Journal of the International AIDS Society最新文献

{"title":"Being yourself is a defect: analysis of documented rights violations related to sexual orientation, gender identity and HIV in 2022 using the REAct system in six eastern European, Caucasus and Central Asian countries","authors":"Oksana Kovtun, Elvira Tilek kyzy, Nadira Masiumova","doi":"10.1002/jia2.26311","DOIUrl":"https://doi.org/10.1002/jia2.26311","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Removing legal barriers to HIV services is crucial for the global 2030 goal of ending the HIV and AIDS epidemic, particularly in eastern Europe, the Caucasus and central Asia. Despite state commitments to uphold human rights, gay, bisexual and other men who have sex with men (gbMSM), along with transgender people (TP) still face stigma and discrimination. This article presents an analysis of rights violations based on sexual orientation and gender identity (SOGI) and HIV reported in 2022 across six countries, highlighting features and their links to legislation and law enforcement practices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We examined documented cases of rights violations among gbMSM and TP in Armenia, Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan and Ukraine in 2022 using the REAct system, a tool for documenting and responding to rights violations against key populations. Initially, we employed directed content analysis based on Yogyakarta Principles to analyse narratives of violations. A codebook was developed through contextual, manifest and latent coding, with themes, categories and codes converted into quantitative variables for statistical analysis. Descriptive statistics were used to identify the characteristics of violations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 456 cases of rights violations related to SOGI and HIV were documented, ranging from 22 cases in Tajikistan to 217 in Ukraine. Most violations concerned gbMSM (76.5%), with one-fifth involving TP, predominantly transgender women. Complex violations with multiple perpetrators or infringements were documented in Armenia and central Asia. Privacy rights were commonly violated, often through outing. Cases of violations of the right to the highest attainable standard of health (13.6%) and protection from medical abuses (2.6%) were also documented. Other rights violations were sporadic, with each country exhibiting distinct patterns of violated rights and types of violations. In Ukraine, the full-scale war in 2022 influenced the nature of documented cases, reflecting the challenges faced by gbMSM and TP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Monitoring rights violations proved effective for assessing the situation of gbMSM and TP, particularly in the insufficiently studied and diverse eastern Europe, Caucasus and central Asia regions. As rights violations are linked to both legislation and law enforcement practices, comprehensive interventions to minimize structural and interpersonal stigma are essent","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26311","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730027","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":"Patterns of daily oral HIV PrEP adherence among people who inject drugs in Ukraine: an analysis of biomarkers","authors":"Olga Morozova, Marina Kornilova, Olena Makarenko, Svitlana Antoniak, Mariia Liulchuk, Olga Varetska, Kostyantyn Dumchev","doi":"10.1002/jia2.26319","DOIUrl":"https://doi.org/10.1002/jia2.26319","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Daily oral HIV pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine (TDF/FTC) is recommended for people who inject drugs (PWID) but coverage is low. The real-life effectiveness of PrEP among PWID is unknown as previous studies were conducted in controlled settings and mainly relied on self-report. Analysis of PrEP metabolites—tenofovir diphosphate (TFVdp) and emtricitabine triphosphate (FTCtp)—offers an objective measure of adherence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To analyse longitudinal patterns of PrEP adherence among PWID in Ukraine, we used data from a community-based implementation trial conducted in Kyiv between July 2020 and March 2021 to test the efficacy of SMS reminders to improve adherence. Among 199 enrolled participants, 156 (78.4%) were retained through 6 months. Based on TFVdp/FTCtp levels assessed at 3 and 6 months, we identified groups with various adherence patterns (adherent at ≥2 doses/week, improved, worsened, non-adherent). Correlates of adherence