Disclosure of HIV serostatus is critical in managing the health and well-being of people living with HIV/AIDS (PLWHA), yet the decision to disclose is shaped by complex interpersonal and contextual factors. The purpose of this study was to examine patterns of HIV status disclosure and social support, and to characterize disclosure networks among a cohort of PLWHA in Kenya. We conducted a cross-sectional egocentric social network analysis of 174 PLWHA and their network members to examine whether characteristics of participants (egos), their networks, and network members (alters) were associated with HIV serostatus disclosure. Generalized linear mixed model (GLMM) examined alter characteristics, social support, trust levels, and an interaction between trust and intimate partners in predicting disclosure. The model was also stratified by trust to assess differences between low and high trust. Overall, 163 (93.7%) participants disclosed their HIV status to at least one person in their network. In the multivariable analyses stratified by trust, in ego-alter dyads where trust is high, the odds of disclosure are higher (aOR 35.34, 95% CI [10.05-124.32]) if the alter is a partner and a child (aOR 3.60, 95% CI [1.31-9.87]). In addition, disclosure was significantly more likely with alters perceived to provide health-related support (aOR 16.43, 95% CI [8.17-33.03]) or emotional support (aOR 3.20, 95% CI [1.75-5.86]). In Kenya, where disclosure decisions intersect with social dynamics, understanding the characteristics of disclosure networks can inform public health interventions that strengthen supportive relationships and reduce barriers to disclosure.

Despite advances in antiretroviral (ARV) medications, the most common regimens require daily pill-taking. While there is consensus that social determinants of health (SDoH) hinder ARV adherence, these are typically measured and intervened upon at the individual level. Meanwhile, the relationship among neighborhood conditions, individual exposure to SDoH, and HIV medication adherence is not well understood. To explore pathways among them, we used structural equation modeling (SEM), linking a neighborhood disadvantage index (NDI) to baseline data from a national cohort study of intimate partner violence among partnered gay, bisexual and other men who have sex with men living with HIV. Among 371 participants, SEM analysis supported an indirect association of NDI to low ARV adherence (b=0.03; 95% confidence interval [0.01, 0.06]), through cumulative exposure to SDoH. Understanding the contribution of neighborhood conditions to SDoH exposure may improve HIV medication interventions, destigmatizing disclosure of non-adherence and the selection of correspondingly forgiving regimens.

Paediatric HIV outcomes in sub-Saharan Africa (SSA) have significantly improved over the past two decades, largely due to donor-funded programmes that promote early infant diagnosis (EID), antiretroviral therapy (ART), and community-based service delivery. Despite these achievements, many countries in the region remain highly dependent on external donor financing, raising concerns about the sustainability of paediatric HIV services during periods of funding uncertainty. This scoping review examined how donor funding disruptions impact paediatric HIV service continuity in SSA and their system-level consequences for children. This review included studies published between January 2005 and November 2025. Following the PRISMA-ScR guidelines, studies were analysed using descriptive statistics and narrative synthesis with findings organised across the paediatric HIV care cascade. Across nine studies, donor transitions, especially those related to PEPFAR, were linked to workforce reductions, supply chain disruptions, and the elimination of community-based outreach programmes. These changes contributed to delays in EID, weakened linkage to care, disruptions in ART initiation, and decline in retention. These effects occurred through interconnected health-system pathways rather than isolated programme failures. Overall, the results show that paediatric HIV services remain highly dependent on donor-supported systems, with limited transition preparedness. Transition frameworks should prioritise paediatric service continuity, strengthen health-system resilience, and align financing responsibilities between donors and governments to reduce preventable child morbidity and mortality.

This study analyzes the enforcement of viral hepatitis criminalization in the United States. Indiana is one of nine states with laws criminalizing viral hepatitis exposure. Using a legal epidemiological approach, we reviewed court records and probable cause affidavits to identify prosecutions involving people living with hepatitis C virus (HCV) under Indiana's Battery by Bodily Fluid and Waste law between 2011 and 2025. We identified 94 cases involving 98 HCV exposure incidents and assessed transmission risk using a novel HCV Transmission Risk Classification Framework. None of the incidents alleged conduct posing a plausible risk of HCV transmission; most involved saliva exposure through spitting (72.5%). Defendants were primarily white (94.7%), male (61.7%), and 18-68 years old. Case filings peaked in 2018-2019 but persisted through 2025. Hepatitis prosecutions operated largely independently of HIV criminalization. Our findings suggest the need for infectious disease law reform to align with current transmission science.

