HIV disproportionately affects populations by age, sex/gender, race/ethnicity, and transmission mode. This study evaluated the yield of new HIV diagnoses through a universal emergency department (ED) -based screening program in South Broward County, Florida, and examined disparities across demographic and behavioral subgroups. A retrospective cohort study was conducted using electronic health records from six EDs within a single public, non-profit healthcare system. Between July 2018 and February 2024, all patients aged ≥18 years were offered free opt-out HIV combination assay testing. Patients with known HIV infection or who declined testing were excluded. Annual case detection rates were calculated, and year-adjusted Poisson regression with annual testing volume as an offset estimated incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Among 111,758 tests, 671 were positive, yielding a positivity rate of 0.60% and an annual case detection rate of 600 per 100,000 patients screened. Case detection was significantly higher among males than females (IRR 1.83, 95% CI 1.56-2.15) and among Black patients than White (IRR 4.28, 95% CI 3.45-5.31) or Hispanic patients (IRR 3.56, 95% CI 2.91-4.34). These findings support continued universal opt-out ED-based HIV screening in high-burden communities while emphasizing persistent demographic disparities in newly diagnosed HIV.

Black men who have sex with men (MSM) have continued to face disproportionately high rates of HIV and STIs, yet few studies specifically address STI risk in Black MSM, particularly those on HIV pre-exposure prophylaxis (PrEP). The aim of this study was to examine STI incidence (gonorrhea, chlamydia, and syphilis) and PrEP care discontinuation in a prospectively enrolled cohort of young Black MSM engaged in PrEP care. We enrolled 63 Black MSM PrEP users; total follow -up time was 81.8 person -years (PY). Mean age was 29.9 (SD 4.3); 45 participants (71%) had insurance, and 30 (48.4%) had an STI diagnosed in the year before enrollment. There were 56 STI infections over follow-up (6 syphilis, 18 chlamydia, 32 gonorrhea), yielding an STI incidence of 68.5/100PY. There were 2 incident cases of HIV (2.4/100PY). Additionally, 32 (51%) participants had PrEP discontinuations (either intermittent, i.e., missed visits, or complete loss to follow -up prior to the end of the study period). Overall, Black MSM PrEP users had suboptimal engagement in PrEP care and high rates of STIs and HIV. Further efforts are needed to enhance PrEP use and prevent STIs in this population.

In Tacoma, Washington, people with HIV (PWH) face significant barriers to care. This study compares viral suppression and patient-centered outcome effectiveness of co-located Ryan White (RW) and MAX (low-barrier, walk-in, engaging previously disengaged PWH with unsuppressed viral loads (VL) clinics.Mixed-methods, prospective cohort study of MAX/RW participants surveyed/interviewed at baseline, 6 and 12 months, assessing VL suppression (86 qualitative interviews coded thematically across six health/medical care domains). Eligibility criteria: VL >200 copies/mL (last 12 months), out of care ≥12 months, or facing engagement barriers. EMR VL data were collected between January 2020 and February 2025.Participants enrolled: 30 MAX and 70 RW. Viral suppression by timeline: -6 months (69.6% MAX, 78.4% RW; p = 0.4). -2.5 years (60.0% MAX, 92.1% RW; p = 0.003). MAX had higher baseline rates of housing instability (p = 0.11) and mental illness (p = 0.02) but cited immediate access, non-judgmental care, and wraparound services as being "lifesaving", with fewer unmet mental health needs and greater care access and education.Low-barrier models play a vital role in re-engaging PWH facing barriers. While RW achieved higher long-term viral suppression, MAX achieved improved trust, health literacy, and retention-foundations for long-term health. Integrated, patient-centered approaches can complement traditional care and address service gaps.

