ABSTRACT The COVID-19 pandemic caused 10.5 million children and adolescents worldwide to lose a caregiver, with South Africa facing this crisis alongside the world's largest HIV epidemic. This study examines how overlapping crises shape HIV-related risk behaviours and mental health among affected young people. Using longitudinal data from 389 participants aged 9–18; researchers assessed HIV risk behaviours, mental health symptoms and social risks at two time points. Half the sample (50.4%) experienced COVID-19-associated orphanhood. Overall, HIV risk behaviours were common, reported by 78.9% at baseline and 73.5% at follow-up. However, reductions occurred only among non-orphaned children; those experiencing COVID-19 orphanhood showed a slight increase in risk behaviours over time. Orphanhood, older age, bullying, domestic violence and community violence were associated with higher HIV risk, while female sex and larger households were protective. Mental health symptoms were significantly worse among children living in HIV-affected households who also experienced COVID-19 orphanhood (66.7% at baseline), a pattern that persisted at follow-up. These findings highlight the heightened vulnerability of children facing multiple, overlapping crises. Effective HIV prevention and support strategies must account for the compounded impacts of pandemic-related loss, violence and pre-existing HIV burdens to protect long-term wellbeing.

ABSTRACT Deeply ingrained cultural beliefs shape how HIV is framed and stigmatized, particularly among rural minoritized communities such as the Yi-Nuosu of Liangshan, China. This parallel-convergent mixed-methods study investigated the sociocultural formation and determinants of HIV-related stigma among Yi-Nuosu minorities. We conducted qualitative interviews with 19 Yi-Nuosu participants to understand local beliefs about the HIV-illness course and perceptions of people living with HIV (PLWH). We then administered an online quantitative survey to Yi-Nuosu (n = 221) and Han-Chinese (majority group; n = 109) residents of Liangshan to examine the relationships between HIV etiology beliefs and HIV-related stigma. Qualitative results indicated that prevailing fear of “unclean blood” and its perceived threat to communal harmony and familial lineage perpetuated stigmatization and exclusion of PLWH. Quantitatively, endorsement of traditional spiritual explanations of HIV, attributions of HIV transmission to unhygienic practices and casual contact with PLWH were associated with higher levels of stigma towards PLWH for both groups. Collectively, these findings underscore the importance of HIV stigma-mitigation interventions that integrate biomedical and traditional belief frameworks that challenge fears of proximal engagement with PLWH and reify intra- and inter-familial support for PLWH – a core cultural value within Yi communities.

ABSTRACT Adherence to antiretroviral therapy (ART) is important in people with HIV (PWH). This study explores perceptions of a novel adherence measurement system (TruTag) using silica-based microparticles in ART pills that when scanned with a smartphone camera, indirectly measure adherence. Twenty PWH on ART were recruited from a community health center and operated the TruTag system during a semi-structured interview. Qualitative data were analyzed using a framework matrix to understand perceptions and recommendations for the use of the TruTag system. Participants ranged in age from 26 to 68 (median 46 years), were White (60%), and homosexual or gay (70%). Most participants (70%) self-reported 100% ART adherence over the past 6 months. After instruction, all participants successfully operated the TruTag system, with many participants willing to consider it as a platform for their own adherence measurement. Key facilitators included the ability to verify medication, track adherence over time, and share data with healthcare providers. Some participants expressed concerns about scanning difficulties and perceived the system as an unnecessary step in their adherence routine. Participants suggested refinements to enhance scanning and emphasized the importance of reminders to support adherence. These findings suggest that this system may be a strategy for measuring ART adherence in PWH.

