In the US, COVID-19 has caused 7+ million deaths since 2020; influenza caused roughly 28,000–52,000 deaths between 2023–2024, and RSV caused about 33,000 in-hospital deaths in older adults annually. Vaccines for these viruses are highly effective in reducing illness and death. Evidence suggests that discrimination may influence vaccine uptake. In predominantly Black and Latinx communities in New York City, we measured Experiences of Discrimination (EOD), examined social determinants and measured their association with COVID-19, influenza, and RSV vaccination.Sociodemographic characteristics and COVID-19, influenza, and RSV vaccination. This cross-sectional study recruited adults 18+ living near Columbia Medical Center. From Sep 2023 – Aug 2024, participants completed an online questionnaire collecting demographics, medical history, vaccine status, and EOD. We tabulated descriptive statistics for continuous and categorical variables and logistic regression analyses to estimate associations with vaccination.Figure 1Percentage of COVID-19, influenza, and RSV vaccine doses and uptake. Among 2033 participants, the mean age was 38.3 years and 58% were female. Nearly half identified as Hispanic (48.7%) and 14.9% identified as Non-Hispanic Black (Table 1). Most had received 1–4 COVID-19 vaccine doses (84.5%), 42.7% reported 1–4 influenza vaccinations in the past 5 years and 2.7% of those aged 60+ received the RSV vaccine (Figure 1). Self-reported major and everyday discrimination were low (Table 2, 3). In unadjusted tests, age, sex, gender, education, income and health insurance status were associated with vaccination (Table 1). In adjusted models, family caregivers had lower odds of receiving the COVID-19 (OR=0.14, 0.02-0.98, p=0.0363) or influenza (OR=0.18, 0.04-0.83, p=0.0276) vaccines compared to employed participants. Those with less than high school education had lower odds of influenza vaccination than those with college degrees (OR=0.32, 0.42, 1.41, p=0.004). Although most participants were vaccinated against COVID-19 and a many against influenza, RSV uptake was low. We also observed unexpectedly low levels of discrimination. The relatively high levels of vaccination and low levels of self-reported discrimination in this sample of predominantly minoritized, lower income individuals warrant further investigation and triangulation with other recent data from these communities. Lawrence Purpura, III, MD, MPH&TM, Regeneron: Grant/Research Support

BACKGROUND:Sexually transmitted infections pose a threat to public health and continue to rise in New York City despite reductions in other parts of the United States. Chlamydia and gonorrhea can infect multiple anatomic sites, including the urogenital tract, pharynx, and rectum. Guidelines recommend multisite testing for select populations, yet multisite testing is not routinely performed, limiting our understanding of trends in positivity and missed infections. METHODS:We conducted a retrospective cross-sectional study of patients who underwent triple-site testing for chlamydia and gonorrhea in New York City between January 2018 and June 2023 using data from Healthix, the largest public health information exchange in the country. We examined rates of triple-site testing, the prevalence of positivity at any anatomic site, and the proportion of extragenital-only positivity. We fit logistic regression models using generalized estimating equations to identify predictors of triple-site testing as well as overall and extragenital-only positivity. RESULTS:We identified 11,405 individuals who received triple-site testing during the study period, representing 28,565 triple-site tests, 2742 chlamydia cases, and 2702 gonorrhea cases. The rectum was the most common site of infection for both sexually transmitted infections. Overall, 82% of chlamydia infections (82% in men and 77% in women) and 86% of gonorrhea infections (86% in men and 87% in women) would have been missed with urogenital-only testing. CONCLUSIONS:In this cross-sectional study of health information exchange data, we examined citywide testing and found that, among patients undergoing triple-site testing, the majority of chlamydia and gonorrhea cases would have been missed through urogenital-only testing.

