AIDS and Behavior最新文献

This study examined how three dimensions of sexual stigma (enacted, felt, and internalized) were related to mpox preventive intentions among gay and bisexual men (GBM) through mediating pathways outlined by the Reasoned Action Approach (RAA). Data were collected from 439 GBM via an online survey during the peak of the 2022 mpox outbreak in the U.S. Path analysis examined associations among sexual stigma dimensions and mpox preventive intentions mediated through RAA behavioral predictors, including instrumental attitude, experiential attitude, injunctive norm, descriptive norm, capacity, and autonomy. Results showed that enacted stigma was not associated with any RAA predictors or mpox preventive intentions. Felt and internalized stigma were positively related to all RAA predictors, but neither of them was associated with intentions. Except for experiential attitude and injunctive norm, all other RAA predictors were positively related to intentions. Indirect effect analysis showed that felt and internalized stigma positively predicted intentions (R² = 0.74) through instrumental attitude, descriptive norm, capacity, and autonomy regarding mpox prevention. The findings demonstrate that different dimensions of sexual stigma predicted mpox preventive intentions through distinct cognitive pathways. Prevention interventions should leverage these pathways to encourage protective intentions while working to reduce the harmful impacts of stigma.

This study aims to better understand the association between community social vulnerabilities (e.g., income-to-poverty ratio, health insurance coverage) and the ability of people with HIV (PWH) to achieve viral suppression and optimal CD4 cell count levels. We conducted an observational study within the CFAR Network of Integrated Clinical Systems (CNICS) cohort of adult PWH in care at two CNICS sites between 1/2015 and 3/2023 with an identifiable residential address and HIV-related laboratory measures. Our exposure of interest, 2022 Community Resilience Estimates (CRE) from the US Census Bureau, is calculated at the census tract level and categorized as 0, 1-2, or 3-10 social vulnerabilities that impact community resilience. Outcomes included individual-level unsuppressed HIV viral load (≥ 50 copies/mL) and low CD4 count (< 350 cells/mm³). We estimated prevalence ratios and 95% confidence intervals (CI) using multivariable relative risk regression clustered by census tract, adjusting for individual-level demographic characteristics, site, and year of outcome measurement. Among 3,191 PWH, 342 (11%) were virally unsuppressed and 528 (17%) had low CD4 cell count. Compared to PWH in tracts with 0 vulnerabilities, those living in census tracts with 1-2 social vulnerabilities were 1.28 times more likely (95%CI: 1.00-1.63) to be virally unsuppressed. Those in census tracts with ≥ 3 social vulnerabilities were 1.95 times more likely (95%CI: 1.22-3.10) to be virally unsuppressed and were 1.51 times more likely (95%CI: 1.12-2.04) to have low CD4 cell counts. In the context of PWH, the CRE could be used to highlight areas for targeted interventions based on community-level influences to improve HIV-related outcomes.

There is growing recognition of the important health risks of tobacco use in people with HIV (PWH). Multiple randomized controlled trials have tested cessation treatments in this population, but little is known about factors that mediate successful quitting. We conducted a randomized, placebo-controlled 2 × 2 factorial design trial of a behavioral intervention (Positively Smoke Free [PSF] one-on-one counseling) vs. brief advice to quit ± bupropion vs. placebo in PWH who smoked cigarettes in Nairobi, Kenya. Abstinence from cigarettes was assessed by self-report and exhaled carbon monoxide (ECO). We conducted pre-planned analyses of putative mediators of the effects of bupropion (i.e. craving, withdrawal, negative affect) and of PSF counseling (i.e. abstinence self-efficacy, decisional balance, and loneliness) at 12-weeks on biochemically-confirmed abstinence at 36-weeks. 269 participants were included in the final analytic cohort (mean age = 42.7 years, 70.3% male, smoking a mean of 10.6 cigarettes per day). The biochemically verified abstinence rate at 36-weeks was 24.2%. PSF counseling increased abstinence self-efficacy and reduced loneliness significantly more than brief advice to quit at 12-weeks. Mediation analyses suggested a mediating effect of change in self-efficacy at 12-weeks in the relationship of PSF to abstinence at 36-weeks. None of the putative mediators demonstrated a significant mediation effect of bupropion on quitting. These results indicate that self-efficacy was one mechanism through which PSF counseling, but not bupropion, increased smoking abstinence among PWH who smoked cigarettes in Nairobi, Kenya.Trial Registration: NCT02460900.

