Journal of acquired immune deficiency syndromes (1999)最新文献

{"title":"Can Traditional Health Practitioners Deliver HIV Counseling and Testing Services? A Pilot Study in Rural South Africa.","authors":"Carolyn M Audet, Tshegofatso Seabi, Wonderful Mabuza, Praises Mnisi, Taofik Oyekunle, Jennifer Hove, Taylor Carty, Kathleen Kahn, Ryan G Wagner","doi":"10.1097/QAI.0000000000003712","DOIUrl":"10.1097/QAI.0000000000003712","url":null,"abstract":"<p><strong>Introduction: </strong>In 2021, 7.2 million South Africans were living with HIV. Uptake of HIV testing is undermined by a combination of factors, including HIV stigma, distrust in the health system, skepticism toward allopathic medicine, preference for traditional medicine, and long distances to the nearest health facility.</p><p><strong>Methods: </strong>We conducted a single arm pilot trial to determine the acceptability and feasibility of training traditional healers to conduct rapid HIV counseling and testing in rural South Africa. Seventeen healers were enrolled in a nationally recognized training program with the goal of healers recruiting their clients for testing during regular clinical visits.</p><p><strong>Results: </strong>Sixteen healers completed training and began offering HIV counseling and testing services; 14 healers enrolled participants of which 4 healers accounted for 73% of enrolled (tested) participants. Healers offered testing to 575 clients; 64 (11.1%) self-reported that they were HIV+ so were not eligible to participate and 93 refused. Healers conducted 418 HIV tests (82% uptake) with 20 (4.8%) testing HIV positive. The median age of clients was 30 years (IQR: 23-40) and 51.1% were women. In total, 34.4% had never completed an HIV test, with significantly more men reported never having tested than women.</p><p><strong>Conclusions: </strong>Traditional healers in rural South Africa successfully completed a rapid, point-of-care HIV counseling and testing training. The clients of trained healers were largely willing to be tested; referral of those with a positive result to treatment proved more difficult to implement, with only 60% of those testing positive enrolling in HIV treatment services.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":"115-122"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12319957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Depressive Symptom Severity on Stroke Risk in a US Cohort of People with HIV.","authors":"Jimmy Ma, Robin M Nance, Stephanie A Ruderman, Lydia N Drumright, L Sarah Mixson, Felicia C Chow, Joseph Zunt, Christina M Marra, Maile Karris, Emily L Ho, Kyra Becker, Rizwan Kalani, Andrew Huffer, Rob Fredericksen, Sonia Napravnik, Richard D Moore, Barbara Gripshover, Amanda Willig, Jacklyn D Foley, Greer Burkholder, Michael S Saag, Katerina Christopoulos, Mari M Kitahata, David Tirschwell, Joseph A C Delaney, Heidi M Crane","doi":"10.1097/QAI.0000000000003710","DOIUrl":"10.1097/QAI.0000000000003710","url":null,"abstract":"<p><strong>Background: </strong>Depression is a common psychiatric condition and an independent stroke risk factor among people with HIV (PWH). The impacts of depressive symptom severity on stroke are not clear in PWH.</p><p><strong>Methods: </strong>We studied adult PWH in clinical care at 5 Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites with ≥1 assessment for depressive symptoms (Patient Health Questionnaire-9) from 2010 to 2022. We used Cox models to evaluate (1) associations between time-varying depressive symptom severity and adjudicated incident stroke, serially adjusted for clinical factors and (2) modification of this association by age and sex. Participants were followed from 6 months after first CNICS visit or date the CNICS site began stroke adjudication (baseline) (whichever later) until the first stroke, death, loss to follow-up, last clinic visit, or study end.</p><p><strong>Results: </strong>Among 13,817 PWH (mean age 45 years, 19% women, 58% non-White race/ethnicity), 23% screened positive for depression at baseline and 173 had an incident stroke during follow-up (mean follow-up 7.6 years). Time-varying depressive symptom severity (per 5 points Patient Health Questionnaire-9 score) was associated with higher stroke risk (adjusted Hazard Ratio 1.16, P = 0.01) with greater impact in PWH <50 years than ≥50 years (interaction P = 0.02) but no significant difference by sex. Adjusting for combinations of sociodemographic, cardiovascular, HIV, and substance use factors only slightly attenuated estimates.