AIDS and Behavior最新文献

Chronic pain and mental health conditions are common among women living with HIV (WLWH) and can negatively impact the HIV care continuum, decrease quality of life, and negatively affect aging trajectories. A strong sense of purpose in life, while potentially being protective, can also be attenuated or accentuated by varying sociobehavioral-structural correlates. However, less is known about how these factors intersect. This cross-sectional analysis of the British Columbia CARMA-CHIWOS Collaboration Study examines the prevalence of self-reported mental health conditions, differences in purpose in life, as measured by the Oregon Brief Purpose Measure, and associated correlates in 176 WLWH and 273 HIV-negative controls (median age 48, 41% white). Depression (38%), anxiety (37%), post-traumatic stress disorder (24%), substance use disorder (13%) and attention deficit hyperactivity disorder (12%) were most prevalent, and the burden of mental health diagnoses was greatest among women with chronic pain, compared to those without, independent of HIV. Higher scores on measures of resilience, purpose in life, and social support were associated with upwards of 43% (95% CI 29-54%) fewer mental health diagnoses, whereas histories of childhood violence and higher perceived sexism scores were associated with upwards of 96% (95% CI 40-274%) more diagnoses. Purpose in life scores were altogether comparable across groups, with post-hoc comparisons showing no statistically significant difference in women with concurrent HIV and chronic pain relative to others. In adjusted regressions, resilience emerged as the strongest predictor of a greater sense of purpose in life (ß = 3.50, 95% CI 2.78-4.22), with employment (ß = 1.14, 95% CI 0.43-1.96) and caring for dependents (ß = 1.01, 95% CI 0.24-1.78) also contributing. Programs and activities that promote a greater sense of purpose in life may help women living with HIV and chronic pain.

Antiretroviral therapy (ART) adherence is crucial for HIV viral suppression. Tenofovir diphosphate (TFV-DP) concentrations in dried blood spots (DBS) offer a potential tool for monitoring and supporting adherence. We assessed acceptability and preferences of fingerstick-based DBS collection and drug-level feedback among 224 people living with HIV (PLWH) in South Africa. DBS monitoring was highly acceptable (99%) and viewed as helpful (96%). Participants indicated willingness for clinic staff-administered collection (79.5%) and less willingness for community health workers (26.1%) or pharmacists (37.0%). Participants favored receiving results in clinic (52%). These findings demonstrate high acceptability and strong preferences among participants for DBS-based collection procedures.

Pre-exposure prophylaxis (PrEP) has proven to be a powerful tool in preventing HIV infection. There is limited information about the factors associated with willingness to use different PrEP modalities among adolescent girls and young women (AGYW) in Africa. We assessed willingness to use long-acting injectable PrEP (LAI-PrEP) among 14-24-year-old AGYW at high risk of HIV in Uganda, and associated factors determined using multivariable complementary log-log regression. Of the 285 participants, 69.8% of participants showed willingness to use LAI-PrEP despite only 3.9% having knowledge about it before enrolment. Report of recent transactional sex was high (92.6%). Participants that were divorced/separated (aOR = 1.74, 95% CI 1.03-2.92) and those with multiple sexual partners (aOR = 2.11, 95% CI 1.46-3.06) compared to those with one partner were more likely to be willing to use LAI-PrEP while those that were screened as heavy episodic drinkers (consuming 6 or more drinks on an occasion as per the AUDIT tool) were less likely to be willing to use LAI-PrEP (aOR = 0.61, 95% CI 0.42-0.87). LAI PrEP has shown efficacy in clinical trials; the product is approved for use by the Government of Uganda (MoH) and should be expedited for use by AGYW engaged in paid sex and those with multiple sexual partnerships. As it becomes available, we recommend PrEP education and counseling to increase awareness of LAI PrEP as an alternative HIV prevention method.

This study aimed to explore the awareness, willingness, and engagement with pre-exposure prophylaxis (PrEP) among high-risk Chinese men who have sex with men (MSM) and to investigate the factors influencing its use. A cross-sectional survey of 1800 HIV-negative MSM was conducted in Chengdu, Suzhou, and Wuhan between June 2022 and February 2023 through in-person and online recruitment methods. Univariate and multivariate logistic regression analyses were used to identify predictors of PrEP use. Bayesian network models were constructed using the bnlearn package in R 4.1.2, and inference was conducted using Netica software. Among the 1800 participants, 1467 had ever heard of PrEP, 696 were aware of its target population, and 195 had taken PrEP in the past 6 months. PrEP use was higher among individuals reporting multiple male sex partners, illicit substance use, alcohol use, HIV testing, PEP use, and sexual partners who had used PrEP. Conversely, having a female sexual partner was a barrier to PrEP use. Bayesian network modeling unveiled factors directly and indirectly impacting PrEP use. Variables like PrEP use of sexual partners, PEP use, alcohol use, HIV testing, and WeChat-based HIV knowledge platforms exhibited direct effects. Indirect effects included having a female sexual partner, number of male sexual partners, and illicit substance use. Despite high awareness, the usage of PrEP remains low among MSM. Encouraging social agencies to leverage social media platforms to provide comprehensive HIV care services, especially to meet the PrEP needs of MSM.

