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

Methamphetamine use often co-occurs with sexual behaviors that may increase HIV acquisition risk and disrupt adherence to HIV pre-exposure prophylaxis (PrEP). To explore barriers and opportunities for PrEP among people who use methamphetamine, we conducted semi-structured interviews with 28 self-reported HIV-negative adults (ages 18-55) with current moderate-to-high risk methamphetamine use in the New York City metropolitan area. Transcripts were thematically analyzed with double coding and iterative consensus. Participants described sexualized methamphetamine use, polysubstance use, and sexual behaviors associated with increased HIV exposure risk (condomless intercourse, group sex, transactional sex, encounters with unfamiliar partners). Awareness of PrEP was high (86%), whereas 46% reported current use. Adherence frequently decreased during periods of heavy methamphetamine and polysubstance use, despite self-management strategies (e.g., phone/calendar reminders). Reported obstacles included insurance coverage interruptions, concerns about side effects, and reluctance to discuss sexual health with clinicians. Interest in long-acting PrEP was considerable (71% would try injections; 57% would try implants), though some expressed concerns about comparative efficacy, visit adherence, and access. Findings suggest that long-acting formulations may mitigate daily dosing burdens, particularly if delivered in settings already accessed by this population. Prospective clinical studies, ideally randomized trials, are needed to determine whether long-acting PrEP improves adherence and reduces HIV incidence in methamphetamine-using populations.Trial registration: ClinicalTrials.gov identifier: NCT06101342.

In Bhutan, HIV testing uptake among key populations remains low, with most cases diagnosed late. Evidence shows index testing and partner notification services (PNS) enhance diagnosis among partners of people living with HIV (PLHIV). However, traditional PNS are limited by HIV related stigma, fear of disclosure, and partner reluctance to visit health facilities. Integrating HIV self-testing (HIVST) within the PNS provides an alternative for earlier diagnosis. This qualitative study used in-depth interviews to explore the feasibility and acceptability of index testing using HIVST among PLHIV. Deductive and inductive thematic analysis conducted. Three themes emerged: bridging HIVST knowledge; trust and power in HIVST distribution; and reimagining support systems. Participants reported knowledge gaps due to fragmented information, undermining confidence in HIVST uptake for partner notification (PN), and suggested instructional videos and printed guides. Experiences of assisted PN (aPN), including fear of misunderstanding, relationship breakdown, and judgment, negatively influenced willingness to use index HIVST. Trust and emotional preparedness shaped perceptions of HIVST distribution, with most participants preferring aPN as the primary strategy and index HIVST as an alternative. Misconceptions, inadequate post-test counseling, and stigma may hinder uptake. HIVST could increase testing in Bhutan, but effectiveness depends on addressing stigma and structural barriers through provider-assisted distribution strategies.

Despite improved access to antiretroviral therapy (ART) in Zambia, adherence among young people with HIV (YPHIV) remains suboptimal, compromising treatment effectiveness. YPHIV face unique developmental and socio-behavioral challenges including HIV-related stigma, depression and substance use, which further undermine consistent ART adherence. Alcohol and drug use impair cognitive and emotional functioning, increasing the likelihood of disrupted medication routines. This study applied the Hierarchical Model of Medication Adherence (HMMA) to examine how individual, social and structural factors influence ART adherence among YPHIV in Zambia. A qualitative descriptive design was employed using six focus group discussions (FGDs) with 48 purposively selected participants aged 18-24 years, all reporting <80% adherence and recent substance use. Data were audio-recorded, transcribed verbatim and thematically analyzed. HIV-related stigma, mental health distress and negative healthcare experiences were key drivers of substance use. Substance use impaired adherence by causing forgetfulness and other factors. Depression and emotional exhaustion also emerged as major contributors to substance use and poor adherence. The study offers novel, context-specific insights into the multilevel drivers of poor adherence among Zambian youth aged 18-24. Findings highlight the need for youth-centred interventions that address stigma, mental health and substance use to improve ART adherence and health outcomes.

