AIDS and Behavior最新文献

Human-animal interaction (HAI; e.g., pet ownership) may contribute to enhanced health and well-being among individuals managing chronic conditions like HIV; however, responsibilities associated with pet ownership may also prevent owners from accessing timely healthcare. This study investigates the relationship between pet ownership, pet-related barriers to healthcare (PRBH), and comfort derived from pets with durable HIV viral suppression among people with HIV (PWH) in Florida. We tested three hypotheses using survey data from the Florida Cohort Study linked with Florida Department of Health HIV surveillance data, which included 623 participants recruited through HIV care providers and community health clinics. First, we hypothesized that pet owners would exhibit a higher likelihood of durable viral suppression compared to non-owners. While initial findings suggested that pet owners were more likely to be durably virally suppressed (OR = 1.82, p < 0.01), this association weakened, though remained marginally significant, after adjusting for covariates (OR = 1.55, p = 0.06). Second, we hypothesized that, among the pet-owning subset (n = 221), both experienced and anticipated PRBH would be negatively associated with viral suppression among pet owners. Our results confirmed that previously experienced PRBH were significantly associated with lower rates of viral suppression (OR = 0.22, p = 0.02), while anticipated barriers were not (OR = 0.44, p = 0.12). Lastly, we hypothesized that comfort from pets would be associated with better viral suppression; however, this was not supported (OR = 1.00, p = 0.98). These findings suggest that integrating pet-related support into HIV management strategies (e.g., providing pet sitting for patients receiving HIV care) could be supportive of HIV patient health by enabling owners to access timely care while maintaining the human-animal bond. Future research should assess the efficacy of collaborative efforts between healthcare providers and veterinary services in addressing the PRBH faced by pet-owning PWH to promote HIV management while supporting pet ownership in this population.

Pregnant and breastfeeding women (PBFW) on oral pre-exposure prophylaxis (PrEP) face barriers to adherence and persistence which may be improved by point-of-care adherence monitoring using urine tenofovir testing. We explored the acceptability of urine tenofovir testing for PrEP adherence monitoring among PBFW on oral PrEP, and how this, together with PrEP biofeedback adherence counselling, may have shaped PBFW's PrEP adherence and persistence. Between September 2022 and May 2024, we conducted a study among PBFW without HIV on oral PrEP in Cape Town, South Africa. Participants were randomized to intervention (urine tenofovir testing at each study visit with biofeedback adherence counselling) or standard-of-care arms (urine collected but not analyzed with participant, with standard PrEP adherence counselling). Participants, with consistent and inconsistent PrEP use, were purposively sampled from both study arms between October and December 2023 for qualitative interviews. Analysis was guided by the Theoretical Framework of Acceptability and Consolidated Framework for Implementation Research 2.0 using codebook thematic analysis. Among n = 39 women, who were pregnant (n = 16) or postpartum (n = 13); mean age was 29 years (SD = 7), and median time on PrEP was 11.9 weeks (IQR = 4.0,12.1). Acceptability of urine tenofovir testing was high, as it was perceived as familiar, appropriate and easy to use. Most felt that the limited perceived burden and opportunity costs were outweighed by the benefits, which included receiving feedback on their PrEP-taking behavior and if PrEP was present for HIV protection. Urine tenofovir testing with biofeedback counselling was seen as motivational to daily PrEP use. It positively reinforced PrEP-taking behaviors among those consistently using PrEP and allowed others the opportunity to reconsider their risk for HIV acquisition. Urine tenofovir testing facilitated more accurate self-reporting of PrEP adherence, although some reported restarting taking PrEP prior to visits. Participants' PrEP-taking was supported by non-judgmental and encouraging biofeedback counselling which included co-development of strategies to overcome pregnancy and postpartum related barriers to PrEP persistence. Confusion of urine tenofovir testing with other antenatal urine tests and perceptions of blood-based testing being more effective hindered application to motivating PrEP use. Addressing perceived efficacy and coherence related to urine tenofovir testing within counselling is key. Urine tenofovir testing with biofeedback counselling was perceived as acceptable and motivational to PrEP adherence among PBFW. Integration is further recommended, given that other urine tests are routinely utilized in antenatal care.