Long-acting injectable cabotegravir (LAI-CAB) is a novel HIV pre-exposure prophylaxis (PrEP) modality found to significantly lower HIV risk in key populations. EquiPrEP was an observational implementation science study to examine multilevel barriers and facilitators to LAI-CAB implementation among Black and/or Latine MSM, Black and/or Latine cisgender women, and transgender and nonbinary persons. This study took place at the Pride Health Center (PHC) at NYC Health+Hospitals (H+H)/Bellevue in New York City (February 2023-February 2025). Sociodemographic and health related social needs screening data were collected from EquiPrEP participants via a survey. We conducted in-depth interviews with study participants (N=26) and implementers (N=25) guided by The Consolidated Framework for Implementation Research 2.0. Descriptive statistics were used to assess sociodemographics for all EquiPrEP participants versus those recruited for in-depth interviews. Qualitative data was analyzed using thematic content analysis. Comparing all EquiPrEP participants (N=129) with the subgroup (N=26), the subgroup was older, with more Black cisgender MSM, and transgender women, a higher percentage ever on oral PrEP, and referred from an external clinic. Facilitators included open communication among staff, a patient-centered culture of care delivery and the EquiPrEP Navigator. Barriers included distance to clinical services, financial issues and insurance access. EquiPrEP is one of the first LAI-CAB implementation studies for HIV prevention to center equitable access for communities with the highest burden of HIV and elucidate implementation determinants to LAI-CAB. Findings may inform future implementation strategies seeking to incorporate equity as part of LAI-PrEP care.

Self-assessment of sexual behavior may empower adolescent girls and young women (AGYW) to reflect on HIV/STI risk and adopt prevention strategies. We developed a web-based sexual behavior self-assessment tool providing real-time feedback based on a numeric score and examined associations of scores with STI detection and HIV pre-exposure prophylaxis (PrEP) initiation among AGYW in South Africa. The tool was implemented as part of PALESA, a pilot randomized trial which followed up 55 sexually-active AGYW (16-20 years) for six months in Johannesburg between June 2023 and May 2024. Participants received monthly links to the tool, monthly oral PrEP offering and quarterly chlamydia, gonorrhea, and trichomoniasis testing. Multivariable generalized linear mixed-effects models and survival models assessed associations between participants' scores and STI detection and PrEP restart; interrupted time series analysis examined score changes around PrEP initiation. Tool completion rate was high (94.8%). Frequently reported items included older partners (38.4%), vaginal STI symptoms (26.3%), new sexual relationships (20.0%), multiple partners (18.9%) and partner distrust about STI symptom experiences (17%). Higher scores were associated with increased odds of STI detection (adjusted odds ratio: 2.61, 95% CI: 1.46-4.68) but not significantly with PrEP initiation (adjusted hazard ratio: 1.43, 95% CI: 0.56-3.63). Among participants who restarted PrEP, scores decreased by 0.47 points per month before PrEP restart (p = 0.002) and remained stable afterward (p = 0.39). Our findings demonstrate this tool as feasible to implement among AGYW with potential to support self-reflection and awareness of HIV/STI risk. Larger studies are warranted to fully evaluate its utility.

For people living with HIV (PLWH), the configuration of social support networks may shape access to support, yet the structural position of support sources remains poorly understood. We conducted a cross-sectional study among 446 PLWH receiving community follow-up in Luzhou, China, from March to May 2023. A two-mode network (participants × 10 support-source categories) was analyzed in UCINET to describe support-source degree and core-periphery structure. Community Health Service Centers, hospitals, and family members occupied core positions. Overall support scores differed by gender (female vs male: t = -2.66, p = .008), age (≥ 50 vs <50 years: t = -6.79, p < .001), and transmission route (heterosexual vs homosexual: t = 6.25, p < .001). Overall, 52.47% of participants were classified as core actors. The proportion was 46.88% in the combined homosexual-transmission and other-routes group and 44.53% among young/middle-aged men. These findings describe how support sources are positioned within the community follow-up setting and may inform efforts to connect PLWH with fewer core-source ties to available services.

Unhealthy alcohol use is prevalent among people living with HIV (PLH) and is associated with worse HIV care outcomes. Non-alcoholic beverages (NABs; beer, wine, or spirits containing 0.0% to 0.5% alcohol by volume) may represent a novel alcohol reduction strategy; however, the prevalence and correlates of NAB use among PLH remain unexamined. This study utilized baseline data from the Florida Cohort Study (N = 589; June 2024-October 2025). Self-report measures assessed past 12-month NAB consumption and likelihood of future NAB use. Multivariable logistic regression models examined sociodemographic and health-related correlates of past-year NAB consumption and future use. Overall, 26.83% of participants consumed NABs in the past 12 months; 18.34% were likely or extremely likely to use NABs in the future. In multivariable analyses, higher odds of past-year NAB consumption were associated with identifying as Non-Hispanic Black (AOR = 3.10, 95% CI: 1.77-5.42 vs. Non-Hispanic White) or Latine (AOR = 2.57, 95% CI: 1.36-4.86 vs. Non-Hispanic White), lesbian, gay, bisexual, or queer (AOR = 1.74, 95% CI: 1.14-2.64 vs. straight/heterosexual), and moderate/high risk of alcohol use disorder (AUD) (AOR = 2.43, 95% CI: 1.39-4.23 vs. no/low risk). Similar patterns were observed for future likelihood to use NABs. Approximately one-quarter of PLH reported past 12-month NAB consumption, although relatively fewer expressed interest in future use. NABs may represent a promising, yet underutilized, alcohol reduction strategy for PLH; however, additional research is needed to understand motivations, contexts of use, and impacts on alcohol-related and HIV outcomes.

