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

Objective: Advances in treatment have transformed HIV into a manageable chronic illness, yet people living with HIV (PLHIV) continue to face psychosocial challenges that reduce quality of life (QoL). These factors often co-occur and interact, creating syndemic effects that worsen outcomes. Method: This study examined relationships between HIV-related stigma, mental health difficulties, and social disconnection in predicting QoL. Participants were 213 PLHIV (184 male, 21 female, eight transgender/other/undisclosed) attending Albion, an urban tertiary HIV clinic in Sydney, Australia. They completed questionnaires assessing stigma, mental health, social support, and QoL. Results: HIV-related stigma, mental health difficulties, and social disconnection each independently predicted poorer QoL. A syndemic effect was found between stigma and social disconnection, with QoL lowest when both were high. Conclusions: Psychosocial comorbidities significantly impact QoL in PLHIV. Findings underscore the value of a syndemic framework to guide clinical research and highlight the need for holistic interventions addressing stigma, social support, and mental health.

Heterosexually identifying migrants in Australia are among populations experiencing increasing HIV notifications, highlighting concerns about low rates of sexual health testing and awareness of Pre-Exposure Prophylaxis (PrEP). Utilising in-depth interviews, we explored perceptions of HIV risk among 16 heterosexually identifying migrants from Southeast Asia, Northeast Asia, and sub-Saharan Africa. Domains of inquiry were HIV risk assessment and management, knowledge and attitudes. Participants were majority female, aged 35 years and above, living in Australia for at least three years. Constructed themes were stigma and personal responsibility, access and awareness, proximity and distance, and differing socio-cultural attitudes. Cultural or community-based stigma influenced participants' perceptions of HIV or their reluctance to use PrEP, linked to morality and safety concerns. Limited uptake of PrEP was contrasted by generally high knowledge of HIV transmission, prevention, and treatment. Attitudes and perceptions were commonly influenced by access to sexual health education, exposure to and visibility of HIV information, social proximity to people living with HIV, and sociocultural norms. Participant insights highlight the need for culturally responsive public health education outside dedicated sexual health spaces, particularly regarding PrEP, and reinforce the need for targeted, peer and community-led health promotion responses to support virtual elimination of HIV.

HIV competence, encompassing knowledge, skills, attitudes, and practices to prevent, manage, and reduce HIV impact, is critical for meeting young people's HIV prevention and care needs. This study evaluated the effect of the Community of Practice on HIV (CoP-HIV) educational intervention on staff HIV competence and prevention knowledge in Ugandan schools, where HIV prevalence is rising among youth. Using a stepped-wedge cluster randomized trial, the intervention was implemented across six schools in western Uganda (March-September 2023). It included two eight-hour workshops and a handbook on HIV prevention and care, delivered over one month per school. Data were collected from 174 randomly selected staff (mean age 34.9 years, 49.9% female) at four points: baseline, T1, T2, and T3. Linear mixed-effects modeling showed significant improvements in HIV competence (20-point increase; β = 19.87, SE = 1.02, p < 0.05) and prevention knowledge (5.5-point increase; β = 5.5, SE = 0.97, p < 0.05). Competence varied by school and time, while prevention knowledge improved consistently. The CoP-HIV intervention enhanced staff capacity, demonstrating potential for broader school-based HIV control. Despite pragmatic design strengths, short follow-up and reliance on self-reported data were limitations. Longer-term studies should examine effects on students' preventive behaviors and well-being.

Falls result in adverse outcomes such as hospitalization, disability, and increased mortality among older people. There is a paucity of data on falls among older PLHIV in sub-Saharan Africa. We determined the prevalence and factors associated with falls among older PLHIV in Kampala, Uganda. We carried out a cross-sectional analysis of 500 people aged ≥ 60. We administered structured questionnaires to collect participants' characteristics, the number and type of falls in the previous 2 years. We then performed a modified Poisson regression analysis to assess the factors associated with falls. Overall, 51.2% were male. The mean age was 65 years (SD ± 4.9 years), and 41.2% reported having a fall in the previous 2 years. Falling was associated with being female (prevalence ratio (PR) 1.28, 95% CI: 1.01-1.63), current (PR 1.44, 95% CI: 1.05-1.96), or past alcohol use (PR 1.41, 95% CI: 1.07-1.87), and low household income (PR 1.33, 95% CI: 1.07-1.64). Given the high prevalence of falls found in our study, integrating risk awareness and screening for falls into the routine care of older people with HIV is desirable. Effective education programs aimed at promoting alcohol cessation could reduce the occurrence of falls among older people living with HIV.

