Fenway Health

Little is known about Undetectable=Untransmittable (U = U) awareness among MSM in India. We analyzed baseline survey data from MSM (N = 1004) in an mHealth HIV testing trial in Mumbai and Thane, India. We assessed factors associated with U = U awareness and agreement (HIV treatment optimism) using multivariable Poisson regression. U = U awareness (29%) was associated with English survey completion, searching for sexual health information online, awareness of PrEP/PEP, and participation in MSM-focused HIV prevention programs (all P < 0.05). Overall, 50% of the participants agreed with HIV treatment optimism, which was associated with searching for sexual health information online, PrEP knowledge, and being out about their sexual orientation. Focused, culturally tailored U = U education is needed to improve awareness and treatment optimism among diverse Indian MSM.

Gender-affirming care (GAC) improves the mental health and well-being of transgender and gender-diverse people. In January 2025, the Trump administration announced major National Institutes of Health (NIH) grant terminations, specifically aimed at defunding research related to transgender populations. To examine the scope, timing, and financial impact of NIH GAC grant terminations. This was a cross-sectional study of terminated and active federal research grants administered by the NIH, identified through the Grant Witness and NIH RePORTER databases. Inclusion criteria required that grants involve GAC outcomes or research related to its access or provision. Data were collected on May 12, 2025, and included funding status, dates of termination, and grant characteristics. Termination of NIH grants related to GAC. Primary outcomes included the number and proportion of terminated grants, total funding lost, date of termination, and study focus. Of 64 identified NIH grants related to GAC, 41 (64.1%) were terminated within a 3-week span ranging from March 3 to March 21, 2025. Among these terminated grants, 46.9% of their combined funding remained unspent at the time of cancellation, amounting to nearly $22 million lost in research dollars. Of the research topics that were terminated, the largest proportion focused on the interaction of GAC with physical health conditions (eg, breast cancer, HIV, cardiovascular outcomes). Findings of this study illustrate the scope and depth of a targeted disruption to a vital area of scientific inquiry and health equity, emphasizing the need for insulated funding streams to preserve ongoing GAC research.

The 2022 mpox outbreak significantly impacted gay, bisexual, and other men who have sex with men (MSM) in the U.S., with Los Angeles representing nearly 40% of California cases. Limited data exist on how MSM living with and without HIV navigated the outbreak and their decision-making regarding vaccination. Between November 2023 and March 2024, we conducted a mixed-methods study with 21 cisgender MSM in Los Angeles who completed a semi-structured interview and quantitative survey. Recruitment prioritized diversity in mpox vaccination history, HIV status, race, and ethnicity. Interviews were recorded, transcribed, and analyzed using thematic content analysis; surveys were analyzed using descriptive statistics. Participants had a mean age of 40 years; 33% were living with HIV; 48% identified as Black/African American or mixed-race, 38% White; nearly half identified as Hispanic/Latinx (48%); 57% reported receiving at least one mpox vaccine dose, and 38% reported two doses for maximum protection. Knowledge about mpox transmission, prevention, treatment, and outcomes varied. Participants self-reported hearing that mpox could be transmitted by skin-skin contact (76%), kissing (67%), engaging in oral sex (67%), and contact with semen (33%); 62% had heard there was a treatment for mpox, 14% thought that mpox was not curable, and 48% believed that mpox was likely to cause death. Psychosocial impacts were prominent at both individual and community levels, including fear and distress. Mpox vaccination was motivated by fear and a desire for protection, facilitated by accessible venues and peer influence. Barriers included initially poor availability of vaccine and the specific eligibility criteria requirements for vaccination early on in the epidemic. Logistical challenges, such as long wait times (> 2h), work hours, lack of transportation, mistrust in research, and confusing initial rollout also presented unique barriers. LGBTQ+ community-based organizations and peer networks were the primary trusted source of mpox-related information. Most initially adopted risk reduction behaviors but generally viewed the mpox response more favorably than COVID-19 due to time differences in vaccine availability. Post-vaccination, many resumed pre-outbreak activities, feeling more prepared for future outbreaks despite some lingering concerns. Findings underscore varied mpox knowledge and significant psychosocial impacts, reminiscent of the early HIV epidemic. Key facilitators and barriers to vaccination highlight the critical reliance on LGBTQ+ community-based organizations and peer networks for sources of trustworthy information. Providing referrals to mental health counseling and other forms of support during vaccination is recommended.

OBJECTIVETo evaluate semaglutide use among people with HIV (PWH) with medical indications by race and ethnicity.RESEARCH DESIGN AND METHODSWe identified PWH in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort at nine sites eligible for semaglutide therapy between 2019 and 2023. Semaglutide eligibility was based on BMI ≥30 or HbA1c ≥6.5. We evaluated differences in semaglutide receipt among eligible PWH by race and ethnicity using relative risk regression adjusted for demographic characteristics.RESULTSAmong 11,617 eligible PWH, 774 (6.7%) received semaglutide (92% eligible by BMI ≥30, 62% by HbA1c ≥6.5, and 54% by both criteria). Eligible Black PWH were 20% less likely to receive semaglutide versus White PWH (prevalence ratio [PR] 0.80, 95% CI 0.67–0.95). The lower rate of semaglutide for Black (PR 0.66, 95% CI 0.53–0.83) and Hispanic PWH (PR 0.70, 95% CI 0.53–0.93) was more pronounced among those with higher HbA1c (≥8.0).CONCLUSIONSWe describe inequitable semaglutide use among PWH, with lower initiation rates in eligible Black PWH.

