AIDS and Behavior最新文献

Youth living with HIV have low rates of medication adherence. Youth ages 15–24 years with adherence ≤ 80% or with HIV RNA PCRs (VL) ≥ 200 recruited through social media and clinical sites were randomized to brief weekday cell phone support (CPS) calls or daily, two-way, personalized text message (SMS) reminders for 3 months. Those with VL ≥ 200 or adherence ≤ 80% were rerandomized to receive SMS or CPS with monthly incentives for those utilizing the intervention at least 75% of days for 3 months. Those with VL < 200 or adherence > 80% after the initial 3 months were rerandomized to usual care or 3 months of tapered, 2x/week CPS or SMS. Self-reported adherence and VLs were collected every 3 months for one year. Eighty-three youth were recruited with 81% identifying as cisgender males, 55% Black, 22% Latine/x, and 76% gay, and 56% recruited from the Southern US. Both cohorts initially randomized to CPS and SMS demonstrated significant improvements in adherence over the 12-months (P <.001). Participants randomized to CPS had significant improvements in 7-day self-reported adherence over 12 months compared to those on SMS (P <.027). Those receiving a tapered intervention for an additional 3 months had improved self-reported adherence compared to those randomized to the standard of care arm (P <.001). Both SMS and CPS appear to be effective interventions for youth with poor antiretroviral adherence. Tapering the intervention for an additional 3 months is useful in maintaining adherence after the initial intervention. Additional research is required to determine how to best sequence these interventions, including the use of incentives.

Graphical Abstract

Previous research suggests that depression impacts HIV outcomes, including viral suppression. This meta-analysis quantifies the association between depression and HIV viral suppression. A systematic literature search was conducted in PubMed, Web of Science, EBSCO, and OVID to identify studies published through 2012 to 2022. The software Rayyan was used to evaluate eligibility of studies, and the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were used for abstracting data. A random effects meta-analysis was performed using Review Manager 5.4.1. Of the 1911 articles screened, 16 studies were included covering 80,103 participants. The results showed individuals without depression were more likely to achieve HIV viral suppression or undetectable viral load compared to individuals with depression (OR 1.30; 95%CI 1.15, 1.48; I² = 76%). Subgroup analysis indicated this effect was significant among the general population of people living with HIV (n = 75,353; OR 1.32; 95%CI 1.12, 1.55; I² = 85%) and cisgender women living with HIV (n = 4553; OR 1.28; 95%CI 1.09, 1.50; I² = 16%), but not among cisgender men living with HIV (most identified as men who have sex with men) (n = 197; OR 2.13; 95%CI 0.43, 10.61; I² = 83%). This meta-analysis shows a significant positive association between the absence of depression and achieving HIV viral suppression overall and among the subgroup of cisgender women. Public health interventions for people living with HIV should include strategies to identify and address the depressive symptoms that impact adherence to treatment, increase the risk of psycho-behavioral co-morbidities, and exacerbate social or structural factors impeding viral suppression.

Young sexual and gender minority (SGM) people assigned male at birth who use substances are at elevated risk of HIV acquisition. This brief report leverages a large cohort of SGM people assigned male at birth to estimate substance use homophily (i.e., same-same substance use status) in sexual partnerships. We found substance use homophily in this sexual network for marijuana, poppers, methamphetamine, and hallucinogens but not heavy episodic drinking, cocaine, or ecstasy. These results suggest substance use is associated with sexual network structure and may increase HIV disparities between individuals who do and do not use substances.

