AIDS and Behavior最新文献

{"title":"Association Between Electronic Patient Portal Enrollment and HIV Care Outcomes Among People Living with HIV at an Urban Academic Medical Center.","authors":"Jessica P Ridgway, Daniela Zimmer, Raj Shetty, Neda Laiteerapong","doi":"10.1007/s10461-025-04869-7","DOIUrl":"10.1007/s10461-025-04869-7","url":null,"abstract":"<p><p>Electronic patient portals are associated with improved health outcomes in primary care settings. We assessed the relationship between patient portal enrollment and retention in care and HIV viral suppression in an urban HIV care clinic. In multivariable models, people with HIV with an active portal account had higher odds of HIV viral suppression (Odds Ratio [OR]: 2.02, 95% CI [1.3-3.7]) and higher odds of retention in care (OR: 2.2 95% CI[1.4-3.4]) than those without an active portal account. Our findings suggest that portal enrollment is associated with improved HIV care outcomes among people with HIV.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938837","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":"FANMI (\"My Family\"): A Randomized Trial of Community Cohort Care for Adolescent Girls and Young Women Living with HIV in Haiti.","authors":"Vanessa Rouzier, Lindsey K Reif, Rose Cardelle Riche, Marie J Bajo, Genevieve Hilaire, Jessy G Devieux, Heejung Bang, Elaine J Abrams, Marie Marcelle Deschamps, Bruce R Schackman, Jean W Pape, Daniel W Fitzgerald, Margaret L McNairy","doi":"10.1007/s10461-025-04826-4","DOIUrl":"https://doi.org/10.1007/s10461-025-04826-4","url":null,"abstract":"<p><p>Adolescent girls and young women (AGYW) are the epicenter of the global HIV epidemic. The FANMI trial is an unblinded randomized-controlled trial which evaluated the effectiveness of a community-based model of cohort HIV care vs. standard clinic-based care among AGYW living with HIV in Haiti. Participants ages 16-24 years were randomized 1:1 to FANMI vs. standard care. In the FANMI intervention, cohorts of 5-10 participants attended monthly sessions in a community center for integrated HIV clinical care, group counseling, and social activities led by the same provider. The primary outcome was 12-month retention, defined as any visit 9-15 months from study enrollment. Secondary outcomes included viral suppression (< 1000 copies/ml), risk behaviors, and acceptability. 120 AGYW with HIV enrolled (60 per arm) between May 2018 and January 2021. 73% (44/60) in FANMI vs. 68% (41/60) in standard care achieved 12-month retention (RR = 1.07; 95% CI 0.85-1.35). Excluding participants who never returned after enrollment, 83% (38/46) in FANMI vs. 71% (41/58) in standard care (RR = 1.17; 95% CI 0.95-1.45) achieved 12-month retention. 47% (28/60) in FANMI and 43% (26/60) in standard care achieved 12-month viral suppression (p = 0.45). FANMI participants reported high acceptability, decreased stigma, and increased social support. There was no significant difference in 12-month retention between arms. The FANMI intervention was more effective for participants who self-presented to the clinic for HIV testing compared to those tested in a community-based setting. FANMI was highly acceptable to participants and offers promise as a complementary program for AGYW with HIV in low-income settings.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938955","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":"Associations Between Forced Sexual Initiation, Post-exposure Prophylaxis Cascades and Subsequent Violence Experiences Among Displaced Young Women in Ugandan Informal Urban Settlements.","authors":"Moses Okumu, Carmen H Logie, Thabani Nyoni, Flora Cohen, Bernadette K Ombayo, Joseph C Wabwire, Catherine N Nafula, Robert Hakiza, Peter Kyambadde","doi":"10.1007/s10461-025-04837-1","DOIUrl":"https://doi.org/10.1007/s10461-025-04837-1","url":null,"abstract":"<p><p>Along their displacement trajectory, displaced adolescent girls and young women (AGYW) face elevated HIV risk early in their sexual life course, often due to forced sexual initiation (FSI), marking the beginning of cycles of violence. However, knowledge gaps exist regarding FSI prevalence rates and the association between FSI, violence experiences, and post-exposure prophylaxis (PEP) cascades (awareness, access and uptake) among displaced AGYW in Uganda. Using peer-driven sampling, we conducted a community-based cross-sectional survey of 201 sexually active displaced AGYW living in informal settlements in Kampala. We conducted bivariate analyses to examine associations between FSI and PEP cascades and multivariable