When is Enough, Enough? How the Absence of Dose-Determination Trials Impedes Implementation of HIV Behavioral Interventions
AbstractCarefully controlled clinical trials have determined that theory-based behavioral interventions delivered by adherence nurses, professional and paraprofessional counselors, and case managers improve ART adherence and viral suppression. However, there are no studies that empirically inform how much intervention is needed for which patient populations and at what cost. This Editorial raises the issue of how a lack of intervention dosing limits interpretation of trial results and impedes implementation, therefore calling for behavioral intervention dose-finding studies. (Source: AIDS and Behavior)
Source: AIDS and Behavior - August 22, 2019 Category: Infectious Diseases Source Type: research

Differentiating Types of Self-Reported Alcohol Abstinence
AbstractWe contrast three types of abstinence: quit after alcohol associated problems (Q-AP), quit for other reasons (Q-OR), and lifetime abstainer (LTA). We summarized the characteristics of people living with HIV (PLWH), and matched uninfected individuals, by levels of alcohol use and types of abstinence. We then identified factors that differentiate abstinence and determined whether the association with an alcohol biomarker or a genetic polymorphism is improved by differentiating abstinence. Among abstainers, 34% of PLWH and 38% of uninfected were Q-AP; 53% and 53% were Q-OR; and 12% and 10% were LTA. Logistic regressio...
Source: AIDS and Behavior - August 21, 2019 Category: Infectious Diseases Source Type: research

The Effect of Social Networks and Social Constructions on HIV Risk Perceptions
AbstractRoughly 1 in 7 people living with HIV in the United States is unaware of their sero-status, signaling that individuals may be underestimating their  risk for HIV. Few studies have examined the effect of socio-structural and socio-cognitive factors on HIV risk perceptions. This analysis identifies individual, interpersonal and network influences on HIV risk perceptions among high-risk heterosexuals. Data come from the Colorado Springs study, a CDC-funded project focused on HIV transmission among high-risk heterosexuals. Using social network data, analyses were first conducted at the individu...
Source: AIDS and Behavior - August 21, 2019 Category: Infectious Diseases Source Type: research

Health Literacy Among In-Care Older HIV Diagnosed Persons with Multimorbidity: MMP NYS (Excluding NYC)
AbstractOlder persons living with diagnosed HIV (PLWDH) are also at risk for age-related chronic conditions. With conflicting results on studies assessing health literacy and durable viral suppression, this study is the first in assessing this relationship using representative data on older in-care HIV-diagnosed persons with multimorbidity. Weighted data collected 2009 –2014 from the Medical Monitoring Project (MMP) was used. Health literacy was assessed using the three-item Brief Health Literacy Screen (BHLS). The mean health literacy score was 11.22 (95% CI 10.86–11.59), and the mean multimorbidity was 4.75 (...
Source: AIDS and Behavior - August 21, 2019 Category: Infectious Diseases Source Type: research

Anticipated HIV-Related Stigma and HIV Treatment Adherence: The Indirect Effect of Medication Concerns
AbstractAlthough anticipated HIV-related stigma —the expectation that one will experience prejudice and discrimination in the future as a result of others learning his or her HIV positive status—is theorized to be a robust predictor of antiretroviral therapy (ART) non-adherence, the association between anticipated stigma and ART non-adherence has been inconsistent. It may be, however, that anticipated stigma reliably, but indirectly, contributes to poor ART adherence through other psychosocial mechanisms. In the current study, we examine whether anticipated stigma indirectly contributes to treatment non-adheren...
Source: AIDS and Behavior - August 20, 2019 Category: Infectious Diseases Source Type: research

Severe Food Insecurity, Gender-Based Violence, Homelessness, and HIV Risk among Street-based Female Sex Workers in Baltimore, Maryland
AbstractDespite established links between food insecurity and HIV outcomes, no studies have examined the role of food insecurity among female sex workers (FSW) in the United States (US). The aim of this exploratory study was to identify correlates (structural vulnerability and health factors) of severe food insecurity among street-based FSW in Baltimore, Maryland using multivariable logistic regression. In adjusted models, FSW with severe food insecurity were at greater odds of recent homelessness, physical intimate partner violence, client condom refusal, and HIV infection. Multi-sectoral approaches must take into conside...
Source: AIDS and Behavior - August 20, 2019 Category: Infectious Diseases Source Type: research

