AIDS And Behavior[JOURNAL]
Sun
200 papers
Intersecting Vulnerabilities: Depression, Suicidality, and HIV Risk Among Young Mothers in South Africa.
Miller AP, Joseph Davey DL, Groenewald C … +4 more , Filiatreau LM, Petersen Z, van Rooyen H, Essack Z
AIDS Behav · 2026 Jun · PMID 42234303 · Publisher ↗
Many African women who are pregnant or parenting face intersecting challenges including intimate partner violence, unplanned pregnancies, and motherhood-related stresses that heighten vulnerability to poor mental health....
Many African women who are pregnant or parenting face intersecting challenges including intimate partner violence, unplanned pregnancies, and motherhood-related stresses that heighten vulnerability to poor mental health. Depression and suicidal ideation are associated with behaviors that increase HIV risk, yet limited research has explored these relationships in African contexts. This study examined associations between depressive symptoms, suicidal ideation, and sexual risk behaviors among unemployed young women aged 19-24 years in KwaZulu-Natal, South Africa. Baseline data were collected between June-October 2018 from participants who had been sexually active in the past year. Prolonged sadness (≥ 2 weeks) and suicidal ideation in the past year were measured using validated single-item indicators. The composite HIV risk outcome captured transactional sex, partners with unknown HIV/STI status, and substance-influenced sex. Poisson regression models adjusted for age, intimate partner violence, and HIV serostatus; moderation by HIV status was tested. Among 1,026 women (median age 22 years), 8.6% were living with HIV, 34% reported prolonged sadness, and 10% reported suicidal ideation. Both exposures were associated with elevated HIV risk (prolonged sadness: PRR = 1.79, 95% CI 1.41-2.27; suicidal ideation: PRR = 1.67, 95% CI 1.24-2.27). Moderation analysis showed no interaction between depressive symptoms and HIV serostatus but identified a significant interaction for suicidal ideation, with a stronger association among women living with HIV. Findings underscore the burden of depressive symptoms among young mothers and its contribution to HIV vulnerability. Integrating mental health screening and referral within antenatal, postnatal, and HIV care could improve outcomes for both women and their children.
Hyper-Local, Place-Based Strategies to Increase PrEP Uptake Among Black Sexual Minority Men in Alabama.
Carlisle NA, Bruxvoort KJ, Delay M … +4 more , Smith T, Cole-Crum M, Lawson K, MacCarthy S
AIDS Behav · 2026 Jun · PMID 42234302 · Publisher ↗
We describe a community-academic pilot to strengthen pre-exposure prophylaxis (PrEP) outreach for Black sexual minority men (BSMM) in Birmingham, Alabama, using hyper-local, place-based digital advertising delivered in t...
We describe a community-academic pilot to strengthen pre-exposure prophylaxis (PrEP) outreach for Black sexual minority men (BSMM) in Birmingham, Alabama, using hyper-local, place-based digital advertising delivered in two micro-settings. Brief formative interviews with BSMM and local consensus discussions with a trusted community partner informed two tailored advertisements. Using platform metrics and routine program data, we assessed feasibility and pre/post changes in HIV testing and PrEP continuum indicators. The campaign achieved strong reach and engagement and coincided with increased testing and modest improvements in PrEP awareness and initiation among Black men, though tailored advertisement performance did not differ by setting.
Cognitive Functioning and Its Stability Among Young Adults with Perinatal HIV Exposure or Acquisition in a U.S.-Based Longitudinal Cohort Study.
Nichols S, Huo Y, Garvie PA … +11 more , Caniglia S, Smith R, Malee K, McHenry MS, Paul ME, Moscicki AB, Avendano GM, Tassiopoulos K, Wilkins ML, Berman CA, Williams PL
AIDS Behav · 2026 Jun · PMID 42228346 · Full text
The growing population of young adults with perinatal HIV acquisition (YAPHIV) or exposure without acquisition (YAPHEU) warrants investigation of ongoing cognitive effects of PHIV and lasting neurodevelopmental consequen...
The growing population of young adults with perinatal HIV acquisition (YAPHIV) or exposure without acquisition (YAPHEU) warrants investigation of ongoing cognitive effects of PHIV and lasting neurodevelopmental consequences of perinatal exposure to HIV and antiretroviral therapy (ART). Within the US-based AMP Up longitudinal cohort study, 608 YAPHIV and 131 YAPHEU completed the NIH Toolbox (NIHT) assessment of cognitive functioning and provided information on mental health, demographic variables, social determinants of health (SDOH), HIV-related health and ARTs. YAPHIV were categorized at entry as YAPHIV-C (history of CDC Class C AIDS-defining criteria or nadir CD4%<15) or YAPHIV-non-C. General linear regression models were fit to examine associations of HIV status with NIHT age-adjusted Fluid, Crystallized and Total Cognition Composite standard scores and change in scores from entry to the three-year follow-up visit. NIHT performance between YAPHEU and all YAPHIV was comparable, with borderline/low average Fluid and average Crystallized Composite scores; however, we observed overall differences among the three groups, with lowest mean scores among YAPHIV-C and highest among YAPHIV-non-C. In adjusted analyses, mean Fluid Composite scores increased longitudinally across groups, with significantly less increase in both YAPHIV groups versus YAPHEU. Differences were not mediated by mental health variables. Few associations with current or change in HIV disease severity were observed. SDOH analyses supported benefits of greater access to social and economic resources. Although results highlight concerns about long-term effects of perinatal HIV among young adults, differences were subtle and emphasize the importance of modifiable factors such as viral control and access to resources.