ABSTRACT Background HIV pre-exposure prophylaxis (PrEP) is an effective biomedical prevention strategy, but uptake remains low among key populations, raising concerns about PrEP hesitancy. This review examines the relevance of the 5C Vaccine Hesitancy Framework in explaining psychosocial and contextual factors influencing PrEP hesitancy. Objective To apply the 5C Vaccine Hesitancy Framework to better understand reasons for PrEP hesitancy. Method A systematic search was conducted in May 2025 across PubMed, Google Scholar, Scopus, and Sage Journal. English-language studies published between 2010 and May 2025 were included using the keywords ‘HIV', ‘PrEP', ‘acceptance', ‘rejection', ‘refusal', and ‘uptake’. Findings from 162 studies were synthesized narratively. Results Confidence was influenced by mistrust in healthcare providers and concerns about side effects. Complacency arose from low perceived HIV risk. Constraints included cost, stigma, and restrictive policies. Calculation reflected trade-offs between protection, pill burden, and stigma. Collective responsibility was supported by peers and communities but undermined by family stigma. Additional barriers included privacy concerns, digital literacy, and service delivery preferences, while mHealth and differentiated care models showed promise. Conclusions The 5C Framework is a useful model for understanding PrEP hesitancy and informing context-specific interventions and tailored measurement tools to improve Pr EP uptake.

ABSTRACT In this paper, we describe the central role of caregivers in shaping adolescent engagement with long-acting injectable antiretroviral therapy (LAI-ART) within the Long-Acting Treatment for Adolescents (LATA) trial conducted in South Africa and Uganda. Adolescents’ participation in HIV care is embedded within emotional, moral, and cultural relationships rather than individual decision-making. Drawing on the bioecological model of human development and the adolescent well-being framework, we conceptualise caregiver support as an evolving relational process that fosters adolescents’ connectedness, competence, optimism, and autonomy – psychosocial attributes critical to sustained treatment adherence. Our findings reveal that caregivers provide emotional anchoring, interpretive guidance, and motivational reinforcement, while adolescents’ growing agency reshapes caregiving dynamics toward collaborative partnership. By addressing disclosure-related guilt and emotional burdens among caregivers, we advance a relational model of adolescent-centred HIV care. We call for interventions that recognise caregivers as co-participants essential to improving treatment uptake, adherence, and long-term well-being.

ABSTRACT Adolescents living with HIV in Sub-Saharan Africa face significant psychosocial and structural challenges that can shape their future. Despite these barriers, many maintain strong aspirations and develop adaptive strategies to achieve long-term goals. This study explored how adolescents living with HIV construct their future orientation amidst the psychological burden of living with the diagnosis. An exploratory qualitative design was employed through six focus group discussions (FGDs) with 42 adolescents (17 males, 25 females; aged 13–19 years, mean age 16.14) attending Operation Triple Zero. The study was conducted at Adeoyo Maternity Teaching Hospital, Ibadan, Nigeria. Discussions were audio-recorded, transcribed, and thematically analysed. Four major themes emerged: (1) emotional reactions, participants reported fear, anxiety, emotional suppression, and concern about stigma; (2) future aspirations, adolescents expressed strong desires to pursue altruistic and justice-driven careers shaped by personal experiences; (3) strategies for achieving goals, educational commitment, medication adherence, and reframing HIV as manageable facilitated progress; (4) hope and resilience, participants maintained optimism, self-belief, and adaptive coping despite uncertainty. Findings suggest that adolescents living with HIV demonstrate strong future orientation and resilience. Strengths-based interventions that reinforce hope, support educational and career aspirations, and normalise antiretroviral adherence may improve psychosocial outcomes in this population.

ABSTRACT This study explores how gay and bisexual men in Indonesia access, mobilise, and sustain social capital within a context of stigma, limited institutional support, and uneven community infrastructures. Drawing on in-depth interviews and document analysis of health-focused NGOs and LGBTQ + networks, it examines how bonding, bridging, and linking social capital are shaped by community network strength, socioeconomic conditions, self-acceptance, and identity negotiation. The findings show that access to social capital is fluid and unequal, structured by the availability of trusted physical and digital spaces and by strategies of identity disclosure and safety management. Strong networks support emotional wellbeing, resource sharing, and service access, while fragmented networks, economic precarity, and stigma constrain social participation. The study concludes that social capital is a key mechanism of resilience and survival for gay and bisexual men in Indonesia, underscoring the need for inclusive public health policies and community-based interventions that address structural stigma and strengthen community infrastructures.

