Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv最新文献

Objective: Achieving viral suppression is central to the UNAIDS 95-95-95 targets. Beyond clinical determinants, socio-medical factors such as stigma, community support, and healthcare accessibility are increasingly recognized as influencing treatment outcomes. This study examined the impact of these factors on viral suppression among people living with HIV (PLHIV) in Indonesia.

Method: A cross-sectional analytic study was conducted among 350 PLHIV enrolled in antiretroviral therapy (ART) programs at three treatment centers. Data on stigma, community support, and healthcare accessibility were collected using validated questionnaires, while viral load results were obtained from medical records. Chi-square and multivariate logistic regression analyses were performed to identify predictors of viral suppression.

Results: Among the participants, 74.3% achieved viral suppression. Multivariate analysis showed that lower stigma (aOR = 0.52; p = 0.016), stronger community support (aOR = 2.15; p = 0.004), better healthcare accessibility (aOR = 1.87; p = 0.019), and longer ART duration (aOR = 2.74; p = 0.001) were significant predictors of viral suppression.

Conclusions: Socio-medical factors significantly influence viral suppression among PLHIV in Indonesia. Strengthening stigma reduction, community support, and healthcare accessibility may help improve HIV treatment outcomes and support progress toward global elimination targets.

Adolescents living with HIV in Sub-Saharan Africa face significant psychosocial and structural challenges that can shape their future. Despite these barriers, many maintain strong aspirations and develop adaptive strategies to achieve long-term goals. This study explored how adolescents living with HIV construct their future orientation amidst the psychological burden of living with the diagnosis. An exploratory qualitative design was employed through six focus group discussions (FGDs) with 42 adolescents (17 males, 25 females; aged 13-19 years, mean age 16.14) attending Operation Triple Zero. The study was conducted at Adeoyo Maternity Teaching Hospital, Ibadan, Nigeria. Discussions were audio-recorded, transcribed, and thematically analysed. Four major themes emerged: (1) emotional reactions, participants reported fear, anxiety, emotional suppression, and concern about stigma; (2) future aspirations, adolescents expressed strong desires to pursue altruistic and justice-driven careers shaped by personal experiences; (3) strategies for achieving goals, educational commitment, medication adherence, and reframing HIV as manageable facilitated progress; (4) hope and resilience, participants maintained optimism, self-belief, and adaptive coping despite uncertainty. Findings suggest that adolescents living with HIV demonstrate strong future orientation and resilience. Strengths-based interventions that reinforce hope, support educational and career aspirations, and normalise antiretroviral adherence may improve psychosocial outcomes in this population.

The aim of this study was to determine the prevalence of anxiety and depression symptoms in WLHIV in antiretroviral therapy and the associated factors. A cross-sectional study was conducted in Ceará, Brazil, with a sample of 387 WLHIV. Inclusion criteria were female individuals with HIV, over 18 years of age and on antiretroviral therapy. Data collection was carried out through interviews, using the Sociodemographic, Epidemiological, Behavioral and Clinical Form, Beck Anxiety Inventory and Beck Depression Inventory. Univariate and multivariate logistic regression analysis were performed. The odds ratio and 95% confidence interval were calculated. The prevalence of anxiety and depression symptoms were respectively 64.0% and 66.0%, in addition to concomitant symptoms (53.8%). The most commonly used contraceptive method was tubal ligation (41.3%). In the multivariate analysis, the factors associated with anxiety symptoms were age under 46 years (p < 0.001), unemployment (p = 0.025), retirement/leave (p = 0.007) and diagnosis of depression (p < 0.001). Physical exercise was a protective factor against anxiety (p = 0.015). The factors associated with depression were unemployment (p = 0.028), retirement/leave (p = 0.025) and having a diagnosis of anxiety (p < 0.001). More than half of the sample had symptoms of anxiety and depression, mainly associated with unemployment and retirement/leave. Physical exercise was a protective factor against anxiety.