</p><p><strong>Conclusions: </strong>Depressive symptom severity was an independent risk factor for stroke with higher severity depressive symptoms predicting higher stroke risk and greater impact in PWH <50 years. Depression may be a modifiable risk factor for stroke and should be studied further to understand, develop, and target interventions to reduce stroke risk, especially in younger PWH.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":"154-161"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brief Report: Sex and HIV Modify Immune Activation Biomarkers in Ugandans Post-Tuberculosis.","authors":"Rebecca A Abelman, Jessica Fitzpatrick, Josephine Zawedde, Gabriele Beck-Engeser, Ingvar Sanyu, Florence Marzan, Patrick Byanyima, Gabrielle C Ambayec, Sylvia Kaswabuli, Emmanuel Musisi, Abdulwahab Sessolo, Elinor Velasquez, Rejani Lalitha, Katerina L Byanova, Francesca T Aweeka, Amelia N Deitchman, Jue Lin, John Lucian Davis, Kristina Crothers, William Worodria, Peter W Hunt, Laurence Huang","doi":"10.1097/QAI.0000000000003713","DOIUrl":"10.1097/QAI.0000000000003713","url":null,"abstract":"<p><strong>Background: </strong>Although there are sex and HIV differences in tuberculosis (TB) prevalence, the underlying mechanisms are incompletely understood. Few studies have evaluated whether sex and HIV modify the inflammatory response to TB.</p><p><strong>Methods: </strong>Adults with pulmonary TB with and without HIV in Kampala, Uganda had 12 immune activation biomarkers measured at TB diagnosis and at completion of therapy. Associations between biomarkers and sex were assessed using multivariable regression models at baseline and follow-up after adjusting for age, HIV status, and AFB smear grade. Given evidence of sex-HIV interaction in several biomarkers, models were stratified by HIV status.</p><p><strong>Results: </strong>Overall, 151 participants were included and 74 (49%) were female. Forty-nine (32%) participants had HIV; 21 (43%) of those with HIV were female. At baseline, biomarkers were overall higher in men, whereas at follow-up, suPAR ( P < 0.001) and sCD163 were higher in women ( P = 0.02) and IL-6 ( P = 0.01) and IFABP ( P = 0.02) were higher in men. After stratifying by HIV status, at baseline, most of the biomarkers were higher in men without HIV and there were no sex differences in those with HIV. At follow-up, women without HIV had higher levels of suPAR ( P = 0.01) and sCD163 ( P = 0.051). Women with HIV had higher levels of suPAR, C-reactive protein, and IP-10 ( P < 0.05 for all); no other sex differences were observed.</p><p><strong>Conclusions: </strong>Among adults with pulmonary TB in Uganda, men had greater immune activation than women only in the absence of HIV. After treatment, women tended to have more immune activation than men in the setting of HIV.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":"137-142"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recommendations for Interpreting Intraerythrocytic Tenofovir Diphosphate and Emtricitabine Triphosphate for HIV-1 Preexposure Prophylaxis Adherence Assessment.","authors":"Peter L Anderson, Corwin Coppinger, Mackenzie L Cottrell, Mark A Marzinke","doi":"10.1097/QAI.0000000000003715","DOIUrl":"10.1097/QAI.0000000000003715","url":null,"abstract":"<p><strong>Background: </strong>Intraerythrocytic tenofovir diphosphate (TFV-DP) and emtricitabine triphosphate (FTC-TP) in dried blood spots (DBS) have emerged as a gold-standard approach to assess adherence for oral preexposure prophylaxis (PrEP), but several considerations are important for proper interpretation.</p><p><strong>Methods: </strong>Key articles were reviewed related to use of intraerythrocytic TFV-DP and FTC-TP for adherence assessment including studies of pharmacokinetics, analytical methodologies, and application to a variety of PrEP settings. Important considerations were identified that influence TFV-DP and FTC-TP adherence interpretations by ≥15% and guidance was provided to assist when these considerations arise.