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

This comparative study analyzed changes in caregiver-related factors known to influence pediatric HIV disclosure using baseline data from two clinical trials in Ghana - Sankofa 1 (recruitment 2013-2016) and Sankofa 2 (recruitment 2021-2023). Changes in caregiver characteristics and psychosocial domains were measured using validated instruments: social support (Social Provisions Scale), HIV knowledge (Brief HIV Knowledge Questionnaire), illness perception (Brief Illness Perception Questionnaire) and HIV stigma (HIV Stigma Scale). Caregivers of children aged 7-18 years who had not disclosed the child's HIV status completed the same structured questionnaires at baseline. Changes from Sankofa 1 to Sankofa 2 baseline periods in psychosocial domains were modeled using multivariable linear regressions. Compared to Sankofa 1, caregivers in Sankofa 2 were more likely to be female (85.6% vs. 81.6%), single (19.7% vs. 13.9%), without formal education (20.5% vs. 16.3%), HIV positive (66.0% vs. 60.2%) and earn higher incomes (47.1% vs. 27.6% > 300 GHS/month). From Sankofa 1 to Sankofa 2, social support changed only modestly (mean difference: 0.89, 95% Confidence Interval [CI]: - 0.15, 0.92), illness perception worsened (4.48, 95% CI: 3.16, 5.80), stigma increased (2.25, 95% CI: 1.54, 2.95) and HIV knowledge declined (-1.02, 95% CI: -1.29, -0.74). HIV status and younger age were consistently linked to higher stigma.Trial registration: ClinicalTrials.gov identifier: NCT01701635.Trial registration: ClinicalTrials.gov identifier: NCT04791865.

Introduction: There is a high prevalence of poor mental health among people with HIV, intersecting with structural inequalities, stigma and co-morbidities. A new person-centred approach to care that utilises health coaching to prioritise health and well-being and connects people to existing sources of support or voluntary sector organisations (social prescribing) could benefit people with HIV.

Methods: Theory of Change (ToC) methodology was used to develop a health coaching and social prescribing intervention for people with HIV. Two successive ToC workshops were held in September 2023 with a multi-disciplinary group of 39 stakeholders from across the HIV sector.

Results: The two workshops resulted in a TOC map which specified the components and intended outcomes of the intervention, identified the target population of people with HIV for the intervention, identified training requirements for healthcare staff and developed process indicators for monitoring and evaluation of the intervention.

Conclusion: The ToC method enabled stakeholders with broad-ranging experience, skills and perspectives concerning the mental health and well-being among people with HIV, to co-develop an appropriate which is being evaluated in the "Psychosocial intervention for people Living with HIV: Evidence from a Randomised Evaluation (SPHERE)" trial across eight HIV clinics in England in 2025.

This study examined how relationships with a Blesser, a form of transactional partner, along with age-disparate men, affect sexual health risks among adolescent girls and young women (AGYW) in South Africa. Using data from a cross-sectional survey of 4932 AGYW aged 15-24 conducted between February and May 2024 across eight provinces, we explored links to HIV, adolescent pregnancy, intimate partner violence (IPV), and sexually transmitted infections (STIs). About 5.7% reported a recent relationship with a Blesser, and 25.8% had an age-disparate partner. AGYW involved with both were significantly more likely to be HIV positive, experience IPV, have an STI diagnosis, and among adolescents, be pregnant. Specifically, combined relationships increased odds of HIV (AOR: 1.31), IPV (AOR: 1.87), STI (AOR: 1.55), and adolescent pregnancy (AOR: 1.66). These findings underscore how transactional and age-disparate partnerships heighten AGYW's vulnerability to the intertwined risks of HIV, pregnancy, and violence. Interventions must address the social and economic factors driving such relationships and equip AGYW to make safer choices, highlighting the critical need for comprehensive, context-sensitive programming.

