Ending the HIV epidemic in the U.S. requires access to comprehensive care. Traditional measures of service access have focused on distance and time. This study used the enhanced two-step floating catchment area (E2SFCA) method to measure geospatial accessibility and its association with HIV care continuum outcomes. Data from South Carolina's 2020 enhanced HIV/AIDS reporting system (eHARS) were used to calculate aggregated county-level percentage linkage to care (LTC), retention in care (RIC), and viral suppression (VS) among adult people living with HIV (PLWH). E2SFCA was used to measure geospatial accessibility, using the 60-min index as the threshold. County-level mean percentage of dependent variables and covariates were calculated. A linear regression model (LRM) was used to evaluate the association between accessibility index and LTC, RIC, and VS after adjusting for covariates. Accessibility index ranged from 17.9 to 198 across the 46 counties (mean = 67.5, SD = 36.5). Counties with better accessibility were more likely to have a higher percentage of LTC (β = 5.07, 95% CI = 0.83, 9.31) but a lower percentage of VS (β = -2.85, 95% CI= -4.60, -1.10). The negative association between accessibility index and VS was moderated by the percentage of household without vehicle ownership (β = 2.00, 95% CI = 0.02, 4.00). No association was found between the accessibility index and RIC. Counties with lower uninsured rates (β= -3.11, 95% CI= -5.35, -0.87) had higher % LTC. Suboptimal geographic accessibility to HIV care is an important structural barrier in South Carolina. Targeted policies and interventions are needed to address this challenge.

A multidisciplinary collaboration is needed to improve antiretroviral (ARV) therapy adherence among people with HIV (PWH) to ensure adequate patient outcomes. The AdhereP4 program was a collaboration among pharmacies, prescribers, payers, and public health agencies that identified PWH with a ≥30-day gap in ARV access using pharmacy claims data. While pharmacy claims data are useful for identifying adherence gaps, limited guidance exists on structures and processes needed to integrate such data in pharmacy and clinical services to better provide adherence support. The AdhereP4 program identified key programmatic structures and processes for a successful collaboration of pharmacy claims data with dispensing pharmacy and clinical patient data. Structures include staffing, data, and procedures while programmatic processes include adherence assessment, adherence intervention, and training/communication. AdhereP4 implementation required support from an information technologist, database managers, programmers, pharmacists, clinicians, social workers/case managers, and a public health specialist. Key lessons learned from the development and implementation of the AdhereP4 program were identified through monthly collaborator meetings and informal collaborator interviews. Lessons identified included (1) develop support and training for all collaborators; (2) develop a data dictionary for each site prior to data collection; (3) develop a standard operating procedure manual related to data management; and (4) complete periodic review of data to address any concerns early. Monthly pharmacy claims data can be successfully used by pharmacy and clinic staff to identify and address ARV adherence gaps. Successful implementation requires collaboration across stakeholders and a clear data management plan.

Extreme weather events (EWE) may elevate HIV risk across Sub-Saharan Africa by worsening resource insecurities, yet limited research has included adolescent girls and young women (AGYW). We examined associations between EWE exposure, resource insecurities, and HIV vulnerabilities among AGYW in Kenya. We conducted a community-based cross-sectional survey with a purposive sample of AGYW aged 16-24 in Nairobi and Kisumu. We used latent profile analysis (LPA) to identify resource insecurity profiles based on food, water, and sanitation access; multinomial logistic regression to assess associations between past-year EWE exposure and profile membership; and multivariable regression to assess associations between profile membership and HIV vulnerabilities (transactional sex, intimate partner violence [IPV], adolescent sexual and reproductive health stigma [ASRH-S], sexual relationship power [SRP]). LPA categorized participants (n = 597; mean age: 20.13 years) into three profiles: mild, moderate, and severe insecurity. Multiple EWE exposure (vs. 1 EWE) was associated with increased odds of moderate (2-4 EWEs: Adjusted Relative Risk Ratio [aRRR]: 1.71, 95% Confidence Interval [CI] = 1.03-2.83; > 5 EWEs: aRRR: 2.24, 95%CI: 1.10-4.53) and severe insecurity (≥ 5 EWEs: aRRR: 6.55, 95%CI: 1.78-24.05). The severe resource insecurity group reported increased transactional sex (aOR = 4.72; 95%CI: 2.45-9.07), IPV (aOR = 3.02; 95%CI: 1.22-7.48), and ASRH-S (aβ = 1.88; 95%CI: 0.45-3.30), and lower SRP (aβ = -3.16; 95%CI: -5.85, -0.47), than those with mild insecurity. EWE exposure is associated with heightened resource insecurities, which are linked to HIV vulnerabilities among AGYW in Kenya. Findings highlight the need for climate-responsive, gender and youth-tailored interventions to address multiple resource insecurities and strengthen HIV prevention with climate-affected Kenyan AGYW.