</p><p><strong>Results: </strong>Factors identified included pregnancy status, specific drug interactions, hematocrit outside of 35%-50%, laboratory methodology, use of tenofovir alafenamide vs tenofovir disoproxil, whether DBS was collected before TFV-DP reaching steady state, and daily versus event-driven PrEP. Recommendations were provided in the form of adherence interpretation tables or mathematical adjustments to account for these considerations.</p><p><strong>Conclusions: </strong>Proper interpretation of TFV-DP and FTC-TP in DBS requires accounting for the factors identified above to maximize the value of these measurements.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":"162-169"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Online and In-Person Sex-Seeking Venues among Men who have Sex with Men in Berlin, Germany.","authors":"Kartavya J Vyas, Sarah Moreland, Stefan Esser, Heiko Jessen, Erica Broach, Merlin L Robb, Hendrik Streeck, Trevor A Crowell","doi":"10.1097/QAI.0000000000003766","DOIUrl":"10.1097/QAI.0000000000003766","url":null,"abstract":"<p><strong>Background: </strong>Understanding sex-seeking venues used by men who have sex with men (MSM) may facilitate better study recruitment. We examined online and in-person sex-seeking venues among Berlin MSM.</p><p><strong>Methods: </strong>We enrolled participants with and without HIV receiving care in Berlin, Germany between 2018 and 2023. Participants completed a socio-behavioral questionnaire every six months for up to 24 months. Kruskal-Wallis tests and Joinpoint regression models were fitted to examine trends in use of sex-seeking venues. Robust Poisson regression models with generalized estimating equations were fitted to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for associations between characteristics and online sex-seeking.</p><p><strong>Results: </strong>Of 285 visits among 126 MSM, sex-seeking via online venues was reported at 225 (78.9%) visits and via in-person venues at 185 (64.9%) visits. Grindr (66.0%) and Gayromeo (58.9%) were the most common online venues; clubs (42.9%) and parties (33.7%) were the most common in-person venues. Online sex-seeking was associated with sex under the influence of drugs (aPR [95% CI]; 1.26 [1.13, 1.41]), increasing numbers of sex partners (6-24: 1.59 [1.36, 1.86]; ≥25: 1.63 [1.38, 1.93]; compared to 1-5 partners), inconsistent condom use during receptive anal sex (2.15 [1.26, 3.65]), and being in a non-committed (4.94 [2.37, 10.29]) or non-monogamous (4.62 [2.29, 9.33]) relationship.</p><p><strong>Conclusions: </strong>Our findings suggest that venues that had been popular a few years ago may not be effective channels for study recruitment. Commonly used sex-seeking apps may be useful venues for studies to recruit participants to test HIV prevention, diagnosis, and treatment interventions.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low Cholesterol associated with TB in people living with HIV in an Asia-Pacific cohort.","authors":"Rebecca T Henry, Vohith Khol, Cuong DO Duy, Ivan Marbaniang, I Ketut Agus Somia, Nagalingeswaran Kumarasamy, Evy Yunihastuti, Iskandar Azwa, Rossana Ditangco, Sasisopin Kiertiburanakul, Man Po Lee, Anchalee Avihingsanon, Hsin Pai Chen, Romanee Chaiwarith, Suwimon Khusuwan, Thach Ngoc Pham, Sanjay Pujari, Chiaw Yee Choy, Jun Yong Choi, Yasmin Gani, Haruka Uemura, Jeremy Ross, Awachana Jiamsakul","doi":"10.1097/QAI.0000000000003761","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003761","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) remains the leading cause of illness and death among people living with HIV (PLHIV), particularly in high-burden areas. This study examined associations between TB and routine clinical markers: serum cholesterol, platelet count, and CD4 cell count.</p><p><strong>Setting: </strong>The analysis included data from the TREAT Asia HIV Observational Database (TAHOD), a multicenter cohort of adult PLHIV receiving care across the Asia-Pacific region.</p><p><strong>Methods: </strong>We conducted a cross-sectional matched case-control study of prospective and retrospective TB cases, comparing clinical and laboratory data within ±3 months of TB diagnosis. Conditional logistic regression assessed associations between TB and covariates.