Journal of the International AIDS Society最新文献

{"title":"PrEP use and willingness cascades among GBMSM in 15 Asian countries/territories: an analysis of the PrEP APPEAL survey","authors":"Gede Benny Setia Wirawan,&nbsp;Heather-Marie Schimdt,&nbsp;Curtis Chan,&nbsp;Doug Fraser,&nbsp;Jason J. Ong,&nbsp;Michael Cassell,&nbsp;Lei Zhang,&nbsp;Warittha Tieosapjaroen,&nbsp;Nittaya Phanuphak,&nbsp;Weiming Tang,&nbsp;Nicky Suwandi,&nbsp;Kimberly A. Green,&nbsp;Timothy Dobbins,&nbsp;Benjamin R. Bavinton","doi":"10.1002/jia2.26438","DOIUrl":"https://doi.org/10.1002/jia2.26438","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite the high HIV incidence among gay, bisexual and other men who have sex with men (GBMSM) and the demonstrated effectiveness of HIV pre-exposure prophylaxis (PrEP), PrEP is not accessible at scale across Asia. To help inform future scaling efforts, our study aimed to examine PrEP use and willingness to use among GBMSM to identify opportunities and target groups for upscaling PrEP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The PrEP APPEAL survey was a cross-sectional survey, promoted through online advertising and community organizations, from May to November 2022. Eligible participants were adult GBMSM who self-identified as HIV negative residing in Asia. We constructed two cascades: PrEP use (comprising awareness, lifetime use and current use of PrEP) and PrEP willingness among participants who were aware of PrEP but had never used it (comprising HIV exposure risk, willingness in PrEP and willingness to pay for PrEP). Multivariable logistic regression models identified factors associated with lifetime PrEP use and PrEP willingness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 15,339 participants, 1440 were excluded due to missing data, leaving 13,899 for analysis. Most lived in large or capital cities (68.3%) and in lower-middle-income countries (45.1%). The median age was 30 (25−36) years old. For the PrEP use cascade, 82.2% (<i>n</i> = 11,427/13,899) of participants were aware of PrEP, 35.0% (<i>n</i> = 4000/11,427) had used it before and 70.1% (<i>n</i> = 2803/4000) of them were currently on PrEP. For the PrEP willingness cascade, 54.8% of (<i>n</i> = 4068/7427) PrEP-naïve participants engaged in one or more behaviours with a higher risk of HIV acquisition, 73.7% (<i>n</i> = 2996/4068) of them expressed willingness to use PrEP and 83.0% (<i>n</i> = 2487/2996) of them were willing to pay for PrEP. Multivariable logistic regression models identified system-level (PrEP availability, accessibility and affordability) predictors of PrEP use. Individual-level behaviours associated with higher HIV acquisition risks were associated with PrEP use and willingness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While PrEP uptake was suboptimal, there was high awareness and willingness in PrEP among GBMSM. This is encouraging for future scale-up efforts. Future PrEP programmes should address system-level barriers to support PrEP uptake.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26438","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143726848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence from high-income countries on the effectiveness of psychosocial interventions to improve mental health, wellbeing and quality of life for adults living with HIV: a systematic review and meta-analysis","authors":"Ada R. Miltz,&nbsp;Janey Sewell,&nbsp;Fumiyo Nakagawa,&nbsp;Sophia M. Rein,&nbsp;Lorraine Sherr,&nbsp;Alison Rodger,&nbsp;Andrew N. Phillips,&nbsp;Sanne vanLuenen,&nbsp;Nadia Garnefski,&nbsp;Vivian Kraaij,&nbsp;Colette J. Smith,&nbsp;Valentina Cambiano,&nbsp;Fiona C. Lampe","doi":"10.1002/jia2.26424","DOIUrl":"https://doi.org/10.1002/jia2.26424","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;There is a need to synthesize recent evidence on the effectiveness of psychosocial interventions to improve mental health, quality of life and wellbeing in adults living with HIV in high-income countries. A systematic review and meta-analysis was conducted to address this research gap.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Medline, Embase, Psychinfo and Web of science were searched (from 2008 to December 2023). In total, 67 randomized controlled trials (RCTs) of psychosocial intervention among adults living with HIV in high-income countries were eligible.