AIDS and Behavior最新文献

{"title":"Exploring Adolescent Girls' and Young Women's Perceptions of HIV Prevention Pre-exposure Prophylaxis Use: A Qualitative Synthesis of Evidence from Sub-Saharan Africa.","authors":"Magreth Thadei Mwakilasa, Deodatus Sabas, Deodatus Kakoko, Brynne Gilmore, John Gilmore","doi":"10.1007/s10461-026-05266-4","DOIUrl":"https://doi.org/10.1007/s10461-026-05266-4","url":null,"abstract":"<p><p>Adolescent girls' and young women's (AGYW) perceptions of HIV prevention Pre-Exposure Prophylaxis (PrEP) shape interest in use, uptake and sexual decisions. Although PrEP and its choices are increasingly available in Sub-Saharan Africa (SSA), evidence on how AGYW perceive its use in their daily lives remains fragmented. This qualitative evidence synthesis reviewed existing studies on AGYW's perception of PrEP in SSA. Embase, MEDLINE, CINAHL, CABI, and ProQuest were searched for studies published between January 2012 and December 2024 that reported AGYW's views on PrEP use in SSA. Two reviewers independently screened titles, abstracts, and full texts, with disagreements resolved by a third reviewer. Data were synthesised using thematic synthesis and managed in NVivo. The methodological quality was appraised using the appropriate Critical Appraisal Skills Program checklist. Reporting adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ). A total of 3,104 studies were identified; 24 studies from seven countries in SSA met the inclusion criteria. Three themes were developed regarding AGYW's perceptions of PrEP use: the protective role of PrEP, confidence, and its effectiveness; empowerment, agency, and hope for future health and sexuality; and behaviour change concerns while on PrEP. This systematic review highlights the complex and paradoxical perceptions of PrEP among AGYW, emphasising the need for comprehensive sexual health education, risk reduction counselling, and promotion of dual prevention interventions. These interventions are crucial to balancing and maximising PrEP's benefits while mitigating potential risks.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676746","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":"Educational Disruption, School Dropout, and Sexual and Reproductive Health (SRH) Outcomes Among Adolescent Girls and Young Women in South Africa.","authors":"Gavin George, Sean Beckett, Nonjabulo Gwala, Kate Bergh, Catherine Mathews, Kim Jonas","doi":"10.1007/s10461-026-05232-0","DOIUrl":"https://doi.org/10.1007/s10461-026-05232-0","url":null,"abstract":"<p><p>Adolescent girls and young women (AGYW) in South Africa continue to experience high rates of HIV, early pregnancy, and gender-based violence (GBV). While schooling is widely recognised as protective, most studies conceptualise educational participation as a binary exposure, overlooking variation in absenteeism and school dropout. This study examined whether school dropout and varying levels of absenteeism were associated with HIV status, early pregnancy, contraceptive use, intimate partner violence (IPV), and non-partner sexual violence among AGYW in South Africa. Data were drawn from the HERStory 3 Impact Evaluation (2024), a multi-province quasi-experimental study conducted across 24 sub-districts in eight provinces. Household surveys and biomarker-confirmed HIV testing were completed among AGYW aged 15-24 years. Analyses included AGYW currently enrolled in school (n = 2,275) and AGYW not enrolled in school (n = 1,842). Mixed-effects regression models accounting for household and geographic clustering were used to estimate associations between educational disruption and sexual and reproductive health (SRH)/GBV outcomes. AGYW not enrolled in school had higher HIV prevalence (14.1% vs. 7.7%) and pregnancy history (48.2% vs. 20.6%) than those enrolled. Among out-of-school AGYW, dropout before Grade 12 completion was associated with higher HIV positivity, early pregnancy, IPV, and sexual violence. Among AGYW still enrolled, frequent absenteeism was associated with early pregnancy, IPV, and sexual violence. The findings are consistent with a continuum of educational disengagement in which absenteeism may represent an earlier manifestation of vulnerability that, for some AGYW, precedes school dropout. Monitoring school attendance may help identify AGYW at elevated risk before formal school exit.