We aimed to describe long-term use trajectories and predictors prior to recreational cannabis legalization in people with HIV in Ontario, Canada. We analysed interview data from the prospective Ontario HIV Treatment Netw...We aimed to describe long-term use trajectories and predictors prior to recreational cannabis legalization in people with HIV in Ontario, Canada. We analysed interview data from the prospective Ontario HIV Treatment Network Cohort Study from 2008 to 2017. We conducted Latent Class Growth Analyses to describe cannabis use trajectories and chi-square tests to identify trajectory group predictors. Most participants ( = 3,299) were male (81%), gay (57%), current/former tobacco smokers (58%), and many had significant symptoms of depression (43%). Four cannabis use trajectory groups were identified (Low/No Use (67%); Increased Use (4%); Decreased use (2%); High Use (26%)). Relative to the Low/No Use group, membership in the High Use group was associated with several predictors such as being older age, completing university, smoking tobacco, and significant depressive symptoms. Future research should explore the relationship between cannabis use and depressive symptoms, outcomes associated with trajectory groups and changes in use trajectories following recreational legalization.
Disparate rates of HIV infection among Black MSM and TGW emphasize the need for interventions designed to overcome obstacles to increasing PrEP adoption within these populations. This study compared PrEP-use groups on a...Disparate rates of HIV infection among Black MSM and TGW emphasize the need for interventions designed to overcome obstacles to increasing PrEP adoption within these populations. This study compared PrEP-use groups on a variety of attitudinal and behavioral factors related to PrEP adoption. Regression analysis confirmed that current and former users demonstrated greater PrEP knowledge and communicated more frequently to friends about PrEP and its benefits than nonusers. Former users exhibited more positive attitudes and perceived less stigma regarding PrEP use than other groups. Current users reported the highest prevalence of condomless anal sex and multiple partners; conversely, former users were most often in stable monogamous relationships. Our findings are consistent with the notion of prevention-effective adherence and advance our understanding of attitudinal supports for that paradigm. This research also suggests that recruitment of former PrEP users could increase the pool of effective peer behavior-change agents in future intervention efforts.
Rodríguez-Díaz CE, Zangeneh SZ, Chen YO
… +9 more, Guo X, Tsuyuki K, Ransome Y, Friedman RK, Srithanaviboonchai K, Roberts ST, Mimiaga MJ, Mayer KH, Safren SA
AIDS Educ Prev
· 2025 Apr · PMID 40323670
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In the field of HIV prevention and care, most studies of HIV syndemic problems are cross-sectional, few differentiate by HIV transmission groups, and few focus on people living with HIV (PWH). We analyzed one-year longit...In the field of HIV prevention and care, most studies of HIV syndemic problems are cross-sectional, few differentiate by HIV transmission groups, and few focus on people living with HIV (PWH). We analyzed one-year longitudinal data of 692 sexually active PWH (heterosexual men [HM], heterosexual women [HW], and men who have sex with men [MSM]) in care from Brazil, Thailand, and Zambia. Syndemic scores (0-3+) included stimulant use, polydrug use, depression, alcohol use, and fear of discrimination. Overall, syndemic scores were associated with lower ART adherence over time, but this differed across sexual transmission categories. For HM and HW, those with 2 or 3+ syndemic problems had lower odds of ART adherence than those with none. However, for MSM, the association between syndemic scores and ART adherence was not significant. While syndemic problems generally predicted suboptimal ART adherence among PWH, the association appears nuanced across subgroups.
Alohan DI, Chandra C, Young HN
… +3 more, Quamina A, Holland DP, Crawford ND
AIDS Educ Prev
· 2025 Apr · PMID 40323669
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This mixed-methods study explored willingness to use long-acting injectable pre-exposure prophylaxis (LAI-PrEP) among a pharmacy-based sample of men, including sexual and gender minoritized (SGM) individuals. We conducte...This mixed-methods study explored willingness to use long-acting injectable pre-exposure prophylaxis (LAI-PrEP) among a pharmacy-based sample of men, including sexual and gender minoritized (SGM) individuals. We conducted qualitative interviews ( = 10) with HIV-negative Black men, including Black SGM individuals, and surveys ( = 103) across three study phases with men recruited from community pharmacies in Atlanta, Georgia. Interviews explored perceived benefits and concerns related to LAI-PrEP; surveys assessed willingness and related reasons. Thematic analysis was used for interview transcripts, and descriptive statistics summarized survey responses. Participants mentioned benefits such as improved adherence and reduced stigma, but also noted concerns about medical mistrust and fear of needles. Willingness was higher in the transitional pilot phase than in the pilot phase, where concerns about side effects and comfort were more common. Findings highlight the need for tailored LAI-PrEP strategies that address barriers among Black SGM populations and promote equitable HIV prevention.