Background: Suicide disproportionately affect people with HIV. To prevent suicide, it is crucial to enhance our understanding of the etiology of suicidality and develop prevention strategies for people with HIV. This study explored healthcare workers' perspectives on risk factors, barriers to care, and prevention needs in primary healthcare settings in South Africa.

Methods: We conducted semi-structured interviews with thirteen healthcare workers from three primary healthcare clinics in Khayelitsha, South Africa. The interviews were audio recorded, transcribed verbatim, and analyzed using a reflexive inductive thematic analysis.

Results: The findings demonstrate that suicide among people with HIV is influenced by several factors including fear of disclosure, HIV-related stigma, comorbidity with psychiatric disorders, and social stressors. The clinics lack routine screening for suicide, insufficient training in suicide risk assessments for healthcare workers, and have limited trained mental health professionals. Combined, these inadequacies result in missed identification and lack of necessary support for patients at risk of suicide, which in turn cause frustration and helplessness among healthcare workers, negatively affecting their mental well-being.

Discussion: Our research highlights the importance of implementing interventions in primary healthcare settings to support individuals with HIV at risk of suicide. Our findings emphasize the need to integrate mental health services into regular HIV care to ensure proper identification of people at risk of suicide, as well as the need to implement preventive measures for this population.

Indigenous youth in the United States are at elevated risk of infection with Human Immunodeficiency Virus (HIV) and other sexually transmitted infections (STIs) compared to non-Indigenous youth populations. Condom use is an effective strategy to mitigate HIV and STI transmission, and condom use self-efficacy (CUSE) is a key focal point of sexual and reproductive health interventions for Indigenous youth. CUSE scales can be used to measure CUSE, but most CUSE scales have been validated with non-Indigenous youth. The current study utilized a community-based participatory research framework to involve Indigenous research partners in validating a 12-item CUSE scale used with Indigenous youth using exploratory factor analysis and structural equation modeling. Results were co-interpreted with tribal research partners. Co-interpretation sessions were recorded and relevant quotes were matched to quantitative results. The 12-item CUSE scale had good model fit, and tribal research partners provided tribally specific interpretations of the study results. The study highlights a decolonial process that empowers Indigenous research partners to assert their values and culture during quantitative results interpretation. Other Indigenous researchers and allies can use this study as an example for validating and using existing psychometric scales in their research.

Improving access and retention in programs aimed at reducing the transmission of HIV from mothers to children is a key focus area for HIV care and prevention. Despite these efforts, retention in the prevention of mother-to-child transmission (PMTCT) programming in Rwanda is suboptimal. This study gathered nuanced information on the experiences of patients and providers of PMTCT services to identify strategies for improving retention. 25 interviews were conducted across 14 health facilities in Rwanda. The data were analyzed using a thematic analysis. Both patients and providers described resource deficiencies that impeded their ability to attend or provide optimal PMTCT services. Specifically, patients described struggling with poverty (e.g., ensuring access to food and shelter), let alone covering transportation fees to attend PMTCT appointments. Providers described not having enough space or personnel to attend to patients. They also described the absence of the required equipment and medications. Participants also identified facilitators of patient retention in PMTCT services, including acceptance of HIV status, knowledge of PMTCT services, and social support. These findings highlight the persistence of known barriers to the successful implementation of PMTCT services, suggesting that new strategies are needed to address the context-specific challenges experienced by patients and providers in Rwanda.

Adolescent and young women (AYW) in Sierra Leone face high HIV risk and low testing rates, hindering progress toward the 95-95-95 targets. This study examines the spatial distribution and factors influencing recent HIV testing among AYW in Sierra Leone using the 2019 Sierra Leone Demographic and Health Survey, which included 6,062 participants aged 15-24. Techniques such as spatial autocorrelation (Moran's I), hotspot analysis (Getis-Ord GI*), and Kriging interpolation identified testing clusters, alongside a multilevel logistic regression model for associated factors. Hotspots for testing were found in Kailahun and Kenema, while cold spots were noted in Karene, Falaba, and Tonkolili. Approximately 24.3% of AYW reported recent testing. Key factors linked to recent testing included being aged 20-24, having multiple sex partner, age at first sex (before age 18), age at first sex (18 and above), history of sexually transmitted infections (STIs), and HIV knowledge. Regional disparities were evident, with lower testing odds in the Northern, Northwestern, and Southern regions compared to the Eastern region. The study recommends a multilevel approach, integrating targeted outreach in high-risk areas with community education and awareness campaigns to address disparities in HIV testing among AYW in Sierra Leone.

