Sexual health最新文献

{"title":"A systematic review of barriers to cervical cancer screening among Thai women based on the social ecological model: a multi-level analysis of local evidence.","authors":"Zhenyu Zou, Bingyan Zhai","doi":"10.1071/SH26059","DOIUrl":"10.1071/SH26059","url":null,"abstract":"<p><strong>Background: </strong>Cervical cancer is a significant public health issue in Thailand. Despite the implementation of a national screening program, its coverage remains suboptimal. This study aims to systematically review local Thai evidence and comprehensively analyze the multi-level barriers affecting women's participation in cervical cancer screening using the social ecological model (SEM).</p><p><strong>Methods: </strong>Systematic searches were conducted in PubMed, Scopus, CINAHL and ThaiJO databases from inception to 2025. Literature was screened according to pre-defined inclusion and exclusion criteria, resulting in the inclusion of 11 studies. The Newcastle-Ottawa scale and a mixed-methods assessment tool were used for rigorous quality appraisal. Thematic synthesis was used to categorize screening barriers into five levels: individual, interpersonal, community, health system and public policy.</p><p><strong>Results: </strong>The key obstacles identified include: at the individual level, lack of knowledge, fear, shame and insufficient risk perception; at the interpersonal level, the influence of family and social norms; at the community level, cultural, religious and regional factors; at the health system level, poor service accessibility and system inefficiencies; and at the public policy level, incomplete health insurance coverage and insufficient awareness campaigns. Many of these obstacles show distinct characteristics of Thai society and culture.</p><p><strong>Conclusion: </strong>Barriers to cervical cancer screening among Thai women constitute a complex, multi-level system. Future intervention strategies must move beyond single-level health education, and should develop cross-level, culturally-appropriate, comprehensive measures. These include promoting HPV self-sampling, conducting community empowerment education, optimizing the health service system and strengthening policy support to systematically increase screening participation.</p>","PeriodicalId":22165,"journal":{"name":"Sexual health","volume":"23 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing overall PrEP uptake, daily PrEP and event-driven PrEP use among men who have sex with men in 15 countries across Asia.","authors":"Curtis Chan, Heather-Marie A Schmidt, Jason J Ong, Warittha Tieosapjaroen, Nittaya Phanuphak, Kimberly E Green, Michael M Cassell, Lei Zhang, Midnight Poonkasetwattana, Benjamin R Bavinton","doi":"10.1071/SH25064","DOIUrl":"10.1071/SH25064","url":null,"abstract":"<p><strong>Background: </strong>Event-driven PrEP (ED-PrEP) is an established method of preventing HIV among men who have sex with men (MSM).</p><p><strong>Methods: </strong>This analysis seeks to assess overall PrEP uptake and PrEP dosing regimen (daily or ED-PrEP) using survey data from the PrEP APPEAL study, an online cross-sectional survey of MSM across 15 countries in Asia.</p><p><strong>Results: </strong>Among 15,012 cisgender MSM, 12,050 (80.3%) were aware of PrEP, 12,264 (81.7%) were not currently taking PrEP, 941 (6.3%) were taking ED-PrEP and 1742 (11.6%) were taking daily PrEP. Among current PrEP users (n = 2683), Lao People's Democratic Republic (17/23, 73.9%), Taiwan (252/359, 70.2%) and Japan (105/184, 57.1%) had the highest proportion of ED-PrEP users. Compared with ED-PrEP users, factors independently positively associated with non-PrEP users included identifying as bisexual and condomless vaginal sex, whereas factors negatively associated with non-PrEP users included living in a high-income country, having a university education, receiving an HIV test in the past 12 months, knowing people with a positive attitude about PrEP, having more sexual partners, condomless anal sex and chemsex. Compared with ED-PrEP users, factors independently positively associated with daily PrEP included being in a romantic relationship and receiving an HIV test or STI diagnosis in the past 12 months, and factors negatively associated with daily PrEP users included living in a high-income country, having a university education and chemsex.