Measuring alcohol and other drug (AOD) use remains challenging in HIV care in low- and middle-income countries, where self-report and point-of-care (POC) urine biomarkers capture different time windows. Among 2,059 people with HIV aged 40 years or older across eight IeDEA clinics (2020 to 2022), we examined what self-reported AOD use (AUDIT, ASSIST) and POC urine tests (uEtG for alcohol; 5-panel drug screen) each capture. Self-report identified more use than urine testing (unhealthy alcohol 19.7% versus uEtG-positive 12.2%), consistent with its longer recall window. Higher self-reported alcohol intensity was associated with uEtG positivity in a graded pattern, more strongly among women. Urine-positive but self-report-negative results, more common among men, suggested under-reporting. Self-report and biomarkers answer different measurement questions: self-report for longer-term burden and screening, biomarkers for recent use and corroboration. Combining both, including longer-window biomarkers, can strengthen AOD measurement among older PWH in LMICs.

Intravaginal rings (IVRs) can be efficacious, user-controlled devices to prevent pregnancy and HIV. Understanding potential user preferences for device characteristics can promote device uptake and use by informing design optimization. We elicited sensory perceptions from a convenience sample of women aged 18-45 years from a large statewide health system to iteratively inform design of a novel 3D-printed multipurpose (contraception and HIV prevention) technology IVRs. We assessed reactions to varying IVR designs and colors in nine virtual focus groups. We modified designs and assessed perceptions of visual AND tactile aspects of modified IVR designs in 25 individual in-person interviews. Overall, women perceived texture, hue, size, comfort, and hygiene as important. Smoother surface topography was preferred for perceived ease of insertion and ability to "see what was on it" for cleanliness. Lighter hues were seen as "calming". IVR size and pliability related most to perceived comfort, a priority for participants.

Hazardous alcohol consumption (HAC) among people living with HIV (PLHIV) has been associated with poor antiretroviral therapy (ART) adherence and unsuppressed HIV viral load (VL). We examined potential correlates of alcohol use and HAC among PLHIV aged ≥ 18 years using nationally representative data from the Tanzania HIV Impact Survey 2022-2023, a cross-sectional population-based household survey. Consenting individuals were tested for HIV and HIV-positive specimens were tested for HIV VL. HAC was determined using the World Health Organization "Alcohol Use Disorders Identification Test-Concise." Correlates of alcohol use and HAC were determined using binary logistic regression and sampling weights. Jackknife variance estimation was used to generate 95% confidence intervals (95% CI) and p values. Of 1793 individuals with positive HIV test results, 686 (34.5%) reported any alcohol consumption in the past year, and 364 (17.8%) reported HAC. Higher odds of HAC were observed among PLHIV aged 35-44 years (aOR = 2.35; 95% CI, 1.12-4.93; p = 0.026), 45-54 years (aOR = 2.66; 95% CI, 1.23-5.74; p = 0.015), and 55-64 years (aOR = 2.92; 95% CI, 1.31-6.55; p = 0.011) compared to those aged ≤ 24 years (7.5%). Also, among PLHIV with one sexual partner (18.3%, aOR = 1.85; 95% CI, 1.29-2.65; p = 0.002) and multiple partners (27.7%, aOR = 3.27; 95% CI, 1.84-5.81; p < 0.001) compared to those with no partner in the past 12 months (11.0%). No significant associations were found between alcohol use or HAC and reported ART missed days or VL suppression. In Tanzania, although nearly one-fifth of PLHIV reported HAC, it was not associated with HIV treatment outcomes.

In the United States, Black gay, bisexual, and other men who have sex with men (BGBM) continue to face disproportionate burdens of HIV. Contributing factors include unprotected sex with multiple partners, limited awareness of HIV prevention, stigma, racism, and structural barriers to healthcare access. Biomedical prevention strategies such as pre-exposure prophylaxis (PrEP) have demonstrated effectiveness in reducing HIV transmission. However, social perceptions, stigma, and anticipated discrimination continue to influence uptake and adherence. This scoping review examined literature published between 2017 and 2024 to identify how social networks and social media shape prevention behaviors among BGBM. Guided by Social Network Theory (SNT), the review synthesized findings from 21 studies across four contexts: House Ballroom communities, social media, faith-based settings, and dating apps. Results highlight the role of culturally tailored and community-based interventions, including those delivered in religious settings, in supporting prevention uptake, while digital platforms demonstrated strong potential for outreach, testing, and linkage to care. These findings underscore the need for interventions that integrate biomedical prevention tools with culturally responsive approaches to reduce disparities and improve HIV prevention outcomes for BGBM. Findings provide suggestions for future HIV interventions for BGBM.

