ART adherence, essential to preventing disease progression for people living with HIV (PLHIV), remains challenged by factors like poor mental health condition, insufficient social support, and substance use. This study investigates the roles of social support and substance use as mediators in the relationship between mental health and antiretroviral therapy (ART) adherence among PLHIV in a multisite, international context. Cross-sectional data from N = 1598 PLHIV across eight countries were analyzed using parallel mediation analyses in R. Results indicated that both social support and substance use independently mediated the relationship between mental health and ART adherence. Hallucinogens mediated the mental health-adherence link. Cocaine, Amphetamine-type stimulants, inhalants, and opioids directly influenced adherence but did not mediate this relationship. In contrast, no significant effects were observed for tobacco, alcohol, cannabis or sedatives. This large-scale, nurse-led, international study offers critical insights into the roles of social support and substance use as psychosocial influencers in the cascade of care for PLHIV. Clinical implications include prioritizing educative, preventative, and harm-reductive approaches to specific substances that impact ART adherence. Findings may also inform interventions that emphasize strengthening social support to improve adherence in ART and care while addressing substance use as a barrier to care and well-being.

In Eastern and Southern Africa (ESA), there is heterogeneity within adolescent mothers' (AMs') sexual relationships. However, existing studies focus on single relationship characteristics, even though these characteristics do not operate in isolation. Moreover, no studies have examined multilevel predictors of AMs' relationships. Identifying and characterizing typologies by multilevel factors can inform targeted interventions to lower HIV risk. Data are from the Population-based HIV impact Assessment (PHIA) Project on AMs (15-19 years) from 9 ESA countries (N = 2,761). We conducted multilevel latent class analysis to identify relationship typologies at the AM and community (PHIA cluster) levels, multinomial logistic regression to characterize typologies by multilevel predictors, and multivariable generalized estimating equations (GEE) log-binomial regression to calculate prevalence ratios of HIV for relationship typologies. There were 3 typologies: married with minimal transactional sex (61%), unmarried peer partnership (30%), and working and high transactional sex (9%). Individual-level (i.e., age, school enrollment, low-wealth household, number of sexual partners) and community-level factors (i.e., urbanicity and proportion of low-wealth households) were associated with typologies. Married with minimal transactional sex was associated with a 51% lower HIV prevalence compared to the unmarried peer partnership (adjusting for multilevel factors). We also identified 2 PHIA cluster-level classes: high age-disparate marriage (49%) and low marriage (51%). Low-wealth communities had higher odds of being high age-disparate marriage communities. Results suggest that AMs' relationships fall into 3 distinct typologies and 2 community-level classes. Further, HIV prevalence varies across relationship typologies. Utilizing tailored approaches could optimize interventions that reduce AMs' HIV risk in ESA.

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%) had permissive attitudes toward GBV. Being AGYW and in a relationship were associated with permissive GBV attitudes. FGDs revealed that participants perceive GBV as occurring both in society and communities, as well as within interpersonal relationships at home. This violence is perpetuated by enduring patriarchal beliefs, male authority, and economic inequalities. Effective prevention of GBV requires integrated, multi-level strategies addressing patriarchal norms, economic inequalities through contextually tailored interventions at home and throughout society.

Pain is prevalent among people with HIV (PWH), and many PWH who experience pain also use substances (illicit drug and/or unhealthy alcohol use). While cocaine use and cocaine and alcohol co-use are prevalent in this population, their effects on pain in PWH are unknown. This study aims to investigate the association of cocaine use and co-use of cocaine and alcohol with pain interference among PWH. We completed a secondary analysis of the Boston Alcohol Research Collaboration on HIV/AIDS (ARCH) study, a longitudinal cohort of PWH with a history of substance use. The outcome was pain interference (Brief Pain Inventory). Exposures were recent cocaine use (Addiction Severity Index) and recent unhealthy alcohol use (Timeline Follow Back). Generalized Estimating Equation (GEE) ordinal logistic regression models were employed, adjusted for demographic factors, illicit/non-medical opioid use and cannabis use. Among 251 participants, 22.3% reported unhealthy alcohol use only, 11.1% reported cocaine use only, and 13.2% reported use of both. Cocaine use was associated with greater pain interference (adjusted odds ratio [aOR]: 1.73, 95% confidence interval [CI]: 1.15-2.60), whether or not participants had unhealthy alcohol use (interaction term, p = 0.695). Participants reporting both cocaine and unhealthy alcohol use had greater pain interference than participants reporting neither (aOR: 2.27, 95%CI: 1.35-3.79). Cocaine use was associated with greater pain interference as was co-use of cocaine and unhealthy alcohol among PWH. Considering patterns of substance use can inform clinicians conversations with PWH who may be using substances for pain management.

