Chemsex, defined as the intentional use of psychoactive substances to enhance sexual experiences, is associated with increased risk of sexually transmitted infections (STIs), mental health harms, and disruptions in continuity of care, particularly among men who have sex with men. In Brazil, health services lack an integrated, stigma-sensitive care pathway (CP) for prevention, clinical management, and harm reduction. Embedding a CP within the Health Care Network (HCN) is essential to organize access, continuity, and quality of care. This study aims to develop an evidence-informed CP for people who engage in chemsex, grounded in the needs of users, managers, and health professionals within the HCN, and supported by educational tools and implementation strategies. This sequential multimethod study is guided by the Knowledge-to-Action framework. Phase 1 (predevelopment) focuses on establishing partnerships and mapping the local context. Phase 2 (Knowledge Creation) includes (1) cross-sectional surveys with adults from the general population (target n≈1600) to estimate chemsex prevalence and associated factors, and with managers (n≈54) and health professionals (n≈135) to assess knowledge, attitudes, practices, barriers, and stigma; (2) a scoping review following established methodological guidelines; and (3) triangulation and concept mapping to integrate quantitative and qualitative findings. Data will be collected via REDCap (Research Electronic Data Capture), online and in person, during testing events. Quantitative analyses will involve descriptive statistics and regression models. Interviews and focus groups will undergo thematic analysis supported by Nvivo software. Educational products will be developed and evaluated for appearance, content, and usability by experts using a content validity index ≥0.78 as a cutoff. Phase 3 (Action Cycle) includes adapting knowledge to the local context, co-designing and validating the CP with stakeholders, piloting implementation in priority municipalities, and establishing monitoring processes. Process indicators (eg, number of trained professionals, educational activities, rapid tests performed, and app engagement) and outcome indicators (eg, STI testing and linkage to care, service use across the HCN) will be monitored through official information systems. Ethical approval was obtained in April 2025. Recruitment and data collection began in June 2025 through online and in-person strategies. By December 2025, 3061 individuals had been screened online, and 1723 participants had undergone rapid testing for STIs. Data collection is expected to conclude by June 2026, followed by data cleaning and preliminary analyses between April and June 2026, inferential and qualitative analyses between July and September 2026, and CP development and validation between October and December 2026. This protocol will generate a CP tailored to chemsex and validated educational resources to support harm reduction, mental health, and STI prevention within the HCN. Findings are expected to inform inclusive policies, reduce stigma, and strengthen care coordination within Brazil's Unified Health System. DERR1-10.2196/84068.
Relationships and recent sexual experience can impact sexual behaviors, networks, and STI testing. How they affect trends in these factors and increasing STI rates is understudied. We analyzed data from 28,027 females and 23,479 males ages 15-44 from the National Survey of Family Growth, 2008-2010 through 2017-2019. We used survey-weighted linear or logistic regression to evaluate linear trends in self-reported sexual behaviors with opposite-sex partners; sexual network attributes; and STI testing, stratified by sex and, separately, by marital/cohabiting status and number of past-year vaginal sex partners (1 vs. ≥ 2). Trends p < 0.050 reported below. From 2008-2019, condom use at last vaginal sex decreased among never-married females (51.9% in 2008-10 to 42.9% in 2017-19), never-married males (61.9%-56.3%), and individuals with ≥2 partners (females = 45.3%-34.9%; males = 54.0%-45.7%). Mean number of vaginal sex acts in past 4 weeks decreased among cohabiting females (9.46-7.40), never-married males (4.11-3.40), and males with 1 partner (7.25-6.62). The proportion of never-married females reporting sex with males with male partner(s) increased from 2.5% to 5.1%; similarly, percentages of never-married males (3.8%-5.5%) and males with ≥2 partners (4.6%-6.3%) reporting sex with males increased. Racial/ethnic homophily with current vaginal sex partners decreased among cohabiting females (86.5%-80.4%) and married and never-married males (married = 88.9%-85.9%; never-married = 81.2%-72.3%). Past-year chlamydia testing increased among females who were married (13.0%-17.1%), previously-married (27.6%-45.8%), or had 1 partner (21.7%-25.4%). Changes in sexual behaviors, network attributes, and STI testing from 2008-2010 through 2017-2019 varied by marital/cohabiting status and number of past-year opposite-sex partners in complex ways, most commonly among never-married females and males and males with multiple partners. While these changes' combined potential impact on STI transmission is uncertain, understanding trends in sexual behaviors, networks, and testing by marital/cohabiting status and partner number can contextualize their contributions to the STI epidemic and support sexual health services tailoring and prioritization.