North American societies recommend that Pregnant People Living with Human Immunodeficiency Virus (PLWHIV) use formula to feed their infants to eliminate the risk of perinatal HIV transmission. However, many Canadian PLWHIV have migrated from HIV-endemic countries, where the World Health Organization recommends exclusive breastfeeding. These opposing recommendations, along with the complex interplay of social, cultural, and personal factors, create tension when making decisions regarding infant feeding. This study describes the experiences of PLWHIV in making decisions to inform healthcare providers and enhance guidelines for the use of breast milk. In-depth interviews were conducted with patients (n = 10) from a tertiary hospital in Toronto, Ontario. All participants were immigrants to Canada, with the majority (n = 8) self-identifying as African or Caribbean. Regarding their most recent pregnancy, 6 exclusively formula-fed, three exclusively used breast milk, and one used a combination of both feeding methods. The thematic analysis revealed four key themes: values and facilitators in the decision-making process, challenges experienced with infant feeding choices, reflections on these decisions, and recommendations for enhanced care. The findings highlight the need for socially and culturally inclusive evidence-based counseling, a safe environment, multidisciplinary care, and access to information that supports the best possible outcomes for both mothers and babies through informed decision-making.

Bangladesh exhibits a low prevalence of HIV; however, socioeconomic and gender disparities contribute to an increased vulnerability among women, primarily due to limited awareness of transmission methods, preventive measures, and testing services. This study employs data from the Multiple Indicators Cluster Survey (MICS) 2019, utilizing descriptive statistics, Chi-square tests, and logistic regression analyses to examine the influence of socio-demographic factors, educational attainment, and media exposure on HIV awareness. The findings indicate a moderate level of awareness, albeit accompanied by widespread misconceptions; only 27.5% of women knew where to access testing services. Women residing in urban areas, possessing higher education levels, belonging to wealthier households, and with media exposure demonstrated significantly higher awareness levels. Disparities are evident across different regions, notably in Barishal and Mymensingh. Futhermore, women with higher secondary education exhibited a 17.5-fold increase in HIV knowledge compared to those with primary education. The study underscores the importance of targeted educational initiatives, media campaigns, and enhanced testing acessibility, particularly in underserved regions, to improve awareness and mitigate stigma.

People living with HIV (PLWH) are at risk for mental health (MH) disorders and pain, but this burden is largely unknown in low/middle-income countries. From February-October 2023, we conducted a cross-sectional survey at a large HIV clinic in Lima, Peru to quantify the prevalence of MH disorders and pain amongst PLWH established in care and to explore relationships between MH and well-managed HIV. At clinic visits, PLWH were invited to complete validated measures for depression, post-traumatic stress disorder (PTSD), alcohol use disorder (AUD), and pain (PHQ-8, PCL5, AUDIT-C, and BPISF). We abstracted data on treatment and viral suppression from medical charts. We calculated the prevalence of depression (PHQ8 ≥ 10), PTSD (PCL-5 ≥ 30), AUD (AUDIT-C ≥ 4 for men, ≥ 3 for women), and pain severity/interference (none, mild, moderate, or severe). We conducted logistic regression analyses to determine associations between MH/pain and viral suppression. Among 397 participants, 32% (95% CI: 27-37%) reported AUD, 21% (17-26%) reported depression, and 13% (9.5-16%) reported PTSD; 14% (11-18%) and 12% (9.3-16%) reported moderate/severe pain intensity and interference, respectively. There were no associations between MH/pain and viral suppression. High levels of MH disorders and pain among PLWH established in care suggest screening is needed for all PLWH, even those with well-controlled HIV.