We aimed to determine differences in the occurrence and timing of all-cause excess mortality among people with HIV (PWH) in Florida early in the COVID-19 pandemic by sex, race and ethnicity, age, rural/urban residence, and neighborhood poverty levels. We used de-identified data from the Florida Department of Health enhanced HIV/AIDS reporting system. Expected numbers of monthly deaths and the 95% upper bound from March to December 2020 were estimated from observed deaths during January 2016-February 2020. The difference between expected and observed deaths was considered excess mortality. We also compared the age-adjusted all-cause mortality rate for PWH in 2020 to the average age-adjusted mortality rate for 2016 - 2019 using direct standardization. During the observation period from 2016 to 2020, there were a total of 9843 deaths among PWH. From March to December 2020, there were an estimated 314 excess deaths, and 61 excess deaths above the estimated 95% upper bound. The highest excess mortality occurred in July and August and was primarily due to increases in COVID-19 deaths. All groups of PWH experienced excess mortality except rural residents. Deaths among female, non-Hispanic Black, andurban-residing PWH exceeded the 95% upper bound of expected deaths. Compared to males, female PWH experienced a greater absolute increase in the 2020 age-adjusted mortality rate. Non-Hispanic Black and non-Hispanic White PWH had larger absolute and relative increases in the 2020 age-adjusted mortality rate compared to Hispanic PWH. Findings related to excess mortality should be considered in pandemic planning and preparation efforts for vulnerable groups like PWH.

People living with HIV (PLWH) face unique biopsychosocial challenges due to both infection and antiretroviral therapy (ART), one of which is body image disruption. This study comprehensively reviewed relevant studies to explore body image issues, identify associated factors, and describe assessment methods and interventions targeting body image in this population. Guided by the PRISMA, a thorough search of PsycINFO, PubMed, Embase, and Web of Science was conducted in November 2024, using search terms relevant to HIV and Body image. NIH Study Quality Assessment Tools were used to assess the quality of the included studies, and a narrative synthesis was conducted to identify common themes, including definitions of body image, associated factors, measurement instruments, and interventions targeting body image among PLWH. From 2197 publications, 26 studies met the inclusion criteria. The majority of studies demonstrated an association between negative body image and psychosocial factors, including depression, anxiety, social withdrawal, and substance use. Body image dissatisfaction was also associated with physical health factors such as lipodystrophy. Sixteen distinct body image measurement tools were used across studies. Cognitive Behavioral Therapy for Body Image and Self-Care (CBT-BISC) was the only target intervention that showed effectiveness in mitigating body image disturbance and improving ART adherence among PLWH. This is the first comprehensive scoping review to exclusively consider body image, associated factors, measurements, and target interventions among PLWH, which highlighted the need for comprehensive, culturally sensitive interventions that address both the physical and psychological dimensions of body image concerns.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10461-025-04991-6.

This study examined how three dimensions of sexual stigma (enacted, felt, and internalized) were related to mpox preventive intentions among gay and bisexual men (GBM) through mediating pathways outlined by the Reasoned Action Approach (RAA). Data were collected from 439 GBM via an online survey during the peak of the 2022 mpox outbreak in the U.S. Path analysis examined associations among sexual stigma dimensions and mpox preventive intentions mediated through RAA behavioral predictors, including instrumental attitude, experiential attitude, injunctive norm, descriptive norm, capacity, and autonomy. Results showed that enacted stigma was not associated with any RAA predictors or mpox preventive intentions. Felt and internalized stigma were positively related to all RAA predictors, but neither of them was associated with intentions. Except for experiential attitude and injunctive norm, all other RAA predictors were positively related to intentions. Indirect effect analysis showed that felt and internalized stigma positively predicted intentions (R2 = 0.74) through instrumental attitude, descriptive norm, capacity, and autonomy regarding mpox prevention. The findings demonstrate that different dimensions of sexual stigma predicted mpox preventive intentions through distinct cognitive pathways. Prevention interventions should leverage these pathways to encourage protective intentions while working to reduce the harmful impacts of stigma.