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In the meta-analysis, there was an overall positive effect of interventions on reducing depression (&lt;i&gt;N&lt;/i&gt; = 40; standardized mean difference [SMD] −0.19 [95% CI: −0.29, −0.10]), anxiety (&lt;i&gt;N&lt;/i&gt; = 15; SMD −0.12 [−0.23, −0.02]), stress (&lt;i&gt;N&lt;/i&gt; = 13; SMD −0.22 [−0.41, −0.04]), and other measures of poor wellbeing (&lt;i&gt;N&lt;/i&gt; = 19; SMD −0.18 [−0.35, −0.02]) and increasing levels of coping/self-efficacy (&lt;i&gt;N&lt;/i&gt; = 8; SMD 0.17 [0.04, 0.31]). For depression, interventions that used symptom screening above a threshold score to identify eligible individuals were more effective than those without such an eligibility criterion (SMD −0.29 vs. -0.10, &lt;i&gt;p&lt;/i&gt; = 0.023). Interventions compared to standard care controls had a greater effect on depression versus interventions compared to not standard care controls, when the latter category included standard care controls that received intentional support (SMD -0.28 vs. -0.11, &lt;i&gt;p&lt;/i&gt; = 0.035). There was also weak evidence of an overall positive effect on: reducing stigma (&lt;i&gt;N&lt;/i&gt; = 7; SMD −0.17 [−0.35, 0.02]), and improving social support/participation (&lt;i&gt;N&lt;/i&gt; = 6; SMD 0.17 [−0.02, 0.35]), mental health quality of life (&lt;i&gt;N&lt;/i&gt; = 12; SMD 0.09 [−0.01, 0.19]), physical health quality of life (&lt;i&gt;N&lt;/i&gt; = 11; SMD 0.07 [−0.02, 0.16]) and quality of social life (&lt;i&gt;N&lt;/i&gt; = 6; SMD 0.10 [−0.04, 0.24]). There was no evidence found for an effect on loneliness, although data were limited.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Discussion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Pooled effect estimates were small or small tomoderate. In line with previous literature, there was no evidence of differential effects on depression according to the intervention type (psychotherapeutic vs. other).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Evidence from RCTs suggest that psychosocial interventions are effective ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26424","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of male peer-led outreach on uptake of HIV testing among male partners of pregnant women in Uganda: a randomized trial","authors":"Faith Naddunga,&nbsp;Michelle A. Bulterys,&nbsp;Agnes Nakyanzi,&nbsp;Deborah Donnell,&nbsp;Juliet Kyomugisha,&nbsp;Juliet E. Birungi,&nbsp;Paul Ssendiwala,&nbsp;Rogers Nsubuga,&nbsp;Timothy R. Muwonge,&nbsp;Joshua Musinguzi,&nbsp;Sue Peacock,&nbsp;Connie L. Celum,&nbsp;Andrew Mujugira,&nbsp;Monisha Sharma","doi":"10.1002/jia2.26440","DOIUrl":"https://doi.org/10.1002/jia2.26440","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Male partner HIV testing and engagement in antenatal care (ANC) is associated with improved clinical outcomes for men, pregnant women and infants. However, testing rates remain low among male partners of pregnant women receiving ANC in Africa. We evaluated the impact of male peer outreach to increase HIV testing among partners of pregnant women in Uganda.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a randomized trial in Kampala, Uganda, enrolling an equal number of pregnant women with and without HIV from public ANC clinics who were randomized 1:1 to intervention or standard-of-care (SOC) with delayed intervention after 1 month. (ClinicalTrials.gov ID, NCT05388084). The intervention consisted of male peer counsellors calling male partners of consenting pregnant women and inviting them to test for HIV. In the SOC, pregnant women received an invitation letter to deliver to their partners for fast-track HIV testing, per national guidelines. We conducted an intention-to-treat analysis using modified Poisson regression, comparing the proportion of male partners tested for HIV by month 1 across arms overall and by female's HIV status. A secondary analysis compared the proportion tested for HIV by 3 months after both arms received the intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between May 2022 and March 2023, we enrolled 150 pregnant women (76 in intervention, 74 in SOC). At 1 month, 18% more males in the intervention arm tested for HIV compared to SOC (32% vs. 14%; risk difference [RD] = 0.18; 95% confidence interval [CI]: 0.05–0.31). This association remained significant after stratifying by female HIV status. HIV testing was 22% higher among male partners of HIV-negative women in the intervention arm compared to SOC (46% vs. 24%; RD = 0.22; 95% CI: 0.004–0.430) and 15% higher among partners of pregnant women with HIV (18% vs. 3%; RD = 0.15; 95% CI: 0.02–0.28). At 3 months, 50% (38/76) of male partners tested in the intervention versus 35% (26/74) in the SOC/delayed intervention (RD = 0.15; 95% CI: −0.01 to 0.31).