HIV testing is a critical strategy to addressing the disproportionate impact of HIV among Black transgender and nonbinary (TNB) individuals in the Southern U.S. We conducted 12 semi-structured qualitative interviews with Black TNB young adults in New Orleans to explore factors influencing HIV testing experiences and perceptions. We used a socioecological framework to guide analysis and identified themes across intrapersonal, interpersonal, organizational, and community levels. At the intrapersonal level, HIV anxiety shaped testing experiences and perceptions. Peer influence and patient-provider interactions emerged at the interpersonal level, and clinic operations at the organizational level. Community-level factors included stigma, medical mistrust, and confidentiality concerns. Participants provided actionable recommendations, emphasizing the need for instrumental support (e.g., transportation), hiring and training Black TNB clinic staff, and creating culturally resonant HIV testing programs. Community-informed strategies centering Black TNB voices are critical for designing effective HIV prevention programs that honor their identities and lived experiences.
Stigma remains a significant barrier to health care and well-being for people living with HIV (PLWH), especially when compounded by racial identity and sexual orientation. Most existing studies address stigma in isolation, overlooking its compounded effects. Guided by the socioecological model, intersectionality theory, and resilience theory, this qualitative study explored how intersectional stigma (perceived, internalized, enacted) related to HIV status, race/ethnicity, and sexual orientation. Semi-structured interviews were conducted with 11 PLWH from diverse backgrounds until thematic saturation was reached. Analysis identified intersecting stigma forms resulting in social rejection, anticipatory discrimination, and internalized shame. Resilience emerged across individual (self-advocacy), interpersonal (peer support), and community (solidarity) levels, mitigating emotional, social, and healthcare-related impacts. Family and community simultaneously served as sources of harm and resilience. Findings indicate the need for multilevel, culturally responsive interventions addressing structural and relational stigma while enhancing supportive networks to promote health care engagement among PLWH.
Black residents of Miami-Dade County experience among the worst HIV outcomes in the United States. Research suggests tailoring strategies to reflect population-specific patterns of risk may improve intervention impact. Yet HIV interventions often prioritize the factors of greatest risk regardless of their prevalence within a given population. To better inform the reach and effectiveness of a community-based HIV intervention for diverse Black communities, we used latent class analysis (LCA) to empirically identify behavioral subgroups within a cohort of over 1,000 predominantly Black South Florida residents. From December 2016 to April 2019, a community health worker-led HIV prevention program collected demographic and HIV risk data. LCA was performed using 12 risk indicators, resulting in five classes: Minimal Engagement (31%), Substance Use (4%), Condomless Engagement (43%), Impaired-Condomless Engagement (18%), and Syndemic Risk (4%). Findings support the value of LCA for designing efficient, context-aware, and resource-conscience HIV interventions.
Holistic approaches to HIV care aim to improve the lives of people living with HIV (PLWH) by shifting focus toward health systems that are more people-orientated and less disease-orientated. Social prescribing is one such approach that refers individuals to co-design non-clinical social prescriptions to improve their health and well-being. This qualitative study aimed to explore PLWH and support personnel preferences for the content and delivery of a socially prescribed psychoeducation model for PLWH in Ireland. Individual interviews were conducted with five PLWH and eight support personnel. Content analysis identified six superordinate categories with thirteen subcategories, identifying opportunities to empower PLWH through shared decision-making with trusted service providers and improved access to community resources, potential for peer support to combat social isolation and improve well-being, methods to overcome barriers to participation and improve cultural competency, and rationale to promote integrated social support that promotes a multidisciplinary approach and continuum of care.
In a secondary analysis from a randomized controlled trial of a peer advocacy training intervention for people living with HIV (PLWH), we examined effects on advocacy targeting specific HIV protective behaviors among enrolled social network members (alters), and whether alter behaviors were predicted by advocacy receipt and tone of delivery. 210 PLWH and 599 alters enrolled and were followed over 18 months. Repeated measures logistic regressions showed that PLWH in the intervention group targeted more alters with advocacy for HIV testing, condom use, pre-exposure prophylaxis, and HIV care, compared to those in the control group. Alters targeted with HIV testing advocacy were more likely to report increased HIV testing at the subsequent assessment. Among alters with HIV-negative main partners, receipt of condom use advocacy predicted increased consistent condom use at the subsequent assessment. Advocacy training for PLWH can increase targeted HIV prevention advocacy, which then promotes HIV testing and condom use.
