AIDS and Behavior最新文献

{"title":"Correlates of Severe Psychological Distress Among Adults Living with HIV in Western Kenya.","authors":"Juddy Wachira, B Mosong, C Kafu, M Wilson-Barthes, D N T Tran, R Vedanthan, D S Pastakia, Y Lee, J Hogan, O Galárraga, B L Genberg","doi":"10.1007/s10461-026-05245-9","DOIUrl":"https://doi.org/10.1007/s10461-026-05245-9","url":null,"abstract":"<p><p>Psychological distress among persons living with HIV (PLWH) can negatively impact behavioral and clinical outcomes. There is need for additional data surrounding mental health status in resource-constrained settings to inform intervention. We assessed social and economic factors associated with symptoms of depression and anxiety among PLWH in western Kenya. Baseline data from the Harambee cluster randomized trial were collected from May 2021 through March 2022 among 1040 PLWH (≥ 18 years of age) receiving care through the Academic Model Providing Access to Healthcare program. Self-reported physiological distress (defined as non-specific symptoms of depression, anxiety and stress) was measured via the four-item Patient Health Questionnaire for Anxiety and Depression (PHQ-4). Multivariable logistic regression analysis was used to identify factors associated with psychological distress. At study baseline, 24% of participants reported severe psychological distress (PHQ-4 summary score ≥ 6). Compared to participants earning <$7 USD per month, those with a monthly income of ≥$35 USD had reduced odds of reporting severe psychological distress (adjusted Odds Ratio (aOR): 0.50; 95% Confidence Interval (CI): 0.27-0.93). Participants in the highest (versus lowest) wealth quintile (aOR: 0.36; 95% CI: 0.18-0.70), and those reporting moderate or high (versus low) levels of social support (aOR: 0.46; 95% CI: 0.46-0.98) were less likely to report severe psychological distress. Among PLWH in rural Kenya, higher monthly income, greater household wealth, and higher levels of social support were negatively associated with severe psychological distress. Multilevel interventions that provide both economic and social support may be essential for improving their mental health.Trial Registry ClinicalTrials.gov Identifier: NCT04417127.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Decade of Improvement and Signs of Decline in PrEP Awareness and Use in Young Trans Women.","authors":"Colbey Ricklefs, Bow Suprasert, Willi McFarland, Erin C Wilson","doi":"10.1007/s10461-026-05215-1","DOIUrl":"10.1007/s10461-026-05215-1","url":null,"abstract":"<p><p>The risk of HIV is significantly higher in transgender women compared to the general population, with young trans women having higher incidence compared to older trans women. Effective efforts to ensure PrEP uptake and persistence among young trans women is key to addressing the HIV epidemic in the U.S. We analyzed serial cross-sectional data from the Trans women Empowered to Advance Community Health (TEACH) studies conducted in San Francisco in 2013, 2016-2017, 2019-2020, and 2023-2024. Our study included 83 young adult (18-26 years old) trans women living without HIV. We used the Cochran-Armitage test for trends to assess changes in PrEP awareness, use, and key HIV risk and preventive behaviors. PrEP awareness among young trans women significantly increased from 6% in 2013, 94% in 2016-2017, 100.0% in 2019-2020, and 86% in 2023-2024 (z = 7.96, p < 0.001). PrEP use also significantly increased from 0% in 2013, 19% in 2016-2017, 46% in 2019-2020, and 36% in 2023-2024 (z = 9.90, p < 0.001). Meanwhile, condomless sex in the last 12 months has risen from 33% in 2013 to 86% in 2023-2024 (z = 4.15, p < 0.001). PrEP awareness and use have significantly increased among young trans women in San Francisco since FDA approval in 2012. However, our study points to a potential leveling off or decrease in PrEP awareness and use in recent years. Furthermore, PrEP use still lags need. Young trans women must be prioritized in PrEP awareness and demand creation efforts in addition to efforts to support adherence and persistence.