Pure and total movement dispersion are measures of the spread of physical activity (PA) across the day, without (pure) and with (total) intensity. Men with HIV (MWH) tend to have lower PA, more sedentary behavior, and poorer sleep quality and quality of life than men without HIV (MWOH). This study explores the relationship of pure and total movement dispersion with sleep quality, total sleep time, and quality-of-life (QoL) among MWH and MWOH. This study was a secondary analysis from the MACS/WIHS Combined Cohort Study (MWCCS). Participants wore an ActiGraph and an Actiwatch accelerometer on their wrist for 7 days to measure PA and sleep and completed the Pittsburgh Sleep Quality Index and the Medical Outcomes Study Short Form. Spearman's Rank Correlation and multivariable linear regressions were used to analyze relationships among variables. 594 participants were included (Mage = 58.1, 55% MWH, 62% White). MWH demonstrated higher pure (Z = - 3.893, p < 0.001) and total movement dispersion (Z = - 3.826, p < 0.001) than MWOH. MWH reported worse sleep quality (t = - 3.030, p=.003) and general QoL (t = 2.942, p = 0.003), yet better health compared to last year (t = - 2.557, p = 0.011) than MWOH. Pure movement dispersion was significantly associated with less total sleep time (B = - 1.227, p < 0.001), and total movement dispersion was significantly associated with a higher global general health (B = 7.498, p = 0.044). Movement across the day, with and without regard to intensity, warrants exploration on whether the way an individual achieves PA is dispersed matters more than the accumulated minutes.

Engaging in moderate-to-vigorous physical activity (MVPA) is essential for healthy aging in people with HIV (PWH), though social determinants may influence activity levels. This cross-sectional study examined associations between neighborhood social vulnerability, social support, and MVPA among 198 PWH aged ≥ 50 from the PROSPER-HIV study across four U.S. sites. MVPA was measured with ActiGraph accelerometers (minutes/week), social vulnerability with the Social Vulnerability Index (SVI), and social support with the Multifactorial Assessment of Perceived Social Support-Short Form. Linear regression models were used to estimate the associations between study variables, adjusting for age, sex, and site. Median MVPA was 110 min/week (IQR: 48.03-237.05). Higher SVI was associated with MVPA in unadjusted models but did not reach statistical significance (β= -1.77; p = 0.053), and this association was attenuated after adjustment (p = 0.20). Social support was not associated with MVPA. Findings highlight the need for larger studies using more precise measures of structural factors relevant to physical activity among older PWH.

Sexualized drug use (SDU) is a known phenomenon with significant implications for HIV vulnerability. Chemsex, a specific subset of SDU, involves the use of substances such as GHB/GBL, mephedrone, or methamphetamine to facilitate sexual activity. This study investigated factors associated with SDU among sexual and gender diverse adolescents (SGDa) in Brazil. This study used data from the PrEP15-19 project, a cohort investigating the implementation of daily oral PrEP among SGDa in Brazil. A structured sociobehavioral questionnaire was administered at baseline between February 2019 and February 2023. SDU was defined as the use of alcohol or drugs before or during sexual intercourse. Bivariate and multiple logistic regression models were used to identify factors associated with SDU. Among 1,264 adolescents, the prevalence of SDU was 30.1%. The most frequently used substances in the three months prior to the survey were alcohol (87.7%), marijuana (44.8%), and cocaine (8.5%). The prevalence of chemsex was low (2.4%). Adjusted factors significantly associated with increased SDU included: being a transgender woman (aOR: 1.80; 95% CI: 1.04-3.11); engaging in transactional sex in the last 3 months (aOR: 2.16; 95% CI: 1.45-3.23); engaging in group sex in the last 3 months (aOR: 1.54; 95% CI: 1.07-2.22); and having more than three sexual partners in the last 3 months (aOR: 1.67; 95% CI: 1.20-2.33). SDU has a high prevalence among Brazilian SGDa and represents a critical factor in understanding the high rates of HIV infection in this population.

