AIDS and Behavior最新文献

This study analyzed the association between family-based discrimination and non-disclosure of sexual orientation or gender identity (SOGI) and the initiation of oral pre-exposure prophylaxis (PrEP) for HIV prevention among adolescent men who have sex with men (AMSM) and transgender women (ATGW). This analysis used baseline data from the PrEP1519 project. Latent class analysis (LCA) was applied to identify patterns of family-based discrimination and non-disclosure of SOGI using three categorical indicators. Descriptive, bivariate, and multivariate analyses were conducted, and logistic regression models estimated the adjusted odds ratios (aOR) for the association between latent classes and PrEP initiation. The majority of the 1,309 participants identified as AMSM (91.4%) were aged 18-19 years (74.9%), were Black and Pardo or mixed race (72.1%), had enrolled in high school (71.9%), resided in São Paulo (49.6%), and lived with parents or other family members (81.9%). Overall, 79.5% of patients initiated oral PrEP. LCA identified three distinct profiles: (i) low discrimination (67.6%, n = 885), (ii) high discrimination (22.4%, n = 293), and (iii) no disclosure within the family context (10.0%, n = 131). Multivariate analysis revealed non-disclosure of SOGI within the family was significantly associated with lower odds of initiating oral PrEP (aOR: 0.54; 95% CI: 0.33-0.78), whereas high levels of family discrimination were not significantly associated with oral PrEP initiation (aOR: 1.22; 95% CI: 0.84-1.76. Enhancing, structural interventions, stronger community support systems, and expanded access to alternative prevention options such as injectable PrEP may improve the initiation and adherence to HIV-prevention efforts among adolescents who experience family-related barriers to disclosure.

Intimate partner violence (IPV) is a significant barrier to HIV prevention service utilization, yet little is known about its impact on pre-exposure prophylaxis (PrEP) adherence among gay, bisexual, and other men who have sex with men (GBMSM). This study examines the association between IPV victimization and PrEP adherence using data from an online survey of 937 current PrEP users in Ukraine, conducted in early 2022, a few days before Russia's invasion. Participants reported on six types of IPV experienced in the past six months, physical, sexual, emotional, and financial abuse as well as partners' monitoring and controlling behaviors. Further, they self-reported their PrEP adherence and were asked to describe the reasons for missing PrEP medications through an open-ended question. Nearly 40% of respondents experienced at least one form of IPV, with sexual and emotional IPV being most common. Only 35.4% reported excellent or very good adherence to PrEP medication. Self-reported reasons for missed doses included COVID-19 restrictions, changes in sexual behavior, use of alternative HIV prevention methods, and health or psychological factors. In multivariable models adjusting for sociodemographic and behavioral factors, sexual IPV, monitoring, and controlling IPV were associated with higher PrEP adherence. The positive association may suggest that IPV survivors increase their PrEP adherence as a protective strategy against HIV infection. These findings highlight the importance of integrating trauma-informed IPV screening and support within PrEP programs and adopting flexible service models to sustain adherence, especially during social and political crises. Future longitudinal research should explore mechanisms linking IPV and PrEP adherence and develop structural interventions to better support this vulnerable population.

Migrant populations face a disproportionate risk of undiagnosed HIV and viral hepatitis, posing a major challenge to elimination goals. The HEPINMIGRA study evaluated the acceptability, feasibility, and effectiveness of an integrated community-based screening program for migrants in Alicante, Spain. Between March 2024 and February 2025, nine outreach campaigns were conducted in community settings with the support of intercultural mediators. Screening was performed using finger-prick dried blood spots. Among 535 attendees, 529 migrants were screened (acceptance rate 98.9%). Participants had a median age of 39 years, 56.1% were male, and 77.9% were of African origin. Seroprevalence was 1.1% for HIV (95% CI: 0.4-2.3%), 0.6% for HCV (95% CI: 0.1-1.6%), and 4.5% for HBsAg (95% CI: 2.9-6.6%). Although most individuals with positive results were successfully contacted and linked to care, treatment initiation rates were low. Community-based DBS screening was highly feasible and effective for case detection, but major gaps were identified in linkage to care and treatment initiation.