were analysed using multinomial logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Most participants (53.8%, <i>n</i> = 84/156) had no detectable metabolites at both assessments; 7.1% (<i>n</i> = 11/156) were consistently taking ≥2 doses/week; 1.3% (<i>n</i> = 2/156) were consistently taking ≥4 doses/week; 13.5% (<i>n</i> = 21/156) exhibited improved and 21.8% (<i>n</i> = 34/156) had worsened adherence at 6 compared to 3 months. “White coat compliance” (increased dosing prior to assessment) was common. Consistent adherence was associated with SMS reminders, younger age, employment, lower income, longer injection drug use duration, recent high-risk injecting (receptive syringe sharing, using pre-filled syringe, back- or front-loading, container sharing), absence of overdose in the past 6 months, perceived HIV risk through sexual intercourse and higher PrEP self-efficacy. Alcohol consumption was associated with inconsistent PrEP use. Groups with improved and worsened adherence did not differ.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Daily oral PrEP may not achieve the desired effectiveness among PWID as a standalone intervention, calling for testing of alternative PrEP formulations and innovative integrated risk reduction strategies, especially in the context of HIV epidemics associated with injection drug use in eastern Europe and central Asia and the public health crisis in Ukraine caused by the war with Russia. SMS reminders may be effective among PWID who prioritize PrEP. Our findings offer p","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26319","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730026","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":"Changes in risk behaviour following a network peer education intervention for HIV prevention among male Tajik migrants who inject drugs in Moscow: a cluster-randomized controlled trial","authors":"Mary Ellen Mackesy-Amiti, Mahbatsho Bahromov, Judith A. Levy, Jonbek Jonbekov, Casey M. Luc","doi":"10.1002/jia2.26310","DOIUrl":"https://doi.org/10.1002/jia2.26310","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The “Migrants’ Approached Self-Learning Intervention in HIV/AIDS for Tajiks” (MASLIHAT) recruits and trains Tajik labour migrants who inject drugs as peer educators (PEs) in delivering HIV prevention information and encouragement to adopt risk-reduction norms and practices within their diaspora social networks while reducing their own HIV risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The MASLIHAT intervention was tested in Moscow in a cluster-randomized controlled trial with 12 recruitment sites assigned to either the MASLIHAT intervention or an equal-time peer-educator training focused on other health conditions (TANSIHAT). From October 2021 to April 2022, 140 male Tajik migrants who inject drugs were recruited as PEs to attend the 5-session MASLIHAT training or the TANSIHAT non-HIV comparison condition. Each participant in both groups recruited two network members (NMs) who inject drugs with the intent to share with them the information and positive strategies for change they had learned (<i>n</i> = 280). All PEs and NMs (<i>n</i> = 420) participated in baseline and follow-up interviews at 3-month intervals for 1 year. All received HIV counselling and testing. Modified mixed effects Poisson regressions tested for group differences in injection practices, sexual risk behaviours and heavy alcohol use over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, across both groups, 75% of participants reported receptive syringe sharing (RSS), 42% reported condomless sex and 20% reported binge drinking at least once a month. In contrast to TANSIHAT where HIV risk behaviours remained the same, significant intervention effects that were sustained over the 12 months were observed for receptive syringe and ancillary equipment sharing among both MASLIHAT PEs and NMs (<i>p</i> < 0.0001). Significant declines in the prevalence of sexual risk behaviours were also associated with the MASLIHAT intervention (<i>p</i> < 0.01), but not the comparison condition. Binge alcohol use was not affected in either condition; the MASLIHAT intervention had a transitory effect on drinking frequency that dissipated after 9 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The MASLIHAT peer-education intervention proved highly effective in reducing HIV-related injection risk behaviour, and moderately effective in reducing sexual risk behaviour among both PEs and NMs. Network-based peer education is an important tool for