Globally, young people are falling behind in the push to end the HIV epidemic. Understanding the characteristics of HIV-positive young people who are out-of-care (not on antiretroviral treatment) in Mozambique is important to effectively reach and ensure access to services for this priority population. Using data from the 2021 Mozambique Population-based HIV Impact Assessment, we conducted a sub-analysis of HIV-positive young people aged 15–24 years whose blood specimens were tested for the presence of antiretrovirals. Participants testing negative for the presence of antiretrovirals were classified as out-of-care. Weighted prevalence estimates of HIV-care status and select covariates are reported. We used multivariable logistic regression to assess factors associated with out-of-care status. Analyses were weighted and adjusted for the complex survey design. Among the 245 HIV-positive young people included, 58.0

Objective: The increasing adoption of EVs presents challenges in balancing energy supply and demand. Smart charging offers a potential solution. This study examined which factors support citizen engagement with smart charging, using the Capability-Opportunity-Motivation-Behavior model and related specific mechanisms of actions. Methods: Using an exploratory sequential mixed-methods design, Study 1 involved semi-structured interviews with 47 EV users in a major city in the Netherlands anticipating (increasing) grid congestion issues, applying a thematic abductive analysis. Findings informed a cross-sectional survey in Study 2 (N = 282), with hierarchical multiple regression analyses assessing the (relative) influence of key factors. Results: Overall willingness for smart charging of EVs was high. Engagement with smart charging was influenced by opportunities (charging at home or using public charging stations, concerns regarding availability of a charging station, social norms about occupying charging stations), and motivational factors (preference for green energy, importance of grid stability, financial benefits, and trust in the charging system). Capabilities played a less prominent role. Conclusion: Using a mixed-methods approach, EV users' willingness to engage with smart charging was shown to be shaped by individual as well as contextual factors. Findings offer valuable guidance for policymakers and stakeholders seeking to promote smart charging. These include, the importance of addressing charging infrastructure availability, social norms against prolonged use of public charging stations, and appealing to attitudinal drivers to promote smart charging behavior effectively.

Increasing HIV prevention coverage among migrant gay and bisexual men (GBM) and non-binary people in Australia has become a priority, as recently arrived migrants are at higher risk of HIV acquisition than longer-term Australian residents. We compared GBM and non-binary participants who were willing to use but had never used pre-exposure prophylaxis (PrEP) before with current PrEP users, and explored how migration status was associated with PrEP uptake. A national, online cross-sectional survey of GBM and non-binary people was conducted in June–July 2023. Migration status was measured by region of birth and length of residency in Australia. Logistic regression was used to examine migration status, along with sociodemographic, behavioural, and health characteristics, as predictors of PrEP status. Of 2046 respondents, 1907 (93.2

Discrimination against LGBTIQA+ adolescents in schools is a global issue. Perspective-taking and empathy are widely recognized as effective mechanisms for reducing prejudice and discrimination. Theater plays have the potential to enhance audience members' empathy for marginalized groups represented in the play. This study examines the impact of a theatrical performance and the post-performance dialogue on reducing prejudice among students at secondary vocational education toward LGB people. The theatrical performance depicted the lives of several gay individuals, aiming to foster empathy. A qualitative non-participant observation of student reactions was conducted across 16 observations at 11 schools in the Netherlands. Findings suggest that both perspective-taking and empathy are elicited by the theater performance itself, particularly through its emotionally charged scenes and the moderator's questions. However, some unexpected findings revealed that several critical conditions must be met to avoid adverse effects.

