AIDS and Behavior最新文献

We have monitored Australia's maturing HIV pre-exposure prophylaxis (PrEP) program for the past decade, providing a unique view of long-term implementation among gay, bisexual and queer men and non-binary people. Using two national surveys, the GBQ + Community Periodic Surveys (GCPS, 2014-2023, N = 78,378) and the PrEPARE Project (2017-2023, N = 5,278), we constructed and iteratively refined cascades to monitor PrEP suitability, awareness, use, and service engagement. The PrEPARE cascade also included willingness, provider engagement and psychosexual benefits of PrEP. By 2023, both cascades showed near-universal PrEP awareness among PrEP-suitable participants. In the GCPS cascade, PrEP use increased from < 1% of PrEP-suitable participants in 2014 to 30% in 2023, while in PrEPARE it increased from 21% in 2017 to 46% in 2023. However, in 2023, 29% of GCPS participants who were suitable and aware were not using PrEP, and 14% of PrEPARE participants who were PrEP-suitable and aware were unwilling to use it. PrEP use was lower among younger participants, bisexual and queer-identified participants compared with gay-identified participants, those outside metropolitan areas, and migrants without government-subsidised healthcare. Australia is among the few countries with repeated PrEP cascades that have been revised as implementation has evolved. We show that Australia has achieved near-universal PrEP awareness but highlight persistent inequities in uptake. Our findings demonstrate the value of long-term cascade monitoring and the need to address financial, geographic, and risk-perception barriers to close remaining gaps.

HIV incidence is high among young female sex workers (YFSW) in Kenya. Pre-exposure prophylaxis (PrEP) for HIV prevention is recommended for at-risk populations, but its effectiveness requires consistent access and adherence. The IPrEP study compared the feasibility, acceptability, and effectiveness of two adherence support interventions on PrEP adherence among YFSW in Kisumu, Kenya. Study follow-up coincided with national restrictions on travel and gatherings due to the COVID-19 pandemic. We conducted an unblinded, randomized-controlled trial enrolling 18-24 year-old HIV-negative YFSW with no current or recent PrEP use (NCT03988387, registered: June 17, 2019). Participants were initiated on oral PrEP and randomized to either peer-delivered adherence support (PS), or SMS reminders and resource transfer (RRT) to support adherence for 12 months. PrEP was provided without these interventions for an additional 12 months to assess the durability of their effect. Intention-to-treat analysis of effectiveness was conducted at 12, 18, and 24 months using plasma tenofovir levels and self-report. Of the 289 YFSW screened, 200 were enrolled (100 per arm). Median age was 22 years, 46% reported condom use at last sex, and 26 male clients averaged in the past month. At 12, 18, and 24 months, detectable levels of tenofovir in plasma were 3%, 1%, and 0% in the PS arm and 9%, 9%, and 1% in the RRT arm (p-value = 0.4). Perfect 7-day adherence was self-reported by 85%, 81% and 83%, and 86%, 87% and 76% in the PS and RRT arms at 12, 18 and 24 months, respectively. Two seroconversions occurred during follow-up: one at 12 months and one at 18 months of follow-up. In this population of YFSW, no difference in tenofovir levels by arm was noted. The very low levels of tenofovir in the plasma, in contrast to high self-reported adherence, may be due in part to perceived lower HIV risk resulting from decreased frequency of sex work during the COVID-19 period. Findings highlight the urgent need for long-acting PrEP for this population.

Stigma in healthcare settings is a critical barrier to HIV prevention and treatment among people who inject drugs (PWID). While previous tools have measured anticipated stigma, few account for the intersectional and provider-specific experiences of PWID-particularly from syringe service programs (SSPs). We developed and validated the Substance Use Anticipated Provider Stigma Scale (SU-APSS), a multidimensional instrument assessing anticipated stigma from four provider types: healthcare workers, substance use treatment staff, pharmacists, and SSP personnel. Data were drawn from a cross-sectional survey of 264 PWID who were 18 or older, HIV-negative, had injected drugs and used opioids within the past 30 days, and showed visible signs of recent injection. We conducted confirmatory factor analysis (CFA) on responses from 218 participants to evaluate structural validity and used Cronbach's alpha to assess internal consistency. The CFA supported a four-factor structure with strong model fit indices (CFI = 0.97, RMSEA = 0.09 [0.07, 0.11], SRMR = 0.04). All items significantly loaded onto their respective factors (loadings: 0.62-1.06). Internal consistency was high across all subscales (α = 0.85-0.96) and for the overall scale (α = 0.87). Attribution analysis revealed drug use, physical appearance, and income level as the most common perceived reasons for anticipated stigma. The SU-APSS offers a practical tool for identifying provider-specific stigma, informing stigma-reduction interventions, and evaluating implementation strategies to improve HIV prevention and care engagement among PWID.

