AIDS and Behavior最新文献

{"title":"Assessing PrEP Initiation and Adherence Among High-Risk, Sexually Active Adolescents and Young Adults: A Population-Based Prospective Study Across Diverse Service Delivery Models in a High HIV Prevalent District in South Africa.","authors":"Edward Nicol, Wisdom Basera, Eunice Turawa, Carl Lombard, Noluntu Funani, Dakalo Chavhalala","doi":"10.1007/s10461-025-04719-6","DOIUrl":"https://doi.org/10.1007/s10461-025-04719-6","url":null,"abstract":"<p><p>Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy for high-risk populations, including adolescent girls and young women (AGYW) and adolescent boys and young men (ABYM). While various PrEP-delivery models exist in South Africa, little is known about optimizing PrEP-uptake and adherence for AGYW and ABYM. This study explored preferred and feasible PrEP care models to enhance initiation and adherence among at-risk adolescents and young adults (AYAs) in a high-HIV prevalent rural district in South Africa. We conducted a longitudinal, population-based cohort study from August 2021 to July 2022 across 22 service delivery points (SDPs) in KwaZulu-Natal. High-risk, sexually active HIV-negative AGYW (15-24 years) and ABYM (15-35 years) were recruited from clinics, schools, and community-based youth zones. PrEP-uptake and adherence, based on national guidelines, were assessed using Pearson's Chi square test and binomial regression. Of 2,772 HIV-negative AYA, 781 (28%) initiated PrEP. Despite 65% being classified as high risk for HIV (p < 0.001), only 22% initiated PrEP. Initiation was higher in female (82%, p < 0.001) and among the 15-19 years (51%, p = 0.11). PrEP uptake varied significantly by SDPs, lowest in clinics (9%, p < 0.001), higher in youth zones (58%, p < 0.001), and highest in schools (73%, p < 0.001). Adherence declined significantly over time, dropping from 12% at one month to 2% at six months (p < 0.001). These findings highlight the need for targeted interventions in schools and communities, addressing barriers such as awareness, side effects, and accessibility. Expanding PrEP services to non-traditional settings may enhance uptake and adherence, reducing HIV risk among young people.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959728","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 Competing Risks Duration Model to Study PrEP Discontinuation Among MSM in France: The ERAS 2023 Study.","authors":"Clément Boutet, Marion Di Ciaccio, Bruno Spire, Annie Velter, Luis Sagaon-Teyssier","doi":"10.1007/s10461-025-04729-4","DOIUrl":"https://doi.org/10.1007/s10461-025-04729-4","url":null,"abstract":"<p><p>Although PrEP prevents HIV among at-risk populations, high discontinuation rates hinder its effectiveness. We investigated three reasons for PrEP discontinuation in real-life settings in France and associated factors, in order to assess weariness taking PrEP. We used data from the French online survey Enquête Rapport au Sexe 2023 which targeted gay and bisexual men having sex with men (GBMSM). First, we constructed the outcome 'PrEP duration'. Second, we created a three-category 'reason for PrEP discontinuation' variable as follows: changes in sexual behaviors, a desire to discontinue PrEP, and clinical reasons. Third, we calculated PrEP survival probability. We then performed a Weibull accelerated failure time model with competing risks to assess how the duration of time on PrEP influenced discontinuation, and whether specific factors were associated with different discontinuation reasons. The analysis included 4819 GBMSM. Median PrEP duration was 19 months. Discontinuation because of changes in sexual behaviors was less likely among GBMSM who initiated PrEP prescription in a sexual health structure (AF = 0.604 [0.424-0.858]). A desire to stop PrEP was more likely among those living in regions with the lowest reported seropositivity rates (AF = 2.320 [1.054-5.107]). Discontinuing PrEP for clinical reasons was more likely among participants coming from smaller municipalities (AF = 2.312 [1.099-4.868]). PrEP duration dependence was negative for all three reasons, implying that the longer the time taking PrEP, the lower the probability of discontinuation. We found no weariness with PrEP use among GBMSM; this highlights the need to detail specific factors associated with PrEP discontinuation.