ABSTRACT:Pain in people living with HIV (PWH) is associated with greater psychological distress, poor sleep quality, and functional limitations. Yet the interconnections among these relationships remain understudied. Our study examined whether (a) sleep quality mediates the relationship between pain and depressive symptoms, (b) depressive symptoms mediates the relationship between pain and functional limitations, and (c) pain is associated with functional limitations through a serial pathway. A cross-sectional secondary analysis of 261 PWH was conducted. Pain was assessed using the pain subscale from the Medical Outcomes Study HIV Health Survey; lower scores indicated worse pain. Participants also completed the Pittsburgh Sleep Quality Index, the Center for Epidemiologic Studies Depression scale, and the Lawton and Brody Instrumental Activity of Daily Living (IADL) scale. Mediation analysis was performed using age, race, and education as covariates. Sleep quality partially mediated the relationship between pain and depressive symptoms, accounting for approximately 42% of the total effect. Depressive symptoms partially mediated the association between pain and IADL impairments (22%), whereas the serial pathway through sleep and depressive symptoms explained 8.4% of pain's total effect on IADL impairments. Improving sleep quality and depressive symptoms may reduce the negative impacts of pain on everyday functioning.
Abstract Using qualitative methods, we investigated barriers and facilitators to promoting physical activity in an HIV clinic in New Haven, CT. We conducted focus groups with HIV clinicians/staff ( n = 12) and interviews among people with HIV with unhealthy substance use ( n = 10). Data collection and deductive analysis were guided by the Health Equity Implementation Framework domains. Innovation barriers included lack of evidence-based interventions; facilitators included behavioral strategies and app-based programs. Clinical encounter barriers included lack of protocols and competing priorities; facilitators included discussing the benefits of physical activity. Recipient-level barriers included cost, physical capacity restrictions, and unhealthy substance use; facilitators included social support and tailoring interventions to individual interests/fitness levels. Contextual barriers included budget restrictions and lack of billing options; facilitators included having a physical activity specialist and infrastructure to link patients to physical activity services. Future research should investigate the feasibility of implementing a physical activity intervention into HIV clinical care.
ABSTRACT:Evidence suggests that HIV antiretroviral therapy (ART) adherence is suboptimal in long-term care (LTC) settings. We studied an HIV-specialized LTC facility to understand how a person-centered care model impacts ART adherence among older adults with HIV (OAWH). We conducted semistructured, in-depth interviews with 11 OAWH and five LTC staff/clinicians asking about barriers and facilitators to ART adherence. Interviews were recorded, transcribed verbatim, and analyzed using deductive and inductive rapid analysis matrices. Three themes emerged: functional support, routines, and fostering resident autonomy, which were achieved by the facility through increased availability of prescribing authorities, highly collaborative efforts in patient care planning, and medication reconciliation that prioritized interdisciplinary communication. The significant social and personal challenges of OAWH preadmission provided context emphasizing the magnitude of improvement from nearly none to 100% ART adherence. This facility's approach may serve as the basis for demonstration projects aimed at revising procedures in non-HIV-specialized LTC facilities.
ABSTRACT:We present nationally representative estimates of cancer diagnoses among US persons with HIV (PWH) using data from the Medical Monitoring Project, a complex sample survey of US adults with diagnosed HIV. Data were collected June 2019-May 2023 from a probability sample of 14,798 PWH. Weighted frequencies and percentages of cancer diagnoses during the past 24 months were calculated, and differences between the groups were quantified using prevalence ratios. An estimated 66,641 PWH (6.7%) had a cancer diagnosis and 54,863 (5.5%) had a non-AIDS-defining cancer diagnosis. PWH with a cancer diagnosis had higher prevalence of formerly smoking cigarettes, being unable to work or retired, poor self-rated health, advanced HIV disease, retention in HIV care, and viral suppression compared with those without a cancer diagnosis. Providing recommended cancer screenings and cancer prevention and treatment strategies-in addition to HIV standard of care-may support overall well-being among PWH.