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contextual Drivers of HIV Vulnerability and Retention in Care in the Central African Republic: An Ecological Analysis.","authors":"Gaspard Tekpa, Jules Inikoutiyo, Christian Yonli, Celia Noguera, Pierre Prince Lujwiro, Laure Gigout, Aboubacar Hachimou, Sidney Romaric, Raphaël Mabaïlao, Marie Charlotte Banthas, Larissa Bertille Mbia, Paulette Rose Mbay, Kevin Romuald, Alain Sana, Florida Roberte, Laura Moretó-Planas, Eric Goemaere, Calorine Mekiedje, Stella Ouanekpone, Maria Amparo Núñez-Andrés, Sarah Hoibak, Xavier Vallès","doi":"10.1007/s10461-026-05211-5","DOIUrl":"https://doi.org/10.1007/s10461-026-05211-5","url":null,"abstract":"<p><p>HIV transmission is shaped by specific contextual factors that are best understood through ecological and geospatial analysis. This study aimed to investigate three key drivers of HIV infection and vulnerability in the Central African Republic (CAR), a country affected by a long-standing socio-political crisis. To do so, we used sentinel surveillance data from antenatal HIV screening between 2019 and 2021 to estimate the spatial distribution of HIV and conducted an ecological analysis to examine its association with (1) forced population displacement and the presence of internally displaced persons (IDPs), (2) the location of small-scale artisanal mining sites, and (3) retention in care among people living with HIV receiving antiretroviral therapy (ART). As a result, we estimated national HIV prevalence was 2.0%, with clearly defined areas with high prevalence (rates exceeding 5%). Significant regional differences were observed in loss to follow-up (LTFU) rates and care retention dynamics. A notable geographic overlap was found between regions with higher prevalence of HIV, areas of forced displacement, and zones with informal mining activities. These findings, in line with previous studies, suggest a strong interaction between displacement, high-risk behaviours associated with mining and mobility, poor retention in care, and increased HIV vulnerability-particularly among young women. This study underpins the idea that vulnerability to HIV or failure to access to ART is mostly due to surrounding contextual factors beyond the individual-level control. They underscore the need for context-specific interventions such as differentiated service delivery models, mobile clinics, and targeted programs focused on identified areas with higher HIV prevalence and vulnerable groups, including displaced populations, miners, and women. In conclusion, our results highlight the complex challenges of HIV prevention and care in fragile and conflict-affected settings.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and Preliminary Effectiveness of a Data-to-Care Intervention for HIV-Positive People Who Inject Drugs in Ukraine: A Pilot Cluster-Randomized Trial.","authors":"Kostyantyn Dumchev, Brian Weir, Khushee Prasad, Shannon Fuller, Farren Rodrigues, Julia Burlaka, Olena Makarenko, Tetiana Kiriazova, Jill Owczarzak","doi":"10.1007/s10461-026-05224-0","DOIUrl":"10.1007/s10461-026-05224-0","url":null,"abstract":"<p><p>Antiretroviral therapy (ART) interruptions are common among people who inject drugs (PWID) and contribute to viral rebound, disease progression, and onward transmission. Data-to-Care (D2C) strategies, which use routine health data to identify and re-engage people living with HIV who have fallen out of care, are widely used in high-income settings but rarely evaluated in low- and middle-income countries. We piloted a Ukrainian Data-to-Care (UD2C) intervention integrated into the national HIV Medical Information System among HIV-positive PWID recently out of care. Four specialized HIV clinics were randomized to UD2C or care as usual (CAU), with 40 participants enrolled per clinic (n = 160). UD2C combined an optimized data query to identify out-of-care patients with multidisciplinary, acuity-based case management. Recruitment, data extraction, and intervention delivery were feasible across all clinics. Because recruitment required clinic attendance, the pilot assessed UD2C's post-linkage care component rather than its re-engagement function. The primary analysis accounted for clinic-level clustering using cluster-robust standard errors. Median ART coverage during follow-up was higher in UD2C than CAU (97% vs. 89%; adjusted rate ratio 1.15, 95% CI 0.87-1.51); this difference was significant in the model-based sensitivity analysis but not in the primary clustered analysis. Viral suppression was achieved or maintained more often in UD2C than CAU (58.8% vs. 28.8%; adjusted odds ratio 4.6, 95% CI 1.76-12.1). The UD2C model was feasible to implement and evaluate using a cluster-randomized design and showed promising improvements in longitudinal viral suppression. A fully powered definitive trial is warranted to confirm effectiveness and inform national scale-up. The trial is registered at www.clinicaltrials.gov as NCT05821413.