How Bachelorhood and Migration Increase the HIV Transmission Risk Through Commercial Sex in China?
This study explored whether and how bachelorhood and migration increased the HIV transmission risk through commercial sex. By combining two cross-sectional survey data from never married men in rural areas and male migrants (including both married and unmarried men) in urban areas, a total of 1030 participants who were never married and age 28 and above or married male migrants were included in this study. The results show that both bachelorhood and migration put the never married male migrants at particularly higher HIV transmission risk by increasing both the possibility of engaging in commercial sex, and the frequency a...
Source: AIDS and Behavior - August 19, 2019 Category: Infectious Diseases Source Type: research

Comparing Different Measures of Retention in Care Among a Cohort of Adolescents and Young Adults Living with Behaviorally-Acquired HIV
AbstractYoung people living with HIV (YLWH) have some of the lowest rates of retention in HIV care, putting them at risk for negative health outcomes. To better understand retention in care in this age group, we conducted a retrospective cohort analysis of YLWH initiating care at a multidisciplinary, adolescent-focused HIV clinic (N = 344). Retention was calculated using a variety of definitions, and relationships between different definitions were assessed. During the 1-year study period, on average YLWH missed two scheduled appointments, and attended 80% of appointments, usually at least once every 3 m...
Source: AIDS and Behavior - August 19, 2019 Category: Infectious Diseases Source Type: research

Successful Functional Aging in Middle-Aged and Older Adults with HIV
We examined frequency and correlates of successful functional aging (SFA) in PLWH. Using gold-standard questionnaires, SFA was defined in 174 HIV+ and 71 HIV − adults as absence of significant everyday cognitive symptoms and declines in instrumental activities of daily living. More HIV− (45%) than HIV+ (18%) adults met SFA criteria (p 
Source: AIDS and Behavior - August 14, 2019 Category: Infectious Diseases Source Type: research

VITAL Start: Video-Based Intervention to Inspire Treatment Adherence for Life —Pilot of a Novel Video-Based Approach to HIV Counseling for Pregnant Women Living with HIV
AbstractWe developed and piloted a video-based intervention targeting HIV-positive pregnant women to optimize antiretroviral therapy (ART) retention and adherence by providing a VITAL Start (Video-intervention to Inspire Treatment Adherence for Life) before ART. VITAL Start (VS) was grounded in behavior-determinant models and developed through an iterative multi-stakeholder process. Of 306 pregnant women eligible for ART, 160 were randomized to standard of care (SOC), 146 to VS and followed for one-month. Of those assigned to VS, 100% completed video-viewing; 96.5% reported they would recommend VS. Of 11 health workers int...
Source: AIDS and Behavior - August 13, 2019 Category: Infectious Diseases Source Type: research

Correlates of Transactional Sex Among a Rural Population of People Who Inject Drugs
AbstractIn the United States, high rates of HIV infection among persons who engage in transactional sex are partially driven by substance use. Little is known about transactional sex among rural populations of people who inject drugs (PWID). Using data from a 2018 survey of 420 rural PWID in West Virginia, we used logistic regression to identify correlates of recent transactional sex (past 6  months). Most study participants were male (61.2%), white (83.6%), and reported having injected heroin (81.0%) in the past 6 months. Nearly one-fifth (18.3%) reported engaging in recent transactional sex. Independent correla...
Source: AIDS and Behavior - August 13, 2019 Category: Infectious Diseases Source Type: research

Pilot Randomized Controlled Trial of a Syndemics Intervention with HIV-Positive, Cocaine-Using Women
AbstractThis pilot randomized controlled trial examined the feasibility and acceptability of a Syndemics intervention targeting the intersection of stimulant use, trauma, and difficulties with HIV disease management in cocaine-using women. All participants received contingency management (CM) for 3  months with financial incentives for stimulant abstinence during thrice-weekly urine screening and refilling antiretroviral medications monthly. Sixteen participants were randomized to complete four expressive writing (n = 9) or four neutral writing (n = 7) sessions delivered during the CM inter...
Source: AIDS and Behavior - August 12, 2019 Category: Infectious Diseases Source Type: research

A Person-Centered Approach to HIV-Related Protective and Risk Factors for Young Black Men Who Have Sex with Men: Implications for Pre-exposure Prophylaxis and HIV Treatment as Prevention
AbstractAlthough young Black men who have sex with men (YBMSM) are disproportionately affected by HIV, they may be more heterogeneous as a group than is typically appreciated. Thus, the present study used a person-centered data-analytic approach to determine profiles of HIV-related risk among YBMSM and whether these profiles could be distinguished by age, HIV status, and socioeconomic risk (i.e., socioeconomic distress). YBMSM (N  =  1808) aged 18 to 29 years completed a survey of sociodemographic characteristics, HIV status, and HIV-related behavioral and attitudinal factors (i.e., safer-sex self-effica...
Source: AIDS and Behavior - August 12, 2019 Category: Infectious Diseases Source Type: research

