AIDS and Behavior最新文献

Young Black and Latinx men and transgender women who have sex with men (YBLMT) face persistent underrepresentation in clinical trials. This study examined the odds of study enrollment among 3327 eligible YBLMT (ages 15-29) screened between July 2020 and August 2022 for a status-neutral mHealth HIV prevention and care intervention in the United States. Only 23% of eligible individuals enrolled. In adjusted analyses, higher education (associate's degree or higher, AOR 1.53, 95% CI 1.22-1.92), recent anal sex (AOR 1.64, 95% CI 1.10-2.43), and known HIV status (negative, AOR 1.36, 95% CI 1.02-1.82; positive, AOR 2.25, 95% CI 1.63-3.10 vs. unknown status) were associated with greater odds of enrollment. Recruitment through social media (AOR 4.41, 95% CI 3.35-5.81) and research registries or community referrals (AOR 1.93, 95% CI 1.53-2.43) resulted in higher enrollment than sexual networking apps. Younger participants (ages 15-17) had higher odds of enrolling than those aged 18-24 (AOR 1.96, 95% CI 1.06-3.70). These findings highlight the need for inclusive, community-informed recruitment strategies and suggest that perceived HIV relevance and trust in digital platforms influence enrollment. Future mHealth interventions should prioritize accessible, affirming study designs and targeted outreach to improve YBLMT engagement and representation in HIV research.

While financial incentivization has been found to significantly increase HIV retesting, receipt of HIV test results, and viral suppression, little research has examined community-based organizations (CBOs) perspectives on implementing financial incentives. We interviewed 22 CBOs related to implementing financial incentives for client engagement in a digital HIV prevention intervention, Keep It Up! (KIU!). KIU! was designed with and for young men who have sex with men (YMSM) who tested HIV-negative to maintain their negative status by reducing risk and enhancing protection. Most CBOs changed their incentive amounts and structures across two years of implementation to attempt to increase recruitment and retention. CBOs originally proposed a mean of $39 incentive in their applications for funding. One year later, the average incentive increased to $40, and then $68 the next year. Most CBO staff felt incentives may be effective in increasing recruitment, retention, and engagement. They highlighted the role of incentives in alleviating social determinants of health. Nearly a third of staff, though, felt the size of incentives may not be high enough. Further, these staff highlighted that incentives may be most helpful in recruiting participants but less beneficial for retention and engagement. Our analysis is among the first to examine CBO staff perceptions of implementing financial incentives for digital HIV prevention interventions in the U.S. Future research is needed to assess the effectiveness of financial incentivization of digital HIV prevention interventions and to identify the amount an incentive should be to increase recruitment and retention.Trial Registration: NCT03896776.

This longitudinal concurrent mixed-methods study examined the impact of initiating HIV pre-exposure prophylaxis (PrEP) on depression severity and HIV- and PrEP-related stigma among gay, bisexual, and other men who have sex with men (GBMSM) in Singapore. A cohort of 53 HIV-negative, GBMSM was followed over 12 months, utilizing repeated quantitative assessments and in-depth qualitative interviews to explore psychosocial outcomes and lived experiences. Quantitative analyses revealed significant reductions in depressive symptoms (adjusted coefficient = -1.55; 95% CI: -2.81, -0.29), HIV-related stigma (-2.26; 95% CI: -4.20, -0.32), and PrEP-related stigma (-2.08; 95% CI: -3.35, -0.81), with the most pronounced improvements observed at the 12-month follow-up compared to baseline and 6-month assessments. Qualitative findings highlighted PrEP's role in alleviating HIV transmission anxiety, enhancing sexual confidence, and fostering a greater sense of agency in participants' health management. Although anxiety was not directly quantified, participants' narratives supported its relief as a psychological benefit of PrEP. Nevertheless, external stigma, particularly the perception of PrEP users as promiscuous persisted, representing a substantial barrier to uptake and adherence. While some participants expressed concerns about risk compensation behaviours, such as reduced condom use, these apprehensions were not corroborated by longitudinal behavioural data. Importantly, PrEP initiation contributed to destigmatization of individuals living with HIV, as participants reported a shift toward greater empathy and openness in their sexual and social relationships. These findings underscore PrEP's dual utility as both a biomedical intervention and a psychological support mechanism. To maximize its public health impact, targeted educational campaigns and culturally tailored stigma reduction strategies, such as, (1) public education to dispel myths about PrEP users, (2) integration of PrEP counselling into primary care and sexual health services, (3) training for healthcare providers on LGBTQ + affirming practices, and (4) financial subsidies to improve affordability. These efforts are critical for promoting PrEP uptake and adherence in Singapore and similar sociocultural settings. This study highlights the multifaceted benefits of PrEP, advocating for its prioritization within comprehensive HIV prevention strategies in the region.

