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

The increasing population of older people living with human immunodeficiency virus (PLWH) highlights the importance of advance care planning (ACP) and tailored approaches to later life and end-of-life care. This study examined the extent to which PLWH consider their own aging and end-of-life stage, their discussion of these topics with healthcare providers, and factors associated with such discussions. PLWH aged ≥50 years were recruited from nine hospitals and one clinic in Japan. Among 715 eligible participants, 48.9% had considered the person they would like to entrust with important decisions, and 47.8% had considered the preferred medical treatments at the end of life. However, fewer than 10% of the participants had discussed their own aging and end-of-life stage with healthcare providers. In the multivariate analysis, the following factors were significantly associated with such discussions: consideration of late-life and end-of-life planning (β = 0.226, p < 0.001), shared decision-making (β = 0.157, p < 0.001), over 70 years of age, very good perceived health status, highest educational level, and social support. These findings emphasize the need to create opportunities for PLWH to concretely reflect on their aging and end-of-life preferences and to facilitate communication with healthcare providers to promote ACP.

This study investigated virologic suppression and antiretroviral therapy (ART) adherence in pregnant people living with HIV (PLWH) at a Prevention of Mother-to-Child Transmission (PMTCT) unit. The objective was to assess how prior ART experience impacts virologic suppression during pregnancy. A total of 350 pregnant PLWH were included and divided into three groups: ART-naïve, ART-experienced who conceived while on continuous ART, and ART-experienced who restarted ART during pregnancy. Virologic load (VL) was measured at entry, quarterly, and near delivery, with a primary endpoint of undetectable HIV VL (<40cp/mL) near delivery. Genotype tests were conducted for those with VL > 500 cp/mL at entry. Adherence was measured by ART pickup rates at the pharmacy. Results showed 89% achieved virologic suppression near delivery. Suppression rates were 93% in ART-naïve, 96% in those on continuous ART, and 60% in those who restarted ART. Resistance rates varied, with 24% for NNRTI and 0% for INSTI. Median ART pickup rates were highest in ART-naïve (100%) and lowest in those who restarted ART (71%). No vertical transmission occurred, but two stillbirths were reported. While overall virologic control was good, challenges remain for ART-experienced PLWH restarting ART during pregnancy.

Tobacco use is disproportionately high among people living with HIV (PLWH), increasing tobacco-related morbidity and mortality and potentially undermining antiretroviral therapy adherence. We conducted a cross-sectional survey of 88 PLWH attending a university infectious diseases outpatient clinic (mean age 40.8 ± 10.9 years; 97.7% male). Sociodemographic characteristics, smoking history, quit attempts, and awareness of electronic cigarettes (e-cigarettes) were collected using a structured questionnaire, and nicotine dependence was measured with the Fagerström Nicotine Dependence Test. Mean dependence score was 3.94 ± 2.55 and was higher in participants with lower versus higher education (4.45 ± 2.62 vs 3.17 ± 2.26; mean difference 1.28, 95% CI 0.24 to 2.32; p = 0.020). Although 76.1% had attempted to quit, only 18.2% reported receiving professional support. Friends were the main source of e-cigarette information (60.2%). Only 21.6% considered e-cigarettes a tobacco product, while 44.3% did not. Most participants (76.1%) believed e-cigarettes are harmful. Smoking cessation services embedded in HIV care should address nicotine dependence and misinformation about e-cigarettes through targeted, multidisciplinary interventions.

Leaving the emergency department (ED) before treatment completion (LBTC) - either without being seen by a physician or against medical advice - is common in substance use-related presentations and associated with adverse outcomes. We assessed determinants and outcomes of LBTC among people with and without HIV (PWH, PWoH) attending an ED with a suspected overdose between 2012-2020 in British Columbia, Canada, using linked administrative data. We identified suspected overdose events presenting to the ED and classified LBTC using diagnosis codes and/or discharge disposition. Using multivariable regression, we assessed (1) whether HIV was associated with LBTC, (2) determinants of LBTC stratified by HIV-status, and (3) whether LBTC was associated with risk of another overdose-related ED attendance, primary care contact, and OAT dispensation within 30 days. Although LBTC was more common among PWH attending the ED with a suspected overdose (13.9% of 632 presentations) than among PWoH (9.0% of 3,057 presentations), HIV was not independently associated with higher LBTC risk. Determinants of LBTC among PWH were age 19-38, lower triage acuity, ED attendance from 04/2016-03/2020, and opioid agonist therapy in the prior five years. Of note, LBTC was independently associated with increased risk for another overdose-related ED attendance within 30 days (adjusted risk ratio: 1.46; 95%CI: 1.06, 2.01).

