As pre-exposure prophylaxis (PrEP) options expand, providers play a critical role in supporting clients to select the method that best meets their needs. We examined how client-provider interactions during PrEP choice counselling influenced women's autonomous decision-making and early continuation on PrEP. CATALYST was a mixed-methods study that delivered an informed choice of oral PrEP, the dapivirine vaginal ring, and injectable cabotegravir among women attending 28 public-sector facilities in Kenya, Lesotho, South Africa, Uganda, and Zimbabwe. We analysed cohort data collected between June 2024 and January 2025 and adapted a family planning Autonomous Decision-Making (ADM) scale into a six-item PrEP-specific measure (PrEP-ADM scale). Factor analysis assessed scale structure, and logistic regression identified factors associated with fully autonomous decision-making (PrEP-ADM score of 18/18) and refilling PrEP within three months. Twenty-six in-depth interviews explored counselling experiences. Among 2,488 women, 92% reported fully autonomous decision-making. Two subscales were identified: "communicating information" and "supporting informed choice". Women in sero-different partnerships had higher odds of reporting fully autonomous decision-making (adjusted odds ratio [aOR]: 1.63, 95% CI: 1.11-2.39), whereas pregnant (aOR: 0.29, 95% CI: 0.17-0.47) and breastfeeding women (aOR: 0.46, 95% CI: 0.28-0.76) had lower odds. Autonomous decision-making was not associated with PrEP refill. Qualitative findings confirmed clear information exchange and supportive counselling, although pregnant and breastfeeding women described more constrained choices. High levels of perceived autonomous decision-making were observed, though further work is needed to refine these measures and identify the essential elements of informed PrEP choice counselling.

Stigma toward people who use drugs (PWUD) in HIV clinical settings undermines engagement in care and worsens health outcomes. Harm reduction (HR) offers relational and structural approaches that may reduce such stigma, yet little is known about how healthcare workers' (HCWs) own experiences shape HR integration into practice. In this sequential explanatory mixed-methods study, 128 HIV HCWs at three clinics in Pittsburgh, PA, and Birmingham, AL, completed surveys on attitudes toward PWUD and HR acceptability. In adjusted models, years of experience caring for people with HIV (PWH) predicted HR acceptability, whereas years of experience with PWUD did not: relative to HCWs with 5 or fewer years, those with 6-10 years (b = 0.45, 95% CI [0.15, 0.74], t = 3.03, p = .003) and more than 20 years (b = 0.62, 95% CI [0.09, 1.14], t = 2.37, p = .02) scored significantly higher on the Harm Reduction Acceptability Scale. Semi-structured interviews with 23 HCWs, analyzed thematically and stratified by years of HIV care, revealed three themes: HR was learned informally rather than through formal training, with HR champions described more often by experienced HCWs; substance use stigma was expressed and recognized differently across experience strata; and personal or family experience with substance use and overdose motivated compassionate care at every level. More experienced HCWs described having HR modeled by mentors and integrating HR into their professional identities. Findings highlight the need for training and mentorship that accelerate this learning so HR becomes a consistently supported standard of care.

Climate change and HIV are intersecting crises, yet their combined impact on Latin America's HIV care continuum remains understudied. Using a descriptive cross-sectional design with data from the 2024 Brazilian HIV Stigma Index, we examined the consequences of extreme climate events-primarily the May 2024 floods in Porto Alegre-on healthcare access, mental health, and socioeconomic stability among 156 people living with HIV. These events were associated with substantial care disruptions, with many participants reporting rescheduled or canceled medical appointments and laboratory monitoring. Furthermore, 60.5% reported negative mental health impacts and 37.3% suffered household income reductions. Institutional support reached a minority, leaving many reliant on civil society for survival needs. These findings highlight an urgent need for climate-resilient HIV policies integrating mental health care and social protection to sustain treatment adherence during public calamities.

