AIDS and Behavior最新文献

People living with HIV (PWH), more than half of whom are age 50 years and older, experience a high prevalence of multiple chronic conditions (MCC) and fragile social networks. Although social engagement can be protective against detrimental physical, cognitive, and mental health outcomes, there is limited evidence about older PWH's social engagement and associated factors in engaging with family, friends and the community. This study examined the state of social engagement in a population of older PWH, using the 13-item Frequency of Leisure Activities Scale from the Research on Older Adults with HIV (ROAH 2.0) study conducted in New York City. We performed factor and regression analyses to characterize social engagement activities and examine their relationships with MCC, AIDS diagnosis, social vulnerability index (SVI), financial strain, loneliness, HIV-related stigma, and depressive symptoms, controlling for demographic factors. PWH (n = 349, age range = 50-84) were less engaged in social (Mean = 1.31; SD = 0.71) and cultural-physical (Mean = 1.55; SD = 0.78) than in media-based activities (Mean = 3.09; SD = 0.72), with Omega reliability estimated at 0.716, 0.651, and 0.620 respectively. Financial strain, AIDS diagnosis, greater HIV-related stigma, loneliness, and depressive symptoms were associated with low social activity engagement (F(6, 316) = 9.87, p < 0.001). High SVI score and financial strain were negatively associated with engagement in cultural-physical activities (F(5, 317) = 2.61, p < 0.001). High levels of depressive symptoms were negatively associated with engagement in media-based activities (F(4, 318) = 5.88, p < 0.001). The findings provide foundations for future research to improve our understanding of social engagement in older PWH and help create interventions that could target different dimensions of social engagement to improve mental health outcomes in this population.

People living with HIV (PLWH) face unique biopsychosocial challenges due to both infection and antiretroviral therapy (ART), one of which is body image disruption. This study comprehensively reviewed relevant studies to explore body image issues, identify associated factors, and describe assessment methods and interventions targeting body image in this population. Guided by the PRISMA, a thorough search of PsycINFO, PubMed, Embase, and Web of Science was conducted in November 2024, using search terms relevant to HIV and Body image. NIH Study Quality Assessment Tools were used to assess the quality of the included studies, and a narrative synthesis was conducted to identify common themes, including definitions of body image, associated factors, measurement instruments, and interventions targeting body image among PLWH. From 2197 publications, 26 studies met the inclusion criteria. The majority of studies demonstrated an association between negative body image and psychosocial factors, including depression, anxiety, social withdrawal, and substance use. Body image dissatisfaction was also associated with physical health factors such as lipodystrophy. Sixteen distinct body image measurement tools were used across studies. Cognitive Behavioral Therapy for Body Image and Self-Care (CBT-BISC) was the only target intervention that showed effectiveness in mitigating body image disturbance and improving ART adherence among PLWH. This is the first comprehensive scoping review to exclusively consider body image, associated factors, measurements, and target interventions among PLWH, which highlighted the need for comprehensive, culturally sensitive interventions that address both the physical and psychological dimensions of body image concerns.

In Kenya, the primary driver of perinatal HIV transmission is disengagement from care. Virologic monitoring can reinforce adherence and enable timely intervention, yet results are often delayed. Among pregnant (≥ 27 weeks) and postpartum (≤ 6 months) women in HIV care in Kisumu Kenya, we conducted a pilot study in which Mentor Mothers (peer support) returned viral load results (GeneXpert) after a clinic visit between June-December 2023. We assessed feasibility, acceptability, and factors associated with time from sample collection to results to participants via generalized estimating equations with log-transformed time as the outcome and report geometric mean ratios (GMR). We assessed the potential impact on viremia after 6 months using two control groups (one retrospective, one prospectively enrolled). Among 545 participants (273 pilot,123 prospective and 149 retrospective controls), the median age overall was 30 years (interquartile range [IQR] 26-35) and 40% were pregnant. In the pilot, Mentor Mothers returned 100% of 422 viral load results of which 90% were suppressed. The median time from sample collection to result return was 27.0 h (IQR 23.3-54.6). We observed a trend towards slower times among women with prior viremia (adjusted-GMR 1.22, 95%CI: 0.98-1.52). The odds of subsequent viremia did not differ between pilot and control groups (adjusted-OR 1.30, 95%CI: 0.71-2.38). Mentor Mothers reported this approach was a good use of their time. In conclusion, Mentor Mothers rapidly delivered viral load results though we did not observe an impact on viremia. This approach could complement other strategies to optimize person-centered care for pregnant and postpartum women.Trial registry NCT05845619.

