AIDS and Behavior最新文献

{"title":"Randomized Controlled Trial Testing an HIV/STI Prevention Intervention Among People Leaving Incarceration Who Were Assigned Male at Birth, Have Sex with Men and A Substance Use Disorder.","authors":"Katrina M Schrode, Gabriel G Edwards, Brandon Moghanian, Robert E Weiss, Cathy J Reback, Charles McWells, Charles L Hilliard, Nina T Harawa","doi":"10.1007/s10461-025-04818-4","DOIUrl":"https://doi.org/10.1007/s10461-025-04818-4","url":null,"abstract":"<p><p>HIV disproportionately impacts minoritized individuals, particularly those of intersectional minoritized identities. Incarceration disproportionately impacts minoritized individuals as well, and increases HIV risk, in part due to its disruption to people's lives, social networks, and access to care. We developed MEPS, a 6-month intervention designed to holistically support HIV prevention in men who have sex with men and transgender women leaving incarceration. We tested MEPS in a 1:1 randomized controlled trial with 208 individuals. All participants received a needs assessment and personalized wellness plan, followed by either standard of care or the MEPS intervention. MEPS integrated support from a Peer Mentor, incentives for engagement in social and health services, and a mobile app. Participants completed baseline assessments and follow-up assessments at 3, 6, and 9 months. We tested for changes in PrEP use using a group-based trajectory model, for changes in HIV and STI testing, frequent substance use and recidivism using logistic mixed models, and for changes in HCV testing and in having a regular place for care using Poisson models. MEPS participants were significantly more likely than control participants to be among those who used PrEP [AOR (95% CI) = 3.8 (1.8, 8.0)]. Recent HIV testing in the MEPS arm remained above 50% over time while decreasing in the control arm, with a significant difference between arms at 6 months [AOR (95% CI) = 3.5 (1.3, 9.5)]. There were no significant differences between arms in the other outcomes. The MEPS intervention was effective in increasing PrEP uptake and HIV testing in people leaving incarceration. Interventions that implement peer mentor support and incentives to encourage service engagement can improve engagement in HIV prevention services among populations that experience unique barriers to care. This study was registered with ClinicalTrials.gov on July 25, 2019 (NCT04036396).</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599100","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":"Efficacy of CHAMPS for Improving Viral Suppression: A Randomised Clinical Trial","authors":"Rebecca Schnall,&nbsp;Haomiao Jia,&nbsp;Maeve Brin,&nbsp;Emma S. Kay,&nbsp;Olivia R. Wood,&nbsp;Joseph Abua,&nbsp;D. Scott Batey","doi":"10.1007/s10461-025-04811-x","DOIUrl":"10.1007/s10461-025-04811-x","url":null,"abstract":"<div><p>Given the fragmented condition of the United States healthcare system and the challenges inherent in the lives of poor, stigmatized, and minoritized groups, our study team conducted a multi-site randomized (1:1) controlled efficacy trial of Community Health Workers And MHealth to ImProve Viral Suppression (CHAMPS), a combination intervention comprised of both the WiseApp and community health worker delivered health information, among adults with HIV in New York City and Birmingham, Alabama. Data analysis used an intention-to-treat approach. Enrollment for this study was from May 2021-May 2023 with follow-up completed at 6- and 12-months following study enrollment. In the analytic sample of 300 study participants, the mean age was 48.1 years; 219 (73.2%) participants identified as Non-Hispanic Black, 28 (9.4%) as Non-Hispanic White, 39 (13.0%) as Hispanic, and 10 (3.3%) as Other Non-Hispanic. From baseline to six months, the proportion of participants who were virally suppressed increased for both study arms, with OR = 1.16 (SE = 0.26, <i>p</i> = 0.52, 95%CI 0.75–1.79) for standard of care and OR = 1.66 (SE = 0.33, <i>p</i> = 0.010, 95%CI 1.13–2.44) for CHAMPS. However, there was no statistically significant difference in changes between the two study arms (<i>p</i> = 0.28). The CHAMPS intervention did not have a significant effect on HIV viral suppression relative to non-suppression at 12-months compared with the standard of care arm. Nonetheless, these findings should be interpreted in the context of the COVID-19 and Monkeypox pandemic with persistent concerns related to exposure to the viruses and limited access to healthcare and other social services. <i>Trial Registration</i>: ClinicalTrials.gov Identifier: NCT04562649.