Doxycycline post-exposure prophylaxis (doxyPEP) engagement-awareness, willingness, and use-for bacterial sexually transmitted infection (STI) prevention remains understudied in Taiwan. This secondary analysis used logistic regression to examine doxyPEP engagement and its correlates among 1,654 men who have sex with men (MSM) in Taiwan (November-December 2023). Awareness, willingness, and use were reported by 24.4%, 33.0%, and 2.9% of participants, respectively. Awareness, willingness, and use were greater among MSM not living with HIV and taking PrEP and MSM living with HIV than among MSM not living with HIV and not taking PrEP. Bacterial STI diagnosis was associated with greater willingness and use; age ≥ 40 years, condomless anal sex, and receipt of ≥ 1 mpox vaccine dose were also associated with greater willingness. These findings suggest that PrEP and HIV treatment services and bacterial STI screening and treatment encounters may offer opportunities for doxyPEP delivery, while additional strategies may be needed to reach MSM not routinely engaged in these services.

Gay, bisexual, and other men who have sex with men (MSM) continue to be disproportionately affected by HIV in the United States, with viral suppression rates among MSM across varied racial and ethnic groups remaining below national targets. Stigma is a major barrier to viral suppression, while community connectedness may serve as a protective factor. However, few studies have examined whether different forms of community connectedness are associated with viral suppression or moderate the negative effects of stigma. Data were drawn from 490 MSM with HIV enrolled in the HIV Prevention Trials Network (HPTN) 078 study (2016-2017). Multivariable logistic regression estimated adjusted odds ratios with 95% confidence intervals. Exploratory moderation analyses tested interactions between stigma and community connectedness, and significant interactions were further examined using stratified models. Viral suppression was documented in 78% (n = 383) of participants. Having a medium-sized MSM network (6-25 vs. low [0-5 MSM known personally]) was associated with lower odds of viral suppression, whereas medium (2-5) and high (> 5) levels of recent peer interactions (vs. low [0-1]) were associated with higher odds of viral suppression. Perceived connectedness to the broader lesbian, gay, among MSM across varied racial and ethnic groups bisexual(LGB) community was not significantly associated with viral suppression. Exploratory analyses suggested that the association between provider-related MSM stigma and viral suppression may vary by levels of network size and peer interactions, with associations observed only at medium levels of connectedness. These findings suggest that fostering active peer interactions may improve viral suppression among MSM.

Sexual activities are perceived as risky behaviors among people living with HIV (PLWH), which leads to stigmatization. Today, effective treatment and the strengthened Undetectable=Untransmittable (U = U) message are supposed to be key in freeing PLWH from the fear of HIV transmission. We conducted a cross-sectional study in 2024 at four HIV clinics in Chiang Mai, Thailand. We enrolled PLWH aged ≥ 18 years who were receiving ART. We collected data through face-to-face interviews using structured questionnaires to assess sexual behaviors and U = U awareness. Logistic regression analyses were performed to identify factors associated with being sexually active. Among 404 study participants, with a median age of 46 years, 235 (58.2%) were sexually active in the past 12 months. While most participants, 335 (83.0%), agreed that PLWH can be sexually active, only 76 (18.8%) were aware of the U = U message. Of those who were aware of U = U, a lower proportion reported 100% condom use compared to those who were not, either with steady (37.0% vs. 63.5%) or casual partners (33.3% vs. 84.6%). Factors associated with being sexually active included being young adults or middle-aged, having a sexual debut age < 20 years, alcohol use, and having a monthly income > 10,000 baht but not U = U awareness. While perceiving their sexual right, our findings demonstrated a U = U awareness gap among PLWH. We support the need to strengthen communication, share messages with the public, and tailor sexual health counseling to match the unique sexual and reproductive needs of PLWH at different stages of life.

Transitioning from oral to injectable HIV therapy raises unique considerations. We examined the scope and types of questions that people with HIV (PWH) raised about long-acting cabotegravir and rilpivirine (LA-CAB/RPV). We conducted semi-structured interviews with patients at four urban HIV clinics in San Francisco, Chicago, and Atlanta (n = 131). Two cross-sectional samples were recruited during August 2020 to May 2023: (1) pre-implementation, prior to widespread clinical availability (n = 72); and (2) early adopters of LA-CAB/RPV (n = 59). Each dataset was analyzed separately and comparatively using thematic analysis. Participants were 65% male, 45% Black and 27% Latine with median age of 46 years. Questions clustered into four domains: (1) potential side effects; (2) effectiveness; (3) injection visit logistics; and (4) comparison to other injectable medications. Early adopters emphasized the importance of cultivating broader awareness about LA-CAB/RPV. Findings highlight the need for clear, patient-centered information across multiple domains to support informed decisions about LA-CAB/RPV initiation.