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668319","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":"Psychosocial Mechanisms Linking Intersecting Stigmas and Condomless Anal Sex Among Transgender Women in India","authors":"Venkatesan Chakrapani,&nbsp;Jasvir Kaur,&nbsp;Alexander C. Tsai,&nbsp;Ayden I. Scheim,&nbsp;Murali Shunmugam,&nbsp;Murugesan Sivasubramanian","doi":"10.1007/s10461-026-05271-7","DOIUrl":"10.1007/s10461-026-05271-7","url":null,"abstract":"<div><p>Transgender women in India experience a disproportionate HIV burden, but the pathways linking intersecting stigmas and condomless receptive anal sex (CAS) have not been elucidated. Using minority stress theory, and psychological mediation and intersectionality frameworks, we tested the mediating and synergistically interacting pathways linking these stigmas to HIV risk. Between November 2020 and March 2022, we conducted a prospective three-wave cohort study among 500 trans women in Mumbai and Chennai. We assessed stigmas (transgender identity, perceived HIV, sex work), five psychosocial variables (depression, anxiety, problematic alcohol use, internalized transprejudice, social support), and CAS with male nonregular partners. We used causal mediation analysis to examine indirect pathways between stigma and CAS. We also tested for synergistic effects. Baseline levels of all three stigmas were high. In Wave-2, we noted relatively high prevalence rates of anxiety (38%), internalized transprejudice (46%), low social support (46%), depression (15%), alcohol use (15%), and CAS (61%, Wave-2; 81%, Wave-3). In mediation analyses, we found that stigmas increased anxiety and depression while eroding protective social support, each of which subsequently increased CAS risk. Social support and anxiety showed the strongest and most consistent indirect effects across stigma types, whereas depression mediated associations primarily for transgender identity and HIV-related stigmas. We demonstrated strong synergistic interactions between specific stigma combinations and anxiety, depression, problematic alcohol use, and low social support. The findings underscore the need for multicomponent interventions that simultaneously address stigmas and their psychosocial consequences, including screening and treatment for depression and anxiety, while bolstering social support.</p></div>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":"30 9","pages":"2825 - 2842"},"PeriodicalIF":2.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668266","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":"Correction: Procedures to Verify Legitimacy and Uniqueness of Responses in an Online Study with U.S. Young Gay and Bisexual Men Who Use Stimulants.","authors":"Pablo K Valente, Giselle O'Connor, Caroline Useda, Celia Fisher, Katie B Biello, Matthew J Mimiaga, Brandon Brown","doi":"10.1007/s10461-026-05225-z","DOIUrl":"https://doi.org/10.1007/s10461-026-05225-z","url":null,"abstract":"","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668276","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 Systematic Review of Barriers and Facilitators to the Uptake and Adherence of Injectable PrEP Among Adolescent Girls and Young Women in Sub-Saharan Africa.","authors":"Noah Mancuso, Stacy Endres-Dighe, Definate Nhamo, Miranda Diaz, Alinda M Nyamaizi, Nomvuyo Thelma Mangxilana, Elizabeth T Montgomery, Sue Napierala, Sybil Hosek, Nyaradzo M Mgodi, Millicent Atujuna, Sarah T Roberts","doi":"10.1007/s10461-026-05201-7","DOIUrl":"10.1007/s10461-026-05201-7","url":null,"abstract":"<p><p>Adolescent girls and young women (AGYW) in sub-Saharan Africa bear a disproportionate burden of HIV. Long-acting injectable PrEP (LAI-PrEP) may address adherence challenges associated with daily oral PrEP, but social and structural barriers threaten real-world implementation. Drawing on parallels with injectable contraception and multipurpose prevention technologies (MPTs), this systematic review synthesizes evidence on barriers and facilitators to LAI-PrEP use among AGYW in sub-Saharan Africa. Following PRISMA guidelines, peer-reviewed studies published January 2015 to February 2025 were identified across four databases. Studies were included if they examined barriers or facilitators to uptake or adherence of injectable PrEP, contraception, or MPTs among AGYW in sub-Saharan Africa. Data were abstracted using a socioecological model adapted for PrEP implementation. Of 1,716 screened references, 53 met inclusion criteria, spanning 37 countries. Most studies focused on injectable contraception; only nine examined injectable PrEP, eight of which assessed hypothetical use. Cross-cutting barriers included fear of side effects, misinformation, stigma, and logistical