HIV status disclosure is an ethical obligation and, in some jurisdictions, a legal requirement that supports treatment adherence. In Eastern and Southern Africa (ESA), where intimate partner violence (IPV) is prevalent, disclosure may have harmful consequences. The objective of this scoping review was to map the relationship between IPV and HIV disclosure across health care settings in ESA. Following PRISMA-ScR guidelines, peer-reviewed English-language studies (2012-2024) were identified through EBSCOhost, PubMed, and Google Scholar using a SPICE-informed search strategy. Thirty-six quantitative, qualitative, and mixed-methods studies met the inclusion criteria and were analyzed thematically. Three themes emerged: factors influencing disclosure, including relationship dynamics and fear of violence; the positive and negative consequences of disclosure, particularly IPV; and the role of health care workers, whose limited IPV training tended to increase risk. Integrating IPV screening, safety planning, and gender-sensitive training into HIV counseling is essential to support safe, client-led disclosure.
Adolescents are disproportionately affected by sexually transmitted infections, particularly HIV and syphilis, yet testing rates remain low. We conducted semistructured interviews with 15 adolescents (14-20 years old) at an urban pediatric clinic in Milwaukee to identify facilitators and barriers to HIV and syphilis testing. Data were analyzed using thematic analysis. Results highlight strikingly low levels of syphilis knowledge. Modifiable testing barriers include needle anxiety, fear of results, confidentiality and parental disclosure concerns, and structural challenges including transportation and scheduling conflicts. Despite barriers, nearly all participants described trusted, nonjudgmental providers that supported testing. Critical syphilis knowledge gaps and intersecting barriers persist, yet provider relationships create a feasible opportunity for brief, clinic-embedded HIV/syphilis education.
HIV remains a critical global public health concern. While no cure exists, treatments like antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) effectively reduce transmission rates. However, PrEP uptake is low, especially in areas facing stigma and misinformation, such as the southern United States, where high HIV stigma further hinders compliance. This study examined PrEP-related knowledge, attitudes, and prescribing behaviors among 179 nurse practitioners (NPs) in one southeastern state. Results indicated significant gaps in PrEP knowledge. Qualitative interviews highlighted stigma rooted in religious and regional contexts and emphasized the need for better education and provider-patient communication. These findings confirm that providers with PrEP knowledge and tools to reduce stigma may foster an increase in PrEP uptake in high-need areas.
Long-acting injectable antiretroviral therapy (LAI-ART) has the potential to transform HIV treatment by improving adherence, reducing stigma, and expanding access through decentralized care. The INVITE-Home study evaluates home-based LAI-ART administration by trained nonmedical treatment buddies (TBYs) selected by people with HIV (PWH). This article describes the development of a TBY training curriculum guided by Adult Learning Theory and refined through iterative stakeholder input. The five-phase process included review of existing materials, qualitative interviews with clinicians, PWH, and TBYs (n = 50), curriculum development, community advisory panel feedback (n = 9), and final refinement. Stakeholders emphasized structured hands-on practice, multimodal learning resources, and accessible language to build technical skills and confidence. The resulting curriculum integrates synchronous and asynchronous learning tailored to diverse learning preferences. Home-based LAI-ART may enhance privacy, reduce clinic burden, and support equitable, person-centered HIV care while maintaining safe administration and clinical oversight.
This study evaluated the acceptability and perceived impact of a three-session national HIV education program integrating biomedical advances, team-based care, and stigma reduction strategies. Using a mixed-methods pre-post design, participants completed surveys assessing perceived knowledge, utility of training, planned actions, and ability to support virologic suppression. Participants reported significant increases in perceived knowledge across all sessions. Sessions were rated highly useful, particularly the stigma-focused training. Participants described intentions to apply learning to patient care, staff training, and organizational practices. Qualitative findings highlighted improved communication skills and greater awareness of stigma's role in care engagement. These findings suggest that interdisciplinary virtual HIV education is acceptable and may support provider capacity across diverse settings. Programs that integrate biomedical and stigma-informed approaches may strengthen efforts to improve HIV care outcomes.
