Hospitalization remains a significant concern among people living with HIV (PLWH), particularly when admissions are recurrent. While prior research has identified psychiatric comorbidities and HIV disease severity as predictors of initial hospitalization, less is known about the factors that drive repeated hospitalizations in the modern treatment era. This study examined psychiatric, demographic, and HIV-related predictors of first and subsequent hospitalizations using longitudinal data from 9,793 PLWH with follow-up care in the Bronx, New York, between 2016 and 2023. Two primary outcomes (i.e., time to non-psychiatric hospitalization and time to HIV-related hospitalization) were modeled independently using Prentice, Williams, and Peterson gap-time models. Recent mental health visits and diagnoses, substance use-related diagnoses, lower CD4 T-cell count, and detectable viral load were each associated with increased risk of first and subsequent hospitalization. Prior mental health care engagement was associated with reduced risk of non-psychiatric hospitalization. Demographic disparities were also observed: women, older people, and patients with Medicaid had higher risk for hospitalization, while those with commercial insurance had lower risk. These findings extend previous research on first-time hospitalization in this population by explicitly distinguishing predictors of first versus subsequent hospitalizations, and underscore the need for integrated psychiatric care, sustained viral suppression, and tailored outpatient support to reduce avoidable hospitalizations.
South African women are disproportionately affected by HIV, with increased incidence during pregnancy and postpartum. While oral TDF/FTC pre-exposure prophylaxis (PrEP) is safe, effective, and recommended for pregnant and postpartum women, adherence to a daily pill is challenging, particularly during the postpartum period. Longer-acting injectable (LAI) PrEP products may be more desirable for postpartum women however, limited data on factors influencing uptake are available to inform roll-out of LAI products among postpartum women. Using the Consolidated Framework for Implementation Research (CFIR), we explored LAI PrEP implementation determinants among postpartum women in South Africa. From March-April 2023, 4 focus group discussions (FGDs) were conducted among postpartum women in KwaZulu-Natal. A directed content analysis method was performed. Among 23 women, median age was 27 (range 19–36) years. Two (9
People living with HIV (PLWH) experience disproportionately high rates of depression and anxiety. Human–animal interactions (HAI), particularly through pet ownership, may provide emotional support and companionship; however, the human–animal bond can be threatened by structural and socioeconomic factors that impede one’s ability to meet pets’ needs. The current study examined how comfort from pets and unmet pet caregiving needs were associated with depression and anxiety symptoms among pet-owning PLWH. Data were derived from the Florida Cohort (2021–2023), a survey study of PLWH in Florida. Participants included 210 pet-owning PLWH who completed the optional pet ownership module. Depression and anxiety were measured using the PHQ-8 and GAD-7; comfort from pets was assessed using the Comfort from Companion Animals Scale; unmet caregiving needs captured difficulty affording boarding, pet food/medication/supplies, and veterinary care. Linear regression models adjusted for sociodemographic covariates and perceived social support. Participants reported high levels of comfort from pets; however, comfort was not significantly associated with depression or anxiety symptoms, even after adjustment. Unmet pet caregiving needs showed a more consistent pattern: difficulty affording veterinary care was the most robust predictor, remaining significantly associated with both depression (B = 2.04, p < 0.01) and anxiety (B = 2.49, p < 0.001) after adjusting for covariates. Difficulty affording boarding and difficulty affording pet food/medications/supplies were associated with higher depression and anxiety symptoms in unadjusted models but did not remain significant after covariate adjustment. Findings highlight the dual role of pets in the lives of PLWH; while pets may provide emotional comfort, unmet pet caregiving needs—particularly around veterinary care—are associated with poorer mental health independent of broader social support and sociodemographic factors. Addressing pet caregiving needs may represent an important opportunity to reduce psychological strain and support emotional wellness among pet-owning PLWH, with implications for HIV care, social services, and future research.