ABSTRACT:Our study examined how perceived stigma influences multidimensional frailty among older adults living with HIV. In this cross-sectional study, 591 older people living with HIV (PWH) were recruited from a designated HIV institute in Shanghai, China, between December 2022 and October 2023. The participants completed face-to-face surveys that assessed five domains: perceived stigma, social support, social isolation, loneliness, and multidimensional frailty. SPSS 24.0 and AMOS 23.0 were used to conduct path analysis and examine the relationships between these variables. Perceived stigma had a significant effect on multidimensional frailty (β = -0.2591), with a small direct effect (β = -0.09), and the majority had an indirect effect via depression (β = -0.1067) and social isolation (β = -0.0188). This is one of the initial studies to show how perceived stigma can affect the psychological and social correlates of PWH to further contribute to multidimensional frailty among older PWH in China.
Abstract Thai men who have sex with men living with HIV face persistent self-management challenges. This Phase 2 mixed-methods quasi-experimental study evaluated the feasibility, acceptability, and preliminary efficacy of the Interactive HIV/AIDS Self-Management Education Application, a theory-informed mHealth intervention integrated within primary care. Sixty-three participants ( n = 32 intervention; n = 31 comparison) were assessed at baseline, 6 weeks, and 12 weeks, with propensity score weighting used to reduce bias. Feasibility was high (79.4% retention; 72.0% adequate engagement), and acceptability was strong, with high ratings on the Acceptability of Intervention Measure (median = 4.5/5). Qualitative findings supported acceptability by highlighting sustained engagement and perceived usefulness. The intervention demonstrated promising preliminary efficacy signals for improving antiretroviral therapy adherence, HIV self-management, and quality of life, supporting further evaluation in a fully powered randomized controlled trial and suggesting potential benefits of mHealth-supported self-management within primary care settings for long-term patient-centered HIV care delivery.
ABSTRACT:The aim of our study was to develop consensus from experts and advocates on the health care transition for young people living with HIV from pediatrics to adult care in Thailand using a modified Delphi method. Participants included physicians (58%), nurses (20%), clinic coordinators (11%), and outreach workers (11%). Survey items were distributed to gather responses. Consensus was achieved after two rounds of surveys (response rates: 86% and 94.5%, respectively). Key priorities identified included (1) pediatric clinics: early transition planning, individualized readiness assessment, and focusing on youth with an increased risk of poor treatment outcomes; (2) transition process: strong pediatric-adult clinic collaboration; (3) health care coverage scheme and system: making sure that youth are familiar with their resources and options; (4) adult clinics: providing communication skills training for providers aimed at offering youth-friendly, nonstigmatizing services; and (5) post-transition follow-up: communication to ensure a warm handoff. Effective transition care for young people living with HIV requires early preparation, sustained interclinic communication, and continuity-supportive care models.
ABSTRACT:This case study examines Spain's HIV prevention gap. Although pre-exposure prophylaxis (PrEP) is subsidized, decentralized health care creates a "postcode lottery" for key populations. We present the 5-year trajectory of a 28-year-old Senegalese man who has sex with men who immigrated to Spain. His temporary administrative status, precarious night shifts, and language barriers complicated medical interactions. Using the modified social-ecological model, which operationalizes how macro-level determinants like policy rigidities construct vulnerability, we illustrate how what is frequently mislabeled as patient noncompliance actually stems from institutional barriers. Despite theoretical health care availability, he faced a cascade of missed opportunities. Initial primary care visits yielded only behavioral advice; subsequent PrEP-access attempts were blocked by structural violence, compounded by residential mobility, linguistic isolation, and intersectional stigma. Successful PrEP access was achieved through a nurse-led navigation intervention addressing social determinants. Without structural competency and flexible nurse-led models, universal health rights remain theoretical for marginalized populations.
ABSTRACT:Addressing stigma, mental health, and health care access challenges for people living with HIV requires a multifaceted approach. Generative artificial intelligence (GenAI) chatbots may be one component of this approach. GenAI chatbots can reduce travel costs and save time. They provide opportunities to offer users a discreet alternative to human interaction, helping reduce stigma and improve comfort. They are easy to use, have multilingual capabilities and high levels of user satisfaction. Emerging evidence on GenAI chatbots suggests promising potential for enhancing HIV prevention, such as supporting HIV self-testing and providing information on PrEP, counseling, providing access to information, and role-playing HIV status disclosure. Successful implementation of GenAI for HIV care, however, requires careful consideration of ethical and practical issues to ensure safe and responsible use. Building user AI knowledge, trust, and ensuring ethical integrity will require meaningful collaboration between technologists, clinicians, researchers, and those most affected by HIV.