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148443870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State HIV Prevention Policy Environments and HIV Prevention Outcomes: Racial and Ethnic Differences in the United States.","authors":"Bita Fayaz Farkhad, Feng Yi Chew, Janet Lopez, Angela Zhang, Yubo Zhou, Dolores Albarracin","doi":"10.1007/s10461-026-05230-2","DOIUrl":"https://doi.org/10.1007/s10461-026-05230-2","url":null,"abstract":"<p><p>State governments have adopted policies to improve the uptake of Pre-Exposure Prophylaxis (PrEP), routine HIV testing, and future HIV vaccination when available. However, associations between policy environments and PrEP use, recent HIV testing, and HIV vaccine intentions may differ across racial and ethnic groups, signaling varying effectiveness across populations. We collected HIV prevention policies across the US as of January 2024 and constructed policy indices grouped into access-focused, attitude- or norm-focused, and punitive domains. Linking our policy indices to a national survey of men who have sex with men and transgender women, we examined associations of policy environments with current PrEP use and recent HIV testing, as well as HIV vaccine intentions if a vaccine becomes available. More supportive access-focused and attitude- or norm-focused policy environments were associated with higher PrEP use and recent HIV testing among White participants. In contrast, these associations were not significant for Latinx and Black participants. Exploratory analyses provided suggestive evidence that differences in these associations across groups were consistent with differences in access and norms. These results suggest that supportive policy environments are not necessarily associated with smaller racial and ethnic disparities in HIV prevention outcomes.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148443918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Substance Use and HIV Risk Among African Refugee and Migrant Sex Workers in Italy: A Mixed-Methods Study Informed by Syndemic Theory.","authors":"Samira Shirzaei Nichols, Gamji Rabiu Abu-Ba'are, Carolina Rigo, Marco Barracchia, Osman Wumpini Shamrock, Al-Mardhiyyah Adams, Saina Abolmaali, LaRon Nelson","doi":"10.1007/s10461-026-05238-8","DOIUrl":"10.1007/s10461-026-05238-8","url":null,"abstract":"<p><p>Substance use is a recognized driver of HIV vulnerability among sex workers, yet little is known about how behavioral patterns intersect with structural exclusion for African male and gender-diverse refugee and migrant sex workers in Italy. Informed by syndemic theory, we conducted a sequential mixed-methods study in partnership with a community-based organization in Northern Italy. The qualitative strand included 20 in-depth interviews and two focus group discussions exploring experiences of substance use, stigma, and healthcare engagement. The quantitative strand comprised a structured survey of 150 participants assessing changes in substance use before and after entering sex work and its associations with HIV-related outcomes. Participants reported significantly higher substance use after entering sex work than before entering sex work, with increases observed for both substance types. Logistic regression and chi-square analyses revealed distinct patterns by substance type: injection-related substance use was associated with a lower likelihood of HIV testing, reduced enjoyment of sex work, reduced healthcare engagement, alongside higher STI diagnosis and testing. Non-injection use was linked to greater HIV service awareness, higher odds of disclosure, and higher STI diagnosis and testing. Chi-square tests indicated that escalating tobacco, alcohol, and drug use were associated with increased HIV testing, higher reports of healthcare stigma, immigration-related barriers, and reduced voluntary healthcare access. Qualitative findings contextualized these patterns, highlighting how stigma, financial precarity, and institutional exclusion shaped substance use trajectories and HIV risk. Integrated analysis underscores the need for interventions addressing structural discrimination and immigration-related barriers alongside behavioral HIV prevention for refugee sex workers.