</p><p><strong>Conclusion: </strong>More work is needed to promote general PrEP uptake across the region and to promote choice of PrEP dosing regimen to suit the HIV prevention needs of the individual.</p>","PeriodicalId":22165,"journal":{"name":"Sexual health","volume":"23 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contraceptive awareness and use among Aboriginal and Torres Strait Islander youth: a cross-sectional analysis from the 'Next Generation Youth Wellbeing Study'.","authors":"Alison J Gibberd, Elizabeth M Ford, Simon Graham, Christopher D McKay, Catherine Chamberlain, Robyn Williams, Katiska Davis, Sandra J Eades","doi":"10.1071/SH25117","DOIUrl":"10.1071/SH25117","url":null,"abstract":"<p><strong>Background: </strong>Contraception enables reproductive choices, yet little is known about its use by Aboriginal and Torres Strait Islander youth. This study describes contraceptive awareness and use among Aboriginal and Torres Strait Islander youth.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of baseline data from the 'Next Generation Youth Wellbeing Study' participants aged 16-24 years from Central Australia, Western Australia and New South Wales. They reported their awareness of contraceptive methods, contraceptive use and reasons for not using condoms.</p><p><strong>Results: </strong>Among the 375 participants, awareness was particularly high for condoms (83%), the oral contraceptive pill (78%) and Implanon (77%). Females, older participants and sexually active participants demonstrated higher awareness. Among 219 participants who were sexually active, 27% reported using no contraception the last time they had sex, whereas 44% used condoms. The most common reasons for not using condoms were using another contraception method (28%), being in a long-term relationship (24%) and not having or liking condoms (22%). After condoms, long-acting reversible contraception was most frequently used, then the oral contraceptive pill.</p><p><strong>Conclusions: </strong>Participants had a good awareness of contraceptive options. Understanding how females and sexually active participants became aware may guide initiatives to increase awareness in other groups. Not using contraception was common. Strategies to normalise discussions about contraception, increase health service visits, influence school sex education and address power imbalances in relationships may increase use. Higher uptake of long-acting reversible contraception over the oral contraceptive pill suggests that Aboriginal and Torres Strait Islander youth may have adopted these more effective contraceptives earlier in time than non-Indigenous youth.</p>","PeriodicalId":22165,"journal":{"name":"Sexual health","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146053703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Watching and doing: are pornography use and sex motives correlated with hooking up among Chinese university women.","authors":"Ke Yu, Anise M S Wu","doi":"10.1071/SH25160","DOIUrl":"10.1071/SH25160","url":null,"abstract":"<p><strong>Background: </strong>Research on pornography use and casual sex has lacked a comprehensive understanding of university women's engagement with such content. To address this gap, we examined pornography use, sexual motives and hookup behavior among university women in China from a sexual scripting perspective.</p><p><strong>Methods: </strong>Participants (N = 1242) provided self-reported data on their frequency of pornography viewing, motives for and against sex, and hookup behavior.</p><p><strong>Results: </strong>The findings showed that pornography consumption was positively associated with hookup behaviors. Pornography use was also positively correlated with all motives for sex, and negatively correlated with not ready motives. In turn, hookup behaviors were positively associated with enhancement and coping motives, but negatively associated with value and not ready motives. Moreover, some of these motives (e.g. enhancement and not ready) partly explained the link between pornography use and hookup.</p><p><strong>Conclusion: </strong>These findings underscore the association between pornography use and casual sex engagement among Chinese university women, with specific motives for and against sex playing a relevant role. These insights may help inform targeted sexual health promotion strategies that support autonomy and sexual well-being among Chinese university women.