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961058","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 Booklet Self-Help Intervention for People Living with HIV and Depressive Symptoms in Botswana: A Randomized Controlled Trial.","authors":"Boitumelo Vavani, Nadia Garnefski, Sanne van Luenen, Elise Dusseldorp, Kennedy Amone-P'Olak, Philip Spinhoven, Vivian Kraaij","doi":"10.1007/s10461-025-04742-7","DOIUrl":"https://doi.org/10.1007/s10461-025-04742-7","url":null,"abstract":"<p><p>In low- and middle-income countries (LMICs), there is a scarcity of psychological treatment options for people living with HIV (PLWH) with depressive symptoms. Self-help programs for depressive symptoms, in particular, are cost-effective and scalable, and therefore a promising tool in the treatment of depressive symptoms for people in low-resourced countries. This paper presents the results of a study that examined the effectiveness of a guided self-help program in reducing depressive symptoms in PLWH in Botswana. A Randomized Controlled Trial (RCT) was conducted on a sample of PLWH who were screened at HIV treatment centers in Botswana. The RCT had two conditions: an intervention group that received the self-help program with coaching and an attention-only control group. In both groups, a pre-test, post-test, and 3-month follow-up measurement were administered. Patients in the intervention group followed a booklet Cognitive Behavioral Therapy (CBT)-based self-help program. Seventy-two participants were included in the study. The results indicated significantly larger decreases in depressive symptoms in the intervention group than in the attention-only control group, both in the short and longer term, with large effect sizes. In addition, there were significant reductions in anxiety symptoms in the intervention group compared to the control group. The user satisfaction was high. Implementing this low-cost and scalable self-help program in a LMIC such as Botswana is critical in bridging the existing mental health treatment gap. This clinical Trial was registered with the Netherlands Trial registry, number NTR5407on August 23, 2018.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968562","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":"Physical Activity, Cigarette Smoking, and Depression Among People with HIV.","authors":"Nicholas J SantaBarbara, Melissa A St Hilaire, Deborah J Konkle-Parker, Warren Scott Comulada, Jennifer Cantrell, Amber D'Souza, Robert Foronjy, Susan L Koletar, Matthew J Mimiaga, Frank J Palella, Daniel Merenstein, Anna A Rubtsova, Sarath Raju, Claudia A Martinez, David B Hanna, M Bradley Drummond, Kathleen M Weber, Richard Wang, Kristine M Erlandson","doi":"10.1007/s10461-025-04727-6","DOIUrl":"https://doi.org/10.1007/s10461-025-04727-6","url":null,"abstract":"<p><p>People with HIV (PWH) smoke cigarettes 2-3 times more and are 3 times more likely to have clinical depression relative to the general population. Physical activity (PA) can aid in smoking cessation and reduce depression in the general population; the role of PA for smoking cessation among PWH is unknown. Data collected between October 2021-September 2022 from the Multicenter AIDS Cohort Study (MACS)/Women Interagency HIV Study (WIHS) Combined Cohort Study (MWCCS) were analyzed using logistic regression and structural equation modeling to examine associations between cigarette smoking, PA and depression. Among adult PWH (n = 1584), 505 were insufficiently active (MET-min/week ≤ 500), 400 were currently smoking, and 420 had clinically significant depressive symptoms (CES-D ≥ 16). The odds of current smoking were significantly higher among PWH who were insufficiently active compared to sufficiently active, even after adjusting for age, sex, body mass index, race, ethnicity, substance use, and viral load (aOR = 1.40 [95% CI: 1.04-1.87], p = 0.03). Similarly, the odds of current smoking were significantly higher among PWH with more symptoms of depression in adjusted models (aOR = 1.57 [95% CI: 1.16-2.12], p = 0.003). When stratified by sex, the odds of current smoking remained significantly higher among female PWH, but not male PWH who were insufficiently active. The odds of current smoking also remained significantly higher among females but not males with more symptoms of depression. Structural equation modeling indicated that PA and depression have independent and direct effects on smoking among PWH. Physical inactivity and depression are associated with smoking, but longitudinal studies are needed to better understand directionality and causality.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956106","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":"Impact of DEI on HIV Research.","authors":"David M Stoff","doi":"10.1007/s10461-025-04715-w","DOIUrl":"https://doi.org/10.1007/s10461-025-04715-w","url":null,"abstract":"","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952555","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":"Exercise Interventions Conducted Among Individuals with Co-occurring HIV and Unhealthy Substance Use: A Systematic Review.","authors":"Colleen B Mistler, William Allen, Alyssa A Grimshaw, Christie I Idiong, Dini Harsono, Melinda L Irwin, Garrett Ash, Linda S Pescatello, Jaimie P Meyer, E Jennifer Edelman","doi":"10.1007/s10461-025-04735-6","DOIUrl":"10.1007/s10461-025-04735-6","url":null,"abstract":"<p><p>Unhealthy substance use and physical inactivity are prevalent co-occurring risk factors for morbidity and mortality among people with HIV (PWH). Evidence-based exercise interventions