AIDS Educ Prev
· 2025 Feb · PMID 39932447
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PrEP campaigns often promote a "private" frame emphasizing personal HIV risk management. We explore how a "public" frame emphasizing community-managed sexual health is relevant among men who have sex with men (MSM) and c...PrEP campaigns often promote a "private" frame emphasizing personal HIV risk management. We explore how a "public" frame emphasizing community-managed sexual health is relevant among men who have sex with men (MSM) and can advance HIV prevention. We sampled MSM from the United States ( = 311 in 2015) and the Netherlands ( = 222 in 2020) soon after each country's official PrEP introduction to study the early adoption of PrEP frames. Using regressions and machine learning, we quantified support for different PrEP frames, person-level correlates, and relationships to personal PrEP disclosure. Respondents were generally neutral about PrEP framing (U.S.: 44%, Netherlands: 48%), yet many held private (U.S.: 23%, Netherlands: 28%) and public (U.S.: 33%, Netherlands: 24%) frames. Public and neutral frames were associated with PrEP users and disclosure comfort. PrEP messaging and uptake could improve by understanding how and when MSM frame their PrEP use as a public or private matter.
AIDS Educ Prev
· 2025 Feb · PMID 39932446
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HIV prevention research on sexual minority men focuses predominantly on risk factors, yet there is potential for enhancing HIV risk reduction by also examining resilience factors. We used mixed methods to explore HIV-rel...HIV prevention research on sexual minority men focuses predominantly on risk factors, yet there is potential for enhancing HIV risk reduction by also examining resilience factors. We used mixed methods to explore HIV-related resilience pathways among 20 HIV-negative sexual minority men reporting HIV syndemic risks (childhood sexual abuse, partner abuse, mental health problems, substance abuse). Using grounded theory, we found that stress-related growth after mental health problems and/or unwanted sexual experiences can trigger development/use of HIV prevention resilience resources that, in turn, help sexual minority men cope and enhance HIV prevention behavior. We identified 23 HIV resilience resources at individual, interpersonal, community, health system, and structural levels. These findings informed a preliminary Theory of HIV Prevention Resilience for Sexual Minority Men. Our findings identified resilience resources to be nurtured through public health or mental health/substance use-focused interventions at broader levels to better address the HIV epidemic.
Masa R, Operario D, Villegas N
… +4 more, Pineda O, Baruah D, Zulu G, Garcia B
AIDS Educ Prev
· 2025 Feb · PMID 39932445
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This mixed-methods study explored resilience-enabling behaviors and practices exhibited by young Latino sexual minority men (YLSMM) to cope with stigmatizing experiences attributed to their multiple minoritized identitie...This mixed-methods study explored resilience-enabling behaviors and practices exhibited by young Latino sexual minority men (YLSMM) to cope with stigmatizing experiences attributed to their multiple minoritized identities and reduce their HIV risk. Guided by a positive deviance approach, we identified and interviewed 15 YLSMM (aged 18 to 24) with a history of regular HIV testing and lived experiences of intersectional stigma. Thematic analysis reveals multilevel strategies used by participants to mitigate the adverse effects of stigma on mental health and HIV preventive behaviors. Strategies included using positive self-talk and self-expression, having an immediate network of supportive friends and families, and engaging in community-based support groups and events. In turn, these strategies motivated participants to exercise self-care, accept their minoritized identities, especially their sexual orientation, seek emotional and informational support, and connect with other Latino sexual minority men and the larger Latine community.