</p>","PeriodicalId":22165,"journal":{"name":"Sexual health","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there value in routine screening exercises for syphilis? Coincidental syphilis detection in samples submitted for routine HSV investigations.","authors":"Taylah K Anderson, Jocelyn W Hume, Rita Gupta, Michael Thomas, David M Whiley, Emma L Sweeney","doi":"10.1071/SH25148","DOIUrl":"10.1071/SH25148","url":null,"abstract":"<p><strong>Background: </strong>A sustained outbreak of infectious syphilis has been documented in Australia since 2011. Although treatment of syphilis with antibiotics is highly effective, the ongoing spread of this pathogen in Australia suggests that diagnosis may be suboptimal. Molecular detection of syphilis is now commonly performed; however, in many instances clinicians request separate tests for specific pathogens, which may lead to issues in failing to request testing for Treponema pallidum subspecies pallidum, the causative agent of syphilis.</p><p><strong>Methods: </strong>In this study, we performed routine screening of 5052 samples submitted to our local pathology provider for routine herpes simplex virus investigations. Samples were tested for the presence of T. pallidum.</p><p><strong>Results: </strong>We identified a total of 41 samples (0.8%) which were T. pallidum positive. Of these, the majority of samples reassuringly had requests for T. pallidum testing requested; however, samples from three patients (including a pregnant female) were identified as part of this exercise, who would have otherwise remained undetected and untreated.</p><p><strong>Conclusion: </strong>This study demonstrates the clear value in routine screening exercises such as this to improve the timely detection and management of syphilis in Australia.</p>","PeriodicalId":22165,"journal":{"name":"Sexual health","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical epidemiology and management challenges of genital Mycoplasma and Ureaplasma infections: a retrospective observational study at a Japanese urban clinic.","authors":"Nobuaki Mori, Kenya Yukawa, Masahito Oda, Masashi Tanaka, Issei Tokimatsu, Akihiro Sato","doi":"10.1071/SH25204","DOIUrl":"10.1071/SH25204","url":null,"abstract":"<p><strong>Background: </strong>Genital Mycoplasmas and Ureaplasmas pose diagnostic and therapeutic challenges due to their varying pathogenicity and increasing antimicrobial resistance. This study aimed to characterise the positivity, clinical associations, and treatment outcomes of Mycoplasmoides genitalium, Metamycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum in an urban clinic in Tokyo, Japan.</p><p><strong>Methods: </strong>This retrospective study was conducted at a single clinic in Tokyo, Japan. Electronic medical records of patients who underwent polymerase chain reaction testing for the four target pathogens between January 2023 and April 2024 were included in the study. To minimise confounding, a sub-analysis was performed on a chlamydia/gonorrhoea-negative subset. The statistical association between specific organisms and symptoms was assessed, and the treatment success rate (negative test-of-cure after ≥3 weeks) was evaluated.</p><p><strong>Results: </strong>Of 524 patients tested, 213 (40.7%) tested positive for at least one pathogen. M. genitalium was the most prevalent (81/213, 38.0%), and showed a robust association with dysuria (P < 0.01) and purulent genital discharge (P = 0.03) in the chlamydia/gonorrhoea-negative subset. In contrast, M. hominis and Ureaplasma spp. were predominantly associated with colonisation or non-specific symptoms. The clinical success rate for M. genitalium (minocycline followed by sitafloxacin) was suboptimal at 68.8%. Notably, U. parvum showed an alarmingly low success rate against moxifloxacin (28.6% in the subset). The overall test-of-cure completion rate was low (60.1%).</p><p><strong>Conclusions: </strong>In a Tokyo clinical setting, M. genitalium was the most prevalent species and the primary driver of symptoms, whereas M. hominis and Ureaplasma spp. frequently suggest colonisation. Management remains challenging due to suboptimal cure rates and poor follow-up adherence. These findings support a tiered diagnostic strategy that prioritises exclusion of major sexually transmitted infections and emphasises species-specific management.