AIDS And Behavior[JOURNAL]
Sun
200 papers
The Relationship Between Financial Well-Being and Antiretroviral Therapy Adherence in Youth with HIV in the United States.
Stoner MCD, Shrestha I, Neilands TB … +5 more , Ming K, Smith L, Balaban C, Johnson MO, Saberi P
AIDS Behav · 2026 Apr · PMID 42045638 · Full text
Youth and young adults experience high attrition across the HIV care continuum, including elevated risk of antiretroviral therapy (ART) nonadherence and virologic failure. This study examined how financial well-being rel...
Youth and young adults experience high attrition across the HIV care continuum, including elevated risk of antiretroviral therapy (ART) nonadherence and virologic failure. This study examined how financial well-being relates to ART adherence among youth with HIV (YWH), including those using oral or LAI-based regimens. We analyzed baseline data from YWH aged 18-29 years in the United States enrolled between 2023 and 2025 in a randomized controlled trial addressing HIV care barriers, mental health, and substance use. Oral ART adherence was measured using a validated scale, with high adherence defined as a score ≥ 80%. For participants on LAI-ART, high adherence was defined as having no missed or delayed injection visits. We assessed the associations between financial well-being (i.e., unmet subsistence needs, overall financial situation, and mobile technology vulnerability) and adherence using descriptive statistics and adjusted prevalence ratios (PRs) estimated with log-Poisson models with robust standard errors. Among 201 participants, the median age was 27 years. Most (89.1%, n = 179) used oral ART, while 10.0% (n = 20) received LAI-ART. High adherence was achieved by 69.8% of oral ART users and 90% of LAI-ART users. Participants who reported they could "barely get by" financially had significantly lower adherence compared to those living comfortably (RR 0.70, 95% CI 0.52-0.95). Greater unmet subsistence needs were also associated with reduced adherence (RR 0.85, 95% CI 0.73-0.99). Financial well-being was linked to adherence among YWH using both oral and LAI-ART. Efforts to reduce financial hardship may support improved HIV treatment outcomes.
Cost Considerations for Rapid Start Implementation: Analysis from Seven Rapid Start Provider Sites.
Murnane PM, Shade SB, Damle M … +6 more , Donohoe T, Middleton D, Friedman S, Jimenez T, Brooks K, Senter L
AIDS Behav · 2026 Apr · PMID 42045637 · Publisher ↗
Antiretroviral treatment (ART) initiation within days of HIV diagnosis, also known as "Rapid Start", improves linkage to care, virologic suppression and retention in care. However, data on the costs of Rapid Start implem...
Antiretroviral treatment (ART) initiation within days of HIV diagnosis, also known as "Rapid Start", improves linkage to care, virologic suppression and retention in care. However, data on the costs of Rapid Start implementation in the United States are limited. We aimed to estimate the costs and cost-effectiveness of Rapid Start among seven geographically diverse Ryan White-funded programs with broad variability in populations served and services offered. Each site estimated the costs of ART initiation services, management, and Rapid Start planning activities in three 12-month periods: pre-, initial, and sustained implementation. We estimated quality-adjusted life years (QALY) saved, incremental costs per-person and incremental cost per QALY saved during implementation. We considered an intervention cost-effective if it cost <$76,399 USD per QALY saved (US per capita GDP, 2021). The number of persons initiating ART increased at most sites during implementation, which, together with assumed shorter times to viral suppression contributed to QALYs saved. Pre-implementation, the per-person cost of ART initiation and Rapid Start planning ranged from $549-$30,626, which declined at most sites during implementation. Incremental costs per-person ranged from a cost savings of -$21,284 up to $23,850 additional costs during the initial year and from $24,303 savings up to $11,774 additional costs during sustained implementation. The cost-effectiveness threshold was met by five sites during initial implementation and by all seven during sustained implementation. In conclusion, we demonstrated that Rapid Start was cost effective across a wide range of clinical settings, further bolstering this model's importance in ending the HIV epidemic.
Assessing an Implementation Science Strategy to Improve PrEP Primary Care Serving Black and Latino Communities.
Gomez BN, Beacham AR, Datta D … +5 more , Andrade E, Starbuck L, Beil R, Golub SA, Patel VV
AIDS Behav · 2026 Apr · PMID 42033626 · Publisher ↗
We examined the impact of a PrEP navigation implementation strategy on care engagement at nine New York City Federally Qualified Health Centers (FQHCs) in an Ending the HIV Epidemic (EHE) jurisdiction. Between March 2021...
