AIDS and Behavior最新文献

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.

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 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.

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.

People with HIV (PWH) with a history of cancer are more likely to experience poor psychosocial well-being compared to those without HIV. This study aims to assess the associations between social and healthcare disruptions due to the COVID-19 pandemic with psychosocial well-being among cancer survivors with and without HIV. A cross-sectional survey was conducted between April and September 2020 among participants of the MACS/WIHS Combined Cohort Study with a history of cancer. The primary exposures were social disruptions (loss of job, child care, financial support, housing, and health insurance) and healthcare disruptions (unable to attend a healthcare appointment, obtain medications, and afford medical care). Psychosocial outcomes included depressive symptoms, anxiety symptoms, stress, loneliness, social support, social support satisfaction, and resilient coping. We estimated adjusted prevalence ratios (aPRs) with 95% confidence intervals (95% CIs) using multivariable Poisson regression. Cancer survivors (N = 452) included 63.7% PWH and 51.5% men. Overall, PWH were more likely to experience social disruptions compared to those without HIV (49.6% vs. 36.6%; p = 0.008). Among cancer survivors with HIV, two or more social disruptions were associated with high depressive symptoms (aPR = 2.19, 95% CI = 1.56, 3.08), anxiety symptoms (aPR = 2.36, 95% CI = 1.25, 4.48), stress (aPR = 3.32, 95% CI = 1.25, 8.79), and loneliness (aPR = 2.16, 95% CI = 1.25, 3.74), and one or more healthcare disruptions were associated with high depressive symptoms (aPR = 1.53, 95% CI = 1.22, 1.94), stress (aPR = 2.92, 95% CI = 1.53, 5.58), loneliness (aPR = 1.78, 95% CI = 1.23, 2.57), and low social support (aPR = 1.75, 95% CI = 1.08, 2.82). Disruptions were associated with poorer mental health among PWH but not among people without HIV.

Mental health diagnoses have been linked to poor HIV treatment outcomes and poorer quality of life among people living with HIV (PLWH). Therefore, this study aimed to investigate the association between sociodemographic and HIV-related characteristics, and common and serious mental health disorders among PLWH in South Carolina (SC). Data were obtained from the integrated system of statewide electronic health record (EHR) data in SC (2006-2019; N = 8,124). Multivariable logistic regression models were used to determine the associations between sociodemographic and HIV-related characteristics, and common mental health disorders and serious mental health disorders. Among the study population, 4% were 60 and older, 22% were female, 17% lived in rural areas, and 10% were virally suppressed. Approximately 19% had common mental health disorders while 7% had serious mental health conditions. Sex, race, population type, alcohol use, viral load and comorbidities were associated with having a common mental health diagnosis and serious mental health diagnosis. Mental health intervention and prevention programs should consider addressing these factors and the specific populations that are greatly impacted by adverse mental health outcomes.

In South Africa, gender-based violence (GBV) is a public health crisis contributing to the transmission of HIV and requiring urgent intervention. Using mixed methods, this study evaluated the relationship between adolescents' attitudes toward GBV and their sexual behaviors. Adolescent girls and young women (AGYW) and adolescent boys and young men (ABYM) completed a questionnaire assessing socio-demographic characteristics, sexual risk behavior, and attitudes regarding GBV. Two focus group discussions (FGDs) were conducted to explore perceptions of GBV. Among 178 participants, 80 (44.9%) had permissive attitudes toward GBV. Being AGYW and in a relationship were associated with permissive GBV attitudes. FGDs revealed that participants perceive GBV as occurring both in society and communities, as well as within interpersonal relationships at home. This violence is perpetuated by enduring patriarchal beliefs, male authority, and economic inequalities. Effective prevention of GBV requires integrated, multi-level strategies addressing patriarchal norms, economic inequalities through contextually tailored interventions at home and throughout society.

Self-testing is a critical component of public health initiatives aimed at slowing and stopping the spread of HIV. It has the promise of accessibility, reliability, and convenience, and because of the benefits derived from its inherent privacy, self-testing may overcome the barriers associated with HIV screening with at-risk populations. Still, questions remain about whether and how self-testing can adequately link patients to care and engage them with other interventions when needed. This presents an opportunity for digital platforms to bridge the gap, connecting patients with the HIV continuum of care. During a recent clinical trial of the mLab App, a mobile health intervention designed to increase HIV testing rates, we collected screen-level paradata-detailed logs of user interactions within the application-focusing specifically on user behavior during the test-result interpretation workflow. Among enrolled participants, 330 HIV self-tests were completed in the app, with 74.2% occurring within the scheduled testing window. Three post-timer screens (Preview Test, Upload Picture, and Visual Result) accounted for 60.6% of incomplete testing sessions, highlighting friction points in the result interpretation workflow. Users who experienced discordant automated results (i.e., when the app's automated interpretation differed from the user's visual inspection) demonstrated reduced subsequent engagement but did not significantly alter future test-taking behavior. These findings identify critical moments in the HIV self-testing workflow and provide actionable insights for improving the design of digital tools that support accurate testing and linkage to care.