A childhood sexual abuse (CSA) history is more prevalent among people living with HIV and may have lingering effects among older adults living with HIV (OALH). However, studies examining the impact of trauma-informed interventions among OALH are scant. The aim of the study was to determine the preliminary effect of the Coping with Childhood Sexual Abuse, HIV, and Aging (CoSHA) intervention on depressive symptoms, coping and ART adherence among OALH. Data were obtained from 28 OALH recruited from an immunology clinic and an AIDS service organization in South Carolina. Generalized estimating equation (GEE) models were used to determine the preliminary effect of the intervention on depressive symptoms, coping and ART adherence among OALH from baseline to 6-week, 3- and 6- month follow-up using intention-to-treat analysis. The intervention reduced depressive symptoms over the 6-month period (B=-9.13, 95% CI: -10.3, -8.00). There were also positive changes in planning coping (B = 0.73, 95% CI: -0.08, -1.54) and religious coping (B = 1.13, 95% CI: -0.08, 2.34), and ART adherence (B = 15.2, 95% CI: -0.95, 31.3) but these were borderline statistically significant. Future research should determine the impact of the CoSHA intervention in a full randomized controlled trial.

Culturally tailored, community-informed media can enhance pre-exposure prophylaxis (PrEP) awareness and acceptance among Black gay, bisexual, queer, same-gender-loving, and other men who have sex with men (Black SGL/MSM). To inform the development of a health campaign to increase PrEP utilization, we conducted four focus groups with Black SGL/MSM (N = 20) between February and June 2023. Discussions explored participants' perceptions of and engagement with HIV prevention messaging, with particular attention to strategies for redesigning campaigns to reduce PrEP-related stigma. Participants articulated preferences that clustered within three interrelated domains of effective PrEP messaging: content, delivery, and context. Within the content domain, participants emphasized the need for practical, actionable information (e.g., dosing options, visual demonstrations, and adherence support), alongside sex-positive and empowering narratives that reframed HIV prevention around pleasure, intimacy, and self-care rather than fear. Participants also called for destigmatization and normalization of PrEP by positioning it as a responsible, routine component of sexual wellness. Within the delivery domain, participants favored social media-driven formats, particularly strategies leveraging influencers, humor, and storytelling to enhance engagement and relatability. Within the context domain, participants prioritized authentic representation of Black queer communities through inclusive imagery, culturally resonant cues, and rejection of stereotypes, while also acknowledging structural and logistical realities such as competing priorities, privacy concerns, and the need for discreet, accessible messaging. PrEP messaging must move beyond traditional public health narratives by pairing clear "how-to" guidance with culturally concordant, sex-positive, and stigma-reducing strategies to improve PrEP relevance, awareness, and uptake.Trial registry NCT06785376.

Women who have migrated from Sub-Saharan Africa (WMSSA) account for a disproportionate share of new HIV diagnoses in France yet remain underserved by prevention strategies, including pre-exposure prophylaxis (PrEP). We conducted a cross-sectional survey of 151 HIV-negative WMSSA attending two family planning centers (FPCs) in Greater Paris (2023-2024) to assess knowledge, attitudes, and perspectives regarding PrEP delivery. PrEP eligibility was determined using clinical criteria, and logistic regression identified factors associated with willingness to use PrEP. PrEP awareness was low (11.3%), yet 62.2% reported willingness to initiate PrEP after receiving information, and 51.0% met eligibility criteria. Most participants (80.1%) identified FPCs as their preferred location for PrEP services. Willingness to initiate PrEP was higher among women meeting eligibility criteria (aOR = 2.37, 95%CI [1.13-4.96]) and decreased with longer time living in France (aOR = 0.91/year, 95%CI [0.83-0.99]). Integrating PrEP into FPCs could be a key strategy to reduce HIV disparities in this population.

Since 2010, Kazakhstan has experienced an increase in HIV transmission. Men and transgender/gender-expansive people who have sex with men (MSM and TSM) carry a disproportionate HIV burden. Building on Paine et al. (2021), which linked HIV testing to stigma, internalized homophobia, and sexual- and gender-expansive (SGE) community connectedness-this brief report examined biologically confirmed HIV and other sexually transmitted infections (STIs). SGE connectedness was significantly associated with HIV infection, while HIV stigma and internalized homophobia were significantly associated with STIs. Interventions reducing stigma and strengthening SGE community ties may curb HIV and STI transmission among MSM and TSM in Kazakhstan.

Female sex workers (FSW) are disproportionately burdened with HIV. Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV transmission, yet determinants of willingness to use PrEP among young FSW is less understood. We assessed factors associated with willingness to use PrEP, using data from a cross-sectional study on PrEP adherence strategies, among HIV-negative FSW aged 18-24 years living in Kisumu City, Kenya. We characterized differences in demographics and sexual history by awareness of PrEP using Pearson's chi-square test. Among FSW aware of PrEP, we further assessed factors associated with willingness to use PrEP. We enrolled 200 FSW, of whom 83% reported being aware of PrEP. Among those aware of PrEP, 16% had previously taken PrEP. On average, for each additional day or night spent away from the neighborhood in the past month, FSW had 12% decreased odds (AOR = 0.88, 95%CI: 0.77, 0.99) of willingness to use PrEP. While most FSW in Kisumu City were aware of PrEP and perceived it positively, uptake was hindered by stigma, discomfort with health services, and lifestyle factors like mobility. To close the gap between awareness and actual use of PrEP, there is need for flexible and mobile PrEP delivery models tailored to the unique lifestyles of FSW, such as community-based outreach, peer delivery, or digital health interventions that support care continuity despite mobility.