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Male peer outreach is a promising intervention to increase knowledge of HIV status among partners of pregnant women. Additional support is needed to increase HIV testing among partners of women with HIV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26440","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing post-tuberculosis sequelae among people living with HIV: an unmet need","authors":"Vidya Mave,&nbsp;Samyra R. Cox,&nbsp;Akshay N. Gupte,&nbsp;Jonathan E. Golub","doi":"10.1002/jia2.26439","DOIUrl":"https://doi.org/10.1002/jia2.26439","url":null,"abstract":"&lt;p&gt;In 2023, an estimated 10.8 million people fell ill with tuberculosis (TB) and 662,000 (6%) of them were living with HIV. Over the same period, an estimated 1.1 million people died with TB, and HIV co-infection contributed to an additional 161,000 TB-related deaths [&lt;span&gt;1&lt;/span&gt;]. Since 2010, global TB incidence and related mortality have been gradually declining due to increased access to new diagnostics and expanding treatment options. However, there is growing evidence that TB survivors experience excess morbidity and mortality even after successfully completing treatment. We must begin focusing more on caring for the 155 million TB survivors worldwide who are struggling with the aftermath of TB disease [&lt;span&gt;2&lt;/span&gt;]. The post-TB sequelae that these survivors experience include TB recurrence, lung disease, cardiovascular disease, mental health issues and an overall decline in quality of life [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Screening TB survivors for recurrent TB could lead to major reductions in TB transmission and improvements in patient outcomes, particularly in high HIV-prevalence countries which tend to have higher rates of TB recurrence [&lt;span&gt;4&lt;/span&gt;]. Recent evidence suggests that periodic screening for TB survivors is a high-yield approach for active case finding. The Targeted Universal Testing for TB study in South Africa found a new TB diagnosis among 12% of people with recent prior TB—higher than what was found among people living with HIV and among close contacts of people with TB in the study [&lt;span&gt;5&lt;/span&gt;]. However, so far, the World Health Organization has only made a conditional recommendation for post-TB screening due to limited evidence [&lt;span&gt;6&lt;/span&gt;]. To help address this gap, results are forthcoming from the first active case-finding trial targeting TB survivors and their household contacts, TB Aftermath [&lt;span&gt;7&lt;/span&gt;]. More work is needed to optimize post-TB screening so that it can be effective in a range of settings, including among people living with HIV. A priority is to identify post-TB screening algorithms that are low-cost but accurate and deployable in both clinic and community contexts, as well as efficient strategies that target the highest-risk groups for TB recurrence, without deepening TB and HIV-related stigma.&lt;/p&gt;&lt;p&gt;Comorbidities and non-TB conditions affecting people with TB during TB treatment almost always persist beyond TB, and some of these conditions first develop as TB treatment concludes. Screening for and treating non-TB conditions is, thus, necessary as early as possible to reduce post-TB morbidity and mortality. Identifying optimal care strategies for multi-morbidities during and after completion of TB treatment, including maintaining continued care and treatment of HIV, is also critical to optimize health outcomes. However, more research on the longer-term health outcomes of TB beyond 24 months of follow-up would help identify interventions and resources that national programmes need to