Trans women, or Khawaja Sira, are a marginalized community in Pakistan. There is limited social inclusivity and high stigma for them in mainstream spaces. This leads to mental distress and compromised psychological well-being. The current study aims to identify latent classes of mental distress, substance use patterns, and their associated factors. A cross-sectional analytical study was conducted from 1 May 2025 to 10 June 2025 at seven community-based organizations. Self-identified trans women were recruited through the HIV community organization. Anxiety and depressive symptoms were measured using the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. Ask for Suicide Screening Questionnaire was used. A total of 681 trans women participated in the study. About 23.94% reported illicit drug use, 2.94% reported injectable drug use, 14.54% reported sexualized drug use (SDU), and 5.14% reported amphetamine-type stimulant use in the last six months. The latent class analysis revealed two latent classes with high and low mental distress. The probability of at least moderate depression, anxiety symptoms, and past-week suicidal ideation was 92.30%, 90.82%, and 53.23% in the high mental distress class. There was a significant relationship between higher education and mental distress, with an adjusted odds ratio (AOR) of 3.032 (95% CI 1.434-6.297) for those educated up to college and an AOR of 4.226 (95% CI 1.841-9.535) for those with university education. SDU had higher odds of mental distress, AOR 3.361 (95% CI 2.032-5.527). The study suggests that trans women need sensitive mental health services that cater to SDU as part of essential healthcare for the trans women community.

Despite progress in HIV prevention and treatment, global data suggests that youth living with HIV remain at risk of mental disorders and suicidality. However, reliable epidemiological data from South Africa (SA) are limited. We conducted a systematic review and meta-analysis to synthesize evidence on the prevalence of mental disorders and suicidality among SA children and adolescents (≤ 19 years) living with HIV. Following PRISMA guidelines, we searched PubMed, PsycINFO, Web of Science, Scielo (SA), and Google Scholar published before 19th February 2025. Twelve studies published between 2010 and 2024 met inclusion criteria, yielding 33 prevalence estimates for mental disorders and nine for suicidality. All studies used non-probability samples and screening instruments. Random-effects meta-analyses produced pooled apparent prevalence estimates of 11.5% for depression, 8.6% for anxiety, and 2.3% for PTSD, with substantial heterogeneity (I[2] >90%). After adjusting for measurement error related to screening tool sensitivity and specificity, pooled true prevalence estimates were markedly lower: 3.9% for depression, 4.0% for anxiety, and 1.3% for PTSD. Estimates of suicidality were sparse and highly variable, with suicidal ideation ranging from 1% to 42% and suicide attempts from 0.2% to 20%. Overall, the evidence base is geographically constrained and methodologically limited. When appropriately adjusted, the burden of mental disorders among young people living with HIV in SA appears more modest and heterogeneous than commonly reported, highlighting the need for improved measurement, broader diagnostic coverage, longitudinal designs, and nationally representative studies focused on structural and contextual determinants of mental health risk across childhood and adolescence.

Long-acting injectable (LAI) antiretroviral therapy (ART) for treatment of HIV requires more frequent healthcare interactions than standard care, offering opportunities to enhance monitoring and management of comorbid chronic conditions among people with HIV (PWH). We conducted in-depth interviews with PWH to explore perspectives on LAI-ART uptake and readiness to switch from oral ART, as well as opportunities to integrate chronic disease care into routine LAI-ART visits. Participants who were virally suppressed and had one or more chronic medical conditions were eligible. Transcripts were analyzed using applied thematic analysis, and readiness for LAI-ART was characterized using the Transtheoretical Model. Twenty-four PWH were interviewed (8 on LAI-ART and 16 on oral ART). Perceived advantages of LAI-ART included logistical convenience and relief from pill-related emotional burden, while disadvantages included dislike of injections and increased visit frequency. Provider guidance played a central role in decision-making, and satisfaction with current regimens reduced interest in LAI-ART. All participants receiving LAI-ART intended to continue this regimen, and readiness to switch among those receiving oral ART ranged from little interest to actively planning a transition. Despite varied views on LAI-ART as a personal treatment choice, most participants viewed integrating chronic disease management into LAI-ART visits as acceptable and beneficial, particularly for cardiovascular risk assessments, mental health, and social needs. Some participants on oral ART reported that access to integrated services could increase openness to initiating LAI-ART. Overall, LAI-ART visits were viewed as a potentially valuable platform for integrating chronic disease management that aligns with patient priorities.