ABSTRACT People with HIV (PWH) in rural China continue to experience multiple forms of stigma that threaten their overall wellbeing. This study explored how internalized stigma and mental health distress mediate the relationship between social stigma and physical health using baseline data from 800 PWH (42% women; mean age 54.8 years) from the Rise-Up Project in Guangxi, China. Social stigma was modeled as a latent construct composed of perceived and anticipated stigma, while mental health distress was represented by depressive, anxiety symptoms and perceived stress. Physical health included general health perception, physical functions, role limitations, and pain interference. Structural equation modeling revealed that social stigma was positively associated with internalized stigma (β = .465, p < .001), which in turn heightened mental health distress (β = .396, p < .001), and reduced physical health (β = −.505, p < .001). The indirect effect was significant (β = −.093, p < .001), and model fit was good (RMSEA = .027; CFI = .968; TLI = .934; SRMR = .020). Multi-group SEM indicated consistency across men and women. These results suggest that social stigma impairs physical health through internalized stigma and psychological distress, highlighting the need for resilience-based interventions to improve PWH well-being.

ABSTRACT We examined determinants of quality of life (QoL) at enrollment and over time among people living with HIV(PLWH) aged ≥19 years in British Columbia, Canada, between January 2016-September 2021. The participants completed the surveys at enrollment, 18 and 36 months. QoL was measured using the Short-Form Six-Dimension Scale, social support using the Medical Outcome Study Social Support Survey, and depressive symptoms using the Center for Epidemiologic Studies Depression Scale-10. We used generalized linear mixed modeling to examine the factors associated with QoL at enrollment and changes in QoL scores over time. Among the 644 participants, higher depression scores (β = −0.009, p < 0.001), mental health diagnoses (β = −0.023, p = 0.015), and, counterintuitively, higher satisfaction with physician care (β = −0.002, p = 0.047) were associated with lower QoL scores at enrollment. Higher QoL scores were associated with transgender or non-binary participants (β = 0.044, p = 0.021), Latin American ethnicity (β = 0.081, p < 0.001), income of ≥$30,000 per year (β = 0.044, p < 0.001), and food security (β = 0.043, p < 0.001). Increases in QoL scores over time were associated with lower depression scores in follow-up (β = 0.05863, p = 0.001) and reporting a change from food insecure to food secure (β = 0.0066, p = 0.017). Decreases in QoL scores over time were associated with changes from food secure to food insecure (β = −0.0688, p < 0.001). These results highlight the importance of socio-structural factors and mental health as determinants of QoL in PLWH.

ABSTRACT This study investigated the spatial distribution of HIV testing and antiretroviral therapy initiation among adolescents and youth in rural KwaZulu-Natal, South Africa, to inform the optimal allocation of HIV services. The sample included 5,352 participants aged 13–35 years from nested cohort studies within Africa’s largest population-based prospective cohorts, with global positioning system data collected for all homesteads. HIV testing prevalence and ART initiation prevalence were mapped using a kernel density approach, and socio-demographic correlates were examined using multivariable regression. Kernel density mapping revealed substantial geographic disparities in HIV testing and ART initiation. Multivariable analysis showed that tertiary education (aβ: 4.53; 95% CI: 2.11, 6.88), rural residence (aβ: −31.14; 95% CI: −32.32, −29.65), and living within 3 km of a health facility (aβ: −2.42; 95% CI: −3.88, −0.96) were associated with HIV testing prevalence. ART initiation prevalence was associated with rural residence (aβ: −5.44; 95% CI: -7.38, -3.37), participation in HIV self-testing (aβ: 3.21; 95% CI: 0.64, 5.80), and lack of participation in STI screening and treatment (aβ: −1.22; 95% CI: −2.44, −0.03). Our research underscores the urgent need for addressing geographical access to HIV testing and treatment uptake amongst adolescents and youth in rural communities, and promoting HIV self-testing.