Alidina Z, Dolcini MM, Huun C
… +6 more, Urban AJ, Fleury N, Singh R, Conserve DF, Ndyetabula C, Catania JA
AIDS Educ Prev
· 2025 Feb · PMID 39932444
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In sub-Saharan Africa, HIV is the leading cause of death among 15-24-year-olds. Tanzanian youth rank fifth in HIV prevalence, yet testing rates are low. Dissemination of oral HIV self-implemented tests (Oral-SIT) may imp...In sub-Saharan Africa, HIV is the leading cause of death among 15-24-year-olds. Tanzanian youth rank fifth in HIV prevalence, yet testing rates are low. Dissemination of oral HIV self-implemented tests (Oral-SIT) may improve access if tests are coupled with graphic instructions to address low literacy. This study analyzed how a graphic instruction book (GIB) alone, compared to a GIB combined with an instructional video (GIB-video), affected comprehension of the Oral-SIT kit procedures. In a randomized experiment ( = 257; 14-19 yrs), we analyzed misunderstandings of testing procedures across the two study arms. Participants in the GIB-only condition reported more misunderstandings (59%) than in the GIB-video condition (41%). Fifty-eight percent of misunderstandings contained major errors, though most centered on a few graphics. Fewer than 6% of participants had four or more misunderstandings. Overall, the GIB was comprehended well and with modifications, could enhance Oral-SIT fidelity in low-literacy settings.
AIDS Educ Prev
· 2025 Feb · PMID 39932443
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Couples HIV testing and counseling (CHTC) emerged as an early HIV prevention intervention for male couples in the US. Understanding how couples speak to a testing counselor may enhance CHTC training and delivery. Raters...Couples HIV testing and counseling (CHTC) emerged as an early HIV prevention intervention for male couples in the US. Understanding how couples speak to a testing counselor may enhance CHTC training and delivery. Raters analyzed CHTC sessions involving 66 adult cisgender male couples and noted three distinct styles. When co-speaking, partners collaborated in the construction of a shared response, often using plural pronouns. Parallel speaking involved partners sharing individual perspectives in turn, often using singular pronouns. The spokesperson style was typified by one partner consistently speaking first and saying more. Most (65.1%) couples adopted a consistent style. The majority of these were co-speaking (72.1%). Fewer had a consistent spokesperson (18.6%) or parallel speaking style (9.3%). Where observed, style changes often accompanied shifts in topic or in the CHTC counselor's attention. A couple's communication style may provide CHTC counselors with information about partners' familiarity with each other's perspectives as well as relationship power. Implications for rapport building and engagement are discussed.
Arinda A, Nakasujja N, McKay MM
… +2 more, Ssewamala FM, Mugisha J
AIDS Educ Prev
· 2024 Dec · PMID 39705178
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Adolescents with intellectual disability (ID) are often deficient in knowledge about HIV/AIDS. This pilot study evaluated the impact and acceptability of an HIV education intervention for adolescents with mild-to-moderat...Adolescents with intellectual disability (ID) are often deficient in knowledge about HIV/AIDS. This pilot study evaluated the impact and acceptability of an HIV education intervention for adolescents with mild-to-moderate ID delivered in a peri-urban setting in Uganda. This quasi-experimental study involved 60 adolescents with mild to moderate ID evenly split between the intervention and control groups. Data were collected using a questionnaire that included sociodemographic information, HIV knowledge and attitudes, and acceptability measures, administered at baseline, immediately postintervention, and 3 months later. Approximately 53.3% of the participants were male, and 50% had mild ID. Immediately post-intervention, the intervention group reported a significantly higher increase in HIV knowledge (8.5 vs. -0.2, < .001) and attitudes (3.9 vs. 0.1, < .001) than the control group. A similar significant increase was maintained at 3 months post-intervention. These findings show that tailored education programs can improve HIV knowledge and attitudes in adolescents with ID.