Over the past decades, as social contexts and knowledge about HIV have evolved, the conceptualization and understanding of HIV stigma, as well as the measures used to assess it, may have also shifted. This study aimed to examine the psychometric properties of a revised version of the Berger scale which updated language to better capture HIV stigma in the Southern U.S. The revisions were informed by focus group discussions with people with HIV (PWH) in Florida. Following three focus groups, the updated scale was tested among 461 PWH. The internal structure was evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The EFA analysis supported a four-factor structure. These four latent factors corresponded to the original dimensions of the Berger scale. All evaluated models demonstrated good model fit indices. The revised scale also showed high reliability, with composite reliability (omega) values for each subscale exceeding 0.89. Measurement invariance testing across race and gender groups further indicated that invariance was upheld. The revised scale also demonstrated high reliability, and composite reliability omega for each sub-scale was over 0.89. We further conducted measurement invariance across race and gender groups, and the measurement invariance was hold. We found that the revised scale is highly reliable, encouraging wider testing of this scale in a variety of populations.

Despite the well-established need to increase access to HIV testing and prevention services among people with serious mental illness, little is known about the determinants of implementation of these services in behavioral health organizations. This multi-method study was conducted in King County, Washington, an EHE priority jurisdiction. A quantitative survey of 16 county behavioral health organizations explored the HIV testing and prevention services currently offered. Three organizations that viewed HIV testing and prevention services as very important or essential for their clients participated in in-depth qualitative interviews; 21 staff, providers, and leaders were interviewed about barriers and facilitators to on-site HIV testing and prescription or referral for Pre-exposure prophylaxis (PrEP). We used a rapid deductive qualitative analysis approach guided by the Consolidated Framework for Implementation Research (CFIR) 2.0. Commonly identified facilitators were organizational culture and a non-judgmental approach to care, frequent contact and long-standing relationships with clients, and a mission to provide holistic care. Commonly identified barriers were lack of resources and trained staff, infrastructure challenges (inability to bill services, weak referral pathways), higher priorities for services (including testing for Hepatitis C and sexually transmitted infections), and lack of knowledge and information. Lack of trained staff and the complexity of the service were more often perceived as barriers to providing PrEP on-site than HIV testing. Opportunities to build capacity were also identified, and included training, implementing universal testing, and expanding partnerships with other organizations to provide HIV testing and prevention services on-site at the behavioral health organization.

The integration of HIV pre-exposure prophylaxis (PrEP) into STI services can improve PrEP uptake among a population at elevated risk of acquiring HIV. The effectiveness of PrEP relies on ongoing coverage during periods of HIV risk, however, and little is known about longitudinal PrEP use among people accessing PrEP through STI clinics in sub-Saharan Africa. In this study, we analyzed routine records data from people who newly initiated PrEP at an STI clinic in Lilongwe, Malawi in March-December 2022. We assessed PrEP persistence among clients who received Malawi’s standard-of-care PrEP services (n = 662) and reweighted the data to reflect the baseline distribution of age, sex, and PrEP indication among the full study population (n = 835). We used weighted generalized estimating equations to estimate the proportion of clients expected to persist on PrEP if all clients had received Malawi’s standard-of-care services. We also assessed predictors of persistence and described re-engagement in PrEP among clients who did not persist. We estimated that, had all clients received standard-of-care services, 17% (95% CI: 14%, 20%), 7% (95% CI: 6%, 10%), and 4% (95% CI: 3%, 5%) would have persisted on PrEP at 1, 3, and 6 months, respectively, and that 8% (95% CI: 5%, 11%) of those who did not persist on PrEP at 1 month would have re-engaged in PrEP services by 12 months. Persistence varied by age and PrEP indication. Our findings indicate very low PrEP persistence in this population and suggest opportunities to support ongoing PrEP use in settings with integrated PrEP/STI services.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10461-025-04937-y.