Background:Timely and accurate estimates of HIV incidence are essential for program monitoring and planning clinical studies. Real-world evidence from electronic medical records (EMRs) in sexual health clinics may provide a pragmatic alternative to resource-intensive surveys and surveillance.Setting:We conducted a retrospective cohort study across 5 health centers in the United States, South Africa, and Thailand to assess the feasibility of estimating HIV incidence using EMR data.Methods:Clients aged 16-64 years assigned male at birth who reported ever having sex with someone assigned male at birth and had at least 1 HIV test between July 1, 2022, and December 31, 2023, were included. Deidentified data were extracted and subcohorts created considering 1 versus more than 1 HIV test during the study period. Incidence rates were calculated within the multiple-test (MT) cohort using person-time at risk; diagnosis proportions were calculated for all cohorts.Results:All sites met data quality thresholds for essential demographic and clinical variables. A total of 25,801 clients were included. Diagnosis proportions in single-test cohorts were higher (2.9%-12.6%) than in MT cohorts (0%-0.53%). Incidence rates among MT cohorts ranged from 0.22 to 0.72 per 100 person-years, substantially lower than expected, likely due to PrEP use and selection bias toward health-engaged clients.Conclusion:EMR-based HIV incidence estimation is feasible but limited by data variability and selection bias thus incidence estimates from MT cohorts may not reflect true community incidence. Diagnoses data may be used for incidence modeling where there is sufficient sample size.

STUDY OBJECTIVE:To evaluate the efficacy of a digital patient decision aid, Sexually Transmitted Infection Check in the Emergency Room (STIckER), in increasing sexually transmitted infection testing among adolescents and young adults in the emergency department (ED). METHODS:We conducted a randomized controlled trial in adult and pediatric EDs at a large urban academic medical center. We randomized health care clinicians to deliver either the STIckER digital decision aid or usual care to sexually active adolescents and young adults patients aged 14 to 24 years. The tool, developed through human-centered design, provided personalized sexually transmitted infection testing recommendations and values clarification exercises via smartphone. The primary outcome was documentation of gonorrhea/chlamydia testing. Secondary outcomes included extragenital testing, patient-reported decisionmaking measures, and implementation. We conducted descriptive statistics of patient-level and health care provider-level outcomes by study arms. We estimated the efficacy of STIckER using log-binomial regression. RESULTS:We randomized 44 health care clinicians and enrolled 139 adolescents and young adult participants (median age 19 years). Participants in the STIckER arm were 1.76 times more likely to receive gonorrhea/chlamydia testing (95% confidence interval, 1.10 to 3.00) and 4.56 times more likely to receive pharyngeal testing (95% confidence interval, 1.30 to 28.66). Participants in the STIckER arm reported greater clarity about testing options and higher satisfaction with ED care. Adolescents and young adults and health care clinicians rated the tool as highly acceptable, appropriate, and feasible. CONCLUSION:A digital, patient-centered decision aid increased sexually transmitted infection testing among adolescents and young adults in the ED. STIckER is feasible for integration into ED clinical workflows and may represent a scalable strategy to expand equitable sexual health screening in acute care settings.

Abstract Participatory qualitative methods such as Photovoice are increasingly used to link research with social action. Recent advances in artificial intelligence (AI) may enhance data analysis, inference, and action planning within such participatory approaches. This study explored medical students’ perceptions of social justice using conventional Photovoice analysis and assessed the potential contribution of generative AI (genAI). Nine students joined a six-week seminar, “Exploring the Concept of Social Justice Using Photovoice.” An initial two-hour session covered ethics, the Photovoice framework, and photography techniques. Participants then captured images reflecting their views on social justice, wrote narratives, and engaged in guided group discussions. Human researchers and students conducted a three-stage Photovoice analysis: 1) selecting photographs, 2) contextualizing them with participant narratives, and 3) inductively coding themes. To explore how AI might support data analysis, the research team analyzed the same data with five generative tools, including Sonix, ChatGPT, and Copilot. AI-generated themes and visual representations were compared with human-derived results for congruence, depth, and suggested action steps. Conventional analysis identified five major themes: (1) Social Justice and Inequality, (2) Contradictions and the Costs of Justice, (3) Community and Collective Action, (4) Environment and Environmental Justice, and (5) Perception, Subjectivity, and Perspective. AI-assisted analysis yielded six unified themes that closely aligned with human findings. Traditional Photovoice images conveyed authentic, lived experiences and strong emotional meaning, providing a powerful foundation for advocacy. AI-generated images and thematic summaries offered efficiency, creativity, and reduced researcher bias, improving generalizability. However, they lacked the emotional depth and contextual nuance present in participant-created visuals.