Crowdsourcing is a participatory problem-solving approach that engages a large and diverse group of individuals to generate ideas or solutions. In HIV prevention, it provides a structured mechanism for involving youth in shaping intervention strategies. The Innovative Tools to Expand Youth-Friendly HIV Self-Testing and Long-Acting Injectable PrEP Uptake in Ghana (Y-FIT GH) National Open Call applied this method to generate youth-driven ideas to promote HIV self-testing (HIVST) and long-acting injectable PrEP (LAI-PrEP) in Ghana. This study describes youth responses to the open call and identifies strategies they proposed to strengthen HIV prevention among their peers. Ghanaian youth aged 15–24 years were invited to submit creative entries illustrating how HIVST and PrEP could be promoted and accessed by young people. Submissions were received through online platforms and community-based channels between May and August 2025. Following independent review, 103 eligible entries from 12 regions were qualitatively analyzed using an inductive multimodal approach. Written narratives (32
Measuring alcohol and other drug (AOD) use remains challenging in HIV care in low- and middle-income countries, where self-report and point-of-care (POC) urine biomarkers capture different time windows. Among 2,059 people with HIV aged 40 years or older across eight IeDEA clinics (2020 to 2022), we examined what self-reported AOD use (AUDIT, ASSIST) and POC urine tests (uEtG for alcohol; 5-panel drug screen) each capture. Self-report identified more use than urine testing (unhealthy alcohol 19.7
Intravaginal rings (IVRs) can be efficacious, user-controlled devices to prevent pregnancy and HIV. Understanding potential user preferences for device characteristics can promote device uptake and use by informing design optimization. We elicited sensory perceptions from a convenience sample of women aged 18–45 years from a large statewide health system to iteratively inform design of a novel 3D-printed multipurpose (contraception and HIV prevention) technology IVRs. We assessed reactions to varying IVR designs and colors in nine virtual focus groups. We modified designs and assessed perceptions of visual AND tactile aspects of modified IVR designs in 25 individual in-person interviews. Overall, women perceived texture, hue, size, comfort, and hygiene as important. Smoother surface topography was preferred for perceived ease of insertion and ability to “see what was on it” for cleanliness. Lighter hues were seen as “calming”. IVR size and pliability related most to perceived comfort, a priority for participants.
Hazardous alcohol consumption (HAC) among people living with HIV (PLHIV) has been associated with poor antiretroviral therapy (ART) adherence and unsuppressed HIV viral load (VL). We examined potential correlates of alcohol use and HAC among PLHIV aged ≥ 18 years using nationally representative data from the Tanzania HIV Impact Survey 2022–2023, a cross-sectional population-based household survey. Consenting individuals were tested for HIV and HIV-positive specimens were tested for HIV VL. HAC was determined using the World Health Organization “Alcohol Use Disorders Identification Test–Concise.” Correlates of alcohol use and HAC were determined using binary logistic regression and sampling weights. Jackknife variance estimation was used to generate 95
In the United States, Black gay, bisexual, and other men who have sex with men (BGBM) continue to face disproportionate burdens of HIV. Contributing factors include unprotected sex with multiple partners, limited awareness of HIV prevention, stigma, racism, and structural barriers to healthcare access. Biomedical prevention strategies such as pre-exposure prophylaxis (PrEP) have demonstrated effectiveness in reducing HIV transmission. However, social perceptions, stigma, and anticipated discrimination continue to influence uptake and adherence. This scoping review examined literature published between 2017 and 2024 to identify how social networks and social media shape prevention behaviors among BGBM. Guided by Social Network Theory (SNT), the review synthesized findings from 21 studies across four contexts: House Ballroom communities, social media, faith-based settings, and dating apps. Results highlight the role of culturally tailored and community-based interventions, including those delivered in religious settings, in supporting prevention uptake, while digital platforms demonstrated strong potential for outreach, testing, and linkage to care. These findings underscore the need for interventions that integrate biomedical prevention tools with culturally responsive approaches to reduce disparities and improve HIV prevention outcomes for BGBM. Findings provide suggestions for future HIV interventions for BGBM.