</p></div>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":"29 11","pages":"3703 - 3713"},"PeriodicalIF":2.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599099","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":"Recent Alcohol Use Influences Associations between Cortisol Levels and Negative Affect: The New Orleans Alcohol Use in HIV Study.","authors":"Taylor Fitzpatrick-Schmidt, Evrim Oral, David A Welsh, Patricia E Molina, Tekeda F Ferguson, Scott Edwards","doi":"10.1007/s10461-025-04815-7","DOIUrl":"https://doi.org/10.1007/s10461-025-04815-7","url":null,"abstract":"<p><p>Human immunodeficiency virus (HIV) infection contributes to both neurological and psychiatric disorders. People with HIV (PWH) are disproportionately affected by chronic pain and negative affective comorbidities, such as generalized anxiety disorder (GAD), major depressive disorder (MDD), and post-traumatic stress disorder (PTSD). PWH are also more likely to consume alcohol, further exacerbating these conditions. Dysregulation of biological stress systems, including the hypothalamic-pituitary-adrenal (HPA) axis, is believed to contribute to these comorbidities. The current analysis sourced data from the New Orleans Alcohol Use in HIV (NOAH) study, a longitudinal investigation of alcohol use patterns in an underserved cohort of PWH. Prior findings from this cohort demonstrated that higher alcohol consumption is associated with worse mental health outcomes (e.g., greater depression and anxiety). Here we examined the relationships between negative affective comorbidities (anxiety, depression, and PTSD), pain, alcohol use, and plasma levels of cortisol, the major stress hormone, in PWH. Our analysis revealed significant associations between cortisol levels, PTSD symptoms, and pain intensity. Moreover, the relationship between PTSD and cortisol was stronger among recent alcohol drinkers (PEth-positive participants) and males. The association between pain intensity and cortisol was also stronger in recent alcohol drinkers. Although depression and cortisol levels showed no overall relationship, females with the highest depression scores exhibited significantly higher cortisol levels. Our findings emphasize the need for further investigation into how ongoing alcohol use may increase relationships between cortisol and the deterioration of mental health in male and female PWH.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574655","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":"Attrition from Care and Barriers to PrEP Use Among Key Populations in Kinshasa, DRC: A Multiple Methods Study","authors":"Natalia Zotova,&nbsp;Alisho Shongo,&nbsp;Patricia Lelo,&nbsp;Nana Mbonze,&nbsp;Didine Kaba,&nbsp;Paul Ntangu,&nbsp;Qiuhu Shi,&nbsp;Adebola Adedimeji,&nbsp;Kathryn Anastos,&nbsp;Marcel Yotebieng,&nbsp;Viraj Patel,&nbsp;Jonathan Ross","doi":"10.1007/s10461-025-04809-5","DOIUrl":"10.1007/s10461-025-04809-5","url":null,"abstract":"<div><p>Female sex workers (FSW) and gay and other men who have sex with men (MSM) are disproportionately affected by HIV. Oral pre-exposure prophylaxis (PrEP) is increasingly available in African countries, including the Democratic Republic of Congo (DRC), but data on factors influencing PrEP use remain limited. This multiple methods study examined PrEP attrition patterns and barriers to engagement among FSW and MSM in Kinshasa, DRC, using programmatic data from five sites, clinical records, and qualitative interviews. Logistic regression identified factors associated with attrition; qualitative data were thematically analyzed. Among 8,822 FSW and MSM eligible for PrEP in 2019–2021, only 24% (<i>n</i> = 2,070) initiated it. Of 809 FSW initiators, 33% (<i>n</i> = 268) were lost to follow-up by 1 month and 78% (<i>n</i> = 421) by 3 months. Among 1,261 MSM, 26% (<i>n</i> = 332) and 87% (<i>n</i> = 808) were lost by 1 and 3 months, respectively. For FSW, prior PrEP use and recent STIs were associated with higher attrition at 1 month. Older age, more sexual partners, income beyond sex work, and no prior PrEP use were linked to lower attrition at 3 months. Among MSM, no prior PrEP use predicted higher attrition at 1 month but lower attrition at 3 months. Qualitative findings identified stigma, side effects, dislike of daily dosing, and limited services for key populations at risk of HIV as major barriers. Findings underscore the need for improved PrEP messaging, including information on side effects decreasing over time. Raising awareness among key and general populations may reduce stigma and improve PrEP engagement.