Effective physician-patient communication is essential for addressing HIV-related stigma and supporting patient-centred care. This study aimed to examine medical students' communication during an AI-supported patient interview in which ChatGPT-4o acted as a standardised patient living with HIV, with a focus on empathy and stigma-sensitive communication. A sequential explanatory mixed-methods study was conducted with third-year medical students at a public medical school in Türkiye. Of 277 students who completed a standardised, text-based AI-supported consultation, 260 completed the surveys and were included in the quantitative analysis; 30 participated in two focus-group discussions. Quantitative data were analysed using descriptive statistics, independent-samples t-tests and Pearson correlations, while qualitative data were thematically analysed using MAXQDA 2022. The highest mean item ratings concerned supportive and non-judgemental communication and appropriate responses to the patient's concerns. However, lower ratings were observed for providing accurate HIV-related information and using open-ended questions. A very weak positive correlation was found between students' self-assessment and educator assessment ratings (r = 0.136, p = 0.037). Qualitative findings highlighted empathy, ethical sensitivity and difficulty in formulating questions. AI-supported patient simulation may provide a complementary, preparatory opportunity for students to practise patient-centred and stigma-sensitive communication before patient contact.
Sexually transmitted infections (STIs) are on the rise across Europe, with the Netherlands experiencing a marked increase. The present research explores how STI risk perception is understood and experienced among two high-incidence populations: men who have sex with men (MSM) and heterosexual university students. Sixteen semi-structured interviews (8 MSM, 8 students) were conducted and analyzed by reflexive thematic analysis. Four central themes were identified: risk behaviors, risk awareness, perceived severity, and affective responses. Both samples reported behaviors that elevate STI risk, including casual sex, inconsistent condom use, and infrequent testing. However, their perceptions of risk diverged notably. MSM participants demonstrated higher perceived susceptibility and more emotionally charged responses. In contrast, heterosexual students often underestimated their risk and minimized STI severity, shaped by cognitive dissonance, limited knowledge, and peer norms. These findings show that STI risk perception extends beyond factual awareness, shaped instead by emotional, cognitive, and social dynamics. Public health interventions must therefore be tailored to these group-specific influences to promote accurate risk appraisal and improve sexual health outcomes.
Despite biomedical advances that have transformed HIV into a manageable chronic condition, stigma remains a persistent social issue, particularly in everyday interactions. This study examines the factors associated with behavioural expressions of HIV-related stigma among Spanish young adults, a generation that has grown up in a post-crisis, biomedically transformed HIV landscape. Drawing on a quota-based sample of 400 individuals aged 18-24 in Spain, we assess the roles of attitudinal stigma, interpersonal contact with LGBT individuals, educational attainment, political ideology, and HIV-related knowledge. Behavioural stigma was measured through a scenario-based item capturing intended actions toward a person living with HIV. Multivariate regression showed that attitudinal stigma was the strongest predictor of behavioural responses. Interpersonal contact with LGBT individuals was associated with lower stigma, both directly and indirectly through its effect on attitudes, supporting a mediation model consistent with intergroup contact theory. Higher educational attainment was also associated with reduced stigma, though not through attitudinal change, whereas political ideology and HIV-related knowledge were not significant predictors. These findings suggest that stigma among young adults is driven less by lack of information than by broader social and psychological processes, and that interventions should prioritise attitudinal change and interpersonal contact over purely informational strategies.
People living with HIV (PLWH) bear a disproportionate burden of suicidal ideation. This study examined whether social support relates to suicidal ideation through HIV-related stress and depressive symptoms, and whether these pathways differ by antiretroviral therapy (ART)-related side effect status. A cross-sectional survey of 391 PLWH in Zhejiang Province, China, used generalized structural equation modeling (GSEM) to test mediation pathways, estimated separately among participants with and without ART-related side effects. Overall, 23.02% reported suicidal ideation. Social support was not directly associated with suicidal ideation (β = -0.007, p = 0.924) but had indirect effects through HIV-related stress alone (β = -0.020, p < 0.001) and sequentially through HIV-related stress and depressive symptoms (β = -0.013, p < 0.001). Pathway structure differed by side effect status: among those without side effects, only the chain mediation was significant; among those with side effects, HIV-related stress predicted suicidal ideation both directly and indirectly, and prevalence was higher. Between-group differences in path coefficients were not formally tested; subgroup findings are exploratory. Social support was negatively associated with suicidal ideation primarily through indirect mechanisms, with the structure of that risk pathway differing by ART-related side effect status. Differentiated interventions integrating suicide risk screening into HIV care are needed.