ObjectivesTo explore the association between family relationships and quality of life (QoL), and the mediating role of resilience among people living with HIV (PLWH) and their family members (FMs).MethodsBaseline data were drawn from an ongoing study in Guangxi, China, including 783 PLWH-FM dyads. The actor-partner interdependence mediation model examined how individuals' family relationships/cohesion affect their own (actor effects) and their partners' QoL (partner effects), and the mediating role of resilience.ResultsA significant actor-direct effect was observed for FMs' family relationships on their own mental QoL (β = 0.136, P < 0.001), while no such effect was found for PLWH. Resilience functioned as a mediator between PLWH's family cohesion and PLWH's QoL (physical: β = 0.109, mental: β = 0.089, P < 0.001) and between FMs' family relationships and FMs' QoL (physical: β = 0.062, mental: β = 0.075, P < 0.001). Regarding partner effects, FMs' resilience mediated the association between PLWH's family cohesion and FMs' QoL (physical: β = 0.036, mental: β = 0.044, P < 0.01).ConclusionFindings underscore that future interventions should target the family as a unit to strengthen family ties and improve the cross-dyadic role of resilience, particularly that of FMs. How Family Relationships and Resilience Shape Well-Being in Families Affected by HIVFamilies play a central role in the lives of people living with HIV (PLWH). Supportive family relationships can help individuals cope with stress, stay healthy, and maintain a good quality of life. However, we still have limited understanding of how family relationships shape the well-being of both PLWH and their family members, and whether resilience—the ability to adapt and stay strong during challenges—helps explain these connections.In this study, we adopted the baseline data of an ongoing cohort study including 783 pairs of PLWH and one of their family members in Guangxi, China. We wanted to better understand how each person's perception of their family relationships or cohesion was linked to their own well-being, and also whether it affected their partner's well-being. We also examined whether resilience played an important role in these relationships.Our results showed that family members who felt they had strong, positive family relationships tended to report better mental and physical well-being. We also found that resilience helped explain how good family relationships led to better physical and mental health for both PLWH and their family members. Additionally, the resilience of family members played a role in connecting PLWH's family relationships to the family members' own well-being.These findings show that HIV affects not just individuals, but entire families. Strengthening family relationships and helping both PLWH and their family members build resilience may improve their overall well-being. Interventions that focus on the family as a unit—not just the individual living with HIV—may be especially helpful in supporting long-term health and quality of life in HIV-affected families.
ObjectivesWe assessed whether survey mode influenced reporting of sexual behaviors and psychosocial factors among men who have sex with men (MSM) in Kenya.MethodsIn cross-sectional analysis of baseline data from 493 MSM in Kisumu and Nairobi enrolled in a prospective cohort study, participants were randomized 1:1 to Computer-Assisted Personal Interview (CAPI) or Audio Computer-Assisted Self-Interview (ACASI). We compared responses across survey modes using Poisson regression with robust variance, adjusting for socio-demographics.ResultsIn both sites, CAPI users more frequently reported sex with a female partner. In Kisumu, CAPI users were less likely to report receptive anal intercourse. In Nairobi, CAPI users were less likely to report food insecurity, transactional sex, and STI symptoms.ConclusionWhile most responses were similar across modes, ACASI prompted higher reporting of sensitive behaviors, highlighting added value for capturing stigmatized and sensitive information. Offering both methods may enhance data quality and respect participant preferences. Different ways of asking survey questions affect the answers given for sensitive and stigmatized behaviorsPlain Language SummaryWe wanted to know if the way surveys are given changes how men who have sex with men answer sensitive questions about their lives and behaviors. We surveyed 493 men, who were randomly assigned to either answer questions face-to-face with an interviewer (CAPI) or privately on a computer with audio support (ACASI). We found that men answering face-to-face were more likely to report having sex with women, but less likely to report certain behaviors and challenges, such as receptive anal sex, food insecurity, transactional sex, and STI symptoms. Overall, most answers were similar, but the computer based method encouraged more reporting of sensitive and stigmatized behaviors. We recommend offering both methods to improve data quality and give participants a choice in how they share information.
Social media intervention may enhance HIV prevention among men who have sex with men, but the effect of this intervention in resource-limited settings remains unclear. This randomized controlled trial evaluated whether a social media intervention grounded in the information-motivation-behavioral skills (IMB) model could be beneficial for HIV prevention among men who have sex with men in resource-limited settings. Participants were recruited in Nanning, China, between April 2023 and April 2024. Eligible participants were randomly assigned to either the social media intervention group or the routine HIV prevention services control group. Participants in the intervention group received a 3-month social media intervention, which included completing video-based tasks. Baseline surveys were conducted, followed by follow-up surveys every 3 months, for a total of 2 follow-ups. Outcomes included HIV testing uptake, high-risk behavior, AIDS-related knowledge, safe sex self-efficacy, and attitude. A total of 180 eligible men who have sex with men were enrolled (90 per group). Follow-up rates were 97.8% (88/90) and 95.5% (86/90) for the intervention and control groups, respectively. At the follow-ups, the intervention group demonstrated significantly higher uptake of HIV testing, a lower proportion of participants reporting high-risk sexual behaviors, and higher condom use self-efficacy compared to the control group (all P<.05). After controlling for sociodemographic variables, generalized estimating equations analysis revealed that the intervention group had significantly higher odds of HIV testing (risk ratio [RR] 1.739, 95% CI 1.110-2.730), HIV self-testing (RR 2.306, 95% CI 1.593-3.340), and consistent condom use (RR 2.457, 95% CI 1.636-3.690) than the control group. Cochran-Armitage trend tests within the intervention group revealed that with increasing intervention duration, both HIV testing and HIV self-testing significantly increased, while high-risk sexual behaviors significantly decreased (all P<.05). The social media intervention guided by the IMB model demonstrated a positive effect on expanding HIV testing coverage, reducing high-risk behavior, enhancing AIDS-related knowledge, and improving safer sex self-efficacy among men who have sex with men in resource-limited settings. These findings provide valuable guidance for future HIV prevention and control efforts targeting this population.
