AIDS and Behavior最新文献

The purpose of this study is to describe experiences with healthcare among transgender women. Data are from cross-sectional surveys conducted in San Francisco in 2019 (N=201) and 2023 (N=339). Most transgender women in both surveys had health insurance (92.5% and 92.0%, respectively). Having a provider they felt comfortable with discussing gender-related health issues declined from 81.1% in 2019 to 63.7% in 2023. Many reported being denied healthcare (11.5%), mistreatment by providers (16.4%), and avoiding seeking healthcare (19.2%) due to their gender identity. Training for healthcare providers is needed to ensure respectful and effective care for transgender women.

Despite recognition of the penal system's impact on HIV vulnerability and known HIV disparities among Black Americans, particularly Black gay and bisexual men, limited research has examined the relationship between incarceration and HIV risk for formerly incarcerated Black men who have sex with men and women (BMSMW). This study aims to fill that gap by exploring the role of masculinity-specifically how both hegemonic and prosocial masculinity may influence sexual risk behaviors. Using data from the Public Health Management Corporation of Philadelphia, we assessed differences in masculinity by incarceration status among BMSMW (n = 239). Multivariate regression analyses tested the relationship between types of masculinity and sexual risk behaviors that increase HIV vulnerability in this population. Results revealed significant differences in masculinity ideology between men with and without incarceration histories. Additionally, different forms of masculinity were found to have varying effects (both positive and negative) on HIV risk. Our findings provide new insights into the complex relationship between incarceration, masculinity, and HIV vulnerability in this high-risk group. The study's implications include the need for targeted health promotion and education in correctional settings, reentry policy reform, and further research into masculinity's role in shaping health outcomes for this population. Additionally, there should be a focus on the systemic injustices of incarceration as an area for further exploration to understand its broader impact on health disparities and inequities.

Adolescent girls and young women (AGYW) in South Africa bear a disproportionate burden of the global HIV epidemic. Integrating PrEP into sexual and reproductive health (SRH) services offers a promising strategy to enhance HIV prevention by aligning services with South African AGYW's existing health-seeking behaviors. We performed a scoping review to explore considerations for integrating PrEP into SRH services for AGYW in South Africa. The review involved a comprehensive search in PubMed, Embase, and CINAHL to identify peer-reviewed studies published between 2014 and 2024. Eligible studies reported quantitative or qualitative data regarding attitudes, experiences, or program evaluation regarding PrEP integration within SRH settings in South Africa. Thirty studies met inclusion criteria, representing n = 31,610 participants. Findings revealed four key trends: (i) strong endorsement from AGYW and health care workers for integrating PrEP into SRH services; (ii) potential implementation barriers to PrEP and SRH integration including stigma, socio-economic and community constraints, provider burden, and insufficient infrastructure; (iii) factors to enable integration of PrEP and SRH services including economic and logistical benefits and the likelihood of higher PrEP uptake and adherence if it were offered alongside SRH services; (iv) considerations for integrated PrEP-SRH program design including preferences for long-acting injectable PrEP and differentiated service delivery models tailored to AGYW's unique needs. This body of research findings provides insights for policymakers, researchers, and program designers aiming to scale up integrated HIV and SRH interventions for AGYW in South Africa with implications for other high-burden settings.

Long-acting injectable Cabotegravir (CAB-LA) received regulatory approval in Australia but is not available for prevention. This online cross-sectional study of 1,687 gay, bisexual, and other men who have sex with men (GBMSM) in Australia between May to November 2022 assessed interest in and preference for CAB-LA and other existing and hypothetical PrEP options. When asked for their top preference, the most preferred options were monthly oral pills (28.2%), followed by six-monthly injections (24.6%), removable implants (15.5%), daily oral (14.0%), event-driven oral (13.4%), and CAB-LA (3.9%). Common potential reasons to like CAB-LA included not having to remember to take pills (65.0%), protection against HIV (63.8%), and longer-term protection compared to other methods (46.9%). Common concerns included not knowing enough about CAB-LA yet (46.7%), cost may be unaffordable (44.6%), and potential side effects (n = 547, 32.4%). There were 654 (40.3%) participants who would want long-acting PrEP injections if they could switch back and forth between other forms of PrEP. Interest in using CAB-LA was associated with younger age (aOR = 0.98, 95%CI = 0.97-0.99), having ever taken PrEP (aOR = 2.06, 95%CI = 1.48-2.88), having 11 or more sexual partners in the last 6 months (aOR = 1.65, 95%CI = 1.25-2.17), believing some friends or sex partners are taking PrEP (aOR = 1.58, 95%CI = 1.18-2.11), reporting wanting to try CAB-LA if it was more effective than oral PrEP (aOR = 2.05, 95%CI = 1.48-2.86), or believing CAB-LA is more effective than event-driven oral PrEP (aOR = 1.48, 95%CI = 1.10-1.99). This analysis demonstrated Australian GBMSM have a diverse range of preferences of PrEP options, and access to newer options is needed to increase HIV prevention coverage.