targeting both risk factors are limited. We conducted a literature search across seven databases for relevant articles published through 05/07/24. Studies qualified if they involved: (a) PWH ≥ 18 years old who engage in unhealthy substance use; (b) randomized controlled trials (RCTs) or quasi-experimental designs; and (c) an exercise intervention. Two researchers independently completed the Cochrane Data Collection Form and Joanna Briggs Institute Critical Appraisal Tool. PROSPERO registry: CRD42023473582. Out of 6916 potentially qualifying studies, 46 underwent full-text review, and 7 studies qualified (6 pilot RCTs & 1 quasi-experimental). Most (k = 6) were conducted in the US. Sample sizes ranged from 16 to 73 participants and retention rates ranged from 42 to 100%. Interventions met at least 1x/week for 6-24 weeks and consisted of supervised progressive overload aerobic/resistance training (k = 3), home-based training with virtual behavioral counseling (k = 1), yoga (k = 2), and tai-chi with cognitive behavioral therapy (k = 1). Despite inconsistent assessment tools and outcomes measured, exercise interventions were significantly (p < 0.05) and positively associated with outcomes relating to improving HIV, substance use, physical activity, strength/fall risk, quality of life/stress, and pain relief. All studies were high quality with low risk of bias, safe, and feasible. Despite small sample sizes and heterogeneity across studies, evidence from this systematic review supports the use of exercise to improve a variety of health outcomes among PWH with unhealthy substance use.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959956","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":"Negotiating Access to Healthcare and Experience of Stigma Among Cisgender Gay Men Diagnosed with Mpox During the 2022 Epidemic in France: A Qualitative Study.","authors":"Marie Dos Santos, Manuela Salcedo, Marion Mora, Martin Siguier, Annie Velter, Vincent Leclercq, Gabriel Girard","doi":"10.1007/s10461-025-04739-2","DOIUrl":"https://doi.org/10.1007/s10461-025-04739-2","url":null,"abstract":"<p><p>During the global Mpox epidemic of 2022/2023, the first cases in France were identified on 20 May 2022 among gay men. Scientific data on the experience of individuals concerned during the peak of the epidemic in France are scarce. This paper describes the results of the qualitative phase of the French ad hoc ANRS Mpox-SHS study, which was conducted in September/October 2022 among gay men diagnosed with Mpox.Study participants highlighted that they were not surprised at being diagnosed with Mpox, given that they were more exposed to sexually transmitted diseases in general because they had several partners and they were a target group of prevention campaigns.In contrast, the rapidity and extent of the disease's symptoms (pain, rashes, scabs, etc.) surprised many of them. All participants mentioned strong barriers to accessing appropriate care, the most-cited being stigma. Participants felt they were treated like \"plague victims\". Furthermore, most reported serious social and psychological consequences of being diagnosed with Mpox, arising from their fear that their sexual orientation and/or their sexual practices would be exposed. Moreover, respondents highlighted having an erratic Mpox care pathway, being sent from one health provider to another to receive care. Finally, participants explained that they implemented various negotiation strategies with their healthcare providers, sexual partners, and their employers during their illness.This study highlights the importance of using community health to better understand the development of an epidemic and its impact on affected individuals.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962114","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":"Family Influences on Antiretroviral Therapy Adherence in Youth with HIV in the United States: A Systematic Review.","authors":"Violeta J Rodriguez, Miranda Gessert, Arianna Guerra","doi":"10.1007/s10461-025-04721-y","DOIUrl":"https://doi.org/10.1007/s10461-025-04721-y","url":null,"abstract":"<p><p>HIV poses a significant issue in the United States and understanding how HIV-positive populations adhere to treatments, specifically with antiretroviral therapy (ART), is vital for researchers to find approaches to improve medication adherence. This systematic review aims to explore barriers that children, adolescents, and young people (ages < 25) in the United States may face by exploring family interventions and factors influencing ART adherence. This study conducted a literature search using various databases to retrieve studies within the United States. A total of 36 studies identified family factors (n = 29) and various interventions (n = 7). Across both categories, studies indicated the critical role of family involvement in adherence outcomes. The review also identified significant barriers to ART adherence, including complex medication regimens, HIV-related stigma, and psychosocial stressors. Due to the diverse barriers, policymakers and healthcare providers should focus on a holistic approach to support ART adherence in HIV-positive youth.