Pre-exposure prophylaxis (PrEP) use is not a once-off bio-behavioural strategy but part of ongoing HIV prevention decision-making. We explored PrEP decision-making through qualitative interviews with 68 adolescent girls and young women (AGYW) aged 15-24 years from communities in which a large-scale combination prevention intervention supporting daily oral PrEP uptake for AGYW in South Africa was implemented. Thematic analysis of transcripts was informed by a social-ecological framework. AGYW's decisions to initiate, continue, discontinue, or refuse PrEP were shaped by intersecting individual, interpersonal, health system, and contextual factors. At the individual level, self-motivation for HIV protection and distrust of partners supported initiation and continuation, reinforced by regular HIV-negative results, while side effects, dislike of daily pills, and perceived contraindications drove discontinuation. Decisions to refuse PrEP centred around low perceived HIV risk, fear of side effects, and aversion to daily tablets, although many expressed conditional interest in future long-acting formulations. Interpersonally, disclosure to and encouragement from family, partners, or friends enabled continuation, whereas inability to disclose, limited social support, and relationship changes undermined adherence. At the health system level, provider engagement, support, and perceived confidentiality of services and packaging were pivotal. Contextually, PrEP-related stigma constrained use, while living in high HIV-prevalence, unsafe communities heightened risk perception and encouraged uptake. PrEP use among AGYW is dynamic and temporal, shaped by relationships, communication and disclosure, embodied experiences, stigma, and service experiences. There is a need for tailored, responsive prevention counselling and service delivery to support AGYW's PrEP initiation, persistence, and informed decisions about sexual health.

Pre-exposure prophylaxis (PrEP) is an antiretroviral treatment aimed at reducing the risk of acquiring HIV. PrEP is a particularly important preventative measure for men who have sex with men (MSM), as they account for 21% of new global HIV cases despite being a small percentage of the population. In Denmark, over 50% of the total HIV cases involve MSM, despite MSM only accounting for 5-10% of the total population. MSM face higher HIV transmission risks due to factors such as engaging in unprotected anal intercourse. In 2019, PrEP became available in Denmark, and by 2022 there were approximately 2000 users. Despite free access, PrEP uptake remains low, with a relatively small share of eligible MSM estimated to be using it. Research into barriers to PrEP willingness among MSM is needed to improve uptake. An online cross-sectional survey was conducted from April to May 2024 to investigate biopsychosocial factors that may influence PrEP uptake among Danish MSM. Participants (N = 210) were recruited via LGBT+-specific social media forums and Danish AIDS Foundation clinics. Logistic regression models were used to analyze the data. The analysis showcased that non-users of PrEP, compared to users of PrEP, had 2.02 (CI: 1.10-3.70) times greater odds of experiencing a high stigmatization in the healthcare system and 5.73 (CI: 2.80-11.69) times greater odds of having a high fear of side-effects of PrEP. Out of the 104 non-user participants 40% were eligible for receiving PrEP-treatment fulfilling the Danish treatment specific risk criteria. When investigating non-users' willingness to undergo PrEP-treatment, the results showed that non-users with a high fear of side effects had 2.00 (CI: 1.10-4.40) times greater odds of showing high PrEP willingness and non-users with a high self-assessed risk of HIV had 5.60 (CI: 2.00-15.40) times greater odds of having high PrEP willingness compared to non-users who assess themselves as at low risk. These results indicate that biopsychosocial factors such as fear of side effects, self-assessed risk of HIV, and stigmatization in the healthcare system may influence non-users' uptake and withholding their willingness to seek PrEP-treatment. Biopsychosocial factors such as fear of side effects, self-perceived HIV risk, and healthcare-related stigma influence PrEP uptake among non-users. Effective public health interventions targeting these barriers are needed to increase uptake.