‘My Tablets are on Top of the Fridge’: The Roles of Relationship Desire and Medical Mistrust in ART Adherence for HIV-Positive MSM and Transgender Women Living in Rural South Africa
AbstractGiven the high HIV prevalence for men who have sex with men (MSM) and transgender women in South Africa, there is limited understanding of social determinants that influence antiretroviral treatment (ART) adherence. Although universal testing and treatment (UTT) is available, ART adherence remains suboptimal. We conducted focus groups with MSM and transgender women in order to understand factors influencing their ART adherence in Mpumalanga, South Africa. All focus groups were audio-recorded, transcribed and translated for analysis using a constant comparison approach, guided by the concept of Therapeutic Citizensh...
Source: AIDS and Behavior - August 12, 2019 Category: Infectious Diseases Source Type: research

Neighborhood Alcohol Environment: Differential Effects on Hazardous Drinking and Mental Health by Sex in Persons Living with HIV (PLWH)
AbstractDespite greater mental health co-morbidities and heavier alcohol use among PLWH, few studies have examined the role of the neighborhood alcohol environment on either alcohol consumption or mental health. Utilizing cross-sectional data from a cohort study in a southern U.S. metropolitan area, we examine the association between neighborhood alcohol environments on hazardous drinking and mental health among 358 in-care PLWH (84% African American, 31% female). Multilevel models were utilized to quantify associations between neighborhood alcohol exposure on hazardous drinking and effect modification by sex. Neighborhood...
Source: AIDS and Behavior - August 10, 2019 Category: Infectious Diseases Source Type: research

Alcohol, But Not Depression or IPV, Reduces HIV Adherence Among South African Mothers Living with HIV Over 5  Years
This study fills that gap by including all mothers in specified areas. A cohort study examines MLH in Cape Town, South Africa recruited in pregnancy and followed repeatedly for 5  years, compared to MWOH. Almost all (98%) pregnant women in 12 neighborhoods (N = 594) were recruited in pregnancy. Mothers and children were reassessed five times over 5 years with high retention rates at each of the six assessments, from 98.7% at 2 weeks to 82.8% at 5 years post-birth. ML H’s uptake and adherence to HIV care was evaluated over time associated with maternal comorbidities of alcohol use, de...
Source: AIDS and Behavior - August 10, 2019 Category: Infectious Diseases Source Type: research

A Systematic Review of eHealth Interventions Addressing HIV/STI Prevention Among Men Who Have Sex With Men
AbstractA systematic review was conducted to summarize and appraise the eHealth interventions addressing HIV/STI prevention among men who have sex with men (MSM), and characterize features of successful eHealth interventions. Fifty-five articles (17 pilots and 38 full efficacy trials) were included with the predominance of web-based interventions in the United States-based settings. Intervention modalities include web-based, short message service (SMS)/text messges/email reminder, online video-based, computer-assisted, multimedia-based, social network, live chat and chat room, virtual simulation intervention, and smartphon...
Source: AIDS and Behavior - August 10, 2019 Category: Infectious Diseases Source Type: research

Slow Acceptance of Universal Antiretroviral Therapy (ART) Among Mothers Enrolled in IMPAACT PROMISE Studies Across the Globe
AbstractThe PROMISE trial enrolled asymptomatic HIV-infected pregnant and postpartum women not eligible for antiretroviral treatment (ART) per local guidelines and randomly assigned proven antiretroviral strategies to assess relative efficacy for perinatal prevention plus maternal/infant safety and maternal health. The START study subsequently demonstrated clear benefit in initiating ART regardless of CD4 count. Active PROMISE participants were informed of results and women not receiving ART were strongly recommended to immediately initiate treatment to optimize their own health. We recorded their decision and the primary ...
Source: AIDS and Behavior - August 9, 2019 Category: Infectious Diseases Source Type: research