HIV prevention among people who inject drugs, especially in environments that are not ame","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26310","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730047","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":"“Will you need this health at all? Will you be alive?”: using the bioecological model of mass trauma to understand HIV care experiences during the war in Ukraine","authors":"Jill Owczarzak, Olivia Monton, Shannon Fuller, Julia Burlaka, Tetiana Kiriazova, Olga Morozova, Kostyantyn Dumchev","doi":"10.1002/jia2.26307","DOIUrl":"https://doi.org/10.1002/jia2.26307","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Russia's invasion of Ukraine in February 2022 has severely impacted the healthcare system, including the provision of HIV care. The ongoing war is a human-caused mass trauma, a severe ecological and psychosocial disruption that greatly exceeds the coping capacity of the community. The bioecological model of mass trauma builds on Bronfenbrenner's concept of interaction between nested systems to argue that social context determines the impact of life events on the individual and how an individual responds. This paper uses the bioecological model of mass trauma to explore the impact of Russia's aggression against Ukraine and the ongoing war on HIV-positive people who use drugs in Ukraine, a particularly vulnerable population that may be negatively affected by disruptions to social networks, healthcare infrastructure and economic conditions caused by mass trauma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were collected between September and November 2022. A convenience sample of 18 HIV-positive people who use drugs were recruited from community organizations that work with people living with HIV, drug treatment programmes, and HIV clinics through direct recruitment and participant referral. A total of nine men and nine women were recruited; the age ranged from 33 to 62 years old (mean = 46.44). Participants completed a single interview that explored how the war had affected their daily lives and access to HIV care and other medical services; their relationships with healthcare providers and social workers; and medication access, supply and adherence. Data were analysed using the Framework Method for thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The war had a profound impact on the social, emotional and financial support networks of participants. Changes in social networks, coupled with limited job opportunities and rising prices, intensified financial difficulties for participants. Relocating to different regions of Ukraine, staying at somebody else's home, and losing connections with social workers impacted medication adherence and created lengthy treatment gaps. Participants also experienced a decreased supply of antiretroviral therapy, concerns about accessing medication for opioid use disorder, and overwhelming fears associated with the war, which overshadowed their HIV-related health concerns and negatively impacted medication adherence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our analysis reveals the complex impact of war on social networks and healthcare access. Main","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26307","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730304","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":"An implementation evaluation of the Breaking Down human rights barriers to HIV services initiative in Ukraine","authors":"Diederik Lohman, Yevheniia Kononchuk, Alexandrina Iovita, Mikhail Golichenko, Valeria Rachinska, Pavlo Skala, Olga Gvozdetska, Serhii Myroniuk, Joseph J. Amon","doi":"10.1002/jia2.26328","DOIUrl":"https://doi.org/10.1002/jia2.26328","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Globally, stark inequities exist in access to HIV treatment and prevention. The eastern European and central Asian region is experiencing the sharpest rise in new HIV acquisition and deaths in the world, with low rates of treatment and prevention services, especially for key and vulnerable populations who face a range of human rights-related barriers to HIV prevention and treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An implementation learning evaluation approach was used to examine the implementation of the Breaking Down Barriers initiative targeting key and vulnerable populations in Ukraine. Between September 2022 and April 2023, researchers conducted 23 key informant interviews with individuals from the Ukrainian government, implementing