BackgroundMen living with HIV face heightened cardiovascular disease (CVD) risk due to traditional risk factors and prolonged antiretroviral use. In Pakistan, little is known about how this population perceives and prevents CVD.ObjectiveThis study explored how men living with HIV in Islamabad understand cardiovascular risk and barriers to prevention.MethodsThirteen semi-structured interviews were conducted and thematically analyzed using NVivo. The Health Belief Model served as a sensitizing framework to guide interpretation.ResultFive themes emerged: psychosocial impact and stigma following HIV diagnosis, medication adherence and challenges, limited awareness of cardiovascular disease, fragmented healthcare, and community empowerment. participants showed minimal awareness of HIV-CVD links, and preventive care was rare. Stigma, inadequate counseling, and poor screening access were key barriers.ConclusionsCardiovascular prevention is largely overlooked in HIV care in Islamabad. Integrating CVD education, regular screening, and provider training into HIV care could improve outcomes for people living with HIV in low-resource settings
The COVID-19 pandemic exacerbated health challenges among people who use opioids (PWUO) and substance using men who have sex with men (SU-MSM) in Southeastern United States cities. Within the larger NIDA Clinical Trials Network Protocol 0082 PrEP attitudes and opioid use services implementation survey, N = 171 PWUO and N = 169 SU-MSM answered a COVID-19 vaccine attitudes survey, including measures of vaccine willingness and health beliefs. In mixed-effects linear models for PWUO and SU-MSM, respectively: (1) belief in vaccine protection from illness was positively correlated with vaccine willingness; and (2) sense of being "a guinea pig" was negatively correlated with vaccine willingness. Having previously used a COVID-19 antigen test was positively correlated with vaccine willingness in SU-MSM. This study aims to define vaccine willingness during the COVID-19 pandemic among people who use drugs and proposes the use of the Health Belief Model to conceptualize the correlation between health beliefs and intended behaviors.
The eradication of HIV, viral hepatitis, and other sexually transmitted infections (STIs) remains a global challenge. CASA Torremolinos, a community-based voluntary counseling and testing (CBVCT) initiative in southern Spain, provides comprehensive prevention services (CPS), including rapid HIV, HBV, HCV, and syphilis testing. From 2018 to 2022, 2,288 individuals were screened, identifying a 7.7-fold higher HIV seroprevalence than the national average (2.4% vs. 0.31%) and moderate increases for HBV (0.30% vs. 0.22%) and HCV (0.23% vs. 0.17%). Linkage to care was achieved for 98.2% of HIV and 100% of HBV, HCV, and syphilis cases. CASA Torremolinos also delivered 6,896 CPS sessions, including chemsex counseling and PrEP linkage. These results underscore the importance of CBVCT services in facilitating early diagnosis, community engagement, and continuity of care in high-incidence areas. The findings support scaling up community-led strategies to meet UNAIDS goals and strengthen local sexual health systems.
Pre-exposure prophylaxis (PrEP) in Ontario remains concentrated in large cities, leaving smaller urban and rural communities underserved. To inform targeted expansion, we interviewed 28 primary care providers (family physicians, trainees, public health nurses, clinic managers, and practice leads) working outside major metropolitan areas. Recruitment used multiple outreach methods, and interviews were transcribed and thematically analyzed. Half of participants had direct PrEP experience. Providers cited limited training, knowledge gaps, few continuing-education opportunities, staffing shortages, and lack of administrative support as barriers. Structural forces, stigma, high costs, transportation barriers, further limited access, intersecting with poverty, racism, and substance use, and affecting equity-deserving groups beyond gay and bisexual men. Participants recommended province-wide competency-based training, task-sharing through medical directives, normalization of PrEP in clinical discussions, broader awareness campaigns, and nurse-led models. Findings highlight the need to strengthen provider capacity while addressing social determinants to achieve equitable PrEP uptake outside Ontario's major cities.
This qualitative study explores concerns of mothers living with HIV about the consequences of HIV exposure for their children during pregnancy and early childhood, before and beyond a final HIV negative diagnosis. Conducted in South Africa's Western Cape between January and April 2024, the study involved semi-structured interviews with 20 mothers whose children HIV-exposed, over one year old, tested HIV-negative at 12 months. The study revealed that maternal fear of vertical HIV transmission persisted throughout pregnancy and early childhood. It was triggered by breastfeeding decisions, repeated HIV testing, sickness or growth faltering in the child, and doubts about antiretroviral effectiveness. Mothers adopted coping strategies such as strict medication adherence, routine clinic visits, and heightened hygiene practices. The study indicates that comprehensive, ongoing support for mothers living with HIV throughout the early years of motherhood, including breastfeeding guidance, clear information on HIV testing protocols, and guidance on long-term implications of HIV exposure can alleviate maternal stress.