Procedures to Verify Legitimacy and Uniqueness of Responses in an Online Study with U.S. Young Gay and Bisexual Men Who Use Stimulants.
Valente PK, O'Connor G, Useda C … +4 more , Fisher C, Biello KB, Mimiaga MJ, Brown B
AIDS Behav · 2026 May · PMID 42217129 · Publisher ↗
In this brief report, we describe our procedures to determine the legitimacy and uniqueness of responses in an online study with young gay, bisexual, and other men who have sex with men in the U.S. Our verification proce...
In this brief report, we describe our procedures to determine the legitimacy and uniqueness of responses in an online study with young gay, bisexual, and other men who have sex with men in the U.S. Our verification procedures included automated methods (e.g., Qualtrics' fraud detection, and knowledge, attention, and consistency-checks), manual methods (e.g., reviewing individuals' open-ended descriptions of an image), and verification video-conference or phone calls. In total, 9321 individuals completed our eligibility screener and 2637 met eligibility criteria (28.3%). However, we could only ascertain legitimacy and uniqueness of 251 of these entries (9.5% of eligible individuals). Automated and manual methods flagged 68.4 and 9.4% of eligible entries as non-legitimate or duplicate, respectively; another 12.6% of eligible entries were excluded for not being able to confirm legitimacy in verification calls. Researchers should consider a range of automated and manual verification procedures to ensure data quality in internet-based studies.
High Prevalence of Unhealthy Alcohol Use Among Persons with HIV, Viral Non-suppression and Any Alcohol Use in Mbarara, Uganda: A Brief Report.
Fisk-Hoffman RJ, Kekibiina A, Muyindike WR … +12 more , Cheng H, Agumenaitwe P, Truong V, Allison O, Gnatienko N, Tsui JI, Hahn JA, Emenyonu N, Forman L, Shan W, Karsten L, Samet JH
AIDS Behav · 2026 May · PMID 42213305 · Publisher ↗
Unhealthy alcohol use is associated with HIV viral non-suppression. It is unclear how common unhealthy alcohol use is among non-suppressed persons with HIV (PWH) who drink alcohol. We conducted chart reviews to recruit P...
Unhealthy alcohol use is associated with HIV viral non-suppression. It is unclear how common unhealthy alcohol use is among non-suppressed persons with HIV (PWH) who drink alcohol. We conducted chart reviews to recruit PWH in Uganda with recent viral non-suppression for a study on the efficacy of gabapentin for promoting viral suppression among those with unhealthy alcohol use. Of the 288 PWH screened, 87% self-reported unhealthy alcohol use on the Alcohol Use Disorders Identification Test-Consumption and 73% tested positive for urine ethyl glucuronide. These data suggest that alcohol interventions are needed among Ugandan PWH with viral non-suppression and who drink.
Beliefs About Toxic Interactions Between Alcohol and PrEP Predict Less Initiation and More Discontinuation: Results from the RADAR Cohort Study.
Mustanski B, Ryan DT, Baiers R … +1 more , Newcomb ME
AIDS Behav · 2026 May · PMID 42201480 · Publisher ↗
Young men who have sex with men (YMSM) have high HIV incidence but suboptimal PrEP coverage, so it's critical we identify barriers to PrEP uptake and persistence. Among people living with HIV, research indicates that med...
Young men who have sex with men (YMSM) have high HIV incidence but suboptimal PrEP coverage, so it's critical we identify barriers to PrEP uptake and persistence. Among people living with HIV, research indicates that medication adherence is lower among people who believe that alcohol and HIV medications interact to produce toxic effects. Rates of hazardous drinking are elevated among YMSM, suggesting such beliefs may be common. The goal of these analyses was to examine how alcohol-interactive toxicity beliefs impacts PrEP uptake and discontinuation in a sample of 478 HIV-negative YMSM. This sample had a mean age of 23.0 (SD = 2.8) and was racially and ethnically diverse (24.1% Black; 29.9% White; 36.2% Hispanic/Latino). Longitudinal models examined the direct effects of alcohol consumption and toxicity beliefs, as well as their interaction, on PrEP uptake and discontinuation six months later. Most YMSM endorsed at least one toxicity belief (58%). Among baseline non-PrEP-users, toxicity beliefs were associated with lower PrEP uptake (aHR = 0.76; 95% CI: 0.61-0.95). Among current PrEP users, YMSM with both higher alcohol consumption and toxicity beliefs were those most likely to discontinue PrEP six months later. This study provides new evidence that the prevalence of alcohol-related interactive toxicity beliefs among YMSM are substantial and represent a barrier to effective HIV prevention. Given PrEP efficacy depends on consistent use, discontinuation during periods of HIV risk undermines prevention goals. Interventions addressing alcohol-related toxicity beliefs-through education, counseling, and tailored messaging-may optimize PrEP uptake and persistence, particularly among populations with high alcohol use.
