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

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.

This paper examines the impact of education on women's comprehensive knowledge of HIV and stigma in Malawi, utilizing data from three waves of the nationally representative Malawi Demographic Health Survey. Education plays a critical role in improving health knowledge and countering misinformation, as underscored by SDG3. Our study employs the universal primary education policy implemented in 1994 as an instrumental variable, revealing that women affected by the reform experienced improvements in their education. We find that each additional year of schooling increases the likelihood of women being informed about STIs, enhances their comprehensive knowledge of HIV, and reduces their adherence to HIV stigma beliefs. The robustness of our findings is confirmed through various tests. We also find varying effects of STI knowledge, HIV knowledge, and HIV stigma across demographics. STI knowledge is more significant among rural, low-income, and religious women, while HIV knowledge has subtler impacts on rural and religious women. HIV stigma is stronger among urban, low-income, and religious women. Furthermore, we explore different pathways, such as cognitive skills development, labor market engagement, and exposure to health information, to provide deeper insights into the underlying mechanisms driving these outcomes.

Sharing one's HIV status with others is complex for youth with perinatally acquired HIV (PAH). However, the support from sharing one's HIV status may assist with HIV-related challenges. This study explored barriers and facilitators of HIV status sharing among UK-based youth living with PAH. Drawing on semi-structured interviews with ten youth with PAH, ten members of their social networks and five HIV professionals, this study examined the complex relational nature of disclosure. The data were examined using thematic analysis. While many youths expressed a desire to be open, sharing was shaped by stigma, cultural silence, familial secrecy, fear of rejection and lack of HIV education. Facilitators included emotional readiness, peer support, increased knowledge and positive prior experiences of disclosure. Social network participants often saw themselves as supportive, although professionals tended to focus on potential emotional risks. This study underscores disclosure as a process requiring ongoing support and suggests that empowering youth with education, skills and confidence is key. It identifies the need for better professional guidance and disclosure interventions co-designed with youth to support health and well-being. The findings have implications for stigma reduction, education and psychosocial support, contributing to improving the quality of life for youth with PAH.

Despite major strides in global HIV prevention and treatment, development imbalances and gender disparities continue to shape the epidemic's burden worldwide. This study aimed to examine the associations between development indicators - including the Human Development Index (HDI), Gender Inequality Index (GII), Life Expectancy at Birth (LEaB), and Universal Health Coverage (UHC) - and HIV epidemiological measures (incidence, prevalence, mortality, and antiretroviral therapy [ART] coverage). HIV-related data for 2023 were obtained from the UNAIDS database. Countries with missing data were excluded. Relationships between development indicators and HIV metrics were analyzed using Spearman's correlation and univariable linear regression. Among 129 countries, GII correlated positively with HIV incidence (r = 0.53), prevalence (r = 0.49), and mortality (r = 0.64) (p < 0.001). HDI, LEaB, and UHC were inversely associated with all epidemiological measures, most strongly with mortality (HDI r =  - 0.65; LEaB r =  - 0.77; UHC r =  - 0.58). Sub-Saharan Africa showed the highest burden alongside low development levels. Disparities were also evident in the Caribbean and Eastern Europe. Lower HDI, higher GII, and shorter life expectancy are strongly linked to a greater HIV burden. These findings highlight the need for region-specific, equity-driven strategies targeting gender inequality and healthcare access.List of Abbreviations: HIV, Human Immunodeficiency Virus; AIDS, Acquired Immunodeficiency Syndrome; ART, Antiretroviral Therapy; PLWH, People Living With HIV; HDI, Human Development Index; CHDI, Composite Human Development Index; GDI, Gender Development Index; GII, Gender Inequality Index; LEaB, Life Expectancy at Birth; UHC, Universal Health Coverage; UNAIDS, Joint United Nations Programme on HIV/AIDS; UNDP, United Nations Development Programme; WJP, World Justice Project; FI, Freedom Index; DI, Democracy Index; CHE, Current Health Expenditure.

