AIDS and Behavior最新文献

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.

Female sex workers (FSWs) are often a mobile population, but the role of mobility in influencing FSW social capital outcomes-defined here as engagement with HIV intervention activities and community mobilization-remains unclear. To date, the evidence is mixed, with mobility both facilitating and hindering community engagement, depending on the context. This study is the first to employ a mixed-methods approach to examine how mobility impacts these outcomes. We combined baseline survey data from 211 FSWs living with HIV with semi-structured interview data from a sub-cohort of 20 FSWs in Santo Domingo, Dominican Republic. Contrary to the expectation that mobility would reduce engagement, our quantitative findings indicate that mobile FSWs were more likely to participate in various HIV interventions, such as support groups for people living with HIV, compared to their non-mobile counterparts. Additionally, mobile women were more than twice as likely to engage in community mobilization efforts, such as rallies to promote sex worker rights, even after controlling for sociodemographic variables. Many participants, despite their mobility, shared that they actively engaged in HIV-related and community mobilization activities in Santo Domingo and gained benefits from these activities. Study implications highlight the need for more sex worker-driven activities in and outside of Santo Domingo to offer mobile women greater opportunities to connect and build social cohesion, as well as the development of mobile-friendly service delivery models and apps to facilitate connections when traveling outside the capital.

Street-involved youth (SIY), particularly those who identify as 2-spirit, lesbian, gay, bisexual, transgender, queer, or other sexual and gender diverse identities (2SLGBTQ+), are among key populations disproportionately affected by HIV. We adapted and scaled-up a Peer Navigator intervention to targeted populations of SIY in six sites across Kenya (Eldoret, Huruma, Kitale) and Canada (London, Toronto, Vancouver), with the aim of increasing engagement in HIV prevention, testing, and treatment. This article presents the key quantitative findings, highlighting participant characteristics and their engagement in HIV testing and care before and after implementation of the Peer Navigator intervention. This implementation science study utilized a mixed-methods approach to investigate the adaptation, implementation, and evaluation of the Peer Navigator intervention. The PNs at each site completed study encounter forms with participants at enrollment and all follow ups between 2021 and 2024. Baseline sociodemographic characteristics were summarized separately using descriptive statistics for each study site. HIV testing and treatment outcomes are reported at baseline-reflecting participants' status prior to the intervention-and after their last encounter with Peer Navigators. A total of 686 SIY aged 16-29 years participated across all sites (Kenya, n = 631; Canada, n = 55). The Peer Navigator intervention improved access to and uptake of HIV prevention, testing, and treatment among SIY across Canada and Kenya. Participants' engagement in HIV testing increased from pre- to post-intervention across all sites, with the majority of participants reporting that they had been tested for HIV by the end of the study. This study highlights the need for access to ongoing and accessible HIV testing for all populations of SIY globally. The findings also underscore the critical need to create sustainable Peer Navigator roles to support SIY and expand the availability of widespread access to HIV testing.

We aimed to review perinatal outcomes in HIV-positive pregnant women and their infants, as well as Turkish clinicians' approaches to the management of HIV in pregnancy. This multicenter cohort study included pregnant women living with HIV (WLWH) across Türkiye from 2010 to 2024. 209 pregnancies among 162 WLWH were identified. Nearly 90.9% were diagnosed before or during pregnancy, and 90% were on antiretroviral therapy (ART) at delivery. 150 women had viral loads of less than 1,000 copies/mL during labor. The most chosen ART combination during pregnancy was tenofovir/emtricitabine+raltegravir. Most common mode of delivery was cesarean section (78.9%). Among 174 deliveries, 22 (12.6%) were preterm. Regarding newborn prophylaxis, 137 (88.4%) received zidovudine and 34 received nevirapine. 14 infants were breastfed. No congenital malformation, neonatal or maternal mortality was observed. Overall, 13 infants were diagnosed HIV-positive, indicating an MTCT rate of 7.9% in this cohort. Breastfeeding (OR: 30.1, 95% CI: 4.70-193.50, p < .001) and absence of ART during pregnancy (OR: 30.9, 95% CI: 5.20-183.90, p < .001) were the most prominent variables affecting the infants' HIV positivity. Despite efficient preventative strategies announced over years, we report a high MTCT rate of 7.9%, aligning with previous literature from Türkiye. The findings highlight that the absence of ART and breastfeeding remain critical risk factors for perinatal HIV transmission. This large real-world cohort, reflecting Turkish clinicians' practices, helps define major gaps in MTCT prevention in the modern ART era and provides valuable evidence to inform clinicians, policy makers, and public health strategies.

Adolescent girls and young women (AGYW) at elevated HIV risk often experience common mental disorders (CMD), which are linked to lower PrEP adherence. We piloted a CMD intervention, the Youth Friendship Bench SA (YFB), and delivered alongside PrEP to improve CMD symptoms and PrEP adherence among South African AGYW. From April 2023-February 2024, 116 AGYW (18-25 years) with CMD symptoms were randomized to YFB plus standard of care (SOC) or SOC alone and followed for 12 weeks. In-depth interviews were conducted with 30 AGYW and 13 study staff and key informants. CMD screening alone was seen as beneficial, but referral uptake was low due to perceived severity thresholds, staff attitudes, and logistical barriers. YFB was highly acceptable to AGYW, who valued the intervention for being confidential, informal, and empowering. Integrated CMD and PrEP services were acceptable, and lay counsellor delivery shows promise for addressing the mental health care gap.

