AIDS and Behavior最新文献

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.

Background: Heterosexual sex accounts for 87% of new HIV diagnoses among cisgender women. We sought to explore the intersection of partner dynamics and oral preexposure prophylaxis (PrEP) adherence among cisgender women in heterosexual serodiscordant relationships.

Methods: From June 2017-August 2018, we conducted semi-structured in-depth interviews using a social ecological model framework. Twenty cisgender women in serodiscordant relationships, who participated in a PrEP demonstration project to evaluate adherence and retention in San Diego and Los Angeles, participated in in-depth interviews. Interviews were audio-recorded and transcribed, and transcripts were analyzed using thematic analysis.

Results: Among the 20 participants, the median age was 37.5 years (IQR 32, 48), with n = 6 (30%) identifying as Black and n = 5 (25%) as Hispanic. Sixty-five percent of women had protective drug levels based on real-time tenofovir-diphosphate drug level assays at the study visit prior to their interviews. Some partners played a significant role in PrEP adherence, often showing support by vocalizing encouragement and appreciation, offering reminders to take PrEP, and sometimes administering PrEP. Other partners were unsupportive and discouraged PrEP use, which may have hindered adherence. HIV and PrEP stigma were identified as potential barriers for women to take PrEP and disclose their PrEP use to others.

Conclusions: Within the context of this PrEP demonstration project, partner dynamics impacted PrEP adherence for HIV-negative cisgender women in serodiscordant relationships. We urge further investigation of relationship dynamics and PrEP adherence and persistence specifically among US-based cisgender women.

Oral pre-exposure prophylaxis (PrEP) and family planning (FP) share key characteristics. Both are preventive, both have high efficacy but effectiveness which can be diminished by inconsistent use and both are particularly beneficial for adolescent girls and young women (AGYW) in certain lower- and middle-income countries. When the efficacy of PrEP was proven in field trials, an effort to implement PrEP programs for the populations that would most benefit from it was launched. For AGYW, making PrEP available through existing FP services was seen as a natural opportunity for integration and was the primary effort and until recently, only experience in implementation of PrEP for AGYW. In this systematic review, we attempted to discover whether the integrated delivery of PrEP and FP results in the uptake and consistent use of either or both interventions. We found that no studies that met our inclusion criteria as no valid comparison for a PrEP/FP integration was discovered. Nonetheless, valuable information on the feasibility and acceptability of PrEP was gleaned from some of these studies, much less on the impact of PrEP promotion on FP acceptance and use. Providing PrEP to eligible individuals is an urgent public health priority. Doing so while enhancing uptake and use of FP is equally important. Future studies would benefit from a more encompassing view of this important integration.

ART adherence, essential to preventing disease progression for people living with HIV (PLHIV), remains challenged by factors like poor mental health condition, insufficient social support, and substance use. This study investigates the roles of social support and substance use as mediators in the relationship between mental health and antiretroviral therapy (ART) adherence among PLHIV in a multisite, international context. Cross-sectional data from N = 1598 PLHIV across eight countries were analyzed using parallel mediation analyses in R. Results indicated that both social support and substance use independently mediated the relationship between mental health and ART adherence. Hallucinogens mediated the mental health-adherence link. Cocaine, Amphetamine-type stimulants, inhalants, and opioids directly influenced adherence but did not mediate this relationship. In contrast, no significant effects were observed for tobacco, alcohol, cannabis or sedatives. This large-scale, nurse-led, international study offers critical insights into the roles of social support and substance use as psychosocial influencers in the cascade of care for PLHIV. Clinical implications include prioritizing educative, preventative, and harm-reductive approaches to specific substances that impact ART adherence. Findings may also inform interventions that emphasize strengthening social support to improve adherence in ART and care while addressing substance use as a barrier to care and well-being.