HIV pre-exposure prophylaxis (PrEP) is a highly effective prevention strategy, yet awareness, knowledge, and willingness to use it among people who inject drugs (PWID) remains inadequate despite widespread eligibility. Stigma, particularly HIV-stigmatizing beliefs and attitudes, may be a key barrier to engagement at early stages of the PrEP care continuum. We examine how HIV-stigmatizing beliefs and attitudes affect PrEP awareness, knowledge, and willingness among PWID. We surveyed 262 HIV-negative PWID in Los Angeles and Denver (2021-2023) and used structural equation modeling to examine associations between HIV-stigmatizing beliefs and attitudes (11-item validated scale with α = 0.899 and 1-factor structure) and three early PrEP outcomes: awareness, knowledge, and willingness, while controlling for race/ethnicity, gender, housing status, and conducted sub-analyses on willingness to use long-acting injectable PrEP. HIV-stigmatizing beliefs and attitudes were significantly associated with lower PrEP awareness (β - 0.212, p < 0.001) and less accurate knowledge (β - 0.179, p = 0.006). Accurate knowledge was associated with greater willingness to use PrEP (β 0.175, p = 0.027). Black, Indigenous, and Other Persons of Color (BIPOC) participants reported higher HIV-stigmatizing beliefs and attitudes than non-Hispanic White participants (β 0.196, p = 0.003). Over half (56%) of participants were willing to take daily oral PrEP once informed, and many were interested in long-acting injectable PrEP. HIV-stigmatizing beliefs and attitudes are associated with lower PrEP care continuum engagement among PWID, particularly through limiting awareness and understanding of PrEP. BIPOC participants reported higher levels of stigmatizing attitudes, suggesting that broader structural and intersectional stigma may shape PrEP engagement, consistent with prior research. Interventions to increase PrEP uptake should address both individual- and structural-level stigma and consider leveraging peer networks and community supports to foster resilience and improve equitable access to HIV prevention tools.
Background In foreign countries, many scales have been developed to measure HIV prevention behavior. However, there are only a few developed scales among MSM in Thailand and they are not up to date. The objective of this study is to examine the reliability and validity of the HIV preventive behavior measure among Thai men who have sex with men (MSM). Methods The sample comprised 424 Thai MSM aged 25 years or older who had at least one sexual encounter in the past six months. The total sample was randomly divided into two equal subsamples: one used for exploratory factor analysis (EFA) to identify underlying structures, and the other for confirmatory factor analysis (CFA) to verify model fit. Cronbach's alpha was employed as the primary reliability coefficient because it reflects internal consistency, and the data collection was conducted only once. Convergent and discriminant validity were examined through Pearson's correlation coefficients with theoretically related and unrelated constructs to assess coherence and distinctiveness of the measure. Results The measure comprised nine items forming two components: (1) denial and avoidance of HIV risk, and (2) self-protective actions before and during sexual activity. CFA indicated an excellent model fit (χ 2 = 36.56, p = .06, χ 2/df = 1.46, GFI = 0.96, CFI = 0.98, RMSEA = 0.05), meeting recommended criteria for a valid psychometric model. Internal consistency was acceptable (Cronbach's α = .77). Significant correlations with related scales (he AIDS risk behavior avoidance scale and the AIDS prevention scale) ( r = .21 and.16, p < .01) and the absence of correlation with an unrelated measure (Thai Learning Attitude Scale) supported convergent and discriminant validity. Conclusions The scale demonstrated sound psychometric properties and is applicable for future interventions to promote HIV preventive behaviors among Thai MSM.