We examined the impact of a PrEP navigation implementation strategy on care engagement at nine New York City Federally Qualified Health Centers (FQHCs) in an Ending the HIV Epidemic (EHE) jurisdiction. Between March 2021 and April 2022, FQHCs implemented the strategy, which consisted of five distinct navigation activities conducted by the Navigator (e.g., PrEP refill). We extracted electronic medical record (EMR) data on navigation services attempted/delivered, HIV prevention service delivery (e.g., HIV testing), and demographic characteristics for 303 patients prescribed PrEP and identified as eligible for navigation (27.4% Black, 48.8% Latino). We analyzed differences in HIV prevention service delivery by navigation success. Out of 303 patients, 95 (31.4%) were reached for navigation and 208 (68.6%) were not. Patients who were successfully navigated had significantly greater care engagement during the study period. In addition, patients who were successfully navigated were more likely to have had timely care engagement. There were no differences in navigation success by characteristics examined (e.g., sex in EMR, race/ethnicity, insurance coverage). The navigation service most utilized was medical appointment assistance (77.9%). Navigation appeared effective in enhancing PrEP care engagement. Although additional strategies may be needed to reach patients not successfully navigated through this implementation strategy, our work may inform researchers, policymakers, and practitioners focused on enhancing PrEP care about evaluating implementation strategies.
HIV Concealment and Victimization Among Adolescents with HIV (AWH): The Moderating Role of Emotional Social Support.
Gill A, Bhome A, Seal D … +5 more , Kissinger P, Borse R, Pardeshi M, Suryavanshi N, Theall KP
AIDS Behav · 2026 Apr · PMID 42029825 · Publisher ↗
Adolescents with HIV (AWH) often conceal HIV due to stigma and fear of rejection. Stress-buffering and social embeddedness theory suggest that HIV concealment can increase victimization due to a decline in emotional soci...
Adolescents with HIV (AWH) often conceal HIV due to stigma and fear of rejection. Stress-buffering and social embeddedness theory suggest that HIV concealment can increase victimization due to a decline in emotional social support (ESS). Understanding the moderating role of ESS between HIV concealment and victimization may help inform interventions to reduce victimization among AWH. A cross-sectional survey including egocentric social network data was conducted among 129 AWH (10–19 Years) at a tertiary care centre in Pune, India between September 2021 and December 2023. The association between HIV concealment and victimization was examined by using a Generalized Linear Model for Negative Binomial (GLMNB) and incidence rate ratios (IRR) were calculated. Moderation was assessed by introducing ESS as a two-way interaction term in the subsequent models between HIV concealment and victimization. A one standard deviation increase in proportion of network members from whom HIV was concealed was associated with a 17% decline in exposure to verbal abuse (IRR = 0.83, 95% CI: 0.66–1.03, p-value = 0.09). A one standard deviation increase in ESS was associated with a 36% decline in physical abuse (IRR = 0.64, 95% CI: 0.44–0.92, p-value = 0.02) and a 22% decline in bullying victimization (IRR = 0.78, 95% CI: 0.63–0.96, p-value = 0.02). ESS moderated the relationship between HIV concealment and victimization, such that high ESS was protective for verbal abuse and low ESS was protective for bullying victimization. Findings highlight the importance of strengthening ESS while addressing stigma to reduce victimization among AWH.
Delay, Doubt and Dollars: Exploring Delay and Probability Discounting of Free and Paid HIV Vaccines among Sexual and Gender Minorities.
Tewogbola P, Bodunde VO, Adekunle OF … +8 more , Odaudu DO, Tewogbola O, Ofuokwu-Oduniyi J, Lee YT, Redner RN, McDaniel JT, Asirvatham J, Jacobs EA
AIDS Behav · 2026 Apr · PMID 42018108 · Publisher ↗
This study investigated how delays and uncertainties shape the perceived value of hypothetical HIV vaccines under different cost conditions among sexual and gender minorities (SGMs). In Experiment 1 (N = 260), participan...
This study investigated how delays and uncertainties shape the perceived value of hypothetical HIV vaccines under different cost conditions among sexual and gender minorities (SGMs). In Experiment 1 (N = 260), participants chose between a 60% effective vaccine available immediately and a 99% effective vaccine with varying delays. Experiment 2 (N = 246) assessed choices between a 55% effective vaccine with certain availability and a 95% effective vaccine with uncertain availability. Participants were randomly assigned to free or $150 fee conditions. Hyperbolic discounting models effectively described delay (R² = 0.96-0.99) and probability discounting (R² = 0.95-0.99). Vaccine cost did not significantly affect discounting, while age and STI testing history did, with effects varying by delay versus probability context. Gay or bisexual identity, health insurance status, and political orientation additionally predicted probability discounting. The findings demonstrate the utility of behavioral economic models for quantifying HIV vaccine valuation prior to market availability.
Multilevel Factors Influencing Linkage to HIV Care in a High HIV Prevalence District in South Africa: A Mixed Methods Approach.
Nicol E, Basera W, Mathole T … +4 more , Turawa E, Hlongwa M, Lombard C, Bradshaw D
AIDS Behav · 2026 Apr · PMID 42012632 · Publisher ↗
Timely linkage to HIV care is essential for achieving South Africa's treatment goals, yet significant gaps persist in the early stages of the HIV care continuum. This study examined multilevel factors influencing linkage...