Support for people living with HIV (PLHIV) as they disclose their HIV status can impact continuity of HIV treatment and adherence to antiretrovirals. In the presence of multi-level adversities, resilience among PLHIV can promote health-seeking behaviors and better health outcomes. However, few studies have examined how disclosure experience and resilience work together to impact HIV treatment outcomes among PLHIV. In this study, we assessed the relationships between HIV disclosure experience, resilience and viral suppression among PLHIV in Ghana. The Stigma Index 2.0 questionnaire was completed by 1827 PLHIV in Ghana in 2021 to assess demographics, experiences of HIV related stigma, resilience-factors, and other self-reported outcomes including viral suppression. Participants were also asked to classify their disclosure experience with friends and family as positive or negative. Multivariable log-binomial models estimated adjusted prevalence ratios (PR) and 95% confidence intervals (CI) for the association between disclosure experience and viral suppression. A dichotomized measure of resilience was evaluated as a potential effect measure modifier, and subgroup analyses explored associations by key population. Overall, those with a positive disclosure experience were more likely to have achieved viral suppression than participants with a negative disclosure experience (PR 1.09, 95%CI:1.00-1.19). This association increased among participants with lower resilience scores (PR 1.33, 95%CI:1.11-1.60). Findings suggest the importance of early positive social interactions for sustained engagement in ART, particularly for marginalized populations who face psychosocial and structural stigmas that challenge resilience. Ultimately, optimizing HIV treatment necessitates interventions that mitigate community stigma and promote resilience-building strategies for PLHIV in Ghana.

Pre-exposure prophylaxis (PrEP), an effective biomedical prevention intervention, is not sufficiently reaching populations experiencing high HIV incidence. Behavioral health (BH) treatment addressing mental health and substance use similarly requires increased reach to HIV-affected populations. HIV testing is an opportunity to refer individuals to PrEP and BH treatment. This study, conducted in Miami-Dade County, FL, a domestic HIV epicenter, aimed to assess (1) self-reported rates at which HIV test counselors refer clients to PrEP and BH treatment, (2) barriers and facilitators to PrEP and BH treatment referral, and (3) the relationship between barriers and facilitators and test counselors' referral rates. Among 127 HIV test counselors, the average PrEP referral rate was 63.8% (SD = 41.5) of those potentially meeting PrEP indications. Insufficient time was associated with lower PrEP referral (OR: 0.64, 95% CI: 0.42-0.99, p = 0.023) and training in PrEP screening was associated with higher rates of PrEP referral (OR: 1.27, 95% CI: 0.98-1.64, p = 0.034). The average BH treatment referral rate was 52.7% (SD = 44.4) of clients who the counselor felt would potentially benefit from treatment. Counselors lacking knowledge of screening (OR: 0.4, 95% CI: 0.2-0.78, p = 0.004), referral procedures (OR: 0.45, 95% CI: 0.23-0.87, p = 0.008), or locations to refer clients (OR: 0.47, 95% CI: 0.25-0.86, p = 0.008), as well as those with higher caseloads (OR: 0.998, 95% CI: 0.997-0.999, p < 0.001) were less likely to refer for BH. Training in substance use screening (OR: 1.26, 95% CI: 0.96-1.64, p = 0.046) and referral (OR: 1.28, 95% CI: 0.99-1.66, p = 0.029) were associated with increased BH referral. Implementation strategies are needed to address key barriers to PrEP and BH referrals in HIV testing contexts.

Young men who have sex with men (YMSM) have high rates of substance use, which increases their risk for HIV. Digital Health Interventions (DHI) have the potential to address HIV risk overall and reduce harms in the context of substance use. However, there is limited research on how YMSM with different substance use patterns respond to HIV DHIs and how these programs impact participant outcomes. In this study, we used latent class analysis (LCA) to identify subgroups of participants with specific substance use behaviors in the Keep It Up! (KIU! ) program, an HIV DHI with prior documented effectiveness. This study involved 2,124 participants in a Type III Hybrid trial, comparing two implementation strategies: one via 22 community-based organizations and another through direct-to-consumer recruitment. Evaluations were done at baseline and 12-week follow-up. This analysis identified four classes of substance use: Low Use (minimal alcohol risks, low illicit drug use, infrequent marijuana), Heavy Use (highest alcohol problems, frequent marijuana, elevated illicit drug use), Alcohol and Marijuana Use (high alcohol problems, frequent marijuana), and Methamphetamine and GBH Use (low alcohol risk, moderate marijuana frequency, high illicit drug use). Participants in the Meth & GHB User class were more likely to have an STI at baseline compared to those in the Low User class. Moreover, Heavy Use, Alcohol & Marijuana Use, and Meth & GHB Use reported a greater number of condomless anal sex partners compared to Low Use. Additionally, although Alcohol & Marijuana Use were more likely to use PrEP at the time of their most recent casual partner at baseline, they exhibited the smallest increase in PrEP use during follow-up compared to the other substance use classes. Our analysis did not unveil substantial differences in the success of implementation in terms of reach, suggesting that both implementation strategies effectively engaged YMSM with different levels of substance use. Our research showed a similar level of engagement, as evidenced by the completion rates of modules and time spent, across all substance use classes. However, those within the Meth & GHB category found the intervention highly acceptable, but less so compared to Low Use and Alcohol & Marijuana Use. Understanding how distinct substance use profiles influence intervention outcomes and exploring varied implementation methods can augment future prevention endeavors, broadening the scope and impact of public health initiatives.