Multiple sexual partnerships (MSPs) act as a risk factor, increase vulnerability to sexually transmitted diseases, including HIV, and contribute to interconnected sexual networks that may facilitate broader transmission not only within high-risk networks but also to their partners. This study aims to estimate the prevalence of MSPs and factors associated with it among Hijra and transgender persons (H/TG) in India. This is a secondary data analysis of H/TG data from the National IBBS survey. The survey was conducted in 14 domains across 11 states of India using probability-based sampling. A total of 4345H/TG individuals were analyzed. Out of these, 3774 (86.9%) reported MSPs. Factors such as living with partners (aOR: 1.86; 95% CI: 1.32, 2.62), having first sexual intercourse before the age of 18 years (aOR: 1.44; 95% CI: 1.14, 1.82), involvement in sex work (aOR: 1.69; 95% CI: 1.27, 2.26), and having a commercial partner (aOR: 11.77; 95% CI: 4.80, 28.86) were associated with MSPs among H/TG persons. The findings of this study demonstrate that MSPs are highly prevalent among H/TG persons in India. Interventions aimed at HIV and STI prevention should move beyond individual-level behavior change approaches and incorporate network-based strategies and early sexual health education.

Adolescent girls and young women (AGYW) bear a disproportionate burden of HIV/AIDS. Pre-exposure prophylaxis (PrEP) for HIV prevention is limited to individuals identified as high risk following a prior risk assessment. However, AGYW with epidemiologically assessed HIV risk still struggle to align PrEP use with their sexual behaviors. This review examines how HIV risk and sexual behavior influence decisions to initiate, adhere to or discontinue PrEP. A search was conducted across five databases in November 2025. The search was registered in the Open Science Framework and followed PRISMA-SCR guidelines. A thematic content analysis approach was used to synthesize findings guided by the health belief model and COM-B framework. Forty-nine articles were eligible for synthesis. Knowledge of HIV risk and sexual behaviors motivated PrEP initiation and adherence. There were consistently low adherence and high discontinuation rates among AGYW with objective HIV risk behaviors. Prevention effectiveness and adherence varied with alignment and misalignment of behavioral risk and PrEP adherence. Decisions to use the vaginal ring instead of oral PrEP aligned with individual behavior. Dynamic changes in sexual behavior during PrEP use and decisions to switch to injectable PrEP where multiple alternatives are offered may be explored to support PrEP uptake and persistence.

Non-adherence is of critical concern among youth with HIV (YWH). Socioeconomic and psychosocial determinants often prevent YWH's consistent engagement in HIV antiretroviral therapy (ART). These barriers are further exacerbated among YWH with or at-risk for criminal-legal involvement; however, few studies have explored adherence in this population. The LINK2 intervention utilized Youth Service Navigators (YSNs) to engage participants (n = 35) and included weekly check-in calls to problem-solve barriers to and identify enablers of ART adherence. YSNs administered a standardized call script and systematically recorded summaries of participants' responses. A qualitative analysis of these summaries identified themes related to ART adherence. When asked about factors contributing to missed doses, the most prevalent code was "forgot." Other codes associated with poor adherence such as "going out," "busy," "slept through" and "routine change" contributed to participants' not remembering medication doses; whereas external structural forces ("access to meds," "unmet basic needs") more directly interfered with adherence. The most prevalent codes related to adherence support were "established routine" and "used reminder tools" - options that YLWH have the opportunity to engage, regardless of external forces. Participants commonly described adherence factors that reflected their level of control over their daily lives, with influences from both internal and external forces.

Harm-reduction services for people who inject drugs (PWID) remain vulnerable due to political instability and reliance on external funding. As international donors reduce support, the sustainability of these programmes is increasingly uncertain. This study examines how different HIV financing structures influence the resilience of harm-reduction services in India, Nigeria, and South Africa.A retrospective comparative analysis was conducted using national programme reports, financial data, and global monitoring sources from 2014 to 2024. Trends in domestic and external funding were assessed alongside coverage of opioid substitution therapy and needle-syringe programmes. Hypothetical scenarios modelling 30% and 50% reductions in donor funding were used to evaluate potential impacts. The three countries show distinct financing profiles. India's predominantly domestically financed programme (approximately 93% under NACP-V) appears relatively resilient to external shocks. Nigeria's donor-dominated financing (96.1% in 2021) leaves PWID services highly vulnerable, while South Africa shows intermediate vulnerability, particularly in key-population prevention.A three-pillar framework focusing on financing structure, programme integration, and epidemic-equity alignment, is proposed to assess transition readiness. Strengthening these dimensions is critical to ensure that donor transitions do not undermine harm-reduction services and HIV control among PWID.

