Transgender women experience disproportionate HIV risk because of social and structural inequities that limit access to respectful and confidential healthcare. Targeted Interventions (TIs) under India's National AIDS Control Programme are community-based service platforms that provide peer outreach, HIV and sexually transmitted infection (STI) education, condom and lubricant distribution, counselling, testing and referral linkages. Puducherry, India with an established Community Based Organization (CBO)-led TI programme and high reported service coverage, provides an opportunity to examine whether frequent programme contact translates into acceptable and equitable access to broader healthcare. This convergent mixed-methods study assessed utilisation of TI service components and explored barriers and facilitators influencing service use among transgender women enrolled in a CBO-led TI programme in Puducherry, India. Between November 2023 and January 2024, 99 of 130 active programme beneficiaries completed an interviewer-administered structured questionnaire. Qualitative data were collected through two focus group discussions, two in-depth interviews with transgender women and eight key informant interviews with programme and health-system stakeholders. Quantitative data were analysed descriptively, while qualitative data underwent inductive-deductive thematic content analysis and were mapped to the socio-ecological framework. Most participants received HIV/STI information from peer educators or outreach workers (96.9%), condom-use demonstrations (96.9%), STI check-up and counselling (98.9%), condoms (94.9%), lubricants (92.9%) and had visited the drop-in centre (98.9%). HIV testing had been undertaken by 97.9% of participants, with a median of two tests in the preceding year. Peer-led communication, trust and confidentiality within the CBO, transgender representation among staff, repeated outreach contacts, digital communication, and support for social and legal concerns facilitated service use. However, anticipated stigma, fear of disclosure, gender-binary registration systems and queues, insensitive behaviour by non-clinical staff, privacy concerns at local facilities, inconvenient clinic timings, condom-quality concerns, factional exclusion within community networks, and staff workload and low remuneration constrained access. High TI utilisation among enrolled beneficiaries did not ensure equitable access to routine healthcare. Strengthening gender-inclusive public health services, confidential and flexible referral pathways, commodity quality, social-support linkages and CBO staffing is needed to improve comprehensive care for transgender women.

People with HIV (PWH) smoke cigarettes at a prevalence nearly two times higher than the United States (US) population. Stigma may contribute to persistent smoking among PWH, yet the interaction of HIV- and smoking-related stigma on smoking behaviors remains unexplored. This secondary analysis of self-report survey data included 81 adults with HIV and current cigarette smoking recruited from the Bronx, New York (US). Sequential logistic regression models examined main and interaction effects of HIV stigma and smoking stigma on cigarette dependence and motivation to quit smoking. Greater smoking stigma was associated with higher cigarette dependence, with and without adjusting for age (ps = 0.01). Participants reporting higher smoking stigma had nearly four times greater odds (95% CI: 1.43-10.44) of higher cigarette dependence. Follow-up analyses of smoking stigma subscales found that the Felt Smoking Stigma subscale was associated with higher cigarette dependence (p = 0.04). HIV stigma and the HIV and smoking stigma interaction were not associated with cigarette dependence. Neither stigma was associated with motivation to quit smoking. Smoking stigma, particularly perceiving judgement from others related to smoking, was associated with greater cigarette dependence among PWH. Smoking-related stigma may be an important psycho-behavioral target for cessation interventions for PWH who smoke.

HPV vaccination rates in the United States have plateaued, despite its efficacy in preventing cervical, anal, vaginal, and oropharyngeal cancers. We assessed HPV vaccination rates at the University of Nebraska Medical Center's Specialty Care Center (SCC) following 2019 ACIP/CDC guidance. We retrospectively evaluated patients aged 19-45 who established care at SCC prior to 31 December 2024. The primary outcome was HPV vaccination series completion. Exploratory outcomes included receipt of > 1 HPVvaccine dose, abnormal diagnostic tests, HPV-related cancers, and composite HPV-associated outcomes. Descriptive statistics summarized cohort characteristics, and Chi-square tests compared outcomes. There were 1068 patients included, 402 completing the HPV vaccination series and 553 receiving >1 dose, with no significant difference between patients with HIV and those on HIV PrEP. There were 236 abnormal diagnostic tests in 181 unique patients. Patients receiving > 1 HPV vaccination had more abnormal cervical Pap smears (p = 0.044) and condyloma (p = 0.002) compared to no/unknown HPV vaccination. However, comparison of HPV-associated outcomes versus vaccination timing showed most outcomes occurred either prior to vaccination or in patients with no documented vaccination. Earlier HPV vaccination was associated with a lower incidence of HPV-associated complications, reinforcing clinical effectiveness and the need to prioritize patient follow-up to ensure vaccine series completion.

