AIDS and Behavior最新文献

Transgender women and transfeminine people (TWTFP) experience disproportionately high HIV prevalence, low HIV pre-exposure prophylaxis (PrEP) coverage, and negative healthcare experiences. Long-acting injectable PrEP (LAI-PrEP) and daily oral-PrEP are delivered under different healthcare interaction protocols. We examined the role of healthcare-related experiences on willingness and preference for LAI-PrEP among a U.S. nationwide sample of sexually active TWTFP aged 15+. Recruitment occurred between 6/2022 and 10/2023 via social media advertisements for a cross-sectional online sexual health survey. Analyses included past-year PrEP naïve TWTFP with no prior HIV diagnosis (N = 1648). Participants reported LAI-PrEP willingness and ranked PrEP modality preferences; recent healthcare-related experiences were explored as correlates, using adjusted multivariable Poisson regression with robust variance estimation. Among respondents, 26.3% were willing to use LAI-PrEP (n = 433/1648). Among participants willing to use LAI-PrEP and another modality (n = 390/433; 90.1%), 45.6% (n = 178/390) preferred LAI-PrEP. Discussing sexual health with a healthcare provider (HCP) was associated with increased LAI-PrEP willingness (adjusted prevalence ratio [aPR] = 1.34; 95% confidence interval [CI] = 1.12-1.60; p = 0.001); use of oral prescription medication (non-hormonal) was associated with decreased LAI-PrEP willingness (aPR = 0.60; 95% CI = 0.38-0.93; p = 0.022). No significant associations were found between healthcare-related experiences and LAI-PrEP preference. Given that most TWTFP who were willing to use LAI-PrEP were also willing to use oral-PrEP, but nearly half preferred LAI-PrEP, offering multiple PrEP modalities is essential to meet their needs. Associations between sexual health discussions and increased LAI-PrEP willingness highlight the importance of HCP engagement; initiatives which encourage HCPs to initiate LAI-PrEP conversations in supportive ways are crucial. Associations between oral prescription use and decreased LAI-PrEP willingness, coupled with null findings related to injection use, highlight the need for further investigation.

We examined the association between educational attainment and HIV positivity among pregnant women in a high HIV-prevalence setting and assessed how this relationship varies by age to inform targeted prevention strategies. This cross-sectional study included 2003 pregnant women aged 21-44 years attending their first antenatal visit (<27 weeks' gestation) at four public health facilities in East London, South Africa, between March 2021 and May 2024. Educational attainment was categorized as pre-high school (< grade 10), high school (grades 10-12), diploma (post-high school), or degree (associate's or bachelor's). Age was categorized into four groups (21-24, 25-29, 30-34, and 35-44 years). HIV status was determined through routine antenatal testing. We used logistic regression to assess associations between educational attainment and HIV positivity, adjusting for age, partner's HIV status, and participant sexually transmitted infection (STI) status. Overall HIV prevalence was 31.0% (95% CI, 28.9%-33.0%). Compared with women with less than a high school education, the odds of HIV infection were lower among women who attained high school education (adjusted odds ratio [AOR], 0.59; 95% CI, 0.40-0.87), a diploma (AOR, 0.40; 95% CI, 0.24-0.67), or a degree (AOR, 0.21; 95% CI, 0.09-0.43). However, this inverse association was not observed among women aged 35-44 years. In conclusion, higher educational attainment was associated with lower HIV prevalence among pregnant women, but this protective association diminished with increasing age. HIV prevention strategies should account for both socioeconomic factors and age-related interpersonal dynamics influencing HIV vulnerability.

Young adults experiencing homelessness (YAEH) are significantly more likely to engage in HIV risk-related sexual behavior relative to their stably housed peers, and their social support networks can influence their engagement in these behaviors. However, few studies have investigated HIV risk behaviors among YAEH who are "couch-surfing," a highly prevalent network-based survival strategy that involves cycling through temporary, informal housing arrangements. The current study utilizes survey data collected from 461 YAEH accessing drop-in center services in Los Angeles, California, between September 2016 and October 2018. Egocentric network analysis was used to examine associations among couch-surfing, sources of social support, and HIV risk and prevention behaviors. The potential moderating effect of social support on the relationship between couch-surfing and specific sexual risk behaviors was also tested. Compared to street- and shelter-based youth, couch-surfing YAEH reported the highest rates of recent transactional sex (18.0%) and concurrent or serial sexual partners (38.2%). Relative to residing in emergency shelter or transitional housing programs, couch-surfing was associated with over twice the odds of engaging in recent transactional sex (OR = 2.52, p = .023, 95% CI 1.13-5.62)-as was living unsheltered (OR = 2.06, p = .029, 95% CI 1.08-3.95). While social support was individually associated with several HIV risk-related sexual behaviors, its effect was ultimately eclipsed by homeless situation in the final model. Findings underscore the need for individual- and structural-level interventions that attend to the unique socioenvironmental contexts of couch-surfing YAEH.