</p>","PeriodicalId":22165,"journal":{"name":"Sexual health","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146004227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unravelling complexity: a realist approach to youth participation in sexual and reproductive health research.","authors":"Lore Remmerie, Isabel Schoenmakers, Miranda van Reeuwijk, Alexis Dewaele, Joseph D Tucker, Kristien Michielsen","doi":"10.1071/SH25154","DOIUrl":"10.1071/SH25154","url":null,"abstract":"<p><p>Researchers in the field of sexual and reproductive health and rights (SRHR) increasingly recognise the value of engaging young people (YP) as active partners in research. However, there are also challenges associated with youth participation in research and more evidence is needed on how participatory methods work across settings, for different groups of YP. Starting from realist principles, this paper develops an initial program theory that explains the mechanisms through which youth participatory research can create meaningful outcomes. A realist review was conducted and complemented with realist expert interviews. The review included 87 original and 30 reflective articles published between January 2019 and June 2024. It examines how participatory methods with YP (aged 10-24 years) contributed to SRHR research. Analysis focused on identifying relevant factors and causal relationships that were synthesised in a Causal Loop Diagram (CLD). Realist interviews with eight researchers experienced in implementing youth participatory methods were conducted to refine the CLD. Participatory methods have the potential to enhance YP's ability to talk about SRHR, have sustainable positive impact on YP, and enhance data quality, through the mechanisms of improved control, comfort, rapport, playfulness, and adapted communication tools. Several contextual variables influence these mechanisms; i.e. YP's interests and capacities to participate, rigidity of research institutions requirements, taboo, power dynamics, and opportunities to learn about and evaluate participatory methods. This study proposes a theory that explains how participatory methods can achieve outcomes and offers a foundation for further application of youth participatory methods in SRHR research.</p>","PeriodicalId":22165,"journal":{"name":"Sexual health","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators to sexual partners' PrEP use: perspectives of men who have sex with men with HIV.","authors":"Sarah J Miller, Atticus Wolfe, Cheuk Chi Tam, Xueying Yang","doi":"10.1071/SH26044","DOIUrl":"10.1071/SH26044","url":null,"abstract":"<p><strong>Background: </strong>Pre-exposure prophylaxis (PrEP) is highly effective at preventing the transmission of HIV through sex, yet uptake of the medication is low, including for those most affected by the HIV epidemic, such as men who have sex with men. The present study sought to understand the perspectives of men who have sex with men with HIV (MSMWH) on barriers and facilitators to their HIV-negative partners taking PrEP to inform HIV prevention efforts.</p><p><strong>Methods: </strong>Semi-structured qualitative interviews were conducted with 30 MSMWH focused on perspectives related to HIV-negative sexual partners' use of PrEP. Data were analyzed using a blinded, two-coder, inductive conventional content analytical method.</p><p><strong>Results: </strong>MSMWH described holding a responsibility for their sexual partners' sexual wellbeing, which motivated them to encourage and support PrEP use. Barriers to their sexual partners' PrEP use included limited awareness of PrEP, lack of access to health care, experiences of stigma, medical mistrust and concerns driven by lawsuits related to PrEP. Facilitators included support from sexual partners, social support and recommendations from experts.</p><p><strong>Conclusion: </strong>MSMWH support their sexual partners' use of PrEP in tangible ways, as motivated by a sense of responsibility for their partners, which may be useful in addressing the HIV epidemic. Utilization of couple-based HIV prevention work may be a way to leverage this support. Efforts to increase PrEP uptake should also address barriers to care, including increasing PrEP awareness, addressing medical mistrust and reducing PrEP-related stigma.