One-night stands among men who have sex with men (MSM) significantly increase the risk of HIV transmission. Given the growing role of the Internet in facilitating such encounters, this study examined the factors associated with one-night stands among Internet-recruited MSM in China to identify actionable targets for behavioral interventions and HIV prevention strategies. The study participants were MSM recruited online in May 2024 through a non-governmental organization, and a questionnaire survey was conducted. The participants were divided into two groups based on whether they had experienced one-night stands or not (i.e., one-night stand and non-one-night stand groups). Univariate and multivariate logistic regression analyses were employed to analyze the factors associated with the occurrence of one-night stands among the participants. A total of 604 participants were surveyed, 270 of whom reported having one-night stands and accounted for 44.70% (270/604). The results of multivariate logistic regression analysis showed that older age groups, meeting homosexual partners in offline fixed venues (such as bars, karaoke television, and saunas), seeking male partners primarily via the Internet/dating apps, having anal intercourse with homosexual partners in the last 6 months, engaging in behaviors such as drinking, drug use (including new drugs), or using aphrodisiacs (such as Viagra) during sexual encounters, and believing that condoms can effectively prevent HIV transmission were associated with a higher likelihood of having one-night stands. Conversely, participants who had a regular homosexual partner or knew their homosexual partner's HIV status had a lower likelihood of experiencing one-night stands. The proportion of participants who had one-night stands was relatively high, indicating the need for increased public education within the MSM population. It is essential to promote consistent condom use during anal intercourse, maintain regular homosexual partners, and enhance HIV testing coverage. Furthermore, efforts should be made to avoid behaviors such as drinking, drug use, and using aphrodisiacs during sexual encounters to reduce the risk of HIV and other sexually transmitted infections in MSM.
Objective: To explore the utilization patterns of HIV pre-exposure prophylaxis (PrEP) service and the influence path of medication compliance in male population, and to provide a reference for optimizing the PrEP medication service strategy in China. Methods: A cross-sectional study design was adopted. From June to October 2023, in the three provincial capital cities of Kunming, Zhengzhou and Guangzhou where PrEP was piloted, relying on the Center for Disease Control and Control, social organizations of men who had sex with men and designated hospitals of each city, a snowball sampling method was used to recruit male individuals aged 18 years and above with PrEP medication experience as the research subjects. The recruitment sample size was 306 people. The information such as their sociodemographic characteristics, PrEP service utilization patterns, medication compliance and influence paths were collected. The latent category analysis (LCA) was used to identify its PrEP service utilization patterns, and partial least squares path model was used to analyze the influence paths of PrEP medication compliance to calculate the path coefficient (β) and the moderating effect of PrEP medication compliance was analyzed using the multiple linear regression model [to calculate the slope (k)].The statistical analysis was performed using R 4.4.2 software. Results: A total of 290 subjects were included, with an age of (29.7±7.2) years. The majority of them were unmarried (89.7%) and had engaged in homosexual behavior (88.6%). Regarding the utilization patterns of PrEP medication services for the subjects, according to LCA, they were classified into three categories: category 1 (online initiation-loss to follow-up type), category 2 (health institution-full process management type), and category 3 (digital closed-loop-strong follow-up type), accounting for 31.3% (91/290), 37.7% (109/290), and 31.0% (90/290) respectively. The PrEP medication compliance was classified as poor, good, and moderate.The analysis of the influencing paths of PrEP medication adherence revealed that the positive influencing paths included different cities → different purchasing channels (β=0.599, 95%CI: 0.527-0.668), different purchasing channels → service satisfaction (β=0.482, 95%CI: 0.381-0.573), the frequency of safe sex use in the past 6 months → the risk motivation for unprotected sexual behavior (β=0.373, 95%CI: 0.263-0.482), liver and kidney function tests and follow-up service utilization → service satisfaction (β=0.337, 95%CI: 0.256-0.416). The analysis of moderating effects showed that category 2 (health institution-full process management type) had a strong moderating effect on the influence path from service satisfaction of the research subjects to PrEP medication adherence (k=1.483, P<0.001). Conclusions: The utilization pattern of PrEP medication services had a differentiated impact on the PrEP medication compliance of the male population. Different cities, different purchasing channels, service satisfaction, risk motives for sexual behavior, liver and kidney function tests, and follow-up services were the positive influencing variables of PrEP medication compliance. This study provided a reference basis for promoting PrEP services from standardization to personalized and precise intervention. 