To characterize the lived experience of persons living with HIV/AIDS (PLWHA) during the COVID-19 pandemic, we utilized an innovative survey to assess the experiences of 94 adult respondents receiving medical care and/or case management services from two Ryan White funded sites in New Brunswick, NJ, from May 2020 to November 2021. The Local Inventory of Needs and Knowledge-HIV (LINK-HIV) survey includes five indices and assesses overall and mental/emotional health of PLWHA. We demonstrate internal validity of the indices, describe relationships between indices and health outcomes, and characterize the health of this population. We identified specific unmet needs across the constructs of social determinants of health (SDOH) Needs, Stress due to unmet SDOH, Access to Healthcare, Stress due to COVID-19, and Person-Centered Primary Care. Respondents' self-reported health was suboptimal (47.8% reported better overall health, 40.4% reported better mental/emotional health), and associations were seen between responses to the five indices and self-reported health outcomes.
Spouses and partners play a crucial role in the well-being of women living with HIV (WLWH), especially in family-oriented cultures. This scoping review examined partner-inclusive interventions to strengthen support systems for WLWH. We searched PubMed, Embase, and the Cochrane Library for peer-reviewed studies from 2004 to 2024. Of 1,375 records screened, six randomized trials conducted in the U.S., China, Ethiopia, and sub-Saharan Africa met the inclusion criteria. Four involved WLWH-partner dyads, two included other family members. Interventions varied in format and were facilitated by health care/social service providers and peer leaders. Most interventions were theory-driven and used psychosocial and behavioral strategies. Positive outcomes included improved medication adherence, HIV knowledge, safe sex behaviors, mental/physical health, gender norms, partner relationships, and coping behaviors. However, gaps remain, notably the lack of approaches addressing power imbalances within the dyad. Future research should consider culturally tailored interventions that emphasize gender empowerment and shared decision-making.
During the 2022 mpox outbreak, some LGBTQ+ populations in the United States experienced elevated risk, yet motivations for mpox vaccination remain unclear. This study examined whether mpox vaccination intent/uptake was associated with uptake or intent to vaccinate for other sexually transmitted vaccine preventable diseases (VPDs), including a future HIV vaccine, and whether mpox concern, HIV vaccination intent, and sociodemographic factors predicted mpox vaccination intent/uptake. LGBTQ+ adults in New Jersey and New York completed a cross-sectional web-based survey assessing vaccine behaviors and mpox-related attitudes. Individuals reporting the intent to vaccinate for HIV were more likely to report mpox vaccination intent/uptake, whereas uptake or intent for other sexually transmitted VPDs was not associated with mpox vaccination intent/uptake. In multivariate models adjusting for sociodemographics, higher mpox concern, greater HIV vaccination intent, and employment were associated with higher odds of mpox vaccination intent/uptake. Findings suggest that mpox and HIV vaccination intentions may reflect shared, outbreak-specific prevention orientations shaped by heightened risk.
Long-acting injectable ART (LAI-ART) may mitigate barriers to ART adherence, but research is needed to optimize LAI-ART for Spanish-speaking people with HIV (PWH). As part of a larger multi-site qualitative study, we conducted 20 semistructured interviews with monolingual Spanish-speaking PWH at a Ryan White-funded academic HIV clinic. Transcripts were analyzed in Spanish using thematic analysis. The median age of participants was 47 years (range 25-68), 30% were cis women, 10% were trans women, and all were born in Latin America. Three themes emerged: (1) injection familiarity as a mediator of LAI-ART acceptability, (2) concerns about the compatibility of LAI-ART with one's body, and (3) concerns that use of LAI-ART could impact the ability to return to one's country of origin. Monolingual Spanish-speaking PWH demonstrated substantial interest in LAI-ART. Provider awareness of patients' preferences, beliefs, and migration considerations can help empower patients to make informed decisions about their HIV care.
This qualitative study explores barriers to and facilitators of pre-exposure prophylaxis (PrEP) use among individuals involved in the criminal legal system (CLS) in the Southern U.S. Through in-depth interviews with 72 participants on probation or parole across Florida, Kentucky, and North Carolina, we identified five key themes: (1) depersonalization of HIV risk, where participants acknowledged PrEP's value but excluded themselves as candidates; (2) stigma, including internalized, interpersonal, and structural barriers; (3) financial and insurance constraints, exacerbated in non-Medicaid expansion states; (4) medical mistrust stemming from negative carceral health care experiences; and (5) the unexpected role of research participation as a primary source of PrEP education. Findings align with and extend existing literature on marginalized populations, highlighting the need for tailored interventions addressing systemic, institutional, and community-level barriers. This study underscores the urgency of centering lived experience and policy innovation to improve PrEP access for this high-risk population.