Methamphetamine use is a driver of HIV among men who have sex with men (MSM) and is associated with suboptimal adherence to daily, oral PrEP. Long-acting PrEP may be a promising alternative. We analyzed data from the 2023 National HIV Behavioral Surveillance survey in four western cities to assess interest in long-acting PrEP among HIV-negative MSM participants. Of 1,450 participants, 7% used methamphetamine in the past 12 months. Two-thirds were interested in long-acting PrEP (68%); with no difference in interest (χ² = 1.4, p = 0.24) or prior PrEP use (χ² = 0.56, p = 0.46) by methamphetamine use. A larger proportion of participants unaware of PrEP had used methamphetamine (20% vs. 7%, χ² = 10.7, p < 0.01). Among those interested, a plurality preferred biannual injection (47%). We found high interest in long-acting PrEP and similar PrEP use rates, but lower awareness, among participants who used methamphetamine. However, our sample may not have been representative of those with higher-risk methamphetamine use.

While the message "Undetectable = Untransmittable" (U=U) is increasingly recognised in Japan, its impact-together with social proximity to people living with HIV (PLWH)-on sexual decision-making remains unclear. This study examined whether the combination of U=U awareness and social proximity is associated with attitudes toward sex with PLWH. An online survey was conducted from November 2022 to January 2023 in Japan primarily through a gay dating app. Participants were grouped into four categories based on U=U awareness and having a friend living with HIV. Poisson regression with robust error variance examined associations with reporting that learning a potential sexual partner is living with HIV would have "no" or "little" influence on the decision to have sex. A total of 4715 HIV-negative/unknown cisgender men and gender diverse individuals who have sex with men were included (median age: 36, IQR: 29-46); over two-thirds were aware of U=U. Of all participants, 26.5% had neither U=U awareness nor friends living with HIV, 52.5% had U=U awareness only, 3.1% had friends only, and 17.9% had both. Overall, 8.3% reported no or little influence of a potential sexual partner's HIV-positive status on their sexual decision-making. Compared with those with neither factor, having both was strongly associated with accepting attitudes (adjusted prevalence ratio: 4.53, 95% CI 3.24-6.32). Having a friend living with HIV alone was also significant, whereas U=U awareness only was not. Beyond promoting U=U, fostering opportunities for meaningful interaction with PLWH may help reduce stigma in sexual contexts.

HIV status disclosure remains a persistent challenge for children and adolescents aged 6-19 years. Disclosure is critical to improving treatment adherence, viral suppression, and psychosocial wellbeing, and promoting informed decision-making. This scoping review aimed to identify evidence on interventions focused on disclosing children's and adolescents' HIV statuses to them, and those supporting them with onward disclosure. We conducted a global scoping review to identify and analyze interventions supporting HIV status disclosure to, and by, children and adolescents living with HIV, identifying 25 interventions. Interventions were categorized into (1) disclosure-specific (directly focused on disclosure) and (2) disclosure-inclusive interventions (involving disclosure within broader support). Realist methods were used to evaluate disclosure-specific interventions; narrative synthesis was used for disclosure-inclusive interventions due to their heterogeneity. Disclosure-specific interventions shared common building blocks, including recognition of autonomy and dignity, tools to enhance engagement, and integration with broader health and social support systems. These contributed to improved confidence, communication, and decision-making among children and adolescents. Disclosure-inclusive interventions frequently employed intergenerational and peer support models, alongside health system strengthening strategies. Findings revealed differences in available evidence for disclosure interventions, with limited adolescent-tailored disclosure-specific interventions and few rights-based paradigms. While interventions to promote disclosure and retention in care aimed to work within participants' support systems, fewer made efforts to bolster these systems or enhance linkages; these approaches require further evidence. Priority actions emerging from the review include enhancing training and education, adopting youth-driven and rights-based approaches, strengthening metrics, and adapting to the evolving HIV landscape.

People who inject drugs (PWID) living with HIV in Vietnam experience a high prevalence of common mental disorders (CMDs), which negatively impact their health, treatment adherence and overall quality of life. To address the mental health care needs of this vulnerable population, we adapted and piloted Friendship Bench, a problem-solving therapy-based mental health intervention, for people on methadone maintenance treatment (MMT) who live with HIV and have CMDs in 6 MMT clinics in Hanoi, Vietnam, in 2021-2023. This paper aims to explore the experience of implementing aFB and the possibility of aFB expansion from the perspectives of the intervention providers who were directly involved in the delivery of the aFB program. We conducted formal in-person interviews with aFB providers including doctors (n = 6), counselors (n = 10) and supervisors (n = 2)following aFB intervention completion. Collected data was coded using NVivo 12.0 and thematic analysis was applied. All respondents were satisfied with and praised the aFB. Most providers reported that the aFB was beneficial to both overall and mental health of the MMT patients with HIV. All counselors shared that problem-solving therapy in the aFB was new for them; nevertheless, their counseling skills improved significantly after delivering the aFB sessions. All respondents were optimistic about the expansion of the aFB in other clinics. Application of aFB as a mental health intervention for care and treatment for MMT and ART patients could be a promising approach for Vietnam to address mental health care needs for this vulnerable population. Clinical Trial Number: NCT04790201 registered 3/10/2021.