People with HIV often experience mental health disorders that can hinder engagement in HIV care. Mental health symptoms can be exacerbated during disruptive events such as the COVID-19 pandemic. Telemental healthcare (i.e., synchronous audio/visual mental health treatment) expanded rapidly within the Veterans Health Administration in response to pandemic-related barriers and may play a role in facilitating HIV care engagement. This study examined whether receipt of telemental healthcare was associated with engagement in HIV care among Veterans with HIV (VWH) before and during the first two years of the COVID-19 pandemic. This retrospective cohort study analyzed national Veterans Health Administration data (March 2019-March 2022) for 11,953 VWH. HIV care engagement was defined as attending at least one HIV care encounter per 12-month period. Telemental healthcare was defined as attending a video telehealth mental health encounter. Cross-lagged path models tested autoregressive, concurrent, and cross-lagged relationships among telemental healthcare and HIV care engagement across three time periods: pre-pandemic (Time 1), first pandemic year (Time 2), and second pandemic year (Time 3). The proportion of mental healthcare delivered via video telehealth rose from 3% before the pandemic, to greater than 35% by Time 2 and Time 3. Path analyses did not demonstrate that pre-pandemic telemental healthcare increased subsequent HIV care engagement. However, there were significant concurrent associations. Telemental healthcare may help VWH remain connected to HIV care during major disruptions such as the COVID-19 pandemic. Findings underscore the importance of offering flexible, integrated treatment modalities to promote continuous healthcare engagement among vulnerable populations.

The risk of sexual transmission of HIV in serodiscordant couples when the partner living with HIV (PLHIV) uses antiretroviral therapy (ART) and maintains a suppressed viral load (VL) (< 200 copies/mL) is estimated at 0.00 transmissions per 100 person-years (95% CI 0.00-0.10). A recent review reported an almost zero transmission risk for VL < 1000 copies/mL but lacked quantitative risk estimates. This systematic review aimed to quantify transmission risk across VL levels. A literature search (November 2023, updated January 2025) identified 152 studies, with 9 included in the analysis. Seven possible transmissions occurred when the PLHIV had a VL of < 1000 copies/mL at the last measurement before the estimated time of transmission. However, VL at the exact time of transmission was unknown and VL > 1000 copies/mL cannot be excluded. This review suggests sexual transmission is very rare with recent VL < 1000 copies/mL however, future research is required to establish precise risk estimates.PROSPERO Number: CRD42023476946.

This study examined how three dimensions of sexual stigma (enacted, felt, and internalized) were related to mpox preventive intentions among gay and bisexual men (GBM) through mediating pathways outlined by the Reasoned Action Approach (RAA). Data were collected from 439 GBM via an online survey during the peak of the 2022 mpox outbreak in the U.S. Path analysis examined associations among sexual stigma dimensions and mpox preventive intentions mediated through RAA behavioral predictors, including instrumental attitude, experiential attitude, injunctive norm, descriptive norm, capacity, and autonomy. Results showed that enacted stigma was not associated with any RAA predictors or mpox preventive intentions. Felt and internalized stigma were positively related to all RAA predictors, but neither of them was associated with intentions. Except for experiential attitude and injunctive norm, all other RAA predictors were positively related to intentions. Indirect effect analysis showed that felt and internalized stigma positively predicted intentions (R² = 0.74) through instrumental attitude, descriptive norm, capacity, and autonomy regarding mpox prevention. The findings demonstrate that different dimensions of sexual stigma predicted mpox preventive intentions through distinct cognitive pathways. Prevention interventions should leverage these pathways to encourage protective intentions while working to reduce the harmful impacts of stigma.

This study aims to better understand the association between community social vulnerabilities (e.g., income-to-poverty ratio, health insurance coverage) and the ability of people with HIV (PWH) to achieve viral suppression and optimal CD4 cell count levels. We conducted an observational study within the CFAR Network of Integrated Clinical Systems (CNICS) cohort of adult PWH in care at two CNICS sites between 1/2015 and 3/2023 with an identifiable residential address and HIV-related laboratory measures. Our exposure of interest, 2022 Community Resilience Estimates (CRE) from the US Census Bureau, is calculated at the census tract level and categorized as 0, 1-2, or 3-10 social vulnerabilities that impact community resilience. Outcomes included individual-level unsuppressed HIV viral load (≥ 50 copies/mL) and low CD4 count (< 350 cells/mm³). We estimated prevalence ratios and 95% confidence intervals (CI) using multivariable relative risk regression clustered by census tract, adjusting for individual-level demographic characteristics, site, and year of outcome measurement. Among 3,191 PWH, 342 (11%) were virally unsuppressed and 528 (17%) had low CD4 cell count. Compared to PWH in tracts with 0 vulnerabilities, those living in census tracts with 1-2 social vulnerabilities were 1.28 times more likely (95%CI: 1.00-1.63) to be virally unsuppressed. Those in census tracts with ≥ 3 social vulnerabilities were 1.95 times more likely (95%CI: 1.22-3.10) to be virally unsuppressed and were 1.51 times more likely (95%CI: 1.12-2.04) to have low CD4 cell counts. In the context of PWH, the CRE could be used to highlight areas for targeted interventions based on community-level influences to improve HIV-related outcomes.