Confidentiality concerns are a well-established barrier to sexual health services for adolescents. These barriers are likely even greater for young men who have sex with men (YMSM), who often experience stigma at multiple levels. This study examined the relationship between state laws regulating minors’ access to confidential sexual health services, sexual behavior, and lifetime HIV testing among a large, representative sample of sexually active male high school students from the 2019 state-level Youth Risk Behavior Surveillance System (23 states; N = 17,509). We used multilevel logistic regression to examine whether confidentiality-promoting state laws (i.e., states that explicitly allowed minors to self-consent to HIV testing, did not have an age clause which set a minimum age to self-consent to sexual health services, did not permit parental notification, had confidentiality protections for insured dependents) were associated with lifetime HIV testing, and whether associations differed between YMSM (n = 1,718) and young men who have sex with women only (i.e., YMSWO; n = 15,791). After adjusting for individual- and state-level characteristics, HIV testing was significantly more likely for students in states that explicitly allowed minors to self-consent to HIV testing (adjusted odds ratio [aOR]: 1.12, 95% confidence interval [CI]: 1.05–1.21, p <.001), did not permit parental notification (aOR: 1.09, CI: 1.05–1.12, p <.001), or had confidentiality protections for insured dependents (aOR: 1.40, CI: 1.34–1.45, p <.001), and significantly less likely for those in states that lacked age clauses (aOR: 0.82, CI: 0.80–0.84, p <.001). We found no evidence for moderation of these associations by YMSM status (i.e., the effects of laws being confidentiality-promoting on HIV testing did not differ significantly for YMSM and YMSWO). Findings suggest that certain confidentiality-promoting state laws may be effective at increasing HIV testing among sexually active male adolescents, regardless of sexual behavior.

Sexual assault victimization experience and alcohol consumption are well-documented HIV risk factors for women who have sex with men (WSM). Nonetheless, behavioral mechanisms of the synergistic effects of these factors on women’s increased HIV risk are not well delineated. This study is the first to examine the interactive effects of sexual assault history and acute intoxication on women’s condom negotiation behavior during a face-to-face role-play with a male actor. Participants were female, single, social drinkers, ages 21 to 35, recruited from the community. Women were categorized as having experienced past sexual assault victimization or not based on their questionnaire responses, then were randomly assigned to consume either no alcohol or alcohol (0.08 target BAC) and engaged in a role-play with a male actor that included condom use negotiation. Participants’ verbal, paraverbal, and nonverbal behavior was video recorded and coded by independent raters. As hypothesized, sexual assault history interacted with alcohol condition to significantly influence participants’ assertive condom negotiation behavior. These results further our scientific understanding of how intoxication may exacerbate the relationship between sexual assault history and HIV risk, and can inform prevention programs tailored to the unique needs of WSM who have a history of sexual assault victimization and are social drinkers.

Adolescents in the United States (US) continue to be disproportionately impacted by HIV and STIs. We investigated the associations between sexual health and substance use behaviors with HIV and STI testing among high school students in the US. Cross-sectional weighted stepwise multivariate logistic regression models were conducted to determine the odds of lifetime HIV and STI testing among students, stratified by sex. Drugs and alcohol before sex, condom use during sex, number of sex partners, sex of sexual partners, substance use (e-cigarette, alcohol, and cannabis) frequency, lifetime cocaine use, and lifetime prescription drug misuse were predictors, adjusting for race/ethnicity and age. This analysis used the 2019 and 2021 cycles of the CDC Youth Risk Behavioral Surveillance System (YRBSS) data. Our sample of adolescents (n = 30,909) had a mean age of 16; 51% were male. Females engaging in substance use had increased odds of HIV and STI testing whereas that pattern did not reflect among males. Multiracial male adolescents had increased odds of HIV testing. Females engaging in condomless sex had lower odds of HIV and STI testing. This study highlights the need for tailored HIV and STI testing promotion and ongoing efforts for dismantling barriers to testing services. Furthermore, our study suggests that screenings follow the concurrent nature of sexual health and substance use behaviors of adolescents for integrated HIV/STI testing.

We assessed the uptake of COVID-19 vaccination in a community-recruited sample of people who inject drugs (PWID) in San Francisco in 2022. Overall, 72.4% (95% CI 64.6–80.3) were vaccinated for COVID-19. Independent predictors of vaccination were age 65 years and older (adjusted odds ratio [AOR] 9.7, 95% CI 2.2–28.7) and ever testing positive for COVID-19 (AOR 2.0, 95% CI 1.2–3.5). Homelessness was associated with lower COVID-19 vaccination (AOR 0.5, 95% CI 0.3–0.8). Our study underscores the urgent need for targeted interventions to address unique challenges faced by PWID in accessing COVID-19 vaccination, particularly for those experiencing homelessness and who are younger.