over 20 million people living with HIV (PLWH), including 566,000 children; reached 2.3 million adolescent girls and young women with comprehensive HIV prevention services; supported 6.6 million orphans, vulnerable children and caregivers; enrolled 2.5 million people on HIV pre-exposure prophylaxis; provided 83.8 million people with HIV testing services; and directly supported 342,000 health workers [&lt;span&gt;5&lt;/span&gt;]. Since its inception, PEPFAR is estimated to have saved 26 million lives and prevented 7.8 million infants from being born with HIV [&lt;span&gt;5&lt;/span&gt;]. Additionally, in PEPFAR-supported countries, new HIV infections have been reduced by half since 2010 [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The deadly consequences of even brief pauses in foreign aid cannot be overstated. At stake with the stoppage of U.S. foreign aid is PEPFAR's ability to continue its indispensable work of delivering life-saving HIV treatment to millions of people and supporting local health system capacity. HIV treatment interruption leads to not only loss of virological control but also reversal of immune recovery for PLWH, the potential for viral resistance, the emergence of opportunistic infections, increased risk of tuberculosis and other co-infections, and ultimately increased morbidity, mortality and onward transmission [&lt;span&gt;6&lt;/span&gt;]. Based on previously described mathematical models of HIV epidemiology and intervention programmes in sub-Saharan Africa, a 90-day disruption of HIV treatment and care programmes modelled as discontinuation of ART to 50% of people is expected to lead to a median inc","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26431","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost thresholds for anticipated long-acting HIV pre-exposure prophylaxis products in Eastern and Southern Africa: a mathematical modelling study","authors":"David Kaftan,&nbsp;Monisha Sharma,&nbsp;Danielle Resar,&nbsp;Masabho Milali,&nbsp;Edinah Mudimu,&nbsp;Linxuan Wu,&nbsp;Cory Arrouzet,&nbsp;Ingrida Platais,&nbsp;Hae-Young Kim,&nbsp;Sarah Jenkins,&nbsp;Anna Bershteyn","doi":"10.1002/jia2.26427","DOIUrl":"https://doi.org/10.1002/jia2.26427","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Affordable HIV prevention tools are needed in Eastern and Southern Africa (ESA). Several promising long-acting pre-exposure prophylaxis (LA-PrEP) products are available or in development. However, ESA settings face severe healthcare resource constraints. We aimed to estimate the threshold price at which LA-PrEP products could be cost-effective in three ESA settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We adapted an agent-based model, EMOD-HIV, to simulate LA-PrEP (monthly oral, 2- and 6-monthly injectable) rollout in South Africa, Zimbabwe and Kenya. Due to uncertainties about LA-PrEP use, we examined a range of coverages (5%−20% of HIV-negative sexually active adults) and extents to which LA-PrEP use will be concentrated among those most at risk (prioritized rollout from higher- to lower-risk groups vs. uniform rollout among sexually active adults). To evaluate a 20-year commitment to LA-PrEP delivery, we assumed LA-PrEP was scaled up to target coverage from 2025 to 2030 and maintained at target levels before ending in 2045. We estimated maximum per-dose and per-year LA-PrEP costs that achieve cost-effectiveness (&lt;US$500 per disability-adjusted life-year averted) over 35 years (until 2060), compared to a scenario of daily oral PrEP only. Sensitivity analyses varied PrEP scale-up speeds and eligible populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Risk-prioritized LA-PrEP for 5% of adults was projected to avert 11–21% of HIV acquisitions across settings, with 3–5 times more HIV acquisitions averted and 3–5 times higher maximum cost compared to non-prioritized rollout. Six-monthly injectable PrEP supported the highest per-dose cost: in the scenario with the most cost-effective LA-PrEP use (5% risk-prioritized rollout), the maximum per-dose price in South Africa was $52.99 (95% CI: $48.82–$57.21), in Zimbabwe $14.64 (95% CI: $12.04–$17.38) and in western Kenya $7.50 (95% CI: $6.73–$8.27). For monthly oral PrEP, corresponding per-dose costs were $5.02 (95% CI: $4.67–$5.37), $1.45 (95% CI: $1.10–$1.79) and $0.87 (95% CI: $0.80–$0.93). Results were sensitive to eligible population and prioritization, and moderately sensitive to scale-up speed and product effectiveness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LA-PrEP is likely to require reduced pricing and/or risk-prioritized rollout to be cost-effective in ESA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26427","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}