In the early years of the AIDS epidemic, the occurrence and potential for heterosexual transmission of human immunodeficiency virus type 1 (HIV 1) in the United States were uncertain. To better understand infection among women and the possible role of prostitution in the emerging epidemic, the Centers for Disease Control and Prevention established CDC AIDS Project 72, a multisite study of 1 410 women with recent histories of prostitution recruited from eight areas of the United States during 1986 and 1987. Participants were interviewed, examined, and tested for serologic markers of HIV 1, hepatitis B virus (HBV), syphilis, herpes simplex virus types 1 and 2 (HSV 1 and HSV 2), and human T cell lymphotropic virus types I and II (HTLV I/II). HIV 1 antibodies were detected in approximately 12% of women tested, but prevalence varied considerably across study sites. HSV 2 was the most commonly detected infection, followed by HSV 1, HBV, syphilis, HIV 1, and HTLV I/II. HIV 1, HBV, and HTLV I/II were strongly associated with injection drug use, whereas syphilis and HSV 2 followed different patterns related to sexual exposure. Among women without evidence of injection drug use, infrequent condom use during vaginal intercourse with clients was associated with HIV 1 infection. Project 72 showed that prostitution alone did not explain infection risk among these women. Injection drug use, sexual and injection networks, local prevalence of infection, and the social circumstances in which women lived and worked were also important. The project contributed to an evolving public health approach that emphasized epidemiologic evidence, cooperation with affected communities, and practical strategies for reducing risk rather than assumptions about stigmatized populations.

The HIV/AIDS Services Administration (HASA) provides housing, benefits, and case management for low-income people with HIV (PWH) in New York City (NYC). HASA implemented three differentiated service delivery (DSD) pilots: Permanent Supportive Housing (PSH), Transitional Supportive Housing (TSH), and Emergency Single Room Occupancy (ESRO), testing tiered case management by housing type. The PSH pilot aimed to maintain viral suppression outcomes with higher caseloads (50:1), while the TSH and ESRO pilots aimed to improve outcomes with lower caseloads (25:1). We merged programmatic data with the NYC HIV Surveillance Registry to compare 6-month viral load suppression (VLS) and 12-month durable viral suppression (DVS) between pilot and non-pilot clients with follow-up through August 2022. Adjusted risk ratios (aRR) were estimated using log-binomial models. Actual caseload ratios were lower than planned: PSH (36:1), TSH (17:1), and ESRO (24:1, near its 25:1 target) compared with ~ 34:1 in non-pilot arms. VLS rates were higher among pilot clients: PSH (77% vs. 72%; aRR 1.03, 95% CI 0.99-1.07), TSH (65% vs. 56%; 1.06, 1.01-1.11), and ESRO (50% vs. 46%; 1.08, 0.99-1.17). DVS showed similar trends: PSH (70% vs. 62%; 1.05, 0.98-1.11), TSH (51% vs. 41%; 1.13, 1.05-1.22), and ESRO (37% vs. 29%; 1.11, 0.88-1.39). Implemented partly during the COVID-19 pandemic, the PSH and TSH pilots met their goals of maintaining or improving VLS and DVS, though lower-than-planned caseload ratios may have influenced outcomes. The ESRO pilot may have improved VLS slightly, but wide confidence intervals due to under-enrollment limit interpretation of DVS effects.

