AIDS and Behavior最新文献

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.

Owing to extensive innovations in HIV treatment and care, research attention has shifted to maintaining and improving health instead of survival. Physical activity (PA) is an area of growing focus and importance among people living with HIV (PWH). However, there remains a paucity of research exploring PA within diverse groups of PWH. The current study aims to address this gap in a cohort of men who have sex with men (MSM) living with HIV. Using data from a longitudinal cohort (= 271 at baseline and = 168 at the 6-month follow-up), this study examines factors (e.g., pain, sleep, mental health, social determinants of health) associated with PA. Linear regression and structural equation modeling (SEM) are used to assess these associations. Sleep deficiency along with increased pain, depression, anxiety, and stress were found to be associated with reduced PA, while greater resilience was linked to more PA. A cross-sectional pathway, pain-sleep-mental health-resilience-PA, was confirmed at both time points. In the longitudinal SEM, in addition to the cross-sectional and autoregressive pathways, a feedback path revealed that current PA increased sleep deficiencies in the future. Our data were consistent with previous research regarding barriers and facilitators of PA among PWH. Patterns observed are consistent from baseline and 6-month follow-up. Resilience emerged as a unique factor associated with PA levels. Future interventions should seek to determine how and in what way resilience may promote PA levels among PWH.

Among heterosexual couples in sub-Saharan Africa, fears of relationship dissolution and inability to bear healthy children following an HIV-positive result remain barriers to HIV testing. Recently expanded availability of pre-exposure prophylaxis (PrEP) affords a critical opportunity to promote HIV testing with reassuring communication that highlights use for relationship preservation and healthy childbearing. We aimed to develop a theoretically-grounded communication intervention to promote partner HIV testing within assisted partner notification (APN) and antenatal care (ANC) programs in Uganda. Through an 18-month iterative co-creation process, we developed the HOPE Clinical Communication Campaign (HOPE-CCC) in collaboration with a project advisory board (PAB) of health workers and the Ugandan Ministry of Health (MoH). We designed gain-framed, patient-facing materials (brochures, poster, invitation cards, self-test kit stickers) that frame PrEP as a family-centered benefit of HIV testing. Multiple cycles of PAB field-testing and feedback informed revisions to enhance relevance and easy integration into clinical workflow. Fifteen qualitative interviews with diverse clients and partners confirmed the relevance and demand for the messaging, supported the acceptability of materials, and guided the development of an accompanying patient-centered counseling strategy (Hear-Offer-Plan-Evaluate). MoH collaboration ensured alignment with national policies and potential for scalability across Ugandan HIV testing settings. HOPE-CCC is well-positioned for further evaluation of its acceptability, feasibility and impact on partner testing in APN and ANC programs. Highlighting the availability of PrEP and its benefits in relationship preservation and healthy childbearing has potential to enhance the effectiveness of HIV testing promotion strategies for heterosexual couples.

Men who have sex with men (MSM) are disproportionately affected by HIV, particularly in urban Middle Eastern areas like Beirut, Lebanon. Understanding factors influencing HIV prevention, such as condom use and HIV testing is crucial. This study used the Information-Motivation-Behavioral Skills (IMB) Model determinants and explored social environment factors to assess their associations with condomless sex and HIV testing. Model fit was also examined to compare our IMB model alone versus an extended model incorporating social environment factors. A sample of 164 MSM (ages 18-29) in Beirut was analyzed using IMB determinants (e.g., HIV knowledge, motivation, condom use self-efficacy) and social environment determinants (e.g., safer sex peer norms, network engagement in HIV testing and risk discussions). Bivariate associations and multivariate regressions were conducted, and model fit was assessed using likelihood ratio testing. Findings showed that our IMB model alone better predicted condomless anal sex, whereas neither model adequately fit HIV testing outcomes. Within our IMB model, higher HIV knowledge was associated with increased odds of condomless sex, while greater condom use self-efficacy was linked to reduced odds. These results suggest that condom use and HIV testing are influenced by different factors. Interventions should not only increase HIV knowledge but also enhance self-efficacy to reduce condomless sex.

Men who have sex with men (MSM) experiencing forced sexual encounters (FSE) are at heightened HIV vulnerability. PrEP and PEP are effective HIV prevention strategies; yet, limited research exists exploring the relationships between FSE, PrEP, and PEP use. Primary data were collected from August 2022-July 2023. Among the 21,373 participants, 21% experienced FSE in the last 5 years, 3.26% indicated past-year PEP use, and 24.81% reported current PrEP use. MSM who experienced FSE reported greater odds of past-year PEP use and lower odds of current PrEP use. Communication surrounding HIV prevention is needed among MSM at risk of sexual violence and subsequent HIV acquisition.

In rights-constrained settings with pervasive stigma, a holistic approach to HIV prevention is needed to ensure knowledge and use of different HIV prevention tools and promote both sexual and mental health. In close collaboration with GBMSM community leaders in Kisumu, we developed a theory-based, culturally-tailored HIV prevention intervention that integrates sexual health and mental health support for young Kenyan GBMSM. We conducted a randomized trial with 6 months of follow-up to assess acceptability, feasibility, and safety of the intervention and explore its potential impact on secondary outcomes, compared to standard care. Among 60 participants, median age was 25 years (inter-quartile range 22-28). Retention at month 6 was 93.1% (27 of 29) in the intervention arm and 87.1% (27 of 31) in standard care. Acceptability was high, with most participants rating each session's value and relevance at 1 ("strongly agree"). Intervention delivery was feasible and attendance was excellent, with 29 (100%) intervention participants completing all five sessions and 18 (62.1%) attending an optional session to consolidate learning. No social harms occurred. Exploratory analyses suggest improved PrEP knowledge and improved knowledge about healthy relationships and communication, as well as higher condom use at last sex. The intervention was found to be acceptable, feasible and safe in this small study. Future work is warranted to evaluate this intervention in a larger trial, given the need for person-centered, holistic interventions supporting sexual health, mental well-being, and the full range of HIV prevention tools available.Clinical trial registration: NCT04550221, registered on 9/8/2020.