Adolescent mental disorders affect 14% of youth globally, yet treatment rates remain low (38%), particularly in low-resource settings. While stigma is a recognized barrier to care, limited evidence exists on how multi-level stigma (public, peer, family) transforms into self-stigmatization during adolescence-a critical developmental period characterized by heightened peer sensitivity. This cross-sectional study utilized a dyadic design to examine the transmission of stigma from caregivers to adolescents. We distributed survey sets to 8,500 dyads in Shandong, China. After matching and data cleaning, 4,702 valid adolescent-primary caregiver dyads remained. Validated instruments measured public stigma (STIG-9), peer stigma (PMHSS-R), family stigma (PDD), self-stigma (ISMI-10), and mental health status (GHQ-12). Public stigma directly predicted peer stigma (β = 0.784 [95% CI: 0.752-0.816]), family stigma (β = 0.348 [95% CI: 0.313-0.383]), and self-stigma (β = 0.390 [95% CI: 0.351-0.429]). Peer stigma mediated public-to-self-stigma transmission (β = 0.426 [95% CI: 0.388-0.464]), while family stigma showed no direct effect. Adolescents with mental health problems exhibited higher baseline self-stigma (mean difference: 3.21 [95% CI: 2.83-3.59]) but attenuated response to rising peer stigma. Conversely, mentally healthy youth demonstrated accelerated self-stigmatization when peer stigma increased. Mental health significantly moderated public-to-family (β = -0.269 [95% CI: -0.309 to -0.229]) and peer-to-self-stigma pathways (β = -0.246 [95% CI: -0.287 to -0.205]). Peer stigma operates as the primary conduit through which societal stigma becomes internalized during adolescence, whereas family stigma plays a non-significant direct role. The paradoxical moderating effect of mental health-where affected youth show high baseline self-stigma but reduced reactivity-calls for developmentally tailored interventions. School-based peer initiatives should be prioritized alongside public awareness campaigns, while family programs should focus on support rather than stigma reduction.
Stigma is a well-recognized barrier to substance use (SU) treatment initiation and retention. It is theorized to operate through three distinct mechanisms: internalized, enacted, and anticipated. The unique associations between these specific stigma mechanisms and key psychosocial factors - such as engagement in reinforcing activities (i.e., behavioral activation), depression, and SU-related problems (e.g., social, financial) - remain unexplored, particularly among historically underserved populations. The current study examined how SU stigma in total and each mechanism is associated with these outcomes among individuals in an urban methadone clinic serving a historically underserved community. This cross-sectional study utilized baseline data from a peer-delivered behavioral intervention trial to examine how SU stigma mechanisms are associated with behavioral activation (BA), depressive symptoms, and SU-related problems among a predominantly low-income sample in methadone treatment (N = 212). Linear regression analyses revealed that overall SU stigma was associated with lower BA, higher depressive symptoms, and greater SU-related problems. In multiple linear regression models controlling for relevant covariates and stigma mechanisms, higher internalized SU stigma remained significantly associated with worse outcomes across all domains. Following multiple-testing correction, associations for anticipated stigma (with lower BA and higher depressive symptoms) and enacted stigma (with greater SU-related problems) were marginally significant. Findings highlight differential associations of stigma mechanisms in psychosocial functioning, and may point to a need to address internalized stigma in SU interventions. Future longitudinal research is needed to assess causal and mechanistic relationships between stigma, SU and psychosocial outcomes to inform targeted intervention development.