logistic regressions to examine associations between FSI and (a) non-partner physical/sexual violence and (b) recent sexual/physical intimate partner violence (IPV). Among participants (n = 72), 35.8% reported forced sexual initiation (FSI); of these, 66.7% experienced lifetime non-partner sexual violence, 81.9% non-partner physical violence, 35.2% recent intimate partner physical violence, and 70.4% recent intimate partner sexual violence. Very few participants who experienced FSI reported awareness of and knowledge of access to PEP in their community, and none had accessed PEP in the past 3 months. Multivariable logistic regression findings showed that compared to AGYW who did not experience FSI, those who experienced FSI had increased odds of reporting non-partner lifetime physical violence, non-partner lifetime sexual violence, intimate partner physical violence, and intimate partner sexual violence. FSI appears to be prevalent among displaced AGYW and is linked to multiple forms of violence, and limited PEP awareness, access and use. Tailored, trauma-informed, multisectoral interventions are needed to address FSI and violence and improve PEP access.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938802","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":"Assessing a Syndemic of Discrimination, Material Insecurity, Depression, Substance Use, and Violence Among Sexual and Gender Minorities in Nigeria Using Mixed Methods.","authors":"Rodman Turpin, Megan E Mansfield, Typhanye Dyer, Andrew Mitchell, Chama John, Ruxton Adebiyi, Uchenna Ononaku, Christiana Katu, Jumoke Aigoro, Abayomi Aka-Bashorun, Sylvia Adebajo, Manhattan Charurat, Rachel Sullivan Robinson","doi":"10.1007/s10461-025-04861-1","DOIUrl":"https://doi.org/10.1007/s10461-025-04861-1","url":null,"abstract":"<p><p>Sexual and gender minority people (SGM) in Nigeria experience disproportionate HIV burden, with an HIV prevalence four to ten times higher than the national average. Better understanding the factors that create HIV vulnerability in this population is important for designing effective interventions, particularly in a context largely hostile to SGM. We assessed a conceptual model describing a syndemic of discrimination, material insecurity, depression, substance use, intimate partner violence, and police and other violence among SGM in Abuja, Nigeria. As part of a larger, longitudinal study examining noncommunicable disease outcomes within this population, we conducted a mixed methods analysis using both quantitative intake data (n=515) as well as data from three focus groups (n=36), collected from July 2023 through May 2024. We tested for intercorrelations among syndemic components, and associations between a cumulative syndemic index and HIV status using modified Poisson regression. We also conducted a convergent qualitative assessment of the conceptual model in three focus group discussions. Finally, we examined co-prevalence of syndemic components highlighted in our qualitative findings. There were consistent intercorrelations among syndemic components, supporting the presence of a syndemic. After adjustment for sociodemographic factors, every quartile-unit increase in the syndemic index was associated with an 18% increase in prevalence of HIV (aPR=1.18, 95% CI 1.07, 1.29). Additionally, our qualitative findings highlighted relationships between discrimination, material insecurity, and depression as especially relevant among this population. When using our quantitative data to examine the co-prevalence of pairs of syndemic components identified as particularly salient in our qualitative analyses, nearly every relationship was significantly stronger than expected. We found strong evidence of a syndemic of discrimination, material insecurity, depression, substance use, intimate partner violence, and police and other violence among SGM in Abuja, Nigeria as salient to the health outcomes of SGM in Nigeria. Overall, our findings highlight the presence of a multilevel syndemic that informs multilevel intervention targets. Interventions must target not simply the individual level, but also incorporate larger scale social and structural change efforts.