The present-day food system places a heavy burden on environmental sustainability and human health, underscoring the need for sustainable and healthy food behaviours. Engaging youth in this transition is vital, as dietary habits formed early in life have long-lasting impacts. This systematic review synthesises evidence on how capabilities, opportunities, and motivations-derived from the Capability, Opportunity, Motivation-Behaviour (COM-B) model-and their interactions relate to sustainable and healthy food behaviours among youth, identifying key barriers and facilitators. Medline, Embase, PsycInfo, and Web of Science were searched for studies exploring at least two COM-B components associated with sustainable and healthy food behaviours in school-aged individuals aged 18 years and younger. Studies addressed plant-forward diets, local or seasonal foods, food waste, or general sustainable food practices. Factors were classified as barriers or facilitators using the COM-B framework. Twenty-five studies met the inclusion criteria. Motivation (n = 22), opportunity (n = 22), and capability (n = 19) were examined with comparable frequency. Lack of knowledge was the most studied barrier, but knowledge alone rarely changed behaviour. Taste was the strongest barrier, with young people preferring meat and familiar foods over seasonal or local options. Studies examining interrelations between COM-B components (n = 11) showed that taste was shaped by environmental and motivational factors, including familiarity, prior experience, food identity, and social norms. Sustainable and healthy eating in young people is shaped by interacting capability, opportunity, and motivation factors. Interventions are likely most effective when targeting multiple COM-B domains, particularly by addressing taste and social influences. REGISTRATION: The protocol is registered in PROSPERO: CRD42023408387.

Gay and bisexual men (GBM) and non-binary people may face stigma and discrimination related to their sexual orientation, gender or HIV status, which can negatively impact mental health, wellbeing, and healthcare access. We assessed the prevalence and correlates of each type of stigma or discrimination experienced in everyday life and specifically in healthcare settings. A national, online cross-sectional survey of GBM and non-binary people was conducted in June–July 2023. Participants were asked if they had experienced any stigma or discrimination, or if they had been treated negatively by healthcare workers, in the last year. Sexual orientation-related stigma or discrimination was assessed among all participants, while gender- and HIV-related stigma or discrimination was assessed among trans and gender diverse people or people living with HIV, respectively. Multivariable logistic regression analyses identified factors associated with experiencing stigma or discrimination. Of 2,046 completed surveys (median age 35 years; 81.7

Human immunodeficiency virus (HIV) healthcare providers often encounter challenges when discussing sexual health with people with HIV (PWH), despite recognizing its critical role in comprehensive care. Neglecting sexual health can lead to undetected problems, missed opportunities for guidance, and unaddressed psychosocial consequences. To support providers, we developed a theory- and evidence-based intervention using the Intervention Mapping (IM) approach to enhance sexual health counseling and promote discussions about sexuality. The intervention followed six IM steps: needs assessment, formulation of program objectives, selection of theory-based methods, program development, implementation planning, and evaluation through four online surveys measuring behavioral determinants before and after training. Focus groups and surveys confirmed the need for the intervention. After training, providers were more likely to initiate sexual health discussions with PWH during consultations. Positive trends were observed in attitudes, knowledge, social norms, and perceived skills. Overall, the training strengthened providers’ confidence and competence, with real-life scenarios reinforcing practical skills.

In South Africa, gender-based violence (GBV) is a public health crisis contributing to the transmission of HIV and requiring urgent intervention. Using mixed methods, this study evaluated the relationship between adolescents’ attitudes toward GBV and their sexual behaviors. Adolescent girls and young women (AGYW) and adolescent boys and young men (ABYM) completed a questionnaire assessing socio-demographic characteristics, sexual risk behavior, and attitudes regarding GBV. Two focus group discussions (FGDs) were conducted to explore perceptions of GBV. Among 178 participants, 80 (44.9

Evidence shows that parenting behaviours, including the use of violent discipline, can be changed through programmatic interventions. This study seeks to examine how policymakers and service providers in Tanzania perceive the provision of parenting support as a strategy to prevent violence against children and what the enabling and hindering factors are for the scale-up of existing evidence-based parenting supports. It does this by applying Daly’s analytical framework for parenting support. Qualitative research was undertaken, with interviews conducted with 20 key informants consisting of purposively sampled policymakers and service providers. The interview data were analysed using inductive and deductive coding and analysis. The most prominent enabling factors noted for the scale-up of parenting support interventions in Tanzania include the existing supportive political commitment, the interventions currently on offer at the programmatic level, and the perceived understanding of Tanzanian caregivers of the importance of parenting and, thereby, a willingness to change. Current factors hindering the scale-up include the lack of a common understanding of what evidence-based parenting programmes entail, inadequate provision of human and financial capital to implement the programmes using community resources and deeply engrained social norms around adultism and gender. Daly’s analytical framework allowed us to examine barriers and facilitators to scale-up the provision of parenting support to prevent violence against children, based on the viewpoints of policymakers and service providers. Understanding these barriers and facilitators will allow Tanzanian policymakers and service providers to further close the gap between the policies and the actual implementation of evidence-based parenting support programmes aimed at preventing violence against children.