HIV Testing Service Utilization Among Transgender Communities: Insights from a Respondent-Driven Sampling Survey in India.
Kaptchuk RP, Singh A, Reddy AK … +8 more , Arumugam V, Okram S, Srikrishnan AK, Bell J, Patel EU, Mehta SH, Solomon SS, McFall AM
AIDS Behav · 2026 May · PMID 42201479 · Publisher ↗
Transgender populations in India bear a disproportionate HIV burden and systemic discrimination that limits access to prevention services. We explored psychosocial correlates of HIV testing and reasons for never testing...
Transgender populations in India bear a disproportionate HIV burden and systemic discrimination that limits access to prevention services. We explored psychosocial correlates of HIV testing and reasons for never testing among transgender people across three high-HIV burden states. Transgender individuals aged ≥ 18 years were recruited using respondent driven sampling for an interview-administered survey in Telangana, Maharashtra, and Uttar Pradesh, India in 2022. Summary statistics and reasons for never testing incorporated RDS-II weights. We used Poisson regression with robust variance to assess associations between psychosocial variables and prior HIV testing. Among 1,997 respondents (median age, 27 years), 37% were from Telangana, 43% from Maharashtra, 21% from Uttar Pradesh; 65% identified as transgender, 28% as Hijra, 6% as women, and 1% as men. Half (47%) had never tested for HIV. Prior testing was positively associated with higher and lower HIV risk perception, hazardous alcohol use, past experience of sexual violence, larger transgender peer networks, and past healthcare stigma; it was negatively associated with anxiety or depression. The most cited reasons for never testing were never hearing of HIV (38%), low risk perception (39%), and privacy concerns (25%). The prevalence of each reason for no prior HIV testing differed by gender, mental health status, and the network size of other transgender people in the district. Findings highlight the need for HIV testing strategies to be sensitive to gender identity and psychosocial factors in order to improve access for transgender communities. Community-partnered approaches that integrate mental health and support peer networks may improve testing uptake among transgender populations in India.
Methamphetamine Use and HIV Risk Behaviors in a Cohort of Homeless-Experienced Adults Who Use Drugs.
Fine DR, Ma A, Regan S … +4 more , Sporn N, Gaeta J, Wurcel A, Baggett TP
AIDS Behav · 2026 May · PMID 42201478 · Publisher ↗
Methamphetamine use has increased substantially in the United States, particularly among people experiencing homelessness. While the association between methamphetamine use and HIV risk has been studied in other populati...
Methamphetamine use has increased substantially in the United States, particularly among people experiencing homelessness. While the association between methamphetamine use and HIV risk has been studied in other populations, its impact on HIV risk behaviors among people experiencing homelessness remains less well-studied. The objective of this study was to evaluate the relationship between methamphetamine use and HIV risk behaviors in a cohort of people experiencing homelessness who use drugs. We conducted a cross-sectional survey of adults with recent drug use recruited from three homeless-serving clinical sites in Boston, Massachusetts, between February 2024 and January 2025. The primary exposure was past 3-month methamphetamine use (any vs. none). The primary outcome was a composite measure of HIV risk behavior in the past 3 months, categorized as low (0 events), moderate (1-11 events), or high (≥ 12 events), based on self-reported condomless sex and shared needle events. Secondary outcomes included sex-related and injection-related HIV risk behaviors, examined separately. We used multinomial logistic regression to assess associations with overall and sex-related HIV risk behaviors, and bivariate analyses for injection-related HIV risk behavior due to sparse outcome data. Of 196 participants, the mean age was 48 years. 60% identified as cis-gender male, 56% as White, 31% as Black, and 20% as Hispanic. Methamphetamine use in the past 3 months was reported by 42% of participants. Its use was not independently associated with overall HIV risk behavior (aRR for high vs. low risk: 2.20; 95% CI: 0.84-5.77) or sex-related HIV risk behavior (aRR for high vs. low risk: 1.45; 95% CI: 0.53-4.00). However, in bivariate analyses, methamphetamine use was significantly associated with injection-related HIV risk behaviors: individuals who used methamphetamine were less likely to have low-risk behavior (27% vs. 79%) and more likely to have moderate-risk (43% vs. 8%) and high-risk (31% vs. 4%) behaviors (P < 0.001). Among homeless-experienced adults who use drugs, methamphetamine use was associated with higher-risk injection behaviors but not with sex-related HIV risk behaviors. HIV prevention strategies in this population should prioritize safer injection practices, evidence-based methamphetamine treatment, and equitable access to pre-exposure prophylaxis.