Abstract Long-acting pre-exposure prophylaxis (PrEP) expands HIV prevention options for women. However, PrEP impact depends on addressing persistent gaps in awareness, access, and use. Artificial intelligence (AI) tools, including conversational agents, are being explored to advance PrEP uptake, but comfort with AI may influence their impact. Thus, we examined women’s comfort with AI and its association with PrEP awareness. We analyzed self-reported data from women aged ≥ 18 years in a cross-sectional survey conducted in New York City from August 2023 to August 2024. We performed descriptive analyses, applied latent class analysis to identify AI knowledge/comfort profiles, and estimated unadjusted and adjusted odds ratios to assess associations between profile membership and PrEP awareness. Among 306 respondents without a diagnosis of HIV who completed AI-related survey items, the median age was 36. Most women identified as Hispanic/Latina (60%) or Non-Hispanic Black (18%), had not completed college (53%), and spoke only English or were bilingual (81%). Latent class analysis identified four AI knowledge/comfort profiles that differed by PrEP awareness, race/ethnicity, borough, prior drug use, and technology utilization. Women with varied AI knowledge, broad AI discomfort, and comfort with clinicians maintaining privacy had lower odds of PrEP awareness (OR: 0.35, 95% CI: 0.16-0.75), but this association did not persist after statistical adjustment. PrEP awareness and AI knowledge were limited, yet many women expressed openness to AI-enabled tools when privacy was assured. AI-enabled HIV prevention tools should prioritize trust, transparency, confidentiality, and the lived contexts of the women they intend to serve.

BACKGROUND:Quarterly sexually transmitted infection (STI) screening is recommended for gay, bisexual, and other men who have sex with men (gbMSM) using HIV pre-exposure prophylaxis (PrEP). However, frequent in-person testing can pose engagement barriers and increase costs, prompting interest in risk-based screening strategies to individualize testing frequency. METHODS:We evaluated the extent to which two common sexual risk assessment tools, the I Want the Kit (IWTK) survey and the HIV Incidence Risk Index for MSM (HIRI-MSM), predict bacterial STI acquisition among gbMSM using PrEP. Participants were recruited from a free sexual health clinic in New York City and enrolled in Stick2PrEP2.0 (2018-2020) or Stick2PrEP3.0 (2021-2023). Risk scores were assessed at enrollment and compared with gonorrhea and chlamydia nucleic acid amplification test results at enrollment and during follow-up at three and six months. RESULTS:Among 298 gbMSM PrEP users, 25% had at least one positive gonorrhea or chlamydia test within one year. Most participants were classified as high-risk by IWTK (53%) or HIRI-MSM (87%). Higher IWTK scores were modestly associated with STI positivity within three months, but neither tool reliably predicted STI acquisition beyond this interval. Low-risk cutoff scores that maintained sensitivity would have applied to only a small minority of participants, limiting clinical utility. CONCLUSIONS:Risk-based screening tools demonstrated limited ability to predict bacterial STI acquisition among gbMSM using PrEP. Reliance on these tools to reduce screening frequency could result in missed STI diagnoses and onward transmission. Until more accurate STI risk models are developed, universal and routine laboratory screening remains essential.