Combination HIV prevention approaches, integrating behavioral, biomedical, and social components, have shown promise but remain under-evaluated in trans-specific contexts. This work aimed to compare the effectiveness of different HIV prevention strategies among transgender populations through a network meta-analysis. A systematic search was conducted through PRISMA-NMA 2020 across PubMed, SciELO, LILACS, and Science Direct (2000-2025) using descriptors related to HIV, combined prevention, and Transgender populations. Only original quantitative studies reporting effect measures of interventions were included, using the condom usage behavior as common comparator: A) Restrictive sexual behavior + Safer sex self-efficacy; B) Restrictive sexual behavior + Safe sex with a condom; C) Restrictive sexual behavior + Safe sex with a condom + Social Support. Mean, SD, SE and 95% CI were estimated, and interventions were ranked using SUCRA radial. Four studies and 9 interventions were included. The most effective strategy was safer receptive sex with transgender people (SUCRA 84.3%), followed by safer sex with non-transgender males (SUCRA 66.11%). Direct and indirect comparisons indicated that interventions promoting safer receptive sex practices among transgender individuals were more effective than those targeting condom use behavior alone. The inclusion of gender-specific content and social support appears to enhance the impact of prevention strategies.
Young people living with HIV (YPLH) in Ghana aged 10-24 face elevated barriers to effective HIV management due to structural, social, and economic challenges. These barriers, including poverty, social stigma, gendered inequities, and limited social and household support, disrupt medication adherence and access to healthcare. Inadequate adherence contributes to increased viral loads, reduced HIV knowledge and acceptance, and ongoing transmission. Despite this vulnerability, the lived experiences of YPLH in Ghana and the strategies they use to navigate these barriers remain underexplored. Using a qualitative design, semi-structured interviews were conducted with young people (n = 18) aged 16-25, and data were analyzed using inductive thematic analysis to identify key barriers and coping strategies. Findings reveal that barriers to HIV management are embedded in daily life and shaped by psychosocial, financial, and gendered constraints. Women experienced more frequent and compounded barriers than men, particularly related to stigma, domestic expectations, and economic dependence. Across participants, challenges related to mental and physical health, financial insecurity, stigma, and time demands disrupted engagement with care. Despite these challenges, participants demonstrated resilience and agency, describing adaptive strategies such as reliance on peer and community resources, selective disclosure, and creative approaches to managing medication. These findings highlight the persistent barriers faced by YPLH and their capacity to develop resourceful, peer-informed strategies. Centering lived experiences and coping practices, this study emphasizes the importance of HIV care approaches that strengthen personal skills, foster socially supportive care environments, and address broader structural determinants through gender-responsive, multisectoral programming beyond clinical settings.
Youth experiencing homelessness (YEH) are at increased risk of HIV. Communication among social network members of YEH about sexual health has the potential to promote safer sex practices. We collected self-reported social network data from 731 YEH (age 14-26) accessing homeless youth services in Los Angeles, California, between 2016 and 2018. Multi-level dyadic network analysis was performed to examine the individual- and network-level characteristics associated with communication about condoms, pre-exposure prophylaxis (PrEP), HIV and HIV testing. YEH were significantly more likely to report talking to a social network member about PrEP if the youth was transgender (OR = 3.65, 95% CI 1.53-8.76) or had a gender-expansive identity (OR = 3.06, 95% CI 1.22-7.68). YEH were more likely to talk to a social network member about PrEP if that network member identified as a sexual minority (LGBQ+) (OR = 8.45, 95% CI 1.13-2.77). YEH were also more likely to talk to a romantic/sexual partner about condom use (OR = 5.86, 95% CI 1.25-2.33) or HIV testing (OR = 1.90, 95% CI 1.08-3.35). Study findings highlight opportunities for improving PrEP uptake among transgender and gender-expansive YEH and for emphasizing partner communications within future HIV prevention interventions for youth experiencing homelessness.
Drug toxicity and overdose remain major public health concerns in British Columbia (BC), with People Living With HIV (PLWH) experiencing disproportionately high rates of nonfatal and fatal overdose due to intersecting social and structural inequities. The COVID-19 pandemic exacerbated these vulnerabilities and introduced challenges that impacted health care delivery and prevention efforts, with lasting repercussions. This qualitative study explored perceptions of overdose risk and access to post-overdose care among PLWH who use drugs and the Health Care Providers (HCPs) who support them in Vancouver, BC. Across 10 focus groups and 14 interviews, 38 PLWH and 28 HCPs representing diverse professional backgrounds participated. We conducted an inductive thematic analysis of focus group and interview transcripts. Findings highlight how overlapping public health crises, the toxic drug supply, HIV and the pandemic affect overdose risk and care experiences. Participants expressed confidence in BC's HIV treatment and support systems; however, this was offset by challenges in the form of stigma and pandemic-related disruptions, which amplified care avoidance and hindered access to essential services. Integrating HIV care with overdose prevention, mental health services and harm reduction, supported by trauma-informed training, may improve post-overdose engagement and bolster service resilience, including during future public health emergencies.