"It's Our Superpower": A Mixed-Methods Study to Understand Motivation and Capabilities for HIV Management Among African American/Black and Latine Emerging Adults Living With HIV.
Gwadz M, Cleland CM, Campos S … +7 more , Cluesman S, Munson MR, Wilton L, Downey D, Beharie N, Serrano S, Rosmarin-DeStefano C
AIDS Behav · 2026 May · PMID 42189459 · Publisher ↗
African American/Black and Latine (AABL) emerging adults living with HIV have insufficient engagement along the HIV care continuum, and lower rates than their White peers. Some subpopulations (e.g., those with unsuppress...
African American/Black and Latine (AABL) emerging adults living with HIV have insufficient engagement along the HIV care continuum, and lower rates than their White peers. Some subpopulations (e.g., those with unsuppressed HIV viral load, immigrants) and aspects of their experiences are understudied. This study uses a sequential explanatory mixed-methods design to explore motivational appraisals (e.g., core health goals), generative capabilities (e.g., self-efficacy, resilience), and their relationships to HIV management in a diverse cohort. Structured baseline assessments were conducted (N = 271). A subset of these was purposively sampled for maximum variability for qualitative interviews (N = 41). Quantitative data were analyzed with descriptive statistics and a structural equation model (SEM). Primary outcomes were HIV care engagement and viral suppression. Quantitative results informed qualitative research questions; qualitative data were analyzed with directed content analysis. We used the joint display method to integrate results. Participants were 25 years old (SD = 2), on average. The majority (59%) were Latine/Hispanic, 41% were African American/Black. Nearly all were assigned male sex at birth (96%) and sexual minorities (93%). Approximately half (49.1%) were immigrants. Almost a third (28%) were not well-engaged in care and 19% were not virally suppressed. Motivation, adherence self-efficacy, and medication outcome expectancies were high regardless of viral suppression. In the SEM, self-efficacy had a positive direct effect on motivation (B = 0.24, p < 0.01); and resilience (B = 0.02, p = 0.04) and self-efficacy (B = 0.23, p < 0.01) each had positive direct effects on outcome expectancies. Motivation (B = 0.26, p = 0.02) had a positive direct effect on care engagement. There were no statistically significant direct effects on viral suppression. In the qualitative results, participants focused on medication/viral suppression, but not HIV care. We organized qualitative results into four themes: (1) why participants took medication (e.g., desire for longevity, to be "normal" and attractive, and avoid transmitting HIV); (2) how they took medication (e.g., learning over time, creating routines and habits); (3) factors that interfered (e.g., structural barriers/disruptions could overwhelm motivation); and (4) issues salient to immigrants (e.g., moving to the US for better care, honoring family by taking medication). This study advances knowledge on HIV management among diverse AABL emerging adults living with HIV, and identifies intervention targets.
A Narrative Review of Remote Biospecimen Collection Product and Implementation Considerations for Sexual Health Clinical Research.
Horvath KJ, Rutstein SE, Coyle RP … +11 more , Jennings C, Miller RZ, Unternaher J, Bojan K, Aldrovandi GM, Amico KR, Anderson PL, Dowshen N, Hosek S, Hightow-Weidman L, Marzinke MA
AIDS Behav · 2026 May · PMID 42189458 · Publisher ↗
Remote biospecimen collection (RBSC), such as home-based HIV testing and self-collection of dried blood spots (DBS) to assess adherence to antiretroviral drug regimens, has become an important tool to support clinical re...
Remote biospecimen collection (RBSC), such as home-based HIV testing and self-collection of dried blood spots (DBS) to assess adherence to antiretroviral drug regimens, has become an important tool to support clinical research because it can facilitate participant reach, lower participant burden, and reduce discomfort with attending research visits in clinic spaces. RBSC is common in sexual health clinical intervention trials to assess the impact of an intervention or program on primary and secondary outcomes. However, the products and strategies employed to successfully implement RBSC can vary widely across studies. The purpose of this narrative review is twofold. First, to provide an overview of currently available RBSC products, their attributes, and their suitability for various clinical research applications. Considerations for blood-based and volumetric absorptive microsampling collection products, as well as self-administered sexually transmitted infection testing and other specimen types, are described. Second, RBSC implementation considerations at each stage of the collection process are discussed primarily from the perspective of the authors' collective expertise and experience with RBSC in HIV prevention and treatment clinical research. Successful RBSC product selection and implementation require a multidisciplinary team approach that is participant-centered to achieve high return rates, and ample time should be allotted to address the complexities of the procedures and processes. This review of RBSC product and implementation considerations offers an actionable framework and roadmap when considering incorporation of RBSC into clinical trials research. TRIAL REGISTRATION: N/A.
