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

ABSTRACTDespite advancements in HIV prevention and treatment, disparities persist across the U.S. that are geographically and demographically unique. This study analyzed HIV burden and prevention efforts in three urban counties, Suffolk County, MA (Boston), Orange County, FL (Orlando), and Philadelphia County, PA (Philadelphia), using AIDSVu data. We assessed HIV prevalence, new diagnoses, Pre-Exposure Prophylaxis (PrEP) use, PrEP-to-Need Ratio (PnR), and key social and structural determinants of health (SSDoH) to contextualize local trends within national patterns. Findings revealed significant disparities. For the three counties, Philadelphia exhibited the highest overall HIV prevalence and lowest PrEP uptake, while Orange County reported the highest rate of new diagnoses. Demographic groups, socioeconomic factors, including poverty, insurance coverage and housing instability, further shaped HIV outcomes across these regions. These results highlight the need for evidence-driven interventions, expanded PrEP access, and policy reforms to HIV prevention and care in high-burden communities.

South Africa has the world's highest HIV burden. Assisted partner notification (APN) has been shown to improve HIV testing uptake and case finding, yet little is known about its implementation in contexts where gender inequalities, stigma and complex relationship dynamics shape disclosure. This qualitative study explored implementation experiences of APN services among healthcare providers and patients in Cape Town. Between March 2021 and February 2022, we conducted semi-structured interviews, WhatsApp diary studies and fieldwork observations with 34 participants, including 10 healthcare providers, 12 female patients and 12 key informants. Data were analyzed using thematic analysis. Findings revealed significant disconnect between formal APN protocols and clinical practice. Despite official guidelines emphasizing voluntary participation, informal practices termed "getting involved" emerged where providers engaged in unstructured assistance with partner notification. Key challenges included compromised voluntary participation, coercive tactics, communication barriers and concerns about social harm and privacy breaches. In response, providers and patients developed alternative strategies, notably "collusion-testing" and reliance on informal "assistants" from personal support networks. APN processes and safeguards should be more clearly outlined in HIV testing policies, with greater provider training to reduce coercive practices and better integrate community support systems.

Despite the availability of resources such as Ryan White-funded clinics, which provide free/low-cost HIV care services, significant disparities in viral suppression rates exist. This study investigates whether neighborhood characteristics and socioeconomic factors are associated with viral suppression rates among people with HIV (PWH) in Southern California neighborhoods with Ryan White clinics. Forty Southern California zip codes with a combined estimated population of 1.4 million were analyzed. Beta regression models were used to assess neighborhood characteristics and socioeconomic factors associated with the proportion of PWH who are virally suppressed per zip code. Neighborhoods with a higher public transit score, safety score, and Healthy Places Index score had greater proportions of PWH who were virally suppressed. Longer average commute times, higher poverty rates, lack of health insurance, and higher average hours of work per week were negatively associated with viral suppression. Additionally, no association was found between the proportion of PWH who are virally suppressed and neighborhood walkability score, educational attainment, and employment. Findings highlight the need for tailored interventions that address specific community needs. The presence of HIV treatment services may not ensure access or uptake, underscoring the importance of addressing socioeconomic and local structural contexts.

This qualitative study explores factors influencing counseling on infant feeding options for women living with HIV in a high-income setting. Semi-structured interviews were conducted with twenty healthcare professionals from perinatal HIV teams and eleven women living with HIV to identify barriers and facilitators in the decision-making processes. The findings indicate that the absence of local protocols results in uncertainty and inconsistency in counseling, while both professionals and women emphasize the need for a clear division of responsibilities and up-to-date information tailored to current clinical guidelines. National recommendations are often insufficiently adapted to cultural context and have a paternalistic tone, contributing to anxiety and confusion. The study highlights the importance of expert support as well as accessible, clear communication strategies, including the development of an informative website and the involvement of women living with HIV in creating such educational materials. A systemic approach, engaging all stakeholders, is considered essential to foster both empowerment and trust. Optimal implementation of updated guidelines requires attention to these factors to ensure that women living with HIV can make fully informed and autonomous choices regarding breastfeeding or formula feeding for their children.

An ongoing shift from indoor sex work venues to home-based sex work has resulted in challenges in the provision of sexual healthcare services (SHS) for female sex workers (FSW), such as sexually transmitted infection (STI) testing. The study aimed to explore self-identified characteristics of the home-based FSW population and barriers and facilitators to access and utilise the STI clinic's SHS. For this qualitative study, semi-structured in-depth interviews were conducted with 29 home-based FSW in the Netherlands and thematically analysed using a hybrid of inductive and deductive coding using Atlas.ti 8. Home-based FSW valued autonomy and financial benefits but faced societal stigma, with experiences varying across clients. Main barriers to accessing and utilising SHS were mistrust due to legal concerns and fear of repercussions from authorities, fear of STI test results and concerns about cost, confidentiality, and anonymity of SHS. Main facilitators were direct telephone contact and building trust with STI clinic nurses, and increasing awareness of available SHS. Results highlight the importance of understanding FSW's lived experiences and creating a supportive environment at SHS providers by building trust and offering non-stigmatising SHS. Addressing the identified barriers and facilitators is essential to improve access to and utilisation of SHS by home-based FSW.

