Aids Education and Prevention最新文献

Despite the proven effectiveness of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP), its use remains low in high-incidence areas. This study examined knowledge and barriers to PrEP among individuals at risk in Southern California. From September 2022 to April 2023, we recruited adult men who have sex with men, residing in San Bernardino and Riverside counties, who were not living with HIV and not using PrEP. Recruitment occurred through targeted online advertisements and clinic-distributed materials. Statistical analyses explored associations between demographic factors and barriers to PrEP. While 81% had heard of PrEP, nearly half were unaware of HIV testing requirements or of its availability for uninsured individuals. Uninsured participants were significantly less comfortable discussing sexual health with providers (OR: 0.19, 95% CI [0.05, 0.68]). Addressing misinformation, reducing provider stigma, and expanding access for uninsured individuals are essential for increasing PrEP use.

We aimed to describe long-term use trajectories and predictors prior to recreational cannabis legalization in people with HIV in Ontario, Canada. We analysed interview data from the prospective Ontario HIV Treatment Network Cohort Study from 2008 to 2017. We conducted Latent Class Growth Analyses to describe cannabis use trajectories and chi-square tests to identify trajectory group predictors. Most participants (N = 3,299) were male (81%), gay (57%), current/former tobacco smokers (58%), and many had significant symptoms of depression (43%). Four cannabis use trajectory groups were identified (Low/No Use (67%); Increased Use (4%); Decreased use (2%); High Use (26%)). Relative to the Low/No Use group, membership in the High Use group was associated with several predictors such as being older age, completing university, smoking tobacco, and significant depressive symptoms. Future research should explore the relationship between cannabis use and depressive symptoms, outcomes associated with trajectory groups and changes in use trajectories following recreational legalization.

In the field of HIV prevention and care, most studies of HIV syndemic problems are cross-sectional, few differentiate by HIV transmission groups, and few focus on people living with HIV (PWH). We analyzed one-year longitudinal data of 692 sexually active PWH (heterosexual men [HM], heterosexual women [HW], and men who have sex with men [MSM]) in care from Brazil, Thailand, and Zambia. Syndemic scores (0-3+) included stimulant use, polydrug use, depression, alcohol use, and fear of discrimination. Overall, syndemic scores were associated with lower ART adherence over time, but this differed across sexual transmission categories. For HM and HW, those with 2 or 3+ syndemic problems had lower odds of ART adherence than those with none. However, for MSM, the association between syndemic scores and ART adherence was not significant. While syndemic problems generally predicted suboptimal ART adherence among PWH, the association appears nuanced across subgroups.

This mixed-methods study explored willingness to use long-acting injectable pre-exposure prophylaxis (LAI-PrEP) among a pharmacy-based sample of men, including sexual and gender minoritized (SGM) individuals. We conducted qualitative interviews (n = 10) with HIV-negative Black men, including Black SGM individuals, and surveys (n = 103) across three study phases with men recruited from community pharmacies in Atlanta, Georgia. Interviews explored perceived benefits and concerns related to LAI-PrEP; surveys assessed willingness and related reasons. Thematic analysis was used for interview transcripts, and descriptive statistics summarized survey responses. Participants mentioned benefits such as improved adherence and reduced stigma, but also noted concerns about medical mistrust and fear of needles. Willingness was higher in the transitional pilot phase than in the pilot phase, where concerns about side effects and comfort were more common. Findings highlight the need for tailored LAI-PrEP strategies that address barriers among Black SGM populations and promote equitable HIV prevention.

Disparate rates of HIV infection among Black MSM and TGW emphasize the need for interventions designed to overcome obstacles to increasing PrEP adoption within these populations. This study compared PrEP-use groups on a variety of attitudinal and behavioral factors related to PrEP adoption. Regression analysis confirmed that current and former users demonstrated greater PrEP knowledge and communicated more frequently to friends about PrEP and its benefits than nonusers. Former users exhibited more positive attitudes and perceived less stigma regarding PrEP use than other groups. Current users reported the highest prevalence of condomless anal sex and multiple partners; conversely, former users were most often in stable monogamous relationships. Our findings are consistent with the notion of prevention-effective adherence and advance our understanding of attitudinal supports for that paradigm. This research also suggests that recruitment of former PrEP users could increase the pool of effective peer behavior-change agents in future intervention efforts.