While policy uptake often relies on persuasive narrative framing, some policy initiatives simply make practical sense. We observed this with Zimbabwe's universal HIV test-and-treat policy and examined the factors that may have contributed to this. We conducted nine interviews with healthcare workers and three focus group discussions with 20 people living with HIV and on treatment. We analysed transcripts thematically using thematic network analysis. We found that the treat-all policy made a great deal of sense to patients and providers of HIV treatment. First, participants considered the policy practical and doable, and perceived it as requiring only small changes to existing systems and practices. Second, participants had long wanted the introduction of a treat-all policy to expand access to treatment and reduce the disease burden. Universal test-and-treat was considered a seemingly natural next step in HIV healthcare policy in Zimbabwe. Third, the strongest incentive for implementing universal test-and-treat was the lived experience of early treatment's health benefits, which enabled patients to lead full lives and pursue broader life goals. Successful policy transitions occur when policies make sense - meaning they are anticipated, align seemlessly with existing health system practices, and advance both health and individual life goals.
The COVID-19 pandemic significantly disrupted healthcare systems, including access to HIV testing services. In 2021, community organizations participating in a NYC HIV testing initiative reported a substantial decline in HIV testing between 2019 and 2020. To examine how providers adapted during this period, Health Department staff conducted stakeholder interviews and focus groups to identify the underlying causes of this testing decline. Providers described both enabling and obstructive factors in delivering services during the pandemic. Telehealth, cross-training, service bundling and flexible engagement strategies helped sustain HIV testing programs. However, systemic challenges, including rigid safety protocols, staff furloughs and reassignments, top-down decision-making and resource constraints, hindered service provision. Community mistrust and barriers to access further exacerbated these issues, particularly among marginalized populations. Despite these challenges, some providers leveraged new partnerships and flexible funding to innovate and maintain services. Findings highlight the vulnerability of essential public health services during crises and underscore the importance of community-informed, adaptable and equitable approaches. Sustaining HIV testing access requires trust-building, inclusive planning and workforce policies that prioritize staff well-being and reduce burnout. The experiences of NYC-based providers demonstrate the value of culturally grounded, community-driven strategies in navigating and responding to public health emergencies.
Novel interventions are required to reduce risky sexual behavior among adolescents and young people (AYP). We interviewed a purposive sample comprising AYP residing in the Africa Health Research Institute's surveillance area and individuals involved in delivering a community-based peer navigator support intervention. Interviews were conducted in isiZulu, transcribed and translated into English for thematic analysis. We found that community resilience and trust were enhanced by "having lived in the area for a long time" and having both participants and peers coming from the same community with shared life experiences. Peer support did not mitigate the impact of stigma and community sexual norms toward the use of sexual and reproductive health services by AYP. Due to the focus on health through peer support, Thetha Nami only partially succeeded in linking AYP to supportive networks. The study highlights the importance of strengthening structural interventions to enhance linkages that address AYPs multifaceted needs.Trial registration: NCT04532307, clincialtrials.gov, March 2020, https://clinicaltrials.gov/ct2/show/NCT04532307.
Pre-exposure prophylaxis (PrEP) for HIV has been available in France since 2014, and reimbursed since 2016, with general practitioners allowed to prescribe it since 2021. Despite these policy advances, uptake remains low among some of the most affected populations. This community-based qualitative study explored barriers to PrEP access and retention ten years into its implementation.Interviews were conducted with 28 PrEP frontline actors (healthcare professionals and community-based workers involved in promoting, prescribing, or supporting PrEP). The sample included one group discussion (n = 5), two triads (n = 6), two dyads (n = 4), and nine individual interviews (n = 13). Thematic analysis was inductive, with barriers classified across four main domains.Participants were mostly cisgender men, median age 48, born in France and abroad, and employed by NGOs in Paris. Thirteen barriers and four major themes emerged: (1) Internal psychosocial barriers: lack of knowledge, negative health-related reactions; HIV stigma; STI risk perception, taboos; (2) Internal pragmatic barriers: perceived limits of protection, usage and follow-up constraints; (3) External psychosocial barriers: limited physician knowledge and reluctance; (4) External pragmatic barriers: communication failures; structural constraints, lack of human and financial resources.Findings call for more targeted messaging, simplified care models and provider training. They highlight the need to address social and symbolic dimensions of PrEP, with insights from those supporting users to ensure more equitable implementation.