People with HIV (PWH) with a history of cancer are more likely to experience poor psychosocial well-being compared to those without HIV. This study aims to assess the associations between social and healthcare disruptions due to the COVID-19 pandemic with psychosocial well-being among cancer survivors with and without HIV. A cross-sectional survey was conducted between April and September 2020 among participants of the MACS/WIHS Combined Cohort Study with a history of cancer. The primary exposures were social disruptions (loss of job, child care, financial support, housing, and health insurance) and healthcare disruptions (unable to attend a healthcare appointment, obtain medications, and afford medical care). Psychosocial outcomes included depressive symptoms, anxiety symptoms, stress, loneliness, social support, social support satisfaction, and resilient coping. We estimated adjusted prevalence ratios (aPRs) with 95% confidence intervals (95% CIs) using multivariable Poisson regression. Cancer survivors (N = 452) included 63.7% PWH and 51.5% men. Overall, PWH were more likely to experience social disruptions compared to those without HIV (49.6% vs. 36.6%; p = 0.008). Among cancer survivors with HIV, two or more social disruptions were associated with high depressive symptoms (aPR = 2.19, 95% CI = 1.56, 3.08), anxiety symptoms (aPR = 2.36, 95% CI = 1.25, 4.48), stress (aPR = 3.32, 95% CI = 1.25, 8.79), and loneliness (aPR = 2.16, 95% CI = 1.25, 3.74), and one or more healthcare disruptions were associated with high depressive symptoms (aPR = 1.53, 95% CI = 1.22, 1.94), stress (aPR = 2.92, 95% CI = 1.53, 5.58), loneliness (aPR = 1.78, 95% CI = 1.23, 2.57), and low social support (aPR = 1.75, 95% CI = 1.08, 2.82). Disruptions were associated with poorer mental health among PWH but not among people without HIV.

Mental health diagnoses have been linked to poor HIV treatment outcomes and poorer quality of life among people living with HIV (PLWH). Therefore, this study aimed to investigate the association between sociodemographic and HIV-related characteristics, and common and serious mental health disorders among PLWH in South Carolina (SC). Data were obtained from the integrated system of statewide electronic health record (EHR) data in SC (2006-2019; N = 8,124). Multivariable logistic regression models were used to determine the associations between sociodemographic and HIV-related characteristics, and common mental health disorders and serious mental health disorders. Among the study population, 4% were 60 and older, 22% were female, 17% lived in rural areas, and 10% were virally suppressed. Approximately 19% had common mental health disorders while 7% had serious mental health conditions. Sex, race, population type, alcohol use, viral load and comorbidities were associated with having a common mental health diagnosis and serious mental health diagnosis. Mental health intervention and prevention programs should consider addressing these factors and the specific populations that are greatly impacted by adverse mental health outcomes.

In South Africa, gender-based violence (GBV) is a public health crisis contributing to the transmission of HIV and requiring urgent intervention. Using mixed methods, this study evaluated the relationship between adolescents' attitudes toward GBV and their sexual behaviors. Adolescent girls and young women (AGYW) and adolescent boys and young men (ABYM) completed a questionnaire assessing socio-demographic characteristics, sexual risk behavior, and attitudes regarding GBV. Two focus group discussions (FGDs) were conducted to explore perceptions of GBV. Among 178 participants, 80 (44.9%) had permissive attitudes toward GBV. Being AGYW and in a relationship were associated with permissive GBV attitudes. FGDs revealed that participants perceive GBV as occurring both in society and communities, as well as within interpersonal relationships at home. This violence is perpetuated by enduring patriarchal beliefs, male authority, and economic inequalities. Effective prevention of GBV requires integrated, multi-level strategies addressing patriarchal norms, economic inequalities through contextually tailored interventions at home and throughout society.

Self-testing is a critical component of public health initiatives aimed at slowing and stopping the spread of HIV. It has the promise of accessibility, reliability, and convenience, and because of the benefits derived from its inherent privacy, self-testing may overcome the barriers associated with HIV screening with at-risk populations. Still, questions remain about whether and how self-testing can adequately link patients to care and engage them with other interventions when needed. This presents an opportunity for digital platforms to bridge the gap, connecting patients with the HIV continuum of care. During a recent clinical trial of the mLab App, a mobile health intervention designed to increase HIV testing rates, we collected screen-level paradata-detailed logs of user interactions within the application-focusing specifically on user behavior during the test-result interpretation workflow. Among enrolled participants, 330 HIV self-tests were completed in the app, with 74.2% occurring within the scheduled testing window. Three post-timer screens (Preview Test, Upload Picture, and Visual Result) accounted for 60.6% of incomplete testing sessions, highlighting friction points in the result interpretation workflow. Users who experienced discordant automated results (i.e., when the app's automated interpretation differed from the user's visual inspection) demonstrated reduced subsequent engagement but did not significantly alter future test-taking behavior. These findings identify critical moments in the HIV self-testing workflow and provide actionable insights for improving the design of digital tools that support accurate testing and linkage to care.

