AIDS and Behavior最新文献

People living with HIV who experience stigma in healthcare settings are at increased risk for engaging in health avoidance behaviours, suboptimal adherence to antiretroviral therapy, and viral non-suppression. HIV-related stigma erodes trust between patients and healthcare providers, thereby undermining both individual and public health. This study aimed to identify predictors of stigmatising attitudes, stigma practices, and fear of occupational transmission among healthcare workers in the Republic of Ireland. Data were collected from 295 healthcare workers using a standardised tool designed to measure HIV-related stigma. The outcomes examined were stigmatising attitudes, stigmatising practices (such as excessive infection precaution measures), and fear of occupational transmission. Multiple linear regression analyses were conducted to explore predictors at the individual, clinic, and policy levels. The results indicated that none of the models significantly predicted stigmatising attitudes. However, stigmatising practices were positively associated with never having worked in an HIV clinic, lack of knowledge or agreement with the concept of ‘undetectable equals untransmittable’ (U = U), and the presence of institutional policies, collectively accounting for 25.3% of the variance. Fear of occupational transmission was positively predicted by gender and lack of knowledge or agreement with U = U, explaining 23.8% of the variance. The findings highlight the critical role of U = U knowledge in reducing stigma-related behaviours and fears among healthcare workers. Enhancing knowledge and acceptance of U = U as part of comprehensive stigma interventions may help reduce the stigma experienced by people living with HIV in healthcare settings.

Hypertension is the most common non-communicable disease diagnosed among people in sub-Saharan Africa. However, little is known about client preferences for hypertension care. We performed a discrete choice experiment in Malawi among people with hypertension, with and without HIV. Participants were asked to select between two care scenarios, each with six attributes: distance, waiting time, provider friendliness, individual or group care, antihypertensive medication supply, and antihypertensive medication dispensing frequency (three versus one month). Eight choice sets (each with two scenarios) were presented to each individual. Mixed effects logit models quantified preferences for each attribute. Estimated model coefficients were used to predict uptake of hypothetical models of care. Between July 2021 and April 2022 we enrolled 1003 adults from 14 facilities in Malawi; half were living with HIV and on ART for a median of 11 years. Median age of respondents was 57 years (IQR 49–63), 58.2% were female, and median duration on antihypertensive medications was 4 years (IQR 2–7). Participants strongly preferred seeing a provider alone versus in a group (OR 11.3, 95% CI 10.4–12.3), with stronger preference for individual care among those with HIV (OR 15.4 versus 8.6, p < 0.001). Three-month versus monthly dispensing was also strongly preferred (OR 4.2; 95% CI 3.9–4.5). 72% of respondents would choose group care if all other facility attributes were favorable, although PLHIV were less likely to make this trade-off (66% versus 77%). These findings have implications for the scale-up of hypertension care in Malawi and similar settings.

Little is known about HIV testing, pre-exposure prophylaxis (PrEP) awareness and uptake among adolescent and young men who have sex with men (AYMSM) in Vietnam. We conducted an online survey among AYMSM in Vietnam to determine the prevalence of HIV testing, PrEP awareness, uptake and their correlates. From December 2022-March 2023, 120 HIV-negative AYMSM from 15 to 19 years old in Hanoi and Ho Chi Minh city, Vietnam were recruited through peer referral to complete an online survey, which included questions on demographics, sexual behaviors, HIV risk perception and knowledge, HIV and sexually transmitted infections (STI) testing, PrEP awareness and uptake. Separate multivariable models were used to determine the correlates of HIV testing, PrEP awareness and uptake. Only 58% of participants had ever been tested for HIV. The majority of participants had heard of PrEP before (82%), but only 36% had ever used PrEP. HIV knowledge (aPR (adjusted prevalence ratio) = 1.59; 95%CI:1.06–2.39), a history of STI testing (aPR = 1.32; 95%CI:1.06–1.64), having had anal sex with another man (aPR = 4.49; 95%CI:1.40-14.38) and lower HIV risk perception (aPR = 0.62; 95%CI:0.47–0.83) were associated with HIV testing. HIV knowledge (aPR = 1.38; 95%CI:1.06–1.78) and a history of STI testing (aPR = 1.16; 95%CI:1.03–1.32) were also associated with PrEP awareness. Higher HIV risk perception was negatively associated with PrEP use (aPR = 0.59; 95%CI:0.35–0.99). Our findings underscored the urgent need for further research to explore the causes of the gaps in HIV testing and PrEP use as well as to design innovative interventions tailored to the needs of AYMSM to support HIV testing and PrEP use.