Syringe Service Programs (SSPs) have proven effective in reducing HIV transmission among people who inject drugs (PWID). However, early HIV detection remains an underutilized opportunity for preventing transmission and curbing outbreaks. This paper emphasizes the impact of implementing routine, opt-out HIV screening within SSPs as a strategy to enhance early detection and prevention efforts. In 2022, the IDEA Exchange Tampa, Florida's second legally sanctioned SSP, transitioned from an opt-in to a routine opt-out screening model. This shift identified six anonymous participants with acute and untreated HIV, including three confirmed seroconversions (within 59 days of a prior negative test), two individuals diagnosed during their first HIV screening at the SSP with 'unknown infection duration', and one previously diagnosed individual who had been out of care. Through a robust linkage-to-care framework, all six participants were linked to care within an average of 7.5 days (100% linkage rate). Clinical counseling sessions revealed that these individuals were part of an interconnected 26-person risk network involving needle-sharing and sex exchange behaviors. These findings underscore the critical role of systematic opt-out screening in SSPs for accelerating case detection and facilitating rapid linkage-to-care. Expanding routine, opt-out HIV screening at SSPs is essential to improving detection, curbing outbreaks, and advancing the goals of the Ending the HIV Epidemic (EHE) initiative.

HIV remains a significant public health concern, particularly among Hispanic individuals living with HIV (PWH) in Texas. Despite advancements in antiretroviral therapy (ART), adherence to medication regimens continues to be a challenge due to limited access to healthcare. This qualitative study aims to explore the multifaceted barriers that hinder ART adherence among Hispanic PWH in Texas, providing a comprehensive understanding of the challenges faced by this population and informing targeted interventions. We conducted semi-structured interviews, each lasting approximately 30 to 40 min, with 13 participants recruited from both outpatient and inpatient settings. Interviews were conducted by members of our bilingual research team. Data were analyzed using grounded theory to identify key themes related to adherence challenges, including stigma, healthcare navigation, and socioeconomic factors. The analysis revealed six major themes impacting adherence, with the following distribution based on the percentage of coded references: Health Management and Medication Effects (35.5%), Education and Empowerment (23.9%), Coping Strategies and Adjustment (17.5%), Stigma and Disclosure (10.1%), Social Support and Connection (7.2%), and Access and Affordability (5.8%). Participants highlighted the physical and emotional challenges of managing ART, the role of education in adherence, and the significant impact of stigma and financial barriers. The findings show the complexity of ART adherence among Hispanic PWH in Texas, revealing the need for culturally tailored interventions that address the stigma, healthcare access, and social support. Enhancing education, strengthening support networks, and reducing financial barriers are important steps toward improving ART adherence and health outcomes in this population.

In the United States, men who have sex with men (MSM) and transgender women (TGW) have high HIV pre-exposure prophylaxis (PrEP) awareness, yet uptake rates remain extremely low. This signifies the presence of certain barriers not yet addressed in policy and practice and facilitators not yet utilized in designing effective interventions. This systematic review used the Gelberg and Andersen Model of Vulnerable Populations as a theoretical framework to explore barriers and facilitators to PrEP uptake among MSM and TGW in the US. We searched PubMed, Embase, CINAHL, and Web of Science in May 2025 to identify eligible studies exploring barriers and/or facilitators to PrEP uptake among MSM and TGW in the US. Studies published in 2012 onward in the English language and particularly focusing on uptake (initiation) met the eligibility criteria. We excluded studies focused on awareness, willingness, adherence, persistence, and other components of the PrEP care continuum. The review was conducted in accordance with the PRISMA 2020 Statement. Barriers and facilitators reported in studies were mapped into the domains of the Gelberg and Andersen model and then narratively synthesized using a thematic approach. Eleven studies (9 qualitative and two mixed methods) met the eligibility criteria. Utilizing the Gelberg and Andersen model, within the predisposing factors domain, three themes emerged, namely (a) PrEP knowledge, health beliefs, and misinformation, (b) stigma, discrimination, and trust, and (c) influence of social environment and lived realities. Within the enabling factors domain, three themes emerged, namely (a) financial access and insurance coverage, (b) healthcare provider and system factors, and (c) addressing specific community needs and systemic vulnerabilities. Finally, within the need factors domain, one theme emerged, namely perceived versus evaluated need for PrEP. Additionally, a sub-group analysis showed that Black and Latino TGW may experience additional barriers to PrEP uptake due to intersecting stigma related to race, sexuality, and HIV and scarcity of culturally competent and gender-affirming care. Also, rural MSM may experience additional barriers due to reliance on urban social networks for information and support because of lack of such networks and support tailored to their geographical location. The findings of this review reveal an intricate interplay between predisposing, enabling, and need factors, which aligning with the observations that although PrEP awareness among MSM and TGW has grown, significant gaps in knowledge and misinformation remain, and uptake remains extremely low. These factors extend beyond general awareness levels and hence must be addressed through policy and practice interventions to enhance HIV prevention efforts among this key population in the US.