Despite being recognized as a highly cost-effective HIV prevention strategy, pre-exposure prophylaxis (PrEP) uptake and continuity remain suboptimal among young women, highlighting the urgent need to address underlying barriers and logistical challenges hindering access and utilization of this preventive measure. Maintaining continuity is essential because PrEP's effectiveness depends heavily on adherence and consistent access. This study examined the factors affecting PrEP adherence among young women aged 15-24. Andersen's Behavioral Model (ABM) provided a vital framework for analyzing PrEP continuity. The hypothesis is that an individual's decision to use PrEP is driven by personal characteristics, need, and access. Secondary data were abstracted from routine data for clients seeking HIV prevention services at the Mulago National Referral Hospital's STI clinic. All data were analyzed using Stata IC 16.0. A total of N = 2495 young women were on PrEP from January 2024 to September 2025. This study revealed critically low PrEP continuation rates among young women in Uganda, with only 6.48% remaining on PrEP at 12 months despite substantial HIV risk in this population. There was a significant difference in continuation rates between facility-based (74.88 per 100 person-years) and community-based (11.04 per 100 person-years) service delivery. The findings suggest consideration for hybrid models that combine community outreach for awareness and screening with facility-based initiation and early support. Enrolled clients on PrEP need intense adherence counseling to improve continuity rates.

Adherence to antiretroviral therapy (ART) is essential for effective HIV management in children. Poor adherence can lead to increased viral replication, treatment failure, and development of drug-resistant HIV. Parents and caregivers play a central role in supporting adherence. A cross-sectional study was conducted from 1 May to 30 June 2023, involving 411 participants selected through simple random sampling. Data were collected using an interviewer-administered questionnaire, and associations were examined using multivariate logistic regression. The overall ART adherence rate among children was 82% (339/411). Lower adherence was significantly associated with having non-biological parents (Adjusted OR = 9.81; 95% CI: 2.3-43.74), lack of communication between parents and children (Adjusted OR = 3.92; 95% CI: 1.27-12.04), poor relationships between parents and healthcare providers (AOR = 29.592; 95% CI: 11.33-66.33), inadequate caregiver support (Adjusted OR = 5.92; 95% CI: 3.27-6.04), and having more than four siblings (Adjusted OR = 5.68; 95% CI: 2.10-15.34). Improving adherence requires strengthening parent-child communication and improving caregiver-healthcare provider relationships to support HIV-infected pediatric populations.

People who inject drugs (PWID) in the Southern United States face elevated HIV risk due to limited testing, constrained PrEP access and structural barriers to harm reduction. Within syringe service programs (SSPs), universal PrEP delivery may be inefficient. Key subgroups - individuals engaged in sex work, men who have sex with men (MSM) and people sharing syringes - have distinct risk profiles, awareness, and motivation that influence PrEP uptake. This study identifies high-yield groups for risk-stratified PrEP delivery in SSPs. We conducted a cross-sectional survey of 685 PWID attending SSPs in Tennessee. Measures included demographics, drug use, sexual risk, PrEP awareness, willingness to initiate PrEP and objective HIV risk using the ARCH tool. Multivariate logistic regression identified predictors of willingness. Overall, 63.1% reported willingness to use PrEP. Willingness was highest among those engaged in sex work (80-81%; adjusted OR 2.5-3.3, p < 0.05). MSM had greater awareness but no higher adjusted willingness. Syringe sharers had the highest objective risk yet lower awareness and willingness, indicating a high-risk but harder-to-engage group. These findings highlight the potential value of tailoring PrEP promotion strategies within SSPs. While individuals engaged in sex work may be well positioned for rapid PrEP initiation, additional efforts may be needed to improve PrEP uptake among those who report syringe sharing.

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.