Sexual minority men living with HIV face challenges affecting their quality of life and medication adherence. While self-compassion has shown promise in improving quality of life, targeted interventions for this group remain limited. This pilot study evaluated the efficacy of an online self-compassion group intervention on quality of life and medication adherence among sexual minority men living with HIV. A six-week online intervention, adapted from the Mindful Self-Compassion program, was implemented in a two-arm randomized controlled trial with 28 participants, comparing the intervention to a waitlist control group. The primary outcomes were quality of life and self-compassion, with medication adherence as a secondary outcome. Measures were taken at baseline, mid-intervention, post-intervention, and 1-month follow-up. Linear mixed-effects model showed that the intervention significantly improved quality of life and medication adherence at post-intervention. Although self-compassion showed no significant improvement, over-identification, an uncompassionate self-responding component, showed marginal improvement at follow-up. This pilot study provides preliminary evidence that a self-compassion intervention may improve quality of life and medication adherence in sexual minority men living with HIV, warranting further research with larger sample sizes and a focus on the underlying mechanisms.

This study examines the impact of HIV post-exposure prophylaxis (PEP) on sexual behavior changes in men who have sex with men (MSM), aiming to assess a comprehensive HIV prevention strategy integrating biomedical and behavioral interventions to maximize PEP service effectiveness. From a Guangzhou MSM cohort, participants without prior PEP experience were included. The exposed group received PEP services during follow-up (June 2019-April 2022), while controls did not. Cox proportional hazard regression models assessed PEP's effects on sexual behavior changes. Of 411 participants (mean age: 30.72), 14.1% received PEP during follow-up. The exposed group showed a higher likelihood of reducing Internet partner-seeking (aHR: 3.58, 95%CI: 1.80-7.10, P < 0.001), decreasing anal intercourse partners (aHR: 3.81, 95%CI: 2.14-6.82, P < 0.001) in the past 6 months, lowering last week's anal intercourse occurrences (aHR: 3.95, 95%CI: 2.33-6.68, P < 0.001), and improving condom use during past 6 months' anal intercourse (aHR: 3.94, 95%CI: 1.75-8.90, P = 0.001) and the most recent anal intercourse (aHR: 4.96, 95%CI: 1.77-13.88, P = 0.002) compared to controls. To sum up, PEP services contribute significantly to positive sexual behavior changes in MSM. Strengthening behavioral interventions at PEP's baseline and follow-up stages is crucial for maximizing comprehensive preventive impact on both biomedical and behavioral aspects in MSM.

People with HIV (PWH) are at greater risk of experiencing mental health problems, such as depression and post-traumatic stress disorder (PTSD). The purpose of our study was to determine the prevalence of posttraumatic stress disorder PTSD in PWH. PWH in care Amsterdam University Medical center (Amsterdam UMC) with access to the electronic patient portal were offered patient-reported outcome measures (PROMs) between May 2022 and May 2023, including the PC-PTSD-5 screen for PTSD as part of routine clinical care. Risk factors for a clinically relevant PC-PTSD-5 score were determined using univariate and multiple logistic regression analyses. Of 2476 PWH included, 1384 (55.9%) had access to the electronic patient portal of whom 474 (34.2%) completed the PC-PTSD-5. PWH without access to the patient portal were more often female, born in low- and middle-income countries, acquired HIV more often via heterosexual contact, and had worse HIV-related outcomes compared to those with access. Of 474 PWH who completed the PC-PTSD-5 screening question, 62 (13.1%) reached the threshold for clinically relevant PTSD. Age less than 50 years (OR 2.29, 95% CI: 1.21-4.35), and having originated from low- or middle-income countries (OR 2.02, 95% CI: 1.09-3.76) were associated with PTSD. Our findings show that 13% of PWH with a well-controlled HIV infection with access to the electronic patient portal at Amsterdam UMC experienced clinically relevant PTSD complaints.