AIDS and Behavior最新文献

HIV pre-exposure prophylaxis (PrEP) use is understudied among transgender men in sub-Saharan Africa. Seventy-five transgender men were enrolled in a prospective cohort through social media marketing and followed for 12 months (September 2021-January 2023). The primary outcome was PrEP adherence. Thirty in-depth interviews explored (1) knowledge of HIV and other sexually transmitted infections (STIs), (2) testing for HIV and STIs, (3) access to HIV/STI services, and (4) PrEP use and adherence counseling via point-of-care urine tenofovir assay. Data were analyzed using inductive content analysis. Median age was 27 years; 12-month retention was 81%. HBV, HIV, syphilis, chlamydia, and trichomonas prevalence was 4.1%, 2.7%, 2.7%, 2.7%, and 1.4%, respectively. Overall, PrEP uptake was 48%. Urine tenofovir test positivity and TFV-DP detection increased over time: 25%, 52%, 64%, 67%, and 39%, 52%, 50%, 63%, at the 3-, 6-, 9-, and 12-month visits, respectively. Four themes underscored the intricacies of transgender men's lived experiences: (1) Systematic rejection of gender non-conformity resulted in maladaptive coping behavior, increasing HIV acquisition risk; (2) Economic exclusion hindered social integration, but research participation created meaningful social connections; (3) While oral PrEP provided protection, maintaining adherence was difficult for those favoring post-exposure prophylaxis over PrEP itself; (4) Tenofovir urine testing initially raised concerns but later facilitated open conversations regarding adherence. Ultimately, competing priorities limited PrEP adherence. This first oral PrEP study with African trans men revealed low HIV/STI prevalence and moderate PrEP uptake/adherence. HIV programs should integrate HIV prevention delivery with sexual and mental healthcare for this population.ClinicalTrials.gov identifier NCT04867798.

Social determinants of health (SDOH) predispose Sexual and Gender Minority (SGM) individuals to HIV infection through risky behaviors and less HIV testing. This study used data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) survey to evaluate the association between composite measures of SDOH and HIV risk behaviors and HIV testing among adult SGM population in the US. SGM individuals were identified through two questions that asked about respondents' sexual orientation and gender identity. Two primary outcomes of interest were HIV testing behavior and HIV risk behavior. SDOH was measured by ten items which were summed to get a composite score, where a higher score indicates a worse social disadvantage. Logistic regression models were used to examine the association of SDOH composite score with HIV risk behaviors and HIV testing. Among 10,774 SGM individuals who provided responses to the HIV testing question, 5,696 (52.87%) reported lifetime HIV testing. For the HIV risk behavior question, 10,736 SGM individuals responded, of whom 2,059 (19.18%) reported engaging in HIV risk behaviors. SGMs with more social disadvantages were more likely to engage in HIV risk behaviors (Adjusted Odds ratio (AOR) = 1.15, 95% Confidence interval (CI) = 1.12, 1.19) and have a high likelihood of HIV testing (AOR = 1.09, 95% CI = 1.06, 1.12) compared with those with less social disadvantages. A high composite SDOH score is associated with increased HIV risk behaviors and high HIV testing among SGM individuals. Reducing the HIV burden among the SGM population requires addressing structural factors through multifaceted approaches.