and cognitive challenges related to return visits. Cross-cutting facilitators included familiarity with injectables, social support, and perceived privacy. Partner and provider power dynamics, restrictive sociocultural norms, provider gatekeeping, and health system limitations further shaped injectable use. Despite biomedical advantages, LAI-PrEP uptake among AGYW may face entrenched barriers similar to other PrEP modalities. Although AGYW's familiarity with injectable contraception may enhance LAI-PrEP acceptability, systemic and interpersonal challenges remain under-addressed. Effective LAI-PrEP implementation in the real-world will require integrating lessons from contraceptive programs, improving provider training, expanding delivery channels, and centering AGYW in decision-making to support equitable scale-up.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663389","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":"The Mental Health of Adults Living with HIV in Sub-Saharan Africa: Interventions along the HIV Care Continuum - A Systematic Review.","authors":"Ohemaa Poku, María José Larrea Almeida, Rachel Ling, Parisa Ayoubi, Nora West","doi":"10.1007/s10461-026-05259-3","DOIUrl":"https://doi.org/10.1007/s10461-026-05259-3","url":null,"abstract":"<p><p>Although the relationship between HIV and mental health is well-established, limited research has focused on the available interventions for adults living with HIV (ALWH), particularly those in sub-Saharan Africa (SSA) where the epidemic is most severe. In this paper, we systematically review the literature on mental health interventions for this population during the modern treatment era, aiming to situate them along the HIV care continuum and provide a concise examination of their efficacy. A comprehensive search across PubMed, CINAHL, EMBASE, and PsycINFO identified 13 studies that met the inclusion criteria, and risk of bias was assessed using the Quality Assessment of Controlled Intervention Studies tool. Depressive symptoms were the primary intervention target across all studies, followed by symptoms of anxiety (n = 7). Interventions employed psychosocial, pharmacological, and behavioral mechanisms, including counseling, problem-solving therapy, and antidepressants. Qualitative synthesis showed that interventions were primarily delivered during the \"Receiving HIV Care\" step of the HIV care continuum, with limited evidence at the HIV diagnosis, linkage to care, and viral suppression stages. While interventions were generally associated with improved mental health outcomes, statistically significant effects were not consistently observed. Evidence on HIV-related outcomes was also limited to eight studies and yielded mixed results. These findings underscore the need to expand mental health services and implementation research for ALWH. Addressing gaps across the HIV care continuum, including broader mental health outcomes and culturally adapted assessment tools, may strengthen integrated HIV and mental health programming in SSA and support efforts to end the HIV epidemic.The trial was preregistered at Prospero Registration Number: CRD42024577597.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629300","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":"Relationship Power, Partner Risk Characteristics, and Recent Intimate Partner Violence Among Adolescent Girls and Young Women in a High HIV Incidence Setting in Kenya: Baseline Findings from the Tu'Washindi na PrEP Trial.","authors":"Miriam Hartmann, Daniel Okello Adede, Erica N Browne, Joyce Boke, Jacqueline Ndirangu, Joseph Okore, Rosemary Achieng, Jacob Onyango, Elizabeth T Montgomery, Mark Ayallo, Sarah T Roberts, Alexandra M Minnis","doi":"10.1007/s10461-026-05258-4","DOIUrl":"10.1007/s10461-026-05258-4","url":null,"abstract":"<p><p>Adolescent girls and young women (AGYW) in sub-Saharan Africa face intersecting risks of HIV and intimate partner violence (IPV). Although pre-exposure prophylaxis (PrEP) expands HIV prevention options, its use is often constrained by imbalanced relationship power and male partner behaviors. We used baseline data from the Tu'Washindi na PrEP cluster randomized trial to describe PrEP use, relationship dynamics and identify attributes associated with recent IPV among Kenyan AGYW. From 2022 to 2025, we enrolled 1,557 AGYW, aged 15-24 years, in sexual relationships at elevated HIV risk. Interviewer-administered questionnaires captured socio-demographics, partner characteristics, relationship dynamics, and IPV. Mixed-effects Poisson