AIDS patient care and STDs最新文献

African immigrants in the United States experience increased HIV risk due to social and structural barriers such as language constraints, stigma, and cultural misconceptions. Despite this, research on effective pre-exposure prophylaxis (PrEP) messaging tailored to this population remains limited. This study examines how PrEP communication can be adapted to meet the needs of Ghanaian immigrants who represent a segment of the larger African immigrant population. Semistructured interviews were conducted, transcribed verbatim, and analyzed using NVivo 12. The analysis highlights key considerations for effective PrEP messaging, including the importance of cultural and linguistic relevance, the role of familiar and relatable messengers, and the need for clear and practical information. Participants emphasized the significance of addressing stigma and misinformation with factual, empathetic messaging and expressed a preference for ongoing community-based education about PrEP. Community leaders and health care professionals were identified as influential sources of information, capable of shaping attitudes and increasing uptake. These findings underscore the necessity of culturally tailored, community-driven approaches to PrEP messaging that bridge linguistic and cultural gaps. Integrating these insights into health communication strategies can improve awareness, acceptance, and utilization of PrEP among Ghanaian immigrants, ultimately contributing to more equitable HIV prevention efforts.

In 2022, cisgender women accounted for one in five HIV diagnoses in the United States. Existing structural, social, and behavioral factors impede women's engagement with HIV prevention strategies including Pre-Exposure Prophylaxis (PrEP) access, condom usage, and uptake of HIV testing. This study explores the perspectives of women living with HIV (WLWH) about factors that may contribute to HIV acquisition and their advice for women who may benefit from HIV prevention strategies. We conducted semistructured interviews with 40 WLWH who were diagnosed on or after January 1, 2000. Interviews were conducted via Zoom and lasted 45-60 min. Interviews were professionally transcribed, coded, and analyzed to identify themes. Guided by the AIDS Risk Reduction Model, this study uses qualitative findings to describe the steps for recognizing and reducing HIV vulnerabilities. The analysis revealed three themes: (1) recognizing HIV risk for oneself and partner, (2) commiting to decreasing HIV risk, and (3) enacting HIV risk reduction strategies. After recognizing the personal and partner characteristics associated with increased HIV risk and committing to reducing that risk through self-love, relationship assertiveness, and boundary setting, women will be better prepared to enact risk reduction strategies. The four most commonly discussed strategies by WLWH included HIV testing, condom usage, PrEP, and avoiding drug use. This study highlights the importance of understanding the experiences of WLWH to inform effective HIV prevention strategies. Insights from these women emphasized the need for increased awareness, empowerment, and accessible resources to support HIV risk recognition and reduction among women.

HIV pre-exposure prophylaxis (PrEP) is underutilized in the United States. Emergency departments (EDs) can be strategic locations for initiating PrEP; however, knowledge concerning patients' receptivity to ED PrEP programs is limited. This study explores ED patients' perspectives on PrEP service delivery and their preferences for implementation. Semi-structured qualitative interviews were conducted with 15 potentially PrEP-eligible ED patients to examine their receptiveness to PrEP services, preferences for delivery methods, and logistical considerations. Most participants were open to learning about PrEP in the ED, provided it did not delay care, occur during distress, or compromise privacy. Universal PrEP education was viewed as reducing stigma and increasing awareness, while targeted screening was considered efficient. Participants strongly preferred receiving information in person rather than via videos or pamphlets. Concerns included ensuring ED staff expertise and maintaining privacy during PrEP-related discussions. Opinions on initiating same-day PrEP versus prescriptions or referrals varied, with participants valuing flexibility and linkage to care. This first qualitative study of ED patients' perspectives on PrEP services highlights general receptiveness, with key concerns about privacy, expertise, and wait times. Patient-centered approaches, such as integrating services into ED workflows, offering flexible initiation options, and providing privacy, can address barriers and enhance the feasibility of ED-based PrEP programs.

Indonesia is a country deeply rooted in religion, faith, and spirituality. These aspects significantly determine individuals' decision-making and behavior, including health care decisions. Given the suboptimal attainment of the HIV-cascade targets in the country, we conducted a study to explore the role of religion, faith, and spirituality on antiretroviral therapy (ART) initiation. Our study involved individual interviews with 67 participants recruited from community health centers, public hospitals, and private clinics, predominantly Muslim, including 17 untreated people with HIV (ART-naïve), 30 people with HIV on treatment (ART-experienced), and 20 HIV service providers. Findings revealed that many individuals perceived HIV as a godly punishment related to individual failure (prior risk-prone behaviors), generating shame, guilt, and stigma. Perceiving religion as punitive and unforgiving and holding fatalistic beliefs was linked to postponed ART initiation. Conversely, perceiving religion as loving and forgiving, seeking forgiveness through religious practices, viewing ART intake as a "collaborative" effort with God, and engaging in righteous deeds facilitated ART initiation. These findings indicated that religion, faith, and spirituality can serve as both barriers and facilitators to ART initiation, depending on individuals' faith-based practices and perceptions of religion, whether punishing or forgiving. We recommend that people with HIV and health care providers better recognize the role of religion, faith, and spirituality in coping with shame, guilt, and stigma after an HIV diagnosis. This recognition can facilitate informed decisions regarding ART initiation, ultimately improving health outcomes for individuals with HIV in Indonesia.

