Aids Education and Prevention最新文献

Adolescent sexual minority males (ASMM) are substantially burdened by HIV in the United States. HIV prevention efforts targeting ASMM have primarily focused on male-male sexual contact, often ignoring male-female sexual behaviors. The objective of this study was to explore the sexual behaviors of ASMM with male and female partners among the baseline sample of an online sexual health pilot study (N = 118, ages 14-17 years). We report frequencies of sexual behaviors by partner sex. Almost half of the participants (47%) engaged in sexual activity with female partners in the past 3 months. Frequency of sexual behaviors, condom use, and future intentions to have sex and use condoms varied by partner sex. HIV prevention efforts should address the full range of sexual behaviors ASMM may engage in with both male and female partners. Focusing only on male-male sex among ASMM fails to address the breadth of ASMM's HIV prevention needs.

This cross-sectional study investigated long-acting injectable pre-exposure prophylaxis (LAI-PrEP) perceptions and attitudes among 1,545 Chinese men who have sex with men (MSM) in December 2023. Of participants, 66.5% met PrEP eligibility criteria, 53.7% expressed willingness to use LAI-PrEP within 6 months, and 77.9% were PrEP naïve. Current oral PrEP users showed higher LAI-PrEP willingness (adjusted odds ratio [AOR] = 2.23, 95% CI [1.44, 3.44]) than the PrEP naïve group. Condomless anal intercourse (AOR = 1.32, 95% CI [1.08, 1.61]) and recent sexually transmitted infection diagnosis (AOR = 1.84, 95% CI [1.15, 2.95]) were positively associated with willingness. Structural equation modeling revealed distinct predictors: for PrEP naïve group, LAI-PrEP willingness was influenced by outcome expectancies, HIV risk perception, self-efficacy, and subjective norms (p <.05), while the PrEP-experienced group relied more on outcome expectancies. Tailored interventions addressing group-specific cognitive factors are critical to optimize LAI-PrEP adoption.

There is evidence of disparities in mental health and substance use disorders in the United States among sexual and gender minority young adults, yet the correlates are not well understood. This study examines the prevalence and patterns of substance use among sexual and gender minority men and investigates how substance use relates to depression and anxiety. Data were collected from a randomized clinical trial of the mLab App, a mobile health HIV testing intervention in the United States. Linear regression analysis, adjusted for demographic variables, was conducted to explore the associations between substance use and mental health outcomes. Findings show a high prevalence of substance use in this population, with alcohol, cannabis, and tobacco as the most used substances. Results indicate significant positive associations between alcohol, cannabis, and methamphetamine use with depression, and between alcohol, cannabis, sedatives, and tobacco use with anxiety. These findings highlight the need for targeted prevention strategies and tailored interventions to address the unique challenges faced by sexual and gender minority men.

HIV-related stigma and discrimination remain pervasive despite dramatic improvements in the availability and accessibility of antiretroviral therapy (ART). We examined the experiences of HIV stigma and discrimination and coping strategies among people living with HIV (PLHIV) in urban Zimbabwe in 2018. We conducted eight focus group discussions, stratified by age and gender (women and men 18-29 years, women and men >29), as part of a discrete choice experiment on HIV treatment models. HIV-related stigma emerged as a key theme, with participants expressing the desire to be seen as "normal." However, being mocked, constant reminders that they had HIV, negative comments about PLHIV and regular trips to health facilities made "normality" elusive. Participants coped by ignoring stigmatizing comments and behaviors, minimizing social interactions, carefully selecting allies for support, adhering to ART in order to stay (and appear) healthy, and temporarily stopping ART. Stigma-reduction interventions for PLHIV and communities are urgently needed.

Adolescent girls and young women (AGYW) are disproportionately burdened by new HIV infections in eastern and southern Africa. Data on co-occurrence of behavioral risk factors and associations with sexual HIV risk behaviors can inform layered and targeted HIV prevention efforts. Using nationally representative data of AGYW aged 13-24 years from the 2018 Lesotho Violence Against Children and Youth Survey, we categorized the population into distinct adversity groups comprised of different pattens of sexual violence exposure, substance use, and moderate/severe mental distress. We estimated associations of adversity groups with infrequent condom use and past-year multiple sexual partners. We observed significant associations between some groups and infrequent condom use and multiple sexual partners. Interventions to prevent sexual violence and substance use, in particular, may help reduce sexual HIV risk behaviors and thus HIV prevalence among this population in Lesotho.