</p></div>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":"29 11","pages":"3673 - 3686"},"PeriodicalIF":2.4,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s10461-025-04809-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574719","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":"Medical Mistrust and Willingness to Use Long-Acting PrEP Among Black and Hispanic/Latino MSM","authors":"Jerris L. Raiford,&nbsp;Robin J. MacGowan,&nbsp;Rob Stephenson,&nbsp;Ruth Dana,&nbsp;Lisa Hightow-Weidman,&nbsp;Kristin M. Wall,&nbsp;Jeb Jones,&nbsp;Patrick S. Sullivan","doi":"10.1007/s10461-025-04801-z","DOIUrl":"10.1007/s10461-025-04801-z","url":null,"abstract":"<div><p>Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV infection in the United States, especially Black MSM (BMSM) and Hispanic/Latino MSM (HLMSM). Long-acting preexposure prophylaxis (LA PrEP) is effective in preventing HIV; however, medical mistrust may contribute to barriers in uptake among BMSM and HLMSM. We assessed the role of medical mistrust in BMSM and HLMSM’s unwillingness to use LA PrEP. BMSM and HLMSM aged ≥18 years without a previous HIV diagnosis or current PrEP use were recruited through dating and general interest websites/apps. Using Poisson regression with robust standard errors, we conducted multivariate analyses to assess the association between medical mistrust and willingness to use LA PrEP (i.e., injection or rod implanted in the arm) separately for each racial/ethnic group. Over 90% of the 1,126 BMSM and 924 HLMSM in this study were willing to use some form of PrEP; however, only 74% of BMSM and 81% of HLMSM were willing to use PrEP injections, and significantly fewer BMSM (30%) were willing to receive a PrEP implant compared with 44% of HLMSM. After controlling for sociodemographic, behavioral, and clinical covariates, medical mistrust was associated with lower willingness to use LA PrEP for BMSM, but not for HLMSM. Addressing and reducing medical mistrust among BMSM is important to increase the use of LA PrEP as an effective HIV prevention strategy. Addressing structural barriers and building trust within healthcare systems are crucial steps in reducing disparities in HIV infection among BMSM and HLMSM.</p></div>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":"29 11","pages":"3582 - 3594"},"PeriodicalIF":2.4,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574720","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":"Tobacco and Cannabis Co-use by HIV Status Among United States Adults: Results from the 2021-2023 National Survey on Drug Use and Health.","authors":"Juhan Lee, Ana Paula Xingru Yin, Andrea H Weinberger","doi":"10.1007/s10461-025-04817-5","DOIUrl":"https://doi.org/10.1007/s10461-025-04817-5","url":null,"abstract":"<p><p>Tobacco and cannabis use are prevalent among adults with HIV and co-use is associated with drug dependence and negative health outcomes such as lung disease. This study examined the co-use of tobacco and cannabis by HIV status overall and by sociodemographics. Data came from the adult sample from the 2021-2023 National Survey on Drug Use and Health. Adjusted multinomial logistic regressions were performed on tobacco cannabis co-use by HIV status, adjusting for covariates. We tested potential interaction effects between HIV status and each sociodemographic factor (i.e., age, sex, race/ethnicity, income, state-level medical cannabis legalization status) on the outcome. Among total adult respondents (N = 139,524), 0.4% (weighted) reported lifetime HIV diagnosis and 8.2% reported past-month tobacco and cannabis co-use. After adjusting for covariates, adults with HIV, compared with adults without HIV, were more likely to report past-month tobacco and cannabis co-use (aRRR = 3.35, 95% CI = 1.79, 6.27). We also observed that race/ethnicity and state-level medical cannabis legalization status modified the association between HIV diagnosis and tobacco and cannabis co-use. This study observed a higher prevalence of tobacco and cannabis co-use among adults with HIV overall and identified subgroup sociodemographic differences by race/ethnicity and state-level medical cannabis legalization.