Post-transition Care Retention and Viral Suppression Outcomes Among Youth Living with HIV in South Carolina: A Real-World Data Research.
Zhang H, Xia H, Shi F … +5 more , Li X, Olatosi B, Weissman S, Widener R, Yang X
AIDS Behav · 2026 May · PMID 42185724 · Publisher ↗
Youth living with HIV (YLWH) face substantial challenges following transition from pediatric to adult HIV care, yet evidence on post-transition outcomes in the Southern United States remains limited. Using statewide HIV...
Youth living with HIV (YLWH) face substantial challenges following transition from pediatric to adult HIV care, yet evidence on post-transition outcomes in the Southern United States remains limited. Using statewide HIV surveillance and administrative data, we conducted a retrospective cohort study of 493 YLWH in South Carolina (SC) who transitioned to adult care between 2005 and 2021. Retention in adult care was defined as ≥ 2 viral load or CD4 tests at least 6 months apart within one year of the first adult visit, and viral suppression as a last recorded viral load < 200 copies/mL within one year. Multivariable logistic regression assessed individual- and county-level factors associated with retention in adult care and viral suppression, respectively. Overall, 52.7% of YLWH were retained in care and 49.1% achieved viral suppression one-year post-transition. Younger transition age and lower pre-transition CD4 count (≤ 200 cells/mm³) were associated with higher odds of retention in adult care, while higher pre-transition viral load (> 200 copies/mL), men who have sex with men/injecting drug use, heterosexual transmission, and higher socioeconomic vulnerability were associated with lower retention. For viral suppression, Black race, heterosexual transmission, and lower pre-transition CD4 counts were significantly associated with reduced odds of viral suppression. Post-transition outcomes among YLWH in SC remain suboptimal, highlighting the need for targeted, multilevel interventions addressing immunologic vulnerability and socioeconomic disadvantage in the Southern U.S.
HIV Disclosure and Prevention Advocacy Partially Mediate Advocacy Training Intervention Effect on Reduced Internalized HIV Stigma.
Wagner GJ, Bogart LM, Okoboi S … +5 more , Gwokyalya V, Green HD, Klein DJ, Ninsiima S, Matovu JKB
AIDS Behav · 2026 May · PMID 42176077 · Full text
Reduction of internalized HIV stigma is key to increasing HIV disclosure and engagement in peer advocacy for HIV prevention-and these latter processes may also be important for making further inroads into minimizing stig...
Reduction of internalized HIV stigma is key to increasing HIV disclosure and engagement in peer advocacy for HIV prevention-and these latter processes may also be important for making further inroads into minimizing stigma. We examined mediators of the effect of a peer advocacy training intervention, Game Changers for HIV Prevention (GC-HIV), on reduced internalized HIV stigma among persons living with HIV (PLWH) in Uganda. A randomized controlled trial was conducted with 210 PLWH (105 in each of the intervention and usual care control arms) who were assessed at baseline and months 6, 12 and 18. Internalized HIV stigma was measured with the 6-item Internalized AIDS-Related Stigma Scale. A repeated measures linear regression model found an intervention effect on reduced internalized HIV stigma. Path analysis performed for each mediator separately revealed that this stigma reduction effect was partially mediated with significant indirect effects for increased HIV disclosure [beta (SE) = - 0.05 (0.03); p = .046] and increased prevention advocacy [beta (SE) = - 0.12 (0.05); p = .01], as well as a significant direct effect; inclusion of both these mediators in the model did not alter this result. HIV knowledge did not act as a mediator of the intervention effect on stigma. Findings support not only the value of the intervention for reducing internalized stigma, but also the benefits of HIV disclosure and encouraging others to protect against HIV for stigma reduction and self-acceptance for PLWH. Clinicaltrials.gov registration (NCT05098015), 2021-10-18.
Uptake of HIV Self-testing Among Adolescents and Young Adults in Nigeria: A Secondary Observational Analysis of a Stepped-Wedge, Cluster-Randomized Trial.
Tahlil KM, Pettifor AE, Westreich D … +18 more , Edwards JK, Tang W, Gbajabiamila T, Xian H, Nwaozuru U, Day S, Shah SJ, Rosenberg NE, Oladele D, Musa AZ, Blessing LA, Ogunjemite P, Conserve DF, Ojo T, Ogedegbe G, Ezechi O, Iwelunmor J, Tucker JD
AIDS Behav · 2026 May · PMID 42176076 · Publisher ↗
Adolescents and young adults (AYA) in Nigeria with increased HIV risk, such as those who engage in multiple sexual partnerships (i.e., more than one sexual partner within a specified period), transactional sex (i.e., exc...