</p><p><strong>Results: </strong>The analysis included 4,244 PLHIV from 20 sites: 1,427 TB cases and 2,817 matched controls. TB cases were predominantly male (75.3%) and 45.7% aged 31-40. Multivariable analysis showed greater odds of TB diagnosis among males, those with low BMI, prior AIDS diagnosis, high HIV viral load, low CD4+ counts, or low total cholesterol. CD4+ counts <200 cells/μL had higher TB odds (adjusted OR [aOR] 12.90, 95% CI 8.84-18.82) compared to CD4+ >500 cells/μL. Cholesterol <3.9 mmol/L had higher TB odds (aOR 3.11, 95% CI 1.94-4.98) compared to cholesterol >5.5 mmol/L.</p><p><strong>Conclusion: </strong>In this Asia-Pacific cohort of adults living with HIV, low CD4+ cell count and low total serum cholesterol were associated with increased TB odds. Cholesterol may represent a low-cost adjunct marker to support TB risk stratification in PLHIV in endemic settings, but requires validation and evaluation of feasibility and cost-effectiveness.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV drug resistance among key populations in Nigeria: Insights from the 2020 integrated biological and behavioural surveillance survey.","authors":"Stephanie Melnychuk, Kalada Green, Chukwuebuka Ejeckam, Adediran Adesina, Gambo Aliyu, Gregory Ashefor, Rose Aguolu, Alexandria Reimer, Chantal Munyuza, Rayeil Chua, Xuefen Yang, Leigh M Mcclarty, Shajy Isac, Faran Emmanuel, James F Blanchard, Paul Sandstrom, Hezhao Ji, Marissa L Becker, Souradet Y Shaw, François Cholette","doi":"10.1097/QAI.0000000000003763","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003763","url":null,"abstract":"<p><strong>Objectives: </strong>HIV drug resistance mutations (DRMs) undermine the effectiveness of antiretroviral therapy (ART) and can lead to treatment failure. This study aimed to characterize HIV drug resistance among key populations in Nigeria.</p><p><strong>Design: </strong>A cross-sectional integrated biological and behavioural surveillance survey was conducted across six Nigerian geopolitical zones among female sex workers, men who have sex with men, people who inject drugs (PWID), and transgender individuals (August to December 2020).</p><p><strong>Methods: </strong>Dried blood spot specimens were collected from 2,309 participants, of whom 719 (31.1%) were HIV viremic (>1,000 copies/mL). Partial HIV pol genes were sequenced using an in-house genotyping assay. DRMs were identified from MiSeq reads using HyDRA Web and interpreted with Stanford HIVdb. Pearson chi-square tests assessed associations between sociodemographic factors and DRMs.</p><p><strong>Results: </strong>Among 414 HIV genotyped specimens, 16.7% contained at least one DRM. Common DRMs included K103N, M41L, and M184V, with 9.2% showing high-level resistance to efavirenz and nevirapine. DRM prevalence was highest among PWID (21.6%) and residents of the North Central zone (25.8%). Age was significantly associated with DRMs (p<0.001). Notably, 58.7% of participants were unaware of their HIV-positive status and had never received ART.</p><p><strong>Conclusion: </strong>The presence of DRMs among ART-naïve participants suggests transmitted drug resistance. The association between older age and DRMs may reflect sub-optimal adherence, prior regimen exposure, or longer treatment. High-level resistance to efavirenz supports transitioning to dolutegravir-based first-line regimens and highlights the importance of supporting key populations in accessing and adhering to ART to prevent the spread of drug-resistant HIV.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Health Disparities Associated with the HIV PrEP Initiation Cascade, Baltimore City Health Department Sexual Health Clinics, 2016-2023.","authors":"Norberth Stracker, Sarah Rives, Christina M Schumacher, Matthew M Hamill, Adena Greenbaum, Amanda M Rosecrans","doi":"10.1097/QAI.0000000000003764","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003764","url":null,"abstract":"<p><strong>Background: </strong>Increasing PrEP uptake while ensuring health equity is critical to reach Ending the HIV Epidemic goals. At Baltimore City Health Department (BCHD) Sexual Health Clinics (SHCs), we investigated disparities in PrEP discussions and prescriptions among demographic groups and risk categories over three time periods: 2016-2019, program establishment and scale-up; 2020-2021, COVID-19-impacted; 2022-2023, expansion of rapid PrEP and targeted provider feedback concerning missed opportunities for PrEP discussions.