AIDS and Behavior最新文献

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.

We aimed to determine differences in the occurrence and timing of all-cause excess mortality among people with HIV (PWH) in Florida early in the COVID-19 pandemic by sex, race and ethnicity, age, rural/urban residence, and neighborhood poverty levels. We used de-identified data from the Florida Department of Health enhanced HIV/AIDS reporting system. Expected numbers of monthly deaths and the 95% upper bound from March to December 2020 were estimated from observed deaths during January 2016-February 2020. The difference between expected and observed deaths was considered excess mortality. We also compared the age-adjusted all-cause mortality rate for PWH in 2020 to the average age-adjusted mortality rate for 2016 - 2019 using direct standardization. During the observation period from 2016 to 2020, there were a total of 9843 deaths among PWH. From March to December 2020, there were an estimated 314 excess deaths, and 61 excess deaths above the estimated 95% upper bound. The highest excess mortality occurred in July and August and was primarily due to increases in COVID-19 deaths. All groups of PWH experienced excess mortality except rural residents. Deaths among female, non-Hispanic Black, andurban-residing PWH exceeded the 95% upper bound of expected deaths. Compared to males, female PWH experienced a greater absolute increase in the 2020 age-adjusted mortality rate. Non-Hispanic Black and non-Hispanic White PWH had larger absolute and relative increases in the 2020 age-adjusted mortality rate compared to Hispanic PWH. Findings related to excess mortality should be considered in pandemic planning and preparation efforts for vulnerable groups like PWH.

Unhealthy alcohol use is prevalent among people with HIV (PWH) and associated with significant health-related consequences. We describe here a randomized feasibility/acceptability trial of a brief, telephone-delivered transdiagnostic acceptance and commitment therapy (ACT) intervention for PWH who drink at unhealthy levels. This pilot trail was designed to match the procedures of a planned definitive RCT that will compare the ACT intervention to a brief alcohol intervention (BI). We randomly assigned PWH and unhealthy alcohol use 1:1 to either the ACT or the BI intervention and collected self-report and biomarker data post-treatment and again at 3-, 6-, and 12-months. The primary objectives of this pilot trial were to assess feasibility of recruitment, retention, and intervention delivery, and acceptability of intervention content. We also collected preliminary primary (alcohol use) and secondary (symptoms of anxiety, depression, and experiential avoidance) outcome data to examine general patterns of results at a purely descriptive level. In total, 192 participants were screened, 117 of whom were eligible, and 49 of whom were randomized to either the ACT (n = 24) or BI (n = 25) condition. Results provided evidence of feasibility and acceptability indicating that a definitive trial should proceed. Preliminary outcome data also suggested that ACT is a promising treatment for unhealthy alcohol use and co-morbid symptoms of depression, anxiety, and experiential avoidance. A definitive trial is currently underway and will determine the comparative efficacy of ACT versus BI for unhealthy alcohol use for PWH.

As people living with HIV (PLWH) age, they face various stressors that may negatively affect HIV treatment adherence and management. Resilience and personality characteristics have demonstrated associations with better health outcomes among people with various health conditions. The present study examines the association between dispositional resilience, the Big Five personality traits (openness, conscientiousness, extraversion, agreeableness, neuroticism), and locus of control with self-reported perceived HIV treatment management ability among middle-aged and older PLWH. This cross-sectional study included 174 PLWH aged 40 years and older. Treatment management ability was measured by a composite of three HIV health-related perceived treatment management ability measures. After conducting correlations to determine independent variables, a multivariable linear regression predicting treatment management ability was conducted with resilience, all Big Five personality traits, locus of control, and conceptually relevant covariates (health literacy, race, SES, substance use, depression), using a stepwise approach to determine the optimal number of predictors. The overall model predicting treatment management ability was significant, (F(5,142) = 20.348, p < .001, Adjusted R² = 0.40), and this model retained resilience, openness, depression, and health literacy. Follow up mediation analysis found that resilience partially mediated the association between openness and treatment management ability. Resilience, openness, depression, and health literacy are important psychosocial factors related to treatment management ability. Interventions targeting resilience, openness to new information, depression, and health literacy may improve HIV treatment management abilities and ultimately health outcomes among older PLWH.

