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.

Daily use of pre-exposure prophylaxis (PrEP) effectively prevents HIV, yet uptake remains uneven, particularly among lower socioeconomic and minoritized populations. Approximately 20% of newly approved PrEP prescriptions are reversed (a newly prescribed oral PrEP prescription that is not picked up at the pharmacy within 7-14 days), and most are subsequently abandoned (reversed prescription that is not picked up within a year). The roles of race and income in these outcomes are not well characterized. We analyzed Symphony HealthCare Analytics data on first-time, insurance-approved 30-day oral PrEP prescriptions for lower-income NHB, higher-income NHB, lower-income NHW, and higher-income NHW (referent group) men and women. Intersectional disparities in prescription reversal and abandonment were decomposed into joint, referent race, referent income, and excess intersectional components, stratified by gender. The total sample was 28,019, which included 2,463 women and 25,556 men. Among men, reversal and abandonment were higher among lower-income NHB men compared to higher-income NHW men. Joint disparities were 4.5% for reversal and 3.7% for abandonment, with less than half explained by race or income alone, suggesting an additional intersectional effect. Among women, reversal and abandonment were higher among higher-income NHW women compared to lower-income NHB women. Joint disparities were -11.4% and -12.9%, respectively, and were largely explained by independent race and income effects, with attenuation of intersectional disparities. Both financial and racial factors contribute to PrEP prescription reversal and abandonment, with patterns differing by gender. Interventions addressing cost barriers and structural inequities, alongside gender-specific strategies, may improve PrEP uptake and persistence.

Status-neutral HIV prevention frameworks require outcome measures to evaluate prevention and care strategies across populations without separate endpoints for people living with and without HIV. We developed and conducted a preliminary evaluation of a proposed composite outcome measure, "prevention effective practice," integrating behavioral and biomedical prevention practices into a single binary outcome. Using longitudinal data from 392 transgender women not living with HIV in São Paulo, Brazil, we assessed whether prevention effective practice predicted subsequent HIV seroconversion. Prevention effective practice incorporated sufficient PrEP use, condom use, abstinence from sex, and absence of injection risk. Despite the small number of seroconversions (n = 11), prevention effective practice demonstrated preliminary predictive utility, with a Brier score of 0.0030, sensitivity of 0.59 (95%CI 0.56, 0.62), and specificity of 0.70 (95%CI 0.41, 0.99). These findings support further evaluation of prevention effective practice as a proposed status-neutral outcome measure, including validation among people living with HIV.

Reducing HIV incidence requires effective implementation of evidence-based prevention practices. Long-acting injectable cabotegravir (CAB-LA) offers a new form of effective prevention, but maximizing uptake requires co-designing implementation strategies with impacted populations. In Chicago, where HIV disproportionately impacts sexual minority men (SMM), a community-focused innovation tournament identified home-based CAB-LA delivery as the top strategy. Through a partnership with key constituents, this research aimed to operationalize this strategy for SMM (≥ 13 years) in Chicago, with particular attention to Black SMM and Latino SMM populations, through human-centered design (HCD). A four-hour, in-person workshop convened 19 transdisciplinary participants (e.g., SMM, clinicians, public health leadership, community-based organization leadership, implementation scientists) to co-create a preliminary blueprint for home-based delivery. Virtual follow-up semi-structured interviews with 10 workshop participants elicited feedback on the blueprint. Rapid qualitative analysis refined the blueprint, and final materials were produced in English and Spanish. Key phases of the home-based delivery strategy included: pre-implementation (e.g., outreach; procurement of shots), implementation (e.g., identification of staffing; administration in homes), and maintenance (e.g., post-administration and re-engagement). Patient actions focused on indicating preferences for visit, preparing home for visit, and scheduling follow-up care. Clinician actions emphasized prescribing CAB-LA, sharing financing information, and administration procedures. This research produced a blueprint for a co-designed strategy of "low-barrier PrEP." Future efforts will develop complementary implementation strategies and will test the success of home-based delivery on increasing the uptake of CAB-LA among SMM. The HCD approach can also provide a framework for co-design approaches across the HIV care continuum.

Adolescents and young adults (AYA) bear a disproportionate burden of HIV in the United States, yet gaps in HIV‑related knowledge may undermine engagement in care, antiretroviral therapy (ART) adherence, and prevention efforts. We conducted a cross‑sectional survey of AYA receiving care at a hospital‑based clinic to assess HIV/STI knowledge and its association with clinical and demographic factors. Participants completed a survey capturing demographic variables, health behaviors, and a six‑item HIV/STI knowledge assessment. Electronic medical records were used to ascertain HIV status, mode of acquisition, viral suppression, and STI history. Associations between categorical predictors and item‑level knowledge were evaluated using Pearson's chi‑square tests. Among 76 participants (42.1% aged 22-25; 53.9% female), 46 (60.5%) were living with HIV, including 25 (54.3%) with perinatally acquired. Overall knowledge was low, with fewer than half of participants answering most items correctly, except for viral load monitoring (52.6%). Participants living with HIV were more likely to correctly identify HIV prevention strategies than peers without HIV (χ[2](1) = 5.22, p=.022). Among those with HIV, adolescent‑acquired infection was associated with higher knowledge regarding prevention (χ[2](1) = 10.99, p<.001) and viral load monitoring (χ[2](1) = 5.46, p=.019) compared with perinatal infection. Knowledge did not differ by viral suppression, age, gender, or STI history. These findings demonstrate substantial HIV‑related knowledge gaps among AYA, including those living with HIV, and challenge assumptions that longer disease duration confers expertise. Developmentally tailored education and routine knowledge assessment may strengthen engagement in care and optimize long-term outcomes for youth with HIV.