Female bar or sex workers (FBSWs) in Eastern Africa experience a high burden of HIV, but population-level data on HIV seroprevalence, incidence, and viral suppression among their male partners are limited. We identified 2,420 men who had ever reported sex with FBSWs in the past year among 17,438 male participants through longitudinal population-based HIV surveillance in southern Uganda (2013-2020), spanning four surveys in four Lake Victoria fishing communities (HIV seroprevalence ~40%) and 37 inland agrarian and trading communities (~12%). Primary outcomes were HIV seropositivity, incident infection, and viral suppression (< 200 copies/mL). Prevalence and incidence rate ratios (PR, IRR) were estimated using Poisson regressions with 95% confidence intervals (CIs). Among 17,438 male participants (35,273 visits), 2,420 (13.9%) reported FBSW partners at ≥ 1 study visit, who were generally older, less educated, had lower incomes, and were more likely to be previously married. Men with FBSW partners had significantly higher HIV seroprevalence than those without (32.6% vs. 10.3%; PR=3.16, 95% CI=2.93-3.40). Overall, 154 incident HIV infections occurred over 27,396 person-years of follow-up, with men with FBSW partners having higher incidence than those without (1.93 vs. 0.44/100 person-years; IRR=4.37, 95% CI=3.04-6.16). Viral suppression among men with HIV was similar between groups, but population-level HIV viremia was 1.6 times higher (95% CI=1.41-1.84) among men with FBSW partners due to their higher background seroprevalence. Men in Uganda frequently report sex with FBSWs, which is associated with a significantly higher risk of HIV acquisition. Tailored HIV prevention strategies, including approaches to promote PrEP uptake, may help reduce the HIV burden in this population.

Adverse childhood experiences (ACEs) are common among adolescent girls and young women (AGYW) in Sub-Saharan Africa, who also face a high burden of HIV. While prior research has focused on behavioural pathways linking ACEs and HIV, less attention has been given to the broader spectrum of adversities themselves, particularly household and community violence. This study examined the association between cumulative and individual ACEs and HIV prevalence among AGYW in rural South Africa. This cross-sectional study analysed data from the 2017 follow-up visit of the HIV Prevention Trials Network (HPTN) 068 randomised controlled trial. ACEs were dichotomised into physical abuse, emotional abuse, witnessing verbal violence at home, witnessing physical violence at home, and witnessing community violence. Early sexual debut (< 14 years) served as a proxy for childhood sexual abuse given the lack of a sexual abuse variable. A cumulative ACE score was created. Descriptive statistics assessed ACE prevalence, and logistic regression examined associations with HIV prevalence. HIV prevalence was 11.48%. While 38% of AGYW reported no ACEs, 62% experienced at least one. Cumulative ACEs were not significantly associated with HIV prevalence. However, physical abuse (aOR 1.57; 95% CI 1.03-2.41) and witnessing physical violence at home (aOR 1.63; 95% CI 1.07-2.49) were associated with higher odds of HIV infection. Specific ACEs, particularly childhood physical abuse and witnessing household violence, were associated with increased HIV risk among AGYW. Targeted, trauma-informed interventions are warranted to reduce vulnerability and support HIV prevention efforts.

People with HIV (PWH) are at increased risk for cardiovascular diseases and other age-related comorbidities. These risks can be reduced through moderate to vigorous physical activity (MVPA), but MVPA can be difficult to sustain over time. We tested tailored text messages combined with motivational interviewing (MI) to sustain MVPA among PWH. Messages were created using Two Minds Theory and matched to daily survey responses about exercise barriers. 118 PWH ages ≥ 50 were initially randomized to high-intensity interval training or continuous moderate-intensity exercise. After 16 weeks, 92 participants were re-randomized to receive either tailored messages plus MI, or educational control messages, for 12 weeks. Both groups completed daily barrier surveys and wore an ActiGraph monitor for 1 week/month. PWH in the tailored-messaging plus MI group maintained their MVPA, ending at M = 30.5 min per day (SD = 36.7), compared to a decrease among PWH in the educational-control group, ending at M = 26.0 (SD = 25.8), F(1, 255) = 5.76, p = .02, d = 0.51 for the group-by-time interaction using intent-to-treat principles. Findings were similar based on both actigraphy and self-reported MVPA, and were robust to attrition. PWH in the tailored-messaging group also reported higher exercise self-efficacy and better perceived health over time, relative to the educational-control group. Exploratory analyses suggested that the tailored messages' effects were additive to motivational interviewing. In this study, an automated tailored-messaging intervention led to sustained MVPA. Tailored messages were superior to non-tailored educational messages, and may help PWH maintain their long-term health.Trial registry ClinicalTrials.gov study NCT04550676.