Women of transgender experience (WTE) have been disproportionately burdened by mpox. Using 2024 data from the New York City site of the National HIV Behavioral Surveillance study among WTE and transfeminine people (TFP), we identified factors associated with receiving at least one dose of the mpox vaccine. Of 103 WTE/TFP, most identified as Hispanic/Latina and being born outside of the United States with 40% receiving at least one dose. Participants who self-reported having HIV were more than twice as likely to have received a dose (PR: 2.31; 95% CI: 1.20-4.47). Mpox vaccine outreach efforts may benefit from status-neutral strategies.

Black sexual and gender minority youth (SGMY) face significant disparities in suicidal thoughts and behaviors. Minority Stress Theory (MST) posits that the minoritized social statuses of sexual and gender minority individuals increases experiences of discrimination and victimization, which may increase poor mental health and lead to suicide. Such experiences are further complicated for racial and ethnic minority individuals who hold multiple marginalized positions and thus experience intersectional minority stress. Little research has examined how Black SGMY experience intersectional minority stressors and how these experiences impact suicidal thoughts and behaviors. In this phenomenological study, we explored experiences of minority stress at the intersection of race and sexual and/or gender identity and examined how such experiences can contribute to suicidal thoughts and behaviors. We conducted in-depth interviews with 22 Black SGMY ages 16-24 in Milwaukee, WI. We identified five themes surrounding the compounding minority stressors Black SGMY faced that contributed to poor mental health and suicidal thoughts and behaviors: (1) the journey of self-acceptance; (2) familial rejection; (3) societal marginalization; and (4) suicidal thoughts and behaviors as an escape from oppression. Our findings suggest effective suicide prevention strategies for Black SGMY should move beyond universal models and incorporate culturally responsive and identity-affirming strategies. In addition, peer-led support and community-based programming may be important avenues for affirming and protecting the lives of Black SGMY.

PrEP-related medical mistrust is not simply a lack of trust; it is a relational, historically rooted and continuously reinforced response to perceived institutional betrayal, everyday discrimination, and inequitable prevention systems. Building on recent AIDS and Behavior articles by Simon et al. and Jaiswal et al. describing PrEP-related mistrust, distrust, and misinformation among Black sexual minority men and socioeconomically diverse young sexual minority men from multiple racial and ethnic groups in the United States, we argue that the field must move from documenting mistrust to engineering "trust-ready" prevention ecosystems that can be evaluated, scaled, and sustained. We synthesize converging evidence linking stigma, mistrust, and HIV testing behaviors and situate PrEP mistrust within broader HIV-care experience with antiretroviral therapy adherence and retention. We further highlight that public health narratives that foreground only past abuses can inadvertently obscure ongoing harms that shape lived experience and digital information practices today. We propose three implementation priorities: (1) institutionalize validated trust and fairness metrics within PrEP and HIV programme monitoring; (2) design trust-ready delivery models that embed stigma-reduction, accountability, and rights-based safeguards; and (3) align digital information ecosystems with trust-building by addressing mis- and disinformation, including institutionalized science denialism, while avoiding colonial or paternalistic messaging. These priorities are relevant beyond high-income settings, where overlapping criminalization, under-resourcing, and digital misinformation can compound inequity. Treating mistrust as an implementation outcome-and sometimes a survival-informed response-can accelerate equitable PrEP scale-up.

In 2022, over two thirds of individuals diagnosed with HIV in the United States were people of color, half resided in the south, and 67% of new cases were attributed to male-to male sexual transmission (Centers For Disease Control, 2024). To combat these health disparities, the Ending the HIV Epidemic (EHE) initiative recommends that HIV prevention research focus on targeted populations and geographic regions with high rates of new HIV diagnosis. There are limited data on the relative efficiency of social media and dating apps for the recruitment of key EHE populations to HIV prevention studies. The LITE-2 Study aimed to recruit a national sample of approximately 3,000 young men who have sex with men (YMSM), at least 30% Black/African American and 30% Hispanic/Latino. This analysis compared the success of different social media platforms in relation to study goals, using descriptive statistics from the LITE-2 study (N = 2999) to assess enrollment count, eligibility rates, cost, and geographic distribution for each platform. Facebook had the highest enrollment rate, 45.38%, among eligible screeners. The cost per enrolled participant for Grindr, Sniffies, Scruff, Jack'd, and Adam4Adam was $118.02, $129.46, $220.59, $252.53, and $305.56 respectively. Jack'd had the highest proportion of Black participants, and Sniffies the highest proportion of Hispanic/Latino individuals. Use of Scruff resulted in enrollment of the highest proportion of participants in the rural EHE jurisdictions (47.1%). These findings inform digital recruitment strategies for future studies with similar racial/ethnic and geographic targets.