OBJECTIVES:Initial HIV cure interventions may not meet expert-defined target product profiles (TPPs; desired treatment attributes). Understanding how people with HIV perceive ideal and likely HIV cure attributes is essential. This study examined which optimal TPP attributes people with HIV consider important and which minimum attributes and strategies they find acceptable. Additionally, it explored patterns of importance and their association with the acceptance of minimum attributes and cure strategies. METHODS:A cross-sectional survey (July 2023-March 2024) among 420 people with HIV assessed the importance of eight optimal attributes, the acceptability of fifteen minimum attributes, and five prominent cure strategies. Latent class analysis identified groups of people with different patterns of importance ratings. RESULTS:Optimal HIV cure attributes most frequently endorsed as important were 'no HIV transmission risk' (76.4%), 'immune system recovery' (66.4%), and 'protection from reinfection' (63.8%). Twelve of fifteen minimum attributes and all cure strategies were acceptable (mean > 3). Four latent classes of importance ratings emerged: exacting (N = 129, 30.7%; all attributes important), ambivalent (N = 121, 28.8%; neutral ratings), indifferent (N = 28, 6.7%; most attributes unimportant/neutral), and selective (N = 142, 35.2%; most attributes important except cure regimen-related factors). ANOVAs showed that participants with ambivalent importance patterns were less accepting of minimum attributes and strategies, while participants with indifferent importance patterns were more accepting of unacceptable minimum attributes. CONCLUSIONS:People with HIV in the Netherlands find most HIV cure interventions acceptable, even if they do not meet optimal TPPs. However, perspectives differ across subgroups.

Background: Perinatal mental health is a significant concern globally, especially in low- and middle-income countries. Women's mental well-being is essential for managing daily stresses and positively contributing to their communities. Empowering women can enhance their health and that of their families. Objective: This paper explores how women's empowerment(WE) in rural Kenyan communities affects their maternal mental well-being and discusses the challenges and lessons learned against the backdrop of the COVID-19 pandemic. Methods: An ethnographic approach that involved a four-month participant observation of 20 women in Kakamega County, Kenya, conducted from March to October 2022. The target women were pregnant or had a child <1 year old. Additionally, two focus group discussions were conducted with men and women from the community to explore experiences related to women's empowerment, challenges, and coping strategies. Results: The relationship between women's empowerment and mental wellbeing is cyclical. Access to resources enhanced agency, self-efficacy, and autonomy, while poor mental well-being diminished these aspects. Maternal stress was caused by financial constraints, socio-cultural barriers, limited decision-making, inadequate spousal support, and lack of social support. During the perinatal period, limited economic opportunities left women vulnerable to food insecurity and family conflicts.Participating in savings groups (chama) and individual secret savings (income hiding) enhanced women's agency and autonomy. Their empowerment efforts were, however, affected by limited financial support, sociocultural barriers, and the risk of domestic violence, negatively affecting their well-being. Conclusion: Women's empowerment can enhance perinatal mental health outcomes. Empowerment programs should promote perinatal mental health and involve spousal and family support for improved maternal well-being.

Oral HIV pre-exposure prophylaxis (PrEP) is highly effective when taken appropriately at times of HIV risk, termed “prevention-effective adherence”. To understand suboptimal adherence, we refined a brief measure for surveys among gay, bisexual and queer men and non-binary (GBQ+) people. We used a mixed-methods design, comprising a national, online cross-sectional survey (June–July 2023) and cognitive interviews (August–October 2023). Logistic regression identified characteristics of PrEP users who reported condomless anal intercourse with casual partners (CLAIC) that was not protected by their own PrEP use because they missed PrEP doses (“PrEP-unprotected CLAIC”). Cognitive interviews investigated whether the prevention-effective adherence measure was comprehensible. Of 2,046 survey respondents, 792 current PrEP users who had CLAIC in the past 6 months were included (Median age = 37, 86.7% gay, 34.5% non-daily-PrEP users). Of PrEP users who reported any CLAIC, 194 (24.5%) reported any PrEP-unprotected CLAIC. They were more likely to: be < 30 years old, be born in Asia vs. Australia, be part-time vs. full-time employed, use non-daily PrEP, have recently initiated PrEP, have experienced side effects from PrEP, and report recent sexualized drug use. They were less likely to find it easy to get PrEP. The 14 interviewees asked about the survey items (Mean age = 33; 50% gay; ) were able to answer the questions and reliably interpret the content. This first national estimate of prevention-effective adherence found that 24.5% of PrEP users who had CLAIC reported any PrEP-unprotected CLAIC. Targeted interventions in subgroups with more frequent PrEP-unprotected episodes must address side effects and other adherence barriers.