Antiretroviral therapy (ART) adherence remains suboptimal in sub-Saharan Africa despite expanded access, particularly in Ghana, where structural and psychosocial stressors such as internalized HIV stigma, depression, and food insecurity interfere with sustained ART engagement. Although these factors are often studied separately, limited research has examined how they interact to influence beliefs and attitudes toward ART. We conducted a cross-sectional analysis among 170 adults living with HIV in the Volta Region of Ghana. Participants completed validated measures assessing internalized HIV stigma, depressive symptoms, household food insecurity, beliefs, and attitudes towards ART. We applied mediation and moderated mediation models to test whether depression mediated the association between internalized HIV stigma and beliefs and attitudes toward ART, and whether these indirect effects varied based on food insecurity. Internalized HIV stigma was associated with more negative beliefs and attitudes toward ART (B = .16, SE = .02, p < .001; B = .08, SE = .02, p < .001). Depression significantly mediated these associations (B = .10, 95% CI [.06, .14]; B = .09, 95% CI [.05, .14]), and food insecurity moderated the association between internalized HIV stigma and depression (B = .36, SE = .13, p = .004). Conditional indirect effects were stronger at high (B = .11, SE = .03, 95% CI [.06, .17]) versus low (B = .06, SE = .02, 95% CI [.03, .10]) food insecurity. These findings indicate a syndemic interaction between internalized HIV stigma, depression, and food insecurity. Addressing psychological distress alone may not improve ART adherence unless accompanied by efforts to reduce internalized stigma and improve food security. Integrating depression management, stigma reduction interventions, and food security support within HIV services may better enhance treatment engagement in Ghana and similar settings.
As a major component of air pollution in urban environments, dust particles are similar in size to pollen grains. When deposited on the stigma, dust may occupy the space for pollen deposition and reduce the adhesion of pollen, potentially leading to a decrease in plant female fitness. Unfortunately, to date, the relevant evidence remains scarce. A dust simulation experiment was conducted on 29 plant species at the Yan'an Botanical Garden. The effects of dust deposition on the stigmatic surfaces were examined using microscopy, and female fitness was compared between experimental (dust) and control (non-dust) groups. We demonstrated that dust significantly occupied stigma surfaces and absorbed stigma secretions. The dust simulation treatment significantly decreased the fruit and seed set but did not influence the fruit length or weight. Moreover, plants with wet or more exposed stigmas showed greater susceptibility to dust, evidenced by relatively lower fruit and seed set in both the non-dust and dust treatments. Dust significantly reduces the reproduction of plants by altering the microenvironment of the flower stigma, including absorbed stigma secretions and occupied stigma surfaces, and its principal effect is observed during the critical pre-fertilization phase. Although our study significantly advances the understanding of the harmful effects of pollutants on plant reproduction, much remains to be learned and the underlying mechanisms need to be investigated in the future.
Diabetes is a noncommunicable disease that requires constant self-management and support systems. Managing diabetes can be stressful due to various restrictions and necessary activities for self-care. Diabetes-related stigma can lead to delays in diagnosis, treatment, and management activities. Therefore, there is a need to assess the stigma associated with diabetes. This study assessed the stigma associated with type 2 diabetes mellitus (T2DM) and established the association between diabetes-related stigma, self-management of diabetes, family support for diabetes, and glycemic control. This is a cross-sectional hospital-based study. Three hundred patients of T2DM attending the Medicine and Diabetic Outpatient Department were selected, and the interviewer administered the questionnaire after obtaining informed written consent. The patients' glucose control, treatment received, presence of complications and comorbidities, and regular follow-up visits to the hospital were assessed using their OP cards from the MRD. Data were analyzed using SPSS and JAMOVI software. The study population had a mean age of 57 ± 9 years, with men and women participating at similar rates. Approximately 53% of the study population had not achieved glycemic control. Structural equation modeling showed significant negative associations between diabetes-related stigma and glycemic control, negative associations between family support and stigma, and positive associations between family support and self-management as well as between self-management and glycemic control. In patients of T2DM with uncontrolled blood sugar, there is a need to address stigma associated with the disease as a part of individual assessment.