Life Chaos is Associated with Reduced HIV Testing, Engagement in Care, and ART Adherence Among Cisgender Men and Transgender Women upon Entry into Jail
AbstractLife chaos, the perceived inability to plan for and anticipate the future, may be a barrier to the HIV care continuum for people living with HIV who experience incarceration. Between December 2012 and June 2015, we interviewed 356 adult cisgender men and transgender women living with HIV in Los Angeles County Jail. We assessed life chaos using the Confusion, Hubbub, and Order Scale (CHAOS)  and conducted regression analyses to estimate the association between life chaos and care continuum. Forty-eight percent were diagnosed with HIV while incarcerated, 14% were engaged in care 12 months prior to incarcera...
Source: AIDS and Behavior - August 8, 2019 Category: Infectious Diseases Source Type: research

“That Guy is Gay and Black. That’s a Red Flag.” How HIV Stigma and Racism Affect Perception of Risk Among Young Black Men Who Have Sex with Men
AbstractYoung Black men who have sex with men ’s (YBMSM) attitudes and personal beliefs about themselves and their risk for HIV can be modified as a result of experiences with racism and HIV stigma. In-depth qualitative interviews were conducted with 25 HIV-negative YBMSM, aged 18–24, in North Carolina and Maryland. Data were thematical ly analyzed to capture participants’ experiences and thoughts related to stigmatizing experiences and their perception of risk for HIV. Participants reported experiencing HIV stigmatizing and blatant racist commentary related to their identities as YBMS...
Source: AIDS and Behavior - August 8, 2019 Category: Infectious Diseases Source Type: research

High Levels of Syndemics and Their Association with Adherence, Viral Non-suppression, and Biobehavioral Transmission Risk in Miami, a U.S. City with an HIV/AIDS Epidemic
AbstractMiami is a Southeastern United States (U.S.) city with high health, mental health, and economic disparities, high ethnic/racial diversity, low resources, and the highest HIV incidence and prevalence in the country. Syndemic theory proposes that multiple, psychosocial comorbidities synergistically fuel the HIV/AIDS epidemic. People living with HIV/AIDS in Miami may be particularly affected by this due to the unique socioeconomic context. From April 2017 to October 2018, 800 persons living with HIV/AIDS in a public HIV clinic in Miami completed an interviewer-administered behavioral and chart-review cross-sectional a...
Source: AIDS and Behavior - August 7, 2019 Category: Infectious Diseases Source Type: research

Age, Sex, Race, Ethnicity, Sexual Orientation: Intersectionality of Marginalized-Group Identities and Enacted HIV-Related Stigma Among People Living with HIV in Florida
This study aims to identify individual and interactive marginalized-group identities correlated with enacted HIV-related stigma among PLHIV in Florida. The sample (n = 932) was majority male (66.6%), Black (58.5%), and non-Latino (80.2%) with 53% reporting experiences of HIV-related stigma. In multinomial regression models, the interaction between race and ethnicity was significant where non-White Latinos had higher odds of experiencing high levels of enacted stigma [AOR (CI) 7.71 (2.41, 24.73), p 
Source: AIDS and Behavior - August 7, 2019 Category: Infectious Diseases Source Type: research

Yes to Recreational Drugs and Complementary Medicines But No to Life-Saving Medications: Beliefs Underpinning Treatment Decisions Among PLHIV
This study may serve as guidance for the development of future strategies to address barriers to treatment uptake and adherence and subsequently health outcomes for PLHIV in Australia and elsewhere. (Source: AIDS and Behavior)
Source: AIDS and Behavior - August 6, 2019 Category: Infectious Diseases Source Type: research

Attitudes Toward Long-Term Use of Antiretroviral Therapy Among HIV-Infected Pregnant Women in Moshi, Tanzania: A Longitudinal Study
This study sought to understand how women’s attitudes towards ART changes between the pregnancy and postpartum periods, and the factors associated with these attitudes. The study enrolled 200 pregnant women living with HIV. Structured surveys were administered during pregnancy and at three and 6 months postpartum. Overall, attitudes towards ART were stable over time. More positive attitudes towards ART were associated with HIV acceptance, lower levels of depression, and lower levels of shame. Counselling interve ntions are needed to help HIV-infected women accept their status and reduce shameful emotions. Depres...
Source: AIDS and Behavior - August 3, 2019 Category: Infectious Diseases Source Type: research