目的： 探讨男性人群HIV暴露前预防（PrEP）服务利用模式及其用药依从性的影响路径，为优化我国PrEP用药服务策略提供参考依据。 方法： 采用横断面研究设计，2023年6-10月在开展PrEP试点的昆明市、郑州市和广州市，依托CDC、MSM社会组织和定点医院，采用滚雪球抽样法招募≥18岁男性有PrEP用药经历者306人为研究对象，收集其社会人口学特征、PrEP服务利用模式和用药依从性及影响路径等信息。采用潜在类别分析（LCA）识别其PrEP服务利用模式，采用偏最小二乘路径模型分析其PrEP用药依从性的影响路径［计算路径系数（β）］，采用多元线性回归模型进行PrEP用药依从性的调节效应分析［计算斜率（k）］。应用R 4.4.2软件进行统计学分析。 结果： 纳入研究对象290人，年龄（29.7±7.2）岁，以未婚者（89.7%）和发生同性性行为者（88.6%）为主。研究对象的PrEP用药服务利用模式，按LCA分为3个类别：类别1（线上启动-失访型）、类别2（卫生机构-全程管理型）、类别3（数字闭环-强随访型），占比分别为31.3%（91/290）、37.7%（109/290）和31.0%（90/290），PrEP用药依从性分别为较差、较好和中等。PrEP用药依从性的影响路径分析发现，正向的影响路径包括不同城市→不同购药渠道（β=0.599，95%CI：0.527~0.668）、不同购药渠道→服务满意度（β=0.482，95%CI：0.381~0.573）、近6个月安全套使用频率→发生无保护性行为的风险动机（β=0.373，95%CI：0.263~0.482）、肝肾功能检测和随访的服务利用→服务满意度（β=0.337，95%CI：0.256~0.416）等。调节效应分析结果显示，类别2（卫生机构-全程管理型）在研究对象服务满意度至PrEP用药依从性的影响路径中调节作用较强（k=1.483，P<0.001）。 结论： PrEP用药服务利用模式对男性人群的PrEP用药依从性存在差异化影响，不同城市、不同购药渠道、服务满意度、发生性行为的风险动机、肝肾功能检测和随访的服务利用是PrEP用药依从性正向的影响路径变量。本研究为推动PrEP用药服务从标准化向个性化的精准干预提供参考依据。.
Fusarium head blight (FHB) is one of the most significant diseases in wheat globally, affecting about 200 million tons of grain per year through mycotoxin contamination. Besides yield losses, mycotoxin contamination is a major concern. FHB resistance in wheat is partial and polygenic, and since the efficacy of plant protection measures is generally weak-to-moderate, an integrated approach is needed for successful control. We evaluated a more comprehensive methodology for improved protection; in this two-year study, five registered organic products and six conventional products were compared under artificial and natural infection conditions. The disease index (DI), Fusarium-damaged kernels (FDKs) and deoxynivalenol (DON) contamination were evaluated. The stability of the fungicides was also evaluated based on 10 epidemic conditions. The organic fungicides showed much lower efficacy than the conventional ones, although significant reductions in symptoms and DON contamination were observed. In each group, significant variability was detected. The best fungicides for DON contamination showed the lowest variance (highest stability) between 10 and 20 (Verben, Prosaro, Ascra Xpro). The organic fungicides were much less stable; the least stable showed a variance of 141 (Fusarium control: 264). The best organic fungicide was the Bordeaux mixture supported by sulfur addition (variance: 54). The DI and FDK values presented very similar trends. For the more resistant cultivar GK Pilis, the combined DON reduction exceeded 90% for all fungicides. For the most susceptible cultivar, GK Békés, the values were between 30 and 83%, respectively. High resistance to FHB and toxin contamination is the key to controlling FHB in both organic and conventional production. For efficient fungicide control, stable resistance to disease and toxin accumulation are equally required. Principal component analysis (PCA) verified the importance of considering all traits to identify the fungicidal "fingerprint" and demonstrated the differences between fungicides regardless of their organic or conventional nature. PC response differs for traits and fungicides, supporting the complex evaluation of plant and fungicide behavior. Knowledge of resistance levels, in addition to improving mycotoxin control, aids in disease forecasting and epidemic management. The results are applicable to both organic and conventional production systems. Due to the variability in resistance and fungicidal effects, there is an opportunity to improve food safety in both organic and conventional wheat production.
Antiretroviral Therapy (ART) adherence is a complex outcome influenced by individual, interpersonal, and structural factors. Social support can improve adherence, yet studies report inconsistent associations between social support and ART adherence, potentially resulting from differences in operationalization and measurement. We conducted a scoping review of articles published between 2014 and 2024 using Arksey and O'Malley's framework to (a) identify how social support and adherence are operationalized and measured, (b) explore relationships between social support and ART adherence, and (c) compare associations across different measures. We identified 118 articles; 87 (74%) reported positive associations between social support and adherence, 28 (24%) found no association, and three reported negative associations. Associations varied by support source (children, spouses, family members, and healthcare providers), type (instrumental, emotional, informational), and nature (same-gender ties). Four ART measures were identified: self-report, indirect measures, biological markers, and composite measures. Most studies (109) assessed perceived or functional social support, while only six examined structural support and network relationships (e.g., the respondent and their partners). Significant variations existed in adherence measures and benchmarks. Social support measures also varied substantially, with limited theoretical justification for selection. Mixed findings reflect measurement variations and the multifaceted nature of social support. Future studies should investigate both constructs comprehensively and systematically, using composite measures with objective biomarkers where feasible, and accounting for measurement differences and literature gaps.