Oral HIV pre-exposure prophylaxis (PrEP) is highly effective when taken appropriately at times of HIV risk, termed "prevention-effective adherence". To understand suboptimal adherence, we refined a brief measure for surveys among gay, bisexual and queer men and non-binary (GBQ+) people. We used a mixed-methods design, comprising a national, online cross-sectional survey (June-July 2023) and cognitive interviews (August-October 2023). Logistic regression identified characteristics of PrEP users who reported condomless anal intercourse with casual partners (CLAIC) that was not protected by their own PrEP use because they missed PrEP doses ("PrEP-unprotected CLAIC"). Cognitive interviews investigated whether the prevention-effective adherence measure was comprehensible. Of 2,046 survey respondents, 792 current PrEP users who had CLAIC in the past 6 months were included (Median age = 37, 86.7% gay, 34.5% non-daily-PrEP users). Of PrEP users who reported any CLAIC, 194 (24.5%) reported any PrEP-unprotected CLAIC. They were more likely to: be < 30 years old, be born in Asia vs. Australia, be part-time vs. full-time employed, use non-daily PrEP, have recently initiated PrEP, have experienced side effects from PrEP, and report recent sexualized drug use. They were less likely to find it easy to get PrEP. The 14 interviewees asked about the survey items (Mean age = 33; 50% gay; ) were able to answer the questions and reliably interpret the content. This first national estimate of prevention-effective adherence found that 24.5% of PrEP users who had CLAIC reported any PrEP-unprotected CLAIC. Targeted interventions in subgroups with more frequent PrEP-unprotected episodes must address side effects and other adherence barriers.

Examining the causal pathways through which the Daraja intervention led to sustained improvement in HIV outcomes, including retention in HIV care, ART adherence, and viral load suppression, could highlight critical mechanisms for improving post-hospital outcomes in people with HIV. This pre-specified analysis of the Daraja trial assessed five mediators identified from the Gelberg-Andersen model (self-efficacy, social support, perceived need for HIV services, perceived stigma, and traditional HIV beliefs) and two additional potential mediators, depression and alcohol use. Mediators were quantified pre- and post-intervention. A causal mediation analysis framework was used to construct independent single mediator models for each hypothesized mediator to understand their effect on HIV-related outcomes. Our intervention-mediator analysis demonstrated that the Daraja intervention improved self-efficacy (1.34 (95% CI (0.2, 2.48)) but no effect on other factors in the Gelberg-Andersen model. In our mediator-outcome analysis, improvements in self-efficacy, social support, and traditional HIV beliefs were associated with higher retention in care at 12 months. Results were similar for other HIV outcomes. Self-efficacy was associated with all three HIV outcomes, according to the intervention-mediator effect, mediator-outcome effect, average causal mediation effect, and average total effect. For these outcomes, 37-42% of the intervention effect was mediated by self-efficacy. Self-efficacy was an important mediator of the effect of the Daraja intervention in promoting retention in HIV care, improving ART adherence and reducing HIV viral load. Targeting self-efficacy appears to be critical for enabling hospitalized people with HIV to make the difficult transition from hospital to primary HIV care and live a healthy life with HIV. Clinical Trial Number ClinicalTrials.gov Identifier NCT03858998.

In Uganda, where HIV prevalence remains above 5% among those aged 15 and older, we conducted a randomized controlled trial of Game Changers, an 8-session peer-facilitated group intervention that empowers people living with HIV (PLHIV) to engage in HIV prevention advocacy with their social network members ("alters"). A total of 210 index PLHIV participants (105 intervention, 105 control) and 599 alters were enrolled; assessments were conducted at baseline and 6-, 12-, and 18-months post-baseline. Intention-to-treat repeated measures regressions indicated significant intervention effects on reduced internalized stigma and increased HIV prevention advocacy, prevention advocacy self-efficacy, and disclosure among index participants. In within-intervention group analyses, alters exposed to prevention advocacy showed higher likelihoods of HIV testing and condom use. Game Changers had direct psychosocial benefits for index participants, and indirect benefits for improved HIV prevention behaviors among alters. Implementation research is needed to determine conditions under which Game Changers is most effective.NCT05098015, Registered 2021-10-18.