OBJECTIVE:To examine predictors, correlates, and trajectories of food insecurity (FI) among students during COVID-19. PARTICIPANTS:Undergraduates. METHODS:Between 2020-2021, students completed quarterly (T1-T4) self-administered questionnaires. FI comprised food not lasting or not affording balanced meals. Trajectories were created using cumulative FI reports. RESULTS:Across time, FI varied (T1 = 21%, T2 = 25%, T3 = 17%, T4 = 19%). FI predictors included preexisting FI, need-based aid, low social support, alcohol use, COVID-19 care-seeking behaviors, violence experience, transgender/gender non-conforming [TGNC] identity, and unsafe home perceptions. FI trajectories spanned Never (69%), Rarely (12% FI once), Frequently (14% FI twice/thrice), and Persistently (5%). Along with low social support, Persistently FI students had high psychological distress, need-based aid, unsafe home perceptions, smoking/vaping, drug use, TGNC representation, violence experience, and COVID-19 care-seeking behaviors. CONCLUSIONS:FI was associated with sociodemographic, residential, interpersonal, psychosocial, behavioral, and healthcare-related factors. In routine campus operations and emergency situations, universities must develop multi-component interventions to address multi-factorial stressors.

BACKGROUND:Realizing the potential of HIV prevention options requires understanding product tolerability across diverse groups vulnerable to HIV acquisition. Gender minority (GM) individuals are understudied in clinical trials. SETTING:HVTN 704/HIV Prevention Trials Network 085, a phase 2b randomized HIV prevention trial, enrolled MSM and transgender participants from Brazil, Peru, Switzerland, and the United States to receive an infusion every 8 weeks (10 total) of VRC01 30 mg/kg, VRC01 10 mg/kg, or placebo. Solicited adverse events (AEs) were recorded for 3 days after each infusion. METHODS:Gender was defined by self-report and sex assigned-at-birth. Multivariate mixed logistic models were used to estimate the association between gender (cisgender men [CM] vs. GM participants [transgender women, transgender men, or another gender]) and solicited AE frequency and severity. RESULTS:GM participants reported more solicited AEs than CM among all participants (adjusted OR 1.59, 95% CI: 1.20 to 2.10, P = 0.001) and among placebo recipients (1.72, 1.05 to 2.81, P = 0.031). The severity of solicited AEs (occurrence of grade 2 and higher event) did not significantly differ overall (1.83, 0.79 to 4.20, P = 0.174) or among placebo recipients (3.05, 0.76 to 12.32, P = 0.112). Grade 2 events were reported after 1% and 2% of total infusions among CM and GM participants, respectively. Grade 3-4 events were rare overall (<0.1%). Completion of 10 infusions was high (78.6%) and slightly higher in CM (79.2%) than GM participants (73%). CONCLUSIONS:This is the first report of associations between gender and solicited AEs after monoclonal antibody infusion. GM participants reported more events; severity was low. HIV prevention trials must engage and support GM individuals to best evaluate tolerability of novel agents.

Background Columbia University Irving Medical Center (CUIMC) in New York City, in collaboration with the Division of Infectious Diseases and the Dental School, is addressing a critical gap in HIV testing to support the strategy to End the HIV Epidemic (EHE). This strategy emphasizes increasing testing rates and providing patients with information about pre-exposure prophylaxis (PrEP). Objectives This study aimed to achieve two key objectives: (1) develop a robust clinical decision support system (CDSS) capable of identifying patients who stand to benefit from HIV testing and (2) implement a seamlessly integrated, user-friendly workflow, enabling health care providers to effortlessly order and conduct HIV point-of-care (POC) screening. Methods A targeted CDSS was developed by identifying a patient population, determining qualifying laboratory tests, interpreting HIV and sexually transmitted infections results, and programming based on conditional statements. A workflow was implemented after careful consideration and collaboration with faculty and residents. POC testing was conducted using the OraQuick Rapid Antibody Test Advanced HIV-1/2. Results The implementation of this targeted CDSS and associated new protocols demonstrated a promising 11.5% testing rate, normalizing HIV POC testing within the dental ambulatory care setting, and representing a key pillar of EHE. Conclusion CUIMC's approach presents a promising strategy for bridging gaps in HIV testing disparities and enhancing public health outcomes. By leveraging CDSS and innovative health care delivery methods, CUIMC's desire is to expand the scope and effectiveness of HIV testing to other practices and sites.