Timely linkage to HIV care is essential for achieving South Africa's treatment goals, yet significant gaps persist in the early stages of the HIV care continuum. This study examined multilevel factors influencing linkage to care in a high HIV-prevalence rural district. A prospective convergent mixed-methods cohort study was conducted over 21 months among 1,194 adults newly diagnosed with HIV across 18 facilities in KwaZulu-Natal. Quantitative analyses (Pearson's chi-square, Mann-Whitney tests, and logistic regression) were used to identify factors associated with linkage to care within three months of diagnosis. Qualitative data from in-depth interviews with 38 purposively selected participants were analysed thematically and triangulated with quantitative findings to provide contextual insights. Overall, 83% of participants linked to care within three months. Linkage was significantly higher among those diagnosed at hospitals (OR = 4.90; 95% CI: 1.87-12.82; p = 0.003), while diagnosis at mobile clinics showed borderline significance. Among women, later sexual debut (≥ 17 years) was associated with increased likelihood of timely linkage. In contrast, condom use at last sex (OR = 0.50; 95% CI: 0.32-0.79; p = 0.03) and substance use (OR = 0.67; 95% CI: 0.47-0.96; p = 0.05) were associated with lower linkage. Qualitative findings highlighted supportive family environments and positive provider interactions as key facilitators of linkage, while stigma, fear of disclosure, confidentiality concerns, preference for traditional or spiritual healing, and health system challenges, including lost clinic files and poor counselling, emerged as significant barriers. These findings underscore the need for patient-centred, stigma-free, and responsive health systems to improve timely linkage to HIV care in high-burden settings.
Under the Influence: Alcohol, Substance Use and Treatment Adherence in Youth Living with HIV in the Global Adolescent and Young Adult Network of IeDEA (AYANI) Cohort.
van Dongen N, Technau KG, Jaguga F … +25 more , Murenzi G, Machado DM, Amorissani-Folquet M, Ditango R, Mureithi F, McCoy B, Brazier E, Luque MT, Jesson J, Phuthanakit T, Maxwell N, Vreeman R, Elul B, Pinto JA, Oka G, Sudjaritruk T, Kanguya T, Enane L, Ryumugabe D, Hilaire G, Leroy V, Sohn AH, Brehm A, Anderson K, IeDEA
AIDS Behav · 2026 Apr · PMID 42012631 · Publisher ↗
Alcohol and substance use in youth living with HIV (YLHIV) can influence health and treatment outcomes. We assessed substance use and associations with antiretroviral therapy (ART) adherence among YLHIV. The Adolescent a...
Alcohol and substance use in youth living with HIV (YLHIV) can influence health and treatment outcomes. We assessed substance use and associations with antiretroviral therapy (ART) adherence among YLHIV. The Adolescent and Young Adult Network of IeDEA enrolled YLHIV (15–24 years old) receiving ART (2021–2024) from 6 global regions. We assessed biopsychosocial experiences with validated tools; adherence with self-reported missed medication doses and unsuppressed viral load (VL > 1,000 copies/ml); and substance use by point-of-care urine tests and Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) tool. Among 694 YLHIV, 53% female, median enrolment 20 years old (IQR 18–22), 83% had perinatally-acquired HIV, and 71% received Integrase Inhibitor-based ART. Half (49%) reported missing medication doses and 14% had unsuppressed VL. Any prior alcohol use (47%) was more common than other substances, where cannabis (12%) and sedatives/benzodiazepines (3.9%) contributed. Recent moderate/high-risk alcohol and other substance use were reported by 9.1% of YLHIV. YLHIV with positive urine tests had not reported recent use of alcohol (n = 17/46; 37%), cannabis (n = 12/32; 38%) and benzodiazepines (n = 13/13, 100%). Moderate/high-risk alcohol and other substance use were associated with self-reported adherence difficulties (adjusted odds ratio(aOR) 2.37, 95% CI 1.28–4.38; and aOR 2.13, 95% CI 1.18–3.85) but not unsuppressed VL (aOR 0.80, 95% CI 0.34–1.88; and aOR 1.61, 95% CI 0.79–3.29). Moderate/high-risk alcohol and/or substance use was reported by 15% of YLHIV and was associated with self-reported adherence difficulties. Discrepancies between point-of-care tests and self-reported use suggest alcohol/substance use is underestimated. Enhanced screening and interventions targeting substance use are recommended.
HIV Risk Behaviors Among Community-Recruited Older People Who Inject Drugs (PWID) Prescreening for HPTN 094 in Washington, DC.
Bornstein S, Yellin H, Altman B … +4 more , Balachandran M, Siegel M, Magnus M, Kuo I
AIDS Behav · 2026 Apr · PMID 41999481 · Publisher ↗
Older people who inject drugs (PWID) remain at risk for HIV, yet little is known about HIV risk behavior in this population. We investigated the prevalence and correlates of HIV risk behaviors among older PWID in Washing...