Background: Few studies have examined factors linked to depressive symptomatology among caregivers of children and adolescents living with HIV (CALHIV). This study estimated prevalence of depressive symptoms and identified associated factors among caregivers of CALHIV in KwaZulu-Natal, South Africa.

Methods: We used baseline data from a cluster-randomised controlled trial of the impact of a cash transfer program and an economic empowerment intervention on health and well-being caregivers of CALHIV. Depressive symptoms were assessed using 10-item Centre for Epidemiologic Studies Depression Scale (CES-D-10), with score of ≥12 indicating presence depressive symptomatology. Correlates of depressive symptoms were identified using multilevel generalised linear models.

Results: The prevalence of depressive symptoms was 57% (95% CI: 51% - 63%). Factors associated with increased odds of depressive symptomatology were residing in peri-urban (OR = 4.80, p = 0.038), having any form of disability (OR = 8.12, p = 0.001), having existing medical condition (OR = 3.27, p = 0.009), experiencing physical abuse in the past 12 months (OR = 3.53, p = 0.020), and low social support (OR = 3.94, p = 0.005).

Conclusion: The prevalence of depressive symptoms was high among Caregivers of CALHIV. These findings highlight the need for targeted, context-specific interventions that include mental health screening for caregivers to support their mental health and well-being.

Women living with HIV (WWH) have an increased risk of invasive cervical cancer due to persistent HPV infection and a weakened immune response. Regular cervical screening is recommended, but compliance is poor. This study aims to identify determinants associated with non-compliance and the risk of high-grade intraepithelial lesions (HSIL) in WWH. The study assessed compliance with the national cervical screening guideline of the Dutch Association of HIV Practitioners (NVHB) in Dutch WWH. Data from the ATHENA National HIV cohort, including WWH from seven HIV centers registered from 2000 through 2021, were analyzed. Descriptive and logistic regression analyses were performed to examine the associations between determinants and guideline adherence, as well as the associations between these determinants and cervical smear results in the study population. The study included 1537 WWH, of whom 1007 (65.5%) had at least one cervical smear, resulting in a compliance rate of 0.28 per three patient-years. Among these 1007 women, 228 (22.6%, 23 per 1,000 p-y) had HSIL and 9 (0.9%, 0.9 per 1,000 p-y) developed cervical cancer. Compliance was associated with hormonal contraceptive use, limited alcohol consumption, a history of STDs (other than HIV), and pregnancy. Non-compliance was more common in WWH born in Africa and Western Europe compared to those born in the Netherlands and in those never treated with cART. HSIL was associated with younger age, drug use, high-risk HPV, low CD4 counts, and detectable viral load. Cervical screening compliance in WWH in the Netherlands is moderate to poor, with HSIL incidence twice as high as in the general population. These findings underscore the importance of cervical screening in this high-risk group. The results can guide the development of personalized strategies to improve screening adherence, leading to earlier HSIL detection and a reduced cervical cancer incidence.

Among Adolescents living with HIV (ALHIV) in Uganda, pathways linking HIV-related stigma to mental health (depression, hopelessness and self-esteem) and academic engagement (school satisfaction and self-concept) are under-examined. Using cross-sectional data from 833 ALHIV (ages 10-17), we first estimated a fully latent structural equation model to assess these pathways. Model fit was excellent (χ²[21] = 45.16, p = .002; CFI = .987; RMSEA = .037; SRMR = .028). Stigma was associated with poorer mental health (β = -.214, SE = .058, p < .001); positive mental health predicted academic engagement (β = .956, SE = .262, p < .001), while the direct stigma to academic path was small and marginally non-significant (β = -.089, SE = .046, p = .052). Next, we examined the roles of social support and family cohesion, using an observed-variable path model with composite scores. Higher stigma predicted lower perceived social support (β = -.445, SE = .041, p < .001) and family cohesion (β = -.311, SE = .048, p < .001). Perceived social support significantly buffered mental health (β = -.184, SE = .025, p < .001), and poorer mental health strongly predicted lower academic engagement (β = -.491, SE = .037, p < .001). The findings indicate that HIV stigma undermines academic engagement primarily by eroding mental well-being, while social support is a key upstream protective factor. Interventions for ALHIV should, therefore, prioritise stigma reduction alongside integrated mental health services and programmes to strengthen social support in educational settings.Trial Registration: ClinicalTrials.gov NCT05307250; https://clinicaltrials.gov/ct2/show/NCT05307250.