</p>","PeriodicalId":22165,"journal":{"name":"Sexual health","volume":"23 2","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147481724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HPV awareness and anal cancer prevention among sexual minority men living with HIV in Nigeria: insights from an affirming clinical setting.","authors":"Connor R Volpi, John Chama, Ruxton Adebiyi, Jumoke A Aigoro, Yerima Jibrin Bawa, Kazeem E Kolawole, Uchenna Ononaku, Naomi Ayuba, Ashley Shutt, Abayomi Aka, Stephen E Goldstone, Patrick Dakum, Joel M Palefsky, Sylvia Adebajo, Karin E Tobin, Rebecca G Nowak","doi":"10.1071/SH25193","DOIUrl":"10.1071/SH25193","url":null,"abstract":"<p><strong>Background: </strong>Sexual minority men (SMM) living with HIV face an elevated risk of anal cancer, and SMM-affirming HIV clinics serve as vital entry points for cancer prevention. We evaluated human papillomavirus (HPV) knowledge, vaccine acceptability and whether time living with HIV was associated with anal cancer symptom awareness.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted at an HIV clinic offering anal cancer prevention in Abuja, Nigeria. Descriptive statistics were used to summarize HPV knowledge and vaccine acceptability. Multivariable negative binomial regression evaluated the number of anal cancer symptoms correctly reported using adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Among 249 SMM living with HIV, 20.5% reported having heard of HPV. Fewer than 20% correctly identified key anal cancer symptoms, including anal bleeding (15.7%) and a lump or mass in the anus (16.9%). Time living with HIV was initially associated with anal cancer symptom awareness, but not after adjustment (aPR 1.02, 95% CI 0.98-1.07). Other independent predictors of anal cancer symptom awareness were anal cancer screening (aPR 1.51, 95% CI 1.15-1.97) and knowing HPV vaccine can prevent anal cancer (aPR 1.52, 95% CI 1.18-1.98). Despite low HPV awareness, 93.6% of participants reported willingness to receive HPV vaccine.</p><p><strong>Conclusion: </strong>Integrating cancer prevention services into SMM-affirming HIV care may offer an opportunity to strengthen HPV-related knowledge and reduce cancer disparities.</p>","PeriodicalId":22165,"journal":{"name":"Sexual health","volume":"23 2","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13052982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining HIV risk and prevention behaviors among men who have sex with men in Ending the HIV Epidemic states in the Western US region between 2017 and 2021: a serial-cross-sectional analysis of the American Men's Internet Survey.","authors":"Angel B Algarin, Sarah Portle, Travis H Sanchez","doi":"10.1071/SH25105","DOIUrl":"10.1071/SH25105","url":null,"abstract":"<p><strong>Background: </strong>The Western region of the US has received comparatively less attention in HIV research despite housing several Ending the HIV Epidemic priority areas. Understanding HIV risk and prevention behaviors among men who have sex with men (MSM) in this region is critical. This study examines differences in HIV risk and prevention behaviors among MSM in the Pacific (CA, WA) and Mountain (AZ, NV) sub-regions.</p><p><strong>Methods: </strong>We conducted a serial cross-sectional analysis using 2017-2021 data from the American Men's Internet Survey. The sample included MSM with HIV-negative or unknown status. Key outcomes included condomless anal intercourse, substance use, STI diagnoses, HIV/STI testing, and PrEP awareness, willingness and use. Poisson regression models with robust standard errors estimated prevalence ratios and 95% confidence intervals, adjusting for sociodemographics.</p><p><strong>Results: </strong>Among 7423 MSM, 81.3% resided in the Pacific sub-region, 53.0% were aged <30 years and 50.8% were white. Condomless anal intercourse rates were similar across sub-regions, but STI diagnoses (13.0% vs 10.1%, P < 0.05) and substance use were higher in the Pacific compared with the Mountain sub-region. HIV testing (55.5% vs 59.8%, P < 0.05) and STI testing (39.2% vs 45.7%, P < 0.001) were lower in the Mountain sub-region compared with the Pacific sub-region. PrEP awareness was similar, but usage was lower (17.2% vs 23.1%, P < 0.001) despite higher willingness (51.8% vs 44.5%, P < 0.001) in the Mountain compared with the Pacific sub-region.</p><p><strong>Conclusions: </strong>HIV risk was similar across sub-regions, but disparities in prevention engagement highlight regional barriers. Expanding PrEP access and HIV/STI testing in the Mountain sub-region is critical to achieving Ending the HIV Epidemic goals.</p>","PeriodicalId":22165,"journal":{"name":"Sexual health","volume":"23 2","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}