Globally, significant progress toward ending the HIV/AIDS epidemic includes advances in HIV treatment, converting a fatal infection to a chronic disease. Adolescents living with HIV (AWHIV) continue to underachievein HIV viral suppression (VS) needed to remain healthy. This cross-sectional study aimed to examine the role of self-management and related factors in VS among AWHIV aged 15-19 years in Dar es Salaam, Tanzania. A total of 658 AWHIV from ten large HIV care and treatment sites were assessed on HIV-related self-management, depression, HIV stigma, physical quality of life and social support. HIV viral load was abstracted from clinical records. Generalized linear models were used to examine unadjusted and adjusted mean differences in self-management scores between the two groups. Over half of the AWHIV, 403(78%), had achieved VS. Overall, sub-scale self-management scores did not differ significantly between groups (p > .05); however, three self-management items significantly differed by VS status: health self-efficacy (p = 0.049), life ambitions/goals (p = 0.031) and ART administration knowledge (p = 0.044). Adjusted models attenuated self-efficacy and ambition differences while ART knowledge differences persisted (p = 0.005). Physical quality of life, social support and stigma significantly moderated relationships between self-management items and VS. These findings suggest that focusing on targeted self-management behaviors may provide a more accurate understanding of their influence on VS than aggregated self-management scores.

The prevention of HIV and other sexually transmitted infections remains a challenge in key populations, such as men living with HIV. The aim of this study was to evaluate the acceptability, feasibility, utility, and usability of a single-session, self-administered digital intervention designed to promote condom use. A pilot study was conducted with 30 participants, who completed the intervention and an evaluation questionnaire; in addition, six semi-structured interviews were conducted to explore their experiences. The quantitative results showed significantly high scores across all dimensions assessed, while the qualitative findings indicated that the intervention was perceived as useful, accessible, and relevant for encouraging reflection on sexual practices and decision-making. Furthermore, participants highlighted the importance of the privacy and autonomy offered by the digital format. However, areas for improvement were identified regarding the personalization of content and the inclusion of emotional and relational aspects. Overall, the results suggest that this type of intervention represents a promising strategy within prevention approaches, although further studies are required to evaluate its effectiveness in modifying behaviors, such as consistent condom use.

Even though adolescents remain a priority population in HIV prevention, gendered and contextual conditions continue to shape condom use and HIV testing. Therefore, this study examined how gender, age, location, and school composition intersect in relation to HIV testing and condom use among adolescents. Using a cross-sectional design, the study applied stratified random sampling to select 552 adolescents, collected data via questionnaires and analysed the data using logistic regression. The results indicate that, albeit in different directions, the gender factor was associated with both condom use and HIV testing. Boys had significantly higher odds of reporting condom use than girls (B = 0.482, SE = 0.175, OR = 1.620, 95% CI [1.149-2.285], p = 0.006) whereas adolescent age group (14-16 years versus adolescents aged 17-19 years), location (urban versus rural) and school ownership (private versus public) were not significantly associated with condom use. For HIV testing, boys had lower odds than girls (OR = 0.26, 95% CI [0.12-0.58], p = .001), whereas school type, age, and location were not significantly associated with testing. These findings suggest the need for gender-responsive interventions to further strengthen HIV testing among boys and condom-use negotiation and decision-making skills among girls.

Incidence of dolutegravir (DTG) discontinuation is higher and wider in real-world studies than in clinical trials, with different associated factors. In Brazil, evidence on this matter remains scarce, representing a major gap in the literature. Therefore, this study assessed the incidence and factors associated with DTG discontinuation among patients initiating antiretroviral therapy (ART) in Brazil. A retrospective cohort study was conducted using data from the Brazilian Ministry of Health, which included all individuals recorded in national information systems who initiated ART with DTG between 2017 and 2019 (n = 111,286). Sociodemographic, laboratory, and antiretroviral use data from this period were analyzed. Kaplan-Meier curves described the cumulative incidence and mean time to DTG discontinuation, with comparisons using the log-rank test. Univariate and multivariate logistic regression analyses evaluated factors associated with discontinuation, reporting crude and adjusted odds ratios with 95% confidence intervals. The incidence of DTG discontinuation was 17.9%. Multivariate analysis showed that female sex, lower education, non-white skin color, lower CD4+T cell counts, higher viral load, ART non-adherence, and adverse drug reactions significantly increased the likelihood of discontinuation. These findings provide evidence to support public policies and strategies in the Brazilian Unified Health System to reduce DTG discontinuation and improve outcomes for people living with HIV.