</p>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558812","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":"Shades of Contemplation: HIV Pre-Exposure Prophylaxis Decision-Making among Young Women in South Africa","authors":"Kirsty M. Sievwright,&nbsp;Melissa M. Ertl,&nbsp;Theresa M. Exner,&nbsp;Londeka Mbewe,&nbsp;Nonhlonipho Bhengu,&nbsp;Mariam Onafowokan,&nbsp;Abigail D. Harrison,&nbsp;Jill Hanass-Hancock,&nbsp;Susie Hoffman","doi":"10.1007/s10461-025-04805-9","DOIUrl":"10.1007/s10461-025-04805-9","url":null,"abstract":"<div><p>Expanding women’s awareness of and access to HIV pre-exposure prophylaxis (PrEP) is key to enhancing its uptake, yet young women face difficulties in deciding whether to initiate any form of PrEP. Understanding factors that shape decision-making to initiate PrEP can support uptake and continuation. The Masibambane (“Let us work together”) pilot in eThekwini (Durban), South Africa, compared a gender-enhanced (GE) online group workshop (<i>N</i> = 50) to an “individual access” (IA) control condition (<i>N</i> = 50) for women (ages 18–25 years). Both conditions aimed to increase knowledge and motivation to initiate oral PrEP. This study used 3-month follow-up qualitative interviews from 40 women (20 per condition). The Transtheoretical Model of Health Behavior Change guided interviews and a framework analysis was used to understand stages of and influences on PrEP decision-making. Underscoring that PrEP uptake is not a straightforward or singular decision, most respondents, regardless of condition, conveyed shades of contemplation for initiating PrEP; only a few stated they currently were using or were uninterested in PrEP. Many viewed PrEP as an effective woman-controlled method and believed their partners placed them at risk of HIV. Other considerations included relationship status, pill modality, daily adherence, and side effects. For those who prepared to use PrEP, logistical barriers were frequent. Peers were perceived as sources of encouragement for adopting PrEP. Given these findings, HIV prevention efforts need to include interventions to support PrEP decision-making, recognizing that the process is continuous, multifaceted, and changes over time. This study elucidated relevant factors for supporting young women’s PrEP decision-making in South Africa.</p></div>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":"29 11","pages":"3634 - 3645"},"PeriodicalIF":2.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558811","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":"Suboptimal Patient-Provider Communication About Undetectable = Untransmittable and HIV Transmission Risk in Australia and the US","authors":"Sarah K. Calabrese,&nbsp;Martin Holt,&nbsp;David A. Kalwicz,&nbsp;Justino J. Flores,&nbsp;Kaosisochukwu C. Onochie,&nbsp;Benjamin R. Bavinton,&nbsp;Bridget Haire,&nbsp;Anthony K. J. Smith,&nbsp;James MacGibbon,&nbsp;Loren Brener,&nbsp;Timothy R. Broady,&nbsp;John Rule,&nbsp;Bruce Richman,&nbsp;Carla Treloar","doi":"10.1007/s10461-025-04783-y","DOIUrl":"10.1007/s10461-025-04783-y","url":null,"abstract":"<div><p>The Undetectable = Untransmittable (U = U) campaign aims to raise global awareness that people living with HIV whose viral load is undetectable cannot sexually transmit HIV. Healthcare providers are uniquely positioned to disseminate the U = U message. Our study explored patient-provider communication about U = U and HIV risk from the perspectives of gay, bisexual, and other men living with HIV (MLHIV) and healthcare providers engaged in HIV treatment and prevention service delivery. We conducted 40 semi-structured interviews with key informants recruited through HIV community-based and professional organizations in Australia (<i>n</i> = 20) and the US (<i>n</i> = 20). Key informants included 20 MLHIV and 20 providers. Data were analyzed thematically. MLHIV were cisgender men aged 29–67 years (M[SD] = 52[13.1]). Providers were cisgender adults aged 30–65 years (M[SD] = 38[9.0]). MLHIV preferred that providers use clear and direct language to explain U = U. When prompted to explain U = U as they would to patients, 8 of 10 Australian and 4 of 10 US providers used language consistent with those preferences. MLHIV, especially US MLHIV, reported that their providers’ explanation of the U = U message was often absent, ambiguous, or inaccurate in practice. Such suboptimal communication aligned with the skepticism about U = U and concerns about patient behavior (e.g., adherence) expressed by several providers in the study. Providers relayed multiple reservations regarding new World Health Organization recommendations about informing patients that low-level viremia (detectable viral load <span>(geq)</span> copies/mL) conferred “almost zero” risk. Many Australian and US providers would benefit from training developed in collaboration with people living with HIV to improve patient-provider communication about U = U and HIV transmission risk.