Severe adverse drug reactions (ADRs) associated with antiretroviral therapy (ART) present a major public health challenge, particularly in resource-limited settings like Ethiopia where pharmacovigilance systems are often constrained. Despite the widespread rollout of ART, contemporary evidence on the incidence and predictors of these severe events in the Ethiopian context remains limited. This study aimed to determine the time to development of severe ADRs and identify their significant predictors among adults receiving ART in Northwest Ethiopia. A retrospective follow-up study was conducted, enrolling 634 HIV-positive adults who initiated ART between April 1, 2018, and March 31, 2023. Participants were selected using a stratified random sampling technique. Data were extracted meticulously from patient medical records and analyzed using STATA version 17. Survival analysis was performed using Kaplan-Meier curves and log-rank tests, while bi-variable and multivariable Cox proportional hazards regression models were carried out to identify independent predictors. Over a total follow-up period of 16,315 person-months, 29 patients developed severe ADRs, with the majority of incidents occurring within the first 9 to 21 months of treatment initiation. The overall incidence density was calculated at 18 per 10,000 person-months (95% CI: 12, 26). Multivariable analysis identified advanced baseline WHO clinical stage (III & IV) (Adjusted Hazard Ratio [AHR] = 9.86, 95% CI: 5.21, 13.24) and a low baseline CD4 count below 350 cells/μL (AHR = 3.21, 95% CI: 1.01, 5.43) as statistically significant predictors for a shorter time to severe ADR. The findings indicate that the risk is highest in the initial months of therapy and is strongly correlated with advanced disease stage and immunosuppression at baseline. This underscores the critical need for intensified clinical monitoring and counseling for high-risk patients, especially during the first year of ART, and highlights the urgency of strengthening national pharmacovigilance systems to improve patient safety outcomes.

This study explored the impact of HIV-related stigma on U.S.-based health care providers' (HCPs) confidence and comfort discussing HIV-related topics and providing HIV-related care. It also explored what factors might be associated with such stigma. We developed multivariable models to investigate if stigmatizing beliefs about pre-exposure prophylaxis (PrEP) users, stigmatizing beliefs about people with HIV, and fear of infection (instrumental stigma) are associated with HCPs' demographic characteristics and professional experience. We analyzed how these stigmas are associated with HCP behaviors critical to the HIV prevention and care continuum, such as comfort communicating with patients about prevention and comfort providing care. Across all stigma measures, we found certain types of stigma were associated with identifying as male, identifying as Asian (compared with white), practicing in the South, and having lower knowledge of HIV practices. Many HCP experience-related variables, such as prescribing PrEP to patients, providing primary care for people with HIV, or number of HIV tests ordered, were not associated with HIV-related stigma. More stigmatizing beliefs about people who use PrEP and more instrumental stigma were associated with less comfort communicating with patients about prevention and testing, prescribing PrEP, and providing HIV treatment. The results contribute to understanding the characteristics of HCPs who might hold stigmatizing beliefs and how these beliefs impact their comfort with discussing and providing HIV-related services. Future work includes opportunities for refining an overarching HIV-related stigma framework to inform stigma reduction intervention message development.

Over the past decades, as social contexts and knowledge about HIV have evolved, the conceptualization and understanding of HIV stigma, as well as the measures used to assess it, may have also shifted. This study aimed to examine the psychometric properties of a revised version of the Berger scale which updated language to better capture HIV stigma in the Southern U.S. The revisions were informed by focus group discussions with people with HIV (PWH) in Florida. Following three focus groups, the updated scale was tested among 461 PWH. The internal structure was evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The EFA analysis supported a four-factor structure. These four latent factors corresponded to the original dimensions of the Berger scale. All evaluated models demonstrated good model fit indices. The revised scale also showed high reliability, with composite reliability (omega) values for each subscale exceeding 0.89. Measurement invariance testing across race and gender groups further indicated that invariance was upheld. The revised scale also demonstrated high reliability, and composite reliability omega for each sub-scale was over 0.89. We further conducted measurement invariance across race and gender groups, and the measurement invariance was hold. We found that the revised scale is highly reliable, encouraging wider testing of this scale in a variety of populations.