Previous research on the influence of substance use on PrEP uptake and adherence among transgender women has either relied on cross-sectional analyses or on combined samples of cisgender men who have sex with men and a much smaller subsample of transgender women. To the best of our knowledge, no longitudinal study has examined the relationship of substance use and PrEP use/adherence among young transgender women and nonbinary people assigned male at birth (TNBY). We sought to understand whether substance use (i.e., binge drinking, marijuana use, and illicit drug use) predicts PrEP uptake and adherence for TNBY over time. Using a sample of 242 young and racially/ethnically diverse TNBY from the RADAR cohort study, we performed bivariate and multivariate generalized estimating equations binary logistic regression to assess whether substance use predicted PrEP use and adherence and latent growth curve modeling to examine trends in self-reported PrEP use over time. There were no significant differences in PrEP use or adherence by race/ethnicity, gender or educational attainment. In multivariable models, binge drinking (OR 1.37, 95% CI 1.08-1.74), number of condomless sex partners (OR 1.08, 95% CI 1.04-1.13), and HIV/STI testing (OR 2.20, 95% CI 1.65-2.92) were all significantly positively associated with PrEP use in the past 6 months. Binge drinking (OR 1.27, 95% CI 0.97-1.67), number of condomless sex partners (OR 1.09, 95% CI 1.04-1.13), and HIV/STI testing (OR 1.85, 95% CI 1.35-2.53) were significantly positively associated with current PrEP use. Both age (OR 1.25, 95% CI 1.02-1.54) and binge drinking (OR 8.66, 95% CI 2.12-35.30) were significantly positively associated with PrEP adherence. Cannabis use was significantly negatively associated with PrEP adherence (OR 0.89, 95% CI 0.82-0.97). Latent growth curve modeling detailed that the proportion of participants using PrEP significantly increased over time across age, reducing initial differences in PrEP use by age. These findings provide valuable insights into the relationship between substance use and PrEP use and adherence, showing the different effects of binge drinking and problematic cannabis consumption on PrEP outcomes. These findings emphasize the importance of nuanced and intersectional approaches to HIV prevention, considering both demographic variability and behavioral health factors.
Women of transgender experience and transfeminine people (WTE/TFP) are disproportionately impacted by HIV. Between July 2023 and May 2024, a total of 2059 eligible WTE/TFP across nine project areas participated in the National HIV Behavioral Surveillance (NHBS-Trans) project. Among the 1993 participants with valid HIV test results, 35.7% were living with HIV. Detrimental social and economic factors were common, including low income (57.0%), unemployment (35.4%), homelessness (31.8%), physical abuse and harassment (25.1%), and avoiding seeking healthcare due to discrimination (22.4%). Continued efforts to increase access to HIV testing and prevention strategies are vital to decrease the number of new infections to end the HIV epidemic. However, without increased access to economic opportunities and stable housing and decreases in discrimination and harassment, existing HIV prevention and care services may not address the HIV epidemic among women of transgender experience and transfeminine people. Las mujeres con experiencia transgénero y las personas transfemeninas (WTE/TFP, por sus siglas en inglés) se ven afectadas de manera desproporcionada por el VIH. Entre julio de 2023 y mayo de 2024, un total de 2059 WTE/TFP elegibles en nueve áreas del proyecto participaron en el proyecto Nacional de Vigilancia del Comportamiento del VIH (NHBS-Trans, por sus siglas en inglés). Entre las 1993 participantes con resultados válidos de la prueba de VIH, el 35,7% tenía VIH. Los factores sociales y económicos perjudiciales fueron comunes, incluyendo ingresos bajos (57,0%), el desempleo (35,4%), la falta de vivienda (31,8%), el abuso físico y el acoso (25,1%) y el evitar la atención médica debido a la discriminación (22,4%). Los esfuerzos continuos para aumentar el acceso a las pruebas de VIH y las estrategias de prevención son vitales para disminuir la cantidad de nuevos contagios y poner fin a la epidemia del VIH. Sin embargo, sin un mayor acceso a oportunidades económicas y de vivienda estable, y una reducción de la discriminación y el acoso, los servicios existentes de prevención y atención del VIH podrían no abordar la epidemia entre las mujeres con experiencia transgénero y las personas transfemeninas.