Adolescents and young adults (AYA) in Nigeria with increased HIV risk, such as those who engage in multiple sexual partnerships (i.e., more than one sexual partner within a specified period), transactional sex (i.e., exchange of money or gifts for sex), or needle-sharing (i.e., needles or other injection equipment are shared by multiple people), are eligible for pre-exposure prophylaxis (PrEP). One strategy that has the potential to reach PrEP-eligible AYA is HIV self-testing, which can expand existing HIV testing services and support differentiated PrEP programs. However, little is known about HIV self-testing in these AYA populations. We examined associations between these three high-risk behaviors and HIV self-testing. We analyzed data from Innovative Tools to Expand Youth-friendly HIV Self-Testing (I-TEST), a stepped-wedge trial examining the impact of a combination intervention package on HIV self-testing among AYA aged 14-24 years in Nigeria. We fit generalized linear models, with an identity link and a binomial error distribution, using generalized estimating equations. We generalized trial estimates to all AYA in Nigeria using a two-stage weighted approach. Of 1,429 participants, the median age was 20 years (IQR: 18-22), 50.3% were female, and 69.4% reported secondary school as their highest education level completed. AYA who engaged in transactional sex had higher HIV self-testing uptake (8.1% [4.8, 11.5]) than AYA with no history of transactional sex. There were no statistically significant differences in recent HIV self-testing uptake among AYA by sexual partnerships or needle-sharing history. The trial estimates were similar in the adjusted models. The estimates for the trial and generalized samples were in the same direction, except for AYA with two recent sexual partners. There was a high level of HIV self-testing uptake across all categories of sexual partnerships, transactional sex, and needle-sharing, with significantly higher uptake among those who engaged in transactional sex, indicating that HIV self-testing strategies are reaching these various AYA populations and the need to sustain access for these groups.
Doing Good Well in Unethical Times: A Call to Action for HIV Prevention Research.
Fisher CB, Brown B, Fletcher FE … +4 more , Gómez CA, Hubach RD, Rendina HJ, Sauceda JA
AIDS Behav · 2026 May · PMID 42176075 · Publisher ↗
Since the emergence of the AIDS epidemic, HIV research has been a mirror for humanity's moral choices that transformed biomedical and social science ethics. Four decades after the epidemic the field again faces an ethica...
Since the emergence of the AIDS epidemic, HIV research has been a mirror for humanity's moral choices that transformed biomedical and social science ethics. Four decades after the epidemic the field again faces an ethical reckoning. Once defined by its moral courage and community partnership, HIV research now operates amid political interference, data insecurity, funding contractions, and threats to academic freedom. Drawing on insights from the HIV and Drug Abuse Prevention Research Ethics Training Institute's 2025 Research Symposium, "Ethics, Equity, and the Next 15 Years of HIV Research," this commentary calls for a new era of HIV science grounded in solidarity, humility, and justice rather than procedural compliance. We argue that the moral frameworks forged through the history of HIV research-health justice, respect for personhood, and trustworthiness-are essential tools for survival and resistance in today's restrictive research climate. The paper highlights four ethical imperatives: (1) confronting the political nature of science and the erosion of trust in research institutions with the ethics of resistance; (2) ending a health disparities research cycle that risks perpetuating inequities rather than eliminating them; (3) developing an ethics of implementation science that sustains community benefits beyond the life of a grant; and (4) mentoring the next generation of HIV scientists in the moral frameworks necessary for conducting research with humility, reflexivity and courage. The essay concludes with concrete pathways for action in political and ethically challenging times outlining the commitments necessary to enact principled resistance with integrity.
HIV Stigma Reduction Interventions in People Living with HIV in the United States: A Systematic Review.
Shahdev C, Rajabiun S, Heavner K … +2 more , Wang Y, Cabral H
AIDS Behav · 2026 May · PMID 42176074 · Publisher ↗
HIV-related stigma remains a major barrier to improving health outcomes among people living with HIV (PLWH) in the United States, leading to reduced engagement in care, suboptimal adherence to antiretroviral therapy (ART...
HIV-related stigma remains a major barrier to improving health outcomes among people living with HIV (PLWH) in the United States, leading to reduced engagement in care, suboptimal adherence to antiretroviral therapy (ART), and diminished overall well-being. Stigma arises from misconceptions, societal rejection, and negative perceptions of HIV and manifests in multiple forms, including internalized, enacted, anticipated, and perceived stigma. Despite its well-documented impact, there is limited evidence on effective stigma reduction interventions in the U.S. This study conducted a systematic review to evaluate existing interventions and identify gaps in strategies to improve health outcomes for PLWH. Following PRISMA guidelines, four electronic databases (PsycINFO, MEDLINE, CINAHL Plus with Full Text, and Wiley Online Library) were searched for studies published between 2012 and 2025. Thirteen studies met inclusion criteria and were narratively synthesized. Interventions varied widely in design, including psychoeducation, peer support, mindfulness-based therapies, and multimedia tools, with durations ranging from one month to 12 months. Most studies focused on individual-level outcomes, particularly internalized stigma, and commonly measured outcomes included HIV-related stigma, ART adherence, and engagement in care. However, many studies had small sample sizes, lacked control groups, and had short follow-up periods. Only one study implemented a multi-site bundled intervention that included stigma reduction components. Notably, no studies addressed provider- or system-level stigma, and multilevel intervention approaches were absent. These findings highlight a critical gap in comprehensive stigma reduction strategies and underscore the need for future research targeting structural and provider-level stigma to improve health outcomes among PLWH.
