Aids Education and Prevention最新文献

Since 2015, Mount Sinai HIV/HCV Center of Excellence has implemented two-day HIV and HCV preceptorships for New York State health care. Participants assessed their knowledge of and confidence to perform 13 HIV or 10 HCV prevention- and treatment-related skills, measured on a 4-point Likert scale from "not at all" to "very" knowledgeable/confident at baseline, exit survey, and a recent evaluation. Wilcoxon signed rank sum tests determined mean differences at all three time points. Between baseline to exit assessment and baseline to evaluation assessment, HIV and HCV preceptorship attendees reported significant increases in knowledge for five HIV and three HCV components and confidence for two HIV and three HCV tasks (p < .05), respectively. The preceptorship significantly and positively impacted short-term and long-term knowledge and confidence around HCV and HIV clinical skills. The implementation of HIV and HCV preceptorship programs may increase HIV and HCV treatment and prevention service efficacy within key population areas.

HIV pre-exposure prophylaxis (PrEP) is highly effective, but PrEP use has been suboptimal. We describe a telementoring program for clinics in high-HIV burden areas, focusing on systems-level practice transformation and care for populations disproportionately affected by HIV. We developed and delivered a telementoring program for U.S. health centers. We analyzed participants' baseline and post-session surveys to ascertain experiences providing PrEP and caring for people disproportionately affected by HIV, comparing responses between medical and behavioral health clinicians. Forty-eight people from 16 health centers participated. Medical clinicians were more likely than behavioral health clinicians to care for people taking PrEP, but the groups did not differ in self-rated capacity to counsel about PrEP or care for populations disproportionately affected by HIV. Virtual training on practice transformation for PrEP, involving medical and behavioral health clinicians, is feasible and acceptable. PrEP training and delivery efforts should include behavioral health clinicians.

Adolescents comprise approximately 15% of new HIV infections in Kenya. Impoverished living conditions in informal settlements place residents at high risk for HIV infection. We assessed factors associated with HIV infection among adolescents residing in urban informal settlements in Kisumu. We recruited 3,061 adolescent boys and girls aged 15-19. HIV prevalence was 2.5% overall, all newly identified cases were among girls and infection was positively associated with not completing a secondary education (p < .001). Girls who had ever been pregnant (p < .001) or out-of-school without completing a secondary education (p < .001) were more likely to be HIV-positive. Our findings of higher HIV prevalence among adolescent girls who had been pregnant or did not complete secondary school highlight the need to facilitate access to HIV testing, HIV pre-exposure prophylaxis, and sexual and reproductive health services as components of a comprehensive prevention strategy to decrease HIV infections in this priority population.

Monitoring pre-exposure prophylaxis (PrEP) metrics can guide service delivery yet does not occur routinely. We developed a survey to understand current practices for monitoring PrEP at PrEP-providing organizations in Illinois and Missouri. The survey was distributed from September through November 2020; 26 organizations participated. Most respondents indicated ongoing efforts to screen for PrEP eligibility (66.7%), link to care (87.5%), and retain clients in care (70.8%); 70.8% reported collecting data on PrEP initiation, 41.7% on retention in care, and 37.5% on missed visits. Barriers to monitoring PrEP metrics included lack of IT support (69.6%), manual processes (69.6%), and lack of staff resources (65.2%). Most respondents offered clients support for PrEP retention and adherence and wanted to expand interventions for PrEP persistence, yet fewer monitored corresponding metrics. To enhance PrEP implementation, organizations should improve monitoring and evaluation of PrEP metrics along the entire continuum and respond with appropriate services to support clients.

This study addresses rural Guatemala's poor maternal health and HIV status by culturally adapting an evidence-based HIV intervention, SEPA (Self-Care, Education, Prevention, Self-Care), to extend the capacity of comadronas (Mayan birth attendants) as HIV prevention providers. This mixed-method study examined the acceptability, suitability, and feasibility of SEPA presented to traditional elder and a younger cohort of comadronas over three sessions. Outcome variables were reported as mean scores. Open-ended qualitative responses were categorized under central themes. Session 1, 2, and 3 acceptability (4.6/5, 4.6/5, 4.8/5), suitability (4.7/5, 4.6/5, 4.9/5), and feasibility (4.4/5, 4.7/5, 4.8/5) remained high across sessions. While comadronas reported that information was difficult, they reported high levels of understanding and comfort with SEPA content and they also found it to be culturally appropriate, increasing their confidence to discuss HIV with their community. The broader utilization of comadronas could create a pathway to enhance reproductive health among indigenous women.