Older people who inject drugs (PWID) remain at risk for HIV, yet little is known about HIV risk behavior in this population. We investigated the prevalence and correlates of HIV risk behaviors among older PWID in Washington, DC. We conducted a cross-sectional analysis of self-reported survey data collected between June 2022 and June 2023 from adults recruited through community-based outreach at known drug use hotspots. Respondents who reported injection drug use in the past three months and were aged > 50 were included. We used simple and multivariable logistic regression to determine correlates of HIV risk behaviors in the last three months. Among 260 older PWID, 42% reported at least one HIV risk behavior in the past three months. Benzodiazepine injection was associated with condomless sex (OR = 5.61, 95% CI 1.36-23.06). Reporting an overdose in the last three months (aOR = 3.18, 95% CI 1.08-9.36) and other opioid injection (aOR = 4.61, 95% CI 1.04-20.40) were associated with sharing syringes/needles. Experiencing homelessness (aOR = 2.20, 95% CI 1.17-4.13), reporting an overdose (aOR = 2.57, 95% CI 1.18-5.61), and benzodiazepine injection (aOR = 6.72, 95% CI 1.49-30.24) were associated with sharing other injection equipment. Our findings suggest that older PWID in Washington, DC engage in HIV risk behaviors, particularly those experiencing homelessness, recent overdose, and injecting certain substances. Age-specific substance use treatment and HIV prevention programs are needed to address HIV risk in this population.
The Association Between HIV and Substance Use Stigma and Attitudes and Utilization of HIV Care Among Adults Who Use Injection Drugs: A Systematic Review.
Twitty TD, Brown JL
AIDS Behav · 2026 Apr · PMID 41995928 · Publisher ↗
HIV is a pressing global public health problem, with marked disparities among adults who engage in injection drug use (IDU). Despite the development and implementation of highly effective HIV prevention and treatment opt...
HIV is a pressing global public health problem, with marked disparities among adults who engage in injection drug use (IDU). Despite the development and implementation of highly effective HIV prevention and treatment options, utilization and adherence are still low among those at increased risk, such as those who inject drugs. Stigma may be a significant barrier to accessing care across the HIV prevention and treatment care continuums and may be associated with poorer health outcomes. Those who engage in IDU are likely to experience stigma related to both HIV and substance use, furthering disparities among this group. A systematic literature review was conducted to examine how experiencing HIV and/or substance use stigma was associated with attitudes towards and use of HIV continuum of care outcomes and healthcare more broadly among adults who report IDU. A systematic review utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines yielded 11 studies deemed appropriate for the current study. Experiences of stigma were examined across treatment targets (e.g., HIV prevention, ART initiation). All but two studies found that experiencing stigma was associated with poorer attitudes towards and utilization of HIV prevention and treatment. More specifically, substance use stigma was negatively associated with most HIV care continuum outcomes. A critique of the literature and directions for future research are discussed. For example, there is a need for greater consistency in stigma measurement, integrating cross-cultural and longitudinal approaches to further understand the association with the HIV care continuum among this at-risk population.
Trusted Spaces, New Services: Family Planning Centers and PrEP Acceptability Among Women Who Have Migrated from Sub-Saharan Africa in France.
Ramírez Zamudio A, Manda V, Mason JA … +8 more , Castaneda J, Guilleminot J, Abdou F, Devlin SA, Friedman E, Ridgway JP, Johnson AK, Liegeon G
AIDS Behav · 2026 Apr · PMID 41995927 · Publisher ↗
Women who have migrated from Sub-Saharan Africa (WMSSA) account for a disproportionate share of new HIV diagnoses in France yet remain underserved by prevention strategies, including pre-exposure prophylaxis (PrEP). We c...
Women who have migrated from Sub-Saharan Africa (WMSSA) account for a disproportionate share of new HIV diagnoses in France yet remain underserved by prevention strategies, including pre-exposure prophylaxis (PrEP). We conducted a cross-sectional survey of 151 HIV-negative WMSSA attending two family planning centers (FPCs) in Greater Paris (2023-2024) to assess knowledge, attitudes, and perspectives regarding PrEP delivery. PrEP eligibility was determined using clinical criteria, and logistic regression identified factors associated with willingness to use PrEP. PrEP awareness was low (11.3%), yet 62.2% reported willingness to initiate PrEP after receiving information, and 51.0% met eligibility criteria. Most participants (80.1%) identified FPCs as their preferred location for PrEP services. Willingness to initiate PrEP was higher among women meeting eligibility criteria (aOR = 2.37, 95%CI [1.13-4.96]) and decreased with longer time living in France (aOR = 0.91/year, 95%CI [0.83-0.99]). Integrating PrEP into FPCs could be a key strategy to reduce HIV disparities in this population.