man","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26439","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143689638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community leadership is key to effective HIV service engagement for female sex workers in Africa","authors":"Primrose Matambanadzo,&nbsp;Lilian Otiso,&nbsp;Sibonile Kavhaza,&nbsp;Parinita Bhattacharjee,&nbsp;Frances M. Cowan","doi":"10.1002/jia2.26425","DOIUrl":"https://doi.org/10.1002/jia2.26425","url":null,"abstract":"&lt;p&gt;Although overall HIV incidence has declined across sub-Saharan Africa since 2010, HIV incidence among female sex workers is nine times higher than among cisgender women [&lt;span&gt;1&lt;/span&gt;]. Young women who sell sex are particularly vulnerable. Women who sell sex do so in the context of discrimination and intense stigma, exacerbated by the criminalization of sex work [&lt;span&gt;2&lt;/span&gt;]. Despite impressive population-level gains in treatment cascade engagement, antiretroviral therapy (ART) coverage and rates of viral suppression have remained lower among African female sex workers than in the general population [&lt;span&gt;3&lt;/span&gt;]. Addressing female sex workers’ specific HIV prevention and treatment needs remains central to a comprehensive HIV response and remains one of UNAIDS central pillars for “ending AIDS by 2030.”&lt;/p&gt;&lt;p&gt;Community-led, person-centred prevention and treatment services that address contextually important barriers to service engagement, while considering sex workers’ heterogeneity and multiple intersecting vulnerabilities, remain essential [&lt;span&gt;4&lt;/span&gt;]. Community empowerment approaches seek to build social cohesion, psychological and financial resilience, and facilitate sex workers’ ability to work collaboratively towards shared goals, enabling them to prioritize and address the specific challenges they face including barriers to uptake of, and engagement in, HIV services. There is compelling evidence that community empowerment of female sex workers increases the impact of programmes in Asia [&lt;span&gt;5&lt;/span&gt;] and South America [&lt;span&gt;6&lt;/span&gt;] where sex worker-led programmes are estimated to have averted hundreds of thousands of HIV infections among female sex workers and the general population. Evidence of impact is building in Africa, where community-led approaches have more recently been introduced, resulting in increased effective coverage of HIV services [&lt;span&gt;7, 8&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Community empowerment is a process which takes time and resources to develop in any population, but possibly more so among sex workers who are marginalized, stigmatized and may be distrustful. It necessitates moving from providing services &lt;i&gt;for the community&lt;/i&gt; to services being led and provided &lt;i&gt;by the community&lt;/i&gt; [&lt;span&gt;6&lt;/span&gt;]. For example, sex worker provision of services &lt;i&gt;for the community&lt;/i&gt; might include mobilizing communities to engage with HIV services, deliver health education, distribute condom and HIV self-test kits; whereas when &lt;i&gt;sex workers lead&lt;/i&gt; the service provision, they receive funding directly to commission and monitor the quality of health services, they design and implement both health (e.g. community delivery of pre-exposure prophylaxis (PrEP) or ART to ensure effective community coverage) and social programmes (e.g. violence mitigation or savings schemes) [&lt;span&gt;9&lt;/span&gt;]. The UNAIDS Strategy for 2021–2025 states that 30% of key population programmes, including those for sex workers, should be community-led by ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26425","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143564867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comorbidities and HIV-related factors associated with mental health symptoms and unhealthy substance use among older adults living with HIV in low- and middle-income countries: a cross-sectional study","authors":"Jeremy L. Ross,&nbsp;Dhanushi Rupasinghe,&nbsp;Thida Chanyachukul,&nbsp;Brenda Crabtree Ramírez,&nbsp;Gad Murenzi,&nbsp;Edith Kwobah,&nbsp;Fiona Mureithi,&nbsp;Albert Minga,&nbsp;Ivan Marbaniang,&nbsp;Hugo Perazzo,&nbsp;Angela