The effects of food insecurity (FI) on mental health and HIV treatment outcomes among people with HIV (PWH) in Zimbabwe are not well understood, despite its high prevalence and links to poor health. We examined associations between FI and self-reported health quality, viral load, CD4 count, antiretroviral therapy (ART) adherence, depression diagnosis and symptoms, and gender-based violence (GBV) among PWH in Zimbabwe. Participants were 484 PWH receiving HIV care in Mashonaland East Province who were assessed for enrollment in a randomized controlled trial for depression. Associations were estimated using linear or logistic regression, controlling for gender and income type. We also tested an interaction between FI and depression on ART adherence. In the past 12 months, 51% reported having skipped a meal (moderate FI) and 29% reported having skipped an entire day of eating (severe FI). Moderate FI was associated with poorer overall perceived health quality (b = -8.48, 95%CI[-12.86 to -4.10], p < .001), increased likelihood of depression diagnosis (OR = 2.13, 95%CI[1.47-3.11], p < .001), greater depression severity (b = 0.89, 95%CI[0.27-1.51], p = .005), and being a woman who experienced GBV (OR = 2.35, 95%CI[1.43-3.93], p = .001). Severe FI was associated with poorer overall perceived health (b = -8.02, 95%CI[-12.89 to -3.16], p = .001), increased likelihood of depression diagnosis (OR = 2.91, 95%CI[1.92-4.43], p < .001), greater depression symptom severity (b = 1.36, 95%CI[0.68-2.04], p < .001), and poorer medication adherence (b = -3.90, 95%CI[-7.58 to -0.22], p = .038). There was an interaction between moderate FI and depression diagnosis on ART adherence (b = -8.88, 95%CI[-15.71 to -2.05], p = .011). Screening and targeted interventions are needed to address FI among PWH in Zimbabwe.

Chemsex, defined as the intentional use of psychoactive substances to enhance sexual activity, has been associated with a higher frequency of sexually transmitted infections (STIs) diagnosis among HIV pre-exposure prophylaxis (PrEP) users. Evidence from Latin America remains limited. This research aims to characterize the practice of chemsex and STIs prevalence in PrEP users in Buenos Aires, Argentina. We conducted a descriptive, cross-sectional study using clinical records and a self-administered ad-hoc questionnaire among PrEP users attending four public hospitals. Between February to October 2024, 165 PrEP users were included. The prevalence of chemsex, during the previous year, was 32%. The drugs used, in order of frequency, were MDMA 21%; cocaine 14%; gamma-hydroxybutyrate 12%; ketamine 10%; methamphetamine 6%; mephedrone 2%; and gamma-butyrolactone 1%. Additionally, 48% reported concurrent use of two or more drugs during the practice. A multivariate logistic regression analysis showed that engaging in chemsex was significantly associated with higher odds of reporting an STI in the past year [aOR 3.67 (95% CI 1.67 - 8.42) p 0.001). Age, time on PrEP, number of sexual partners, and engagement in group sex were not independently associated with STI diagnosis. In conclusion, chemsex was common among PrEP users in Buenos Aires and independently associated with recent STI diagnosis, highlighting the importance of integrating behavioral assessments and harm reduction strategies into PrEP and sexual health policymaking.

Despite substantial global efforts, adolescent girls and young women (AGYW) in Southern Africa remain disproportionately affected by HIV. In Zambia, the HIV prevalence among AGYW is nearly three times that of their male peers. The Informed Motivated Aware and Responsible Adolescents and Adults (IMARA) program, an evidence-based HIV/STI prevention intervention initially developed in the United States and later adapted in South Africa, demonstrated promising reduction in HIV risk through culturally tailored, mother-daughter-focused strategies. This paper outlines the process of adapting IMARA for Zambian AGYW by utilizing the Framework for Reporting Adaptations and Modifications-Expanded (FRAME). The adaptation process consisted of four phases: (1) Assessment through stakeholder meetings and focus groups involving adolescents and caregivers; (2) Intervention Delivery Decisions guided by community feedback; (3) Curriculum Adaptation through iterative revisions and collaborative input from Zambian and U.S.-based researchers; and (4) Theater Testing with adolescent-caregiver dyads to refine the content. All modifications were documented using FRAME. Eight key modifications, covering content, context, and training, were implemented to create ZAIMARA (Zambian Informed Motivated Aware and Responsible Adolescents and Adults). These changes were proactively planned, occurred pre-implementation, and were deemed fidelity-consistent. Examples include translating materials into a local language and changing intervention terms and scenarios to reflect cultural norms. Applying FRAME to adapt IMARA in Zambia provided a transparent, systematic method to maintain cultural relevance with fidelity to an evidence-based intervention. Our study demonstrates the utilization of the FRAME for future adaptations of HIV prevention programs in diverse global contexts.