The objective is to investigate associations between anxiety accessing mental health services and structural stigma as self-reported by people with borderline personality disorder. A retrospective cohort design was used to investigate data from the 2017 National Consumer Survey undertaken in Australia between June and July 2017. Analyses were performed using multivariate binary logistic regression models. Data comprised 423 people with borderline personality disorder aged 18 years and above, where 384 (93.7%) were females. Associations were found between anxiety and stigma in relation to mental health service access for borderline personality disorder. Strikingly, most people with borderline personality disorder reported experiencing anxiety accessing mental health services irrespective of having anxiety disorder/s, indicative of stigma leading to anxiety rather than a by-product of anxiety disorder/s. People with borderline personality disorder and anxiety disorder/s were 9.8 times more likely to feel very anxious about not being taken seriously in mental health services, than respondents with no anxiety disorder/s. Contrastingly, people with borderline personality disorder and anxiety disorder/s were 79% less likely to feel anxious about cost of services, than respondents with no anxiety disorder/s. People with borderline personality disorder previously refused public hospital admission were 8.7 times more likely to feel very anxious about cost of services and 5.3 times more likely to feel very anxious about long wait lists for services than people with borderline personality disorder not refused hospital admission. Associations were observed for people with borderline personality disorder experiencing anxiety accessing mental health services, attributed to stigma in health systems. Findings provide nuanced understanding of structural mechanisms and system-level problems affecting services and advances knowledge on the impact of borderline personality disorder-related stigma in healthcare.
Artificial intelligence (AI) chatbots are increasingly used to provide mental health support, but their effectiveness depends on users' willingness to disclose personal information. How gay men develop comfort in sharing sensitive information about sexual orientation and sexual health with AI chatbots remains underexplined. Drawing on the Minority Stress Model and Communication Privacy Management theory, this study surveyed 1024 Chinese gay men to examine how perceived sexual stigma shapes comfort with sensitive self-disclosure to AI chatbots. Using Partial Least Squares Structural Equation Modelling, the study found that perceived sexual stigma did not directly predict disclosure comfort. Instead, its influence operated indirectly through a sequential pathway: stigma increased perceived stress, which promoted general emotional disclosure, and this in turn enhanced comfort with sensitive disclosure. Privacy concerns weakened this positive relationship. Fuzzy-set Qualitative Comparative Analysis further showed that general emotional disclosure was a core condition across multiple pathways leading to high disclosure comfort. These findings highlight a progressive disclosure pathway and position AI chatbots as a potential digital coping resource for stigmatized populations.
This study explores the gendered perceptions surrounding female smoking in Saudi Arabia, where tobacco use is shaped not only by health concerns but also by deeply rooted social norms. Employing a qualitative approach, the study draws on semi-structured interviews with 35 Saudi adults (20 women and 15 men), aged 18 and older. Thematic analysis revealed a clear gendered double standard in smoking-related stigma. Women's smoking was judged more harshly than men's and was often interpreted as a violation of femininity, modesty, moral propriety, and family reputation. Participants also linked female smoking to poor upbringing, emotional instability, and failure to meet expected reproductive or caregiving roles. In contrast, men's smoking was largely normalised, and at times associated with masculinity, despite its recognised health risks. Viewed through gender role, patriarchal, and social control perspectives, these findings show how smoking stigma functions not only as health-related disapproval but also as a mechanism for regulating women's behaviour and reinforcing gendered expectations. The findings show that smoking is a socially regulated practice in Saudi Arabia, particularly for women. Tobacco control strategies should therefore be gender-sensitive, non-moralising, and culturally informed. Public health efforts should frame smoking as a health issue, avoid reinforcing gender stereotypes, and provide confidential cessation support, especially for women who may fear social judgment. Addressing these gendered double standards is important for reducing stigma and promoting more equitable health outcomes.