BackgroundIn available comparative studies, Dutch transgender youth have consistently shown better psychosocial well-being compared to those in other countries. Therefore, the Netherlands (N.L.) could be considered a gold-standard-though imperfect-comparator for transgender youth research. The United States (U.S.) is heterogeneous in its policies and practices impacting transgender youth, and policies are in flux. This study examines similarities and differences between U.S. and Dutch policies, practices, and contexts relevant to the well-being of transgender adolescents.MethodsA three-stage Delphi procedure was conducted with expert panels in the N.L. and U.S.ResultsThis process identified candidate mechanisms driving differences in outcomes for transgender youth between the countries, including: (1) training provided to Dutch students and schools to promote acceptance and understanding of gender diversity; (2) availability of gender specialists for Dutch youth; (3) insurance coverage of broad gender-related services in the N.L., compared to inconsistent coverage in the U.S. and numerous state care bans; and (4) a Dutch public that is largely accepting of gender diversity, with historical roots of acceptance dating back three decades.DiscussionStudy findings indicate intersectional racial inequities remain inadequately addressed in both countries. Primary ongoing needs in each country and novel approaches to improve outcomes are discussed.

HIV remains a persistent global health challenge, emphasizing the urgent need for an effective cure. Meaningful engagement of affected communities is essential for advancing HIV cure efforts. Using stage theories of behavior change, this paper investigated engagement as a dynamic process. Engagement was highlighted with five interconnected stages: awareness, perceived relevance, decision-making, participation, and sustained involvement. These stages were used to understand how individuals and communities engage with HIV cure efforts across diverse contexts. Drawing predominantly, but not exclusively, on our own work in the Netherlands, France, Australia, and plans for work in Sub-Saharan Africa, we identified common patterns and local variations in engagement. Previous research underscored the importance of tailoring engagement strategies to lived experiences and sociohistorical contexts, moving beyond one-way information sharing to foster deeper, more meaningful involvement and engagement. Applying social and behavioral stage models in further interdisciplinary research may help pinpoint key opportunities for intervention and promote sustainable engagement with affected communities. Thus, this structured lens of engagement holds potential to advance the ethical and effective development of HIV cure efforts, ensuring that diverse perspectives shape its future trajectory.

BACKGROUND:Declines in condom use among the general young population highlight the need for effective interventions to prevent sexually transmitted infections and unwanted pregnancies. With this study, we aim to examine the relationship between Behavior Change Techniques (BCTs, the active components of interventions) and the effects of condom interventions among youth. We quantify the number of BCTs used in the interventions, assess their alignment with underlying behavioral theory, and evaluate coverage of specified Mechanisms of Action (MoA, underlying process through which behavior may be influenced) within the behavioral theory. METHODS:Face-to-face theory-based interventions aiming to promote condom use among youth were identified in a previous systematic review. Interventions were analyzed using the BCT Taxonomy v.1.0., alignment with theory was determined using the Theories and Techniques tool. Wilcoxon rank-sum tests assessed BCT effectiveness. Spearman's rank correlation coefficient determined associations between intervention effects and the total number of BCTs, the proportion of BCTs aligned with MoAs, and the proportion of MoA covered by BCTs. RESULTS:In 21 interventions we identified a median of 3 BCTs (IQR = 1-5) per intervention. BCTs were poorly reported. No grouping of BCTs was associated with more intervention effects on increasing condom use. Neither the proportion of BCTs aligned with the MoAs of the underlying theory in the intervention (median = 85.7%, IQR = 50.0-100%, Spearman's ρ = -0.09) nor the proportion of MoAs of the underlying theory covered by at least one BCT in the intervention (median = 44.4%, IQR = 25.0-50.0%, Spearman's ρ = 0.27) were correlated with intervention effects. CONCLUSIONS:This study provides initial insights into the use of BCTs and the application of behavioral theory in theory-based condom promotion interventions targeting the general young population. No associations between the use of BCTs and the intervention effects on condom use were found. Robust conclusions regarding the utilization of BCTs, their alignment with theory, and their effects can only be reached when future research consistently and comprehensively reports the use of BCTs.