Engaging in moderate-to-vigorous physical activity (MVPA) is essential for healthy aging in people with HIV (PWH), though social determinants may influence activity levels. This cross-sectional study examined associations between neighborhood social vulnerability, social support, and MVPA among 198 PWH aged ≥ 50 from the PROSPER-HIV study across four U.S. sites. MVPA was measured with ActiGraph accelerometers (minutes/week), social vulnerability with the Social Vulnerability Index (SVI), and social support with the Multifactorial Assessment of Perceived Social Support–Short Form. Linear regression models were used to estimate the associations between study variables, adjusting for age, sex, and site. Median MVPA was 110 min/week (IQR: 48.03–237.05). Higher SVI was associated with MVPA in unadjusted models but did not reach statistical significance (β= -1.77; p = 0.053), and this association was attenuated after adjustment (p = 0.20). Social support was not associated with MVPA. Findings highlight the need for larger studies using more precise measures of structural factors relevant to physical activity among older PWH.
Pure and total movement dispersion are measures of the spread of physical activity (PA) across the day, without (pure) and with (total) intensity. Men with HIV (MWH) tend to have lower PA, more sedentary behavior, and poorer sleep quality and quality of life than men without HIV (MWOH). This study explores the relationship of pure and total movement dispersion with sleep quality, total sleep time, and quality-of-life (QoL) among MWH and MWOH. This study was a secondary analysis from the MACS/WIHS Combined Cohort Study (MWCCS). Participants wore an ActiGraph and an Actiwatch accelerometer on their wrist for 7 days to measure PA and sleep and completed the Pittsburgh Sleep Quality Index and the Medical Outcomes Study Short Form. Spearman’s Rank Correlation and multivariable linear regressions were used to analyze relationships among variables. 594 participants were included (Mage = 58.1, 55
Access to depression care remains limited in rural Uganda, where individuals, particularly people living with HIV, often seek support from a range of community-based and biomedical providers. Yet little is known about how these providers conceptualize depression in the context of HIV or how their perspectives shape care. This study aimed to explore how biomedical providers, traditional healers, and religious leaders conceptualize depression, perceive one another's roles, and approach depression care for people living with and without HIV. We conducted a qualitative study in Buyende District, Uganda, including 60 in-depth interviews with biomedical providers, traditional healers, and religious leaders (20 per group). Data were analyzed using thematic analysis. Four themes emerged: conceptualizations of depression, perceptions of other providers, strategies for care, and barriers to treatment. Across provider groups, depression was understood as rooted in socioeconomic hardship and frequently linked to the challenges of living with HIV. Material support, livelihood opportunities, and counseling were widely viewed as central components of effective care. While biomedical providers were generally perceived as more legitimate, mistrust toward traditional healers was common. Despite differing explanatory models, participants described overlapping counseling practices and expressed interest in improved communication across provider groups. Participants also expressed concern that reductions in HIV funding could worsen economic insecurity and increase vulnerability to depression. These findings highlight how depression care for people living with HIV unfolds within pluralistic provider systems and underscore the importance of integrating psychosocial care with strategies that address economic vulnerability when designing HIV and mental health interventions in rural settings.
Despite becoming a routine part of clinical care, collection of sexual orientation and gender identity (SOGI) is not standardized, and common measures might not reflect the full range of LGBTQ+ experiences. In this study, we tested a novel expanded SOGI measure that addresses these concerns in a racially and ethnically diverse HIV cohort study. Participants (N = 885) were randomized to complete either a common SOGI measure with fewer SOGI choices or an expanded SOGI measure with more response options. We assessed the sensitivity, specificity, positive and negative predictive values, and area under the curve of the receiver operating characteristic, comparing the common and expanded SOGI measures against a single LGBTQ+ identity question serving as the reference standard. We conducted the DeLong test to evaluate differences in the area under the curve between the common and expanded measures. The expanded measure had a sensitivity of 98.5
Substance use disorders (SUDs) and polysubstance use (defined as co-occurring SUDs involving two or more substances), precursors for high-risk behaviors among key populations like men who have sex with men (MSM), may significantly impede optimal engagement in the HIV care continuum. Leveraging 14 years of Electronic Health Record (EHR) data (2006–2020) from a retrospective population-based cohort in South Carolina, we fitted logistic GLMMs with patient-level random intercepts to estimate lagged associations between prior-year SUD diagnoses and subsequent-year retention in care among 5183 MSM living with HIV. HIV retention in care status was defined as having at least two VL/CD4 tests at least 90 days apart within 365 days. Our findings include the following: (1) Retention in care decreased between baseline (74
Rigorous and timely HIV-related surveillance is essential to monitoring progress toward national, state, and local programmatic goals, making midcourse corrections, and informing policymaking. Decades of work have gone into making HIV surveillance a leading example in public health measurement systems. However, some disruption of, and uncertainty about this key surveillance system has begun. Here, we described the uncertainty regarding the National HIV Behavioral Surveillance (NHBS) system, estimation of HIV incidence, and tracking of HIV-related health disparities. Further, we articulate potential disruptive impact on the field and make recommendations so as to rectify these challenges to the HIV surveillance data systems before further harm is done. While it is still possible to end the HIV epidemic by 2030 in the United States, a strong, rigorous, comprehensive and timely measurement system for key metrics is a necessity.