HIV and Other Sexually Transmitted Infections Among Men and Transgender/Gender Expansive Individuals Who Have Sex with Men in Kazakhstan: Associations with HIV Stigma, Internalized Homophobia, and Community Connectedness.
Yang X, Paine EA, Davis A … +8 more , Lee YG, Vinogradov V, Zhakupova G, Mergenova G, Hunt T, Primbetova S, Terlikbayeva A, Wu E
AIDS Behav · 2026 Apr · PMID 41995926 · Publisher ↗
Since 2010, Kazakhstan has experienced an increase in HIV transmission. Men and transgender/gender-expansive people who have sex with men (MSM and TSM) carry a disproportionate HIV burden. Building on Paine et al. (2021)...
Since 2010, Kazakhstan has experienced an increase in HIV transmission. Men and transgender/gender-expansive people who have sex with men (MSM and TSM) carry a disproportionate HIV burden. Building on Paine et al. (2021), which linked HIV testing to stigma, internalized homophobia, and sexual- and gender-expansive (SGE) community connectedness-this brief report examined biologically confirmed HIV and other sexually transmitted infections (STIs). SGE connectedness was significantly associated with HIV infection, while HIV stigma and internalized homophobia were significantly associated with STIs. Interventions reducing stigma and strengthening SGE community ties may curb HIV and STI transmission among MSM and TSM in Kazakhstan.
Written on the Skin: Participants' Perspectives on Scarring, Discolouration and Implant Site Reactions Experienced During a Phase I Clinical Trial for a Subdermal HIV Prevention Implant in KwaZulu-Natal, South Africa.
Durden E, Govender E, Dlokweni A … +7 more , Ngubane N, Myeni N, Harkoo I, Mansoor LE, Abdool Karim Q, Abdool Karim SS, Gengiah TN
AIDS Behav · 2026 Apr · PMID 41995925 · Publisher ↗
To address challenges associated with the uptake of daily oral pre-exposure prophylaxis (PrEP) by young women at high risk of acquiring HIV, a range of novel, long-acting, slow-release products are being developed and cl...
To address challenges associated with the uptake of daily oral pre-exposure prophylaxis (PrEP) by young women at high risk of acquiring HIV, a range of novel, long-acting, slow-release products are being developed and clinically evaluated. One such technology is an annual implant of tenofovir alafenamide (TAF). This study explores the perspectives of participants from a first-in-human trial of an annual TAF implant to inform considerations for future PrEP implant innovation. The study, conducted in Durban, South Africa between 2022 and 2023, included 29 in-depth interviews (IDIs) and three focus group discussions (FGDs) with 18 participants. All participants experienced some form of implant site reaction (ISR). In some instances, these were minor, and in others, the implant removal process left longer-lasting and more severe skin changes. Participants' perceptions of these ISRs were influenced by concerns about their appearance, social stigma, and associations between scars and gender-based violence. Mild skin changes were deemed acceptable, while severe scarring and discolouration caused concerns about attracting negative attention. Few participants expressed concerns about their own scars, however, visible scars which might be mistaken for a contraceptive implant caused concern. Despite the ISRs experienced, there was positive feedback for this type of technology, and many considered that other women would be interested in adopting a sub-dermal implant should it be effective in preventing HIV. Continued enhancements of next generation implants to enhance drug release rates should consider how to minimise the severity and visibility of ISRs.
A Systematic Review and Meta-analysis on the Association Between Antiretroviral Therapy Refill Type and Viral Suppression.
Badru OA, Edeh JC, Okezie CW … +1 more , Adeagbo OA
AIDS Behav · 2026 Apr · PMID 41995924 · Publisher ↗
To reduce barriers to viral suppression, people living with HIV (PLWH) are placed on multi-month dispensing (MMD) of antiretroviral therapy medication. However, there are concerns about viral rebound following MMD initia...
To reduce barriers to viral suppression, people living with HIV (PLWH) are placed on multi-month dispensing (MMD) of antiretroviral therapy medication. However, there are concerns about viral rebound following MMD initiation, and no existing review has compared viral suppression in PLWH on MMD with that in those on monthly refills [standard of care (SoC)]. This meta-analysis compared viral suppression of PLWH on MMD to those on SoC. In February 2025, we searched Embase, PubMed, Scopus, and Web of Science for articles (PROSPERO ID: CRD420251006737). Meta-analysis was performed using RStudio. 1078 articles were retrieved from the databases; 25 met our eligibility criteria (21 met meta-analysis criteria). Compared to PLWH on SoC, viral suppression was better among PLWH on 3MMD or more [risk ratio (RR): 1.17, 1.06–1.30] and 6MMD (RR: 1.24, 1.15–1.34). However, for both 3MMD and 6MMD, the effect sizes were smaller in RCTs than in observational studies. Furthermore, PLWH on 6MMD were less likely to be virally suppressed than those on 3MMD (RR: 0.76, 0.67–0.85). Lastly, compared with SoC, 3MMD or more was significantly associated with viral suppression if defined as < 1000 copies/mL (RR: 1.15, 1.10–1.21), but viral suppression was similar with a stricter cut-off of 50–500 copies/mL (RR: 1.15, 0.93–1.42). Conclusively, PLWH on MMD had lower viral loads than those on SoC, but those on 3MMD were more virally suppressed than those on 6MMD. The advantage MMD has over SoC is insufficient to conclude its superiority. Therefore, MMD implementation should be carefully considered to meet clinic and PLWH’s needs.