Gender-affirming surgery (GAS) is an effective treatment for gender dysphoria among transgender, nonbinary, and gender diverse (TGD) individuals. Research is needed to assess GAS history, factors associated with GAS satisfaction, desired yet unobtained GAS, and barriers and facilitators to GAS access for TGD individuals. To assess of the prevalence of GAS, surgical satisfaction, and encountered barriers among TGD adults and the factors associated with these outcomes. This cross-sectional study, conducted from October 2024 to June 2025, used baseline electronic survey data from TGD adult primary care patients enrolled in LEGACY, a longitudinal cohort study. Data were collected from February 2019 to March 2021. Age, gender identity, race, Latine or Hispanic ethnicity, educational attainment, homelessness, income, health insurance, HIV status, gender marker change, gender-affirming hormone use, severe psychological distress, self-rated health, and participation during the COVID-19 pandemic. The main outcomes were receipt of GAS, high surgical satisfaction, and encountered barriers to GAS (eg, waiting lists, cost). Descriptive analyses and logistic regression models, stratified by gender identity, were used to examine the association between the exposures and these outcomes. The study cohort of 2176 patients were a mean (SD) age of 30.3 (10.3) years; 1413 (64.9%) identified as transmasculine (TM), 763 (35.1%) as transfeminine (TF), and 672 (30.9%) as nonbinary. A total of 634 patients (29.1%) identified as a member of a racial minority group and 237 (10.9%) as Latine or Hispanic. Overall, 946 patients (43.5%) had received GAS, and 776 of these patients (82.0%) reported high satisfaction. The most desired surgeries were hysterectomy (868 of 1413 [61.4%]) for TM patients and facial feminization (516 of 763 [67.6%]) for TF patients. Most patients (2054 [94.4%]) encountered a barrier to GAS, with the most common being cost (1455 [66.9%]). In multivariable models, younger age (eg, 18-24 years vs ≥40 years) was associated with lower odds of GAS (TM patients: adjusted odds ratio [AOR], 0.19 [95% CI, 0.11-0.34]; TF patients: AOR, 0.22 [95% CI, 0.12-0.42]) and higher odds of encountering a barrier (TM patients: AOR, 3.16 [95% CI, 1.59-6.30]; TF patients: AOR, 9.39 [95% CI, 2.47-35.67]). Gender marker change (TM patients: AOR, 8.61 [95% CI, 6.19-11.98]; TF patients: AOR, 6.29 [95% CI, 4.01-9.87) and hormone use (TM patients: AOR, 4.71 [95% CI, 3.02-7.34]; TF patients: AOR, 7.69 [95% CI, 1.79-33.04]) were associated with greater odds of GAS; lack of insurance was associated with lower satisfaction (TM patients: AOR, 0.31 [95% CI, 0.13-0.76]; TF patients: AOR, 0.09 [95% CI, 0.02-0.49]). In this cross-sectional study, TGD patients reported high GAS satisfaction but substantial unmet need and frequent barriers to care. Efforts appear to be needed to improve accessibility for TGD patients desiring GAS.

Background Despite the high prevalence of violence among transgender and gender-diverse individuals, injury disparities remain understudied and are often attributed to underreporting. To address this limitation, we analysed radiology reports to objectively compare the prevalence and patterns of injuries between transgender women and cisgender women. Methods We used the Research Patient Data Registry at a level 1 trauma centre in the USA to identify 263 transgender women and 525 age-matched, race-matched and ethnicity-matched cisgender women. Adjusted incidence rate ratios (aIRR) and ORs were calculated to compare imaging and injury patterns. Two radiologists, blinded to patients’ gender identity, assessed the presence and type of injuries based solely on radiology reports. Electronic medical records were reviewed for all patients with radiologically evident injuries. Results In our cohort, 25.4% of cases sustained 141 injuries (67/263), compared with 14.7% of controls with 98 injuries (77/525). Injury rates were significantly higher among transgender women (aIRR: 3.3 (2.5–4.3), p&lt;0.01), particularly for cranial (7.8 (2.1–29.1), p&lt;0.01), facial (36.4 (8.6–153.8), p&lt;0.01) and thoracic injuries (4.9 (1.4–17), p=0.01). Notably, 78.9% of facial fractures (15/19) involved the midface. Transgender women were also more likely to undergo imaging in emergency departments compared with cisgender women (OR: 5.3 (3.3–8.3), p&lt;0.01). Conclusion Transgender women experience significantly higher injury rates, particularly to the head, face and chest and more frequently present to emergency departments.