Depression during pregnancy is linked to reduced use and adherence to pre-exposure prophylaxis (PrEP), increasing HIV risk. However, few studies explore how interpersonal factors shape depressive symptoms in pregnant women. We surveyed 110 pregnant women in Cape Town, South Africa, assessing depression and three interpersonal constructs: reproductive autonomy, dyadic trust, and relationship power. Participants had a mean age of 25.7 years and a mean gestational age of 29.3 weeks. In the multivariable model, decreased reproductive autonomy in decision-making remained a significant predictor of increased depression symptom severity (β =  -1.21, 95% CI [-2.05, -0.37], p < .05). A subset of 17 women with likely depression participated in qualitative interviews analyzed using thematic analysis. These narratives revealed four pathways linking reduced reproductive autonomy to worsened depression: (1) loss of control over reproductive events, (2) gendered power imbalances, (3) fear of retaliation for asserting autonomy, and (4) emotional strain in efforts to regain agency. These findings suggest that addressing interpersonal dynamics, especially by involving male partners in communication and shared decision-making may enhance the effectiveness of mental health and HIV prevention interventions for pregnant women in South Africa.

This mixed-methods study examines the feasibility and acceptability of Let's Talk Digital (LTD), a hybrid digital adaptation of Let's Talk, a family-strengthening and sexual health program for adolescents and caregivers in South Africa. LTD uses a blended learning model combining seven in-person live sessions with 27 interactive smartphone-based eLearning modules tailored by audience. A total of 143 families (150 adolescents) were enrolled across rural and peri-urban Mpumalanga. Quantitative monitoring captured module completion and session attendance, while post-intervention surveys and in-depth interviews assessed usability, engagement, and perceived benefits. Among a predominantly female population, 86% of adolescents and 76% of caregivers completed most modules and attended at least five live sessions. Participants reported high usability, peer endorsement, and perceived benefits. Despite language, connectivity, and device challenges, comprehension and acceptability remained strong. Data-free access and incentives were critical enrollment drivers (averaging R845/$$47 per family pair), highlighting the importance of sustained public-private partnerships and government support. To our knowledge, this is the first study in sub-Saharan Africa of a digitally mediated, family-based adolescent sexual health intervention. Findings suggest LTD can promote intervention completion and deliver core skills to improve adolescent well-being in low-resource settings. Further research should assess efficacy, cost-effectiveness and scalable delivery models.

Experiences of interpersonal- and community-level violence are common among people with HIV (PWH) and associated with poor health outcomes, underscoring a need to implement violence screening and support in HIV care. To inform this implementation, we explored preferences of PWH regarding integration of violence screening into HIV care. From February-December 2022, 64 in-depth interviews were conducted with PWH in Atlanta, Georgia as part of a larger mixed-methods study. Participants were purposively selected for diversity of gender, race/ethnicity, violence exposure history, HIV viral suppression, and retention in care. Themes explored included acceptability of violence screening in HIV care and preferences for doing so (in-person, paper-pencil, computerized), screening item phrasing, screening environment (by whom, where), timing of initial screen, and screening frequency. Violence screening in HIV care was highly acceptable and desirable. Collectively, preference was voiced for initiating screening at first HIV care visit and conducting screening regularly thereafter, in-person, by healthcare providers in a trauma-informed, conversational manner, with supplementation by telehealth or computerized comprehensive screeners to accommodate a variety of needs. This study, the first to detail preferences of PWH across gender and retention/viral suppression status, fills a key gap in evidence informing violence screening recommendations in national HIV care guidelines.