regression models examined associations between relationship measures and IPV, adjusting for covariates and clustering at the trial level. Participants mean age was 21 years; 70% experienced food insecurity. PrEP use was low: 7% were current users and 80% had never used it. 17% reported recent IPV (past 3-months). In adjusted models, IPV risk was higher for married AGYW (aRR = 2.42, 95% CI: 1.82, 3.22), and risk increased with relationship length (aRR = 1.10, 95% CI: 1.03, 1.07, respectively). Significant partner-related risks included not knowing his HIV status and weekly alcohol use among partners. Among relationship dynamics, higher relationship power was protective. Healthy communication and PrEP self-efficacy were not significantly associated with IPV. Partner and relationship factors, such as imbalanced power shape IPV amid low PrEP use. Findings underscore the need for interventions that strengthen AGYW's autonomy and relationship power, alongside male engagement, to reduce IPV and improve HIV prevention outcomes.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629247","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":"Barriers and facilitators to adherence of infants living with HIV in sub-Saharan Africa in an era of wide access to ART: a mixed-methods study.","authors":"H L Peay, S Kruger, K Otwombe, H Boene, M G Lain, N Ngwenya, S Domínguez-Rodríguez, S L Barnabas, A Bingaman, M Kunene, C Giaquinto, G E Henderson, F Madiehe, A I Maiga, T Nhampossa, K Nkosi, P Rojo, P Rossi, N Torres, P Vaz, A Tagarro","doi":"10.1007/s10461-026-05252-w","DOIUrl":"https://doi.org/10.1007/s10461-026-05252-w","url":null,"abstract":"<p><p>Infants and very young children with perinatally acquired HIV are solely dependent on caregivers for achieving high levels of adherence to antiretroviral therapy (ART). EARTH was a prospective study of infants from sites in South Africa, Mozambique, and Mali with perinatally-acquired HIV who started ART at ≤ 90 days after diagnosis. We implemented a mixed-methods social/behavioral substudy within the EARTH clinical study. Using data reported from caregivers of children in the EARTH study, this study explored caregivers' appraisals and coping regarding the child's HIV, caregiver-reported child adherence, and barriers and facilitators to adherence. Sixty of 78 participating caregivers (77%) reported that the child missed no ART doses in the previous week. Caregivers described improved child adherence and higher caregiver self-efficacy over time, and most perceived their children as adherent. Adherence was facilitated by caregiver education, psychosocial and practical support in giving ART, using incentives or consequences to encourage ART, and observing benefits to the child's health or development. Barriers included adverse medication characteristics, child resistance to ART, impacts of stigma, child feeling ill or experiencing side effects, and caregivers having trouble complying with timing. We note evidence for caregiver conceptualization of \"good adherence\" that includes tolerance for delayed doses. Even with EARTH-study and local supports, adherence was below the global target of 95%. We suggest interventions to improve outcomes in this vulnerable dyad-mothers who experienced a mother-to-child transmission and very young children living with HIV. Clinicians should attend to potential differences in interpretation of \"good adherence\" between clinicians and caregivers.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618091","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":"Physician Education and Peer Comparisons to Reduce Cardiovascular Risk Among People Living with HIV: A Stepped-Wedge Cluster Randomized Trial.","authors":"Joseph A Ladapo, Allison J Ober, Hoanglong Nguyen, Brian S Mittman, Un Young Rebecca Chung, Chi-Hong Tseng, Soma Wali, Allison L Diamant","doi":"10.1007/s10461-026-05243-x","DOIUrl":"https://doi.org/10.1007/s10461-026-05243-x","url":null,"abstract":"<p><p>Cardiovascular disease is a major cause of death among people living with HIV (PLWH). We developed a multilevel implementation strategy to increase evidence-based statin use, which is under-prescribed in PLWH. Through a stepped-wedge cluster randomized trial in seven HIV clinics in Los Angeles, we implemented a physician champion-led education intervention and behavioral economics-informed peer comparisons. Each clinician's statin prescribing rate relative to top-performing physicians was reported back monthly, with language leveraging social norms and