Biases in large language models (LLMs) such as ChatGPT, particularly in health and HIV contexts, remain underexamined. This study adopted a psychological lens to examine sociodemographic biases in ChatGPT by comparing its predictions of HIV knowledge with actual responses from adolescents and young adults using nationally representative survey data from the Philippines. Prompt-based simulations using GPT-4o were conducted using participants' sociodemographic profiles (n = 1,393) and analyzed using binary and multinomial logistic regression models. ChatGPT was more likely to inaccurately predict HIV knowledge for certain groups, including LGBTQ individuals (adjusted odds ratio [aOR] = 1.65, p = .025), older participants (aOR = 1.08, p = .005), urban residents (aOR = 1.78, p < .001), and those with higher formal education (aOR = 3.58, p < .001). These inaccuracies reflected overestimations. Findings suggest the presence of implicit biases, and underscore the need to evaluate LLMs for equitable application in health education.
Southern U.S. communities experience high HIV incidence and substance use prevalence, yet low PrEP uptake. Providers (N = 191) completed a survey about willingness to refer/link clients with HIV risk to PrEP. Through in-depth interviews, 12 directors (5 sexually transmitted infection [STI] clinics; 5 syringe services programs [SSPs]; 2 substance use treatment programs [SUTPs]) described multi-level factors that contextualized provider willingness. Providers were more willing to refer/link clients with unspecified HIV risk and men who have sex with men to PrEP vs. other populations. SUTP (vs. SSP) providers were less willing to refer/link clients with unspecified risk and men who use opioids. Older (vs. younger) providers were less willing, and more (vs. less) experienced providers more willing to refer/link to PrEP. Directors described facilitators (e.g., comprehensive health center partnerships) and barriers (e.g., provider stigma toward people who use drugs) to PrEP implementation. Findings highlight the importance of considering multi-level factors in PrEP implementation.
Viral load suppression is the goal in current HIV treatment efforts. This was a cross-sectional descriptive qualitative study of 41 purposively selected adult participants, achieved through data saturation. Guided in-depth interviews were conducted to subjectively evaluate QOL and its related drivers among virally suppressed PLHIV in the Eastern Cape province of South Africa. Thematic analysis was employed to identify key themes emerging from the interview responses. Participants consistently evaluated their QOL as improved, acceptable, or excellent, based on their psychological, physical and social wellbeing. Commonly cited drivers for the perceived QOL were positive social relationships, better access to healthcare services and positive self-efficacy, whilst perceived benefits of ART adherence and viral suppression were improved productivity and increased life expectancy. Multidisciplinary interventions are worthwhile where policies and programs must deliberately seek to address QOL determinants and aspirations of PLHIV, apart from targeting viral suppression through medications alone.
Despite efforts to prevent new HIV infections and improve care for People Living with HIV (PLHIV), HIV continue to disproportionately affect African, Caribbean, and Black (ACB) communities in Canada, with these populations facing higher levels of stigma, marginalization, and health inequities. In this qualitative study, 12 HIV healthcare workers from the ACB community in London-Ontario were purposively recruited for a short sociodemographic survey and focus group discussions, lasting between 1 to 2 hours. A blend of inductive and deductive thematic qualitative analysis was conducted to generate knowledge that will inform culturally sensitive policy decisions for effective HIV prevention and stigma reduction. We found that the association of HIV status with promiscuousness, and wrong moral judgements of PLHIV, drives persistent HIV stigma and status non-disclosure. An intersection of gender-based discrimination, sexual and racial stereotypes further compound the stigma and status non-disclosure. Systemic discrimination and structural violence against PLHIV in the form of unequal job opportunities, denial of access to accommodation, lack of comprehensive health coverage, as well as the disproportionate criminalization of immigrants for status non-disclosure, are highly stigmatizing experience that induces status non-disclosure. The findings underscore the urgent need for intersectional approaches to HIV stigma reduction, policy reforms, and culturally responsive stigma reduction interventions.
BackgroundDespite advancements in medical treatment for HIV, stigma related to the virus remains a significant obstacle for people living with HIV. In Iran, social stigma continues to impact the quality of life of patients. This study aimed to investigate the concept of stigma and its effects on people living with HIV.MethodsA qualitative study utilizing conventional content analysis was conducted in 2024 at medical centers affiliated with Shahid Beheshti University. Data were gathered through semi-structured interviews with 27 participants were selected, consisting of individuals living with HIV, primary family caregivers, and healthcare providersResultsAnalysis identified four main themes: Silent Suffering, Striving for Hope, The Shaky Fabric of the Family, and Unmet Needs.ConclusionAddressing stigma is crucial for enhancing the well-being of individuals living with HIV. Interventions should focus on education, community involvement, and psychosocial support to address the various challenges they encounter.
