AIDS and Behavior最新文献

People living with HIV and beginning antiretroviral therapy (ART) often struggle with medication adherence and attending appointments due to multi-level challenges such as depression symptoms, substance use, stigma and disclosure, food insecurity, health system challenges, transportation challenges, and gender inequity. The SUSTAIN trial seeks to improve initiation adherence through multiple monitoring and support interventions in three clinics in Mitchells Plain township, Cape Town, South Africa. We qualitatively explored the multi-level challenges impacting adherence at the individual, interpersonal, and structural levels among 60 study participants within the first six months after initiation on ART. The in-depth interview sample was selected purposively based on participant experiences with at least one of these factors reported through a baseline survey, gender, and age. We conducted a content analysis and utilized syndemic theory to understand the synergistic effects of multiple adherence challenges. To manage their HIV diagnosis, participants described positive and negative coping mechanisms, including how substance use affected adherence particularly on big event days (e.g., birthdays, holidays, or funerals). Participants described fears of stigma motivat decisions on disclosure of their HIV status and decreased potential social support, possibly reducing motivation to adhere to ART. Gender inequity reinforced experiences with and perceptions of stigma and disclosure. Participants indicated that food insecurity resulted in feelings of shame when associated with perceived larger appetites due to ART use and with lack of employment. Participants described both positive and negative ways the health system impacted their adherence and retention in care, citing information provided by clinic staff, clinician attitudes, and clinic operations. Misunderstandings regarding the strict timing of ART dose-taking (often from lack of clear information or counselling by clinicians) meant participants often had limited competence to make decisions about their dosing schedule and how to best integrate treatment into their daily lives. Participants described a notable fear of commuting to and from clinics due to dangerous and difficult paths on which muggings occurred frequently; women were at particular risk of violence. Often, participants mentioned multiple factors simultaneously affecting adherence, with additive or synergistic effects. Syndemic factors affecting ART adherence exist across multiple levels. Enhanced adherence counseling, designed as a behavior change intervention, might help PLWH cope with individual adherence barriers and support strategizing about ways to mitigate or overcome structural barriers. Continued efforts by government and implementers to address health system, gender inequity, and security challenges could further support ART adherence.

Unhealthy alcohol use (UAU) and alcohol use disorder (AUD) disproportionately burden people with HIV (PWH). We aimed to understand barriers and facilitators to the screening and treatment of UAU/AUD through semi-structured interviews with 19 healthcare providers in three HIV clinics. Interviews were coded using a rapid assessment process. Barriers included: (1) mixed use and variable perceived benefit of alcohol screening tools, (2) heterogeneity in perceived benefit of and comfort with AUD pharmacotherapy, (3) perception of alcohol as a lower priority than other substance use disorders and (4) compassion fatigue. Facilitators included: (1) co-located AUD care within HIV clinics (2) clinical champions with experience in alcohol treatment, and (3) Telemedicine as a potential strategy to better engage patients with UAU/AUD. Primary care teams face challenges in screening and offering pharmacotherapy to PWH. Interventions should address beliefs regarding treatment and improve screening for UAU/AUD in HIV care settings.

Research on adolescents and young adults living with perinatally acquired Human Immunodeficiency Virus (HIV) has largely emphasized biomedical aspects, with limited attention to developmental and psychosocial dimensions. This study explored how Portuguese adolescents and young adults understand their diagnosis, adapt to living with HIV, and perceive its impact across life domains. Twelve semi-structured interviews with youth receiving care at a pediatric hospital in northern Portugal were analyzed using Thematic Analysis. Findings highlighted a continuum of adaptation, ranging from denial and resistance to gradual acceptance and integration of the condition into daily life. Adaptation trajectories were shaped by the timing and manner of diagnosis disclosure, treatment adherence, stigma, and the presence or absence of supportive relationships. Secrecy emerged as a predominant strategy to manage anticipated stigma, particularly in family, school, and healthcare contexts, but often reinforced isolation. Challenges were especially acute in intimate relationships and future planning, where disclosure dilemmas intensified fears of rejection. The study underscores the need for developmentally sensitive, stigma-informed, and family-engaged interventions to support disclosure processes, strengthen adherence, and promote psychosocial well-being. Addressing these issues is crucial to fostering resilience and inclusion among young people living with perinatally acquired HIV.