Cancer patients have a higher suicide risk than the general population. Oncology nurses play a critical role in assessing and managing this risk. However, they often lack the necessary awareness, knowledge, and skills. This study developed an Oncology-Specific Suicide Prevention Program (OSP) for oncology nurses. It aims to assess how the OSP affects nurses' suicide literacy, suicide stigma, and efficacy in suicide risk management. Researchers developed the OSP based on findings from cancer-related suicide studies. The intervention included three structured online sessions for the experimental group, each session addressing specific aspects of suicide prevention strategies in oncology care. Researchers conducted a randomized controlled trial with 86 nurses from two oncology hospitals in Ankara. Nurses were randomly assigned to an experimental group (n = 43) or a control group (n = 43) after stratifying by years of work experience. The control group received usual in-service training. Researchers collected data using the descriptive information form, the literacy of suicide scale, the stigma of suicide scale, and the efficacy perception scale for suicide risk management for oncology nurses. The experimental group showed a significant increase in suicide literacy (p < 0.001) and efficacy perception for suicide risk management (p < 0.001). They also showed a decrease in suicide stigma (p = 0.013) compared to the control group. These effects were measured at the end of the program and 3 months later. Integrating the OSP into in-service training for oncology units and national and international suicide prevention strategies is suggested.
Unhealthy alcohol use is linked to several adverse health outcomes among people with HIV (PWH). HIV-related stigma (HRS) has been identified as a potential risk factor for unhealthy drinking, but research has been limited, and findings have been equivocal. This cross-sectional study examined associations between HRS and alcohol-related indices in a national sample of PWH with unhealthy alcohol use enrolled in an intervention trial for one of two common comorbidities that impact functioning among PWH (i.e., chronic pain or physical inactivity; n = 331). Generalized structural equation modeling tested whether depressive symptoms mediated HRS-alcohol involvement associations, and model invariance was assessed across trials. Participants had a mean age of 47.9 (SD = 11.4) years (16.6% identified as female, 29.6% were White, 51.4% were African American). HRS was directly and indirectly associated with greater alcohol use risk severity (as measured by the AUDIT) and mean drinks per day via depressive symptoms only among participants in the chronic pain trial. In the combined sample, HRS was associated with greater alcohol-related consequences, with significant indirect effects through depressive symptoms, although no trial-specific effects emerged. Depressive symptoms may be a pathway through which HRS influences alcohol involvement among PWH. Clinical comorbidities, such as chronic pain, may amplify HRS-alcohol use associations.
Climate change is emerging as a big challenge to Saffron (Crocus sativus L.), which is among the most valuable and costly spice crops worldwide. The present study investigated the effect of key weather parameters viz., solar radiation, rainfall and temperature (max, min, average) on gene expression of CsβCH (Beta carotene hydroxylase) and CsCCD1 (Carotenoid cleavage dioxygenase 1) genes and saffron quality in one traditional saffron growing area (Pampore), three non-traditional areas (Mirgund, Anantnag, Udhampur) and one controlled environment (indoor) site. The study revealed that saffron from field locations of Pampore (0.88; 0.93) and Mirgund (0.71; 1.16) exhibited significantly higher expression levels for both CsβCH and CsCCD1 genes, respectively, corresponding with higher levels of crocin, picrocrocin and safranal content. In contrast, saffron from Anantnag (0.37; 0.48) and Udhampur (0.33; 0.37) showed comparatively lower expression for these two genes and reduced metabolite accumulation. The content of all the three major apocarotenoids viz. Crocin, Picrocrocin and Safranal were found to be highest in Controlled (280.59, 82.66, 36.44) environment, followed by Pampore (215.81, 79.50, 39.78) and Mirgund (212.14, 107.76, 40.62). Among different weather parameters, rainfall and minimum temperature had significant effect on saffron quality (crocin). A minimum temperature of 10℃ during the flowering phase (1st Oct-10th Nov), combined with lower rainfall of 240-265 mm, enhanced saffron quality. This is the first report comparing indoor and in-field grown saffron (both traditional and new areas) of the highest-altitude saffron-growing regions of the world, viz- north-western Himalayas of Kashmir, India. The study links weather variables with gene expression and metabolite profiles, providing mechanistic insights into climate-mediated regulation of saffron quality.