Abstract Cervical cancer (CC) is a leading cause of death, with women with HIV at an increased risk. Geographic disparities in CC and HIV reflect inequities in care access. The purpose of this systematic review was to evaluate integrated models for HIV and CC screening. This review was conducted following PRISMA guidelines. Full-text screening and data extraction were conducted independently. Eligible studies described integrated HIV and CC services. Of 4,280 records, 24 met inclusion criteria. Most studies ( n = 21) were conducted in sub-Saharan Africa; the remaining studies were conducted in high-income settings. Most studies integrated CC screening into HIV care ( n = 19); however, three integrated HIV screening into CC screening/treatment. Two studies implemented fully integrated HIV and CC screening in community settings. Integrated services were considered highly acceptable and feasible. Models introducing CC screening into HIV care will advance global CC elimination goals, but equitable access and HIV metrics will require creative integrative solutions.
Abstract Musculoskeletal (MSK) pain is a chronic age-related condition. People with HIV (PWH) report high rates of chronic pain—with MSK pain reported as the most common source—and joints reported as the most common site. As PWH age, MSK-related pain will likely emerge as a growing clinical and quality of life challenge for patients and providers. This review summarizes what is known about MSK pain in PWH and identifies key knowledge gaps. Many well-established risk factors for MSK pain in clinical populations are even more prevalent in PWH, yet few published studies have focused on MSK pain in PWH. Most do not include well-matched comparisons to determine the direct effect of HIV and antiretroviral therapy. It remains unclear how the complex mix of biopsychosocial factors may accelerate or worsen MSK pain onset, severity, and chronicity and in turn, how best to target safe and effective chronic MSK pain management.
Abstract Our study aimed to identify latent profiles of symptom clusters among 312 older people living with HIV (PLWH) and examine their associated factors. Using latent profile analysis, four distinct patterns were identified: low symptom burden, pain-depression, gastrointestinal-nutritional, and anxiety-insomnia classes. Hierarchical clustering further revealed three primary symptom clusters: nutritional-gastrointestinal-cognitive, depression-pain-fatigue, and sleep-anxiety. Significant differences across profiles were found regarding duration of HIV infection, CD4 + T-cell count, antiretroviral therapy (ART) adherence, and comorbidities ( p < .05). Those in the anxiety-insomnia class reported the lowest ART adherence, whereas the pain-depression class showed the highest comorbidity burden. These findings highlight the significant heterogeneity of symptom experiences in older PLWH, suggesting that tailored supportive care strategies are essential to address specific symptom configurations and improve clinical outcomes in this aging population.
ABSTRACT:Adolescents constitute a vulnerable group in the context of HIV because of early sexual debut and engagement in risk behaviors. Traditional health education methods face significant challenges regarding their effectiveness in altering risk perception and promoting sustainable behavioral changes among youth. In this scenario, serious games (SG)-educational technologies that integrate game mechanics for pedagogical and therapeutic purposes, moving beyond pure entertainment-emerge as an approach for HIV prevention. Our study sought to answer the following: What are the types and themes of SGs produced for the prevention of HIV transmission among adolescents? Thus, the objective of this scoping review was to map the types and themes of these games developed for this purpose in the literature. This scoping review, conducted between June and August 2024, was guided by the Joanna Briggs Institute methodology and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. Thirteen databases were searched. The 21 selected studies identified four types of SG (video games, mobile applications, card games, and board games), addressing five central themes (HIV testing, prevention, risk behaviors, affective relationships, and sexual and reproductive health). The digital format predominated (87.5%), specifically for computers (47.6%) and smartphones (38%). Serious games are effective in HIV prevention among adolescents by surpassing conventional health education methods through immersion and empowerment. They reinforce the need for combination prevention by integrating gaming into health promotion strategies to reduce vulnerability.