Parcesepe,&nbsp;Suzanne Goodrich,&nbsp;Cleophas Chimbetete,&nbsp;Ephrem Mensah,&nbsp;Fernanda Maruri,&nbsp;Dung Thi Hoai Nguyen,&nbsp;Alvaro López-Iñiguez,&nbsp;Kathryn Lancaster,&nbsp;Helen Byakwaga,&nbsp;Mpho Tlali,&nbsp;Marie K. Plaisy,&nbsp;Smita Nimkar,&nbsp;Rodrigo Moreira,&nbsp;Kathryn Anastos,&nbsp;Aggrey Semeere,&nbsp;Gilles Wandeler,&nbsp;Antoine Jaquet,&nbsp;Annette Sohn,&nbsp;the Sentinel Research Network of the International epidemiology Databases to Evaluate AIDS","doi":"10.1002/jia2.26434","DOIUrl":"https://doi.org/10.1002/jia2.26434","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;People with HIV (PWH) are vulnerable to mental health and substance use disorders (MSDs), but the extent to which these are associated with other non-communicable diseases in ageing PWH populations remains poorly documented. We assessed comorbidities associated with symptoms of MSD among PWH ≥40 years in the Sentinel Research Network (SRN) of the International epidemiology Database to Evaluate AIDS (IeDEA).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Baseline data collected between June 2020 and September 2022, from 10 HIV clinics in Asia, Latin America and Africa contributing to the SRN, were analysed. Symptoms of MSDs and comorbidities were assessed using standardized questionnaires, anthropometric and laboratory tests, including weight, height, blood pressure, glucose, lipids, chronic viral hepatitis and liver transient elastography. HIV viral load, CD4 count and additional routine clinical data were accessed from participant interview or medical records. HIV and non-HIV clinical associations of mental illness symptoms and unhealthy substance use were analysed using logistic regression. Mental illness symptoms were defined as moderate-to-severe depressive symptoms (PHQ-9 score &gt;9), moderate-to-severe anxiety symptoms (GAD-7 &gt;9) or probable post-traumatic stress disorder (PCL-5 &gt;32). Unhealthy substance use was defined as ASSIST score &gt;3, or AUDIT ≥7 for women (≥8 for men).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Of 2614 participants assessed at baseline study visits, 57% were female, median age was 50 years, median CD4 was 548 cells/mm&lt;sup&gt;3&lt;/sup&gt; and 86% had HIV viral load &lt;1000 copies/ml. Overall, 19% had mental illness symptoms, 15% unhealthy substance use, 49% BMI &gt;25 kg/m&lt;sup&gt;2&lt;/sup&gt;, 38% hypertension, 15% type 2 diabetes, 35% dyslipidaemia, 34% liver disease and 23% history of tuberculosis. BMI &gt;25 and dyslipidaemia were found in 54% and 40% of those with mental illness symptoms compared to 49% and 34% of those without. Mental illness symptoms were not significantly associated with the clinical factors assessed. Unhealthy substance use was more likely among those with dyslipidaemia (OR 1.55, CI 1.16−2.09, &lt;i&gt;p&lt;/i&gt; = 0.003), and less likely in those with BMI &gt;25 (OR 0.48, CI 0.30−0.77, &lt;i&gt;p&lt;/i&gt; = 0.009).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Improved integration of MSD and comorbidity services in HIV clinical settings, and further research on the association between MSD and comorbidities, and care integration among older PWH in low-middle-income countries,","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26434","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143554242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socio-economic status and adherence to HIV preventive and therapeutic interventions: exploring the mediating role of food insecurity among men who have sex with men and transgender and non-binary persons from Brazil","authors":"Paula M. Luz,&nbsp;Thiago S. Torres,&nbsp;Victor C. Matos,&nbsp;Giovanna G. Costa,&nbsp;Brenda Hoagland,&nbsp;Cristina Pimenta,&nbsp;Marcos Benedetti,&nbsp;Beatriz Grinsztejn,&nbsp;Valdilea G. Veloso","doi":"10.1002/jia2.26432","DOIUrl":"https://doi.org/10.1002/jia2.26432","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Brazil offers free-of-charge antiretroviral therapy (ART) for people living with HIV (PLWH) as well as oral pre-exposure prophylaxis (PrEP) through its national health system. Adherence to ART and to PrEP is essential to achieving the expected benefits of virologic suppression and prevention of HIV acquisition, respectively. Brazil has experienced worsening social inequalities, exacerbated by the COVID-19 pandemic, leading to increases in food insecurity especially among vulnerable populations. We explored whether food insecurity mediated the association of socio-economic status on adherence to ART/PrEP.