Post-exposure prophylaxis (PEP) is a crucial human immunodeficiency virus (HIV) prevention tool, yet utilization among men who have sex with men (MSM) remains suboptimal. This study aimed to describe the longitudinal trends in PEP utilization and identify factors associated with recent PEP utilization. A prospective cohort study enrolled 497 MSM in Qingdao between January and July 2023. Participants underwent baseline assessment and were followed up every 6 months, collecting data on sociodemographic characteristics, sexual behaviors, and health service utilization. This analysis included participants who completed all four assessments. Temporal trends were assessed using the chi-square test for trends. Generalized Estimating Equations (GEE) with a logit link were used to identify factors associated with recent PEP use. A total of 417 MSM were included in the analysis. Over the follow-up period, ever PEP use showed a non-significant increasing trend (32.1% to 36.2%). Conversely, recent PEP use significantly decreased from 5.3% at baseline to 2.6% at final follow-up. Multivariable GEE analysis indicated that higher proportions of recent PEP use were associated with engagement in commercial sex, recent sexually transmitted infections diagnosis, prior PrEP use, and perceiving PEP as effective. Lower proportions were associated with age ≥ 30 years and frequent HIV testing. Although ever PEP use appears relatively high among MSM in Qingdao, recent PEP utilization is low and has declined significantly over time. These findings suggest the need for tailored strategies to sustain and optimize PEP use as part of a comprehensive HIV prevention package.

The 2022 mpox outbreak significantly impacted gay, bisexual, and other men who have sex with men (MSM) in the U.S., with Los Angeles representing nearly 40% of California cases. Limited data exist on how MSM living with and without HIV navigated the outbreak and their decision-making regarding vaccination. Between November 2023 and March 2024, we conducted a mixed-methods study with 21 cisgender MSM in Los Angeles who completed a semi-structured interview and quantitative survey. Recruitment prioritized diversity in mpox vaccination history, HIV status, race, and ethnicity. Interviews were recorded, transcribed, and analyzed using thematic content analysis; surveys were analyzed using descriptive statistics. Participants had a mean age of 40 years; 33% were living with HIV; 48% identified as Black/African American or mixed-race, 38% White; nearly half identified as Hispanic/Latinx (48%); 57% reported receiving at least one mpox vaccine dose, and 38% reported two doses for maximum protection. Knowledge about mpox transmission, prevention, treatment, and outcomes varied. Participants self-reported hearing that mpox could be transmitted by skin-skin contact (76%), kissing (67%), engaging in oral sex (67%), and contact with semen (33%); 62% had heard there was a treatment for mpox, 14% thought that mpox was not curable, and 48% believed that mpox was likely to cause death. Psychosocial impacts were prominent at both individual and community levels, including fear and distress. Mpox vaccination was motivated by fear and a desire for protection, facilitated by accessible venues and peer influence. Barriers included initially poor availability of vaccine and the specific eligibility criteria requirements for vaccination early on in the epidemic. Logistical challenges, such as long wait times (> 2 h), work hours, lack of transportation, mistrust in research, and confusing initial rollout also presented unique barriers. LGBTQ+ community-based organizations and peer networks were the primary trusted source of mpox-related information. Most initially adopted risk reduction behaviors but generally viewed the mpox response more favorably than COVID-19 due to time differences in vaccine availability. Post-vaccination, many resumed pre-outbreak activities, feeling more prepared for future outbreaks despite some lingering concerns. Findings underscore varied mpox knowledge and significant psychosocial impacts, reminiscent of the early HIV epidemic. Key facilitators and barriers to vaccination highlight the critical reliance on LGBTQ+ community-based organizations and peer networks for sources of trustworthy information. Providing referrals to mental health counseling and other forms of support during vaccination is recommended.

