AIDS and Behavior最新文献

Oral pre-exposure prophylaxis (PrEP) and family planning (FP) share key characteristics. Both are preventive, both have high efficacy but effectiveness which can be diminished by inconsistent use and both are particularly beneficial for adolescent girls and young women (AGYW) in certain lower- and middle-income countries. When the efficacy of PrEP was proven in field trials, an effort to implement PrEP programs for the populations that would most benefit from it was launched. For AGYW, making PrEP available through existing FP services was seen as a natural opportunity for integration and was the primary effort and until recently, only experience in implementation of PrEP for AGYW. In this systematic review, we attempted to discover whether the integrated delivery of PrEP and FP results in the uptake and consistent use of either or both interventions. We found that no studies that met our inclusion criteria as no valid comparison for a PrEP/FP integration was discovered. Nonetheless, valuable information on the feasibility and acceptability of PrEP was gleaned from some of these studies, much less on the impact of PrEP promotion on FP acceptance and use. Providing PrEP to eligible individuals is an urgent public health priority. Doing so while enhancing uptake and use of FP is equally important. Future studies would benefit from a more encompassing view of this important integration.

ART adherence, essential to preventing disease progression for people living with HIV (PLHIV), remains challenged by factors like poor mental health condition, insufficient social support, and substance use. This study investigates the roles of social support and substance use as mediators in the relationship between mental health and antiretroviral therapy (ART) adherence among PLHIV in a multisite, international context. Cross-sectional data from N = 1598 PLHIV across eight countries were analyzed using parallel mediation analyses in R. Results indicated that both social support and substance use independently mediated the relationship between mental health and ART adherence. Hallucinogens mediated the mental health-adherence link. Cocaine, Amphetamine-type stimulants, inhalants, and opioids directly influenced adherence but did not mediate this relationship. In contrast, no significant effects were observed for tobacco, alcohol, cannabis or sedatives. This large-scale, nurse-led, international study offers critical insights into the roles of social support and substance use as psychosocial influencers in the cascade of care for PLHIV. Clinical implications include prioritizing educative, preventative, and harm-reductive approaches to specific substances that impact ART adherence. Findings may also inform interventions that emphasize strengthening social support to improve adherence in ART and care while addressing substance use as a barrier to care and well-being.

Women who sell sex (WSS) experience a disproportionate burden of HIV due to various structural barriers and social inequities. While pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV acquisition, awareness and uptake among WSS remains low. Telehealth offers the opportunity to address common barriers to care by embedding PrEP services within trusted community spaces. This study evaluates the acceptability and preliminary effectiveness of a community-embedded telehealth approach to engage WSS in the PrEP care continuum, with a specific focus on expanding awareness. Participants were recruited from two community-based drop-in centers in a Midwestern U.S. city from November 2023 to January 2024. Pre-visit surveys were obtained to assess baseline PrEP knowledge and intention to use PrEP, followed by a 15-30-min telehealth visit with a PrEP provider. Post-visit surveys and qualitative interviews assessed changes in PrEP knowledge, telehealth acceptability, intention to use PrEP, and barriers and facilitators to PrEP uptake. PrEP knowledge and intention to use PrEP increased post-intervention compared to baseline. Qualitative findings highlighted high community-embedded telehealth acceptability, low baseline PrEP awareness, a desire to share new PrEP information with peers, and the need for innovative PrEP outreach strategies. This study supports telehealth as a strategy to increase awareness of PrEP among WSS. Targeted public health messaging and expanded integration of PrEP into community and primary care settings is warranted. Future research is needed exploring strategies for sustained engagement and linkage to long-term PrEP care.

Transactional sex, and HIV remain significant public health concerns in Uganda, necessitating increased HIV testing and results receipt among young females who engage in transactional sex. This study aimed at examining regional variations and factors associated with transactional sex, HIV testing, and receipt of results among young women in the four major regions of Uganda. Stata version 15 was used to analyze the 2016 UDHS data set. The study applied a binary logistic regression model to examine the predictors of HIV testing and receipt of results at multivariate level. Overall, 13.5% of the young women reported engaging in transactional sex. The prevalence of HIV testing and receipt of results was highest amongst respondents who had been involved in transactional sex within Eastern Uganda (24.0%), and lowest among those in Central Uganda (7.2%). The study revealed significant predictors across regions: transactional sex, marital status, and distance to the health facility in the North; age, marital status and frequency of reading newspapers in Central; and age, working status, frequency of reading newspaper and watching television, and stigmatizing attitude in Eastern and Western regions. This study underscores the importance of region-specific programming and the need for an all-encompassing strategy to address the intricate factors driving HIV transmission among young women in Uganda. It is paramount that well designed peer education interventions tailored towards life skills development for young women engaged in transactional sex are implemented.