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Adult men who have sex with men (MSM) and transgender and non-binary persons (TGNB) living in Brazil (May−September/2021) voluntarily participated in a cross-sectional online study advertised on dating apps and social media. Participants living with HIV reporting ART use and participants with HIV-negative status reporting daily oral PrEP use were eligible for the analysis. Self-report of ART adherence was measured by the WebAd-Q instrument (3-items/past week) plus a visual analogue scale. Self-report of PrEP adherence was measured by the number of days the person took PrEP in the past week. The 8-item Brazilian Scale of Food Insecurity (EBIA) was used to measure food insecurity (higher scores indicate more severe food insecurity). Two structural equation models were used to assess the direct and indirect effects of variables on ART adherence among PLWH and on PrEP adherence among people using PrEP.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In total, 1230 PLWH were using ART, and 991 individuals with HIV-negative status were using daily oral PrEP. The median age of PLWH was 37 years (HIV negative: 34 years), most were cismen (98%). More PLWH reported moderate/severe food insecurity (21.7%; HIV negative: 12.9%). Self-report of ART adherence (measured by WebAd-Q, past 7 days) was 55.7% (PrEP adherence: 93.3%). In the two models, socio-economic status had an effect on adherence that was mediated through food insecurity: higher socio-economic status was associated with lower food insecurity, and higher food insecurity was associated with lower adherence.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Our findings suggest that the provision of socio-economic support could help PLWH and people at higher vulnerability to HIV acquisition by improving their adherence to ART or PrEP, and ultimately populations through decreased HIV transmissions.&lt;/p&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26432","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143554241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"We will not end AIDS: addressing the anti-rights movements","authors":"Allan Maleche,&nbsp;Wame Jallow,&nbsp;Jerop Limo,&nbsp;Timothy Wafula,&nbsp;Solomon Wambua","doi":"10.1002/jia2.26429","DOIUrl":"https://doi.org/10.1002/jia2.26429","url":null,"abstract":"&lt;p&gt;In 2015, global leaders made an ambitious commitment to end the AIDS epidemic under the 2030 Agenda for Sustainable Development, through political will, investments and rights-based approaches [&lt;span&gt;1&lt;/span&gt;]. On Zero Discrimination Day 2025, we sound the alarm on the growing wave of anti-rights and anti-gender movements that now threaten to roll back of these gains, putting millions of lives at risk. Anti-gender movements refer to organized efforts aimed at opposing gender equality and the rights of marginalized groups, particularly those advocating for sexual and reproductive health rights and the rights of LGBTIQ+ communities. These movements often target policies and programmes that promote gender inclusivity, comprehensive sexuality education and equal access to healthcare, using narratives that reject evolving gender norms and human rights frameworks.&lt;/p&gt;&lt;p&gt;The UNAIDS 2024 report emphasized that the global momentum in ending AIDS hinges on sustained political and financial investments [&lt;span&gt;2&lt;/span&gt;]. It highlighted the need to protect human rights, warning that any backtracking will undermine gains in the HIV response. This echoes the Global Commission on HIV and the Law (2012) [&lt;span&gt;3&lt;/span&gt;] and the UN Secretary-General's report (2016) [&lt;span&gt;4&lt;/span&gt;], which both reaffirmed that access to HIV services must be ensured for marginalized populations, including people living with HIV, young women in sub-Saharan Africa, sex workers, men who have sex with men (MSM), transgender people and people who inject drugs.