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148443872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identity-Based Behavioral Economic Incentives Increased PrEP Adherence for Transgender and Nonbinary Adults in a Trans-Led PrEP Navigation Program.","authors":"Kimberly Ling Murtaugh, Alex R Dopp, Carrie L Nacht, Risa Flynn, Chloe Opalo, Erik D Storholm","doi":"10.1007/s10461-026-05206-2","DOIUrl":"10.1007/s10461-026-05206-2","url":null,"abstract":"<p><p>Tailored supports are needed to maximize PrEP engagement among transgender and nonbinary (TGNB) adults, a population disproportionately impacted by HIV with low PrEP use, due to structural and economic barriers, particularly among TGNB individuals of color. This study piloted the integration of identity-based behavioral economic incentives, which use the science of decision-making to encourage beneficial behaviors, within an ongoing community-led, multi-component PrEP navigation program called PrEP Well. Prizes were selected through TGNB community input, were TGNB-affirming and specific to community needs, and included items sourced from TGNB-owned businesses; participants earned prize-wheel spins for PrEP-related steps. Among 108 TGNB adults at a trans-led Los Angeles community center (2022-2023; 36 enrolled before and 72 after incentives began), we conducted a non-randomized pilot trial assessing the acceptability, feasibility, and preliminary effects of incorporating these incentives into PrEP Well. Pilot results showed that, compared to standard PrEP Well, the addition of identity-based behavioral economic incentives was seen as feasible and acceptable, and produced a moderate effect on PrEP adherence at 90 days post-enrollment (78.6% vs. 56.3%, X²_{(1, 108)} = 4.38, p < .05, φ = 0.20). Dose-response models indicated that each additional spin earned through the incentive program further increased the odds of PrEP adherence at 90 days by about 4.7-fold (95% confidence interval [2.34, 9.32], B = 1.54, p < .001). This improvement was achieved at a modest additional cost of approximately $51 per participant. Integrating behavioral economic incentives into community-based, identity-affirming service delivery models may be a promising, cost-effective approach for enhancing PrEP engagement and improving HIV prevention outcomes among TGNB adults.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation Journey with CAB LA for PrEP Among Men Who Have Sex with Men and Transgender Men: Insights from the PILLAR Trial Through 12 Months.","authors":"Nanlesta Pilgrim, Hadrian Holder, Julian A Torres, Roberto Ortiz, William Valenti, Dima Dandachi, Peter Shalit, Alvin Kingcade, Peter Ruane, Linda Mercado, Bo Li, Alison Gaudion, Deanna Merrill, Elizabeth Gibbons, Nicola Barnes, Larissa Stassek, Riya Moodley, Todd McKeon, Katherine L Nelson, Harmony P Garges, Kimberley Brown, Maggie Czarnogorski","doi":"10.1007/s10461-026-05216-0","DOIUrl":"https://doi.org/10.1007/s10461-026-05216-0","url":null,"abstract":"<p><p>Men who have sex with men (MSM) and transgender men (TGM) account for an estimated 67% and < 1% of new HIV diagnoses in the United States, respectively. Long-acting cabotegravir (CAB LA), administered every 2 months, is the first LA medication approved for HIV-1 prevention. We present MSM and TGM experiences from CAB LA initiation through Month (M) 12 in the Phase 4 PILLAR trial (NCT05374525). Participants completed feasibility, acceptability, stigma, and perception questionnaires and semi-structured interviews at baseline, M6, and M12. Questionnaires were analyzed descriptively, and interviews were analyzed using a framework analysis approach. Clinical outcomes included HIV acquisition and persistence. During June 2022-August 2024, 201 participants enrolled; 6% were TGM, 23% Black or African American, 39% Hispanic/Latino, and 78% had taken oral PrEP in the last 6 months. Key reasons for choosing/switching to CAB LA were convenience, reduced adherence burden, and less worry about HIV. Most participants (92%) \"always\"/ \"often\" returned to usual activities immediately following injection. Persistence was 85% at M6 and 73% at M12, with no HIV acquisitions. At baseline, 15-29% of participants reported experiencing stigma and anxiety with oral PrEP versus 0-2% with CAB LA at M6 and M12. Participants reported greater engagement with sexual health and stronger patient-provider relationships. Feasibility and acceptability were high at M12 (mean scores of 4.4/5 and 4.6/5, respectively). Overall, CAB LA was perceived as highly feasible and acceptable, with high persistence and no HIV acquisitions, underscoring its potential to improve prevention outcomes and patient experience among MSM and TGM.Trial registry ClinicalTrials.gov number: NCT05374525 (May 2022).