Pollen-stigma interactions constitute the initial step of male-female communication during flowering plant reproduction, ensuring compatible pollen germination and fertilization. In Arabidopsis, the receptor kinase FERONIA (FER) regulates this process, but its downstream signaling mechanisms remain incompletely understood. Here, we identify Glutathione S-Transferase Phi 10 (GSTF10) as a FER-interacting protein. Physical interaction between FER and GSTF10 was confirmed by yeast two-hybrid, luciferase complementation, and co-immunoprecipitation assays. In vitro phosphorylation assays showed that FER directly phosphorylates GSTF10. Loss of GSTF10 function led to accelerated pollen hydration on the stigma and reduced reactive oxygen species (ROS) levels in stigma papillae, accompanied by enhanced pollen tube elongation. Genetic epistasis analysis revealed that the fer-4 gstf10-1 double mutant phenocopied the gstf10-1 single mutant in terms of pollen tube length, placing GSTF10 downstream of FER in regulating pollen tube growth. In addition, gstf10 mutants produce more seeds per silique. Collectively, these findings suggest that FER-mediated phosphorylation of GSTF10 contributes to restraining pollen hydration and tube elongation, likely through modulating ROS homeostasis in the stigma. This study uncovers a previously unrecognized signaling module that governs early events of compatible pollination.
BackgroundPre-exposure prophylaxis (PrEP) is highly effective in preventing human immunodeficiency virus (HIV) transmission, particularly for individuals at increased risk. However, uptake and long-term adherence remain challenging, with limited data on pharmacies beyond pilot studies. This study explored how psychological, social, and structural factors shape perceptions of HIV risk and influence PrEP adherence, using the Tripartite Risk Perception (TRIRISK) model, Protection Motivation Theory, and the Theory of Planned Behavior.MethodsA qualitative design using in-depth interviews (IDIs) was conducted pre-implementation (May 2023) and during implementation (April-July 2024) of pharmacy-based PrEP services. Participants were adults (18+years) accessing pharmacy-based PrEP services in Gauteng and the Western Cape, South Africa. Data were analyzed thematically using Excel and MAXQDA, guided by the integrated behavioral frameworks.ResultsA total of 99 IDIs were conducted, 30 in 2023, 69 in 2024. Through the TRIRISK model, this study found that decisions to start or continue PrEP were shaped by perceived vulnerability to HIV, awareness of risky sexual behaviors, mistrust of partners, and emotional experiences like fear and trauma. The PMT further highlighted how emotional triggers, along with perceived severity and coping efficacy, affected motivation to initiate or continue PrEP. The TPB helped explain how subjective norms, such as stigma and social judgment, and perceived behavioral control, shaped by access, convenience, and privacy, impacted adherence.ConclusionIntegrated behavioral frameworks offer critical insights into PrEP-related decision making. Interventions, including pharmacy-based PrEP models, should address emotional barriers, such as stigma-sensitive messaging, strengthening social support, and reducing structural inequalities. HIV Risk Perception and PrEP UsePre-exposure prophylaxis (PrEP) is a highly effective medicine that helps prevent human immunodeficiency virus (HIV). However, not everyone who needs PrEP uses it effectively. In South Africa, PrEP is being offered in some pharmacies to make it easier to access compared to most public clinic settings. This study looked at what people think and feel about their risk of getting HIV, and how those thoughts shape their decision to take PrEP. We interviewed 2 groups of pharmacy clients at different stages of implementation: one group before pharmacy-based PrEP was rolled out, and another group during implementation after PrEP had been initiated. We used 3 behavioral theories to understand how people assess their risk and make decisions about PrEP use. We found that people were more likely to start PrEP when they felt personally at risk of HIV, for example due to a partner's unfaithfulness or past traumatic experiences. Support from peers, privacy at the pharmacy, and easy access made it easier to keep using PrEP. However, stigma, travel, and life challenges like family responsibilities often made it harder to continue. This study shows that providing PrEP through pharmacies can work well, but emotional, social, and structural barriers must be addressed. PrEP programs should include supportive messaging, flexible access options, and tools that help people stay on PrEP even when life gets difficult.