Mpox affected mainly men who have sex with men (MSM). This study aimed to assess MSM’s response to the threat, and compare MSM living in central Israel vs. its periphery. Data were collected by anonymous electronic surveys between September and October 2022 through a geospatial application (“Grindr”). Of the 665 MSM participants, 221 (33.2%) were vaccinated against mpox. In the multivariate analysis, living in central Israel, being in steady relationships, HIV infection, PrEP use, noticing suspicious skin lesions, and changing sexual behavior predicted vaccination. Of all participants, 317 (47.6%) changed their sexual behavior. In the multivariate analysis, living in central Israel, engaging in risky sexual behavior and being vaccinated against mpox predicted sexual behavior change. Of the 444 participants who were not vaccinated, 245 (55.1%) lived in peripheral regions of Israel. Those who lived in the periphery were less likely to get vaccinated or change their sexual behavior compared with MSM who lived in central Israel. Although the study was limited in size and the study population was relatively homogeneous, MSM perceived mpox as a potential threat on health, and almost 50% changed their sexual behavior and nearly one-third were vaccinated against mpox. The trend was mainly observed in MSM who were at high risk to acquire mpox and those who lived in central Israel.

Linkage to HIV care remains suboptimal among men. We investigated the effectiveness of a male-targeted HIV-specific decision support app, Empowering People through Informed Choices for HIV (EPIC-HIV), on increasing linkage to HIV care among men in rural South Africa. Home-Based Intervention to Test and Start (HITS) was a multi-component cluster-randomized controlled trial conducted among 45 communities in uMkhanyakude, KwaZulu-Natal. The development of EPIC-HIV was guided by self-determination theory and human-computer interaction design to increase intrinsic motivation to seek HIV testing and care among men. EPIC-HIV was offered in two stages: EPIC-HIV 1 at the time of home-based HIV counseling and testing (HBHCT), and EPIC-HIV 2 at 1 month after a positive HIV diagnosis if not linked to care. Sixteen communities were randomly assigned to the arms to receive EPIC-HIV, and 29 communities to the arms without EPIC-HIV. Among all eligible men, we compared linkage to care (initiation or resumption of antiretroviral therapy after > 3 months of care interruption) at local clinics within 1 year of a home visit, ascertained from individual clinical records. Intention-to-treat analysis was performed using modified Poisson regression with adjustment for receiving another intervention (i.e., financial incentives) and clustering at the community level. We also conducted a satisfaction survey for EPIC-HIV 2. A total of 13,894 men were eligible (i.e., aged ≥ 15 years and resident in the 45 communities). The mean age was 34.6 (±16.8) years, and 65% were married or in an informal union. Overall, 20.7% received HBHCT, resulting in 122 HIV-positive and 6 discordant tests. Among these, 54 men linked to care within 1 year after HBHCT. Additionally, of the 13,765 eligible participants who did not receive HBHCT or received HIV-negative results, 301 men linked to care within 1 year. Overall, only 13 men received EPIC-HIV 2. The proportion of linkage to care did not differ between the arms randomized to EPIC-HIV and those without EPIC-HIV (adjusted risk ratio = 1.05; 95% CI:0.86–1.29). All 13 men who used EPIC-HIV 2 reported the app was acceptable, user-friendly, and useful for getting information on HIV testing and treatment. The reach was low, although the acceptability and usability of the app were very high among those who engaged with it. Enhanced digital support applications could form part of interventions to increase knowledge of HIV treatment among men. Clinical Trial Number: ClinicalTrials.gov # NCT03757104.

Depression and low medication taking self-efficacy are among the most important mechanisms contributing to poor adherence to treatment and care for persons with HIV (PWH). While the overall negative relationship between depression and medication taking self-efficacy has been well established, little is known on the precise pathways linking depression and medication taking self-efficacy. Thus, it is critical to identify a specific item of depression and medication taking self-efficacy that derives the overall negative relationship. The current study is a secondary data analysis using the baseline data from a randomized controlled trial that aims to support PWH to self-manage antiretroviral therapy regimens via mHealth technology and community health workers to monitor their adherence using a self-management app. A total of 282 participants were included. The machine-learning based network analysis was conducted to explore the structure of the depression and medication taking self-efficacy network and to identify bridge nodes between depression and medication taking self-efficacy. Our study identified difficulty concentrating on things and confidence to stick to treatment schedule when not feeling well are important bridge nodes connecting the network of depression and medication taking self-efficacy. Future studies should focus on developing interventions that would target the bridge pathway and examine their effectiveness in reducing depression and increasing medication taking self-efficacy.