AIDS and Behavior最新文献

Older people with HIV (those aged ≥ 50 years) are living longer due to advances in HIV and chronic disease treatment. Social capital is often associated with better HIV clinical outcomes, such as high adherence to medication rates. However, this group is experiencing disrupted social connectedness related to shrinking social networks, which may impact their quality of life. We conducted in-depth interviews via web conferencing among a sample of (n = 18) older people diagnosed with HIV late and attending care at two HIV clinics in New Haven, CT, between February 2020 and July 2021. We employed grounded theory and thematic analysis to identify themes related to the influence of social connectedness and social capital on HIV prevention and treatment. Participants' mean age was 59 years, 66% were Black or African American, 58% were male, and 67% had gross incomes < $25,000. Four themes were identified: (1) complexity in using neighbors as sources of social capital, (2) trusted forms of social capital, (3) neighborhood social capital and HIV stigma, and (4) self-empowerment as a response to limited social capital. While social capital may be available in one's social network or community, many felt that they needed additional skills in self-empowerment to obtain or leverage that social capital. Older people with HIV late need additional and unique support to manage their chronic disease along with their HIV care. Structural interventions that help build social connectedness in this population may contribute to a better quality of life.

People who inject drugs (PWID) experience stigma related to drug use and HIV prevention, which can impede engagement with the HIV prevention continuum. Resilience may buffer against stigma's harmful effects, but limited research has examined how resilience operates across different social contexts and stigma types among PWID. Using qualitative interviews and cognitive interviews, we adapted the 10-item Connor-Davidson Resilience Scale to measure resilience to drug use-related stigma and HIV prevention-related stigma among PWID in rural Appalachian Ohio in three contexts: medical, social, and employment. To validate the scale adaptations, we administered a quantitative survey. We assessed internal consistency using Cronbach's alpha and fit Poisson regression models to test the association between high resilience and pre-exposure prophylaxis (PrEP) awareness and overdose response training. Among the 250 PWID who completed the quantitative survey, the six resilience scales demonstrated strong internal consistency. Examining frequency distributions, Bland-Altman plots, and factor analysis, we found the resilience responses varied by stigma type and context. Results of regression models indicated high resilience to HIV prevention-related stigma in the medical context was associated with PrEP awareness (adjusted prevalence ratio [aPR]: 1.37; 95% CI 1.05, 1.80) and overdose response training (aPR: 1.31; 95% CI 1.07, 1.61). Our study provides a novel approach to measuring context-specific resilience to stigma among PWID. Findings highlight the importance of tailoring interventions to both individual resilience and structural stigma, particularly in medical settings. Enhancing resilience and reducing stigma may support greater engagement with HIV prevention and harm reduction services in rural communities.

This study aimed to describe the cultural adaptation and evaluation of a web-based cognitive behavioral stress and self-management (CBSM) intervention for Hispanic sexual minority men living with both HIV and cancer. Using a mixed-method single-group, pre-post design, we assessed the intervention's feasibility, acceptability, and intended effects on health-related quality of life (HRQOL) and psychological distress. Fifteen Hispanic men participated in the study. Baseline assessments revealed low HRQOL, high levels of stress, and cancer-related PTSD symptoms. On average, participants attended seven of 10 sessions, with a 100% completion rate for pre- and post-intervention assessments. Most found the program relevant to their health needs, easy to navigate, and would recommend it. Participants demonstrated significant improvements in emotional well-being and on the PTSD avoidance subscale. Our findings emphasize the acceptability and feasibility of CBSM interventions for this population. However, recruitment challenges highlight the necessity for more inclusive and flexible strategies in future research.