In 2023, an estimated 2.38 million children and adolescents aged 0-19 were living with HIV globally, most in sub-Saharan Africa. In the Democratic Republic of Congo (DRC), stigma, weak psychosocial support, and disclosure challenges undermine adherence among adolescents. In response, Médecins Sans Frontières and Jeunesse Espoir launched youth clubs in Kinshasa in 2019 to promote adherence and peer-based psychosocial care. This qualitative study explored young people's perspectives on these clubs and their impact on treatment, identity, and daily life. We conducted 46 semi-structured interviews, four focus groups, and 16 observational sessions across four youth HIV clubs with adolescents and young adults aged 14-24, alongside healthcare providers and peer facilitators. A participatory Photovoice component engaged 10 youth in documenting their experiences through photography and collective reflection. The clubs were described as safe spaces that fostered peer solidarity, HIV knowledge, adherence strategies, and emotional well-being. Photovoice themes such as "hope" and "agency" highlighted processes of identity reconstruction. While youth valued peer support, they also reported persistent barriers including stigma, limited family involvement in disclosure, and lack of structured transition to adult care. Findings suggest that youth clubs operate as psychosocial ecosystems supporting adherence and self-acceptance, and scaling up this model could strengthen adolescent HIV care.

Migrant sex workers in Canada experience substantial barriers to sexual health. This mixed-methods study examined their sexually transmitted infection (STI) testing experiences in Metro Vancouver, British Columbia. Quantitative data from 167 migrant women sex workers, a subsample of a longitudinal community cohort study, were analyzed. Multivariable generalized estimating equation analyses examined associations of healthcare barriers, insurance coverage, sex work outreach services, language, and stigma with recent STI testing. Qualitative thematic analysis of 22 interviews with indoor migrant women sex workers provided contextual understanding of barriers experienced. Experiencing healthcare barriers and limited English fluency were each associated with reduced recent STI testing; qualitative findings revealed institutional inadequacies in providing multilingual care. Sex work outreach service use was associated with increased recent testing, a finding also confirmed qualitatively. Although healthcare coverage showed no significant association, qualitative narratives revealed concerns about privacy and mandatory reporting, and hesitancy about testing with primary care providers due to stigma and limited multilingual providers. Sex work stigma was associated with increased recent STI testing, a seemingly counterintuitive result that was qualitatively elaborated through participants' strategic disclosure practices. The study suggests an urgent need for culturally responsive STI testing options that prioritize confidentiality, peer support, health system navigation resources, and stigma reduction.

Research on factors associated with quality of life (QoL) among people living with HIV (PLHIV) in Malaysia is reported to be fragmented and underexplored. In response, the current systematic review aimed to synthesise the existing evidence regarding factors associated with QoL among this population. A systematic search for studies in PubMed, MEDLINE, Scopus, APA PsycArticles, and CINAHL databases from inception up to 21 June 2026 was conducted. The inclusion criteria were original peer-reviewed papers, conducted with adult PLHIV in Malaysia, investigated factors associated with QoL, published in English or Malay language, and with available full-texts. Data extraction of the selected articles was conducted, followed by a quality assessment. Eleven studies met the eligibility criteria and were included in the systematic review. Thematic synthesis revealed 27 factors, which were then categorised into five analytical themes (physical, environmental, social, psychological, spiritual), reflecting most of the WHO Quality of Life (WHOQOL) framework. While different factors and domains were significantly associated with QoL among PLHIV in Malaysia, a limited number of papers were available for evaluation. Despite this, this review could offer clarity to disparate localised data, encourage future research, and practice initiatives to focus on these factors and domains in a more holistic manner.Abbreviations: AIDS: acquired immunodeficiency syndrome; ART: antiretroviral therapy; CASP-12: Control, Autonomy, Self-realisation, and Pleasure-12 scale; EQ-5D-3L: European Quality of Life Five-Dimension Three-Level Scale; EQ-VAS: EuroQol Visual Analogue Scale; FAHI: Functional assessment of human immunodeficiency virus infection; HAT-QoL: HIV/AIDS-Targeted Quality of Life; HIV: human immunodeficiency virus; HRQOL: health-related quality of life; IDUs: injecting drug users; JBI: Joanna Briggs Institute; LMIC: Low- and Middle- Income Countries; QOL: quality of life; SF-36: RAND 36-Item Health Survey; UNAIDS: Joint United Nations Programme on HIV/AIDS; WHO: World Health Organization; WHOQOL-BREF: World Health Organization Quality of Life; WHOQOL-HIV BREF: World Health Organization Quality of Life - HIV.