Adolescent girls in Cameroon face substantial sexual and reproductive health vulnerabilities that heighten their risk of HIV exposure. Using data from 2,586 adolescent girls aged 15-19 years from the 2017-18 Cameroon Population-based HIV Impact Assessment, we examined factors associated with multiple sexual partnerships, age-disparate sex, inconsistent condom use, transactional sex, and a composite measure of high-risk sex. Overall, 4.31% reported multiple partners, 25.18% engaged in age-disparate sex, 27.06% reported inconsistent condom use, 3.91% engaged in transactional sex, and 19.61% exhibited high-risk sexual behaviours. In multivariable analyses, marriage or cohabitation was strongly associated with age-disparate sex (aOR = 8.57, 95% CI = 5.84-12.56; p < 0.001) and inconsistent condom use (aOR = 10.07, 95% CI = 6.98-14.53; p < 0.001). Adolescent motherhood was associated with high-risk sex (aOR = 1.71, 95% CI = 1.14-2.55; p = 0.011). School non-enrolment was associated with inconsistent condom use (aOR = 1.76, 95% CI = 1.31-2.37; p = 0.001). Predicted probabilities showed that unmarried, non-mothers who initiated sex later had the lowest probability of high-risk sex (8%), whereas married adolescent mothers with early sexual debut had the highest (72%). These findings underscore the need for combination HIV prevention programming that prioritises married adolescents, adolescent mothers, out-of-school girls, and those initiating sex early. Delaying sexual debut, preventing adolescent motherhood and child marriage, and strengthening age-appropriate, context-specific interventions may substantially reduce HIV exposure among adolescent girls in Cameroon.

Gay, bisexual, and other men who have sex with men (GBM) in the Southern United States (US) experience high HIV incidence yet have relatively lower HIV pre-exposure prophylaxis (PrEP) uptake, especially among GBM of color. Despite awareness, PrEP use remains insufficient to meaningfully impact the HIV epidemic in the Southern US. PrEP promotions largely focus on PrEP messaging, especially product awareness. Theory-based health promotion research has not explored how to develop promotions that drive PrEP uptake. To close this gap, we explored preferences among GBM in the Southern US for promotion content, format, and platform. Grounded in Andersen's Model, we conducted semi-structured interviews with HIV-negative GBM, aged 18-39 years, and used inductive and deductive coding for thematic analysis to develop themes and sub-themes to understand promotion preferences. Forty GBM (68% Black, 10% Latino, 53% not using PrEP) completed interviews. Three major themes emerged: (1) content beyond promoting PrEP awareness, (2) using digital devices and media access for promoting PrEP, and (3) platforms for PrEP promotion. GBM in this study preferred digital promotion of PrEP, focusing on access, safety, and effectiveness that is delivered discreetly; promotion in the non-digital space could normalize PrEP use. Creating promotions that address these themes will make promotions more relevant to drive uptake of PrEP in the Southern US.

Human Immunodeficiency Virus (HIV) is a global health problem that causes many deaths, especially in low- and middle-income countries (LMICs). Most HIV cases occur in sub-Saharan Africa and Asia. In efforts to manage HIV, technologies such as telehealth have begun to be considered as an effective solution, both in high- and low-income countries. This study aims to identify telehealth models used in low-, middle-, and high-income countries and to evaluate their impact on treatment adherence, viral load, and HIV disease management. This study answers the question: "What telehealth models are used in countries with different income levels, and how do they impact HIV/AIDS patients?" This literature review was conducted between February and April 2025 by searching five databases: PubMed, Sage, ProQuest, Scopus, and ScienceDirect, covering the last 10 years, from January 2015 to January 2025. Articles that met the inclusion criteria were original articles on the use of telehealth in HIV patients. Article selection was conducted using the PRISMA flowchart, and quality assessment was conducted using the Quality Assessment of Risk of Bias (RoB 2.0). Of the 4739 articles found, 11 articles met the criteria with four main themes: telehealth models, improving treatment adherence, reducing viral load, and the impact of telehealth on HIV management. The results of this study indicate that telehealth models vary, but their benefits have been proven significant in HIV management, especially in resource-limited countries, and they can improve treatment adherence and reduce viral load.

In Eastern and Southern Africa (ESA), there is heterogeneity within adolescent mothers' (AMs') sexual relationships. However, existing studies focus on single relationship characteristics, even though these characteristics do not operate in isolation. Moreover, no studies have examined multilevel predictors of AMs' relationships. Identifying and characterizing typologies by multilevel factors can inform targeted interventions to lower HIV risk. Data are from the Population-based HIV impact Assessment (PHIA) Project on AMs (15-19 years) from 9 ESA countries (N = 2,761). We conducted multilevel latent class analysis to identify relationship typologies at the AM and community (PHIA cluster) levels, multinomial logistic regression to characterize typologies by multilevel predictors, and multivariable generalized estimating equations (GEE) log-binomial regression to calculate prevalence ratios of HIV for relationship typologies. There were 3 typologies: married with minimal transactional sex (61%), unmarried peer partnership (30%), and working and high transactional sex (9%). Individual-level (i.e., age, school enrollment, low-wealth household, number of sexual partners) and community-level factors (i.e., urbanicity and proportion of low-wealth households) were associated with typologies. Married with minimal transactional sex was associated with a 51% lower HIV prevalence compared to the unmarried peer partnership (adjusting for multilevel factors). We also identified 2 PHIA cluster-level classes: high age-disparate marriage (49%) and low marriage (51%). Low-wealth communities had higher odds of being high age-disparate marriage communities. Results suggest that AMs' relationships fall into 3 distinct typologies and 2 community-level classes. Further, HIV prevalence varies across relationship typologies. Utilizing tailored approaches could optimize interventions that reduce AMs' HIV risk in ESA.