BACKGROUND:Mpox is recognized as a sexually transmitted infection, and the 2022 epidemic and 2024 resurgence of mpox cases through sexual transmission highlighted the need for sexually transmitted infection (STI) testing. Our objective was to observe rates of STI testing and STI diagnoses in patients with confirmed mpox in Houston, Texas and New York City, New York (NY). METHODS:This was a retrospective cohort study involving manual review of confirmed mpox cases at three large clinical centers in Houston, Texas and New York City, NY. Descriptive statistics were calculated for rates of STI testing and new diagnoses of syphilis, chlamydia and gonorrhea. RESULTS:There were 404 patients in the cohort from the three different clinical sites. The median age was 33 years. 66% underwent STI testing within two weeks of their mpox diagnosis. Among those who were tested, there were 71 patients with a new STI. Syphilis was the most newly diagnosed STI with 31 new cases. Most of the chlamydia and gonorrhea cases were extragenital (81%). Rates of chlamydia and gonorrhea tended to be higher in patients reporting site-specific symptoms (ex. pharyngitis, urethritis) than in asymptomatic patients. However, rates of STI testing were still low even in patients reporting site-specific symptoms. 63.6% of those reporting urinary symptoms, 51.9% of those reporting rectal symptoms and 47.4% reporting pharyngitis symptoms were tested for site-specific chlamydia and gonorrhea. CONCLUSIONS:Our findings highlight a gap in STI testing even in patients at high risk presenting with mpox, a sexually transmitted infection.

INTRODUCTION:The ongoing rollout of oral tenofovir-based pre-exposure prophylaxis (PrEP) has the potential to reduce HIV-1 incidence, but HIV drug resistance (HIVDR) in individuals who acquire HIV-1 on PrEP could threaten the treatment effectiveness of overlapping antiretrovirals (tenofovir/emtricitabine), contribute to development of resistance, and undermine HIV control efforts. Accordingly, the Global Evaluation of Microbicide Sensitivity (GEMS) project was established to monitor HIVDR in PrEP rollout programmes in Southern and Eastern Africa. METHODS:GEMS monitored resistance in >100,000 estimated persons who accessed PrEP through national programmes or implementation projects in Southern/Eastern Africa. Participants self-reported demographics and PrEP adherence. HIV-1 RNA and tenofovir-diphosphate levels were measured in blood samples collected at the time of study enrolment from consenting participants diagnosed with HIV who had received PrEP. HIVDR mutations were detected by population genotyping. RESULTS:Of 283 reported seroconversions on PrEP from December 2017 through September 2023, 255 (90%) individuals enrolled in GEMS, of which 81 (32%) were from Kenya, 77 (30%) from South Africa, 69 (27%) from Zimbabwe and 28 (11%) from Eswatini. Half (130; 51%) were 15-24 years of age at seroconversion, and three-quarters (193; 76%) were female. Thirty-four seroconversions occurred within 30 days of PrEP initiation. Tenofovir-diphosphate levels were consistent with moderate to high levels (≥350 femtomoles per punch) in 53% (120 of 226) individuals with drug-level data. Of 154 samples successfully genotyped, 34 (22%; 95% CI [16%, 30%]) had PrEP-associated mutations; these included 27 samples with M184I/V, one sample with K65KR, and six samples with both K65R and M184I/V. CONCLUSIONS:The frequency of HIVDR mutations associated with tenofovir or emtricitabine among individuals diagnosed with HIV who had received PrEP (22%) exceeded background levels of transmitted nucleoside reverse transcriptase inhibitor resistance in Southern and Eastern Africa (≤5%) but people with PrEP-associated mutations are likely to achieve virologic suppression with current first-line antiretroviral therapy (ART). Improved screening for acute infection before initiating PrEP, surveillance of HIVDR with the introduction of new PrEP programmes and the monitoring of longer-term ART outcomes in individuals who acquire HIV-1 on PrEP will be essential to preserve antiretroviral options for both treatment and prevention.