Alcohol Use and the Care Continuum for HIV Preexposure Prophylaxis: An Updated Scoping Review of Research and Interventions.
Yokananth R, Zalmai R, Okoye G … +1 more , Avanceña ALV
AIDS Behav · 2026 Apr · PMID 41995923 · Publisher ↗
HIV preexposure prophylaxis (PrEP) effectiveness depends on engagement across the PrEP care continuum. Alcohol use may influence these steps, but findings remain inconsistent. This scoping review examined studies publish...
HIV preexposure prophylaxis (PrEP) effectiveness depends on engagement across the PrEP care continuum. Alcohol use may influence these steps, but findings remain inconsistent. This scoping review examined studies published since March 2020 that evaluated the association between alcohol use and PrEP outcomes and identified interventions targeting PrEP users who consume alcohol. We searched two databases, conducted citation tracking, and extracted data from studies measuring the association between alcohol use and ≥ 1 step in the PrEP care continuum. We also included intervention studies targeting alcohol use among PrEP users. Findings were combined with four previous reviews to generate an updated evidence map. We identified 55 studies, including 42 quantitative studies reporting 57 associations. Most were cross-sectional, conducted in North America, and focused on men who have sex with men. Adherence was the most frequently examined outcome, followed by uptake, continuation, willingness, and awareness. Associations between alcohol use and PrEP outcomes were mixed. Six intervention studies were identified, but none demonstrated significant improvements in PrEP outcomes. The updated evidence map includes 85 quantitative studies reporting 106 associations between alcohol use and the PrEP outcomes. The association between alcohol use and the PrEP care continuum remains mixed and likely dependent on the measure or intensity of alcohol use, context, and population characteristics. Overall, this evidence suggests the need for more effective interventions and a meta-analysis to better define alcohol's role in PrEP outcomes.
Designing Pleasure-Centered, Culturally Relevant PrEP Messaging for Black Gay, Bisexual, Queer, Same-Gender-Loving, and Other Men Who have Sex with Men (SGL/MSM) in New York City.
Bond KT, Williams PM, Paige M … +9 more , Lam I, Hart K, Matthews D, Smith W, Koffler E, Zhang H, Kelvin EA, Frye V, Duncan DT
AIDS Behav · 2026 Apr · PMID 41995922 · Publisher ↗
Culturally tailored, community-informed media can enhance pre-exposure prophylaxis (PrEP) awareness and acceptance among Black gay, bisexual, queer, same-gender-loving, and other men who have sex with men (Black SGL/MSM)...
Culturally tailored, community-informed media can enhance pre-exposure prophylaxis (PrEP) awareness and acceptance among Black gay, bisexual, queer, same-gender-loving, and other men who have sex with men (Black SGL/MSM). To inform the development of a health campaign to increase PrEP utilization, we conducted four focus groups with Black SGL/MSM (N = 20) between February and June 2023. Discussions explored participants' perceptions of and engagement with HIV prevention messaging, with particular attention to strategies for redesigning campaigns to reduce PrEP-related stigma. Participants articulated preferences that clustered within three interrelated domains of effective PrEP messaging: content, delivery, and context. Within the content domain, participants emphasized the need for practical, actionable information (e.g., dosing options, visual demonstrations, and adherence support), alongside sex-positive and empowering narratives that reframed HIV prevention around pleasure, intimacy, and self-care rather than fear. Participants also called for destigmatization and normalization of PrEP by positioning it as a responsible, routine component of sexual wellness. Within the delivery domain, participants favored social media-driven formats, particularly strategies leveraging influencers, humor, and storytelling to enhance engagement and relatability. Within the context domain, participants prioritized authentic representation of Black queer communities through inclusive imagery, culturally resonant cues, and rejection of stereotypes, while also acknowledging structural and logistical realities such as competing priorities, privacy concerns, and the need for discreet, accessible messaging. PrEP messaging must move beyond traditional public health narratives by pairing clear "how-to" guidance with culturally concordant, sex-positive, and stigma-reducing strategies to improve PrEP relevance, awareness, and uptake.Trial registry NCT06785376.
HIV Self-Test Program Preferences Among Non-Hispanic Black and Hispanic Men Who Have Sex with Men in the Southern United States: A Discrete Choice Experiment.