We examined buprenorphine prescribing among adults in the United States with opioid use disorder or other opioid-related diagnoses and coexisting HIV, hepatitis B, or hepatitis C from 2015 to 2025. Using the TriNetX USA Minimal Date Shift Network, we constructed annual cohorts and assessed encounter-day buprenorphine prescribing, with and without chronic pain diagnoses. Prescribing rose from 6% in 2015 to 17% in 2020, then plateaued at 16-19% through 2025, with marked attenuation after 2020. Despite expanded prescriber eligibility, most were not prescribed buprenorphine at clinical contact, suggesting regulatory reform alone is insufficient and that integrated, systemic approaches are needed.

Pre-exposure prophylaxis (PrEP) is a prevention approach with potential for reducing HIV incidence with widespread adoption. Despite this, more research is needed to inform interventions to optimize PrEP use. Motivational interviewing (MI) shows promise for enhancing PrEP utilization, however, research comprehensively examining its effectiveness in advancing PrEP care continuum participation remains limited. This study aims to address this deficit through a systematic literature review, utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Let Evidence Guide Every New Decision (LEGEND) guidelines to examine facets of MI's impact on PrEP awareness, uptake, and retention. Though this research is relatively nascent (n = 22), findings indicate MI's effectiveness in advancing PrEP care continuum participation, interventions integrating MI are deemed acceptable and feasible, and various factors (e.g. capable staff, cultural tailoring, fidelity/adherence to process) advance intervention effectiveness. Future studies should explore long-acting PrEP modalities and consider the impacts of social determinants.

Promoting pre-exposure prophylaxis (PrEP) initiation to prevent new HIV infections among vulnerable populations continues to present significant challenges. Behavioral economics may provide a useful framework to help elucidate decision-making processes influencing valuation and use of PrEP. We developed two novel behavioral economic tasks assessing demand for PrEP pills and PrEP injection. Participants consisted of Black and Hispanic gay and bisexual men (GBM; N = 144), 18 to 34 years old, and recruited from Texas. Participants completed an online battery including PrEP demand tasks and questions related to PrEP use and intentions. Probability of purchasing PrEP treatment decreased with increasing PrEP price on both tasks and were well described by the exponentiated demand model. Five group comparisons were conducted based on reported PrEP use and intentions. Bayesian generalized linear models were used to compare those responding "Yes" vs. all others (i.e., "No", "Don't know", "Prefer not to say"), revealing generally greater PrEP pill demand among current pill users as well as generally greater PrEP injection demand among those having discussed injectable PrEP with their care-provider, planning on discussing injectable PrEP with their care-provider, and planning on taking injectable PREP (all posterior probabilities ≥ 75%) but not for those having simply heard of injectable PrEP. Findings provide initial support as to the utility and construct validity of our PrEP demand tasks, providing an initial foundation for identifying those requiring additional intervention to improve valuation and use of PrEP.

This study employs a neighborhood-level Social Protection Index (SPI) to analyze how socioeconomic factors relate to the detection of HIV, acquired syphilis, and mpox. We conducted a retrospective analysis of 2022 surveillance data from Rio de Janeiro, Brazil, using case notifications geolocated to neighborhoods. Population data were obtained from the 2022 census. Neighborhoods were stratified by SPI into quintiles, and detection rates per 100,000 population were calculated by sexual exposure category. Associations between age, SPI, and detection rates were analyzed using multilevel Poisson regression models with random intercepts, fitted separately for men who gave sex with men (MSM), heterosexual men and women. Of 2,876 new HIV cases, the highest detection rate was among MSM (1,522/100,000). Of 13,676 syphilis cases, the male-to-female detection ratio was 1.7:1. Of 957 mpox cases, 80% occurred among MSM (812/100,000). HIV and syphilis clustered in lower SPI neighborhoods, while mpox concentrated in higher SPI neighborhoods. For HIV, younger age showed the strongest association among MSM, while lower SPI was strongest among women. For syphilis, younger age was most important among women, with strong SPI associations in both sexes. Among MSM, mpox was concentrated in 25-39 age group and higher SPI neighborhoods. Strong socioeconomic gradients among women reflect intersecting gender and socioeconomic inequalities. Among MSM, attenuated socioeconomic gradients and distinct mpox patterns suggest social and sexual networks shape transmission alongside structural factors. Prevention must address social determinants and network structures.