Persons living with HIV (PLWH) are disproportionately exposed to traumatic events, which are associated with posttraumatic psychological distress and impaired HIV-related health outcomes (e.g., antiretroviral non-adherence, HIV viremia, lower CD4 count). Prior literature has not adequately differentiated the effects of trauma and posttraumatic distress on HIV-related health outcomes. This study examined longitudinal data of trauma exposure and posttraumatic psychological distress among PLWH. Participants were 255 PLWH in care at a public HIV clinic that completed baseline and one-year follow-up psychosocial assessments between April 2017 and May 2024. Assessments included measures of lifetime trauma exposure, symptoms of depression, anxiety, and posttraumatic distress, and antiretroviral adherence. HIV RNA viral load and CD4 count were extracted from medical records. Factor analysis was used to consider multifaceted posttraumatic responses. Path analysis was used to examine direct and indirect effects of trauma exposure and posttraumatic distress on HIV-related outcomes. Most participants endorsed lifetime trauma exposure (88.2%). Trauma exposure was associated with increased posttraumatic psychological distress (est.=0.281, p = 0.004). Psychological distress predicted lower antiretroviral adherence (est.=-0.070, p = 0.033), which was associated with higher log HIV RNA viral load (est.=-0.477, p < 0.001) and lower CD4 count (est.=84.754, p < 0.001). Controlling for distress, trauma exposure did not predict HIV-related health outcomes. Trauma exposure was highly prevalent and posttraumatic psychological distress predicted poorer HIV-related health outcomes at follow-up. These findings highlight the need for universal trauma-informed care and the utility of integrated psychological services for those impacted by posttraumatic distress within HIV treatment settings to improve HIV-related health outcomes.

Cervical cancer remains a leading cause of cancer-related death, especially among women living with HIV (WLH). This qualitative study explored barriers and facilitators to cervical cancer screening from the perspective of healthcare providers and WLH at Clínica de Familia La Romana, a large primary care clinic that specializes in HIV in the Dominican Republic. Ten providers and 25 WLH participated in interviews, which were analyzed in Dedoose using inductive analysis guided by the Framework for Improving the Quality of Cancer Care. Three themes emerged: (1) continuity across stages of cancer care; (2) multilevel factors influencing clinical encounters and follow-up; and (3) organizational strategies to improve screening quality. Our findings explored needs for (1) treatment cascades that streamline sampling and results, (2) increased patient education efforts, and (3) improved linkage to treatment services.

An effective HIV vaccine could significantly reduce HIV incidence, but demand for future HIV vaccines will be affected by misinformation. We conducted an online survey (March-April 2024) to identify the misinformation claims most likely to deter young women in South Africa (n = 188) from receiving an HIV vaccine. Participants rated HIV-vaccine misinformation as most concerning (i.e. would make them not want to get vaccinated) and least concerning (i.e. would not change a decision to get vaccinated). From 54 misinformation claims found in peer-reviewed and grey literature (e.g., reports), participants viewed two sets of 9 randomly chosen claims. Within each set, they selected the 3 most concerning and 3 least concerning claims. Claims were ranked according to their likelihood of being selected as most or least concerning. Misinformation claims that were rated as most concerning were about HIV vaccine safety, particularly those suggesting severe adverse health effects (e.g. the vaccine "will kill you", selected 85% of times viewed). Also rated as concerning were claims that the vaccine was created to harm certain populations (e.g., "designed to sterilise Black women", 60% selected); that the vaccine increases rape and pregnancies (51% selected); and gives you HIV (50% selected). The least concerning misinformation related to the themes of stigma, vaccine efficacy, and the availability of other HIV prevention options. Misinformation that the HIV vaccine causes harm, increases risky behaviour, and gives recipients HIV may have the greatest impact on vaccination intentions. Research is needed to design and test interventions that build resistance to such misinformation.

Men attending social venues face barriers to accessing HIV prevention and care services. These venues-such as bars, guesthouses, nightclubs, and transport hubs-facilitate new sexual partnerships but lack cohesive social networks, making it challenging to design and implement effective HIV prevention strategies. Men who attend social venues are more likely to pay for sex, potentially increasing their risk of acquiring or transmitting HIV. However, data on how HIV-related behaviours and service engagement differ between men who do and do not pay for sex among those attending venues remain limited. This study examines whether men who pay for sex have higher rates of HIV prevalence, lower rates of virological suppression, and poor HIV-prevention-related behaviours compared to those who do not. Using the Priorities for Local AIDS Control Efforts (PLACE) methodology, we collected cross-sectional data from April to December 2022 across 190 venues in four cities and towns in Zimbabwe. Participants underwent finger-prick HIV testing; those testing positive provided dried blood spots (DBS) for viral load measurement. We also collected sexual behaviour data, including condom use. We applied survey weights and used weighted Poisson regression models with robust standard errors to investigate factors associated with HIV status, virological suppression, and condom use among venue-going men, treating paying for sex as the primary exposure variable. All reported percentages are weighted. Among venue-going 2,827 men, 984 (40.1%) reported paying for sex in the past 12 months, and 531 (15.1%) reported consistent condom use in the past month. Overall, HIV prevalence was 10.7%. Among men living with HIV, virological suppression was 67.9%. In adjusted analyses, there were no significant associations between paying for sex and HIV status (adjusted prevalence ratio (aPR) = 1.12, 95% CI: 0.64-1.94), self-reported consistent condom use in the past month (aPR = 0.87, 95% CI: 0.57-1.34), or rates of virological suppression among men living with HIV (aPR = 0.97, 95% CI: 0.71-1.34). Findings indicate substantial HIV risk and suboptimal prevention and treatment engagement among men frequenting social venues, irrespective of paying for sex. Therefore, targeted interventions are needed for both paying and non-paying men.