Barriers and Facilitators to the Successful Transition of Adolescents Living with HIV from Pediatric to Adult Care in Low and Middle-Income Countries: A Systematic Review and Policy Analysis
AbstractThe purpose of this  systematic review was twofold. First, we sought to summarize the literature on barriers and facilitators to successful healthcare transition for adolescents living with HIV from low- and middle-income countries (LMICs). Next, we assessed healthcare transition-related policies in countries fro m which we identified barriers and facilitators to determine the extent to which practice and policy meet to address the country-specific needs of adolescents living with HIV during healthcare transition. Ten studies met inclusion criteria. We identified four sub-the...
Source: AIDS and Behavior - August 3, 2019 Category: Infectious Diseases Source Type: research

Consent Challenges and Psychosocial Distress in the Scale-up of Voluntary Medical Male Circumcision Among Adolescents in Western Kenya
AbstractIn priority sub-Saharan African countries, on the ground observations suggest that the success of voluntary medical male circumcision (VMMC) programs should not be based solely on numbers of males circumcised. We identify gaps in the consent process and poor psychosocial outcomes among a key target group: male adolescents. We assessed compliance with consent and assent requirements for VMMC in western Kenya among males aged 15 –19 (N = 1939). We also examined differences in quality of life, depression, and anticipated HIV stigma between uncircumcised and circumcised adolescents. A substantial pr...
Source: AIDS and Behavior - August 2, 2019 Category: Infectious Diseases Source Type: research

Adherence to Antiretroviral Therapy Among Incarcerated Persons with HIV: Associations with Methadone and Perceived Safety
We examined factors associated with ART utilization and adherence among incarcerated PWH (N  = 150) in Indonesia. ART utilization was positively associated with HIV status disclosure (adjusted odds ratio [aOR] = 5.5, 95% CI 1.2–24.1, p = 0.023), drug dependency (aOR = 3.9, 95% CI 1.2–12.6, p = 0.022), health service satisfaction (aOR = 3.2, 95% CI 1.7–6.2, p 
Source: AIDS and Behavior - July 23, 2019 Category: Infectious Diseases Source Type: research

Pharmacy Refill Data are Poor Predictors of Virologic Treatment Outcomes in Adolescents with HIV in Botswana
AbstractIn adults living with HIV, pharmacy refill data are good predictors of virologic failure (VF). The utility of pharmacy refill data for predicting VF in adolescents has not been reported. We evaluated data from 291 adolescents on antiretroviral therapy. The main outcome measure was VF, defined as two consecutive HIV viral load measurements  ≥ 400 copies/mL during 24-months of follow-up. Pharmacy refill non-adherence was defined as two consecutive refill adherence measurements 
Source: AIDS and Behavior - July 23, 2019 Category: Infectious Diseases Source Type: research

A Systematic Review and Meta-analysis of Antiretroviral Therapy (ART) Adherence Interventions for Women Living with HIV
AbstractA systematic review and meta-analysis was conducted to determine the efficacy of women-focused ART adherence interventions. Included studies (a) reported on a behavioral ART adherence intervention for cis-women living with HIV, (b) measured ART adherence as an outcome, and (c) employed a randomized controlled trial design. Thirteen studies were included in the meta-analysis. Overall, interventions significantly improved ART adherence compared to control conditions (random-effects d  = 0.82, 95% CI [0.18, 1.45], p = 0.01), however, this was largely driven by two studies that had effect si...
Source: AIDS and Behavior - July 23, 2019 Category: Infectious Diseases Source Type: research

The Use of a Brief, Active Visualisation Intervention to Improve Adherence to Antiretroviral Therapy in Non-adherent Patients in South Africa
This study provides initial evidence for the utility of this novel, brief intervention as an adjunct to standard adherence counselling, for improving adherence to ART. (Source: AIDS and Behavior)
Source: AIDS and Behavior - July 23, 2019 Category: Infectious Diseases Source Type: research

Validity of Social Support Scales Utilized Among HIV-Infected and HIV-Affected Populations: A Systematic Review
AbstractSocial support enhances self-management and prevention of behaviors and is typically assessed using self-report scales; however, little is known about the validity of these scales in HIV-infected or affected populations. This systematic review aims to identify available validated social support scales used in HIV-infected and HIV-affected populations. A systematic literature search using key search terms was conducted in electronic databases. After rounds abstract screenings, full-text reviews, and data abstraction 17 studies remained, two of which assessed multiple social support scales, which increased number of ...
Source: AIDS and Behavior - July 23, 2019 Category: Infectious Diseases Source Type: research