Black and Latinx gay, bisexual and other men who have sex with men (BLMSM) face disproportionate HIV burdens due to structural racism and homonegativity which manifest as multiple forms of violence that disrupt consistent HIV care engagement. This study examined pathways linking interpersonal, community and structural violence exposure to antiretroviral therapy (ART) use among young adult BLMSM and explored the mediating roles of substance use and negative affect. Participants (N = 41; ages 18-34) living with HIV in New York City completed a 90-day ecological momentary assessment (EMA) between May 2021 and March 2023. Multilevel logistic regression with Bayesian estimation assessed within- and between-person differences in ART use. Both witnessing and directly experiencing violence were associated with lower odds of same-day ART use, an effect mediated by negative affect. Violence exposure increased negative affect, which reduced same-day ART use by 50%, independent of race/ethnicity, violence exposure type, housing support and substance use. Cannabis use was linked to higher odds of same-day ART use but lower long-term maintenance. Non-Hispanic Black men and those receiving HIV/Services Administration (HASA) housing support demonstrated greater ART engagement, highlighting the critical role of housing stability in improving HIV-related health outcomes. Negative affect emerged as the strongest predictor of daily ART use, underscoring the need to integrate trauma-informed mental health support into HIV care for BLMSM. Additional research is needed to clarify the temporal and differential impacts of violence exposure and cannabis use on ART engagement.

Long-acting injectable PrEP (LAI-PrEP) provides opportunities to expand HIV prevention coverage in the Netherlands. Understanding which Dutch gay, bisexual and other men who have sex with men (GBMSM) are interested in using LAI-PrEP when available can support HIV prevention efforts. Survey data was collected online via the PROTECT survey from 1,447 GBMSM in the Netherlands between October 2023 and March 2024. Multivariable logistic analysis was conducted to determine variables associated with GBMSM who intend to use LAI-PrEP when available. Interest and intention to use LAI-PrEP among Dutch GBMSM is high (76.1% and 73.9%) and among those currently on oral PrEP even higher (80.8% and 79.5%). GBMSM who intend to use LAI-PrEP have more sexual partners in the past 6 months (11-50 partners (aOR = 3.24; 95%CI: 1.54-6.85), 51-100 partners (aOR = 3.10; 95% CI: 1.20 to 8.30), more than 150 partners (aOR = 3.86; 95% CI: 1.74 to 8.67)), engage more in chemsex (aOR = 1.41; 95% CI: 1.00 to 2.01), are less likely to fear LAI-PrEP side effects (aOR = 0.83; 95% CI: 0.74 to 0.94;) or injection pain (aOR = 0.68; 95% CI: 0.61 to 0.75) and more likely to believe they are at risk of acquiring HIV (aOR = 1.23; 95% CI: 1.05 to 1.45). If made available in the Netherlands, many GBMSM are likely to commence using LAI-PrEP, particularly current oral PrEP users or discontinued users. Sexually active Dutch GBMSM, who are already protecting themselves, may be the first group to use LAI-PrEP.

People with HIV (PWH) experience trauma and mental health burdens at higher rates than seronegative individuals. Psychosocial interventions have shown promise for improving mental health and coping among PWH, but relatively few trauma-informed, coping-focused mobile health (mHealth) interventions exist. This pilot study evaluates the preliminary outcomes of NOLA Gem, a just-in-time adaptive intervention (JITAI)-based mHealth app designed to support real-time coping among people living with HIV (PWH) in the New Orleans area. Participants were assigned to either a control or intervention group; the intervention group received access to the NOLA Gem app, which delivered psychoeducation modules and just-in-time skill suggestions based on daily diary responses over a three-week period. Both groups completed brief daily diary surveys over the 3-week period to assess stress, emotion regulation, and coping outcomes. Analyses demonstrated positive changes in treatment compared to control, particularly in the final week. From week 1 to week 3, participants in the treatment group experienced significant reductions in maladaptive coping, rumination, and PTSD symptoms compared to the control group, along with increased feelings of control over stress at both timepoints. These effects were especially pronounced among high completers, who demonstrated greater improvements in maladaptive coping, rumination, and stress control compared to both low completers and controls. High completers also showed significant decreases in overall stress and self-reported alcohol use. These preliminary findings suggest that NOLA Gem is a promising intervention for improving coping and reducing trauma-related symptoms among PWH, particularly for those who actively engage with the app.Trial Registration: ClinicalTrials.gov NCT05784714; https//clinicaltrials.gov/ct2/show/NCT05784714.

Pre-exposure prophylaxis (PrEP) is a medication that significantly reduces the risk of HIV infection when taken as prescribed, however, less than 36% of the 1.2 million eligible-for-PrEP Americans are currently prescribed it. PrEP navigators can help reduce barriers to PrEP uptake and increase access to care for those vulnerable to HIV. As part of formative work for designing an e-peer navigation tool, MyPEEPS Mobile Plus, twenty PrEP navigators were interviewed about barriers and facilitators to PrEP options, delivery, and peer navigation. We analyzed our findings using the nine-step PrEP care continuum as a framework. Participants described how medical mistrust, cultural competency, patient assistance programs, availability of PrEP options, prescriber knowledge and availability, housing insecurity, and rapport contribute to uptake and adherence of PrEP and retention in care. In summary, our study highlights the crucial role of PrEP navigators in facilitating access to HIV prevention services and demonstrates strategies to overcome individual and structural barriers in a clinical setting. These findings will improve the design of the MyPEEPS Mobile Plus intervention and may inform future e-peer navigation strategies.