Wilkerson JM, Atkinson J, Akkala S
… +10 more, Zoschke IN, Anosike MU, Gallardo KR, Rodriguez SA, Brown HS, Cazaban CG, Yang J, Herrera E, Howell J, McCurdy S
AIDS Educ Prev
· 2024 Dec · PMID 39705177
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Of 1.2 million Americans who would benefit from pre-exposure prophylaxis (PrEP), only 36% were prescribed PrEP in 2023. Project HOMES is an ongoing study that evaluates recovery residences for individuals in medication-a...Of 1.2 million Americans who would benefit from pre-exposure prophylaxis (PrEP), only 36% were prescribed PrEP in 2023. Project HOMES is an ongoing study that evaluates recovery residences for individuals in medication-assisted recovery from opioid use disorder across five Texas cities. Behavioral and psychosocial survey data and biomarkers were collected with a focus on the history of HIV testing, PrEP awareness, and willingness to engage in preventive treatments from a subsample of participants. Preliminary results demonstrated varying levels of HIV testing (83%), PrEP awareness (51%), and willingness to use PrEP (44%) among residents. Willingness to use PrEP was further differentiated by the method of administration, including the preference for pills (40%) and injections (40%). The findings underscore the critical role that recovery residences could play in PrEP access and addressing health care disparities among people with a history of injecting drugs.
Wu Y, Chen H, Zhan J
… +6 more, Liu J, Li Y, Cai W, Liu S, Liang N, Lan G
AIDS Educ Prev
· 2024 Dec · PMID 39705176
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In China, pre-exposure prophylaxis (PrEP) uptake among men who have sex with men (MSM) and HIV-serodiscordant couples is low. We offered differentiated PrEP options tailored to MSM in a community-based organization (CBO)...In China, pre-exposure prophylaxis (PrEP) uptake among men who have sex with men (MSM) and HIV-serodiscordant couples is low. We offered differentiated PrEP options tailored to MSM in a community-based organization (CBO) setting, and to HIV-serodiscordant couples attempting conception in a specialized HIV care clinic. The CBO facilitated PrEP by linkage with a telemedicine platform for virtual consultation; additional online follow-up on social media was conducted by peers. PrEP was taken properly in 88.7% of visits. Retention was 82.4% at Month 6. MSM having HIV-infected partners over the past 6 months were more likely to adhere to PrEP; ≥ 50 years old and daily oral PrEP were significant predictors for failing in retention. Five pregnancies were reported in the clinic. A peer-led and social media, telemedicine-assisted PrEP model within a CBO is a feasible approach to roll out PrEP among MSM. Integrated PrEP in specialized HIV clinics is appropriate for serodiscordant couples attempting conception.
David HM, Martin T, Wells A
… +2 more, Little SJ, Mehta S
AIDS Educ Prev
· 2024 Dec · PMID 39705175
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HIV pre-exposure prophylaxis (PrEP) is a cornerstone of the Ending the HIV Epidemic plan. We evaluated sociodemographic factors associated with PrEP use in jurisdictions with high HIV diagnosis rates between the initial...HIV pre-exposure prophylaxis (PrEP) is a cornerstone of the Ending the HIV Epidemic plan. We evaluated sociodemographic factors associated with PrEP use in jurisdictions with high HIV diagnosis rates between the initial years of PrEP rollout in the U.S. Data were abstracted from AIDSVu, U.S. Census Bureau, and Massachusetts Institute of Technology Election Lab data for years 2012-2019. Linear mixed methods modeling was used to correlate county-level PrEP rates and correlational analysis for state-level PrEP rates (PrEP use per 100,000 persons) with year, HIV diagnoses, income, insurance coverage, proportion of Democratic votes for president in 2020, race, and geographic location. Sociodemographic factors such as income, race, and political affiliation were significantly associated with county- and state-level PrEP use. Further research to understand policy differences that lead to inequitable provision of PrEP is needed.