Despite documented efficacy in reducing HIV transmission, pre-exposure prophylaxis (PrEP) uptake among Black sexual minority men (BSMM) is limited. One understudied factor which may impede PrEP uptake is PrEP-related interactive toxicity beliefs (i.e., believing it is hazardous to use alcohol/drugs while taking PrEP). Data from N = 169 HIV negative BSMM over 4 months showed high rates of agreement with at least one alcohol (78%) or drug (84%) interactive toxicity belief. Univariate analyses showed increased alcohol or drug interactive toxicity beliefs predicted lower PrEP uptake. Multivariable regression suggested those with PrEP-related alcohol or drug interactive toxicity beliefs were more likely to report high PrEP stigma, more negative PrEP beliefs (e.g., concern that taking PrEP disrupts life), and were more likely to use alcohol/drugs (respectively) prior to/during sex. Findings warrant intervention work targeting interactive toxicity beliefs with tailored messaging to mitigate PrEP stigma and correct concerns around substance use and PrEP.

Young women in sub-Saharan Africa continue to be disproportionately at risk for HIV. Oral pre-exposure prophylaxis (PrEP) can reduce women's HIV risk when taken daily throughout their "seasons of risk". We used photovoice to describe community views on factors influencing interruptions in PrEP use among young cisgender women in Siaya County, Kenya. Through group discussions, young women taking PrEP and their social network members (female peers, male peers/partners, family, and community members) shared photographs and identified broad social-ecological causes of PrEP interruptions, including: (1) widespread misinformation about PrEP, (2) social pressures from religious communities, (3) health care staff recommendations to interrupt PrEP use, (4) partner rejection of PrEP, (5) changes in women's risk awareness, and (6) a personal desire to occasionally pause daily use. Collectively, participants identified strategies to address these challenges. These findings can inform future programs targeting the broader social-ecological influences on young women's persistent use of PrEP.

While sources of stigma associated with HIV, incarceration, and aging have been explored separately, the concurrent effects of these multiple sources have been understudied. We conducted in-depth interviews with 48 older adults over 50 years of age with HIV infection who were returning from correctional settings concerning their experiences of stigma. Participants described HIV-related stigma substantially more often than incarceration-related stigma and a greater number of stigma experiences as time passed from release. Anticipated stigma experiences were frequently associated with HIV. Enacted stigma was often related to incarceration. Internalized stigma was associated with both HIV and incarceration. However, participants often described aging as a positive experience of gaining wisdom and control over their life. The findings indicated that multiple sources of stigma affect different dimensions of stigma. Postrelease interventions may benefit from addressing increasing experiences of stigma in the rapidly growing population of older adults living with HIV with a history of incarceration.

Internalized HIV stigma is prevalent and research on internalized HIV stigma has increased during the past 10 years. The aim of this systematic review was to synthesize research on internalized HIV stigma and relationships with various health-related variables in order to better inform the development of interventions aimed at reducing internalized HIV stigma. We reviewed 176 studies with a quantitative design reporting correlates that were peer-reviewed, published in English before January 2021, drawn from PubMed, PSYCHINFO, Web of Science, EBSCO, and Scopus. Synthesis showed consistent associations between internalized stigma and negative psychological (e.g., depression, anxiety), social (e.g., lack of social support, discrimination, nondisclosure, and intersecting stigmas), and health (e.g., substance use, treatment nonadherence, negative clinical HIV outcomes) variables. We argue for a more socioecological approach to internalized stigma, with greater attention for intersectional stigmas, and more longitudinal research, if we are to effectively develop interventions that reduce internalized stigma.

Residential substance use disorder treatment is designed to treat more severe substance use disorders. Considering the strong association between substance use and HIV, providing HIV prevention services during residential substance use disorder treatment is imperative. However, not all treatment facilities offer the same services, and differences in residential substance use disorder treatment facilities providing HIV prevention services might stem from facility-level characteristics. Using 3 years (2018-2020) of cross-sectional data from the National Survey of Substance Abuse Treatment Services, we examined which treatment facility characteristics were associated with having HIV prevention services. Using a logistic regression model with HIV prevention services as the outcome, we found that facilities that were accredited, engaged in community outreach, and offered assistance with housing and transportation were more likely to provide HIV prevention services. Furthermore, facilities in the Midwest and West were less likely to provide HIV prevention services than those in the South.