BackgroundControversy persists regarding the appropriate duration of therapy with benzathine penicillin G in persons with early (i.e., primary, secondary, or early latent) syphilis (Treponema pallidum infection).MethodsIn a multicenter, randomized, controlled, noninferiority trial, we assigned persons who had early syphilis, with or without human immunodeficiency virus (HIV) infection, to receive intramuscular injections of benzathine penicillin G in a one-time dose of 2.4 million units or in doses of 2.4 million units administered at three successive weekly intervals. The primary end point was seroreversion to nonreactive status or a decrease in the rapid plasma reagin titer by two or more dilutions at 6 months, referred to here as a serologic response (noninferiority margin, 10 percentage points). A key secondary end point was a serologic response within subgroups defined according to HIV status, also assessed in a noninferiority analysis.ResultsA total of 249 persons with early syphilis were enrolled. Most participants were men (97%), 62% were Black, and 153 (61%) were living with HIV infection. The distribution according to syphilis stage was 19% with primary syphilis, 47% with secondary syphilis, and 33% with early latent syphilis. The percentage of participants with a serologic response at 6 months was 76% (95% confidence interval [CI], 68 to 82) in the single-dose group and 70% (95% CI, 61 to 77) in the three-dose group (difference, −6 percentage points; 90% CI, −15 to 3, indicating noninferiority). No clinical relapse or treatment failure occurred in either group. In the one-dose group, a serologic response at 6 months was observed in 76% of participants who had HIV infection and 76% of those who did not, and in the three-dose group, a serologic response at 6 months was observed in 71% of participants who had HIV infection and 70% of those who did not. Most participants in each group had local injection-site pain and tenderness with treatment (76% with a single dose and 85% with three doses).ConclusionsTreatment with one dose of 2.4 million units of benzathine penicillin G was noninferior to treatment with three doses with regard to serologic response 6 months after treatment. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT03637660.)

Retention in care has recently been de-emphasized as a key national HIV health metric, and its relevance in the era of more effective antiretroviral therapy regimens remains unclear. We assessed the relationship between retention in care and sustained viral suppression (SVS) over a 2-year period for newly established and previously established people with HIV (PWH). We analyzed data from 7 Center for AIDS Research Network of Integrated Clinical Systems (CNICS) sites using modified Poisson regression with generalized estimating equations. PWH were categorized into 2 cohorts: (1) newly established: had initial CNICS visit in 2017 and antiretroviral therapy (ART)-naïve at initial CNICS visit and (2) previously established: had initial CNICS visit before January 1, 2017, or PWH who were not ART-naïve at initial CNICS visit in 2017. Retention was measured using both missed and kept visit-based metrics. The primary outcome was SVS over 2 years, defined as all viral load measurements ≤200 copies/mL. Among 11,994 patients, 11,573 were previously established in HIV care and 421 were newly established and ART-naive. A higher proportion of previously vs. newly established patients were retained in care and achieved SVS. In both cohorts, when controlling for age, sex, race, and risk factor of HIV acquisition, both retention measures were observed to be a predictor of SVS. Retention in care remains a clinically valuable metric for all PWH. Healthcare providers should emphasize consistent care engagement, and national HIV/AIDS strategies should reincorporate retention as a key indicator for improving HIV health outcomes.

Management of severe prolongation of the corrected QT interval (QTc) following acute drug overdose presents a challenge to clinicians, as resulting ventricular dysrhythmias are rare but life-threatening. This study aimed to identify which patients with severe QTc prolongation on presentation to the emergency department (ED) after overdose will develop ventricular dysrhythmias, death, cardiac arrest, the need for rhythm control, or extracorporeal membrane oxygenation utilization. Secondary analysis of Toxicology Investigators Consortium Core Registry data from 2013 to 2023. We included patients ≥ 13 years old with acute or acute-on-chronic overdose, toxicology consultation in the inpatient or ED setting, and initial ED electrocardiogram QTc ≥ 500 ms. We excluded patients with no or unknown toxicologic exposure, symptoms unlikely or unknown whether related to exposure, or missing data. The primary outcome was ventricular dysrhythmia. Secondary outcomes included death, cardiac arrest, rhythm control, and extracorporeal membrane oxygenation. Independent variables included patient and overdose characteristics, initial QTc and bicarbonate values, clinical findings, and drug exposures. Multivariable logistic regression was performed with ventricular dysrhythmia as the dependent variable to identify potential predictors. Diagnostic test characteristics were calculated for risk factors identified in the regression model. Of 2764 patients screened, 1265 were included. Forty-eight (3.79%) patients developed ventricular dysrhythmias. Bradycardia (aOR 3.12, 95% CI 1.35-6.90), acidosis (aOR 3.02, 95% CI 1.42-6.23), and shock (aOR 4.54, 95% CI 2.07-9.75) were independently associated with ventricular dysrhythmia on regression analysis and were each associated with every secondary outcome. The absence of any of these findings had a negative predictive value of 98.2% (97.2%-98.9%) for developing ventricular dysrhythmia. In this large international data registry, we identified predictors of ventricular dysrhythmia in patients presenting to the ED after overdose in the setting of severe QTc prolongation.