Individuals with chronic disease must comprehend their diagnosis (sense) and gain control over the ailment (grip on disease). However, HIV-AIDS is different due to stigma and discrimination. Yet, persons living with HIV, with a robust sense of grip on disease (SoGoD), can lead satisfying lives. This study aimed to assess the SoGoD status and its associates, and then elicit the perspective of the stakeholders. This mixed-method study was conducted among People Living with HIVs (PLHIVs) visiting a tertiary care hospital in Kolkata, India, from November 2023 to January 2024. The quantitative strand of the study was conducted among 120 PLHIVs on antiretroviral therapy (ART), and then the qualitative strand was conducted by in-depth interviews (IDIs) with study participants and key informant interviews (KIIs) with healthcare personnel. SPSS software was utilized for quantitative data analysis, and factors associated with the SoGoD were analyzed using logistic regression models. Qualitative data were analyzed thematically. Among the study participants, 34% have a dynamic grip. Illiteracy (adjusted odds ratio [aOR] = 7.22, 95% confidence interval [CI] = 1.94-10.97), current marriage (aOR = 4.44, 95% CI = 1.61-12.27), no history of substance use (aOR = 2.79, 95% CI = 1.99-7.85), and lesser stigma and discrimination (aOR = 5.41, 95% CI = 1.96-7.86) were significantly associated with dynamic grip. Self-care, family and community support, and integrated institutional care were identified as major ways to enhance disease grip. Since HIV is a heavily stigmatized disease, measures such as early family engagement and counseling, and comprehensive and adaptable institutional care should be undertaken to improve their disease grip.
Across practice and policy, assistive technologies (ATs) are positioned as a pathway to economic inclusion for graduates with sensory disabilities in South Africa. Still, systemic barriers persist. Developing workable interventions requires in-depth attention to the lived experiences of graduates, which include knowledge on the way devices, systems and attitudes interact in everyday employment seeking and enterprise activities. The study endeavoured to examine how unemployed tertiary-level graduates with sensory disabilities in Gauteng use AT in seeking employment and practising entrepreneurship. Specific enablers and challenges were identified to provide an explanation of variation in economic participation. Interpretive methods guided the study within a qualitative design. Sixteen participants took part in semi-structured interviews: 10 unemployed graduates (with visual or hearing impairments), three human resources professionals and three helping professionals. Coding and analytic development followed Braun and Clarke's six-phase thematic approach. Overall patterns were organised into six themes: (1) discrimination and stigma, (2) accessibility, (3) use and effectiveness of AT, (4) training and support, (5) institutional and government support, and (6) self-initiated strategies and adaptation. Device access proved insufficient. Most constraints operated at the system level, consistent with the social model of disability, as stigma, accessibility failures, limited training and weak enforcement shaped outcomes. Sustained change had to address stigma, accessibility, training and support and accountable policy implementation through coordinated multi-stakeholder action. By centring graduate voices, this article contributed evidence on adaptability and multi-stakeholder lenses relevant to inclusive policy and practice in resource-constrained settings.
Stigma and discrimination compound the burden experienced by informal caregivers of people with mental illness, impacting their wellbeing. Prior caregiver stigma research has relied on qualitative or convenience samples, limiting knowledge of groups most affected. This Australian study is the first nationally representative survey of caregiver experiences of discrimination and positive treatment. Participants (N = 2,164) were recruited from a probability-based online panel using stratified random sampling and weighting for age, gender, education, and language background. Descriptive statistics examined prevalence of stigma, discrimination and positive treatment experiences. Multiple regression models were used to assess sociodemographic differences in experiences and associations with psychological distress and wellbeing. Positive treatment experiences were common, with 67.9% (95% CI: 65.4, 70.2) of caregivers reporting understanding from friends and family and 59.6% (95% CI: 57.1, 62.1) feeling valued by the care recipient's treating team. However, 34.3% (95% CI: 31.9, 36.8) reported role concealment, and 18.8% (95% CI: 16.8, 20.9) unfavourable treatment at least sometimes. Positive treatment experiences were more prevalent among caregivers who were older or with higher levels of education, whereas experiences of discrimination were more common among caregivers from non-English speaking backgrounds. Women were less likely to conceal their caregiving role. Positive treatment was associated with lower distress and higher wellbeing, whereas discrimination was associated with higher distress and lower wellbeing. Despite encouraging levels of support, experiences of caregiver discrimination are common and impact on psychological distress and wellbeing. Multi-pronged strategies are needed to address inequities, strengthen peer support and caregiver-inclusive practice frameworks.