Adolescent girls and young women (AGYW) in sub-Saharan Africa are at risk for HIV/unintended pregnancy. Adherence and continuation to effective oral pre-exposure prophylaxis (PrEP) are limited in AGYW. We hypothesized that an over-encapsulated dual prevention pill (DPP) combining PrEP + oral contraceptive (OC) would be preferred, acceptable, and improve adherence compared to PrEP alone. We randomized HIV-uninfected, 16-24 year-olds 1:1 to use DPP or 2-pill regimen (2PR -PrEP and OCs separately) for three 28-day cycles each. We compared preference for DPP vs. 2PR (exact binomial test) and regimen effects on four acceptability domains: use attributes, product attributes, side effects, impact on sex (Wilcoxon signed-rank tests). Adherence was compared by regimen and sequence (mixed-effects logistic regression) using self-report, pill-count, tenofovir-diphosphate levels in dried blood spots (DBS), indicating ≥ 4 doses per week(≥ 500 fmol/punch at Month 1 and ≥ 700 fmol/punch at Months 2-6). 26/30 participants (mean age 19.4years) completed the study (Nov 2022-Sept 2023). 62% preferred DPP, 38% 2PR (p = 0.24). Most rated both regimens as acceptable, with no differences between them (all p > 0.05). Adherence was high by self-report (98%) and pill-count (97%), but low based on DBS results (DPP: mean 392 fmol/punch, 2PR: mean 384 fmol/punch); with only 10% consistently adherent. There was no difference in adherence by regimen, though odds were higher in period 1 vs. 2 (AOR 3.7; 95% CI 1.10-12.8). Both regimens were safe; 2 pregnancies occurred during the DPP regimen, with no HIV seroconversions. No significant differences in preference, acceptability, and adherence between DPP and 2PR were found in this study. Adherence was low and waned over time. A larger study with a smaller co-formulated DPP may better inform its impact on HIV and pregnancy prevention.The study has been registered at ClinicalTrials.gov Identifier NCT04778514.

The HIV Stigma Scale (HSS) is a 40-item psychometrically sound measure capturing four domains of perceived stigma. A 25-item version has been validated in South India. However, the HSS has not been validated among pregnant women with HIV (WWH) in South Africa, a population facing significant stigma. Moreover, they could benefit from the abridged measure to be more efficiently connected to related interventions. Analyzing data from a sample of pregnant WWH (N = 472) recruited from an antenatal care clinic in eThekweni, Kwazulu-Natal Province, we: (1) conducted confirmatory factor analyses (CFA) to determine if the 4-factor structure of the original 40-item scale holds for the 25-item version in this sample; (2) further shortened the 25-item version using data-driven item reduction, and (3) conducted a comprehensive psychometric evaluation on the abridged version that included internal consistency and construct validity. The CFA confirmed a four-factor structure of the 25-item scale (CFI = 1.00, RMSEA = 0.03, SRMR = 0.04) in pregnant WWH. For model identification, we retained three items per factor. CFA of this 12-item version revealed model fit (CFI = 1.00, RMSEA = 0.01, SRMR = 0.03). All four subscales in the abridged scale showed satisfactory internal consistency (Cronbach's α > 0.80) and construct validity. This is the first study validating the HSS among pregnant WWH in an HIV-endemic setting and developing a psychometrically robust 12-item version, maintaining the four-factor structure of the original measure. Clinically, the abridged HSS enables more efficient screening and reduces participant burden, which could improve reporting and early implementation of stigma reduction interventions in resource-limited settings.