Young women who sell sex (YWSS) in Africa are particularly vulnerable to HIV acquisition and may benefit from daily oral pre-exposure prophylaxis (PrEP) but face multiple barriers to uptake. We identified temporal patterns of PrEP continuity/retention and associated characteristics within a cohort of YWSS in Uganda. Cisgender women aged 18-24 years who exchanged sex for money, goods, or services were recruited into a PrEP demonstration study in peri-urban Mukono District. We used group-based trajectory modeling to discern temporal patterns of PrEP continuity over 12 months of follow-up and multinomial logistic regression to identify baseline predictors of PrEP retention trajectories. Among 833 YWSS initiating PrEP, a four-group trajectory model emerged as best-fitting: (1) Rapid PrEP discontinuity (39.7%), characterized by high PrEP program attrition by 3 months; (2) Delayed PrEP discontinuity (24.2%), characterized by PrEP continuation through 6 months; (3) Immediate PrEP discontinuity (19.1%), characterized by high PrEP discontinuation in the month following initiation; and (4) High PrEP continuity (17.0%), characterized by sustained PrEP engagement throughout follow-up. In general, shorter- and longer-term PrEP continuation was associated with older age, higher education, pre-coital alcohol/drug use, and having 10 + paying partners in the past 3 months. Perceived HIV risk and related HIV vulnerabilities helped distinguish observed PrEP retention trajectories, predicting the timing of PrEP discontinuation among YWSS.

Inclusive language in data collection is essential for effective and sustained engagement with marginalised populations. The historic use of imprecise conceptualisations of gender and sexuality in the field of HIV and sexual health research has been challenged in the last decade, particularly cisnormative and monosexist assumptions about identity and practice. This study reports on the process of redesigning a repeated cross-sectional survey questionnaire in Australia to improve gender and sexuality inclusivity. The Gay Community Periodic Surveys (GCPS), repeated since 1996, was redesigned in 2023 to be more inclusive of transgender men, non-binary people, and bi + participants. Changes included a title change (GBQ + Community Periodic Surveys), adoption of gender-neutral language, a shift from an exclusive focus on anal sex, enhanced questions about sex with female partners, new questions about non-binary partners, and better recognition of non-monogamous relationships. Mixed methods were employed to inform and evaluate these changes, including cognitive interviews (n = 30) with a diverse range of gay, bi+, and queer men (cis and trans) and non-binary people, and rapid field interviews (n = 39) with participants who had completed the new questionnaire. Thematic analysis showed that the changes were acceptable, but the maintenance of some cisnormative assumptions about bodies and practices were also observed. The questionnaire will continue to be adapted to recognise a broader range of practices and risks within new subgroups of gay, bi, and queer men and non-binary people, with sensitivity to community expectations about survey length and comprehensibility of terms.

Stable housing and perceived safety in one's residential neighborhood (place security) may be critical to health and mental health outcomes in populations affected by HIV. This paper examines how perceived neighborhood disorder and houselessness affect the mental health of young adults with perinatally-acquired HIV infection (YAPHIV) or perinatal HIV exposure without infection (YAPHEU) in a New York City-based longitudinal cohort study. Participants were recruited between 2003 and 2008 when participants were between the ages of 9 and 16 and followed into young adulthood. Data for this paper was collected from follow-up interviews when participants were between 18 and 29 years old (151 YAPHIV; 97 YAPHEU). Associations between changes in perceived neighborhood disorder and houselessness and psychiatric disorder were examined, and the potential moderating effects of HIV-serostatus and neurocognitive abilities were considered. Results from linear mixed-effects modeling indicated that increased perceived neighborhood disorder and houselessness predicted meeting psychiatric disorder criteria over time, regardless of neurocognitive functioning. Notably, newly experienced houselessness significantly raised the risk of psychiatric conditions for YAPHEU but not for YAPHIV. These findings emphasize the necessity of integrating place security considerations into mental health and housing support interventions for both YAPHIV and YAPHEU.