organizations and human rights experts. Using a concurrent triangulation design, researchers and key informants, in a process of co-creation, sought to describe programme accomplishments, challenges and innovations in implementation, between 2021 and 2023, including periods before and after Russia's February 2022 full-scale invasion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight rights-based interventions related to HIV were identified in Global Fund programme documents and key informant interviews as making up the core of the Breaking Down Barriers initiative in Ukraine. These included programmes seeking to: eliminate stigma and discrimination; ensure the non-discriminatory provision of medical care; promote rights-based law enforcement practices; expand legal literacy (“know your rights”); increase access to justice; improve laws, regulations and policies; reduce gender discrimination, harmful gender norms and violence against women and girls; and mobilize communities for advocacy. These programmes received US$5.9 million in funding. Key informants reported that significant progress had been made addressing human rights barriers and scaling up interventions, both before and after Russia's invasion. Programme implementors adopted innovative approaches, including using paralegals, hotlines and other community-led interventions, to ensure that key and vulnerable populations, including displaced individuals, were able to access prevention and care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>An implementation learning evaluation approach examining programmes addressing human rights barriers to HIV services, designed as a process of co-creation between researchers, programme implementors, government officials and human rights experts, can provide a ro","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26328","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730025","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":"A citizen science approach to develop a digital intervention to reduce HIV stigma and promote HIV self-testing among adolescents and young adults: a mixed methods analysis from Kazakhstan","authors":"Alissa Davis, Susan L. Rosenthal, Joseph D. Tucker, Olga Balabekova, Laura Nyblade, Yihang Sun, Denis Gryazev, Karsten Lunze, Sara E. Landers, Weiming Tang, Azamat Kuskulov, Valera Gulyayev, Assel Terlikbayeva, Sholpan Primbetova, Gaukhar Mergenova, the JasSpark Study Team","doi":"10.1002/jia2.26314","DOIUrl":"https://doi.org/10.1002/jia2.26314","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Kazakhstan has one of the fastest-growing HIV epidemics in the world, with increasing rates among adolescents and young adults (AYA). Innovative strategies are needed to increase HIV testing uptake and decrease HIV stigma among AYA. Citizen science, defined as the active engagement of the general public in scientific research tasks, promotes and facilitates community engagement throughout the research process. This citizen science study used crowdsourcing to engage AYA in Kazakhstan to develop a digital intervention to reduce HIV stigma and promote HIV self-testing. Our objectives in this paper are to describe the approach used, its feasibility and acceptability, and AYA motivations for and lessons learned collaborating on the study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From October 2021 to July 2022, in collaboration with a Community Collaborative Research Board and a Youth Advisory Board, we developed an open call requesting multimedia submissions to reduce HIV testing stigma. Eligible submissions were separated by age group (13−19 or 20−29 years) and judged by a panel composed of AYA (<i>n</i> = 23), healthcare professionals (<i>n</i> = 12), and representatives from the local government and non-governmental organizations (<i>n</i> = 17). Each entry was reviewed by at least four judges and ranked on a 5-point scale. The top 20 open call contestants were asked to submit self-recordings sharing their motivation for and experience participating in the contest and lessons learned. Descriptive statistics were calculated for quantitative data. Qualitative data were coded using open coding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We received 96 submissions from 77 youth across Kazakhstan. Roughly, three-quarters (<i>n</i> = 75/96) of entries met judging eligibility criteria. Of the eligible entries, over half (<i>n</i> = 39/75) scored 3.5 or higher on a 5-point scale (70.0%). The most frequent types of entries were video (<i>n</i> = 36/96, 37.5%), image (<i>n</i> = 28/96, 29.2%) and text (<i>n</i> = 24/96, 25.0%). AYA's primary motivations for collaborating on the study included a desire to improve society and help youth. The main challenges included creating content to address complex information using simple language, finding reliable information online and technological limitations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Crowdsourcing was feasible and highly acceptable among AYA in Kazakhstan. Citizen science approaches hold great promise for addressing the increasingly complex healt","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26314","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730307","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":"“…because the social work never ends”: a qualitative study exploring how NGOs responded to emerging needs while upholding responsibility to HIV prevention and treatment during the war in Ukraine","authors":"Lisa Lazarus,&nbsp;Leigh M McClarty,&nbsp;Nicole Herpai,&nbsp;Daria Pavlova,&nbsp;Tatiana Tarasova,&nbsp;Anna Gnatenko,&nbsp;Tetiana Bondar,&nbsp;Robert Lorway,&nbsp;Marissa L Becker,&nbsp;the Dynamics Study Team","doi":"10.1002/jia2.26309","DOIUrl":"https://doi.org/10.1002/jia2.26309","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Since the onset of the Russian invasion on 24 February 2022, the health system in Ukraine has been placed under tremendous pressure, with damage to critical infrastructure, large losses of human resources, restricted mobility and significant supply chain interruptions. Based on a longstanding partnership between the Ukrainian Institute for Social Research after Oleksandr Yaremenko (UISR after O. Yaremenko) and the Institute for Global Public Health at the University of Manitoba, we explore the impact of the full-scale war on non-governmental organizations (NGOs, including charitable organizations) providing services for key population groups in Ukraine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted in-depth qualitative interviews with key representatives from NGOs working with key population groups (i.e., people living with HIV, sex workers, men who have sex with men, people who inject drugs and transgender people) throughout Ukraine. Members of the UISR after O. Yaremenko research team recruited participants from organizations working at national, regional and local levels. The research team members conducted 26 interviews (22 with women and four with men) between 15 May and 7 June 2023. Interviews were conducted virtually in Ukrainian and interpretively analysed to draw out key themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Applying Roels et al.’s notion of “first responders”, our findings explore how the full-scale war personally and organizationally impacted workers at Ukrainian NGOs. Despite the impacts to participants’ physical and mental health, frontline workers continued to support HIV prevention and treatment while also responding to the need for humanitarian aid among their clients and the wider community. Furthermore, despite inadequate pay and compensation for their work, frontline workers assumed additional responsibilities, thereby exceeding their normal workload during the extraordinary conditions of war.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>NGOs play a vital role as responders, adapting their services to meet the emergent needs of communities during structural shocks, such as war. There is an urgent need to support NGOs with adequate resources for key population service delivery and to increase support for their important role in humanitarian aid.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26309","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730024","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":"Mental health and cognition in relation to adherence to antiretroviral therapy among people living with HIV in Kazakhstan: a cross-sectional study","authors":"Gaukhar Mergenova,&nbsp;Alissa Davis,&nbsp;Louisa Gilbert,&nbsp;Nabila El-Bassel,&nbsp;Assel Terlikbayeva,&nbsp;Sholpan Primbetova,&nbsp;Zhamilya Nugmanova,&nbsp;Andrea Norcini Pala,&nbsp;Deborah Gustafson,&nbsp;Susan L. Rosenthal,&nbsp;Alfiya Y. Denebayeva,&nbsp;Jack DeHovitz","doi":"10.1002/jia2.26320","DOIUrl":"https://doi.org/10.1002/jia2.26320","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 research gap in how mental health and cognition are associated with antiretroviral treatment (ART) adherence among people living with HIV (PLWH) in Kazakhstan.