We assessed the preliminary impact of public health messaging on HPV vaccine uptake among adolescents and young women living with HIV in central Uganda. We conducted a pilot randomized controlled trial involving 100 adolescent girls and young women (ages 10-24) living with HIV across four healthcare facilities in the Greater Masaka region of Uganda. Facilities were randomly assigned to either the treatment or control arm. Participants in the control arm were only exposed to informational posters about HPV vaccination, while those in the treatment arm received educational sessions on cervical cancer and HPV vaccination, supplemented by brochures in addition to the posters. A mixed-effects logistic regression model was used to evaluate the intervention's effect on HPV vaccine uptake. Adolescents in both the intervention and control groups did not differ significantly in HPV vaccine uptake at baseline. At baseline, 46 out of 69 unvaccinated girls (49%) were in the treatment arm, which decreased to 9 (20%) at follow-up, while the number of unvaccinated girls in the control arm remained unchanged. The intervention effect was evident through a significant time × group interaction (χ² (1) = 15.13, p < 0.001) suggesting the intervention was effective in promoting HPV vaccination over time. This study highlights the importance tailored public health messaging, utilizing diverse communication strategies to enhance vaccine uptake in this vulnerable group.

Despite oral daily HIV pre-exposure prophylaxis (PrEP) effectiveness, uptake remains a challenge. Awareness of one's HIV status and engagement in prevention is essential to interrupting transmission among populations at high risk of HIV. We explored gaps in HIV risk perception, screening, and PrEP uptake among high HIV-risk fishermen living and working along Lake Victoria, Kenya. Data are from the Owete study (NCT04772469), which evaluated the impact of secondary distribution of HIV self-tests and supported linkage to health facilities within social-networks on prevention engagement. Using self-reported sexual behavior data and clinical records, we (1) identified PrEP-eligible men based on self-reported sexual behavior, per Kenya national guidelines; (2) reported the proportion of fishermen who (a) linked to a healthcare facility post-testing, (b) initiated PrEP per clinic records; and 3) analyzed the relationship between PrEP eligibility and perceived HIV risk using logistic regression, controlling for socio-demographic characteristics. Among 733 fishermen, 715 were sexually active in the past 6 months. The median age was 37.2, 68.4% had ≤ primary education, and 87% were married. PrEP eligibility was prevalent (474; 65%); of eligible men, 222 (47%) linked to a healthcare facility after testing, of whom 127 (57%) received a confirmatory HIV test, 31 (14%) initiated PrEP and 2 (0.1%) were already on PrEP. Primary reasons for non-initiation include screening as low risk at the facility (n = 66; 30%), declining PrEP (n = 41; 18%), and stock-outs (n = 5; 2%). Participants reporting moderate or high self-perceived HIV acquisition risk had 1.80 (95% CI: 1.09, 2.98, p = 0.023) and 1.75 (95% CI: 1.01, 3.03, p = 0.045) times the risk of screening as PrEP eligible, respectively, compared to those reporting no risk. A substantial proportion of fishermen were eligible for PrEP based on sexual behaviors self-reported during the study surveys which align with standardized PrEP eligibility criteria. Nevertheless, we identified a high discordance between these self-reported criteria which renders one PrEP eligible and actually screening PrEP-eligible at a healthcare facility, highlighting potential gaps in effective screening for and subsequent coverage of PrEP to men at risk for HIV acquisition. Understanding the potential limitations of current PrEP screening protocols, as well as clients' experiences with PrEP screening in the clinic, may increase the sensitivity of PrEP screening and close gaps in effective PrEP coverage.Clinical Trial Registration: NCT04772469.

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.