Advances in antiretroviral therapy (ART) enable women living with HIV to safely conceive and give birth without vertical transmission. However, in sub-Saharan Africa, 1 in 6 people experience infertility and women living with HIV face even higher rates. Research shows that ART and virologic suppression improve fertility/fecundity, yet this benefit is often overlooked in ART adherence education. To map the literature on people's understandings and beliefs about the relationship between HIV, ART, and fecundity, a systematic scoping review of the English and French literature in sub-Saharan Africa was conducted. After iterative search strategy development and implementation in PubMed, three independent reviewers screened texts, read a subset of full texts, and used a charting table to summarize results and identify emerging themes. Of 1,981 sources identified, only 12 met the inclusion criteria uncovering the following themes: (1) Beliefs that HIV and PrEP cause infertility exist but have not been widely documented; (2) Perceptions that ART improves health before pregnancy motivates women to adhere and provides hope about future pregnancy; (3) Stigma from providers discourage women living with HIV from seeking preconception care; and (4) Lack of awareness among providers and patients about the impact of HIV on pregnancy, highlights the need for provider training. Research on perceptions of HIV, ART, and fecundity in sub-Saharan Africa is sparse. Future research is needed to determine whether addressing this gap in understanding could improve ART adherence and help couples living with HIV build their families.
Anxiety and depression are common in people living with HIV and associated with low antiretroviral treatment adherence, elevated HIV viral load, and increased mortality. Yet, anxiety and depression are underdiagnosed and undertreated in this population. Implementing a system for routine anxiety and depression screening may overcome barriers to diagnosis. To improve the identification and management of anxiety and depression within an HIV clinic, we engaged HIV clinicians in the design of the workflow, created electronic health record reminders for screening, and trained medical assistants to deliver the screening questions at clinic visits. We evaluated this 24-month quality improvement project using electronic health record data and clinician surveys. From November 2020 to October 2022, 747 patients had 1166 appointments during which anxiety and/or depression screening was due. During year one, anxiety and depression screening were completed at 75% (311/416) and 77% (362/469) of eligible encounters, respectively. During year two, screening was completed at 85% of encounters for anxiety (425/502) and depression (446/524). On average, anxiety screening increased by 2.2% per month (t = 4.24, p < 0.001), and depression screening increased by 1.2% per month (t = 2.82, p = 0.01) after intervention implementation. Patients who screened positive received follow-up. Clinician satisfaction with screening processes increased from baseline to 6 months. Findings suggest that screening for anxiety and depression can improve detection and management in an HIV clinic, while also being acceptable to HIV clinicians.
Culturally tailored, community-informed media can enhance pre-exposure prophylaxis (PrEP) awareness and acceptance among Black gay, bisexual, queer, same-gender-loving, and other men who have sex with men (Black SGL/MSM). To inform the development of a health campaign to increase PrEP utilization, we conducted four focus groups with Black SGL/MSM (N = 20) between February and June 2023. Discussions explored participants' perceptions of and engagement with HIV prevention messaging, with particular attention to strategies for redesigning campaigns to reduce PrEP-related stigma. Participants articulated preferences that clustered within three interrelated domains of effective PrEP messaging: content, delivery, and context. Within the content domain, participants emphasized the need for practical, actionable information (e.g., dosing options, visual demonstrations, and adherence support), alongside sex-positive and empowering narratives that reframed HIV prevention around pleasure, intimacy, and self-care rather than fear. Participants also called for destigmatization and normalization of PrEP by positioning it as a responsible, routine component of sexual wellness. Within the delivery domain, participants favored social media-driven formats, particularly strategies leveraging influencers, humor, and storytelling to enhance engagement and relatability. Within the context domain, participants prioritized authentic representation of Black queer communities through inclusive imagery, culturally resonant cues, and rejection of stereotypes, while also acknowledging structural and logistical realities such as competing priorities, privacy concerns, and the need for discreet, accessible messaging. PrEP messaging must move beyond traditional public health narratives by pairing clear "how-to" guidance with culturally concordant, sex-positive, and stigma-reducing strategies to improve PrEP relevance, awareness, and uptake.Trial registry NCT06785376.
Globally, curable sexually transmitted infections (STIs) are increasing, particularly in sub-Saharan Africa, yet epidemiological data remain limited, hindering progress towards the 2030 global STI targets. This study assessed the prevalence of self-reported STIs in the last 12 months among adolescent girls and women (AGW) and adolescent boys and men (ABM) aged 15-59 who ever had sex in Zambia and Zimbabwe at three time points. It also assessed whether observed changes across survey rounds persisted after adjusting for sociodemographic and sexual behaviour characteristics. We analysed six rounds of Demographic and Health Surveys, three per country, collected between 2005 and 2018, using descriptive statistics and logistic regression, while accounting for survey design. Zambia and Zimbabwe. A total weighted sample of 86 366 AGW and ABM was included in the study. Self-reported STIs in the last 12 months. Overall, self-reported STI prevalence was higher in Zimbabwe than Zambia. Among Zambian ABM, self-reported STIs increased from 6.2% in 2007 to 7.1% in 2018 (adjOR=1.28, 95% CI 1.05 to 1.57, p=0.005). Among Zimbabwean AGW, prevalence decreased from 11.7% in 2005/2006 to 8.3% in 2015 (adjOR=0.72, 95% CI 0.61 to 0.85, p<0.001). No significant differences between survey rounds were observed among AGW in Zambia (2007: 5.2%, 2018: 5.1%, adjOR=1.01, 95% CI 0.83 to 1.22, p=0.070) and ABM in Zimbabwe (2005/2006: 7.9%, 2015: 8.4%; adjOR=1.13, 95% CI 0.92 to 1.38, p=0.371). Self-reported STIs were associated with marital status, HIV status and number of sexual partners in the last 12 months among ABM and AGW. Among ABM, self-reported STIs decreased with older age at sexual debut. In Zimbabwe, lower educational attainment and wealth were also associated with higher STI prevalence. These findings highlight differences in STI prevalence by sex and country across survey rounds, underscoring the need for tailored STI prevention, diagnostic and treatment strategies, particularly for high-risk groups.