We evaluated a peer-led, community-based service (CBS) model providing integrated HIV/syphilis testing and referral for men who have sex with men (MSM) and transgender women (TGW) in South Sulawesi, Indonesia. Trained community health workers (CHWs) delivered finger-prick HIV RDTs and, where available, dual HIV/syphilis tests through three outreach modalities: door-to-door outreach, "static community posts", and mobile hotspot events. Primary outcomes were acceptability, feasibility , first-time testing, syphilis testing coverage, and linkage to confirmatory testing and ART within ≤7 days. Among 423 clients, acceptability was high, and most were first-time testers. HIV reactivity was 2.8% (12/423); all were referred, confirmed, and initiated ART within ≤7 days. Syphilis testing coverage was 83.0% with lower coverage in Bulukumba reflecting documented commodity/workflow constraints. In 70 observed encounters, checklist items 1-8 demonstrated complete procedural adherence; item 9 highlighted a need for documentation/SOP clarification for corrective actions when deviations occur. Qualitative findings converged with quantitative results: participants valued privacy, convenience, and peer trust, while stakeholders emphasized the need to stabilize test-kit supply, clarify corrective-action procedures, and strengthen client-level time-stamping for scale-up. Findings support scaling up differentiated, peer-led community testing for MSM and TGW with standardized quality assurance, and reliable syphilis test supply.

ABSTRACTIndividuals frequently use substances to enhance sexual experiences, known as chemsex, which reduces inhibitions and increases risk-taking behaviors. This can lead to HIV/STI transmission, followed by stigma and isolation, discouraging HIV/STI status disclosure to partners. Participants were recruited through a larger study during January-March 2025. Eligibility criteria included age ≥18 years, participation in chemsex and having been diagnosed with HIV/STI. Semi-structured interviews (n = 11) were performed to examine the phenomenon of disclosing HIV/STI status during chemsex and reasons for not disclosing. In-vivo coding was used for data analysis of qualitative interviews. Participants were 60% Black or African American, 80% cisgender male, 56% gay, 82% had some college education and 36% were from 40-49 years of age. Initial themes included Individual Responsibility, Reasons for Not Disclosing Status and Harm Reduction Behaviors. Participants avoided disclosure of status to maintain the mood, adhered to norms of condomless sex, relied on visible symptoms to assess status and relied on online platforms to determine status of chemsex partners. These findings highlight the need for education and interventions to reduce stigma and promote safer behaviors in chemsex contexts.

Microbicides are an emerging HIV-focused biomedical intervention offering protection against HIV. Despite potential benefits, willingness to use these products has not been well studied, especially among females who use unregulated drugs. Between June 2021 and May 2022, data were drawn from two prospective cohorts of people who use drugs in Vancouver, Canada. Analyses focused on participants who were female sex at birth and sexually active. Multivariable logistic regression identified correlates of willingness to use a vaginal ring with microbicides. Awareness of microbicides was also assessed. Among 216 participants (median age 36; 47.2% Black, Indigenous, or a Person of Colour), only 32 (14.8%) reported prior awareness of microbicides. Once described, 57 (26.4%) expressed willingness to use a vaginal ring. Independent correlates of willingness included recent access to prescribed alternatives to unregulated drugs (AOR = 3.30, 95% CI = 1.19-9.15), willingness to take pre-exposure prophylaxis (PrEP) (AOR = 14.87, 95% CI = 6.38-34.65), and recent sex work engagement (AOR = 2.92, 95% CI = 1.19-7.15). Findings indicate low awareness and willingness to use microbicides among females who use drugs in Vancouver, Canada. While microbicides appear to offer important opportunities as a biomedical intervention, initial low levels of reported willingness indicate the impact may be limited.

Older people living with HIV (PLWH) in Georgia experience a high rate of behavioral health disorders, the treatment for which requires an integrated approach. However, these older PLWH experience unmet needs for behavioral health services. We aimed to explore barriers for older PLWH to access behavioral healthcare services in Georgia. In 2024, we conducted 28 in-depth interviews with PLWH aged ≥40 years in four major Georgian cities. Participants were purposefully selected from a cross-sectional study sample based on their screened behavioral health disorders. We employed an inductive-deductive thematic analysis approach guided by the Ecological-Behavioral Framework for Healthcare Access and Navigation. Our study found that older PLWH face significant barriers to accessing mental health services, including different types of stigma, cultural beliefs about behavioral health disorders, mistrust in mental healthcare professionals, and a lack of patient-centered care. Fragmented healthcare systems also hindered access to care, particularly for those with substance use disorders. Social support and family responsibilities were key motivators for seeking help. A complex interplay of sociocultural, political, and individual factors hindered PLWHs' access to behavioral health services. Addressing stigma through targeted interventions, raising awareness about behavioral health services, and constructing differentiated service models are crucial to improving access.

Sustained viral suppression (SVS) supports the health of people with HIV (PWH). We conducted a serial cross-sectional analysis using New York City (NYC) HIV registry data. The proportion of PWH with SVS increased from 67.4% in 2014 to 77.9% in 2023 with an annual percentage change (APC) of 2.1% (95% confidence interval [CI]: 1.8, 2.5) in 2014-2020 and 0.5% (95% CI: -0.9, 2.0) in 2020-2023. Among men, the proportion increased from 68.9% in 2014 to 78.5% in 2023 with an APC of 1.9% (95% CI: 1.5, 2.3) in 2014-2020 and 0.5% (95% CI: -0.9, 1.8) in 2020-2023. Among women, the proportion increased from 64.7% in 2014 to 77.7% in 2023 with an APC of 2.8% (95% CI: 2.4, 3.3) in 2014-2020 and 0.6% (95% CI: -1.0, 2.2) in 2020-2023. Among transgender men and women, the proportion increased from 50.2% in 2014 to 66.1% in 2023 with an APC of 2.7% (95% CI: 2.2, 3.1) in 2014-2023. Black men and women, and Latino/Hispanic men and women had a lower proportion of SVS when compared with White men and women. SVS among PWH in NYC improved significantly from 2014 to 2023, but disparities were observed by gender and race/ethnicity.