The objective of this paper is to describe the long-term evolution of HIV-related public stigma and the misconceptions around HIV transmission in Spain. A repeated cross-sectional study was conducted using data from three surveys with random sampling carried out in 2008, 2012, and 2021 with a total of 4,836 participants aged ≥ 16 residing in Spain. The temporal variation of public stigma and discrimination indicators between 2008 and 2021 and 2012-2021 was analyzed adjusting for possible sociodemographic differences among the samples calculating adjusted differences using multivariable Poisson regressions with robust variance and multivariable linear regressions. Most stigma indicators and misconceptions about HIV transmission decreased during the analyzed period. However, the degree of proximity of the participants with people with HIV and their willingness to establish relationships with them did not improve. HIV-related stigma remains a significant issue in Spain although most of the public stigma and discrimination indicators improved between 2008 and 2021.

Adverse childhood experiences (ACEs) reflect childhood exposure to abuse, neglect, and family stressors and are associated with subsequent poor mental health. Maternal ACEs can have lasting effects for mothers and their children. Few studies of maternal ACEs have been conducted in low- and middle-income countries. We aimed to determine the relationship between maternal ACEs and mental health among postpartum mothers in Kenya with and without HIV. This nested cross-sectional study used data from mothers attending 6-week postnatal care visits enrolled in the HOPE study. Outcomes of interest were maternal mental health (depression symptoms, psychological distress, and well-being), and the exposure of interest was self-reported ACEs. High ACEs were defined as four or more ACEs. Log binomial regression models were used to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs). ACEs domain (abuse, neglect, and household dysfunction) was a secondary exposure of interest. Of the 1988 mothers, 49.9% were living with HIV, 17.2% had high ACEs, 3.1% had moderate/severe depression (MSD) symptoms, 3.0% had moderate/severe psychological distress (MPD), and 77.6% had moderate/high psychological well-being (MPW). Mothers with high ACEs had a higher prevalence of MSD symptoms (PR: 3.73 [95% CI: 2.29, 6.08], p < .001), and MPD (PR: 3.68 [95% CI: 2.24, 6.06], p < .001) and a lower prevalence of MPW (PR: 0.75 [95% CI: 0.69, 0.82], p < .001). Findings remained when stratified by HIV status and perceived social support. Peripartum ACEs screening may be useful to identify women who may benefit from mental health support.

Awareness of classification as recent or long-term HIV-infected, could potentially influence behavior that leads to differential ART outcomes. We examined whether persons aware of classification of their HIV infection as recent were more or less likely to initiate same-day antiretroviral therapy (ART) and have viral load suppression (VLS) 6-month post-ART initiation, compared to persons aware of classification of their HIV infection as long-term in a cohort of 1,238 adults newly diagnosed with HIV from August 2021 to October 2022 in Rwanda. All persons received a rapid test for recent infection (RTRI) at baseline and viral load (VL) testing at baseline and at follow-up (approximately 6-months post-ART initiation). Per study protocol recent infection testing algorithm (RITA), HIV infection was classified as RITA-recent (RTRI-recent and baseline VL ≥ 1000 copies/mL) or RITA-long-term (RTRI-long-term and baseline VL ≥ 1000) and recency test results were returned per national guidelines; persons with baseline VL < 1000 copies/mL were presumed previously diagnosed and on ART and excluded. Data were abstracted from Rwanda's case surveillance system. We calculated the proportion of persons with follow-up VLS (< 1000 copies/mL). We estimated Risk Ratios (RRs) for follow-up VLS. Nearly all (99.6%) persons initiated same-day ART. Follow-up VLS did not differ between persons aware of classification of their HIV infection as RITA-recent (94%) versus RITA-long-term (94%). Awareness of RITA classification was not associated with follow-up VLS (RR = 1.01 [95% confidence interval: 0.96-1.06]). In this setting where persons were aware of RITA-classification, the vast majority initiated same-day ART and achieved follow-up VLS, regardless of RITA-recent or -long-term infection.