&lt;/p&gt;&lt;p&gt;However, despite it being an established fact that rights-based strategies are important in ending HIV, 2024 witnessed merciless backlash on those rights. Conservative governments around the world are increasingly posing a threat to human rights, with suppression of human rights defenders, and universal human rights principles and laws being attacked and undermined by these governments.&lt;/p&gt;&lt;p&gt;Most troubling of these trends is the increased criminalization and exclusion of LGBTIQ+ people from healthcare services. In Kenya, for instance, a 2023 Supreme Court decision enabled the registration of the National Gay and Lesbian Human Rights Commission—a landmark victory for human rights [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;But instead of promoting progress, political and religious leaders utilized the ruling to fuel public outrage, which led to a rise in violence towards the LGBTIQ+ community, closures of health service organizations (mainly drop-in centres led by MSM) and interruption of outreach initiatives to key population communities.&lt;/p&gt;&lt;p&gt;Uganda took it a step further. The passing of the Anti-Homosexuality Act in 2024 effectively criminalized LGBTIQ+ livelihoods, with disastrous consequences for HIV prevention and treatment. East African civil society groups warned that such laws push people underground, where they cannot access basic health services [&lt;span&gt;6&lt;/span&gt;]. Ghana followed the same route with a similar bill, which was not sig","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26429","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143513853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid development of an online tracker to communicate the human impact of abruptly halting PEPFAR support","authors":"Brooke E. Nichols,&nbsp;Elvin H. Geng,&nbsp;Eric Moakley,&nbsp;Andrew N. Phillips,&nbsp;Jeffrey W. Imai-Eaton,&nbsp;John Stover,&nbsp;Edinah Mudimu,&nbsp;Anna Grimsrud","doi":"10.1002/jia2.26433","DOIUrl":"https://doi.org/10.1002/jia2.26433","url":null,"abstract":"&lt;p&gt;On 24 January 2025, the global HIV community was confronted with the abrupt announcement that the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), a programme with longstanding bipartisan support, would be paused for 90 days following an executive order to halt all foreign aid [&lt;span&gt;1, 2&lt;/span&gt;]. For the over 20 million individuals worldwide receiving HIV treatment through PEPFAR-supported programmes, the potential consequences were severe and immediate. As the public health community sought mechanisms to respond, an accurate, quantitative and science-based understanding of the potential magnitude of this pause was urgently needed. Systematic quantification of the potential impacts would allow the public health community to plan harm reduction strategies, advocate for policy responses and effectively communicate the severity of the situation to stakeholders, including government officials, civil society leaders, media outlets and advocacy groups.&lt;/p&gt;&lt;p&gt;To provide a rapid assessment, we undertook a near real-time modelling effort. We leveraged existing modelling work, publicly available data and expert consensus to generate projections. Complex mathematical modelling typically requires weeks to generate robust projections, limiting its utility for real-time decision-making. Our focus was on answering the most pressing question—the potential health consequences of this funding pause—using the most parsimonious model possible.&lt;/p&gt;&lt;p&gt;To facilitate accessibility and dissemination, we collaborated with a product development expert to translate these calculations into an interactive website, now available at https://pepfar.impactcounter.com/. The site launched on 28 January 2025, 4 days after the funding freeze was announced [&lt;span&gt;10&lt;/span&gt;]. The platform provides an intuitive tool for users to quickly understand the potential consequences of the PEPFAR funding freeze.&lt;/p&gt;&lt;p&gt;As the tool gained visibility and traction, we continued to refine the modelled estimates through additional expert review. Members of the HIV modelling community, including those affiliated with the HIV Modelling Consortium, independently assessed the calculations, refined assumptions and incorporated the latest available data. This collaborative process ensured that the estimates remained as accurate and reliable as possible while maintaining clarity in communication.