A novel long-acting HIV oral pre-exposure prophylaxis (PrEP) implant was first tested in a Phase I clinical trial in South Africa, and this study sought to understand motivations behind trial participants enrolment, highlighting considerations for recruitment in future studies. Qualitative research was conducted using in-depth interviews (IDIs) with 29 study participants, 18 of whom also participated in focus group discussions (FGDs). Participants were all Black, African women with median (IQR) age 26 (21.5-29.5) years. Of the 29 participants interviewed, 27 (93%) mentioned intrinsic motivations for enrolling on the trial, including wanting to be part of HIV prevention efforts for the benefit of others and contributing to new knowledge. Eight participants (28%) highlighted extrinsic motivations, including personal health benefits and financial benefits. Most participants noted these extrinsic benefits in conjunction with the intrinsic benefits, while just two participants (7%) mentioned only extrinsic benefits as their motivations for enrolling. The analysis reveals that early-phase trial participation was shaped predominantly by intrinsic motivations, such as contributing to scientific knowledge, personal growth and community responsibility, underscoring the importance of recognising participants' values in trial design and engagement.

This study explores how gay and bisexual men in Indonesia access, mobilise, and sustain social capital within a context of stigma, limited institutional support, and uneven community infrastructures. Drawing on in-depth interviews and document analysis of health-focused NGOs and LGBTQ + networks, it examines how bonding, bridging, and linking social capital are shaped by community network strength, socioeconomic conditions, self-acceptance, and identity negotiation. The findings show that access to social capital is fluid and unequal, structured by the availability of trusted physical and digital spaces and by strategies of identity disclosure and safety management. Strong networks support emotional wellbeing, resource sharing, and service access, while fragmented networks, economic precarity, and stigma constrain social participation. The study concludes that social capital is a key mechanism of resilience and survival for gay and bisexual men in Indonesia, underscoring the need for inclusive public health policies and community-based interventions that address structural stigma and strengthen community infrastructures.

We assessed the correlates of willingness to use PrEP among young people (YP) impacted by HIV in Uganda. This cross-sectional study included 905 YP aged 18-21 years, orphaned to AIDS and participating in a longitudinal study in Uganda. Willingness to use PrEP, the primary outcome, was measured using a hypothetical scenario. "If PrEP were safe, effective, free, and used by few people around you, how likely would you be willing to use it?" Independent variables included sociodemographic characteristics, perceived HIV risk, PrEP stigma, barriers to PrEP use, and social support. Multilevel mixed-effects logistic regression was used to examine the relationship between willingness to use PrEP and the independent variables, adjusting for clustering. 74.7% of participants reported willingness to use PrEP. Older age and perceived risk of HIV were associated with a higher likelihood of willingness to use PrEP (aOR = 1.10; 95% CI = 1.01, 1.21 and aOR = 1.65; 95% CI = 1.26, 2.17 respectively). Perceived PrEP stigma was associated with lower willingness (aOR = 0.30; 95% CI = 0.21, 0.42). YP impacted by HIV, show high willingness to use PrEP, influenced by age, risk perception, and stigma.

Engaging gay, bisexual, and other men who have sex with men (MSM) living with HIV in Ghana is challenging due to stigma, discrimination, and fear of legal and safety consequences. This study compared venue-based (VBR) and peer-driven recruitment (PDR) strategies among MSM living with HIV to evaluate efficiency, reach, and range. An analysis was performed using data from 225 MSM living with HIV recruited from January to August 2017 in four Ghanaian cities. The VBR enrolled 148 participants over approximately six months with a median weekly recruitment of 4, while PDR enrolled 77 participants in four weeks, averaging 20 per week (p = 0.0043). Demographics were similar between the two strategies; however, participants recruited via PDR reported higher incomes (p = 0.019). Participants recruited via the PDR had significantly higher odds of not previously being linked to HIV care (adjusted odds ratio = 2.03, 95% CI = 1.04-3.96, p = 0.037). The main challenge raised by peer recruiters was that of a potential breach of confidentiality. Findings suggest PDR may better address recruitment speed and engage MSM populations disconnected from formal HIV services. We endorse PDR strategies as effective, context-sensitive approaches for recruiting and engaging MSM and other stigmatized groups while underlining the need to ensure privacy and confidentiality.