This study identified the preferred features of HIV/STI prevention mobile health (mHealth) apps among rural sexual minority men (SMM) in the southern U.S. and examined preference differences by HIV risk factors. Participants (N = 406) completed an online cross-sectional survey. A series of multiple logistic regression models were used to examine differences. The top three preferred features included ordering at-home STI testing kits, ordering at-home HIV testing kits, and providing a list of local sexual health providers and professionals. HIV risk factor differences were found in participants who had engaged in condomless anal sex and who had been diagnosed with an STI being more likely to prefer the app to have the ability to synchronously or asynchronously talk to a sexual health professional, young adults being less likely to prefer various features, and racial/ethnic minority participants being more likely to prefer various features than non-Hispanic White participants.

We tested the Appalachian Access Project, a bilingual, HIV status-neutral, social network, peer navigation, and mHealth intervention aimed at increasing use of HIV, STI, hepatitis C virus, and mpox prevention and care services among gay, bisexual, queer, and other men who have sex with men (GBQMSM) and transgender and nonbinary persons in Appalachia. The intervention also aimed to support use of medically supervised gender-affirming hormone therapy among participants desiring such care. Trial participants were recruited and randomized by social network to the intervention (n = 7 networks including 56 individuals) or delayed-intervention waitlist control group (n = 7 networks including 57 individuals). At follow-up, relative to control participants, intervention participants reported slight, but nonsignificant, increases in an HIV status-neutral service-use outcome, PrEP use, and HIV testing; and significant increases in HIV and STI knowledge. This intervention provides a foundation for future initiatives to reduce disparities in rural Appalachia; further research with larger sample sizes is warranted.

Self-efficacy may influence several stages of the PrEP care continuum, yet most validated measures capture only one component rather than a comprehensive approach. To address this gap, this study validated the PrEP Use Self-Efficacy (PrEP-USE) scale. Sexual minority men (N = 300) prescribed daily oral PrEP completed a baseline assessment including sociodemographics, the PrEP-USE scale, self-reported adherence, and PrEP-related variables (attitudes, stigma, subjective and descriptive norms) as part of a larger randomized controlled trial. Exploratory factor analysis identified a three-factor model (Challenges, Management, Routine) with acceptable fit. Overcoming challenges was associated with PrEP adherence (b = 1.09, p < .01) and correlated with all PrEP-related variables (p < .05). Management correlated with all variables (p < .05) but not adherence. Routine was associated with adherence (b = 2.42, p < .001) and only with PrEP attitudes (p < .05). Integrating the PrEP-USE scale into intervention frameworks may strengthen self-efficacy measurement.

Sexual and gender minorities experience disproportionately higher rates of depression and anxiety than cisgender heterosexual peers due to intersectional stigma. We conducted latent profile analyses to characterize participants' intersectional stigma experiences and examined associations with mental health outcomes. Among 750 diverse participants, we identified high and low intersectional stigma (IS) profiles for cisgender men (n = 666) and gender-diverse participants (n = 84). Cisgender men and gender-diverse participants with high IS had significantly higher anxiety, depression, and social isolation than cisgender men with low IS. Gender-diverse participants with high IS had significantly higher social isolation than those with low IS. Cisgender men with high IS had significantly higher anxiety, depression, and social isolation than gender-diverse participants with low IS. These findings underscore the need for mental health interventions that explicitly account for compounded effects of racism, cissexism, and heterosexism affecting multiply marginalized sexual and gender minority youth.

Pre-exposure prophylaxis (PrEP) for HIV infection has been shown to be highly effective in preventing infection. Although the overall use of PrEP has increased since its licensure in 2012, substantial disparities in its uptake continue to be documented, especially among Black and Hispanic Americans. Achieving HIV elimination in the U.S. requires scale-up of culturally competent and linguistically appropriate PrEP services in both traditional and non-traditional settings. This commentary examines how recent actions undertaken by the U.S. federal government are likely to impede PrEP uptake and exacerbate existing disparities, thereby interfering with efforts to end the HIV epidemic in America.