People who inject drugs (PWID) are disproportionately impacted by HIV. To end the HIV epidemic, it is necessary to implement interventions that mitigate the risk of HIV transmission among priority populations. We implemented and tested a community-based intervention for PWID informed by a community based participatory approach in two sister cities on the US-Mexico border. The intervention consisted of three components implemented sequentially: social network HIV testing, peer network psychoeducational and skill building intervention, and community wide events to reduce HIV stigma. Using a quasi-experimental design, we evaluated outcomes through cross-sectional surveys at 6- and 12-months post-implementation of each component, focusing on condomless sex in exchange for drugs (primary outcome), and frequency of substance use and syringe sharing (secondary outcomes). For cross-sectional surveys, we recruited 630 PWID using respondent driven sampling (RDS) chain referrals. Outcome analyses indicated significant reductions in condomless sex in exchange for drugs, frequency of substance use, and syringe sharing. Results also indicated that the number of preventative behaviors enacted after participation were influenced by being exposed to peer information dissemination which promoted adoption of harm reduction behaviors and self-efficacy to enact harm reduction behaviors. The community-based participatory research approach proved essential for building trust and ensuring intervention fidelity.

Self-reports and returned pill count as measures of adherence to the daily oral HIV preexposure prophylaxis (PrEP) regimen in clinical trials have led to misleading outcomes. There is limited adherence data for pregnant and breastfeeding women who initiated daily oral PrEP in clinical trials. In an open-label PrEP clinical trial, adherence to daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) was measured using returned pill counts during pregnancy and post-delivery, up to 54 weeks. Intracellular tenofovir diphosphate (TFV-DP) was measured in stored dried blood spot (DBS) twice during pregnancy and at 6, 26, and 54 weeks post-delivery. True adherence was estimated based on TFV-DP levels corresponding to the number of doses taken per week. Of 271 women, 244 (90.0%), 116 (42.8%), and 84 (31.0%) received PrEP during pregnancy, or until 26 or 54 weeks post-delivery, respectively. Based on pill counts, 80-95% of women took > 80% of the dispensed PrEP pills during pregnancy and postpartum. TFV-DP was undetectable in 13.8-32.9% of women during pregnancy, and 32.9-40.5% of women postpartum. Furthermore, only 21.6% and < 10% of women had TFV-DP levels equivalent to 7 doses/week during pregnancy and postpartum, respectively. Real-time pill count data overestimated adherence to a daily oral PrEP regimen among pregnant and postpartum women. Based on TFV-DP levels, only 20% of pregnant women and 10% of postpartum women had levels suggestive of adherence greater than 80%. Lack of transparency in adherence disclosure underscores the need for real-time, objective measures of adherence to inform targeted adherence counseling.Clinical Trial Number CAP016 is on ClinicalTrials.gov ( https://clinicaltrials.gov/ct2/show/NCT03227731 ).

The pre-exposure prophylaxis (PrEP) care cascade depicting eligibility, initiation, and continuation, as well as loss to follow-up (LTFU) among individuals taking PrEP, has not been systematically evaluated in Indonesia. We examined baseline factors associated with PrEP initiation, the PrEP care cascade, and longitudinal risk factors of LTFU in the Indonesia PrEP Pilot Program, a large-scale implementation program for key populations in Indonesia: men who have sex with men (MSM), female sex workers (FSW), people who inject drugs (PWID), transgender women (TGW), and serodiscordant partners of people living with HIV (SD-PLHIV). Of the 16,469 eligible individuals, 9,124 (55.4%) initiated PrEP (mean age 29.4 [SD 7.5], 85.9% men, 74.4% MSM, 92% from Java-Bali). PrEP initiations were significantly higher among older people, women, FSW and TGW (versus MSM), while markedly lower among PWID and SD-PLHIV and those living in provinces not covered by the program. PrEP continuations at months one and three were very low among FSW (37% and 34%, respectively). The cumulative LTFU rate at 12 months was 41.9% (95% confidence interval [CI], 40.9%-43%). Becoming LTFU was predicted by being younger, being a woman, being an FSW, living in South Sulawesi, West Java, or East Java (versus Jakarta), having no STI diagnoses, reporting consistent condom use, and having high adherence. Our findings revealed gaps in PrEP initiation, continuation, and LTFU among key populations taking PrEP in Indonesia. Targeted interventions are needed to address engagement among those likely to LTFU and populations underserved by the program to improve initiation and continuation.