In Romania, the HIV epidemic attributed to male-to-male sexual contact is high, due to multiple sociocultural manifestations of stigma toward gay, bisexual, and other men who have sex with men (GBM), which is associated with inadequate HIV prevention. The current analyses describe the results of an intervention aiming to reduce HIV risk and heavy alcohol use, and improve mental health and minority stress-related outcomes, among GBM in Romania. Between 2019 and 2023, 300 Romanian GBM reporting HIV risk and heavy alcohol use were randomized to receive eight 1-h text-based live counseling sessions (the Comunica condition) or self-directed online educational control modules, both informed by the Information-Motivation-Behavior (IMB) model and minority stress theory. Self-reported assessments were conducted at baseline and at 4-, 8-, and 12-month follow-ups; HIV and STI testing was self-administered at baseline and 12-month follow-up. Analyses compared the conditions in terms of their impact on the primary outcome – past-30-day HIV-transmission-risk behavior. Secondary outcomes included mental (e.g., depression symptoms) and behavioral health (e.g., alcohol use) measures. We also examined between-condition change in hypothesized IMB and minority stress mechanisms. The conditions did not significantly differ in any primary or secondary outcomes over time. Both conditions demonstrated decreases in past-30-day HIV-transmission-risk behavior, number of heavy drinking days, depression and anxiety symptoms, and suicidal ideation over the 12-month follow-up period. Education control participants reported significantly greater increases in alcohol- and HIV/AIDS-related knowledge, while Comunica participants reported significantly greater decreases in perceived benefits of condomless sex across the follow-up period. Both conditions showed improvements in self-efficacy for condom use and alcohol use reduction and in all minority stress factors across the follow-up period. As all participants reported similar improvements across outcomes, future research is needed to determine how to best support this stigmatized population’s health given the limited population-specific supports.
Despite progress in preventing new HIV infections in children, retention in vertical transmission prevention (VTP) remains a challenge in low-resource settings. The REMInD intervention used an adapted Data to Care (D2C) approach with tracing to support mother-infant pairs in completing VTP care. This qualitative study aimed to explore the potential implementation determinants and strategies to enhance the successful implementation of the REMInD intervention in Gugulethu, South Africa. Interviews were conducted with nurses, policy implementers, and mothers who had participated in the REMInD proof-of-concept study. We applied the Consolidated Framework for Implementation Research (CFIR) to identify determinants that could influence future implementation. Data were analysed using inductive thematic analysis. Key potential implementation determinants were identified across multiple CFIR domains. Within the Inner setting domain, limited availability of human resources and infrastructure posed key barriers. Under the Individual domain, the capability to retrieve and use data reports was a central concern. The Innovation domain was reflected in the perceived complexity of data retrieval and tracing procedures, particularly in informal settlements with poor infrastructure. Finally, in the Outer setting domain, HIV-related stigma emerged as a potential barrier. To address these challenges, several strategies were proposed by participants: (i) train and give access to the intervention for all nurses to mitigate staffing shortages, (ii) partnerships with NGOs to enhance patient tracing and support service delivery, (iii) collaboration within the health system to sustain support and resource availability, and (iv) dedicated champions to drive implementation. These findings highlight intersecting systemic, contextual, and individual factors influencing REMInD and similar D2C implementation. Strategies addressing staffing, infrastructure, and tracing gaps could enhance implementation success and HIV retention in low-resource settings.