We analyzed data from 526 people living with HIV (PLWH) enrolled in the Tel-Me-Box study across two urban ART clinics in Karnataka, India, followed for 24 months. Depressive symptoms, internalized HIV stigma, sociodemographic variables, disclosure status, number of physical symptoms, employment status and household income were assessed at baseline, 6, 12, 18 and 24 months. We used logistic regression for repeated measures to examine concurrent and time-lagged associations, adjusting for time-invariant and time-varying predictors. At baseline, the mean age of participants was 39.5 years, half (50.8%) were female, 14.8% reported at least mild depressive symptoms, and the mean number of physical symptoms reported was three. The mean internalized HIV stigma score was 0.52 (range 0-3). In multivariable analyses, internalized HIV stigma (Concurrent analysis: adjusted odds ratio (AOR) 2.23, 95% CI 1.81-2.73, p < 0.001; Lagged analysis: AOR = 1.61; 95% CI 1.30-1.99; p < 0.001) and the number of physical symptoms (Concurrent analysis: AOR 1.68, 95% CI 1.57-1.79, p < 0.001; Lagged analysis: AOR = 1.32; 95% CI 1.23-1.42; p < 0.001) were significantly associated with depressive symptoms. Therefore, internalized HIV stigma independently predicts depression among PLWH in southern India.

Cisgender women and transgender people remain underrepresented in pre-exposure prophylaxis (PrEP) programmes in Spain. This retrospective observational single-centre cohort study aimed to describe sociodemographic characteristics, access pathways and HIV and sexually transmitted infections (STI) prevention interventions among cisgender women and transgender people seeking PrEP at a specialised HIV/STI clinic in Barcelona, Spain, between January 2020 and December 2024. Secondary objectives were to evaluate PrEP initiation and retention and to compare outcomes between cisgender women and transgender participants. A total of 182 participants were included: 63.2% cisgender women, 34.6% transgender women and 2.2% transgender men, with a median age of 34 years. Most were migrants (87.5%), engaged in sex work (92.2%) and 45% reported active drug use. More than half (54.9%) accessed PrEP through community-based organisation referral, especially transgender individuals. PrEP initiation was high among those attending the first visit (86.5%), but retention was poor, with 46.7% considered lost to follow-up. STI prevalence was high before and after PrEP initiation, with transgender participants showing a significantly greater burden. Community-based, gender-affirming, integrated sexual health models are essential to improve equitable access, continuity of care and HIV prevention outcomes.Abbreviations: CBO: community-based organisation; GHB: gamma-hydroxybutyrate; HAV: hepatitis A virus; HBV: hepatitis B virus; HIV: human immunodeficiency virus; HPV: human papillomavirus; IQR: interquartilic range; LGBTIQ+: Lesbian, Gay, Bisexual, Transgender, Intersex, Queer and other identities; LGV: lymphogranuloma venereum; NA: not available; NGO: non-governmental organisation; PEP: post-exposure prophylaxis; PrEP: pre-exposure prophylaxis; STI: sexually transmitted infection; SW: sex worker .

In sub-Saharan Africa, HIV risk increases during pregnancy and the postpartum periods. Biomedical HIV prevention, such as pre-exposure prophylaxis (PrEP), has demonstrated safety and efficacy; however, uptake and continuation rates are low. Male partners are an important influence on women's PrEP use, yet little is known about how to engage partners effectively in PrEP research. Between July and November 2024, 20 qualitative in-depth interviews were conducted with pregnant and postpartum women and their male partners (10 couples) in a clinic in Gaborone, Botswana. Interviews explored PrEP decision-making, perceived risks and benefits, and preferences for partner involvement in PrEP research. Overall, the decision for women to participate in PrEP research was shaped by a couple-focused approach emphasizing partnership. Concern for the baby's health encouraged shared decision-making but sometimes justified women making the final call. Male partner participation in women's PrEP research was seen as beneficial, through increasing support for women and providing an opportunity to link men with health services. Our findings suggest that male involvement in women's PrEP research and services could benefit both partners. Future research should seek to increase men's engagement in women's health while placing importance on safeguarding women's autonomy.

Transwomen in Ghana face significant barriers to accessing HIV prevention and care services because of marginalization and discrimination within health systems. Peer educators are increasingly used as intermediaries, yet their contributions and potential harms for transwomen in under-resourced communities remain underexplored. This study examined how peer educators support or hinder transwomen's engagement with HIV prevention and care services in urban slum communities in Ghana. In-depth qualitative interviews were conducted with 20 transwomen recruited through purposive and snowball sampling in the Greater Accra Metropolitan Area. Guided by the Dennis Peer Support Model, findings showed that peer educators provided emotional, informational, and appraisal support. Emotional support included listening, showing empathy, accompanying transwomen to HIV testing facilities, and encouraging testing. Informational support involved providing guidance on antiretroviral therapy, correcting misconceptions about HIV, and promoting healthier decisions. Appraisal support strengthened participants' sense of responsibility for HIV prevention and care through relevant information and encouragement. Overall, peer educators played an important role in facilitating access to HIV prevention and care services among transwomen in urban slums. The findings underscore the value of peer-based approaches in improving HIV-related health outcomes and supporting transwomen to live fulfilling lives while living with HIV in resource-constrained settings in Ghana.