Adolescents living with HIV represent a vulnerable group with distinct psychological challenges. Yet, there is limited research on the factors influencing their mental well-being and future orientation independently and jointly, particularly in sub-Saharan Africa. Existing studies have primarily focused on the mental well-being of adolescents with perinatal HIV, leaving a gap in understanding those contracted through behavioral forms. This study aimed to investigate whether the mode of HIV transmission (perinatal vs. behavioral) would be associated with mental well-being and future orientation. A sample of 118 adolescents (ages 13-19, M = 16.5, SD = 1.8) living with HIV in Ibadan, Nigeria were assessed using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) to measure mental well-being, and the Future Orientation Scale (FOS) to evaluate future orientation, including planning ahead, time perspective, and anticipation of future consequences. Results from the one-way ANOVA revealed no significant differences in mental well-being [F (2, 114) = 0.318, P = 0.728] and future orientation [F (2, 115) = 0.464, P = 0.630] between perinatally and behaviorally infected adolescents. These findings suggest that the mode of HIV transmission does not significantly affect the mental well-being or future orientation of adolescents living with HIV. Interventions to support this population should focus on shared mental well-being needs, such as coping with stigma and chronic illness management, rather than focusing on the mode of transmission.
Pre-exposure prophylaxis (PrEP) is a highly effective strategy for preventing HIV infection when taken as prescribed. Most studies have focused on adult populations and other vulnerable groups, such as men who have sex with men (MSM) while few studies have explored the barriers young people face toward PrEP uptake yet they contribute a worrying percentage of new infections and HIV related deaths. We conducted 17 in-depth interviews with young people aged 15-24 years and key informants in Lower Gweru, Zimbabwe. Findings highlighted that young people face numerous barriers such as fear of side effects, pill burden, and lack of PrEP awareness. We concluded that addressing challenges to PrEP uptake requires a multifaceted approach that includes improving accessibility and education, as well as addressing cultural and social barriers. Implementing these recommendations can significantly enhance PrEP uptake, ultimately contributing to national HIV prevention goals and better health outcomes for young populations.
This study aimed to examine the determinants of HIV testing among pregnant Indonesian women using a socio-ecological framework that helps navigate HIV testing determinants at the individual, interpersonal, and community levels. Multivariate logistic regression was performed using the 2018 national health data of 40,287 pregnant women. This study found that only 19.09% of pregnant women were tested for HIV. Factors influencing HIV testing included younger age (AOR = 0.823 for age >= 35 years), higher education level (AOR = 1.120), and comprehensive HIV knowledge for women (AOR = 1.667) and their husbands (AOR = 1.371). At the community level, inequalities existed at the household and regional levels due to different household economic conditions and regional development. However, stigma was not a significant determinant (AOR = 1.015). Addressing these health disparities and enhancing community-level exposure to HIV information are crucial efforts for facilitating HIV testing among pregnant women in Indonesia.
Limited information is available regarding caregivers' experiences with disclosing HIV status to children in Northern Ghana. Our study aimed to investigate the prevalence and reasons for pediatric disclosure. We conducted a descriptive phenomenological study with caregivers of children living with HIV in three hospitals. In-depth individual interviews were conducted until data saturation was reached after the 9th participant interview, using a semi-structured interview guide. Rigorous methods were employed, including member checking, peer debriefing, and prolonged field stay. The results revealed four main themes and seven sub-themes: (1) lack of disclosure to children living with HIV, (2) reasons for non-disclosure to children, (3) selective disclosure to others, and (4) reasons for non-disclosure. The findings suggest low levels of disclosure to children and others, which may impact ART adherence, viral load suppression, and support for children. The study highlights the need for improved clinical disclosure interventions for healthcare workers and caregivers.
Despite increasing PrEP use in Canada, uptake remains low among Indigenous Peoples, who experience disproportionately higher rates of HIV. A scoping review following Arksey and O'Malley's framework and PRISMA-ScR was conducted using literature from 2012 to 2024 to explore how Indigenous Peoples conceptualize PrEP regarding awareness, motivation, access, and effectiveness. We included qualitative, quantitative, and mixed-method studies and reports from Canada, Australia, New Zealand, and the United States. Out of 181 identified articles, 11 met our inclusion criteria. The studies highlighted a lack of Indigenous People identifying with mainstream gay communities where PrEP promotion usually occurs. Individuals were motivated to use PrEP to prevent getting HIV and if PrEP was funded. Healthcare provider barriers such as overburdened Indigenous-specific services and a focus on chronic diseases, along with HIV-related stigma and homophobia, limit access to PrEP. This review also revealed a lack of effective use of PrEP by Indigenous populations.
