AIDS and Behavior最新文献

Little is known about Undetectable=Untransmittable (U = U) awareness among MSM in India. We analyzed baseline survey data from MSM (N = 1004) in an mHealth HIV testing trial in Mumbai and Thane, India. We assessed factors associated with U = U awareness and agreement (HIV treatment optimism) using multivariable Poisson regression. U = U awareness (29%) was associated with English survey completion, searching for sexual health information online, awareness of PrEP/PEP, and participation in MSM-focused HIV prevention programs (all P < 0.05). Overall, 50% of the participants agreed with HIV treatment optimism, which was associated with searching for sexual health information online, PrEP knowledge, and being out about their sexual orientation. Focused, culturally tailored U = U education is needed to improve awareness and treatment optimism among diverse Indian MSM.

Humanitarian crises exacerbate challenges to accessing HIV care. Older people with HIV (OPWH, aged ≥ 50 years) may seek additional support with HIV care, which often requires disclosing their HIV status to healthcare providers, family, or friends. We sought to understand how crises, including COVID-19 and the war with the Russian Federation, have changed OPWH disclosure behaviours over time. We surveyed OPWH in Kyiv, Ukraine, by phone at four-time points: May-June 2020 (Wave 1), January-February 2021 (Wave 2), January-February 2022 (Wave 3) and May-June 2022 (Wave 4). Participants' responses were compared longitudinally. The primary outcome was new HIV status disclosure, and the independent variables were living conditions (living alone, not living alone) and HIV care support. Other variables analysed were age, gender, comorbidities, social support, depressive and anxiety symptoms, time since diagnosis, and history of addiction. A mixed-effects multivariable logistic regression model was used to assess the relationship between HIV status disclosure and independent variables. Of the 123 participants recruited, 90 OPWH completed the survey across all four-time points, of which 46 (51.1%) were women, and the mean age was 54.3 (SD = 6.38) in Wave 1 and 58.8 (SD = 6.64) in Wave 4. Men were less likely to disclose their HIV status (adjusted odds ratio [aOR] = 0.29; 95% CI [0.09, 0.94], p = 0.04) as were OPWH living alone (aOR 0.29, 95% CI [0.10 - 0.85], p = 0.02). Other variables were not statistically significant (p > 0.05). Findings underscore the pressing need for interventions that prioritise comprehensive, inclusive, and tailored to address key barriers to HIV disclosure, such as gender norms and social isolation. Future HIV care and support programs should integrate targeted strategies to foster community support, mitigate stigma, and promote disclosure as a pathway to adherence, overall health outcomes, and well-being of OPWH, particularly those living alone or within marginalised subgroups.

To assess the impact of changes in barriers to HIV viral suppression and the moderating role of patient-provider relationships, we conducted a retrospective cohort study using dynamic causal Bayesian network analyses on the first two available needs assessments between May 2020 and December 2022 for clients of the Miami-Dade County Ryan White Program (RWP) Part A Program. A cohort of 1539 individuals was formed using data from the RWP medical case management dataset. These records were merged with summary patient-centered care measures of their provider that were obtained from an earlier survey of clients in the program. Of the 1539 individuals in the longitudinal cohort, 86.2% were virally suppressed at time point 1 and 87.5% at time point 2. At time point 2, 144 (9.4%) were newly suppressed, and 124 (8.1%) were newly non-suppressed. Of the modifiable factors assessed, drug use and tobacco use significantly predicted a low probability of viral load suppression, while provider rating and provider's Health Care Relationship Trust Score significantly predicted a high probability of viral load suppression, although the associations with drug use and tobacco use were stronger than those with any provider variables. Results highlight the need for interventions promoting strong patient-provider relationships and targeting reductions in tobacco and illegal drug use with priorities based on the prevalence of tobacco and illegal drug use within specific RWP client populations.