This study evaluated the initial phase of the #ShesWell campaign, which aimed to increase pre-exposure prophylaxis (PrEP) awareness and uptake among Black women in four Ending the HIV Epidemic jurisdictions. The initial phase of #ShesWell (March to August 2022) sought to increase demand for PrEP among Black women and build the capacity of healthcare providers (HCPs) to prescribe PrEP. In January-March 2023, a cross-sectional survey was conducted 10 months after the campaign was launched. Sexually active women aged 18-64 were recruited from an online panel. Outcome measures included campaign exposure, PrEP attitudinal beliefs, perceived norms toward taking PrEP, perceived behavioral control, and intentions to take PrEP in the next 6 months. A structural equation model analysis was conducted using data from the 396 Black women in the survey sample who were not currently taking PrEP to explore the associations between campaign exposure and the outcome measures. There is evidence of effects of #ShesWell exposure on attitudinal beliefs and norms and a related total effect of exposure on intention. The study confirmed the pathways from exposure to intention posited by the Integrative Model of Behavioral Intention. Specifically, the collective influence of attitudinal beliefs and normative pressure indirectly impacted Black women's intentions to take PrEP after exposure to #ShesWell campaign messaging. To address disparities in PrEP uptake and increase use of PrEP among Black women, communication campaigns should develop messages that speak to women's attitudinal beliefs and norms. HCPs should also endorse these types of messages with their patients.

Black and Latino men who have sex with men (MSM) in the Deep South have the lowest HIV pre-exposure prophylaxis (PrEP) use rates in the United States, and PrEP stigma may deter PrEP use. However, most research on PrEP stigma is at the interpersonal level, which hinders the development of community-level PrEP anti-stigma campaigns. To address this knowledge gap, we conducted a secondary analysis of an online survey of Black and Latino MSM in the Deep South who are not living with HIV (n = 281). Multinomial logistic regression models were used to assess associations between the Community PrEP-Related Stigma Scale (Community-PSS), its four subscales, and PrEP use (never, former, current), controlling for covariates. We found no evidence of an association between the overall Community-PSS nor three of the four subscales and the likelihood of never PrEP use versus current PrEP use. However, we found that a 1-point increase in the extreme stigma perception subscale (i.e., views that community members believe PrEP users are living with HIV, bad people, or hiding something) was associated with a 16% higher relative risk of never PrEP use versus current PrEP use (p = .019, 95% CI: 1.03-1.32). We also found no evidence of a relationship between Community-PSS nor its subscales and the likelihood of former PrEP use versus current PrEP use. Given these results, extreme stigma perceptions may deter current PrEP use among Black and Latino MSM populations. PrEP campaigns that depict PrEP users as everyday people may be an effective socio-structural approach to increasing PrEP use.

We examined the psychosocial factors that predict sexual risk behaviour of adolescents who reside in HIV affected homes in Uganda, to provide evidence for developing suitable interventions. Structured questionnaires were used to collect data about these adolescents' psychosocial and sexual experiences. The scales and data were verified for precision and reliability using factor analyses, while the predictors of sexual risk behaviour were examined using general linear models. Results showed that having been female, in the younger adolescence stage and a Muganda or Lango, living with one caregiver, being a recipient of HIV/psychosocial care and vulnerable to negative peer influence, personal threats, interpersonal problems, psychosocial distresses (e.g. psychosis and delinquency) and coping by deflecting problems, significantly enabled sexual risk behaviour in these adolescents. However, attending school, religious conviction, experiencing orphanhood especially of the mother, living with two caregivers, and experiencing poverty, judgmental HIV stigma, distress (e.g. inattention and depression), self-control and social support significantly deterred it. These results highlight the centrality of gender, age, HIV care, family situations, sociocultural and peer norms, community stressors, psychosocial distresses, and negative coping methods in influencing sexual risk behaviour of adolescents who reside in HIV affected homes. Interventions by families, schools and agencies are needed to prevent or mitigate these risk factors.

Despite the well-established need to increase access to HIV testing and prevention services among people with serious mental illness, little is known about the determinants of implementation of these services in behavioral health organizations. This multi-method study was conducted in King County, Washington, an EHE priority jurisdiction. A quantitative survey of 16 county behavioral health organizations explored the HIV testing and prevention services currently offered. Three organizations that viewed HIV testing and prevention services as very important or essential for their clients participated in in-depth qualitative interviews; 21 staff, providers, and leaders were interviewed about barriers and facilitators to on-site HIV testing and prescription or referral for Pre-exposure prophylaxis (PrEP). We used a rapid deductive qualitative analysis approach guided by the Consolidated Framework for Implementation Research (CFIR) 2.0. Commonly identified facilitators were organizational culture and a non-judgmental approach to care, frequent contact and long-standing relationships with clients, and a mission to provide holistic care. Commonly identified barriers were lack of resources and trained staff, infrastructure challenges (inability to bill services, weak referral pathways), higher priorities for services (including testing for Hepatitis C and sexually transmitted infections), and lack of knowledge and information. Lack of trained staff and the complexity of the service were more often perceived as barriers to providing PrEP on-site than HIV testing. Opportunities to build capacity were also identified, and included training, implementing universal testing, and expanding partnerships with other organizations to provide HIV testing and prevention services on-site at the behavioral health organization.