&lt;/p&gt;&lt;p&gt;The current estimates on adult deaths presented on the website are informed by detailed modelling projections from five well-established HIV mathematical models [&lt;span&gt;11&lt;/span&gt;]. We used estimates from Jewell et al. on the number of excess deaths expected to occur over a 1-year time horizon associated with complete ART service disruptions over a 90-day period—as a reduction in ART is what specifically drives short-term mortality. This number was multiplied by the percent of HIV programmes funded by PEPFAR (47%) [&lt;span&gt;12&lt;/span&gt;]. We assumed a linear distribution of deaths over the year, resulting","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26433","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge as resistance: advancing global health in challenging times","authors":"Marlène Bras,&nbsp;the Editors of the Journal of the International AIDS Society","doi":"10.1002/jia2.26430","DOIUrl":"https://doi.org/10.1002/jia2.26430","url":null,"abstract":"&lt;p&gt;These are extraordinary times, with daily assaults on public health principles. The sudden de-funding of life-saving programmes like PEPFAR poses existential threats to achieving the goals of effective control of the HIV epidemic, which had been predicated on increasing testing, engagement in care, and uptake of evidence-based treatment and prevention. The censorship of terms related to sex, gender, diversity, equity, and inclusion in public health reports and scientific publications is chilling and negates decades of thoughtful scholarship that has demonstrated the relevance of these issues in the lived experiences and health outcomes of people affected by HIV.&lt;/p&gt;&lt;p&gt;The leadership of IAS – the International AIDS Society – has expressed deep concern over the rhetoric surrounding funding cuts, which has misrepresented the use of international development support and needlessly further stigmatized vulnerable populations. As editors of the &lt;i&gt;Journal of the International AIDS Society&lt;/i&gt;, we affirm that the journal will not change our mission nor our standards for evidence-driven and person-centred reporting. We recognize that programmes funded with public money should be subject to government review. However, the acute pause in US funding for global health, along with statements and policy shifts targeting key populations, represent unprecedented attacks on initiatives that have saved millions of lives and prevented millions of new HIV acquisitions.&lt;/p&gt;&lt;p&gt;JIAS will continue to welcome research that is of interest to our diverse readership, can inform the development of effective strategies to decrease HIV transmission, and improve the health and wellbeing of people living with HIV across the globe. Our core principles continue to include an understanding that sex and gender are distinct, and that rigorous science respects the diversity of human experience.&lt;/p&gt;&lt;p&gt;As researchers, clinicians and public health practitioners, we must respond to the challenges posed by recent policy measures while also documenting their intended and unintended consequences. JIAS welcomes submissions that present empirical data, model potential outcomes of resource constraints and policy shifts or highlight best practices and innovative solutions that address current challenges.&lt;/p&gt;&lt;p&gt;We have received requests from authors of manuscripts under peer review to have their names removed or manuscripts withdrawn from further consideration in order to comply with the US administration's recent executive orders. Although we are very concerned about this, we will respect author requests in agreement with our policy on authorship changes.&lt;/p&gt;&lt;p&gt;This is a difficult time, but the global struggle to address the HIV epidemic has faced and overcome existential challenges before. We feel that the best way to counter misinformation is to continue to generate and disseminate new knowledge that provides a compelling, evidence-based narrative. While an instinctive response to such an un","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26430","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}