Health care coverage is key for health among people with HIV (PWH). We assessed differences in health care coverage and HIV outcomes and sexually transmitted infection (STI) testing between pre- and post-Medicaid expansion periods among PWH in Virginia. We analyzed Virginia's CDC Medical Monitoring Project data for 2015-2022 (N = 1169). Weighted percentages were assessed for characteristics. Differences in characteristics and outcomes between the pre-expansion (2015-2018) and post-expansion (2020-2022) were assessed using prevalence differences (PDs) and 95% CIs with predicted marginal means; data from 2019 were excluded as the transition year. The number of PWH covered by Medicaid was higher post- than pre-expansion (30.1%-33.9% vs. 18.9%-25.4%). Overall, the percentage of PWH missing ≥1 antiretroviral therapy (ART) dose in the past 30 days was 37.6% in pre- and 29.9% in post-expansion (PD: -7.7; 95% CI: -14.4-1.1). Rates of testing for gonorrhea, chlamydia, and syphilis during the past 12 months were higher in post- than pre-expansion (34.8% vs. 27.8%; PD: 6.9; 95% CI: 0.5-13.3). Medicaid coverage increases among PWH following expansion were associated with increases in ART adherence and STI testing. Expanding health care coverage options that decrease cost barriers may support ART adherence and STI screening among PWH.
Black women living with HIV (BWLWH) utilize religion/spirituality as a coping mechanism in the face of intersectional adversities, which may be related to various mental health and HIV-related outcomes. However, the literature is still growing, and few studies have analyzed overall measures of religiosity as well as item-level variables in relation to mental and physical outcomes among BWLWH. The current study aims to explore these relations via network analysis. Data were collected from baseline assessments among 151 BWLWH in a longitudinal cohort in the Southeastern United States. Women completed self-report measures to capture religious coping items, depressive and PTSD symptoms, and medication adherence. HIV viral load was measured from blood samples. A network analysis was conducted to view the complex relations between religious coping and health outcomes. Significant associations were found between religious coping and medication adherence at 1, 2, and 4 weeks, depression and post-traumatic stress, and depression and 1- and 2-week medication adherence. Among the religious coping items, seeking "God's love and care" was shown to be of particular importance with the highest centrality indices across most networks. These findings suggest that religious coping is salient for BWLWH, strengthening the support for interventions incorporating religiosity/spirituality.
This retrospective record review examined psychosocial and clinical correlates of virological severity among children and adolescents aged 0-19 years with detectable viral load in the Ngaka Modiri Molema District, South Africa. Of 124 records screened, 109 were eligible and had a classifiable viral-load outcome. The most robust finding was that reported missed doses were inversely associated with high-level virological failure, whereas ART duration was not independently associated with severity. These findings suggest that routine adherence documentation may reflect not only medication-taking behaviour but also the psychosocial and clinical context in which treatment difficulties are reported.
In 2023, the United States (U.S.) changed its national guidelines to restrict women living with human immunodeficiency virus (WWH) from breastfeeding, now supporting WWH in choosing this option under a collaborative decision-making model with health providers. Just prior to the implementation of the new guidelines, we conducted in-depth interviews with 28 WWH aged between 18 and 50 years who had previously given birth. We aimed to compose an understanding of infant feeding knowledge among WWH in our U.S. urban setting who had previously given birth and to understand the support women desire from their healthcare providers when given broader access to infant feeding choices. Three general categories of support need were highlighted. This included the need for: 1. information to raise awareness about breastfeeding as an option for WWH; 2. general guidance on infant feeding options; and 3. practical support to implement their choices. Knowledge gaps and misconceptions regarding HIV transmission and infant-feeding information were identified. This emphasizes the need for comprehensive infant feeding education and guidance among WWH to support the implementation of the current guidelines.
Online platforms or social media connect billions of people globally, allowing interaction and sharing of information. The result of these connections yields a massive amount of data that can be explored by methods such as sentiment analysis to provide insight into public attitudes. This study explored the sentiment surrounding the HIV injection lenacapavir by analyzing comments from some of the largest social media platforms (Facebook, YouTube, Reddit and news channels). These reviews were extracted two days after the world's first FDA-approved HIV prevention shot was announced on 18 June 2025. The examination employed a three-pronged sentiment analysis and topic modeling. The study found an overall positive polarity in public sentiment with lingering skepticism among 1601 comments. The sentiment analysis also revealed ten themes that are of keen concern to the public and strategies for addressing them.