Characterizing Men Who Have Sex with Men and Use Injection Drugs in Vancouver, Canada
We examined factors associated with reporting sex with men among men who inject drugs in Vancouver, Canada. Data were drawn from three open prospective cohorts of people who use drugs between 2005 and 2014. Generalized estimating equations were used to identify factors associated with reporting non-transactional sex with men (MSM) in the previous 6  months. Of 1663 men who used injection drugs, 225 (13.5%) were MSM over the study period. Sex with men was independently associated with younger age [Adjusted Odds Ratio (AOR) = 0.96], childhood sexual abuse (AOR = 2.65), sex work (AOR =&...
Source: AIDS and Behavior - July 20, 2019 Category: Infectious Diseases Source Type: research

Housing First: Unsuppressed Viral Load Among Women Living with HIV in San Francisco
AbstractWhile poverty is an established barrier to achieving success at each step of the HIV care continuum, less is known about specific aspects of poverty and how they overlap with behavior in exceptionally low-income individuals who live in well-resourced areas. We considered unsuppressed viral load over 3  years among women living with HIV in San Francisco who used homeless shelters, low-income hotels and free meal programs. One-hundred twenty study participants were followed; 60% had >  1 unsuppressed viral load and 19% were unsuppressed at every visit. Across six-month intervals, the odds of uns...
Source: AIDS and Behavior - July 19, 2019 Category: Infectious Diseases Source Type: research

Recent Incarceration as a Primary Barrier to Virologic Suppression Among Women Living with HIV: Results from a Longitudinal Community-Based Cohort in a Canadian Setting
AbstractWomen living with HIV (WLWH) are disproportionately represented among incarcerated populations yet there is a paucity of research on how incarceration shapes HIV treatment outcomes for women. Data is drawn from SHAWNA(Sexual health and HIV/AIDS: Women ’s Longitudinal Needs Assessment), a longitudinal community-based open research cohort with cis and trans WLWH in Metro Vancouver, Canada (2010 –2017). Multivariable logistic regression using generalized estimating equations (GEE) longitudinally modeled the effect of incarceration on virologic suppression (HIV plasma VL 
Source: AIDS and Behavior - July 19, 2019 Category: Infectious Diseases Source Type: research

Location of Pre-exposure Prophylaxis Services Across New York City Neighborhoods: Do Neighborhood Socio-demographic Characteristics and HIV Incidence Matter?
AbstractDespite an increasing pre-exposure prophylaxis (PrEP) use among populations at highest risk of HIV acquisition, comprehensive and easy access to PrEP is limited among racial/ethnic minorities and low-income populations. The present study analyzed the geographic distribution of PrEP providers and the relationship between their location, neighborhood characteristics, and HIV incidence using spatial analytic methods. PrEP provider density, socio-demographics, healthcare availability, and HIV incidence data were collected by ZIP-code tabulation area in New York City (NYC). Neighborhood socio-demographic measures of rac...
Source: AIDS and Behavior - July 18, 2019 Category: Infectious Diseases Source Type: research

A Randomized Controlled Trial Evaluating Efficacy of a Brief Setting-Based and Theory-Based Intervention Promoting Voluntary Medical Male Circumcision Among Heterosexual Male Sexually Transmitted Disease Patients in China
This study is registered at ClinicalTrials.gov, number NCT03414710.https://clinicaltrials.gov/ct2/show/NCT03414710. (Source: AIDS and Behavior)
Source: AIDS and Behavior - July 18, 2019 Category: Infectious Diseases Source Type: research

“I Couldn’t Afford to Resist”: Condom Negotiations Between Male Sex Workers and Male Clients in Mombasa, Kenya
AbstractMale sex workers in Kenya face a disproportionate burden of HIV and often engage in condomless sex with their commercial partners, yet little is known about how condom negotiations between male sex workers and clients take place. We conducted semi-structured interviews with 25 male sex workers and 11 male clients of male sex workers in Mombasa, Kenya, to examine barriers and facilitators to condom use and how condom use  negotiation takes place in these interactions. Participants reported positive attitudes toward condom use and perceived condom use to be a health-promoting behavior. Barriers to condom use inc...
Source: AIDS and Behavior - July 18, 2019 Category: Infectious Diseases Source Type: research

Love with No Exceptions : A Statewide Faith-Based, University –Community Partnership for Faith-Based HIV Training and Assessment of Needs in the Deep South
AbstractThis project established a faith-based, university –community partnership with the African Methodist Episcopal (AME) church in Alabama to develop a statewide training model to address HIV knowledge and stigma, promote discussion and generate action plans to address HIV in the Deep South. A community-engaged research team consisting of church leade rship and university researchers developed and implemented the model, “Love with No Exceptions.” Mixed methods were used to evaluate the model delivered in 3-h sessions in five state regions (N = 146 clergy and laity). The majority of parti...
Source: AIDS and Behavior - July 18, 2019 Category: Infectious Diseases Source Type: research