ABSTRACT:This qualitative study used interpretative phenomenological analysis to explore masculine identity reconstruction and sexual behavior transformation among men living with HIV in the Indonesia-Malaysia border region. Participants included 12 men living with HIV and one health care professional. In-depth interviews were analyzed through integrated phenomenological-thematic framework including case study analysis before cross-case pattern identification. Four themes emerged: biographical disruption and meaning-making through diagnosis, reconstructing masculine identity in border contexts, navigating stigma and disclosure across borders, and managing treatment in fragmented health care systems. Three case studies illustrated diverse trajectories shaped by cross-border sex work, masculine identity disruptions, and spiritual reconstruction. Social Ecological Model application revealed how border contexts shape experiences across individual, interpersonal, community, policy, and epidemic levels. Men living with HIV in border areas experience unique vulnerabilities including masculine identity crises when medication requirements foreclose cross-border employment, transnational sexual networks, and small community stigma amplification, requiring multilevel interventions.
ABSTRACT:Although survival for people living with HIV (PLWH) has improved, their need for solid organ transplantation (SOT) is disproportionate. Equitable access remains limited despite the HIV Organ Policy Equity (HOPE) Act, a U.S. federal law enacted in 2013 permitting transplantation from donors with HIV to recipients with HIV under research protocols. This integrative review (PubMed, Embase, CINAHL; 2011-2024) synthesized U.S. studies examining barriers, interventions, and policies affecting access to SOT for PLWH, organized using the Social Ecological Model. Thirty studies met inclusion criteria, with most focused on kidney and liver transplantation with limited evidence for thoracic transplantation. Barriers occurred across individual (stigma, knowledge gaps), organizational (restrictive eligibility), and structural or policy levels (insurance barriers, geographic inequities). Few studies evaluated interventions. Studies evaluating HOPE Act implementation demonstrated reduced wait times and increased transplantation, particularly among Black and publicly insured candidates. Priorities include center accountability and removing research-only barriers to thoracic D+/R+ transplantation.
ABSTRACT:People living with HIV (PWH) experience accelerated aging and elevated frailty risk, representing the convergence of biological and psychosocial aging processes. We enrolled 665 PWH ages ≥50 years in a multicenter study in China. We examined the intersection of biological factors (e.g., CD4+ T-cell count, comorbidities), psychological factors (i.e., depression, anxiety), and social determinants in frailty development. A Bayesian network model was developed to characterize these complex interactions. Frailty prevalence was 17.1%. The Bayesian network identified depression as a central node connecting immune dysfunction to frailty through a CD4→anxiety→depression pathway. The model achieved robust performance (area under the curve = 0.879). Probability of frailty ranged from 1.4% in individuals aged 50-59 years without risk factors to 74.0% in those ages ≥70 years with depression and multiple comorbidities. This model offers clinicians a practical risk assessment tool for aging PWH and highlights depression as a modifiable target, supporting the integration of mental health screening in HIV geriatric care.
Abstract This program brief details the implementation of same-day long-acting injectable PrEP (LAI-PrEP) program at a Southern U.S. community health center. Leveraging interdisciplinary coordination, protocol optimization, and sample medication access, the program enabled rapid transition from oral PrEP to injectable PrEP within 2 hours. Findings demonstrate feasibility of same-day LAI-PrEP and alignment with patient preferences. This model highlights critical structural and clinical components for scaling timely HIV prevention, offering actionable insights for health care providers and institutions aiming to reduce disparities and enhance intervention uptake in high-need populations.
ABSTRACT:Health-related social needs (HRSN) are the individual-level social and economic factors impact health outcomes. We surveyed people with HIV (PWH; n = 154) in a large Midwest health system to understand rates of adverse HRSN, and associations between adverse HRSN and health-related quality of life (HRQoL) and self-reported health status. Most HRSN domains had at least 15 participants (10%) endorse that they were currently experiencing an HRSN. Of the 14 HRSN assessed, participants experienced, on average, 2.57 adverse HRSN, whereas 72% of participants experienced at least one adverse HRSN. Five adverse HRSN were associated with lower HRQoL, one adverse HRSN was associated with poorer self-reported health status, and five adverse HRSN were associated with lower HRQoL and poorer self-reported health status. Addressing adverse HRSN may require a multisectoral approach to impact HRQoL and health status among PWH.