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143951340","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":"Diagnosis of Learning Disabilities but not Academic Difficulties Alone is Associated with Neurocognitive Impairment in People Living with HIV: Evidence from Clinical Research to Support and Refine the Current HAND Diagnostic Guidelines.","authors":"Aneeka Ratnayake, Lucette A Cysique, Sean B Rourke","doi":"10.1007/s10461-025-04711-0","DOIUrl":"https://doi.org/10.1007/s10461-025-04711-0","url":null,"abstract":"<p><p>Diagnosing HIV-associated neurocognitive disorder (HAND) is a complex process aimed at determining the role of HIV versus other causes of neurocognitive impairment. In treated people with living long-term HIV infection, this process is further complicated by the presence of multiple medical and psychiatric comorbidities and varied educational history. Evidence-based research is therefore needed to refine the 2007 HAND diagnostic criteria on how to consider multimorbidity in making differential diagnoses. This is the case for presence of academic difficulties versus diagnosis of learning disabilities (LD), which have not been systematically studied in relation to HAND, and especially in relation to the presence of cognitive and depressive symptoms. The current study included 903 people with HIV referred for a comprehensive neuropsychological assessment of HAND at the Neurobehavioural Clinical-Research Unit (St. Michael's Hospital in Toronto, ON, Canada). Pre-morbid ability was assessed prior to standard testing and participants were classified into LD groups: No learning disabilities (n = 474), academic difficulties (n = 352) or diagnosed learning disability (LD, n = 77). The neuropsychological test battery assessed domains of complex attention, learning and memory, psychomotor efficiency, and executive functioning, and performance was adjusted with demographic corrections. Neurocognitive impairment (NCI) status was determined using the global deficit score method (GDS ≥ 0.5 detecting at least mild global NCI). Depressive symptoms were assessed with the Beck Depression Inventory (BDI), and cognitive symptoms with the Patient's Assessment of Own Functioning (PAOFI). Logistic regression models were used to assess odds of NCI in the three groups while considering main and interactive effects of clinically relevant depression (BDI > 10) or elevated cognitive symptoms (PAOFI > 3). Only LD diagnosis was significantly associated with increased odds of NCI, OR = 1.90, 95% CI (1.15, 3.14). In the same model, both cognitive symptoms, OR = 1.97, 95% CI (1.50, 2.58), and depression symptoms OR = 1.39, 95% CI (1.06, 1.82) were also significantly associated with increased odds of NCI, but not their interaction. Diagnosis of LD, but not academic difficulties alone, is associated with increased odds of NCI among treated persons living with HIV who are clinically referred. While this was in part independent of depression and cognitive symptoms, adults with HIV and LD diagnosis who had high depression and cognitive symptoms had greatest odds of NCI. These findings assist in the refinement of the current HAND diagnostic guidelines.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956436","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":"Rapid Diffusion of Awareness and Uptake of Doxy-PEP among Men who Have Sex with Men in San Francisco.","authors":"Antonio A M Moscatelli, Paloma L Ramirez, Bow Suprasert, Moranda Tate, Stephanie E Cohen, Maria Amelia S M Veras, Glenda Baguso, Erin C Wilson, Willi McFarland","doi":"10.1007/s10461-025-04728-5","DOIUrl":"https://doi.org/10.1007/s10461-025-04728-5","url":null,"abstract":"<p><p>In October 2022, the San Francisco Department of Public Health published guidelines for doxycycline post-exposure prophylaxis (doxy-PEP) to prevent bacterial sexually transmitted infections (STI) among men who have sex with men (MSM). We evaluated awareness and use of doxy-PEP using data from the National HIV Behavioral Surveillance in 2023 in San Francisco (N = 533). In the year following the publication of the guidelines, 66.6% of MSM reported awareness of doxy-PEP, and 19.3% had used it. Among MSM who are not living with HIV, awareness of doxy-PEP was associated with higher educational levels, condomless sex, bacterial STI diagnoses, and PrEP use; use was associated with STI diagnoses and PrEP use. Among MSM living with HIV, both awareness and use were associated with younger age. These findings indicate rapid dissemination and early adoption of doxy-PEP in a priority population in a real-world setting.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963583","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}