self-image. We also conducted post-intervention, semi-structured interviews with providers. We enrolled 37 participants, of which 29 were clinicians seeing PLWH as a primary HIV provider. We were unable to obtain complete electronic health records from two clinics. At baseline, the five clinics saw a total of 1304 PLWH during 4565 office visits, and the proportion of statin-eligible clinic visits during which a statin was prescribed was 53.65%. This increased to 58.1% after the education intervention and was 57.48% after the peer comparison intervention. The effects of the education intervention (- 1.2% points; 95% CI, - 3.68 to 1.10) and peer comparison intervention (0.052% points; 95% CI, - 3.89 to 3.77) were not significant. Providers thought feedback emails were acceptable and could be effective but most found the language and information in the emails to be lacking detail, and most found the peer comparison language to be off-putting. An implementation strategy that included a champion-led education intervention and a physician peer comparison intervention informed by principles of behavioral economics did not significantly increase evidence-based statin prescribing for PLWH.Trial registration: This trial is registered with the National Institutes of Health at ClinicalTrials.gov under identifier NCT03687060.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618158","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":"Development and Preliminary Evaluation of a Digital Intervention to Improve Disclosure to Family Caregivers, Stigma Coping, and Social Support Among Pregnant Adolescents Living with HIV.","authors":"Winnie K Luseno, Bonita Iritani, Adam Gilbertson, Frederick Odongo, Irene Agot","doi":"10.1007/s10461-026-05257-5","DOIUrl":"https://doi.org/10.1007/s10461-026-05257-5","url":null,"abstract":"<p><p>Among sub-Saharan African adolescents, delayed HIV and pregnancy disclosure, stigma, and insufficient social support are barriers to engagement in antenatal care and services to prevent mother-to-child transmission of HIV. We developed and evaluated the acceptability and short-term preliminary efficacy of a digitally illustrated, narrative-based intervention designed to address these barriers among Kenyan pregnant adolescents aged 15-19 years living with HIV. We used an iterative, theory-informed, mixed methods human centered design approach. Individual adolescent and dyadic adolescent-caregiver interview data informed the development of an initial prototype (n = 46 adolescents, n = 24 caregivers). We conducted focus groups to assess initial acceptability and obtain feedback on the initial prototype (n = 22 adolescents). Focus group data informed refinement of the prototype, which was then evaluated for acceptability and short-term preliminary efficacy in a single arm pre/post pilot (n = 33 adolescents). The mean age of pregnant adolescents and caregivers was 17.7 years and 47.4 years, respectively. Adolescent interviewees described disclosure as delayed, staged, or indirect rather than immediate and shared accounts of enacted, anticipated, and internalized stigma, coping strategies, family support, and preferences for digital intervention features. Focus group and pilot participants rated key prototype features highly. Over the two-week period from baseline (B) to follow-up (F), pilot analysis showed statistically significant reductions in internalized HIV stigma (B = 1.00, SD = 1.49; F = 0.55, SD = 1.12; p=.03; d = 0.43) and anxiety symptoms (B = 5.03, SD = 4.83; F = 3.45, SD = 3.80; p=.02; d = 0.46). Findings also suggested improvements in self-efficacy for knowing when it is safe to disclose HIV status (B = 6.24, SD = 3.75; F = 7.59, SD = 3.79; p=.05; d = 0.38) and pregnancy status (B = 5.52, SD = 4.76; F = 8.21, SD = 3.59; p=.002; d = 0.63), fewer reports of difficulty with HIV and pregnancy disclosure, increased perceived social support (B = 54.41, SD = 16.12; F = 60.28, SD = 17.53; p=.02; d = 0.48), and overall improvements across other targeted psychosocial outcomes. This digitally illustrated, narrative-based intervention shows promise for strengthening disclosure and stigma-coping skills among pregnant adolescents in low resource settings, thereby empowering them to seek needed support from caregivers and improving their overall health and wellbeing.Clinical Trials Registration: The study is registered at clinicaltrials.gov under ID Number NCT05383755.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597627","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}