Epilepsy is one of the most common neurological disorders worldwide and is frequently accompanied by stigma and misconceptions. Negative attitudes toward individuals with epilepsy may adversely affect social integration, access to healthcare, and quality of life. Healthcare students represent future professionals whose knowledge and attitudes may influence both patient care and stigma reduction. This study aimed to examine the relationship between epilepsy-related knowledge and attitudes among health services vocational school students and to determine whether knowledge independently predicts attitudes toward epilepsy. This cross-sectional study was conducted among students enrolled in a health services vocational school. Data were collected using a structured questionnaire including sociodemographic characteristics, an Epilepsy Knowledge Scale, and an Attitude Toward Epilepsy Scale. Multivariate regression analyses were performed to identify independent predictors of attitudes while adjusting for demographic and experiential variables. Higher levels of epilepsy-related knowledge were significantly associated with more positive attitudes toward epilepsy. In multivariate analysis, knowledge score remained the only significant independent predictor of attitudes, whereas demographic and experiential factors were not independently associated with attitudes toward epilepsy. Epilepsy-related knowledge appears to play a key role in shaping attitudes among health services vocational school students. Educational strategies aimed at improving epilepsy knowledge may contribute to reducing stigma and promoting more supportive attitudes among future healthcare professionals.
Adolescents with HIV (AWH) have higher rates of detectable viral loads (DVL) than adults. We sought to identify clinical and psychosocial predictors of DVL among AWH in optimized care environments. We prospectively recruited 1,250 AWH (aged 10-19) from four youth-friendly HIV clinics in Eswatini and Lesotho (May 2023-October 2024). Participant clinical data was abstracted from an electronic medical record, and participants completed validated surveys assessing depression, anxiety, stigma, self-efficacy, adverse childhood experiences, and substance use. We developed predictive models from clinical and survey data using logistic regression, elastic net regression, and random forest algorithms, with 70/30 train-test splits. Of 1,222 participants with viral loads, 163 (13.4%) had DVL (≥50 copies/mL). The cohort was evenly distributed by gender and predominantly included older adolescents (72.3% aged 15-19) with perinatally-acquired HIV (median age at diagnosis 2 years). Most (95.1%) received dolutegravir-based therapy. Key features associated with DVL from the models included: prior DVL within 2 years (OR 5.4, 95%CI 3.34-8.74), non-dolutegravir regimens (OR 4.11, 95%CI 1.36-12.42), and survey responses related to low self-efficacy, stigma fears, size of the household, and adherence behaviors. Model performance for prediction of DVL was moderate, with AUROCs for all models ranging between 0.729 and 0.744. While clinical factors, particularly a prior DVL and non-DTG regimen, were associated with DVL, few psychosocial features consistently emerged across predictive models. The high viral suppression rates (86.5%) in these youth-friendly environments demonstrate effective comprehensive care. Results suggest individualized rather than algorithmic approaches may better support adolescents with persistent adherence challenges.