</p></div>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":"29 11","pages":"3367 - 3386"},"PeriodicalIF":2.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s10461-025-04783-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551725","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":"Validity and Reliability of the Kessler 6 Scale for Serious Mental Illness Among Populations with High Burden of HIV","authors":"Rashunda Lewis,&nbsp;Monica Adams,&nbsp;Evelyn Olansky,&nbsp;Catlainn Sionean,&nbsp;for the NHBS Study Group","doi":"10.1007/s10461-025-04765-0","DOIUrl":"10.1007/s10461-025-04765-0","url":null,"abstract":"<div><p>The Kessler 6 (K6) scale has been widely used to screen for serious mental illness (SMI) in general populations. Given that populations with high burden of HIV may be more likely to experience poor mental health outcomes, it is important to validate measures used to assess SMI among these groups. Using data from CDC’s National HIV Behavioral Surveillance (NHBS) system in the United States, we examined psychometric characteristics of the K6 scale, including exploratory factor analysis, scale reliability, construct validity, and review of interviewer feedback to explore scale performance in the field. Analyses confirmed a single factor structure and demonstrated that the K6 scale had high internal consistency and construct validity. Although interviewers noted that the effort item was difficult for some participants to understand, psychometric properties were not greatly improved with the deletion of the item. The results of this analysis suggest that the K6 scale is appropriate for use among NHBS populations with a high burden of HIV, including persons who inject drugs, heterosexually active adults at increased risk for HIV infection, women who exchange sex for money or drugs, and gay, bisexual, and other men who have sex with men.</p></div>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":"29 10","pages":"3141 - 3148"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504479","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":"Exploring the Interplay of Social and Physical Factors in Risk Dynamics and Transitions Across the Life-Course of Female Sex Workers in Blantyre, Malawi: A Longitudinal Narrative Study","authors":"Wezzie Stephanie Lora,&nbsp;Doreen Sakala,&nbsp;Amr Saidi,&nbsp;Wezzie Nyapigoti,&nbsp;Esnart Sanudi,&nbsp;Maryam Shahmanesh,&nbsp;Frances M. Cowan,&nbsp;Joanna Busza,&nbsp;Nicola Desmond","doi":"10.1007/s10461-025-04790-z","DOIUrl":"10.1007/s10461-025-04790-z","url":null,"abstract":"<div><p>Sexual risk amongst female sex workers (FSW) varies across the life-course and is influenced by socio-economic and interpersonal factors that affect behavioural choices and engagement in HIV/STI care. We explored transitions in the life-course of FSW to understand the dynamics of sexual risk in Blantyre, Malawi. We implemented a nested longitudinal qualitative study as part of the AMETHIST Consortium, a study testing approaches to reduce HIV transmission in sex work. We conducted consecutive narrative interviews with 30 FSW at three-time points over 12 months, with a three- to four-month break between each time point. We compared narratives to understand sex work transitions, HIV risk and engagement with HIV services. We identified factors (social and physical) related to sexual risk at the points of (1) transitions into sex work, (2) continuing sex work, and (3) breaks in sex work. At the entry stage, sexual risk was heightened when women lacked the knowledge and skills for protection against HIV/STI. Whilst continuing sex work, women’s immediate financial needs were prioritised over their HIV/STI risk. These behaviours occurred whether they were aware of the associated HIV/STI risk. During breaks, women perceived lower risk and reduced engagement in prevention strategies, particularly when they had stable partners, which paradoxically increased their risk. These narratives reveal how social context informs and limits access to health care while concurrently promoting risky behaviours. A multifaceted and dynamically responsive approach that considers risk differentiation from a temporal perspective can strengthen targeted interventions, effectively addressing the multiple challenges faced by FSW.</p></div>","PeriodicalId":7543,"journal":{"name":"AIDS and Behavior","volume":"29 11","pages":"3444 - 3456"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s10461-025-04790-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504478","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}