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938875","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":"Comparing Implementation and Effectiveness Outcomes for Two Implementation Strategies of the Keep It Up! Digital HIV Prevention Program: A Type 3 Hybrid Effectiveness-Implementation Trial.","authors":"Brian Mustanski, Nanette Benbow, Kathryn Macapagal, Dennis Li, Krystal Madkins, Rana Saber, Benjamin Linas, J D Smith, C Hendricks Brown, Sarah Munroe, Susheel Reddy, Bruce R Schackman, Gregory Swann, Patrick Janulis, Alithia Zamantakis, Juan Pablo Zapata","doi":"10.1007/s10461-025-04838-0","DOIUrl":"10.1007/s10461-025-04838-0","url":null,"abstract":"<p><p>This study sought to compare implementation and effectiveness outcomes for two delivery strategies of a digital HIV prevention intervention: community-based organization (CBO) versus direct-to-consumer (DTC). A type III hybrid effectiveness-implementation trial compared two implementation strategies of Keep It Up! (KIU! ) for young men who have sex with men (YMSM) (n = 2124). Data were collected at baseline and 12-weeks in 2019-2023. DTC enrolled more participants, but CBO recruited more Black (11.7% vs. 21.7%) and Latino YMSM (27.3% vs. 32.9%). CBO enrollees were at higher HIV risk based on condomless anal sex (p < .05) and rectal Gonorrhea rates (p < .01). Although pre-exposure prophylaxis (PrEP) use with adherence was 1.94 times higher at follow-up vs. baseline (p < .0001) across arms, PrEP increase was 1.60 times higher in CBO vs. DTC (p < .0001). CBO delivery averted more HIV infections per 100 people-years than DTC (1.65 vs. 0.62), but the cost of averting an HIV infection was higher in CBO than DTC ($983,029 vs. $173,313). Although CBOs were able to reach participants at higher HIV risk, the DTC strategy was estimated to cost less per infection averted and below established thresholds for cost savings. Findings must be interpreted within the context of data collection during the COVID-19 epidemic. More information about KIU! can be found at https://kiu.northwestern.edu/ .Trial registration: NCT03896776 (date of registration: 04/01/2019).</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144870883","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":"Identifying Hidden Barriers to PrEP Adherence Among Young Men Who Have Sex with Men: Application of Natural Language Processing.","authors":"Se Hee Min, Jihye Kim Scroggins, Dustin T Duncan, Robert Garofalo, Patrick Francis Janulis, Lisa Kuhns, Fengdi Xiao, Rebecca Schnall","doi":"10.1007/s10461-025-04863-z","DOIUrl":"10.1007/s10461-025-04863-z","url":null,"abstract":"<p><p>In the United States, the incidence rate of new HIV diagnoses continues to increase among young men who have sex with men (YMSM). Despite the availability of effective preventive strategies such as pre-exposure prophylaxis (PrEP), the rate of PrEP adherence remains markedly low especially among YMSM. Previous studies have primarily relied on structured surveys with predefined responses to identify barriers to PrEP adherence which may not fully capture the complexities behind the barriers. This is a secondary data analysis of data from a prospective cohort study focusing on YMSM vulnerable to HIV. A total of 581 participants provided free-text responses regarding reasons for discontinuing PrEP, which served as the primary outcome for the analysis. Natural language processing was conducted to identify potential barriers to PreP adherence and to uncover any previously unidentified barriers in this population. A total of nine categories were identified, with the most prevalent being lack of sexual activity (n = 128), followed by issues related to monogamy/partnership/long-term relationship (n = 73), specific insurance or coverage issues (n = 52), medication-related concerns (n = 41), side effects/health concerns (n = 39), forgetfulness/inconvenience associated with the medication regimen (n = 33), limited healthcare access (n = 26), personal reasons (n = 9), and financial insecurity (n = 8). The NLP analysis demonstrated moderate performance via support vector machine, random forest, gradient boost, and random forest (F-score = 0.75). Our study provides critical insights into specific barriers faced by high-risk YMSM, emphasizing the need for development of targeted interventions aimed at these barriers to improve PrEP access and utilization.