The Dual Prevention Pill (DPP), a combination of pre-exposure prophylaxis (PrEP) and combined oral contraception (COC), offers a novel, female-controlled option for HIV and unintended pregnancy prevention. However, new technologies like the DPP often face delays in regulatory approval and uptake due to limited stakeholder involvement early in the introduction process. This project, implemented by Copper Rose Zambia with support from AVAC, aimed to demonstrate how early, multisectoral stakeholder engagement could accelerate DPP approval and adoption in Zambia. Throughout 2024, a series of consultations were conducted with policymakers, healthcare providers, community health workers, female sex workers, adolescent girls and young women, and funders. Feedback informed product messaging, policy alignment, and implementation strategies. The DPP was subsequently included in Zambia's revised National PrEP Guidelines and Implementation Plan as an upcoming product. Stakeholders expressed strong interest but also raised concerns around stigma, access barriers, side effects, and supply chain reliability. These findings underscore the critical role of inclusive, context-specific engagement in the introduction of multipurpose prevention technologies (MPTs). Lessons from this initiative may be relevant to similar high-incidence settings considering the DPP or other integrated prevention products.
Metabolic and morphological changes caused in people living with HIV (PLHIV) by infections and antiretroviral therapy increase cardiovascular risk. Anthropometric indicators are low-cost tools for cardiovascular risk assessment. This cross-sectional study evaluated the association between 11 anthropometric indicators and cardiovascular risk in 354 cis-gender PLHIV of both sexes ≥18 years, attending a public outpatient clinic in northeastern Brazil. Sociodemographic, clinical, personal, and anthropometric data were collected. Cardiovascular risk was determined using the Framingham risk score, and sex-stratified multivariable regression analyses adjusted for confounders were performed (p < 0.05). Participants were predominantly male (58.8%) with a mean age of 42.7±13.0 years. Cardiovascular risk was low in 70.1%, moderate in 16.7% and high 13.3%. Conicity index (CI), waist-to-hip ratio (WHR), body shape index (BSI), waist-to-height ratio (WHtR) and body roundness index (BRI) were significantly associated with cardiovascular risk only in men (standardized beta (β*) = 0.4985, β* = 0.4861, β* = 0.4645, β* = 0.4320 and β* = 0.4204, respectively) after adjustment for relevant confounders. No significant associations wereobserved in women. In conclusion, anthropometric indicators, particularly CI and WHR, were independently associated with cardiovascular risk in men living with HIV. These findings support the use of simple anthropometric measures for cardiovascular risk assessment in men with HIV.
Depression and anxiety disorder (GAD) symptoms are common among people living with HIV (PLHIV). In Panama, despite a growing epidemic and 20 antiretroviral clinics, only eight have integrated institutional mental healthcare. This study examined depression and GAD symptom levels and psychosocial correlates among PLHIV who attended two urban clinics. From August-November 2024, participants self-administered a questionnaire with PHQ-9 and GAD-2 instruments. Hierarchical logistic regression analyses identified associations with demographics, HIV care, psychosocial stressors and health-related functioning variables. Of the 317 participants, 31.0% identified as women, 50.8% men, and 17.4% non-binary/another gender. Moderate to severe depressive symptoms were reported by 16.1%, and high GAD symptoms by 20.4%. Depressive symptoms were associated with younger age (AOR = 0.89, 95%CI[0.81,0.98]), drug use (AOR = 7.77,95%CI[1.28,46.98]), discrimination (AOR = 5.86,95%CI[1.33, 25.79]), chronic pain (AOR=15.20,95%CI[2.44,94.37]) and difficulties with activities (AOR = 51.41,95%CI[4.98,530.61]). GAD symptoms were associated with insufficient resources (AOR = 5.02,95%CI[1.60, 15.77]), ART clinic (0.23[0.06, 0.82]), discrimination (AOR = 5.84,95%CI[1.86,18.29]), chronic pain (AOR = 8.80, 95%CI[1.92,40.39]) and difficulties with activities (AOR = 14.48,95%CI[1.79,116.92]). The findings highlight the mental health burden among PLHIV in Panama. Discrimination, chronic pain and activity limitations are associated with depression and GAD symptoms. Our results underscore the need for enhanced integrated mental healthcare in all clinics and community-based psychosocial support.