Improving perinatal engagement in HIV care is critical to prevent disease progression and transmission. In Haiti and other low-resource settings, poverty contributes substantially to poor perinatal HIV outcomes. Cash transfers are a promising intervention that may alleviate poverty and improve perinatal HIV outcomes through economic and psychological pathways. To inform the design of an unconditional cash transfer intervention, we conducted semi-structured interviews with 20 pregnant and postpartum women with HIV receiving care at St. Boniface Hospital in rural Haiti 12/2023-5/2024. Using an interview guide with open-ended questions, we explored barriers and facilitators to HIV care around the time of birth and perspectives on and preferred features of a potential unconditional cash transfer. Interviews were conducted in Haitian Creole, transcribed and translated into English, and analyzed thematically using a codebook developed through deductive and inductive coding. Participants (median age 24 years; 50% pregnant) described barriers including antiretroviral therapy side effects, particularly when taken without food, interpersonal stigma, poverty, and food insecurity. Facilitators included motivation to protect the child's health, understanding treatment benefits, transportation reimbursement, and social support. Participants viewed cash transfers as a promising way to address poverty-related barriers, reporting they would use funds for household needs, child expenses, and small business activities. Preferred transfer sizes varied, as did preferences about delivery, timing, and frequency. Findings underscore poverty's central role in shaping perinatal HIV care engagement and support the potential of unconditional cash transfers to improve outcomes.

Madagascar has a lower HIV prevalence than countries on the African continent. The 2003-4, 2008-9 and 2021 Demographic and Health surveys and the 2018 Multiple Indicator Cluster survey reports were analysed. Between 2003 and 2021, there was a significant increase in the percentage of people reporting sex with multiple partners: for women from 2.6% [95% CI 2.3% - 2.9%] to 3% [95% CI 2.8% - 3.2%], and for men from 16.7% [95% CI 15.1% - 18.3%] to 24.1% [95% CI 23.2% -25.0%]. Similarly, there was a significant increase in the percentage of people reporting sex with a non-marital, non-cohabitating sex partner for women from 13.1% [95% CI 12.4% - 13.9%] to 18.5% [95% CI 17.9% - 19.1%] and for men from 31.8% [95% CI 29.9% - 33.8%] to 38.1% [95% CI 37.0% - 39.2%]. Between 2008 and 2021, among those reporting sex with multiple partners, condom use had significantly decreased for women from 7.6% [95% CI 4.9% - 10.3%] to 3.3% [95% CI 1.8% - 4.8%] and for men from 7.4% [95% CI 5.9% - 8.9%] to 3.8% [95% CI 2.9% - 4.7%]. Between 2003 and 2021 condom use among men reporting non-marital, non-cohabitating partners decreased significantly from 13.1% [95% CI 10.6% - 15.6%] to 9.1% [95% CI 8.1% - 10.1%]. The trends in risky sexual behavior and condom use are possible drivers of Madagascar's evolving HIV epidemic. An HIV prevalence study among pregnant women could help elucidate the current status of the HIV epidemic among the general population in Madagascar.

HIV self-testing (HST) is a user-controlled approach to increasing HIV testing and status knowledge, the gateway to biomedical prevention and treatment. HST is a promising option for key populations facing stigma-related barriers to testing in primary and specialty (e.g., HIV, substance use) healthcare clinics. We conducted a pilot efficacy trial of AEGIDA, a 4-session intervention designed for women who exchange sex and use substances, in Kazakhstan, where there is a growing HIV epidemic. Between November 2022 and August 2023, we used community-engaged approaches to recruit and screen 305 HIV-negative cisgender and transgender women (47% eligible). Ninety participants were enrolled and randomized in a 2:1 assignment to the active (AEGIDA) or a time-attention control (didactic self-screening information) condition with 6 months of follow-up. AEGIDA's theoretically grounded sessions included evidence-based techniques to reduce internalized intersectional stigma and build HST skills to increase HIV testing (e.g., motivational interviewing, peer education, and cognitive restructuring). Sessions were delivered face-to-face and via videoconference, with a closed Instagram page for active condition participants to access content on demand. The intent-to-treat analysis found that participants randomized to AEGIDA were over 4 times more likely to complete a recent HIV test (1 + test in the prior three months; aOR = 4.08, 95% CI: 1.22,13.62) at 6-month follow-up compared to control participants. The intervention had no significant impact on consistent HIV testing (1 + test per three months over the six-month follow-up period; aOR = 2.02, 95%CI: 0.69-5.88). Overall, the AEGIDA intervention demonstrated feasibility and acceptability, and preliminary efficacy to increase recent HIV testing. NCT Information NCT06150937.