Black women experience a disproportionate burden of human immunodeficiency virus in the United States, yet use of pre-exposure prophylaxis remains low. This article critically reviews published research on barriers to and facilitators of pre-exposure prophylaxis acceptability among Black women and presents findings from a qualitative pilot study examining awareness and preferences for available and emerging prevention modalities. A critical review of 50 peer-reviewed studies published between 2012 and 2025 identified persistent challenges as well as facilitators. The pilot study included focus groups and interviews with 20 pre-exposure prophylaxis-naïve Black women in two high-incidence Texas counties. Participants demonstrated limited awareness of injectable prevention options, varied preferences across modalities, and strong interest in expanded delivery settings such as pharmacies, mobile services, and at-home options. Findings indicate that low uptake reflects structural gaps in prevention systems rather than lack of interest, underscoring the need for diversified modalities and accessible delivery models.
Adolescents and young adults (AYA) aged 15-24 in Tajikistan have the lowest comprehensive knowledge of HIV compared to other AYA in Eastern Europe and Central Asia; however, little research has explored what sources of HIV information they utilize. We conducted a qualitative study with 36 AYA in Dushanbe, grouped by gender and age. Participants engaged in participatory activities and discussions over two sessions. We conducted thematic analysis and identified three main themes: (1) school-based HIV education was limited and technical, leaving practical knowledge gaps; (2) social networks often spread inaccurate, stigmatizing information; and (3) AYA preferred professional sources but had limited access, relying instead on potentially inaccurate sources like social media. Tajik AYA lack information sources which empower them with accurate information and build their capacity to engage in preventive behaviors. Educational efforts must move beyond knowledge enhancement to address social and structural barriers to information sharing regarding HIV.
Men who have sex with men (MSM) account for nearly 70% of new HIV infections annually. Although awareness of pre-exposure prophylaxis (PrEP) is growing, uptake remains low among young MSM. Peer navigators are well positioned to guide patients through PrEP care, provide psychosocial support, build trust, and demystify PrEP. Given strong evidence to support mobile health (mHealth) apps for enhancing HIV prevention knowledge, our team created MyPEEPS Plus, a HIV prevention combination intervention of mHealth and an electronic peer (e-peer) navigation program. In this article, we describe development of a remote intervention that incorporates evidence-based strategies including: HIV Incidence Risk Index for Men Who Have Sex With Men (HIRI-MSM); open-ended questions, affirmations, reflective listening, and summarizing (OARS); shared decision making approach; the PrEP Readiness Assessment (PRA); and motivational interviewing (MI) for use in an RCT. By combining digital education with personalized support, MyPEEPS Plus is designed to empower youth and reduce barriers to PrEP initiation and persistence.
African American faith institutions can play a key role in increasing HIV education and testing in communities disproportionately burdened by HIV. This focus group study explored church participant perspectives of a religiously tailored HIV education and testing intervention implemented through a clustered, randomized controlled trial with 14 African American churches in Kansas City. Focus group participants from intervention churches emphasized the importance of churches providing access to HIV screening/education and support for people with HIV. They noted that pastors' involvement (e.g., integrating messages into sermons, publicly getting tested) encouraged others to get tested. TIPS materials were seen as easy to understand, and the intervention fostered more HIV discussions and partnerships with public health organizations. Challenges included time demands and limited church staff. Participants recommended stronger connections among intervention churches for support and idea sharing. Overall, religiously tailored HIV education and testing interventions are highly acceptable when supported by trusted faith and public health partnerships.
This pilot study introduces Save Yourself, an educational board game designed to teach HIV/AIDS biology and prevention, enhance science communication, and reduce stigma. Using a single-group pretest/posttest design, 42 university students (Mage = 24.6) completed a 20-item HIV/AIDS knowledge quiz, evaluation items, and open-ended feedback. Paired samples t tests revealed significant knowledge gains (pre: M = 64.97%, SD = 9.77; post: M = 85.10%, SD = 7.86; t(41) = -10.68, p < .001, d = -1.65), with large improvements in transmission and prevention subscales. Descriptive ratings were high for gameplay, clarity, and mechanics (≈ 4.5/5). A binomial test showed 81% of participants felt the game addressed stigma (p < .001). Thematic analysis identified seven areas for improvement, including balance of fun and learning, clarity of instructions, and social impact. Measurement issues emerged, as the Educational Game Scale showed poor reliability (α = -.04). Overall, Save Yourself shows promise as a low-tech, engaging HIV/AIDS education tool.