The COVID-19 pandemic may have exacerbated mental health conditions by introducing and/or modifying stressors, particularly in university populations. We examined longitudinal patterns, time-varying predictors, and contemporaneous correlates of moderate-severe psychological distress (MS-PD) among college students. During 2020–2021, participants completed self-administered questionnaires quarterly (T1 = 562, T2 = 334, T3 = 221, and T4 = 169). MS-PD reflected Kessler-6 scores ≥ 8. At T1 (baseline), most participants were cisgender women [96% vs. 4% transgender/gender non-conforming (TGNC)]. MS-PD prevalence was over 50% at all timepoints. MS-PD predictors included low self-rated health and perceptions of local pandemic control, verbal/physical violence experience, food insecurity, cohabitation dynamics, geographic location, and loneliness. Unique MS-PD correlates encompassed drug use and TGNC identity. Trajectories comprised Persistently (40%), Highly (24% MS-PD twice/thrice), Minimally (15% MS-PD once), and Never (21%) Distressed. Persistently Distressed students had low social support and self-rated health; high food insecurity, drug use, physical/verbal violence experience, need-based financial aid, and TGNC representation; and fluctuating self-rated health amid increasing COVID-19 symptomatology. In this sample, MS-PD prevalence was high, persistent, and associated with financial, behavioral, structural, experiential, and intra- and inter-personal factors. Given its complexity, improving and preserving college students’ mental health necessitates comprehensive, multi-component activities to change adjustable stressors while attenuating the adverse effects of immutable influences.

BACKGROUND:As Kenya prepared to introduce the PrEP ring (a long-acting product used by women for HIV prevention), the need to understand the resources required became increasingly important. The aim of this study was to determine the costs and preferences of potential ring clients by conducting a normative cost analysis and a contingent valuation study (In the context of willingness to pay literature, "preference" is used to refer to an interest in a service or product with specified benefits). METHODS:The study incorporates two parts: 1) a normative costing to estimate potential costs of providing the PrEP ring and 2) a willingness to use/pay assessment to evaluate client preference for the PrEP ring. Oral PrEP program managers from 12 facilities were interviewed to assess the direct and indirect resources required to deliver PrEP ring services. 539 women were interviewed (including both younger and older women, as well as female sex workers) using a questionnaire to assess the strength of the expressed interest in PrEP ring use, as reflected by their contingent valuation of the product. Women were presented with payment cards from which they selected the most they would be willing to pay. The primary outcomes of the study were: 1) the annual cost of PrEP ring use and 2) the average willingness to pay for the PrEP ring. Women in the willingness to pay component were selected, using a convenience sample, with approximately equal numbers of oral PrEP users and clients from other health services. RESULTS:The cost to provide a full year of PrEP ring was US$206; 76% (US$156) of that cost was attributed to the PrEP rings. Of the respondents, 78% indicated some interest in using the PrEP ring; among those interested, 83% indicated some willingness to pay for it. Single women and women currently using oral PrEP expressed more interest in using the ring than women who were married or were not currently oral PrEP users. The median willingness to pay per visit was US$1.86. CONCLUSIONS:This analysis revealed that costs are predominantly driven by commodities. Attempts to further reduce the cost of the commodities could significantly reduce the overall cost of PrEP ring service. Approximately half the women were willing to pay up to US$2 per month for the PrEP ring. Since the demand for the PrEP ring appears to be higher among current oral PrEP users compared to non-users, women who have initiated oral PrEP but who are unable or unwilling to continue may be good candidates for PrEP ring use. The annual willingness to pay for the PrEP ring (US$11.16) was significantly lower than the ring's cost ($206 per year), which suggests that attempts to fully recover costs would present a significant barrier for Kenyan women and would minimize societal benefits.