Women who sell sex (WSS) experience a disproportionate burden of HIV due to various structural barriers and social inequities. While pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV acquisition, awareness and uptake among WSS remains low. Telehealth offers the opportunity to address common barriers to care by embedding PrEP services within trusted community spaces. This study evaluates the acceptability and preliminary effectiveness of a community-embedded telehealth approach to engage WSS in the PrEP care continuum, with a specific focus on expanding awareness. Participants were recruited from two community-based drop-in centers in a Midwestern U.S. city from November 2023 to January 2024. Pre-visit surveys were obtained to assess baseline PrEP knowledge and intention to use PrEP, followed by a 15-30-min telehealth visit with a PrEP provider. Post-visit surveys and qualitative interviews assessed changes in PrEP knowledge, telehealth acceptability, intention to use PrEP, and barriers and facilitators to PrEP uptake. PrEP knowledge and intention to use PrEP increased post-intervention compared to baseline. Qualitative findings highlighted high community-embedded telehealth acceptability, low baseline PrEP awareness, a desire to share new PrEP information with peers, and the need for innovative PrEP outreach strategies. This study supports telehealth as a strategy to increase awareness of PrEP among WSS. Targeted public health messaging and expanded integration of PrEP into community and primary care settings is warranted. Future research is needed exploring strategies for sustained engagement and linkage to long-term PrEP care.

Transactional sex, and HIV remain significant public health concerns in Uganda, necessitating increased HIV testing and results receipt among young females who engage in transactional sex. This study aimed at examining regional variations and factors associated with transactional sex, HIV testing, and receipt of results among young women in the four major regions of Uganda. Stata version 15 was used to analyze the 2016 UDHS data set. The study applied a binary logistic regression model to examine the predictors of HIV testing and receipt of results at multivariate level. Overall, 13.5% of the young women reported engaging in transactional sex. The prevalence of HIV testing and receipt of results was highest amongst respondents who had been involved in transactional sex within Eastern Uganda (24.0%), and lowest among those in Central Uganda (7.2%). The study revealed significant predictors across regions: transactional sex, marital status, and distance to the health facility in the North; age, marital status and frequency of reading newspapers in Central; and age, working status, frequency of reading newspaper and watching television, and stigmatizing attitude in Eastern and Western regions. This study underscores the importance of region-specific programming and the need for an all-encompassing strategy to address the intricate factors driving HIV transmission among young women in Uganda. It is paramount that well designed peer education interventions tailored towards life skills development for young women engaged in transactional sex are implemented.

Adolescent girls in Cameroon face substantial sexual and reproductive health vulnerabilities that heighten their risk of HIV exposure. Using data from 2,586 adolescent girls aged 15-19 years from the 2017-18 Cameroon Population-based HIV Impact Assessment, we examined factors associated with multiple sexual partnerships, age-disparate sex, inconsistent condom use, transactional sex, and a composite measure of high-risk sex. Overall, 4.31% reported multiple partners, 25.18% engaged in age-disparate sex, 27.06% reported inconsistent condom use, 3.91% engaged in transactional sex, and 19.61% exhibited high-risk sexual behaviours. In multivariable analyses, marriage or cohabitation was strongly associated with age-disparate sex (aOR = 8.57, 95% CI = 5.84-12.56; p < 0.001) and inconsistent condom use (aOR = 10.07, 95% CI = 6.98-14.53; p < 0.001). Adolescent motherhood was associated with high-risk sex (aOR = 1.71, 95% CI = 1.14-2.55; p = 0.011). School non-enrolment was associated with inconsistent condom use (aOR = 1.76, 95% CI = 1.31-2.37; p = 0.001). Predicted probabilities showed that unmarried, non-mothers who initiated sex later had the lowest probability of high-risk sex (8%), whereas married adolescent mothers with early sexual debut had the highest (72%). These findings underscore the need for combination HIV prevention programming that prioritises married adolescents, adolescent mothers, out-of-school girls, and those initiating sex early. Delaying sexual debut, preventing adolescent motherhood and child marriage, and strengthening age-appropriate, context-specific interventions may substantially reduce HIV exposure among adolescent girls in Cameroon.