Housing Instability as a Barrier to HIV Viral Suppression: Evidence from a U.S. Systematic Review and Meta-analysis.
O'Grady T, Eisenberg M, Weinberg S … +3 more , Kussainova A, Tesoriero J, Leung SJ
AIDS Behav · 2026 May · PMID 42168709 · Publisher ↗
Housing instability and homelessness remain pervasive structural determinants of poor HIV outcomes in the United States. People living with HIV (PLWH) who experience homelessness face intersecting barriers, including sti...
Housing instability and homelessness remain pervasive structural determinants of poor HIV outcomes in the United States. People living with HIV (PLWH) who experience homelessness face intersecting barriers, including stigma, behavioral comorbidities, and fragmented care systems, that undermine antiretroviral therapy adherence and viral suppression (VS). To quantify the impact of homelessness on viral suppression, we conducted a systematic review and meta-analysis of U.S.-based studies published from 2014 to 2024. Following PRISMA 2020 guidelines, PubMed, SCOPUS, and Web of Science were searched using controlled vocabulary and keywords related to HIV, viral suppression, and homelessness. Eligible studies included quantitative and/or qualitative analyses of PLWH reporting associations between housing instability or homelessness and VS outcomes. Study suitability was assessed using an adapted GRACE checklist, and random-effects meta-analysis was conducted in STATA v19 to pool adjusted odds ratios (aORs), with heterogeneity assessed via Q and I statistics. Of 603 identified studies, 43 met inclusion criteria and 21 contributed to the meta-analysis (total n = 46,291). Individuals experiencing homelessness had significantly lower odds of VS compared with housed counterparts (pooled OR = 0.38, 95% CI 0.33-0.45), with moderate to high heterogeneity (I = 74.2%) but consistent directionality across definitions of housing instability and analytic adjustments. No evidence of publication bias was detected (Egger's p = 0.125). Thematic synthesis identified five primary pathways linking homelessness to reduced VS: disrupted ART adherence and retention; psychosocial stressors such as stigma and depression; syndemic interactions with substance use and mental illness; stress-related immune dysregulation; and broader structural inequities including poverty, criminalization, and neighborhood disadvantage. Overall, findings demonstrate a robust and persistent association between homelessness and lower odds of HIV viral suppression, underscoring housing as a fundamental social determinant of health. Integrated, low-barrier housing interventions paired with behavioral health and case management services show the greatest promise for improving viral suppression and advancing equity. Addressing housing instability of any severity is essential to achieving the goals of the Ending the HIV Epidemic initiative and sustaining Undetectable = Untransmittable (U = U) outcomes.
County-Level New HIV Diagnoses, Social Determinants of Health, and Residential Segregation by U.S. Region 2013 to 2023: A Longitudinal Analysis.
Garrett C, Li Z, Xia H … +2 more , Li X, Qiao S
AIDS Behav · 2026 May · PMID 42165949 · Publisher ↗
Health disparities persist along the HIV care continuum. As new HIV diagnoses are a key indicator of the HIV epidemic, we aimed to assess associations of the social determinants of health (SDOH; non-medical factors that...
Health disparities persist along the HIV care continuum. As new HIV diagnoses are a key indicator of the HIV epidemic, we aimed to assess associations of the social determinants of health (SDOH; non-medical factors that are related to health outcomes) and residential segregation, as a proxy for systemic racism, with new HIV diagnosis rates across the major regions of the United States. Publicly available county-level data (i.e., 2013-2023) from an interactive visualization and mapping tool of the HIV epidemic (AIDSVu) and the American Community Survey (ACS) were merged using Federal Information Processing System (FIPS) codes and categorized into four U.S. regions. A Generalized Estimation Equation (GEE) model was run, within each region, to explore the associations between the SDOH, residential segregation, and new HIV diagnoses, over time. Overall, 3,051 counties (97.04%, n = 3,051/3,144) across the four major regions of the U.S. were included in the analysis (i.e., South = 1,398, North = 207, West = 408, Midwest = 1,038). By region, counties with a higher proportion of males aged 18-34 (South: IRR = 1.02, p < 0.001), males aged 35-54 (South: 1.06, West: 1.07, Midwest: 1.13, p < 0.001), Black populations (South: 1.38, North: 1.16, West: 2.78, p < 0.001; Midwest: 1.61, p < 0.01), and individuals experiencing poverty (West: 1.24, p < 0.01; Midwest: 1.78, p < 0.05), or without health insurance (South: 1.02, p < 0.001) were associated with higher rates of new HIV diagnoses. Dimensions of residential segregation (i.e., Gini Index, Delta Index, Spatial Proximity Index) were found to be, primarily, positively associated with new HIV diagnoses in all regions. Two interaction terms were found, Black x Delta (South: 0.91, p < 0.001; West: 0.89, North: 0.81, p < 0.05) and Poverty x Gini (Midwest: 0.62, p < 0.001). Overall, these findings demonstrate ongoing disparities in vulnerabilized populations and an increased likelihood of new HIV diagnoses within counties with higher residential segregation, leading to a call for structural interventions and policy that address systemic racism and subsequent, negative health outcomes.