Trans and non-binary (TNB) people who have sex with gay, bisexual and other men who have sex with men (GBM) are rarely included in HIV behavioural surveillance. Improved data on risk and protective behaviours among TNB people could help identify unmet needs. We analysed data from the Sex and Prevention of Transmission Study, a cross-sectional HIV behavioural surveillance programme in Aotearoa New Zealand that extended eligibility to TNB participants for the first time in 2022. We categorised TNB participants who reported sex with GBM < 5 years into four groups: trans women (TW), trans men (TM), non-binary people assigned male at birth (AMAB), non-binary people assigned female at birth (AFAB). TNB participants were younger, more socioeconomically disadvantaged, and reported more long‑term disability than cis GBM. Compared to cis GBM, TM and non-binary AFAB participants reported fewer male partners and more sex with women and non‑binary partners, whereas TW and non-binary AMAB participants’ partnering more closely resembled cis GBM. HIV testing < 12 months was lower across all TNB groups, and PrEP < 6 months was lower among TM and non-binary AFAB participants. Sexually transmitted infection screening and diagnosis < 12 months appeared similar across all participants; few TNB participants reported living with HIV. TNB participants reported higher levels of negative healthcare experiences and injecting drug use, but not methamphetamine use. Each TNB subpopulation had a unique behavioural profile that differed from both other TNB participants and cis GBM. Lower uptake of HIV testing and PrEP could reflect less risk exposure, service barriers, or both.
Methamphetamine (meth) use is endemic among sexual and gender minority (SGM) populations and a well-established correlate of HIV acquisition. Less understood are the behavioral, psychosocial, and structural vulnerabilities associated with meth use that may complicate HIV prevention. We examined differences in HIV-related vulnerabilities, perceptions of pre-exposure prophylaxis (PrEP) need, and access to PrEP care among SGM people who use meth compared with those who do not. Cross-sectional data were drawn from the baseline assessment (2022–2023) of a U.S. national cohort of SGM individuals aged 16–49 (n = 2,847 who used meth; n = 2,518 who did not). Participants completed an online survey assessing demographics, vulnerabilities associated with HIV acquisition and barriers to PrEP access, and PrEP use and interest. Multivariable logistic regression compared participants who recently used meth with those who did not. Compared with non-users, participants who used meth reported greater HIV-related vulnerability across multiple domains, including higher behavioral risk, greater socioeconomic disadvantage, lower engagement in HIV testing, and poorer psychosocial and mental health outcomes. They were also more likely to perceive themselves as appropriate candidates for PrEP and express interest in initiating PrEP, yet less likely to report access to resources and infrastructure that facilitate engagement in PrEP care. These findings may reflect a phenomenon we term the “Meth-PrEP Paradox,” whereby individuals who use meth recognize their heightened vulnerability to HIV and express interest in PrEP while simultaneously encountering barriers to PrEP care. Longitudinal research is needed to evaluate this framework and identify strategies to improve HIV prevention among SGM people who use meth.
The Southern United States bears nearly half of all new HIV diagnoses, with Miami-Dade County experiencing one of the highest incidence rates nationwide. Black communities in Miami face disproportionate HIV-related outcomes, yet little is known about repeat HIV testing within these populations. This study examined engagement in HIV retesting through the Community-Based HIV Awareness for Minority Populations (CHAMP) program, a community health worker–led, street-based HIV testing and linkage-to-care initiative serving historically Black communities in Miami-Dade County. From December 2016 to February 2020, participants received rapid HIV testing and completed surveys assessing demographic characteristics and behavioral risk factors. Univariable analyses and latent class analysis were used to examine factors associated with CHW-facilitated retesting, defined as completing more than one HIV test through CHAMP. Among 1825 participants, 51