HIV is a pressing global public health problem, with marked disparities among adults who engage in injection drug use (IDU). Despite the development and implementation of highly effective HIV prevention and treatment options, utilization and adherence are still low among those at increased risk, such as those who inject drugs. Stigma may be a significant barrier to accessing care across the HIV prevention and treatment care continuums and may be associated with poorer health outcomes. Those who engage in IDU are likely to experience stigma related to both HIV and substance use, furthering disparities among this group. A systematic literature review was conducted to examine how experiencing HIV and/or substance use stigma was associated with attitudes towards and use of HIV continuum of care outcomes and healthcare more broadly among adults who report IDU. A systematic review utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines yielded 11 studies deemed appropriate for the current study. Experiences of stigma were examined across treatment targets (e.g., HIV prevention, ART initiation). All but two studies found that experiencing stigma was associated with poorer attitudes towards and utilization of HIV prevention and treatment. More specifically, substance use stigma was negatively associated with most HIV care continuum outcomes. A critique of the literature and directions for future research are discussed. For example, there is a need for greater consistency in stigma measurement, integrating cross-cultural and longitudinal approaches to further understand the association with the HIV care continuum among this at-risk population.
Despite robust evidence showing the mediation role of psychological resilience in the impacts of HIV-related stigma on psychological distress, most studies were conducted from an intrapersonal perspective. Limited studies have examined the dyadic effects of HIV-related stigma and resilience on psychological distress for people with HIV (PWH) and their family members. This study aimed to explore the actor-partner effect and the mediation role of resilience in the relationship between internalized stigma and psychological distress among PWH and family members dyads. Between October 2023 and December 2023, a total of 800 PWH-family member dyads were recruited from two urban cities and nine rural counties in Guangxi, China. All participants completed validated questionnaires capturing demographic characteristics, internalized stigma, resilience, and psychological distress. This study employed the actor-partner interdependence mediation model to examine both individual (actor) and dyadic (partner) pathways, along with resilience as a mediator. For actor effects, resilience partially mediated the relationship between internalized stigma and psychological distress in PWH (β = 0.08, SE = 0.01, p < 0.001) but not in their family members (β = -0.00, SE = 0.01, p = 0.68). Regarding partner effects, indirect effects were significant in the association between family members' internalized stigma and PWH's psychological distress through PWH's resilience (β = 0.03, SE = 0.01, p < 0.01). This study underscores the complex interplay between internalized stigma, resilience, and psychological distress in PWH-family member dyads. Psychological health promotion programs would benefit from adopting family-centered strategies that attend to stigma reduction and resilience improvement for both PWH and family members.
HIV, TB, and alcohol use are stigmatized conditions that lead to poor care engagement and health outcomes. Stigmatized traits can operate independently or be intersectional. We examined the relationships between intersectional HIV-, TB-, and alcohol-related stigma on poorer perceived health among people with HIV (PWH) receiving antiretroviral therapy in a study examining TB infection risk among PWH in HIV care in southwestern Uganda (2022-2023). We used proportional odds models to examine associations between high intersectional HIV, TB, and alcohol stigma (defined as above median scores on validated scales) and the outcome of poorer perceived health. Among 379 PWH, 12% described their health status as fair/poor. High intersectional HIV and alcohol stigma was associated with increased odds of poorer perceived health (adjusted odds ratio [aOR] = 1.62; 95% CI: 1.04-2.52), but we found no associations between other HIV, TB, and alcohol stigma intersections and this outcome. We found a significant interaction between intersectional HIV and alcohol stigma and marital status (Wald χ2 = 5.02, p = 0.03), and upon stratification, high intersectional HIV and alcohol stigma was associated with an increased odds of poorer perceived health among unmarried participants (aOR = 2.54; 95% CI: 1.33-4.86; p < 0.01) but not among married participants (aOR = 1.05; 95% CI: 0.56-1.95; p = 0.88). High intersectional HIV and alcohol stigma was associated with poorer perceived health among PWH in care, particularly among unmarried persons. Given the possible benefits of partner support, interventions that strengthen social support for unmarried persons may help mitigate the negative health impact of intersectional stigma.