U.S. Centers for Disease Control and Prevention and Health Resources and Services Administration Initiatives to Address Disparate Rates of HIV Infection in the South
Abstract The US South accounted for 51% of annual new HIV infections, 50% of undiagnosed infections and 45% of persons with HIV infection in 2016 while comprising 38% of the population. Myriad structural and contextual factors are associated with HIV-related disparities. This paper describes initiatives and strategies conducted by the Centers for Disease Control and Prevention and Health Resources and Services Administration to identify opportunities and activities addressing the disparity of HIV diagnoses in the South. Targeted HIV prevention and care efforts can change the trajectory of outcomes along the HIV care cont...
Source: AIDS and Behavior - July 18, 2019 Category: Infectious Diseases Source Type: research

Patterns and Correlates of Prescription Opioid Receipt Among US Veterans: A National, 18-Year Observational Cohort Study
AbstractA better understanding of predisposition to transition to high-dose, long-term opioid therapy after initial opioid receipt could facilitate efforts to prevent opioid use disorder (OUD). We extracted data on 69,268 patients in the Veterans Aging Cohort Study who received any opioid prescription between 1998 and 2015. Using latent growth mixture modelling, we identified four distinguishable dose trajectories: low (53%), moderate (29%), escalating (13%), and rapidly escalating (5%). Compared to low dose trajectory, those in the rapidly escalating dose trajectory were proportionately more European-American (59% rapidly...
Source: AIDS and Behavior - July 17, 2019 Category: Infectious Diseases Source Type: research

The Role of Depression Screening and Treatment in Achieving the UNAIDS 90 –90–90 Goals in Sub-Saharan Africa
AbstractDespite widespread HIV screening and treatment programs across sub-Saharan Africa, many countries are not on course to meet the Joint United Nations Program on HIV/AIDS 90 –90–90 targets. As mental health disorders such as depression are prevalent among people living with HIV, investment in understanding and addressing comorbid depression is increasing. This manuscript aims to assess depression and HIV management in sub-Saharan Africa using a 90–90–90 lens thr ough a discussion of: depression and the HIV care continuum; the state of depression screening and treatment; and innovations such as...
Source: AIDS and Behavior - July 17, 2019 Category: Infectious Diseases Source Type: research

The Relationship of HIV-related Stigma and Health Care Outcomes in the US Deep South
This study examined the prevalence of different forms of stigma and the association of stigma with medication and medical visit adherence in the Deep South. Survey participants included 201 individuals living with HIV recruited from Infectious Diseases Clinics (ID) and AIDS Service Organizations (ASOs) in four Deep South states. Study participants reported high levels of experienced, perceived, and internalized stigma. Multivariable analysis revealed that internalized stigma and recent stigmatizing experiences were significantly associated with poorer HIV medication adherence. Internalized stigma was also associated with h...
Source: AIDS and Behavior - July 17, 2019 Category: Infectious Diseases Source Type: research

Changes in Reported Injection Behaviors Following the Public Health Response to an HIV Outbreak Among People Who Inject Drugs: Indiana, 2016
We reported injection behaviors prior to the response and used Fisher ’s exact Chi square tests (P  
Source: AIDS and Behavior - July 16, 2019 Category: Infectious Diseases Source Type: research

Historical and Current Trends in HIV Criminalization in South Carolina: Implications for the Southern HIV Epidemic
AbstractIn the 1980s, human immunodeficiency virus (HIV) criminalization laws became widespread across the United States. Today, such laws continue to be used to prosecute people living with HIV for a variety of behaviors though there is limited evidence that doing so curbs HIV transmission. HIV criminalization remains understudied, especially in the Deep South. Therefore, the purpose of this paper was to trace the emergence, maintenance, and enforcement of HIV criminalization laws in South Carolina —a Southern state disproportionately burdened by HIV. Specifically, Nexis Uni and other criminology databases were used...
Source: AIDS and Behavior - July 16, 2019 Category: Infectious Diseases Source Type: research