Pre-exposure prophylaxis (PrEP) effectively reduces HIV incidence among South African adolescent girls and young women (AGYW), but barriers to access and sustained use remain. We evaluated the effects of a clinic-level stigma and discrimination (S&D) training and the Young Women's Health CoOp (YWHC) intervention on oral PrEP outcomes among AGYW aged 16-24 years (N = 802) in Tshwane (Pretoria), South Africa. Using a modified 2 × 2 factorial cluster-randomized trial, 12 clinics and their catchment areas were assigned to one of four study arms based on receipt of S&D training for clinic staff and delivery of the YWHC intervention to AGYW. Outcomes included PrEP readiness (self-report), uptake (medical records), adherence, and persistence (dried blood spots), measured at baseline and 3-, 6-, and 9-month follow-up. Multilevel modeling showed that PrEP readiness scores were higher at follow-up among AGYW in the control arm than among those in intervention arms (p < 0.05). Differences in PrEP uptake were not statistically significant (p = 0.11), although they were clinically meaningful. AGYW attending clinics that received S&D training were more than twice as likely to initiate oral PrEP as participants in the control arm. AGYW who received the YWHC intervention were more likely to adhere to oral PrEP than those in the control arm (p ≤ 0.05). Participants in all intervention arms were also more likely to persist with PrEP use over time than controls (p < 0.05). These findings suggest that clinic- and individual-level interventions can optimize PrEP initiation, adherence, and persistence among AGYW.

HIV treatment attitudes and HIV PrEP are associated with sexual behavior that elevates the risk for bacterial STIs (B-STIs) among gay, bisexual and other men who have sex with men (GBM). Using a longitudinal multi-site study (Engage Cohort Study, 2017-2024), we modelled direct and indirect within- and between-person effects of HIV treatment attitudes and PrEP use on condomless anal sex (CAS) and incident B-STIs among 1863 HIV-negative GBM. We modelled up to four years of follow-up visits using multi-level mediation analysis, with CAS as a mediating variable between HIV treatment attitudes and PrEP use on incident B-STIs. We found direct within-person effects of HIV treatment attitudes and PrEP use on incident B-STIs, such that participants were more likely to report incident B-STIs at time points if they reported using PrEP and being more optimistic about HIV treatments; there were no indirect within-person effects through CAS. In contrast, we found both direct and indirect between-person effects. Specifically, participants who reported more PrEP use or who were more optimistic about HIV treatments over the course of the study were more likely to report incident B-STIs. Further, these effects were partially mediated by CAS. Given that we found within-person PrEP use is associated with increased CAS and STIs, and the general increase in adoption of PrEP over time, there is a need to expand biomedical intervention programs for B-STIs prophylaxis by integrating them with social and informational interventions about B-STIs risks, especially for GBM who use HIV PrEP.

Late HIV diagnosis remains prevalent in gay, bisexual, and other men who have sex with men (GBMSM) in Amsterdam and is associated with ongoing transmission. Drawing on proven but underused intervention development approaches, we co-created an innovative communication campaign with GBMSM and HIV prevention experts to promote HIV-testing amongst never or not recently tested GBMSM. The campaign addressed behavioral determinants of HIV testing through tailored messaging for key subgroups. A post-test-only pilot evaluation (N = 86) showed significantly higher HIV testing intention among GBMSM exposed to the campaign. Findings support further evaluation of the intervention and exploration of its broader implementation.

The HIV diagnosis rate in New York State declined substantially from 2013 to 2023, but the rate of decline varied across race/ethnicity groups, exacerbating disparity. For example, in 2013, the HIV diagnosis rate was 7.1 times higher among non-Hispanic Black individuals than among non-Hispanic White individuals. In 2023, it was 7.9 times higher. Racial/ethnic disparity was even more evident among females, especially non-Hispanic Black females, whose HIV diagnosis rate was 14.6 times higher than non-Hispanic White females in 2023. We compared the racial/ethnic composition of the NYS population overall with that of persons newly diagnosed with HIV in NYS and calculated HIV diagnosis rates for all race/ethnicity groups from 2013 to 2023. We calculated the percent change over time and compared the diagnosis rate for each group with that of non-Hispanic White individuals. We further examined racial/ethnic disparity stratified by sex at birth, gender, and transmission risk group.