This prospective cohort study evaluated the real-world effectiveness of doxycycline postexposure prophylaxis use in reducing bacterial sexually transmitted infections (STIs) within a diverse urban sexual health program. Propensity-matched analyses showed significant STI reductions, particularly in rectal Chlamydia trachomatis infections, among early adopters. Uptake was disproportionately higher in non-Hispanic White individuals and those more engaged in care. Findings emphasize the need for targeted outreach to improve care engagement and equitable access to this STI prevention strategy. (Am J Public Health. 2025;115(10):1584-1588. https://doi.org/10.2105/AJPH.2025.308209).

Background:Clients seeking sexual health care often need concurrent mental healthcare services, which were disrupted during the COVID-19 pandemic. Using data from two studies conducted before and after the onset of COVID-19, we examined changes in self-reported depression and anxiety scores among clients in a sexual health clinic in New York City (NYC). Methods:We enrolled 144 participants pre-COVID-19 and 319 post-COVID-19 pandemic onset. Participants completed questionnaires assessing demographics, sexual behaviors, and mental health status. Primary mental outcomes included depression (Patient Health Questionnaire [PHQ-9]) and anxiety (Generalized Anxiety Disorder Scale [GAD-7]). We conducted descriptive analyses and used generalized linear mixed models (GLMM) to estimate predictors of mental health changes. Results:Cohorts were comparable by age, self-identified gender, race/ethnicity, income, HIV, and sexually transmitted infection assessment scores. Post-COVID-19 participants reported significantly higher mean PHQ-9 and GAD-7 scores compared with pre-COVID-19 participants (3.6 ± 4.2 vs 5.7 ± 5.3, P < .001; 3.9 ± 4.3 vs 5.1 ± 5.0; P = .019). Post-COVID-19 participants were also more likely to be uninsured or on Medicaid (2.7% vs 20%, 18% vs 30%, P < .001), and to report intimate partner violence victimization (24% vs 45%, P = .003). Adjusted GLMM showed post-COVID-19 was associated with a 1.55 (95% CI: .07, 3.03, P < .04) mean increase in PHQ-9 scores, but not GAD-7. Conclusions:Depression and anxiety scores increased after the onset of the COVID-19 pandemic in this NYC sexual health clinic sample. The sustained impact of the COVID-19 pandemic on depression calls for integrated, accessible mental health services within sexual health care settings.

Poverty fuels risky sexual behaviors associated with HIV infection among youth. Interventions like cash transfers may mitigate HIV risk. We explored the role of broader social protection (including food, educational, and social transfers) in reducing HIV risk among 15-24-year-olds in Southern Africa. We analyzed Population-based HIV Impact Assessment surveys data from 31,317 youth in eSwatini, Lesotho, Malawi, Namibia, Zambia, and Zimbabwe (2015-2017). Using inverse probability-weighted multivariable logistic regression, we examined associations between types of social protection and condomless sex, multiple partnerships, and high-risk sexual behaviors. Food support was associated with reduced odds of condomless sex (OR 0.71 [95% CI 0.61-0.82]), multiple partnerships (0.77 [0.63-0.95]), and high-risk sex (0.70 [0.60-0.82]). Educational support was associated with reduced odds of condomless sex (0.57 [0.46-0.59]) and high-risk sex (0.59 [0.47-0.73]). Social transfers were associated with reduced odds of condomless sex (0.62 [0.54-0.70]) and high-risk sex (0.50 [0.44-0.56]). The benefits of social protection varied across countries. Educational support was associated with reduced odds of any HIV risk factors in eSwatini, Zambia, and Zimbabwe. However, the protective effect of social transfers was only observed in eSwatini, and the benefit of food support was only significant in Namibia. Furthermore, protective associations were more pronounced among females than males. This study underscores the potential of social protection to strengthen HIV prevention efforts by mitigating poverty-related risk factors, particularly for adolescent girls and young women in Southern Africa. The impact of specific programs appears context-dependent, highlighting the need for tailored interventions.