Advanced liver fibrosis (≥F3) is a significant health concern and is associated with an increased risk of mortality in people living with HIV (PLWH). This study aimed to evaluate the prevalence and factors associated with advanced liver fibrosis over a 5-year longitudinal period among PLWH in Thailand. A total of 1,032 PLWH aged ≥18 years from a Thai HIV cohort in Bangkok, Thailand were enrolled between June 15, 2010 and July 1, 2019. Liver stiffness measurements (LSM) were performed using transient elastography at baseline and at 5-year follow-up. The prevalence of liver fibrosis stages changed significantly between baseline and the 5-year follow-up (p = 0.04). The prevalence of significant liver fibrosis (F2) increased from 8.6% to 9.8% and ≥ F3 rose from 6.1% to 7.8% at the 5-year follow-up. In the multivariable analysis, older age, obesity, elevated AST, a lower platelet count, high glucose levels, lower HDL-C, HCV coinfection, and diabetes mellitus were associated with advanced liver fibrosis (≥F3). Our findings highlight a concerning trend of liver fibrosis progression among PLWH in Thailand, driven by older age, metabolic abnormalities, comorbid conditions, and coinfection. Surveillance among high-risk individuals is essential for the early identification of liver fibrosis progression.

A critical challenge for youth living with HIV is transitioning from pediatric to adult care, a period often marked by disrupted continuity and risks of stigma and isolation. Few Canadian programs address this gap. The HIV Youth Peer Engagement (HYPE) program, developed by the AIDS Committee of Durham Region seeks to address this issue using a peer-led model emphasizing education, mentorship, and community building. This article presents findings from a five-year evaluation (2017-2022) of HYPE's transition-focused activities. Data were collected through surveys, focus groups, participant feedback, and reflections from youth and service providers, analyzed using descriptive and thematic methods. From 2017-2022, HYPE engaged 562 youth living with HIV and 407 service providers. Youth were primarily African, Caribbean, and Black, Indigenous, and 2SLGBTQIA + . A majority reported increased capacity to navigate adult healthcare systems, with 91% indicating greater self-advocacy and 77% identifying reduced social isolation through HYPE's events. Service providers also reported improved confidence in youth-centered, anti-stigma practices. Findings demonstrate that HYPE's integrated approach increases social connectedness and provider capacity, offering a promising model for future youth programming. Embedding youth voices, peer leadership, and community partnerships in transition programming is essential to improving outcomes and reducing stigma.

South Africa has the largest ART programme in the world. ART is provided within the context of the universal test and treat strategy. Sustained high levels of ART adherence are required to ensure viral suppression and prevent ART-drug resistance. However, poor ART adherence remains a challenge in South Africa. While much research has focused on individual - and community-level factors influencing adherence, household-level factors remain under-researched. This study sought to qualitatively examine the role of household-related factors in ART adherence among 15 newly initiated people living with HIV (PLWH) in Cape Town, South Africa. The information-motivation and behavioural skills model and the concept of the HIV competent household provided the conceptual frameworks for the study. Emotional and instrumental support from household members and in particular mothers facilitated adherence. Open HIV dialogue fostered positive health behaviours and ART adherence. Household food insecurity, multimorbidity and busy work schedules both in the absence of household social support hindered ART adherence. Given the significant role of household support, particularly from mothers, in facilitating ART adherence, health facility programmes should aim to involve household members in the treatment of PLWH. This could be facilitated through training community health workers to foster and support HIV competent households.