Disparities in HIV Testing Among Spanish and English-Speaking Hispanic/Latino Men who have Sex with Men and Social Media Use.
De Haro CM, Cumberland WG, Young SD
AIDS Behav · 2026 Jun · PMID 42159984 · Publisher ↗
In 2022, Hispanic/Latino men accounted for 26% of all HIV infections in the US (CDC, 2024). Social media can facilitate behaviors associated with HIV exposure, such as sexual encounters. Therefore, understanding the use...
In 2022, Hispanic/Latino men accounted for 26% of all HIV infections in the US (CDC, 2024). Social media can facilitate behaviors associated with HIV exposure, such as sexual encounters. Therefore, understanding the use of social media is relevant to improving the reach of public health strategies that aim to increase HIV testing among Hispanic/Latino Men. This study analyzes data from 668 Hispanic/Latino Men who have Sex with Men (MSM) participants residing in Los Angeles County who responded to a six-wave survey conducted between February 2017 and January 2022. This study collected information at baseline and 3, 6, and 12-month follow-ups about the participants' sociodemographic information, internet, and social media use, sexual health, and HIV risk behaviors. We ran a logistic regression to explore the relationship between HIV testing and the interaction between being a native Spanish speaker and the use of social media. Participants who used social media for sexual encounters and were native Spanish speakers were less likely to have been tested for HIV in the previous six months compared to those who were not native Spanish speakers (interaction OR = 0.387; p < 0.01; 95% CI: (0.190, 0.787)). Our findings show that participants who used social media for sexual encounters were also more likely to engage in HIV risk behaviors. Therefore, our results highlight disparities in HIV testing among Hispanic/Latino communities and the need to target native Spanish speakers in HIV prevention and outreach strategies. These strategies should also consider internet and social media use and their relationship with HIV risk behaviors.
Beyond the Diagnosis: Exploring Illness Identity in HIV and Its Impact on Health Outcomes.
Sematlane N, Knight L, Campbell L … +2 more , Masquillier C, Wouters E
AIDS Behav · 2026 May · PMID 42159983 · Publisher ↗
This study utilizes the illness identity framework to investigate the incorporation of HIV into a sense of self and how varying degrees of integration influence key patient-reported outcomes. Using baseline data from the...
This study utilizes the illness identity framework to investigate the incorporation of HIV into a sense of self and how varying degrees of integration influence key patient-reported outcomes. Using baseline data from the SINAKO Cluster Randomised Controlled Trial, we analysed responses from 316 adults living with HIV (PLHIV) attending 12 healthcare facilities in the Cape metropole, South Africa. Respondents completed assessments on four illness identity dimensions (rejection, acceptance, engulfment, and enrichment) alongside measures for depression and anxiety symptoms, stigma, medication adherence, and self-management. Regression analyses with robust standard errors assessed associations between illness identity and patient-reported outcomes, controlling for gender, age, and illness duration. Longer illness duration was associated with acceptance and enrichment. There was no evidence of an association between gender or education level and illness identity, while age showed a weak positive association with acceptance. Higher engulfment scores correlated with greater depression and anxiety symptoms, increased stigma, and poorer treatment adherence and self-management. Higher enrichment scores were associated with better self-management and lower stigma. Higher rejection scores were associated with heightened negative self-image. Acceptance did not show unique associations with any outcome. This study highlights the vital role of illness integration in shaping health outcomes among PLHIV in resource-limited, high-prevalence settings. Strategies that rapidly identify those in an engulfment state early in the illness trajectory and foster adaptive illness integration, specifically enrichment, could improve outcomes for PLHIV.
Correction: Predictors of Past-Year Formal and Informal Mental Health Services Utilization Among Young Black Sexually Minoritized Men Living with HIV in Atlanta, GA.
Alohan DI, Wade RM, Harper GW … +3 more , Newman A, Doraivelu K, Hussen SA
AIDS Behav · 2026 May · PMID 42151705 · Publisher ↗
Abstract loading — click title to view on PubMed.
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