AIDS and Behavior最新文献

Alcohol-serving venues in East Africa are high-risk environments for HIV transmission but few studies in sub-Saharan Africa (SSA) have examined perceived HIV risk and sexual risk behaviors by alcohol use levels on a broader population of persons at alcohol-serving venues in the era of biomedical HIV prevention. We conducted a cross-sectional analysis of adults (≥ 18 years) at alcohol-serving venues in eight communities (~ 10,000 residents/community) in rural western Kenya and southwestern Uganda. We distributed recruitment cards to patrons and workers and invited them for free HIV screening at nearby health facilities, with same-day initiation of HIV pre- or post-exposure prophylaxis or antiretroviral therapy (ART) if eligible. Using generalized estimating equations with adjustment for age, sex, and country, we assessed whether increasing levels of alcohol use, as measured by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), categorized as no/low use (< 4 for men, < 3 for women), medium use (4-5 for men, 3-5 for women), high use (6-7), and very high use (≥ 8) were predictive of perceived HIV risk (current or anticipated in the next three months) and four HIV-risk factors (i.e., sex with a partner with HIV or unknown HIV status, multiple sexual partners, transactional sex, and sexually transmitted infections) among persons without HIV. We also evaluated the association between AUDIT-C levels and untreated HIV (defined as newly diagnosed or previously diagnosed but out of care for ≥ 6 months) among persons with HIV and between AUDIT-C levels and HIV-risk factors among persons with untreated HIV. We distributed 9,375 recruitment cards at 480 venues: 7,744 (83%) adults participated in screening at health facilities (median age 34 years; 38% women; 91% patrons). Overall, 4,107 (53%) reported unhealthy alcohol use: 26% medium, 11% high, 16% very high. Of 6,124 (79%) persons who tested HIV-negative, 2,285 (37%) reported perceived HIV risk. Increasing alcohol use was significantly associated with higher odds of perceived HIV risk (medium use: adjusted odds ratio (aOR) = 1.36, 95% CI: 1.17-1.58, p < 0.001; high: aOR = 2.06, 95%CI: 1.71-2.47, p < 0.001; and very high: aOR = 2.07, 95%CI: 1.74-2.47, p < 0.001; vs. no/low alcohol use) as well as sexual risk factors. Of 1,620 (21%) PWH, 219 (14%) had untreated HIV: 141 (9%) newly diagnosed; 78 (5%) previously diagnosed, not on ART. Increasing levels of alcohol use were not associated with untreated HIV. Our findings highlight the ongoing need for interventions to reduce alcohol use and improve engagement in biomedical HIV prevention and treatment among adults at alcohol-serving venues in East Africa.

Evaluating trends in Hepatitis C virus (HCV) prevalence is critical for tracking the progress in HCV elimination efforts. We evaluated the changes in the prevalence of HCV infection (HCV antibody) among people who inject drugs (PWID) participating in the National HIV Behavioral Surveillance in Los Angeles County (LAC). Steady decreases in HCV antibody seroprevalence over time was observed among PWID from 81.2% in 2012 to 64.9% in 2015, 59.1% in 2018, 50.1% in 2022, and 34.2% in 2024. Chronic HCV infection (positive on both antibody and RNA tests) also declined from 37.1% in 2018 to 30.6% in 2022 and 18.2% in 2024. This downward pattern is further supported by multivariable analyses which showed a consistent reduction in HCV prevalence over time (aPR = 0.91, 95% CI 0.89-0.92). The largest decreases occurred among participants aged ≥ 30 years and among female PWID, with both decreasing 9.1% annually. HCV antibody positivity remained significantly higher among males, those with lower education, daily injectors, participants with incarceration history, and those engaging in receptive syringe sharing. Decreases in HCV antibody and RNA prevalence, alongside improved sterile injection practices, greater awareness of HCV status, and increases in treatment uptake, may reflect the impact of harm reduction efforts at reducing transmission among PWID in LAC. To achieve and sustain equitable progress, it remains essential to continue expanding HCV testing and treatment, particularly for communities that have not yet fully benefited from these interventions.

Men in sub-Saharan Africa lag behind women in HIV testing and awareness. We pooled 2019-2023 Population-based HIV Impact Assessments from seven countries (Eswatini, Lesotho, Malawi, Mozambique, Tanzania, Uganda, Zimbabwe). Among 59,293 men, HIV prevalence was 5.9% (95% CI 5.7-6.2). Of 5,394 HIV-positive men, 22.1% (95% CI 20.0-24.3) were unaware of their status (8.4% in Eswatini; 31.5% in Mozambique), declining with age (41.0% at 15-29 vs. 11.5% at ≥ 50). Survey-weighted Poisson regression identified independent correlates: condom-free last sex (aPR 2.5), hazardous drinking (aPR 1.3), infrequent/no prior testing (aPR 1.9), and higher wealth (lower 60% vs. upper 40%: aPR 0.8). Age amplified behavioral gaps in condom use. Among men classified as aware, 5.4% were identified solely through ARV biomarker detection despite self-reported unawareness. Youth-centered, behavior-tailored retesting strategies are essential to close the awareness gap.

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.