HIV disparities among U.S. Latino men who have sex with men (LMSM) persist alongside lower PrEP use. We examined correlates of PrEP cascade outcomes among 287 cisgender immigrant LMSM. PrEP conspiracy beliefs were negatively associated with HIV testing (OR = 0.77, 95% CI: 0.59-0.99, p=.04); knowing a PrEP user was positively associated (OR = 3.09, CI: 1.81-5.28, p<.0001). PrEP readiness was associated with positive PrEP attitudes (belief: OR = 2.23, CI: 1.51-3.30, p<.0001; plan: OR = 1.86, CI: 1.13-3.06, p=.02), multiple sexual partners (belief: OR = 2.06, CI: 1.02-4.16, p=.04; plan: OR = 2.25, CI: 1.04-4.87, p=.04), knowing a PrEP user (belief: OR = 4.18, CI: 2.10-8.32, p<.0001; plan: OR = 3.78, CI: 1.43-10.03, p=.008), and internalized sexual orientation stigma (plan: OR = 1.78, CI: 1.11-2.85, p=.02). Positive PrEP attitudes (OR = 1.59, CI: 1.17-2.18, p=.004) and lower barriers (OR = 0.70, CI: 0.52-0.95, p=.02) were associated with increased PrEP use, and medical mistrust (OR = 2.95, CI: 1.32-6.58, p=.008) with nonadherence. Las disparidades relacionadas con el VIH entre hombres latinos que tienen sexo con hombres (LMSM, por sus siglas en inglés) en los Estados Unidos persisten y se relacionan con un menor uso de la profilaxis preexposición (PrEP). Examinamos los correlatos de resultados a lo largo de la cascada de PrEP en una muestra de 287 LMSM inmigrantes cisgénero. Las creencias conspirativas sobre la PrEP se asociaron negativamente con la realización de la prueba de VIH (OR = 0.77, IC 95%: 0.59–0.99, p=.04); mientras que conocer a alguien que utiliza PrEP se asoció positivamente (OR = 3.09, IC: 1.81–5.28, p<.0001). La disposición para iniciar PrEP se asoció con actitudes positivas hacia la PrEP (creencia: OR = 2.23, IC: 1.51–3.30, p< .0001; plan: OR = 1.86, IC: 1.13–3.06, p=.02), tener múltiples parejas sexuales (creencia: OR = 2.06, IC: 1.02–4.16, p=.04; plan: OR = 2.25, IC: 1.04–4.87, p=.04), conocer a alguien que utiliza PrEP (creencia: OR = 4.18, IC: 2.10–8.32, p<.0001; plan: OR = 3.78, IC: 1.43–10.03, p=.008) y mayor estigma internalizado relacionado con la orientación sexual (plan: OR = 1.78, IC: 1.11–2.85, p=.02). Las actitudes positivas hacia la PrEP (OR = 1.59, IC: 1.17–2.18, p=.004) y la presencia de menores barreras para acceder a ella (OR = 0.70, IC: 0.52–0.95, p=.02) se asociaron con un mayor uso de la PrEP, mientras que la desconfianza médica (OR = 2.95, IC: 1.32–6.58, p=.008) se vinculó con la falta de adherencia.
Alcohol-related liver disease (ALD) remains a leading cause of preventable morbidity and mortality in Europe. Despite robust evidence that alcohol-related population-level policies delay use initiation and reduce associated harms, their implementation in Europe has been inconsistent and frequently undermined by alcohol industry interference, fragmented governance, and policy inertia. The burden of ALD as well as combined metabolic dysfunction and alcohol-associated liver disease (MetALD) has grown steadily, driven by increased alcohol intake, widespread metabolic risk factors, delayed diagnosis, and poor integration between primary care, substance use services, endocrinology, and hepatology. In this Series paper, we combine epidemiology, policy evaluations, and clinical evidence to examine these findings through the lenses of policy, system preparedness, education, and stigma. We highlight screening strategies for alcohol use and liver disease and describe models of multidisciplinary and digital care. Finally, we outline priorities for policy reform, stigma reduction, youth-focused prevention, and research on biomarkers, pharmacotherapies, and digital/artificial intelligence tools.