Peru's already concentrated HIV epidemic confronted an unprecedented shock with the arrival of SARS-CoV-2. With a natural experiment design, leveraging 96 months (2017-2024) of aggregate national death-certificate data (n = 9,917), we applied join-point regression, attributable-fraction calculations of deaths excess, and Newey-West-corrected interrupted time series models to disentangle indirect service disruptions from direct viral coinfection on HIV/AIDS mortality. Using population-level data, we estimated both relative and absolute measures of disparity, providing novel insights into population-level differences. A sharp inflection occurred in March 2020, producing an immediate monthly surge of 56.3 additional HIV/AIDS deaths (95% CI 42.81-69.93). Across the pandemic biennium 2020-2021, deaths rose from 2,258 to 3,357-an excess of 48.7% versus the 2018-2019 baseline. Co-occurring HIV/COVID-19 accounted for 38% of the excess, while HIV/AIDS-only deaths evidenced the heavier burden, underscoring collateral damage from disrupted testing, ART refills, and inpatient capacity. Analysis of population subgroups revealed substantial disparities: relative rate ratios peaked at 80.5 for adults ≥ 50 years, 4.7 for secondary-versus-university education, and 141 for users of the public Seguro Integral de Salud compared with private insurance. Although mortality declined after mass vaccination and service adaptations, 2024 levels remained above pre-pandemic trajectories. Findings reveal a dual pathway-biological vulnerability plus health-system failure-that nearly erased a decade of progress, disproportionately harming socially marginalized Peruvians. Safeguarding HIV programs within pandemic preparedness plans and targeting equity gaps are therefore urgent to avert similar reversals in future crises.

Illicit drug use has been increasing rapidly in Sub-Saharan Africa in the past decade. However, until recently HIV prevention has largely ignored people who inject drugs and medications to treat opioid use disorder (MOUD) were largely absent. This paper reports results of a pilot intervention that integrated buprenorphine into a harm-reduction drop-in-center for people with opioid use disorder (OUD) in Kampala, Uganda. We collected implementation outcomes and changes in self-reported drug use after buprenorphine initiation. We conducted qualitative interviews with a subset of 14 participants who had initiated buprenorphine. Sixty-two participants were screened for OUD, of whom 57 were eligible for buprenorphine; of those, 55 initiated buprenorphine and 39 were still taking buprenorphine at three months (70.9%). Participants reported significant reductions in opioid use, marijuana and cocaine at 3-month follow up (p < 0.001, p = 0.006 p < 0.001 respectively). Integration of buprenorphine into DICs was successful and removed many barriers patients face in accessing MOUD.

The integration of HIV pre-exposure prophylaxis (PrEP) into STI services can improve PrEP uptake among a population at elevated risk of acquiring HIV. The effectiveness of PrEP relies on ongoing coverage during periods of HIV risk, however, and little is known about longitudinal PrEP use among people accessing PrEP through STI clinics in sub-Saharan Africa. In this study, we analyzed routine records data from people who newly initiated PrEP at an STI clinic in Lilongwe, Malawi in March-December 2022. We assessed PrEP persistence among clients who received Malawi's standard-of-care PrEP services (n = 662) and reweighted the data to reflect the baseline distribution of age, sex, and PrEP indication among the full study population (n = 835). We used weighted generalized estimating equations to estimate the proportion of clients expected to persist on PrEP if all clients had received Malawi's standard-of-care services. We also assessed predictors of persistence and described re-engagement in PrEP among clients who did not persist. We estimated that, had all clients received standard-of-care services, 17% (95% CI: 14%, 20%), 7% (95% CI: 6%, 10%), and 4% (95% CI: 3%, 5%) would have persisted on PrEP at 1, 3, and 6 months, respectively, and that 8% (95% CI: 5%, 11%) of those who did not persist on PrEP at 1 month would have re-engaged in PrEP services by 12 months. Persistence varied by age and PrEP indication. Our findings indicate very low PrEP persistence in this population and suggest opportunities to support ongoing PrEP use in settings with integrated PrEP/STI services.