&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;We randomly selected and enrolled 230 PLWH from the Almaty City AIDS Center registry (June−November 2019) into a cross-sectional study. We examined associations between self-reported ART adherence for the last 1 and 2 weeks; the Adherence Self-Efficacy Scale (ASES) and symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder tool [GAD-7]), post-traumatic stress disorder (PTSD Checklist [PTSD]); cognitive function (PROMIS v2.0 Adult Cognitive Function 8a short form) and forgetfulness (Forgetfulness Assessment Inventory). We used cut points of ≥5 for at least mild and ≥10 for at least moderate symptom severity for PHQ-9 and GAD-7 and of ≥44 for PTSD. Logistic and linear regression analyses were used.&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;Participants’ median age was 40.0 (IQR: 34−47) with 40.9% (&lt;i&gt;n&lt;/i&gt; = 94) of females in the sample. Those who missed at least one pill for the last 2 weeks had higher odds of reporting at least mild depression (aOR = 3.34, 95% CI: 1.22–9.11, &lt;i&gt;p&lt;/i&gt; &lt; 0.05); mild anxiety (aOR = 3.27, 95% CI: 1.20–8.92, &lt;i&gt;p&lt;/i&gt; &lt; 0.05); and PTSD (aOR = 4.04, 95% CI: 1.15–14.21, &lt;i&gt;p&lt;/i&gt; &lt; 0.05) symptoms. Participants who missed at least one pill for the last week had higher odds of at least mild depression (aOR = 7.74, 95% CI: 1.31–45.7, &lt;i&gt;p&lt;/i&gt; &lt; 0.05), moderate anxiety (aOR = 21.33, 95% CI: 3.24–140.33, &lt;i&gt;p&lt;/i&gt; &lt; 0.005) and PTSD (aOR = 13.81, 95% CI: 2.36–80.84, &lt;i&gt;p&lt;/i&gt; &lt; 0.005) symptoms. Participants with better cognitive function had lower odds of non-adherence over the last week (aOR = 0.88, 95% CI: 0.81–0.96, &lt;i&gt;p&lt;/i&gt; &lt; 0.005) and higher ASES scores (β = 0.26, 95% CI: 0.13–0.40, &lt;i&gt;p&lt;/i&gt; &lt; 0.005). Poor memory was associated with higher odds of non-adherence over the last week (aOR = 4.64, 95% CI: 1.76–12.24, &lt;i&gt;p&lt;/i&gt; &lt; 0.005) and lower ASES score (β = −0.31, 95% CI: −0.45 to 0.16, &lt;i&gt;p&lt;/i&gt; &lt; 0.005). Those who had at least mild depression (β = −0.21, 95% CI: −0.35 to −0.07, &lt;i&gt;p&lt;/i&gt; &lt; 0.005); moderate anxiety (β = −0.21, 95% CI: −0.34 to −0.07, &lt;i&gt;p&lt;/i&gt; &lt; 0.005) and PTSD (β = −0.19, 95% CI: −0.33 to −0.05, &lt;i&gt;p&lt;/i&gt; &lt; 0.005) symptoms had lower ASES scores.&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;Depression, anxiety and PTSD symptoms, poorer cognition, and forgetfulness w","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26320","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730201","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":"The HIV epidemic in eastern Europe and central Asia in difficult times: a story of resilience and change","authors":"Miłosz Parczewski,&nbsp;Deniz Gökengin","doi":"10.1002/jia2.26325","DOIUrl":"10.1002/jia2.26325","url":null,"abstract":"&lt;p&gt;The eastern European and central Asian (EECA) region is facing the fastest-growing HIV epidemic in the world with 160,000 (130,000–180,000) people newly acquiring HIV in 2021, an overall 48% increase in the number of new acquisitions, and a 32% rise in AIDS-related deaths over the past 10 years [&lt;span&gt;1&lt;/span&gt;]. The World Health Organization East European region is estimated to accommodate 1.4 million people living with HIV (PWH), with the majority of new transmissions reported to occur locally and to be unrelated to cross-country migrations [&lt;span&gt;2, 3&lt;/span&gt;]. Sadly, according to UNAIDS, in 2022 only 62% of people living in the EECA region were aware of their HIV status and 51% of PWH received HIV treatment, which resulted in an overall viral suppression rate of 48% [&lt;span&gt;1&lt;/span&gt;]. Common (&gt;50%) late diagnoses (with either AIDS-defining condition or CD4&lt;sup&gt;+&lt;/sup&gt; T cell count &lt;350 cells/µl at presentation) [&lt;span&gt;4&lt;/span&gt;] further add to the epidemiological issues and complexity of client management [&lt;span&gt;5&lt;/span&gt;]. Although the key acquisition risk in the region has changed from unsafe injection practices to heterosexual transmission, access to opioid agonist therapy (OAT) and needle and syringe programmes is often still limited (Kazakhstan) or unavailable (Uzbekistan, Turkmenistan), which results in OAT regional coverage as low as 4%, far below the UNAIDS target of 50%.