People living with HIV and beginning antiretroviral therapy (ART) often struggle with medication adherence and attending appointments due to multi-level challenges such as depression symptoms, substance use, stigma and disclosure, food insecurity, health system challenges, transportation challenges, and gender inequity. The SUSTAIN trial seeks to improve initiation adherence through multiple monitoring and support interventions in three clinics in Mitchells Plain township, Cape Town, South Africa. We qualitatively explored the multi-level challenges impacting adherence at the individual, interpersonal, and structural levels among 60 study participants within the first six months after initiation on ART. The in-depth interview sample was selected purposively based on participant experiences with at least one of these factors reported through a baseline survey, gender, and age. We conducted a content analysis and utilized syndemic theory to understand the synergistic effects of multiple adherence challenges. To manage their HIV diagnosis, participants described positive and negative coping mechanisms, including how substance use affected adherence particularly on big event days (e.g., birthdays, holidays, or funerals). Participants described fears of stigma motivat decisions on disclosure of their HIV status and decreased potential social support, possibly reducing motivation to adhere to ART. Gender inequity reinforced experiences with and perceptions of stigma and disclosure. Participants indicated that food insecurity resulted in feelings of shame when associated with perceived larger appetites due to ART use and with lack of employment. Participants described both positive and negative ways the health system impacted their adherence and retention in care, citing information provided by clinic staff, clinician attitudes, and clinic operations. Misunderstandings regarding the strict timing of ART dose-taking (often from lack of clear information or counselling by clinicians) meant participants often had limited competence to make decisions about their dosing schedule and how to best integrate treatment into their daily lives. Participants described a notable fear of commuting to and from clinics due to dangerous and difficult paths on which muggings occurred frequently; women were at particular risk of violence. Often, participants mentioned multiple factors simultaneously affecting adherence, with additive or synergistic effects. Syndemic factors affecting ART adherence exist across multiple levels. Enhanced adherence counseling, designed as a behavior change intervention, might help PLWH cope with individual adherence barriers and support strategizing about ways to mitigate or overcome structural barriers. Continued efforts by government and implementers to address health system, gender inequity, and security challenges could further support ART adherence.

Unhealthy alcohol use (UAU) and alcohol use disorder (AUD) disproportionately burden people with HIV (PWH). We aimed to understand barriers and facilitators to the screening and treatment of UAU/AUD through semi-structured interviews with 19 healthcare providers in three HIV clinics. Interviews were coded using a rapid assessment process. Barriers included: (1) mixed use and variable perceived benefit of alcohol screening tools, (2) heterogeneity in perceived benefit of and comfort with AUD pharmacotherapy, (3) perception of alcohol as a lower priority than other substance use disorders and (4) compassion fatigue. Facilitators included: (1) co-located AUD care within HIV clinics (2) clinical champions with experience in alcohol treatment, and (3) Telemedicine as a potential strategy to better engage patients with UAU/AUD. Primary care teams face challenges in screening and offering pharmacotherapy to PWH. Interventions should address beliefs regarding treatment and improve screening for UAU/AUD in HIV care settings.

Research on adolescents and young adults living with perinatally acquired Human Immunodeficiency Virus (HIV) has largely emphasized biomedical aspects, with limited attention to developmental and psychosocial dimensions. This study explored how Portuguese adolescents and young adults understand their diagnosis, adapt to living with HIV, and perceive its impact across life domains. Twelve semi-structured interviews with youth receiving care at a pediatric hospital in northern Portugal were analyzed using Thematic Analysis. Findings highlighted a continuum of adaptation, ranging from denial and resistance to gradual acceptance and integration of the condition into daily life. Adaptation trajectories were shaped by the timing and manner of diagnosis disclosure, treatment adherence, stigma, and the presence or absence of supportive relationships. Secrecy emerged as a predominant strategy to manage anticipated stigma, particularly in family, school, and healthcare contexts, but often reinforced isolation. Challenges were especially acute in intimate relationships and future planning, where disclosure dilemmas intensified fears of rejection. The study underscores the need for developmentally sensitive, stigma-informed, and family-engaged interventions to support disclosure processes, strengthen adherence, and promote psychosocial well-being. Addressing these issues is crucial to fostering resilience and inclusion among young people living with perinatally acquired HIV.

This study evaluated the initial phase of the #ShesWell campaign, which aimed to increase pre-exposure prophylaxis (PrEP) awareness and uptake among Black women in four Ending the HIV Epidemic jurisdictions. The initial phase of #ShesWell (March to August 2022) sought to increase demand for PrEP among Black women and build the capacity of healthcare providers (HCPs) to prescribe PrEP. In January-March 2023, a cross-sectional survey was conducted 10 months after the campaign was launched. Sexually active women aged 18-64 were recruited from an online panel. Outcome measures included campaign exposure, PrEP attitudinal beliefs, perceived norms toward taking PrEP, perceived behavioral control, and intentions to take PrEP in the next 6 months. A structural equation model analysis was conducted using data from the 396 Black women in the survey sample who were not currently taking PrEP to explore the associations between campaign exposure and the outcome measures. There is evidence of effects of #ShesWell exposure on attitudinal beliefs and norms and a related total effect of exposure on intention. The study confirmed the pathways from exposure to intention posited by the Integrative Model of Behavioral Intention. Specifically, the collective influence of attitudinal beliefs and normative pressure indirectly impacted Black women's intentions to take PrEP after exposure to #ShesWell campaign messaging. To address disparities in PrEP uptake and increase use of PrEP among Black women, communication campaigns should develop messages that speak to women's attitudinal beliefs and norms. HCPs should also endorse these types of messages with their patients.