Pre-exposure prophylaxis (PrEP) is the cornerstone of HIV prevention in the United States, yet uptake remains low among bisexual men compared to gay men. Theory-driven communication interventions have promise for addressing this disparity. Prior research among gay and bisexual men has shown that the Reasoned Action Approach (RAA) can predict PrEP intentions through attitudes, norms, and perceived behavioral control, while other studies highlight the influence of sexual identity-related stressors on prevention behaviors. However, bisexual men remain underrepresented in this work. This study sought to address this gap by exploring modifiable socio-cultural influences on bisexual men's PrEP use that can inform the development of PrEP promotion messages. Through an online survey of N = 276 US bisexual men, this study examined the relative impact of RAA factors (e.g., attitudes, perceived norms, and control beliefs) and identity-related stressors (e.g., concealment, masculine consciousness, and identity conflict) on intentions to use PrEP. The results revealed that, in contrast to previous work, only experiential attitudes toward PrEP (e.g., worry over HIV risk) were significantly associated with intentions, while instrumental attitudes, norms, and control beliefs were not. Regarding identity-related stressors, concealment from family was negatively associated with intentions, but masculine consciousness and identity conflict were not. Findings suggest that bisexual men's PrEP decisions may be shaped less by the cognitive predictors and more by affective and concealment-related processes. The results underscore the risk of generalizing findings from studies of gay men to bisexual men and highlight the need for more research to understand bisexual men's PrEP use motivations.

Despite evidence that undetectable equals untransmittable (U=U), negative attitudes toward people living with HIV persist among men who have sex with men (MSM). We examined HIV-related knowledge, attitudes and relationship willingness among Swedish MSM and evaluated an anti-stigma campaign. Repeated cross-sectional online surveys of MSM aged ≥ 18 years were conducted in Sweden (2020-2021) before and after an anti-stigma campaign. Participants were recruited via LGBTQIA+ media and dating or cruising platforms. Multivariable logistic regression adjusted for sociodemographic and behavioral factors. We analyzed 3100 pooled responses and 1132 post-campaign responses. Knowledge gaps were substantial: 72% had not encountered U=U messaging and only 53% knew that treatment prevents transmission. Nearly half expressed unwillingness to consider relationships with people living with HIV. Negative attitudes decreased with higher knowledge (adjusted odds ratio [aOR] 0.38; 95% confidence interval [CI] 0.28-0.53) and increased with greater worry (aOR 3.66; CI 2.75-4.90). Greater relationship willingness was associated with higher HIV knowledge (aOR 3.79; CI 2.67-5.41). Less negative attitudes and greater relationship willingness were also linked to openness about sexual orientation. Campaign exposure was significantly associated with higher knowledge, less negative attitudes, lower worry, and greater relationship willingness. U=U awareness remains limited and stigma persists. The interrelations between knowledge, worry, and attitudes highlight cognitive and emotional dimensions of stigma. Observed links with campaign exposure suggest potential value of concise, context-specific U=U-centered communication in addressing stigma among MSM.

The Baltimore HIV epidemic among men who have sex with men (MSM) has been characterized by high HIV prevalence and stark racial disparities. We examined trends in HIV infection and service utilization among Baltimore MSM using data from CDC's National HIV Behavioral Surveillance (NHBS) project from 2008 to 2023. A total of 2,180 venue-recruited MSM participated: 68% Black, 19% White, and 13% other/multiple racial identities. By 2023, HIV prevalence remained high (35.4% overall) and disproportionately concentrated among Black MSM (43.9%). From 2008 to 2023, predicted probability of HIV infection declined from 48% to 37% among Black MSM and remained stable at approximately 19% among White MSM. HIV service utilization exceeded 90% by 2023, particularly among Black MSM. These improvements reflect considerable community response and public health investment. Ending the HIV epidemic in Baltimore will require sustained prevention and treatment funding, continued efforts to reduce racial disparities, and focused attention on social determinants of health.

Among men who have sex with men (MSM), motivation for condom use in sexual situations varies as a function of trait-level characteristics and state-level contextual factors. To-date, however, condom use motivation has been assessed in cross-sectional research designs by single use, questionnaire-based self-report measures. This study describes the development and validation of a novel sexual effort discounting task that was designed to rapidly assess individual differences in motivation for condom use by measuring how much effort a participant would invest into acquiring a condom prior to engaging in anal intercourse with a partner of unknown HIV and STI status. The task was repeatedly administered as part of an ecological momentary assessment (EMA) study of condom use motivation to a pilot group of 55 MSM who regularly engaged in risky sexual behavior. Results demonstrated good reliability across administrations, and validity was supported by significant longitudinal associations with daily fluctuations in motivation to use condoms, significant correlations with self-reported sexual behavior, condom use, and cognitions related to condom use (e.g., intentions to use condoms), and significant positive associations with performance on a newly-developed EMA version of the well-established Sexual Delay Discounting Task (Johnson and Bruner in Drug Alcohol Depend 123:15-21, 2012). Use of the novel sexual effort discounting task may allow for greater insight into how differing levels of motivation for condom use may impact sexual decision-making among MSM, both in terms of indexing individual differences in motivation for condom use and assessing the impact of changing contextual variables on motivation in repeated-measures research designs.