Guigayoma J, Ong JJ, Kanamori M … +5 more , Hickson D, Ward L, Becker SJ, Biello K, Wray T
AIDS Behav · 2026 Apr · PMID 41995921 · Publisher ↗
Non-Hispanic Black and Hispanic men who have sex with men (BHMSM) in the Southern United States (US) have the highest rates of new HIV diagnoses in the country. Self-testing can increase detection and contribute to decre...
Non-Hispanic Black and Hispanic men who have sex with men (BHMSM) in the Southern United States (US) have the highest rates of new HIV diagnoses in the country. Self-testing can increase detection and contribute to decreasing diagnoses, but it is unclear which self-test program characteristics encourage the highest engagement. To inform the design of self-test programs, we conducted an online discrete choice experiment with BHMSM in this region who did not have an HIV diagnosis (n = 290) to understand their preferences for the following self-test program attributes: delivery strategy (home delivery, friend delivery, clinic pickup), support (instructions only, during the test, 1 week after delivery), delivery speed (same day, next day, 3 days, 5 days), and price ($0, $20, $40, $50, $60). We analyzed choice data using random parameters to estimate preferences and marginal willingness to pay. BHMSM preferred free (b = 2.67) self-tests, home delivery (b = 0.60), and same-day (b = 0.24) or next-day (b = 0.35) delivery and had a preference against support 1 week after delivery (b=-0.19). Marginal willingness to pay estimates showed that BHMSM would pay $6.71 more for home delivery compared to clinic pickup and $9.10 more for same-day delivery and $10.96 more for next-day delivery compared to 5-day delivery. Based on these results, a self-test program with free rapid home delivery and support via instructions only or during the test would best address the preferences of BHMSM in the Southern US. Patients may also be willing to pay for rapid home delivery, highlighting the possibility of cost-sharing models for self-test programs.
Alignment Between HIV Vulnerability and Pre-exposure Prophylaxis Use in a Longitudinal Study of Young, Black Men Who Have Sex with Men.
Guo Z, Whitfield D, Edwards OW … +4 more , Bohl C, Caldwell JA, Sullivan PS, Jones J
AIDS Behav · 2026 Apr · PMID 41995920 · Publisher ↗
When taken as a daily pill, pre-exposure prophylaxis (PrEP) requires sufficient levels of adherence to confer strong protection against HIV. For protection against HIV transmission via anal sex, this corresponds to at le...
When taken as a daily pill, pre-exposure prophylaxis (PrEP) requires sufficient levels of adherence to confer strong protection against HIV. For protection against HIV transmission via anal sex, this corresponds to at least 4 daily pills per week for those on a daily dosing regimen. Measuring oral PrEP adherence requires valid assessments of pill-taking; it also requires assessments of contemporaneous sexual behavior because PrEP adherence is only functionally relevant in the context of contemporaneous HIV vulnerability. We conducted an online cohort study of Black, PrEP-using men who have sex with men (MSM) to assess the alignment between self-reported PrEP adherence and condom use and concordance between self-reported PrEP adherence and laboratory-assessed adherence. Data collection occurred from 2021 to 2023. Participants completed 11 weekly surveys to report PrEP use and sexual behavior for the preceding 7 days. At the end of follow-up, they were asked to submit a dried blood spot sample for laboratory analysis. There were few periods of self-reported non-adherence, but, among these, condomless sex was frequent. Self-reported adherence was not predictive of laboratory-assessed adherence. Despite their cost, studies of PrEP adherence should incorporate laboratory measurements of adherence whenever feasible.
Longitudinal Analysis of Substance Use as a Predictor PrEP Use and Adherence Among Young Transgender Women and Nonbinary Individuals.
Zamantakis A, Queiroz AAFLN
AIDS Behav · 2026 Jun · PMID 41984388 · Full text
Previous research on the influence of substance use on PrEP uptake and adherence among transgender women has either relied on cross-sectional analyses or on combined samples of cisgender men who have sex with men and a m...