Hospitalization remains a significant concern among people living with HIV (PLWH), particularly when admissions are recurrent. While prior research has identified psychiatric comorbidities and HIV disease severity as predictors of initial hospitalization, less is known about the factors that drive repeated hospitalizations in the modern treatment era. This study examined psychiatric, demographic, and HIV-related predictors of first and subsequent hospitalizations using longitudinal data from 9,793 PLWH with follow-up care in the Bronx, New York, between 2016 and 2023. Two primary outcomes (i.e., time to non-psychiatric hospitalization and time to HIV-related hospitalization) were modeled independently using Prentice, Williams, and Peterson gap-time models. Recent mental health visits and diagnoses, substance use-related diagnoses, lower CD4 T-cell count, and detectable viral load were each associated with increased risk of first and subsequent hospitalization. Prior mental health care engagement was associated with reduced risk of non-psychiatric hospitalization. Demographic disparities were also observed: women, older people, and patients with Medicaid had higher risk for hospitalization, while those with commercial insurance had lower risk. These findings extend previous research on first-time hospitalization in this population by explicitly distinguishing predictors of first versus subsequent hospitalizations, and underscore the need for integrated psychiatric care, sustained viral suppression, and tailored outpatient support to reduce avoidable hospitalizations.

Crowdsourcing is a participatory problem-solving approach that engages a large and diverse group of individuals to generate ideas or solutions. In HIV prevention, it provides a structured mechanism for involving youth in shaping intervention strategies. The Innovative Tools to Expand Youth-Friendly HIV Self-Testing and Long-Acting Injectable PrEP Uptake in Ghana (Y-FIT GH) National Open Call applied this method to generate youth-driven ideas to promote HIV self-testing (HIVST) and long-acting injectable PrEP (LAI-PrEP) in Ghana. This study describes youth responses to the open call and identifies strategies they proposed to strengthen HIV prevention among their peers. Ghanaian youth aged 15-24 years were invited to submit creative entries illustrating how HIVST and PrEP could be promoted and accessed by young people. Submissions were received through online platforms and community-based channels between May and August 2025. Following independent review, 103 eligible entries from 12 regions were qualitatively analyzed using an inductive multimodal approach. Written narratives (32%), posters (19%), and audiovisual pieces (18%) were the most common. Six interconnected thematic domains were identified: (1) HIVST and PrEP as pathways to autonomy, safety, and self-respect; (2) creative, peer-led, and culturally resonant communication; (3) multilevel, hybrid delivery models prioritizing accessibility, familiarity, and privacy; (4) stigma shaping youth engagement; (5) gaps in navigation, support, and trust in existing services; and (6) AI and AI-enabled chatbots as emerging channels for confidential information and peer support. The contest effectively engaged Ghanaian youth and generated actionable, contextually grounded strategies to enhance HIVST and PrEP uptake.

South African women are disproportionately affected by HIV, with increased incidence during pregnancy and postpartum. While oral TDF/FTC pre-exposure prophylaxis (PrEP) is safe, effective, and recommended for pregnant and postpartum women, adherence to a daily pill is challenging, particularly during the postpartum period. Longer-acting injectable (LAI) PrEP products may be more desirable for postpartum women however, limited data on factors influencing uptake are available to inform roll-out of LAI products among postpartum women. Using the Consolidated Framework for Implementation Research (CFIR), we explored LAI PrEP implementation determinants among postpartum women in South Africa. From March-April 2023, 4 focus group discussions (FGDs) were conducted among postpartum women in KwaZulu-Natal. A directed content analysis method was performed. Among 23 women, median age was 27 (range 19-36) years. Two (9%) reported a pregnancy partner living with HIV, 7 (30%) had ever used PrEP, and 21 (91%) had ever breastfed. Factors that may influence LAI PrEP implementation are organized by three CFIR domains. Individuals expressed interest in and potential willingness to use LAI PrEP, but limited knowledge. At the implementation process domain, participants perceived LAI-PrEP users to have high HIV risk perception, and were themselves worried about side-effects, access, and fear of partner conflict. They also identified implementation opportunities including peer PrEP mentors, mobile clinics, and community clinic integration. At the outer setting, cultural beliefs/practices during postpartum were important determinants. Our findings indicate interest and willingness to consider LAI PrEP among postpartum women and highlight implementation opportunities to reduce HIV acquisition and perinatal transmission.