</p><p><strong>Methods: </strong>We utilized routinely collected patient demographic, sexual history, substance use, clinical, and treatment data from electronic health records at BCHD SHCs. The \"priority for PrEP initiation\" group was based on clinical and epidemiologic indications for PrEP. Relative differences in 1) patient-clinician discussions about PrEP and 2) PrEP prescriptions, across the three time periods, were analyzed using multivariable regression.</p><p><strong>Results: </strong>We observed 8672 priority patients over eight years. PrEP discussions increased from 42% to 70%. Regression identified significantly lower discussions among cis women, straight cis men, and MSM age ≥30 in all time periods, but magnitudes of disparities decreased over time. Prescriptions among all priority patients increased from 14% to 34% over time. Compared with Black MSM age <30, we observed significantly more prescriptions among non-Black/non-Latino MSM (+29%) and Latino MSM (+60%) in 2016-19. By 2022-23 the disparities lost statistical significance for non-Black/non-Latino MSM and decreased for Latino MSM.</p><p><strong>Conclusions: </strong>Expansion of access to PrEP and usage of 'priority patient' criteria for PrEP initiation, along with direct feedback to clinicians, was associated with decreased disparities in 1) PrEP discussions overall and 2) prescriptions among MSM.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of causes of death in People with HIV between 2000 and 2023: a single center retrospective Study.","authors":"Giorgia Carrozzo, Giacomo Pozza, Andrea Poloni, Stefania Caronni, Maria Vittoria Cossu, Davide Moschese, Maddalena Matone, Cristina Gervasoni, Anna Lisa Ridolfo, Letizia Oreni, Agostino Riva, Spinello Antinori, Andrea Gori, Andrea Giacomelli","doi":"10.1097/QAI.0000000000003762","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003762","url":null,"abstract":"","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of state-level policy climate on HIV pre-exposure prophylaxis use and the role of internalized stigma.","authors":"Nicole K Kelly, Shabbar I Ranapurwala, Brian W Pence, Lisa B Hightow-Weidman, Jaime Slaughter-Acey, Audrey L French, Sybil Hosek, Audrey E Pettifor","doi":"10.1097/QAI.0000000000003760","DOIUrl":"https://doi.org/10.1097/QAI.0000000000003760","url":null,"abstract":"<p><strong>Background: </strong>Anti-lesbian, gay, bisexual, transgender, and/or queer (LGBTQ+) legislation has dramatically increased in the United States. These laws limit the rights of sexual and gender minoritized (SGM) youth, but their health effects remain understudied. We estimated how a hypothetical intervention setting states to have more equitable LGBTQ+-related policies would affect individual-level pre-exposure prophylaxis (PrEP) use among SGM youth and young adults, and whether internalized stigma mediates this effect.</p><p><strong>Methods: </strong>Keeping it LITE-1 was a national cohort (2017-2022) of 3330 SGM youth and young adults (ages 13-34) at an increased HIV risk. Semiannual surveys collected geolocation, internalized HIV and LGBTQ+ stigma (high/low), and self-reported PrEP use (yes/no). Geolocation was linked with state-level LGBTQ+ policy data from the Movement Advancement Project (MAP). LGBTQ+ laws were characterized as less or more discriminatory based on MAP score distributions. We estimated the average treatment effect of state-level LGBTQ+ policy environment on PrEP use, and the controlled direct effect if all participants had lower internalized stigma.</p><p><strong>Results: </strong>If all participants lived in states with less discriminatory anti-LGBTQ+ policies, we would expect PrEP use to increase by 14%, compared to if all lived in states with more discriminatory policies (0.14; 95% CI: 0.09-0.18). This increase was largest among Black participants (0.23; 0.05-0.38). Reducing internalized stigma did not change this effect (13% vs. 14%).</p><p><strong>Conclusion: </strong>Creating more equitable state-level LGBTQ+ policy climates could considerably increase national PrEP use, and thereby decrease HIV incidence. Repealing harmful anti-LGBTQ+ laws and implementing protective policies could substantially reduce population-level HIV transmission.</p>","PeriodicalId":520658,"journal":{"name":"Journal of acquired immune deficiency syndromes (1999)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}