A Pilot Study of a Mobile App to Support HIV Antiretroviral Therapy Adherence Among Men Who Have Sex with Men Who Use Stimulants
AbstractAPP+  is a theoretically-grounded mobile app intervention to improve antiretroviral (ART) adherence among men who have sex with men (MSM) who use stimulants. We assessed the feasibility and acceptability of APP+ in a six-month randomized controlled trial among a national sample of 90 MSM recruited on line; secondarily, we examined changes in self-reported ART adherence by study arm. Retention at the final assessment was 82%, and acceptability ratings were comparable to other technology-based interventions. MSM in the APP+ group reported higher self-reported percentage ART adherence in the past ...
Source: AIDS and Behavior - July 15, 2019 Category: Infectious Diseases Source Type: research

Characterizing Men Who Have Sex with Transgender Women in Lima, Peru: Sexual Behavior and Partnership Profiles
We examined baseline data from TW, PTW, and men who have sex with men (MSM) from a treatment-as-prevention study in Lima, Peru. Individual and partnership characteristics were compared across groups, and Poisson regression was used to calculate prevalence ratios for associations between sexual concurrency and potential correlates. We found that 81% of PTW had no cisgender male partners. Prevalence of alcohol dependency, concurrency, and condomless anal intercourse was high and HIV testing was low compared to the other groups. Our results suggest that PTW are a distinct population from MSM and TW, engage in behavior associa...
Source: AIDS and Behavior - July 12, 2019 Category: Infectious Diseases Source Type: research

New Measures for Research on Men Who Have Sex with Men and for At-Risk Heterosexuals: Tools to Study Links Between Structural Interventions or Large-Scale Social Change and HIV Risk Behaviors, Service Use, and Infection
AbstractLarge-scale structural interventions and “Big Events” like revolutions, wars and major disasters can affect HIV transmission by changing the sizes of at-risk populations, making high-risk behaviors more or less likely, or changing contexts in which risk occurs. This paper describes new measures to investigate hypothesized pathways that could connect macro-social changes to subsequent HIV transmission. We developed a “menu” of novel scales and indexes on topics including norms about sex and drug injecting under different conditions, experiencing denial of dignity, agreement with cultural them...
Source: AIDS and Behavior - July 11, 2019 Category: Infectious Diseases Source Type: research

eHealth Interventions for Early Infant Diagnosis: Mothers ’ Satisfaction with the HIV Infant Tracking System in Kenya
This study explored mothers ’ experiences receiving standard and HITSystem-enhanced EID services to assess perceived intervention benefits, acceptability, and opportunities for improvement. This qualitative study was embedded within a cluster-randomized control trial to evaluate the HITSystem at six Kenyan government hospita ls (3 intervention, 3 control). We conducted semi-structured interviews with 137 mothers attending EID follow-up visits. Compared to control sites, participants at HITSystem sites described enhanced EID quality; HITSystem-generated texts informed them of result availability and retesting needs, p...
Source: AIDS and Behavior - July 11, 2019 Category: Infectious Diseases Source Type: research

Suboptimal HIV Pre-exposure Prophylaxis Awareness and Willingness to Use Among Women Who Use Drugs in the United States: A Systematic Review and Meta-analysis
AbstractIn the United States (U.S.), more than 12 million women reported illicit drug use in the past month. Drug use has been linked to increased risk for HIV, but little is known about the uptake of HIV pre-exposure prophylaxis (PrEP) to prevent HIV among women who use drugs (WWUD). Following the PRISMA guideline, we conducted a multi-database literature search to assess engagement along the PrEP care continuum among WWUD in the U.S. Seven studies with a total of 755 women were included in the review: 370 (49%) Black, 126 (16.7%) Hispanics, and 259 (34.3%) Whites. Employing random-effect models, data indicate 20.6% (95% ...
Source: AIDS and Behavior - July 11, 2019 Category: Infectious Diseases Source Type: research

Accessing Pre-exposure Prophylaxis (PrEP): Perceptions of Current and Potential PrEP Users in Birmingham, Alabama
AbstractLimited studies to date assess barriers to and facilitators of PrEP uptake and utilization using a patient-centered access to care framework, among diverse socio-demographic groups, or in the U.S. Deep South, an area with disproportionate HIV burden. We examine perceptions of PrEP access in qualitative interviews with 44 current and potential PrEP users in Birmingham, Alabama. Participants were 32  years old on average, 66% Black, 66% gay or lesbian, 70% male, and 66% single. Perceived barriers to PrEP access included: lack of PrEP awareness and advertisement; sexuality-related stigma; time and resource constr...
Source: AIDS and Behavior - July 11, 2019 Category: Infectious Diseases Source Type: research