Gender affirmation (GAF) is a multidimensional (psychological, social, medical, administrative) social determinant of health for transgender individuals. Transactional sex (TS) is prevalent among transgender women living with HIV (TWLH), who face intersectional discrimination. GAF's relationship with TS is understudied. ANRS-Trans&HIV(2020-2022) was a French cross-sectional, community-based, life-event study of TWLH. We used clustering analyses to identify patterns of GAF among TWLH and compared TS engagement across clusters. 331/506 (65%) were currently engaged in TS. Most reported income <1000€/month. Three clusters were identified: "Sparse engagement with medical and administrative dimensions" (s-MA) - less likely to report lifetime feminizing hormone-use, gender-affirming surgery, or a gender-concordant identity document, "Past and predominant engagement with medical dimension" (p-M) - lifetime but not current feminizing hormone use, and feminizing-but-not-genital surgery, and "Current and comprehensive engagement with all dimensions" (c-MAPS) - current feminizing hormone use & genital surgery, gender-concordant identity documents, infrequent misgendering, and less frequently envisioning gender-affirming care. S-MA (aPR = 1.60, CI = 1.15-2.22) and p-M (aPR = 1.60, CI = 1.17-2.20) had higher TS engagement than c-MAPS. We identified diverse GAF experiences, though some may forego hormone use or genital surgery because they interfere with TS (e.g., erectile dysfunction). Findings underscore improving access to formal employment, reducing socioeconomic marginalization, and offering person-centered care.Trial registration: ClinicalTrials.gov identifier: NCT04849767.

Understanding women's decision-making when offered different HIV pre-exposure prophylaxis (PrEP) options is critical for improving uptake. This qualitative study explored factors influencing PrEP choices among Swazi women in 2022-2023. In-depth interviews were conducted with 17 women who accepted or declined oral PrEP or the Dapivirine vaginal ring; and 6 healthcare workers who prescribed PrEP. One focus group discussion (FGD) with eight women eligible for PrEP and three FGDs with six to eight male community members explored attitudes to PrEP. Data were collected in Siswati, transcribed into English, and analyzed thematically. Women's decisions around PrEP use and product preferences were shaped by social norms around sexual relationships, practicalities of use and perceptions of effectiveness. Many preferred "invisible" methods, such as the ring, to avoid stigma or partner violence, while oral PrEP was favored by some women practicing anal sex. Ease of adherence, side-effects and ring insertion practicalities also influenced choices. Some participants questioned PrEP effectiveness or feared it might spread HIV, while some healthcare workers noted that future injectable options could reduce blame in cases of seroconversion. The findings highlight the need to offer women a range of PrEP options, supported by accurate information, to expand coverage in high-incidence settings.

ABSTRACTCOVID-19, caused by SARS-CoV-2, accounts for 186 million infections and more than 4 million deaths globally. This systematic review concentrates on the epidemiological profiling of HIV/AIDS, along with the unique challenges posed by COVID-19 in delivering health services across different regions of the world. This review includes 16 studies and documents from various world regions that show the negative effects of the pandemic on HIV treatment and services. A reduction in medication compliance, missing appointments, and interruption of both clinical and non-clinical HIV-related services has been reported. Additional barriers to obtaining HIV care include fear of infection, lack of transportation and poverty. The review calls for formal agreements between governments, health systems and public health expert communities to make health systems more responsive to the needs of PLWH during and after the COVID-19 pandemic.

Although the Kenyan Ministry of Health recognizes key populations in addressing the country's HIV epidemic, gay, bisexual, and other men who have sex with men (GBMSM) face challenges in HIV testing, linkage, and retention in care. This study aimed to inform the development of context-specific interventions to improve GBMSM's initiation in HIV care in Kenya. Drawing on in-depth semi-structured interview data from the Patient-Centered Care Project (PCCP), a qualitative study exploring the experiences of people with HIV (PWH) across the continuum of care, we focused on GBMSM aged ≥18 years with HIV in Homa Bay, Kisumu, and Siaya Counties. Data from 93 interviews conducted in 2017 (60 in- and 33 out-of-HIV care) were analyzed. Participants reflected on interpersonal (stigma, emotional support) and structural (distance of clinics, food and economic insecurity) challenges and identified valuable programs that could address these (GBMSM-focused support groups, economic opportunities, food supplementation, government support). These findings highlight how stigma (related to HIV and GBMSM identity) hinders access to HIV testing services and linkage to care. Creating inclusive healthcare environments and fostering opportunities for economic support and social connections are essential for improving engagement with HIV services.