Silence, the deliberate non-disclosure of HIV status - remains an overlooked yet central aspect of long-term antiretroviral therapy (ART) survivorship. While disclosure is promoted as empowerment, such framings may neglect the gendered, relational, and institutional contexts in which non-disclosure occurs. We conducted in-depth interviews with 21 long-term ART users (10-22 years on treatment) in Tamil Nadu, India, and analysed narratives using stigma, social identity, emotion work, spiritual reframing, and institutional betrayal lenses. Silence emerged not as absence, but as a moral-behavioural strategy. Women's silence reflected care-based labour aimed at protecting children and preserve family integrity; while men often framed silence as endurance, restraint, or sacrifice. Participants sustained concealment through spiritual meaning-making and, over time, selectively withdrew from systems experienced as stigmatising or confidentiality-compromising. We identified four interlinked patterns - of emotional rupture, strategic non-disclosure, moral reframing, and institutional withdrawal - highlighting silence as an adaptive, gendered survival strategy. HIV care systems should depathologize silence and redesign counselling approaches to centre dignity, caregiving, and emotional safety.

Children living with HIV are not routinely informed of their HIV diagnosis: open communication is not yet standard global practice (Warburton et al., 2022). This article presents data from a qualitative study aimed at establishing an evidence-based approach to telling children they are HIV positive. An arts-based narrative inquiry methodology was used. Sixteen young people and ten parents were recruited via voluntary sector organizations in the United Kingdom and shared their experiences through focus group participation. Participants used arts resources to create something of their choice as a vehicle to share their untold stories. Creative pieces made by participants included masks and boxes illustrating the experiences of stigma and self-stigma and highlighting the need felt by participants to hide HIV. Stigma prevents HIV-related conversations and creates self-stigmatization. Secrecy in family homes exacerbates self-stigma and a cycle of intergenerational stigma, as a new concept, was identified in the narratives. The burden of hiding a health diagnosis is an overwhelmingly negative experience for children and their families. Early naming of HIV and open communication will reduce the weight of self-stigma and intergenerational stigma experienced by children and families. It is time to break the cycle of stigma.

Young adults living with perinatally acquired HIV (YAPHIV) and those perinatally exposed but uninfected (YAPHEU) can face mental health challenges during the transition to adulthood, including depression, anxiety and life stressors. Social support from family and friends may help attenuate the impact of stress on mental health. This longitudinal study examined whether family relationships and friend support predicted psychiatric disorders and moderated the association between stress and mental health outcomes among 197 young adults affected by HIV in the United States (62% YAPHIV; 39% YAPHEU). Data were drawn from two adult assessment points: Time 1 (mean age = 22.9 years) and Time 2 (mean age = 24.1 years). Logistic regression analyses indicated that greater family support and family organization at Time 1 were consistently associated with lower odds of any psychiatric disorder and, specifically, anxiety and mood disorders at Time 2. Among YAPHEU participants only, higher family organization was associated with lower odds of anxiety disorders. Stress was not significantly associated with mental health outcomes, nor did family or friend support moderate the association between stress and mental health. The findings highlight the protective role of family support and organization in reducing mental health challenges and suggest that specific family dimensions may be important targets for intervention.

Polysubstance use (PSU) is common among people with HIV (PWH), and cannabis use, both medical and non-medical, is increasingly prevalent in this population. This study examined patterns of PSU by cannabis use status and motivation among 333 PWH who reported past-year substance use. The sample was 67.6% non-Hispanic Black/African American, 54.3% male, and 78% current cannabis use. PSU was defined as the number of non-cannabis substances used in the past 12 months (range: 0-9). Cannabis use was associated with significantly higher use of most substances (p < 0.05), particularly crack/cocaine and cigarettes. Those who use cannabis had a higher mean PSU count (M = 2.5, SD = 1.7) compared to non-users (M = 0.63, SD = 0.98; p < 0.001). Among those using cannabis regularly, latent class analysis identified three motivation groups: medical/emotional (24.4%), recreational (37.0%), and mixed (38.6%). Recreational use reported lower PSU compared to those in the medical/emotional group (β = -0.24, 95% CI [-0.47, - 0.01]); no significant difference was observed between the mixed and medical/emotional groups. These findings suggest that cannabis use motivations may be associated with broader substance use patterns among PWH. Understanding these patterns is critical for tailoring interventions, especially given the potential impact of PSU on HIV-related health outcomes.