Human-animal interaction (HAI; e.g., pet ownership) may contribute to enhanced health and well-being among individuals managing chronic conditions like HIV; however, responsibilities associated with pet ownership may also prevent owners from accessing timely healthcare. This study investigates the relationship between pet ownership, pet-related barriers to healthcare (PRBH), and comfort derived from pets with durable HIV viral suppression among people with HIV (PWH) in Florida. We tested three hypotheses using survey data from the Florida Cohort Study linked with Florida Department of Health HIV surveillance data, which included 623 participants recruited through HIV care providers and community health clinics. First, we hypothesized that pet owners would exhibit a higher likelihood of durable viral suppression compared to non-owners. While initial findings suggested that pet owners were more likely to be durably virally suppressed (OR = 1.82, p < 0.01), this association weakened, though remained marginally significant, after adjusting for covariates (OR = 1.55, p = 0.06). Second, we hypothesized that, among the pet-owning subset (n = 221), both experienced and anticipated PRBH would be negatively associated with viral suppression among pet owners. Our results confirmed that previously experienced PRBH were significantly associated with lower rates of viral suppression (OR = 0.22, p = 0.02), while anticipated barriers were not (OR = 0.44, p = 0.12). Lastly, we hypothesized that comfort from pets would be associated with better viral suppression; however, this was not supported (OR = 1.00, p = 0.98). These findings suggest that integrating pet-related support into HIV management strategies (e.g., providing pet sitting for patients receiving HIV care) could be supportive of HIV patient health by enabling owners to access timely care while maintaining the human-animal bond. Future research should assess the efficacy of collaborative efforts between healthcare providers and veterinary services in addressing the PRBH faced by pet-owning PWH to promote HIV management while supporting pet ownership in this population.

Pregnant and breastfeeding women (PBFW) on oral pre-exposure prophylaxis (PrEP) face barriers to adherence and persistence which may be improved by point-of-care adherence monitoring using urine tenofovir testing. We explored the acceptability of urine tenofovir testing for PrEP adherence monitoring among PBFW on oral PrEP, and how this, together with PrEP biofeedback adherence counselling, may have shaped PBFW's PrEP adherence and persistence. Between September 2022 and May 2024, we conducted a study among PBFW without HIV on oral PrEP in Cape Town, South Africa. Participants were randomized to intervention (urine tenofovir testing at each study visit with biofeedback adherence counselling) or standard-of-care arms (urine collected but not analyzed with participant, with standard PrEP adherence counselling). Participants, with consistent and inconsistent PrEP use, were purposively sampled from both study arms between October and December 2023 for qualitative interviews. Analysis was guided by the Theoretical Framework of Acceptability and Consolidated Framework for Implementation Research 2.0 using codebook thematic analysis. Among n = 39 women, who were pregnant (n = 16) or postpartum (n = 13); mean age was 29 years (SD = 7), and median time on PrEP was 11.9 weeks (IQR = 4.0,12.1). Acceptability of urine tenofovir testing was high, as it was perceived as familiar, appropriate and easy to use. Most felt that the limited perceived burden and opportunity costs were outweighed by the benefits, which included receiving feedback on their PrEP-taking behavior and if PrEP was present for HIV protection. Urine tenofovir testing with biofeedback counselling was seen as motivational to daily PrEP use. It positively reinforced PrEP-taking behaviors among those consistently using PrEP and allowed others the opportunity to reconsider their risk for HIV acquisition. Urine tenofovir testing facilitated more accurate self-reporting of PrEP adherence, although some reported restarting taking PrEP prior to visits. Participants' PrEP-taking was supported by non-judgmental and encouraging biofeedback counselling which included co-development of strategies to overcome pregnancy and postpartum related barriers to PrEP persistence. Confusion of urine tenofovir testing with other antenatal urine tests and perceptions of blood-based testing being more effective hindered application to motivating PrEP use. Addressing perceived efficacy and coherence related to urine tenofovir testing within counselling is key. Urine tenofovir testing with biofeedback counselling was perceived as acceptable and motivational to PrEP adherence among PBFW. Integration is further recommended, given that other urine tests are routinely utilized in antenatal care.