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144870884","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":"PrEP Use Likelihood Among People Who Use Opioid Drugs: Understanding Clinical Correlates Along the Opioid Use Disorder Treatment Cascade.","authors":"Matthew C Sullivan, Madison J Davis, Conall O'Cleirigh, Abigail W Batchelder","doi":"10.1007/s10461-025-04857-x","DOIUrl":"10.1007/s10461-025-04857-x","url":null,"abstract":"<p><p>People with opioid use disorder (PWOUD) are at high risk of HIV infection, yet uptake of PrEP remains low in PWOUD. To understand opportunities to increase PrEP engagement, this cross-sectional study sought to examine clinical correlates of perceived PrEP use likelihood in a sample of PWOUD along the OUD Treatment Cascade. We enrolled 120 PWOUD with past-6-month injection drug use (IDU) or condomless sex in a cross-sectional survey study. Participants were recruited from sites serving PWOUD in the Boston area, including substance use disorder (SUD) treatment programs and harm reduction service providers. PWOUD characterized their substance use and treatment history, perceived risk of acquiring HIV, and likelihood of using oral and long-acting injectable (LAI) PrEP. Ordinal logistic regression and Pearson correlations were used to examine correlates of likelihood of using oral and LAI-PrEP. Contrary to hypotheses, current MOUD engagement was not associated with perceived likelihood of using oral or LAI-PrEP. More recent IDU was associated with greater likelihood of using both oral PrEP (OR = 0.98, 95% CI: 0.97, 0.99) and LAI-PrEP (OR = 0.99, 95% CI: 0.98, 1.00). PWOUD who received past-year emergency department-based SUD treatment endorsed lower likelihood of using LAI-PrEP (OR = 0.40, 95% CI: 0.19, 0.84). Among PWOUD, a greater number of sex partners was a stronger correlate of perceived risk of acquiring HIV than IDU-related risk behaviors. Results suggest opportunities to engage PWOUD at greatest HIV risk in PrEP care; findings also suggest need for education interventions to inform judgments of HIV risk among PWOUD.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144870885","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":"Profiling the HIV Pre-exposure Prophylaxis (PrEP) Cascade in Japan: A Latent Class Analysis of a Nationwide Cross-Sectional Study.","authors":"Takeshi Miwa, Carol Strong, Stephane Wen-Wei Ku, Chia-Wen Li, Poyao Huang, Huei-Jiuan Wu, Masazumi Yamaguchi, Yuzuru Ikushima","doi":"10.1007/s10461-025-04854-0","DOIUrl":"https://doi.org/10.1007/s10461-025-04854-0","url":null,"abstract":"<p><p>To understand opportunities for improving pre-exposure prophylaxis (PrEP) uptake, this study constructed a PrEP cascade and examined subgroup profiles associated with transitions along the cascade among gay, bisexual, and other men who have sex with men (gbMSM) in Japan. An online cross-sectional survey was conducted from February to March 2021. The four-step PrEP cascade included awareness, willingness, initiation, and regimen use. Latent class analysis (LCA) identified participant subgroups, and logistic regression examined associations with the most significant drop-off in the cascade. Among 5,831 cisgender gbMSM not living with HIV (median age: 38 years), 52.6% were aware of PrEP, 76.4% of whom were willing to use it. However, only 20.5% of those willing had initiated PrEP-the largest decline in the cascade. Among those who initiated, 43.8% were on a daily regimen. LCA identified four subgroups: (i) Sexual Adventurers (32.1%)-high sexual activity and strong HIV community ties; (ii) Reserved Bystanders (26.7%)-low engagement with the HIV community and sexual health services; (iii) Positive Allies (24.6%)-strong HIV community ties and comfort discussing sexual health; and (iv) Young Explorers (16.7%)-younger, moderately sexually active, with limited HIV community ties. Compared to Reserved Bystanders, Sexual Adventurers (OR 5.27, 95% CI 3.91-7.10) and Positive Allies (OR 1.60, 95% CI 1.14-2.26) had significantly higher odds of PrEP initiation. Despite increasing acceptability, barriers to PrEP uptake persist. Targeted interventions are needed to address subgroup-specific challenges-particularly for younger gbMSM and those with limited access to HIV community networks and sexual health services.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854241","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":"From Crisis to Connection: HIV Care Telehealth as an Antidote to Loneliness During the COVID-19 Stay-at-Home Era.","authors":"Shanti Parikh, Zeles Vargas, Khadijah Kareem, Johnelle Lamarque, Trisha Bose, Julia D López","doi":"10.1007/s10461-025-04827-3","DOIUrl":"https://doi.org/10.1007/s10461-025-04827-3","url":null,"abstract":"<p><p>This study investigated the impact of COVID-19-related disruptions to healthcare systems on engagement with HIV care among people enrolled in treatment at a university hospital's infectious disease (ID) clinic. Clinical outcome data from January 2019 to December 2020 were analyzed, and in-depth, semi-structured interviews were conducted from March 2021 