Pre-exposure prophylaxis (PrEP) is a highly effective biomedical intervention for preventing HIV, yet uptake remains disproportionately low among individuals involved in the criminal legal system (CLS), particularly those under community supervision in the Southern United States. Multi-level stigma - including self, interpersonal, and structural stigma - has been identified as a significant barrier to PrEP awareness and acceptance. This study draws on in-depth, semi-structured interviews with 72 participants across three Southern states - Florida, Kentucky, and North Carolina - who were under community supervision and met clinical indications for PrEP. These findings illustrate the compounding impact of stigma across levels, and how the overlapping stigmas associated with HIV, sexuality, drug use, and incarceration can hinder engagement with preventive care. This study fills a critical gap in the literature by centering the voices of CLS-involved individuals under community supervision in the South - a population that exists in a unique space between incarceration and community reentry. Our findings underscore the need for stigma-informed interventions that address not only knowledge and access gaps but also the social and institutional conditions that shape health behavior. Future PrEP implementation efforts must be context-specific, trauma-informed, and embedded in systems that CLS-involved individuals routinely engage with.

Providers often counsel young sexual/gender minority (YSGM) of color about HIV "risk" in ways that feel unrelatable and stigmatizing. Our study explored: (1) needs for sexual wellness-based HIV prevention among 18-29-year-old YSGM of color, (2) challenges and opportunities in using this counseling approach, and (3) preliminary feasibility and acceptability of a wellness-based counseling intervention. Aim 1 collected surveys and in-depth interviews with YSGM of color. Aim 2 recruited providers to understand their needs when counseling YSGM of color and implementing wellness-based approaches. Aim 3 piloted the intervention with providers and included exit surveys and focus groups to assess acceptability and feasibility; however, this aim was cut short due to funding cuts in early 2025. In Aim 1, 23 interviews and 70 surveys were completed, with 94.3% identifying as sexual minorities. Nearly two-thirds reported that consulting a health professional who uses a sex-positive approach for HIV prevention would increase their ability to effectively use pre-exposure prophylaxis (PrEP). In Aim 3, we trained 23 providers across three sites and conducted one site debrief. If feasibility and acceptability are demonstrated, this intervention is positioned for rapid dissemination to reduce HIV prevalence among a group that has historically benefitted less from PrEP.

HIV continues to be a significant global health issue, with 39 million people living with HIV in 2022, including 1.3 million new infections. Of those, 27% were young people aged 15-24, highlighting the vulnerability of this demographic. Despite advances in HIV prevention and treatment, particularly with antiretroviral therapy (ART), low to middle-income countries (LMICs) remain disproportionately affected by the epidemic. The identification and promotion of resilience factors is critical to both decreasing infections and enhancing coping mechanisms for those young people living with HIV (YPLHIV). This review investigates resilience by examining definitions, measurement processes, and tools, and identifying factors associated with resilience in YPLHIV within LMIC settings. To ensure quality, studies published from April 2014 to March 14, 2025, were reviewed using the Mixed Methods Appraisal Tool (MMAT). Findings revealed that definitions of resilience often involved overcoming adversity, and measurement processes and tools varied widely. Social support was a key resilient factor encompassing support from family, friends, loved ones, spiritual, cultural, and institutional support. This review underscores the importance of resilience as a framework for addressing the psychosocial needs of YPLHIV and calls for the standardization of measuring resilience across studies.

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.

Pre-exposure prophylaxis (PrEP) is an effective medical option for HIV prevention. This study aimed to examine PrEP uptake among men having sex with men (MSM) in Switzerland and to develop and test a theoretical model explaining PrEP use. We used an anonymous self-administered online questionnaire to collect data. In 2022, we recruited a convenience sample of 743 HIV-negative MSM who had had anal sex with casual partners 12 months prior to the survey. Approximately one-third of the participants used PrEP with casual partners. We used structural equation modeling to test a theoretical model of PrEP use based on an extended information-motivation-behavioral skills model (IMB model). The dependent variable measured how often MSM used PrEP with casual partners in the past year using a 7-point Likert scale. PrEP use was positively associated with intention to use PrEP (β = 0.51) and PrEP self-efficacy (β = 0.10). The intention to use condoms (β = -0.26) and the subjective HIV risk perception (β = -0.14) were negatively associated with PrEP use. The extended IMB model appeared suitable for explaining the frequency of PrEP use with casual partners (χ²(44) = 103.11, CFI = 0.98, RMSEA = 0.04, SRMR = 0.04, R² = 0.49). The theoretical model provides valuable insights for prevention to further promote PrEP use among eligible MSM.

Children and adolescents living with HIV face complex decisions about disclosing their HIV status, influenced by social, emotional and contextual factors, including perceived support and experiences of stigma. This study examined the relationship between perceived social support, HIV-related stigma and motivations for non-disclosure, and assessed whether stigma mediates the link between social support and non-disclosure among young people living with HIV. A cross-sectional study was conducted with 90 participants aged 10-18 years receiving antiretroviral therapy at a tertiary hospital in northern India. Participants completed standardized measures of perceived social support, HIV-related stigma and non-disclosure motivations. Higher social support was associated with lower stigma, and greater stigma predicted stronger non-disclosure motivation. Mediation analysis showed a significant indirect effect of social support on non-disclosure through stigma, indicating partial mediation. Findings underscore the central role of stigma in disclosure decision-making. Interventions that enhance supportive relationships and reduce stigmatizing attitudes in families, schools and healthcare settings may promote healthier coping and developmentally appropriate disclosure.