Aids Education and Prevention最新文献

Despite the disproportionate burden of HIV among sexual minority men (SMM), PrEP is underutilized among this population. This study used a discrete choice experiment (DCE) to examine preferences and concerns related to PrEP uptake among HIV-negative, PrEP-eligible SMM (n = 271). Participants evaluated hypothetical PrEP profiles based on administration method, side effects, provider language, and peer use. On-demand PrEP was preferred over daily and long-acting injectable regimens. Side effects, particularly headaches and nausea, were rated as more influential than other attributes. Participants who knew someone taking PrEP had increased odds of taking PrEP themselves. Language concordance with providers did not significantly affect preferences. These findings underscore the importance of flexible PrEP options and minimizing side effects to increase acceptability. Tailoring healthcare delivery and messaging to these preferences may improve PrEP uptake among SMM.

The Philippines faces a rising HIV epidemic despite global declines, partly due to limited access to pre-exposure prophylaxis (PrEP). SAIL-teleprep, a telehealth-based differentiated service delivery model, was implemented to expand PrEP access among key populations (KPs) in underserved areas. Using the RE-AIM framework, this study evaluated its first-year implementation through a retrospective cohort analysis of 5,876 PrEP clients across four clinics in 2023. Of these, 8.4% accessed SAIL-teleprep, with higher uptake among clients aged > 24, residing outside Greater Manila, and identifying as men who have sex with men or sex workers. PrEP persistence among teleprep users was high (86.5%). Uptake varied by clinic, and use of courier deliveries peaked seasonally. Findings highlight SAIL-teleprep's potential to reach underserved groups while maintaining adherence. However, gaps remain in engaging younger KPs and people who inject drugs, underscoring the need for adaptable, client-centered strategies in decentralized HIV prevention.

In the United States (U.S.), sexual minority youth (SMY) are disproportionately impacted by HIV and other sexually transmitted infections (STIs) and structurally marginalized from routine testing for HIV and STI. This study examines neighborhood violence predictors (saw violence, safety concerns, and being threatened) on HIV and STI testing among a sample of SMY in the U.S. Data came from the 2021 Youth Risk Behavioral Surveillance System (YRBSS). Weighted bivariate and multilevel logistic regressions examined the odds of ever testing for HIV and STIs in the past 12 months and neighborhood violence. Our weighted sample (n = 806) had a mean age of 16 years, majority female (80%), and identified as White (53%). SMY reported increased odds of testing for HIV and STI when witnessing someone get physically attacked, beaten, stabbed, or shot in their neighborhood, felt unsafe at school or on their way to or from school, or threatened or injured with a weapon on school property. Additionally, increased odds of testing for HIV and STIs patterned exposure to neighborhood violence among SMY who identified as male, of color (non-White), and multi-ethnoracial background. The study highlights the need for examining potential protective social-structural factors that complicate the relationship between HIV and STI testing and exposure to neighborhood violence.

Accurate assessment of general HIV and pre-exposure prophylaxis (PrEP) knowledge is essential for evaluating contemporary prevention efforts. This study examined the psychometric properties of a revised HIV and PrEP knowledge instrument for young sexual and gender minority (SGM) men. Data were collected from 1,519 participants (ages 17-29) via an online survey. Of the original 31 items, 7 were removed based on item analysis, and Exploratory Factor Analysis (EFA) was conducted on the remaining 24 items. EFA supported a two-factor structure-18 items assessing general HIV knowledge and 6 assessing PrEP knowledge-with acceptable model fit (RMSEA = 0.06) and strong factor loadings (0.32). The instrument demonstrated measurement invariance across major racial/ethnic groups, moderate to strong item-total correlations (≥0.30), and acceptable internal consistency for both subscales. Findings validate this 24-item, two-factor instrument as a reliable tool for assessing HIV and PrEP knowledge among SGM men.

The HIV Vaccine Trials Network (HVTN) is the largest publicly funded international collaboration facilitating the evaluation of vaccines to prevent HIV and TB. Central to the HVTN's success is the reliance on robust community engagement methods, ensuring community participation and facilitating community awareness and knowledge of research. Community engagement is a dynamic process that requires active participation from all stakeholders to ensure success. The HVTN and its global Clinical Research Sites (CRSs) located in Africa, Latin America, and North America are known as the Network. We describe relationships across the Network, specific staff roles and responsibilities, and the myriad activities undertaken to ensure optimal community engagement. Key activities include involving active Community Advisory Boards (CABs), using community consultations, and having trained Community Engagement staff at each CRS. Operating with robust community engagement has resulted in rapid enrollment and high retention of diverse participant populations across Network studies.

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.