</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148429707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV and Syphilis Seroprevalence and Correlates of HIV-Syphilis Co-infection Among Black and Latina Women of Transgender Experience and Transfeminine People in Los Angeles County, 2023–2024","authors":"Yingbo Ma,&nbsp;Gia Olaes,&nbsp;Angela Cristobal,&nbsp;Benny Deng,&nbsp;Siri Chirumamilla,&nbsp;Ekow Kwa Sey","doi":"10.1007/s10461-026-05242-y","DOIUrl":"10.1007/s10461-026-05242-y","url":null,"abstract":"<div><p>Women of transgender experience and transfeminine people (WTE/TFP) are disproportionately impacted by HIV, yet local data on syphilis seroprevalence and HIV-syphilis co-infection among Black and Latina WTE/TFP in Los Angeles County (LAC) remain limited. This study examined HIV and treponemal syphilis seroprevalence and identified correlates of HIV-syphilis co-infection among Black and Latina WTE/TFP in LAC. From August 2023 through June 2024, the National HIV Behavioral Surveillance (NHBS) in LAC recruited WTE/TFP using respondent-driven sampling. Among 352 non-Hispanic Black (<i>n</i> = 99) and Latina (<i>n</i> = 253) participants with valid HIV and treponemal syphilis test results, HIV seroprevalence was 42%, treponemal syphilis seroprevalence was 56%, and HIV-syphilis co-infection was 33%, indicating substantial overlap of the two epidemics. Structural vulnerability was widespread, including food insecurity (70%), incarceration history (46%), homelessness (39%), and unemployment (39%). Co-infection was unevenly distributed. In adjusted analysis, Black participants had a 70% higher prevalence of co-infection than Latina participants (aPR = 1.70, 95% CI 1.14–2.52), and methamphetamine use was associated with nearly twice the prevalence of co-infection (aPR = 1.89, 95% CI 1.22–2.94). Continued efforts to expand routine syphilis screening, timely staging and treatment, doxycycline post-exposure prophylaxis education and counseling, and integrated harm reduction services are vital to addressing this overlapping epidemic. These findings also support sustained investment in Black-centered, peer-led trans community organizations and trans-competent clinical care to better address the co-occurring HIV and syphilis burden among Black and Latina WTE/TFP in LAC.</p></div>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":"30 9","pages":"2751 - 2762"},"PeriodicalIF":2.5,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Motivations and Barriers to Sustained PrEP Use Among Men in Buffalo City Metro, South Africa: A Qualitative Study.","authors":"Philip John Smith, Joseph Daniels, Linda-Gail Bekker, Andrew Medina-Marino","doi":"10.1007/s10461-026-05239-7","DOIUrl":"https://doi.org/10.1007/s10461-026-05239-7","url":null,"abstract":"<p><p>Men in sub-Saharan Africa experience disproportionately poor HIV outcomes, yet their engagement with HIV prevention services remains limited. Although oral pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy, relatively little research has examined the factors that support men's sustained use of PrEP after initiation. We conducted a qualitative sub-study among men who initiated PrEP through a community-based HIV prevention program in Buffalo City Metro, South Africa. Men who returned for their three-month PrEP refill were invited to complete an in-depth interview. Thematic analysis was guided by the Network-Individual-Resource Model. Twelve of 22 men who initiated PrEP returned for their three-month follow-up visit and participated in interviews. Men described several interconnected factors supporting continued PrEP use. Awareness of sexual risk and confidence in PrEP's protective benefits motivated continued use, while encouragement from partners and trusted male peers reinforced adherence. Participants also described developing daily routines that helped integrate PrEP into their lives. Structural conditions further shaped engagement: men preferred convenient community-based PrEP services, while anxiety surrounding routine HIV testing was described as discouraging for men more broadly, although many participants reported that their own concerns diminished with repeated testing. Men's sustained PrEP use was shaped by networked mental and tangible resources, including risk awareness, social support, adherence routines, and accessible service delivery environments. Community-based PrEP delivery models that leverage men's social networks may help improve sustained PrEP engagement among men in high HIV burden settings.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}