Previous research on the influence of substance use on PrEP uptake and adherence among transgender women has either relied on cross-sectional analyses or on combined samples of cisgender men who have sex with men and a much smaller subsample of transgender women. To the best of our knowledge, no longitudinal study has examined the relationship of substance use and PrEP use/adherence among young transgender women and nonbinary people assigned male at birth (TNBY). We sought to understand whether substance use (i.e., binge drinking, marijuana use, and illicit drug use) predicts PrEP uptake and adherence for TNBY over time. Using a sample of 242 young and racially/ethnically diverse TNBY from the RADAR cohort study, we performed bivariate and multivariate generalized estimating equations binary logistic regression to assess whether substance use predicted PrEP use and adherence and latent growth curve modeling to examine trends in self-reported PrEP use over time. There were no significant differences in PrEP use or adherence by race/ethnicity, gender or educational attainment. In multivariable models, binge drinking (OR 1.37, 95% CI 1.08-1.74), number of condomless sex partners (OR 1.08, 95% CI 1.04-1.13), and HIV/STI testing (OR 2.20, 95% CI 1.65-2.92) were all significantly positively associated with PrEP use in the past 6 months. Binge drinking (OR 1.27, 95% CI 0.97-1.67), number of condomless sex partners (OR 1.09, 95% CI 1.04-1.13), and HIV/STI testing (OR 1.85, 95% CI 1.35-2.53) were significantly positively associated with current PrEP use. Both age (OR 1.25, 95% CI 1.02-1.54) and binge drinking (OR 8.66, 95% CI 2.12-35.30) were significantly positively associated with PrEP adherence. Cannabis use was significantly negatively associated with PrEP adherence (OR 0.89, 95% CI 0.82-0.97). Latent growth curve modeling detailed that the proportion of participants using PrEP significantly increased over time across age, reducing initial differences in PrEP use by age. These findings provide valuable insights into the relationship between substance use and PrEP use and adherence, showing the different effects of binge drinking and problematic cannabis consumption on PrEP outcomes. These findings emphasize the importance of nuanced and intersectional approaches to HIV prevention, considering both demographic variability and behavioral health factors.
Health-Related Quality of Life in People Living with HIV andHypertension: Effects of a Short Message Service-Based Mobile HealthIntervention (MOPHADHIV Trial).
Hongoro DJ, Kengne AP, Peer N … +2 more , Nguyen K, Alaba OA
AIDS Behav · 2026 Apr · PMID 41975054 · Publisher ↗
Mobile health (mHealth) interventions offer scalable support for adherence and self-management, yet their effects on health-related quality of life (HRQoL) among people living with HIV (PLWH) and comorbid hypertension re...
Mobile health (mHealth) interventions offer scalable support for adherence and self-management, yet their effects on health-related quality of life (HRQoL) among people living with HIV (PLWH) and comorbid hypertension remain unclear. We evaluated HRQoL outcomes using data from the MOPHADHIV trial, a 12-month short message service (SMS)-based randomized controlled trial conducted at four community health centres in Cape Town, South Africa. HRQoL was measured using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) utility index (Ugandan value set) and the EuroQol Visual Analogue Scale (VAS) at baseline and 12 months. Between-group differences were assessed using two-sample t-tests and analysis of covariance (ANCOVA) models adjusting for baseline HRQoL and covariates. A total of 582 participants (279 control; 303 intervention) with complete HRQoL data at baseline and 12 months were included in the analysis. Baseline HRQoL was high and comparable across arms. At 12 months, EQ-5D-5L utility was slightly higher in the control arm (0.97 vs 0.95; mean difference 0.03; t = 2.66, p = 0.01), corresponding to a small effect size (Cohen's d = 0.22). In adjusted models, intervention allocation was associated with a small reduction in EQ-5D-5L utility (β = - 0.02, p = 0.01; fully adjusted β = - 0.03, p < 0.01). VAS scores improved in both groups, with no significant between-arm differences. In this cohort of PLWH with hypertension, a 12-month SMS-based intervention did not improve HRQoL and was associated with a small reduction in EQ-5D-5L utility. High baseline HRQoL and limited sensitivity of EQ-5D-5L to HIV-related psychosocial domains may partly explain these findings.
Leveraging the Barriers and Facilitators of Pre-exposure Prophylaxis (PrEP) Care Among Latino Men Who Have Sex with Men in the U.S. to Inform Intervention: A Systematic Literature Review (2018-2023).
Davour RD, Vecsey H, González-Díaz L … +5 more , Dubare S, Samayoa SP, Carrico A, Rodriguez-Diaz CE, Colón-Burgos JF
AIDS Behav · 2026 Apr · PMID 41968265 · Publisher ↗
HIV disproportionately affects Latino men who have sex with men (LMSM) in the United States (U.S.). Pre-exposure prophylaxis (PrEP) reduces HIV transmission, but prescription and use rates remain low among this populatio...
HIV disproportionately affects Latino men who have sex with men (LMSM) in the United States (U.S.). Pre-exposure prophylaxis (PrEP) reduces HIV transmission, but prescription and use rates remain low among this population. This systematic literature review aimed to (1) identify and categorize barriers and facilitators of LMSM's PrEP use, and (2) leverage findings for future interventions. The PICOS structure was used to establish inclusion criteria to search studies published between 2018 and 2023 on December 24 2023. Covidence was used to screen studies and PRISMA 2020 to report the findings. Barriers/facilitators were categorized across the PrEP continuum of care and domains of the WHO 2024 Operational framework. Most barriers and facilitators were related to PrEP information/knowledge, provider influences, PrEP/insurance costs, immigration status, and government/medical mistrust. Findings highlight the need for culturally adapted/tailored PrEP interventions that leverage LMSM social networks, incorporate accessible PrEP service delivery, address language barriers, and involve community-based PrEP navigators.
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