Gay, bisexual, and other men who have sex with men (GBM) in the Southern United States (US) experience high HIV incidence yet have relatively lower HIV pre-exposure prophylaxis (PrEP) uptake, especially among GBM of color. Despite awareness, PrEP use remains insufficient to meaningfully impact the HIV epidemic in the Southern US. PrEP promotions largely focus on PrEP messaging, especially product awareness. Theory-based health promotion research has not explored how to develop promotions that drive PrEP uptake. To close this gap, we explored preferences among GBM in the Southern US for promotion content, format, and platform. Grounded in Andersen's Model, we conducted semi-structured interviews with HIV-negative GBM, aged 18-39 years, and used inductive and deductive coding for thematic analysis to develop themes and sub-themes to understand promotion preferences. Forty GBM (68% Black, 10% Latino, 53% not using PrEP) completed interviews. Three major themes emerged: (1) content beyond promoting PrEP awareness, (2) using digital devices and media access for promoting PrEP, and (3) platforms for PrEP promotion. GBM in this study preferred digital promotion of PrEP, focusing on access, safety, and effectiveness that is delivered discreetly; promotion in the non-digital space could normalize PrEP use. Creating promotions that address these themes will make promotions more relevant to drive uptake of PrEP in the Southern US.

Human Immunodeficiency Virus (HIV) is a global health problem that causes many deaths, especially in low- and middle-income countries (LMICs). Most HIV cases occur in sub-Saharan Africa and Asia. In efforts to manage HIV, technologies such as telehealth have begun to be considered as an effective solution, both in high- and low-income countries. This study aims to identify telehealth models used in low-, middle-, and high-income countries and to evaluate their impact on treatment adherence, viral load, and HIV disease management. This study answers the question: "What telehealth models are used in countries with different income levels, and how do they impact HIV/AIDS patients?" This literature review was conducted between February and April 2025 by searching five databases: PubMed, Sage, ProQuest, Scopus, and ScienceDirect, covering the last 10 years, from January 2015 to January 2025. Articles that met the inclusion criteria were original articles on the use of telehealth in HIV patients. Article selection was conducted using the PRISMA flowchart, and quality assessment was conducted using the Quality Assessment of Risk of Bias (RoB 2.0). Of the 4739 articles found, 11 articles met the criteria with four main themes: telehealth models, improving treatment adherence, reducing viral load, and the impact of telehealth on HIV management. The results of this study indicate that telehealth models vary, but their benefits have been proven significant in HIV management, especially in resource-limited countries, and they can improve treatment adherence and reduce viral load.

In Eastern and Southern Africa (ESA), there is heterogeneity within adolescent mothers' (AMs') sexual relationships. However, existing studies focus on single relationship characteristics, even though these characteristics do not operate in isolation. Moreover, no studies have examined multilevel predictors of AMs' relationships. Identifying and characterizing typologies by multilevel factors can inform targeted interventions to lower HIV risk. Data are from the Population-based HIV impact Assessment (PHIA) Project on AMs (15-19 years) from 9 ESA countries (N = 2,761). We conducted multilevel latent class analysis to identify relationship typologies at the AM and community (PHIA cluster) levels, multinomial logistic regression to characterize typologies by multilevel predictors, and multivariable generalized estimating equations (GEE) log-binomial regression to calculate prevalence ratios of HIV for relationship typologies. There were 3 typologies: married with minimal transactional sex (61%), unmarried peer partnership (30%), and working and high transactional sex (9%). Individual-level (i.e., age, school enrollment, low-wealth household, number of sexual partners) and community-level factors (i.e., urbanicity and proportion of low-wealth households) were associated with typologies. Married with minimal transactional sex was associated with a 51% lower HIV prevalence compared to the unmarried peer partnership (adjusting for multilevel factors). We also identified 2 PHIA cluster-level classes: high age-disparate marriage (49%) and low marriage (51%). Low-wealth communities had higher odds of being high age-disparate marriage communities. Results suggest that AMs' relationships fall into 3 distinct typologies and 2 community-level classes. Further, HIV prevalence varies across relationship typologies. Utilizing tailored approaches could optimize interventions that reduce AMs' HIV risk in ESA.