HIV prevention research on sexual minority men focuses predominantly on risk factors, yet there is potential for enhancing HIV risk reduction by also examining resilience factors. We used mixed methods to explore HIV-related resilience pathways among 20 HIV-negative sexual minority men reporting HIV syndemic risks (childhood sexual abuse, partner abuse, mental health problems, substance abuse). Using grounded theory, we found that stress-related growth after mental health problems and/or unwanted sexual experiences can trigger development/use of HIV prevention resilience resources that, in turn, help sexual minority men cope and enhance HIV prevention behavior. We identified 23 HIV resilience resources at individual, interpersonal, community, health system, and structural levels. These findings informed a preliminary Theory of HIV Prevention Resilience for Sexual Minority Men. Our findings identified resilience resources to be nurtured through public health or mental health/substance use-focused interventions at broader levels to better address the HIV epidemic.

PrEP campaigns often promote a "private" frame emphasizing personal HIV risk management. We explore how a "public" frame emphasizing community-managed sexual health is relevant among men who have sex with men (MSM) and can advance HIV prevention. We sampled MSM from the United States (N = 311 in 2015) and the Netherlands (N = 222 in 2020) soon after each country's official PrEP introduction to study the early adoption of PrEP frames. Using regressions and machine learning, we quantified support for different PrEP frames, person-level correlates, and relationships to personal PrEP disclosure. Respondents were generally neutral about PrEP framing (U.S.: 44%, Netherlands: 48%), yet many held private (U.S.: 23%, Netherlands: 28%) and public (U.S.: 33%, Netherlands: 24%) frames. Public and neutral frames were associated with PrEP users and disclosure comfort. PrEP messaging and uptake could improve by understanding how and when MSM frame their PrEP use as a public or private matter.

Couples HIV testing and counseling (CHTC) emerged as an early HIV prevention intervention for male couples in the US. Understanding how couples speak to a testing counselor may enhance CHTC training and delivery. Raters analyzed CHTC sessions involving 66 adult cisgender male couples and noted three distinct styles. When co-speaking, partners collaborated in the construction of a shared response, often using plural pronouns. Parallel speaking involved partners sharing individual perspectives in turn, often using singular pronouns. The spokesperson style was typified by one partner consistently speaking first and saying more. Most (65.1%) couples adopted a consistent style. The majority of these were co-speaking (72.1%). Fewer had a consistent spokesperson (18.6%) or parallel speaking style (9.3%). Where observed, style changes often accompanied shifts in topic or in the CHTC counselor's attention. A couple's communication style may provide CHTC counselors with information about partners' familiarity with each other's perspectives as well as relationship power. Implications for rapport building and engagement are discussed.

In sub-Saharan Africa, HIV is the leading cause of death among 15-24-year-olds. Tanzanian youth rank fifth in HIV prevalence, yet testing rates are low. Dissemination of oral HIV self-implemented tests (Oral-SIT) may improve access if tests are coupled with graphic instructions to address low literacy. This study analyzed how a graphic instruction book (GIB) alone, compared to a GIB combined with an instructional video (GIB-video), affected comprehension of the Oral-SIT kit procedures. In a randomized experiment (N = 257; 14-19 yrs), we analyzed misunderstandings of testing procedures across the two study arms. Participants in the GIB-only condition reported more misunderstandings (59%) than in the GIB-video condition (41%). Fifty-eight percent of misunderstandings contained major errors, though most centered on a few graphics. Fewer than 6% of participants had four or more misunderstandings. Overall, the GIB was comprehended well and with modifications, could enhance Oral-SIT fidelity in low-literacy settings.

This mixed-methods study explored resilience-enabling behaviors and practices exhibited by young Latino sexual minority men (YLSMM) to cope with stigmatizing experiences attributed to their multiple minoritized identities and reduce their HIV risk. Guided by a positive deviance approach, we identified and interviewed 15 YLSMM (aged 18 to 24) with a history of regular HIV testing and lived experiences of intersectional stigma. Thematic analysis reveals multilevel strategies used by participants to mitigate the adverse effects of stigma on mental health and HIV preventive behaviors. Strategies included using positive self-talk and self-expression, having an immediate network of supportive friends and families, and engaging in community-based support groups and events. In turn, these strategies motivated participants to exercise self-care, accept their minoritized identities, especially their sexual orientation, seek emotional and informational support, and connect with other Latino sexual minority men and the larger Latine community.