Pain is prevalent among people with HIV (PWH), and many PWH who experience pain also use substances (illicit drug and/or unhealthy alcohol use). While cocaine use and cocaine and alcohol co-use are prevalent in this population, their effects on pain in PWH are unknown. This study aims to investigate the association of cocaine use and co-use of cocaine and alcohol with pain interference among PWH. We completed a secondary analysis of the Boston Alcohol Research Collaboration on HIV/AIDS (ARCH) study, a longitudinal cohort of PWH with a history of substance use. The outcome was pain interference (Brief Pain Inventory). Exposures were recent cocaine use (Addiction Severity Index) and recent unhealthy alcohol use (Timeline Follow Back). Generalized Estimating Equation (GEE) ordinal logistic regression models were employed, adjusted for demographic factors, illicit/non-medical opioid use and cannabis use. Among 251 participants, 22.3% reported unhealthy alcohol use only, 11.1% reported cocaine use only, and 13.2% reported use of both. Cocaine use was associated with greater pain interference (adjusted odds ratio [aOR]: 1.73, 95% confidence interval [CI]: 1.15-2.60), whether or not participants had unhealthy alcohol use (interaction term, p = 0.695). Participants reporting both cocaine and unhealthy alcohol use had greater pain interference than participants reporting neither (aOR: 2.27, 95%CI: 1.35-3.79). Cocaine use was associated with greater pain interference as was co-use of cocaine and unhealthy alcohol among PWH. Considering patterns of substance use can inform clinicians conversations with PWH who may be using substances for pain management.

Young men who have sex with men (YMSM) in the United States remain disproportionately affected by HIV, yet their awareness and uptake of post-exposure prophylaxis (PEP) remain suboptimal. Patient-provider communication about sexual health has been shown to influence engagement with HIV prevention services, yet its role in shaping PEP awareness among YMSM not currently using pre-exposure prophylaxis (PrEP) is poorly understood. This study analyzes cross-sectional data from 570 HIV-negative YMSM aged 15-24 to examine associations between provider discussions of sexual health topics and PEP awareness. Multivariable logistic regression models controlled for demographic, behavioral, and structural factors. PEP awareness was associated with prior HIV testing (OR = 2.65, 95% CI: 1.65-4.27), having health insurance (OR = 2.30, 95% CI: 1.20-4.43), prior healthcare access barriers (OR = 1.83, 95% CI: 1.08-3.11), and discussing HIV/STI prevention with a provider (OR = 2.04, 95% CI: 1.32-3.16). Because only HIV/STI prevention discussions, not the broader range of sexual health topics, were associated with PEP awareness, our findings emphasize the value of targeted prevention-focused dialogue between providers and YMSM not on PrEP. Future research should examine how such communication influences not only awareness but also PEP uptake and adherence in this high-priority population.

While urban refugee youth face HIV vulnerabilities spanning socio-ecological levels, knowledge gaps persist in HIV prevention outcomes. We conducted a baseline analysis of a cohort enrolled in Tushirikiane-4-Uthabiti, an intervention focused on HIV testing practices among urban refugee youth aged 16-24 in Kampala, Uganda (N = 330). Using regression models, we examined the societal, community, and interpersonal factors associated with condom use self-efficacy [CUSE], consistent condom use, HIV self-testing [HIVST] kit access, and recent HIV testing. Most participants were women (53.3%), with a mean age of 21.3 years (SD = 2.9). One-fifth reported consistent condom use (19.1%), over half accessed HIVST kits (56.4%), and recent HIV testing (50.6%). Statistically significant results showed that higher education (β = 0.18, p < 0.001) and financial resilience (β = 0.18, p < 0.001) were positively associated with CUSE, whereas food insecurity (β =  - 0.21, p < 0.05) was negatively associated with CUSE. Being in a casual relationship (adjusted odds ratio [aOR] 3.33, p < 0.05) and CUSE (aOR 1.12, p < 0.010) were associated with increased odds of consistent condom use. Higher education (aOR 2.45, p < 0.001), adolescent sexual and reproductive health stigma (aOR 1.16, p < 0.010), and perceived HIV stigma (aOR 1.05, p < 0.05) were associated with increased odds of recent HIVST kit access. Financial resilience (aOR 1.05, p < 0.010) and young parenthood (aOR = 2.32, p < 0.010) were associated with increased odds of recent last year HIV testing. The findings demonstrate suboptimal HIV prevention outcomes and highlight the need for tailored multilevel interventions to improve the sexual health of urban refugee youth.