The purpose of this study was to describe the HIV care continuum postpartum in a cohort of postpartum women with HIV (WWH) in Philadelphia, and assess the impact of the City's perinatal case management (PCM) program on engagement in the HIV care continuum. A cohort of 937 mothers who gave birth between 1/1/2012 and 12/31/2023 and who lived, gave birth, or received perinatal and pediatric care in Philadelphia, PA were enrolled. Using public health surveillance data, the impact of PCM use on engagement in care at 90 days postpartum, retention in care at 1-year postpartum, and viral suppression at 1-year postpartum was assessed using logistic regression with robust standard errors. Overall, 51.1%, 65.4%, and 42.0% of the population was engaged in care at 90 days, and retained in care and virally suppressed at 1-year, respectively. A larger percentage of PCM users than non-users were engaged in care at 90 days (56.4% versus 43.9%) and retained in care (73.2% versus 59.2%) and virally suppressed (48.2% versus 37.1%) at 1 year. After controlling for confounders, PCM use was significantly associated with increased engagement in care at 90 days (aOR = 1.403 [1.030-1.913]), retention in care at 1 year (aOR = 1.576 [1.163-2.136]), and viral suppression at 1 year (aOR = 1.412 [1.060-1.881]). Philadelphia's PCM program is effective in improving engagement in the HIV care continuum during the postpartum period. Other US cities, particularly those with high HIV prevalence, should consider adopting a similar city-funded PCM program for pregnant and postpartum WWH.

Dyadic coping among sexual minority men (SMM) has been a focus of HIV prevention research for decades, but few studies have examined relationship quality as a covariate of HIV care cascade outcomes (ART adherence and an undetectable viral load (VL)). This study utilized a 5-category relationship status variable (single; non-monogamous, sero-discordant; non-monogamous, sero-concordant; monogamous, sero-discordant; monogamous, sero-concordant) to test the hypothesis that relationship quality would moderate associations between relationship status and HIV care outcomes. Adult SMM living with HIV (LWHIV) (n = 1389), recruited via social networking applications between January and December 2021, completed a cross-sectional, online survey. At average levels of relationship quality, only non-monogamous SMM with sero-discordant partners were more likely to be adherent to ART (OR = 3.064, p<.001) and have an undetectable VL (OR = 2.595, p<.001) compared to single SMM. Among non-monogamous SMM with sero-discordant partners, relationship quality was positively associated with ART adherence (OR = 1.065, p<.001) and having an undetectable VL (OR = 1.046, p=.003). Among monogamous SMM with sero-concordant partners, the effect of relationship quality on ART adherence (OR=0.855, p=.007) and having an undetectable VL (OR=0.909, p=.011) was significantly smaller compared to non-monogamous SMM with sero-discordant partners. Among non-monogamous SMM with sero-concordant partners, the effect of relationship quality on ART adherence (OR=0.956, p=.039) was also significantly smaller compared to non-monogamous SMM with sero-discordant partners. Results suggest non-monogamous SMM with sero-discordant partners in high-quality relationships may experience the greatest motivation to engage in HIV care. Messages enhancing motivation for care engagement to improve individual health for SMM LWHIV may augment treatment as prevention.

Alcohol use and risky alcohol use are associated with health, social, and psychological complications and may interfere with HIV/AIDS treatment. This study assessed the prevalence and factors associated with alcohol use and risky alcohol use among adults living with HIV in Dar-es-Salaam, Tanzania. This cross-sectional study included data from 771 adults living with HIV on antiretroviral therapy (ART) who were enrolled in a non-inferiority cluster randomized controlled trial. Alcohol use and risky drinking in the past 12 months were assessed using the Alcohol Use Disorders Identification Test (AUDIT-C) tool. Log-binomial regression models were applied to identify factors associated with alcohol use and risky alcohol use. Overall, 31.4% of participants reported current alcohol use (n = 242). Among these individuals, 45.5% (n = 110) engaged in risky alcohol use (14.2% among all participants). About a quarter (23.2%) were classified as engaging in heavy episodic drinking (HED). In multivariable models, older adults (RR = 0.27; 95%CI: 0.13-0.54) and males (RR = 0.68; 95%CI: 0.46-1.01) had a lower risk of risky alcohol use. Individuals who had disclosed their status to their partners were more likely to report risky alcohol use compared to those who had not disclosed (RR = 1.33; 95%CI:1.00-1.78). These findings indicate that alcohol use is common among adults living with HIV, with half of current drinkers engaging in risky consumption patterns, including HED. Risky alcohol use was more prevalent among younger adults and women. These results underscore the need for targeted interventions addressing risky alcohol use within primary HIV care settings, particularly for young adults and women.