to October 2021 with 20 participants enrolled in HIV care at the clinic. Informal interviews were conducted with seven people who work directly with clients at the ID clinic and similar settings to inform the refinement of the interview guide and support the triangulation of findings. Bivariate analyses of clinical outcome data were completed for 2019 and 2020, while qualitative data were analyzed using deductive thematic analysis. Demographic characteristics were similar across the 2019 and 2020 clinical cohorts, with median ages of 44.6 (IQR: 32.2, 55.4) and 45.1 (IQR: 32.9, 56.1), respectively. Most of the population identified as Black and cisgender men in both years. There were unexpected improvements in clinical outcomes. Retention rates increased from 72.5% (n = 5355/7373) in 2019 to 73.6% (n = 4982/6769; p < 0.01) in 2020. Additionally, median duration between visits decreased significantly from 98 days (63, 126) in 2019 and 91 (56, 98) days in 2020 (p < 0.01). Qualitative interviews suggest that, during the 2020 stay-at-home period, the clinic's integrated HIV care model played a significant role in improving clinical outcomes. Participants who engaged actively in the integrated HIV care model were encouraged to advocate for their own health and pursue personal goals and life projects beyond clinical care. Their involvement in HIV care and positive relationships with care teams led to two major outcomes. First, strong ties to the clinic staff fostered participants' trust in health information and empowered them to actively seek out health knowledge, which together motivated their early adoption of COVID-19 precautions. Paradoxically, adhering to COVID-19 precautions exacerbated their feelings of isolation, anxiety, substance use, and other psychological and physical co-morbidities. Second, participants mitigated these feelings of isolation by maintaining regular HIV care appointments-efforts that were supported by the expanded availability of telehealth during this period. Finally, despite initial negative feelings about telehealth, participants viewed their HIV appointments as valuable opportunities for social connections.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854238","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":"PrEP and PEP for HIV Prevention Among Gay, Bisexual, and MSM in Brazil: Findings from the SMESH Study.","authors":"Ben Hur Graboski Pinheiro, Thayane Martins Dornelles, Gustavo Eidt, Emerson Silveira de Brito, Rafael Steffens Martins, Giovana Petracco de Miranda, Natalia Luiza Kops, Suelen Porto Basgalupp, Flávia Moreno Alves de Souza, Gerson Fernando Mendes Pereira, Maiko Luis Tonini, Eliana Marcia Wendland","doi":"10.1007/s10461-025-04853-1","DOIUrl":"https://doi.org/10.1007/s10461-025-04853-1","url":null,"abstract":"<p><p>The HIV epidemic remains a global concern, particularly among vulnerable populations. Effective strategies, such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), are crucial to reducing HIV transmission. This study assessed HIV prophylaxis use among men who have sex with men (MSM) in Brazil, examined associated factors, and evaluated perceptions regarding access through the public healthcare system (SUS). A cross-sectional study (2019-2023) was conducted using respondent-driven sampling (RDS) in ten state capitals across five Brazilian regions. Eligible participants were men aged ≥ 18 years, identifying as MSM, who reported oral or anal sex with another man in the past 12 months. Data were collected via structured questionnaires on socio-behavioral characteristics. Descriptive analyses used RDS-II estimators, and associations with prophylaxis use were examined using survey-weighted Poisson regression. Among 1,139 participants, 21.4% reported PrEP use and 20.5% reported PEP use. PrEP uptake was significantly lower among individuals identifying as pardo (PR = 0.58 [95% CI 0.36-0.92]), with no significant associations found for education or social class. Both PrEP and PEP use were positively associated with having more than five sexual partners in the past six months and with having a partner living with HIV. Notably, 86.3% of participants (95% CI 81.1-91.6) expressed willingness to access PrEP through SUS. Despite high willingness, PrEP uptake remains suboptimal, particularly among pardo MSM. These findings underscore the urgency of targeted public policies to expand equitable access to HIV prevention services in Brazil.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854240","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}