Despite its benefits, partner notification (PN) for HIV faces multiple barriers. This study explores HIV PN experiences, barriers and enabling factors in Rotterdam, the Netherlands, between November 2019 and February 2022. Semi-structured interviews were conducted with 19 recently HIV diagnosed individuals (<2 years; indexes), 11 notified partners and 10 key persons, alongside two focus groups with 10 peers. Data collection was iterative, and analysis was guided by the social-ecological model of McLeroy et al. The findings showed that most indexes were surprised by their diagnosis and had limited knowledge of HIV. PN was often supported by healthcare providers and conducted through digital platforms such as WhatsApp or anonymous online PN tools. Motivations for disclosure included moral responsibility and protecting partners, while barriers included fear, stigma, emotional distress, lack of contact details and perceived illness. Empathic support from providers and peers was a key enabling factor. Most interviewed notified partners underwent testing, often for the first time, and none tested positive. Participants emphasised the need to normalise HIV testing, promote undetectable = untransmittable messaging, improve PN tools, expand testing access and strengthen public awareness. In conclusion, PN is shaped by intersecting personal, social and structural factors, requiring flexible, context-specific interventions.

Oral pre-exposure prophylaxis (PrEP) is a highly effective and safe way to prevent HIV acquisition among men who have sex with men (MSM). PrEP became available to MSM in Sweden in 2018, but there have been challenges in its accessibility. The aim of this study was to gain an improved understanding of the lived experience of MSM enrolled in a PrEP program in Sweden. Data were collected through in-depth interviews with 16 MSM enrolled in the Uppsala PrEP program, which was the first PrEP program in Sweden. After being transcribed verbatim, data were analyzed using qualitative content analysis with an inductive approach to explore both the manifest and latent meanings of the interviews. The analysis resulted in an overarching theme: Transforming the sexual health landscape through PrEP, based on three descriptive sub-themes representing the perceptions and experiences among the participants: Constructing the "deserving" PrEP user, Being in the process of re-defining HIV, and Becoming a new sexual being. The results suggest that while several benefits, such as reduced HIV anxiety and sexual freedom, are experienced by PrEP users, continued HIV worry, risks of bacterial STIs and negative experiences of stigma and control are challenges that need to be addressed further.

Durable HIV viral suppression is the primary goal of initiatives aimed at ending the HIV epidemic. This study (1) identified viral suppression patterns over a four-year period, and (2) determined the association of viral suppression patterns with demographic characteristics. This study was a retrospective observational analysis of insurance claims data of 2,677 members of a New York City managed care plan who were living with HIV (PLWH). Using cluster analysis, five distinct viral suppression patterns were identified: consistently unsuppressed (15%), became unsuppressed (12%), fluctuated (16%), became suppressed (12%), and consistently suppressed (45%). Adults aged 18-29 were more likely to be consistently unsuppressed than older individuals. Compared to non-Hispanic White individuals, PLWH who were non-Hispanic Black had greater odds of becoming suppressed or becoming unsuppressed, and to be consistently unsuppressed. Hispanic PLWH also had greater odds of being consistently unsuppressed. Transgender or gender diverse PLWH had greater odds of being in the fluctuated viral load group than their cisgender peers. Thus, demographic characteristics are useful in identifying groups at-risk for viremia, reflecting the association of these factors with social determinants of health. Future research should examine how to reduce barriers to healthcare and increase care engagement for these populations.