Homelessness adversely impacts continuity of care for people with HIV (PWH). The POP-UP program is a low-barrier drop-in care model embedded within an HIV clinic in San Francisco and is designed to serve PWH experiencing homelessness. We conducted a pilot study of mobile outreach for PWH in POP-UP who remain out-of-care despite the drop-in program. We conducted a mixed-methods study to evaluate the effectiveness of mobile outreach through a retrospective cohort of PWH eligible for this outreach and semistructured interviews. Patients with POP-UP were eligible for outreach if they had (1) HIV viral load ≥200 copies/mL and no visit in ≥30 days, (2) no clinic visit in ≥180 days, or (3) urgent re-engagement need identified by the clinic team. We report the proportion of patients re-engaging in clinic-based care within 30 days and thematic findings from semistructured interviews with patients who experienced mobile outreach. Of 74 patients eligible for outreach, 55 were outreached, 48 located, and 30 returned to clinic within 30 days. Most were currently housed in a single-room occupancy hotel (39%) or permanent supportive housing (25%), 87% had a substance use disorder, and 51% had a mental health diagnosis. Qualitative findings highlighted the value of mobile outreach in terms of interpersonal relationships with the clinical team and the perception that outreach was a helpful nudge to return to clinic. Among PWH with housing instability who are out-of-care despite access to drop-in clinic-based services, mobile outreach was acceptable and promising for locating patients and facilitating care re-engagement.

This mixed-methods study explored self-image among people with HIV participating in an HIV cure-related study involving analytical treatment interruptions (ATIs). Using both quantitative and qualitative approaches, we described how self-image emerged across study participation, focusing on internalized stigma, emotional strengths, and the psychosocial dimensions of study participation. Data come from the SCOPE-ATI substudy (NCT00187512) of the University of California San Francisco SCOPE cohort (NCT04359186). Quantitative data were collected at three timepoints: pre-ATI (n = 15), post-ATI (n = 12), and end of the study (n = 14). We observed a general decline in self-image scores over time. However, participants maintained a moderately high agreement with statements about contributing to reducing HIV stigma through their involvement in the study. Qualitative interviews were collected pre-ATI (n = 11), during ATI (n = 8), and post-ATI (n = 6). Qualitative findings revealed two major themes shaping self-image: (1) experiencing and reconciling internalized HIV stigma and (2) self-evaluations in relation to life purpose. Many participants expressed disappointment at having to resume antiretroviral therapy, viewing it as a reminder of their HIV status and its associated stigma. Nevertheless, some found purpose and pride in their participation, motivated by altruistic contributions to improving future HIV control options. The findings highlight the emotional complexities of participating in HIV cure research and underscore the need for psychosocial support throughout ATI studies. While most participants experienced a decline in self-image, some derived meaning and empowerment from their involvement. This study suggests that addressing emotional well-being and reinforcing participants' contributions to science can enhance their experience in future research.

Interventions that leverage telehealth technologies have the potential to improve health outcomes among people with HIV who experience multiple complex barriers to care. To assess the current state of knowledge on telehealth interventions for people with HIV in the United States, we searched the literature for recent (2019-2023) telehealth interventions designed to improve outcomes along the HIV care continuum, including linkage to care, retention in care, antiretroviral therapy adherence, and viral suppression. Our search identified 23 interventions. Text messaging was the most common telehealth delivery mode, followed by videoconferencing, commercially available applications, and novel applications. Nine interventions used more than one delivery mode. Common features across interventions to address barriers along the HIV care continuum included: HIV care self-management and monitoring tools; HIV treatment and adherence education; resources and referrals provision; live messaging for ongoing support or urgent issues; videoconference-based coaching, counseling, case management, or care; online peer-to-peer support; ecological momentary assessments to monitor and address barriers; and game-based elements to increase engagement. Interventions were reported as acceptable and feasible, with several showing an effect on antiretroviral therapy adherence. Further research is needed to fully leverage the potential of telehealth for ending the HIV epidemic in the United States.