&lt;/p&gt;&lt;p&gt;Furthermore, pre-exposure prophylaxis (PrEP) and combination prevention services are of limited availability or not formally implemented across multiple countries in the region usually due to financial barriers to access, such as lack of state funding for medicines, limited technical capacity or cost of service delivery [&lt;span&gt;6&lt;/span&gt;]. This results in a substantially larger HIV PrEP gap (the proportion of populations at risk of acquiring HIV “very likely” to use PrEP if accessible, compared with the proportion currently using PrEP) across countries located in the EECA region (up to 45%) compared to the overall median of 17.4% estimate for the European Union [&lt;span&gt;7&lt;/span&gt;]. Moreover, there is a high level of stigma across the countries, especially against gay men and other men who have sex with men.&lt;/p&gt;&lt;p&gt;The growing epidemic and the suboptimal access to prevention, testing and treatment are the main reasons that challenge the 2030 targets.&lt;/p&gt;&lt;p&gt;The humanitarian crisis related to the Russian invasion and war in Ukraine has challenged the situation even further hindering testing and treatment efforts, forcing both internal displacement (estimated 3.7 million) and external migration of locals as refugees (estimated 6.4 million, as of March 2024) [&lt;span&gt;8&lt;/span&gt;]. On top of massive casualties, civilian and healthcare infrastructures were destroyed, forcing refugees to seek safety, protection and assistance, including continued access to medical care. Ukraine is home to ∼260,000 PWH with &gt;130,000 on antiretroviral treatment (ART). Although significant pr","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11255029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632082","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":"The effects of regular home delivery of HIV self-testing and follow-up counselling on HIV testing and prevention outcomes in men who have sex with men who test infrequently in the United States: a pragmatic, virtual randomized controlled trial","authors":"Tyler B. Wray,&nbsp;Philip A. Chan,&nbsp;Jeffrey D. Klausner,&nbsp;Lori M. Ward,&nbsp;Erik M. S. Ocean,&nbsp;Daniel J. Carr,&nbsp;John P. Guigayoma,&nbsp;Siddhi Nadkarni","doi":"10.1002/jia2.26318","DOIUrl":"10.1002/jia2.26318","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Past research shows that HIV self-testing (HIVST) can increase testing and facilitate more HIV diagnoses relative to clinic testing. However, in the United States, the use of HIVSTs is limited due to concerns that those who use HIVST could be less likely to be linked to care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From January 2019 to April 2022, we recruited 811 men who have sex with men (MSM) in the United States who tested infrequently using an online marketing campaign and randomized them 1:1:1 to receive one of the following every 3 months for a year: (1) text message reminders to get tested at a local clinic (control); (2) mailed HIVST kits with access to a free helpline (standard HIVST); and (3) mailed HIVST kits with counselling provided within 24 hours of opening a kit (eTest). Quarterly follow-up surveys assessed HIV testing, sexually transmitted infection (STI) testing, pre-exposure prophylaxis (PrEP) use and sexual risk behaviour.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Eight participants were diagnosed with HIV, and all but one were through HIVST. Participants in either HIVST condition, standard or eTest, had significantly higher odds of any testing (<i>OR</i> = 7.9, 95% CI = 4.9−12.9 and <i>OR =</i> 6.6, 95% CI = 4.2−10.5) and repeat testing (&gt;1 test; <i>OR</i> = 8.5, 95% CI = 5.7−12.6; <i>OR =</i> 8.9, 95% CI = 6.1−13.4) over 12 months relative to the control group. Rates of STI testing and PrEP uptake did not differ across study condition, but those in the eTest condition reported 27% fewer sexual risk events across the study period relative to other groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>HIVST vastly increased testing, encouraged more regular testing among MSM, and identified nearly all new cases, suggesting that HIVST could diagnose HIV acquisition earlier. Providing timely follow-up counselling after HIVST did not increase rates of STI testing or PrEP use, but some evidence suggested that counselling may have reduced sexual risk behaviour. To encourage more optimal testing, programmes should incorporate HIVST and ship kits directly to recipients at regular intervals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 7","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26318","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632081","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}