Illness perceptions (beliefs about illness identity, impact, understanding, and control) are connected with clinical and psychological outcomes. According to the relationship-oriented model of HIV-related stigma, stigma affects individuals and their significant others. Among mothers living with HIV and their children with perinatally acquired HIV (PHIV) who experience stigma, adaptive or maladaptive illness perception clusters could play a moderating role. This study investigated the extent to which illness perception clusters moderate the dyadic stigma-resilience associations among such mothers and children. In this cross-sectional survey, 123 Chinese dyads of mothers living with HIV and children with PHIV completed measures of illness perceptions, HIV-related stigma, and resilience. For both mothers and children, hierarchical cluster analyses identified an adaptive cluster (lower perceived impact and higher control; mothers: 37.4%, children: 56.9%) and a maladaptive cluster (higher perceived impact and lower control; mothers: 62.6%, children: 43.1%). Mothers and children in the adaptive cluster reported lower stigma and higher resilience. Actor-partner interdependence models (APIM) examined dyadic stigma-resilience associations, showing that higher maternal and child stigma predicted lower child resilience. APIM moderation models showed that illness perception clusters moderated the dyadic stigma-resilience associations: only among dyads with mothers in the maladaptive cluster, mothers' and children's higher stigma predicted their own lower resilience. Only among children in the adaptive cluster, children's higher stigma predicted their lower resilience. These findings extend the relationship-oriented model to mothers and their children living with HIV and call for consideration of both members' illness perceptions and mothers' HIV-related stigma.

Pre-exposure prophylaxis (PrEP) is central to Ending the HIV Epidemic, yet uptake in the United States remains low and geographically uneven. Counties with persistently low PrEP use and limited local PrEP-prescribing infrastructure may represent "PrEP deserts," where geographic and structural barriers to HIV prevention converge. Prior studies have relied on travel-time measures or census tract-level analyses, limiting county-level insight. We conducted an ecological study of 2,257 US counties by linking AIDSVu PrEP-use estimates (2019-2023) with 5,856 PrEP-prescribing clinics identified through the CDC National Prevention Information Network. PrEP deserts were defined as counties with PrEP use in the lowest quartile in at least 3 of 5 years and no in-county PrEP-prescribing clinic in 2025. Mixed-effects logistic regression with a state-level random intercept was used to identify characteristics associated with PrEP desert status. Compared with metropolitan counties, micropolitan counties had higher odds of PrEP desert status (aOR: 2.90; 95% CI, 2.10-4.01), as did rural counties (aOR: 2.12; 95% CI, 1.50-3.01). Each 1-percentage-point increase in the proportion of uninsured residents was associated with 17% higher odds of PrEP desert status (aOR: 1.17; 95% CI, 1.04-1.32). Compared with counties in the South, counties in the Midwest had higher odds of PrEP desert status, whereas counties in the Northeast had lower odds. PrEP desert counties were concentrated in nonmetropolitan areas, in the Midwest and South, and in counties with higher uninsurance rates. Expanding pharmacy-based PrEP services and telePrEP, alongside strategies to reduce financial barriers, may improve access and reduce geographic disparities in HIV prevention.

Patient-centered PrEP choice in antenatal care may promote effective use of PrEP to reduce the risk of maternal HIV acquisition. To inform patient-centered counseling, we sought to understand values that pregnant women considered in their PrEP decision-making and their relationship with PrEP use in the context of an adherence support trial in Lilongwe, Malawi. 200 women completed an enrollment survey reporting values (motivations and concerns) they considered when deciding to use PrEP. We examined the associations of these values with study retention and adherence to PrEP (pharmacologic assessment), at 3 and 6 months after enrollment by estimating probability differences (PD). Thirty women and 10 study staff also completed in-depth interviews on the influence of women's values on PrEP adherence. We thematically analyzed interview transcripts through topical coding and summary matrices. Quantitatively, women reporting concerns related to PrEP disclosure and stigma were less likely to be retained. At 6 months, women concerned about partner disclosure (65.0% vs. 87.8%; PD: -22.8%, 95% CI: -44.2%, -1.3%) and family disclosure (68.2% vs. 87.6%; PD: -19.5%, 95% CI: -39.5%, -0.1%), and those who worried they would be perceived as living with HIV (74.5% vs. 88.9%; PD: -14.4%, 95% CI: -27.8%, -1.0%) were less likely to be retained than women without these concerns. Qualitatively, stigma-related concerns led women to avoid PrEP disclosure and conceal their PrEP use which made adherence difficult. Many missed early doses due to concerns about side effects and safety. Some who enrolled with an STI perceived less need for PrEP after their STI resolved. To address adherence barriers, counseling should address the difference between PrEP, ART, and STI treatments. Disclosure support and follow-up counseling to address side effects may also promote PrEP adherence.