In the United States (U.S.), the highest burden of new HIV diagnosis continues to occur in Southern states. Healthcare access among at-risk populations is crucial to mitigate HIV transmission, yet data on the association between HIV risk and healthcare access is limited. This study examined the association between HIV risk, (i.e., injecting any drug other than those prescribed, engaging in transactional sex, receiving treatment for a sexually transmitted infection, having condomless anal sex, or having four or more lifetime sexual partners-all within the past year) and healthcare access among adults in the South, adjusting for covariates. The 2022 Behavioral Risk Factor Surveillance System for Southern states was analyzed, and 191,266 respondents participated. Rao-Scott Chi-square tests and weighted logistic regression analyses using complex sampling design were performed in SAS v. 9.4. Findings suggest that U.S. adults in the South at risk for HIV had higher odds of not having health insurance coverage (OR=1.55; 95% CI: 1.34-1.79), not having a personal doctor (OR=2.00; 95% CI: 1.78-2.25), delaying routine check-ups for a year or more (OR=1.75; 95% CI: 1.57-1.96), and being unable to afford medical care in the past year (OR=2.26; 95% CI: 2.00-2.56), compared to those not at risk, for unadjusted analyses. After adjusting for covariates, findings suggest that adults in the South at risk for HIV had 1.69 higher odds of being unable to afford medical care in the past year due to financial constraints (95% CI: 1.45-1.97) compared to those not at risk. Among adults at risk for HIV in the South, enhancing access to HIV preventive services, particularly during public health emergencies, has the potential to mitigate HIV transmission risks and reduce the associated financial burden. This association warrants reevaluation in the post-pandemic era to guide future prevention efforts effectively.

The purpose of this study was to understand the impact of the coronavirus disease 2019 (COVID-19) pandemic and mitigation efforts on health and social outcomes for people with HIV at the individual, social, and structural levels of the Social Ecological Model. The International Nursing Network for HIV collected data for a cross-sectional survey of people with HIV in Botswana, Canada, Colombia, Hong Kong, Kenya, Nigeria, South Africa, Thailand, and the United States from August 2021 through June 2023. Among 1,400 participants, 47.5% experienced decreased quality of life, 40.9% experienced increased anxiety, 33.0% had reduced connection with friends, and 38.8% had reduced access to resources. Participants' reported impacts of COVID-19 varied by socioeconomic factors. Among these people with HIV, changes in quality of life, anxiety, social connectedness, and access to resources due to the COVID-19 pandemic were significantly associated with individual, social, and structural level factors using the Social Ecological Framework.

The Undetectable equals Untransmittable (U=U) message improves health outcomes among people living with HIV (PLHIV) and reduces HIV-related stigma. Some PLHIV are unaware of U=U, and those who know about U=U sometimes perceive it as inaccurate. Healthcare providers (HCP) are an important source of information for PLHIV, but they don't consistently or accurately communicate U=U with PLHIV. We conducted web-based surveys among PLHIV and HCP in Thailand from December 2021-August 2022 to assess awareness, belief and understanding of U=U. Binary logistic regression analysis assessed associations between U=U awareness, belief and understanding, and wellbeing (i.e. optimal physical, mental, sexual and overall health, and HIV-related worries) among PLHIV. HCP were asked how and how often they discussed U=U in their clinics. Logistic regression assessed associations between U=U awareness, belief, and correct communication among HCP. Among 172 PLHIV 86.0% were aware of U=U, of whom 88.3% understood it and 90.3% believed it. Awareness, belief and understanding of U=U were associated with improved wellbeing, e.g. undetectable viral load and not being worried about HIV transmission. Among 249 HCP, 91.6% had heard about U=U, of whom 84.4% understood it, 87.1% believed it, and 23.5% correctly communicated it (using 'zero' or 'no' risk). HCP who understood U=U or were confident in U=U communication were more likely to correctly communicate U=U. Gaps in U=U knowledge, belief and understanding still exist among PLHIV and HCP. More efforts to create awareness, belief and understanding are needed, along with interventions to increase confidence and correct U=U communication among HCP.