Accurate assessment of general HIV and pre-exposure prophylaxis (PrEP) knowledge is essential for evaluating contemporary prevention efforts. This study examined the psychometric properties of a revised HIV and PrEP knowledge instrument for young sexual and gender minority (SGM) men. Data were collected from 1,519 participants (ages 17-29) via an online survey. Of the original 31 items, 7 were removed based on item analysis, and Exploratory Factor Analysis (EFA) was conducted on the remaining 24 items. EFA supported a two-factor structure-18 items assessing general HIV knowledge and 6 assessing PrEP knowledge-with acceptable model fit (RMSEA = 0.06) and strong factor loadings (0.32). The instrument demonstrated measurement invariance across major racial/ethnic groups, moderate to strong item-total correlations (≥0.30), and acceptable internal consistency for both subscales. Findings validate this 24-item, two-factor instrument as a reliable tool for assessing HIV and PrEP knowledge among SGM men.
Despite the disproportionate burden of HIV among sexual minority men (SMM), PrEP is underutilized among this population. This study used a discrete choice experiment (DCE) to examine preferences and concerns related to PrEP uptake among HIV-negative, PrEP-eligible SMM (n = 271). Participants evaluated hypothetical PrEP profiles based on administration method, side effects, provider language, and peer use. On-demand PrEP was preferred over daily and long-acting injectable regimens. Side effects, particularly headaches and nausea, were rated as more influential than other attributes. Participants who knew someone taking PrEP had increased odds of taking PrEP themselves. Language concordance with providers did not significantly affect preferences. These findings underscore the importance of flexible PrEP options and minimizing side effects to increase acceptability. Tailoring healthcare delivery and messaging to these preferences may improve PrEP uptake among SMM.
In the United States (U.S.), sexual minority youth (SMY) are disproportionately impacted by HIV and other sexually transmitted infections (STIs) and structurally marginalized from routine testing for HIV and STI. This study examines neighborhood violence predictors (saw violence, safety concerns, and being threatened) on HIV and STI testing among a sample of SMY in the U.S. Data came from the 2021 Youth Risk Behavioral Surveillance System (YRBSS). Weighted bivariate and multilevel logistic regressions examined the odds of ever testing for HIV and STIs in the past 12 months and neighborhood violence. Our weighted sample (n = 806) had a mean age of 16 years, majority female (80%), and identified as White (53%). SMY reported increased odds of testing for HIV and STI when witnessing someone get physically attacked, beaten, stabbed, or shot in their neighborhood, felt unsafe at school or on their way to or from school, or threatened or injured with a weapon on school property. Additionally, increased odds of testing for HIV and STIs patterned exposure to neighborhood violence among SMY who identified as male, of color (non-White), and multi-ethnoracial background. The study highlights the need for examining potential protective social-structural factors that complicate the relationship between HIV and STI testing and exposure to neighborhood violence.
The HIV Vaccine Trials Network (HVTN) is the largest publicly funded international collaboration facilitating the evaluation of vaccines to prevent HIV and TB. Central to the HVTN's success is the reliance on robust community engagement methods, ensuring community participation and facilitating community awareness and knowledge of research. Community engagement is a dynamic process that requires active participation from all stakeholders to ensure success. The HVTN and its global Clinical Research Sites (CRSs) located in Africa, Latin America, and North America are known as the Network. We describe relationships across the Network, specific staff roles and responsibilities, and the myriad activities undertaken to ensure optimal community engagement. Key activities include involving active Community Advisory Boards (CABs), using community consultations, and having trained Community Engagement staff at each CRS. Operating with robust community engagement has resulted in rapid enrollment and high retention of diverse participant populations across Network studies.
The Philippines faces a rising HIV epidemic despite global declines, partly due to limited access to pre-exposure prophylaxis (PrEP). SAIL-teleprep, a telehealth-based differentiated service delivery model, was implemented to expand PrEP access among key populations (KPs) in underserved areas. Using the RE-AIM framework, this study evaluated its first-year implementation through a retrospective cohort analysis of 5,876 PrEP clients across four clinics in 2023. Of these, 8.4% accessed SAIL-teleprep, with higher uptake among clients aged > 24, residing outside Greater Manila, and identifying as men who have sex with men or sex workers. PrEP persistence among teleprep users was high (86.5%). Uptake varied by clinic, and use of courier deliveries peaked seasonally. Findings highlight SAIL-teleprep's potential to reach underserved groups while maintaining adherence. However, gaps remain in engaging younger KPs and people who inject drugs, underscoring the need for adaptable, client-centered strategies in decentralized HIV prevention.