Among young persons, declining condom use trends in many countries, high prevalences of chlamydia, and recent increases in gonorrhea diagnoses highlight the need to promote condom use. Individual social-cognitive factors and those of partners are known to influence condom use decision-making in steady partnerships, whereas research on casual partnerships is lacking. Our vignette study examined the influence of partner characteristics on condom use decision-making during casual vaginal sex. Dutch young people aged 16–24 (n = 1070) were recruited online in 2023. Participants indicated the likelihood of using a condom (‘If I were in this situation, I would use a condom’) after reading one of six randomly assigned partner vignettes. The last sentence of each vignette indicated the partner characteristics. The different partner characteristics in the vignettes were attitudes (positive/negative), norms (condom use/condom nonuse), and risk behavior (higher risk/lower risk). We performed three ANOVA analyses with Benjamini-Hochberg corrections; the dependent variable was the participant’s condom use decision, the three manipulated constructs were categorical between-participant independent variables. We explored interactions between the conditions and participant characteristics (i.e., demographic, social-cognitive and sexual behavior). Participants were on average 19 years old, 55

This study explored how risk in the context of sexual health is conceptualised in research related to gay, bisexual, and other men who have sex with men during a period of major biomedical change, including the scale-up of pre-exposure prophylaxis (PrEP) and the Undetectable = Untransmittable (U = U) campaign, prior to the COVID-19 pandemic. A systematic search across Medline (OVID), CINAHL, and Scopus identified studies published and/or with data collected between 2015 and 2020, from high-income countries in the Global North. A novel saturation-based approach, adapted from qualitative research, was used to determine when no new implicit or explicit conceptualisations of risk were evident. Ten initial papers were reviewed, followed by sets of three, stopping after saturation was reached at 24 papers. The word 'risk' appeared 722 times across included studies. Hundreds of distinct implicit and explicit conceptualisations were identified and grouped according to five interconnected dimensions: health outcomes, and their focus on biomedical, behavioural, interpersonal, and individual factors. Findings highlight the pervasive yet variable use of 'risk' in the sexual health literature, which may hinder clear communication between researchers, clinicians, and service users. Study findings support calls for the use of more precise language.

Behavioral measures played a critical role in mitigating the COVID-19 pandemic, and their success hinged on continued public support and adherence. This study provides novel evidence on changes in support and adherence to behavioral mitigation measures and appraises the role of pandemic fatigue to provide robust guidance for effective governance of future public health and safety crises. Data were collected from a population cohort study in the Netherlands. This study used data from six assessments (December 2020-March 2022) at 12-week intervals, aligned with differences in pandemic severity and policy stringency. The analytic sample consisted of participants (N = 20,475) randomly allocated to answer questions on support and adherence to measures, focusing on physical distancing, avoiding crowds, mask-wearing on public transport, COVID-19 testing when symptomatic, and staying home when symptomatic. Changes in adherence and support and their interplay across time were assessed using random intercept cross-lagged panel models, controlling for age, gender and education. At the end of 2020, support for mitigation measures was found to be high, with little difference between measures. Subsequent changes in support for most measures broadly paralleled changes in pandemic severity and policy stringency. Adherence was less responsive to pandemic severity and policy stringency, and was mostly stable, albeit with differences between behavioral measures. Support and adherence to COVID-19 testing steadily increased after this was recommended as of early 2021. Changes in support and adherence did not reflect the notion of pandemic fatigue as a monotonic decline in support and adherence across behaviors. Findings highlight the need to better understand and address the factors influencing differing dynamics in support and adherence to specific protective behaviors.