Importance Sexually transmitted infections (STIs) pose a substantial public health challenge, but fragmented reporting systems have limited capacity for disease surveillance approaches that might support a learning public health system, where near real-time data-driven insights are integrated to inform, evaluate, and adapt public health strategies. Objective To examine how health information exchanges and open government data can be leveraged to foster a learning public health system by characterizing and comparing patterns in diagnosis vs testing at a scale commensurate with regional public health agencies. Design, Setting, and Participants In this cross-sectional study, chlamydia, gonorrhea, and HIV testing and diagnosis between January 1, 2018, and June 30, 2023, were assessed to study concurrent testing and coinfections and estimate correlates of laboratory testing and positive results. Patient-level electronic health record data from 4 767 322 patients aged 18 years or older spanning multiple health systems in New York City and collected by the public health information exchange Healthix were linked with neighborhood-level information from the American Community Survey. Exposures Age, sex, race and ethnicity, socioeconomic status, residential neighborhood, and concurrent STI testing. Main Outcomes and Measures Primary outcomes were performance of a laboratory test and test positivity. The viability of using clinical data from public health information exchange to enhance disease surveillance to identify testing gaps, disparities, and important trends, key characteristics of a learning public health system was assessed. Results The dataset included 4 767 322 patients (mean [SD] age, 46 [18] years; 61% women) with approximately 33% living in areas of high or very high poverty levels and 66% in areas of low or medium poverty levels. Among 1 519 121 tests for chlamydia, 2% were positive; among 1 574 772 tests for gonorrhea, 1% were positive; and among 1 200 560 tests for HIV, 0.3% were positive. Chlamydia and gonorrhea co-occurred in 1854 cases, representing 7% of chlamydia cases and 21% of gonorrhea cases. Testing behavior was often incongruent with geographic and sociodemographic patterns of incident cases. For example, people living in areas with the highest poverty levels were less likely to be tested for gonorrhea (adjusted odds ratio [AOR], 0.90 [95% CI, 0.89-0.91]; P < .001) but almost twice as likely to test positive for gonorrhea (AOR, 1.91 [95% CI, 1.72-2.12]; P < .001) compared with those in low poverty areas. Conclusions and Relevance This cross-sectional study suggests that health information exchanges and open government data sources may support regional disease surveillance by contributing information not typically available through public health reporting to elucidate inefficiencies and disparities in testing given positivity and coinfection patterns. These and similar insights could be used to continuously drive public health improvements and foster a learning public health system.

BackgroundSexually transmitted infections (STIs) continue to cause morbidity among women in resource-constrained settings, where asymptomatic infections are often overlooked due to syndromic management protocols. We investigated correlates of asymptomatic STIs among women in the Dominican Republic (DR).MethodsWe analyzed data collected from cisgender women in DR between 2015 and 2019. Classified groups included pregnant youth (PY), people with HIV (PWH), residents of bateyes (RB), and sex workers (SW). Nucleic acid amplification or rapid plasma reagin tests detected STIs (Chlamydia/Gonorrhoeae/Syphilis/Trichomonas). Asymptomatic comprised no self-reported vaginal discharge, dysuria, groin lymphadenopathy, and genital/anal pain/ulcers. Logistic regressions identified sociodemographic, clinical, and behavioral correlates.ResultsAmong 833 asymptomatic women (median age 29, IQR 19-37), 35% were PY, 27% PWH, 11% RB, and 27% SW. STI prevalence was 24%: most (61%) had Chlamydia and few (≤25%) had Gonorrhoea, Syphilis, or Trichomonas. Asymptomatic STI correlates included age ≤24 (Adjusted Odds Ratio [aOR] = 2.32, [1.65-3.28]), early (≤14) sexual debut (aOR = 1.56, [1.11-2.18]), greater mobility (aOR = 1.41, [1.01-1.97]), lack of regular doctor (aOR = 1.42, [1.01-1.99]), and drug use in last 6 months (aOR = 1.88, [1.07-3.26]).ConclusionsCorrelates of asymptomatic STIs-age, sexual debut, mobility, healthcare access, and drug use-should inform targeted screening and prevention efforts where diagnostic testing is not widely available.