People with HIV (PWH) have a higher prevalence of smoking compared to the general population, which contributes to an increased risk of non-AIDS-related comorbidities. Heated tobacco products (HTPs) and electronic cigarettes (e-cigarettes) have added complexity to tobacco use behaviors. This study aimed to investigate smoking habits, including HTPs and e-cigarettes use and to describe patterns of tobacco use. We conducted a cross-sectional survey among PWH attending five Italian University Hospitals. An anonymous questionnaire collected information on smoking status, history, use of HTPs and e-cigarettes, motivations for product use, and engagement with smoking cessation services and lung health screenings. A total of 1,081 PWH were included: 41.9% were current smokers (CS), 31.5% former smokers (FS), and 26.6% never smokers. CS reported a median consumption of 15 cigarettes per day and a smoking duration of 30 years. HTP use was reported by 10.6% of participants, most commonly among FS and CS, while e-cigarette use was reported by 15.9%, with the highest prevalence among younger individuals. Dual use of cigarettes and e-cigarettes was found in 21.0% of CS. The main reasons for e-cigarette use were smoking reduction (75%) and perceived lower harm (53.5%). Only 5% of participants accessed smoking cessation services, and 60.5% of CS had attempted to quit, but physician recommendations for cessation support were infrequent (21.0%). Lung health screening was underutilized, with only 17.0% undergoing a CT scan and 12.7% a pulmonology consultation. These findings underscore the need for targeted strategies to address tobacco use and improve preventive care in PWH.

The HIV epidemic remains a critical public health challenge in the Southern U.S., where barriers such as healthcare shortages, structural racism, and social determinants of health exacerbate disparities. Mobile- and self-HIV testing offer promising approaches to address these barriers. Partnering with a community-based healthcare organization in Alabama, we surveyed 181 individuals accessing facility- and community-based HIV testing from August 2022 to November 2023. Most participants were Black (92%), women (78%), and heterosexual (83%), with 73% reporting annual incomes below $50,000. While 72% felt unlikely to acquire HIV, a fifth reported forgoing healthcare due to competing financial needs like housing (23%) and food (21%). Barriers to care were rated as "very slight" to "somewhat of a problem," and medical mistrust was highest in group disparities (mean 27.2/60). Community-level HIV stigma averaged 3.45/5, while social support scored 61.1/100. Mobile-based HIV testing was favorably rated for acceptability (3.9/5), appropriateness (4/5), and feasibility (4/5). Among participants, 61% were aware of HIV self-testing, 21% had used it, and 47% expressed interest in future use. Findings reveal low perceived HIV risk and significant community stigma, though individual stigma was less of a barrier than factors like fear of a positive result and lack of knowledge about care. This study highlights the need for tailored interventions to improve HIV testing access for vulnerable populations across Alabama and other rural U.S. settings.

This study investigates the effectiveness of a targeted intervention aimed at improving vaccination rates among People Living with HIV (PLWH) at the University of Miami/Jackson Memorial Hospital's Adult HIV Outpatient Clinic, a key provider for a predominantly minority population in Miami-Dade County, Florida. Despite the established efficacy of vaccines and their endorsement by various health agencies, vaccination rates among PLWH remain suboptimal, particularly in minority groups. Our intervention, structured around the CERPS framework (Champion, Education, Reminder, Performance feedback, and Standing orders), was designed to address these disparities by increasing educational outreach, reminders, and accessibility to vaccinations within the clinic. The study was conducted over two years and included 400 Hispanic participants, randomized into intervention and control groups. Results showed high retention and vaccination rates that approached or exceeded national averages. However, comparisons between the intervention and control groups were not significant, suggesting potential benefits from increased general awareness and inadvertent cross-group contamination. The findings highlight the complexities of measuring intervention impacts in real-world settings and underscore the need for clinic-wide strategies to enhance vaccination rates. This study adds to the understanding of effective strategies to increase vaccination uptake in urban HIV care settings and highlights the need for further research into provider and patient-centered barriers and facilitators.