Hussen SA, Wade RM, Newman A
… +2 more, Alohan DI, Harper GW
AIDS Educ Prev
· 2024 Dec · PMID 39705174
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Young Black gay, bisexual, and other men who have sex with men who are living with HIV are at an increased risk of experiencing poor mental health due to their exposures to intersectional stigma and discrimination, but o...Young Black gay, bisexual, and other men who have sex with men who are living with HIV are at an increased risk of experiencing poor mental health due to their exposures to intersectional stigma and discrimination, but often do not seek traditional mental health care. We qualitatively explored conceptualizations of mental health through interviews with 40 participants and analyzed our data using a phenomenology-informed approach. Participants conceptualized mental health as having inward-facing (cultivation of a healthy relationship with oneself, maintaining a peaceful state of mind, lack of depressed mood) and outward-facing components (goal-oriented behavior, resilient coping mechanisms). Some participants espoused an internal locus of control over one's mental state, while others focused on structural or environmental factors as key drivers of mental health. Our findings suggest that provider trainings and service integration, consistent with a more holistic conception of mental health, could help providers support well-being among this population.
AIDS Educ Prev
· 2024 Oct · PMID 39509260
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Publisher ↗
Despite its efficacy, pre-exposure prophylaxis (PrEP) for HIV has a low uptake, with many disparities remaining. This study aimed to assess the impact of Medicaid expansion and social determinants of health (SDOH) on PrE...Despite its efficacy, pre-exposure prophylaxis (PrEP) for HIV has a low uptake, with many disparities remaining. This study aimed to assess the impact of Medicaid expansion and social determinants of health (SDOH) on PrEP prevalence and PrEP-to-need ratio (PnR) using county-level data from 2012 to 2022. Differences-in-differences regressions indicated that Medicaid expansion is associated with increased PnR but not PrEP prevalence. Linear regressions were conducted to evaluate the impact of county-level SDOH on PrEP outcomes. Rurality was associated with lower PnR and PrEP prevalence. Racial disparities were present, with areas with greater concentrations of non-Hispanic Black populations having lower PrEP prevalence and PnR. Greater concentrations of Hispanic populations were associated with lower PnR. Income inequality, socioeconomic status vulnerability, and primary care physician concentration were all associated with higher PnR. Medicaid expansion supports increasing PrEP use in the areas of greatest need. Efforts should be made to improve PrEP access, particularly in areas with high SDOH vulnerabilities.
Smart BD, Alonzo J, Mann-Jackson L
… +9 more, Aviles LR, Tanner AE, Galindo CA, Bessler PA, Courtenay-Quirk C, Garcia M, Aguilar-Palma SK, Reboussin BA, Rhodes SD
AIDS Educ Prev
· 2024 Oct · PMID 39509259
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There is a dearth of HIV prevention behavioral interventions for transgender Latinas, despite this population's HIV risk. ChiCAS (Chicas Creando Acceso a la Salud) is an intervention to increase PrEP, condom, and gender-...There is a dearth of HIV prevention behavioral interventions for transgender Latinas, despite this population's HIV risk. ChiCAS (Chicas Creando Acceso a la Salud) is an intervention to increase PrEP, condom, and gender-affirming hormone therapy (GAHT) use among transgender Latinas. To inform future work, semistructured interviews were conducted postintervention with 28 ChiCAS participants. Thematic analysis with inductive coding was used. Six themes emerged: (1) health-related priorities include sexual health and avoiding discrimination; (2) safe and collaborative community is of high importance; (3) interactive education with time for sharing stories and discussion was valued; (4) PrEP uptake was facilitated through awareness and health care navigation; (5) accessing GAHT depends on cost, clinic location, and individual goals; (6) ChiCAS could be improved with more PrEP/GAHT details and social connection. Interventions with goals similar to those of ChiCAS should prioritize building community, PrEP and GAHT education tailored to participants' needs, and emphasize health care options available locally.
Sprott RA, Anderson KD, Wert E
… +5 more, Mulwa KW, Ratcliff SE, Forer R, Harvey N, Randall A
AIDS Educ Prev
· 2024 Oct · PMID 39509258
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A growing proportion of the global population engages in alternative sexual behaviors and relationships, which are commonly grouped and known as kink or BDSM (bondage-discipline, dominance-submission, sadism-masochism)....A growing proportion of the global population engages in alternative sexual behaviors and relationships, which are commonly grouped and known as kink or BDSM (bondage-discipline, dominance-submission, sadism-masochism). Mainstream stigma and provider pathologizing of these behaviors and relationships may make kink-involved populations reticent to seek health care treatment. Moreover, some kink activities appear to expose kink-involved people to higher risks for HIV infection. To date, no studies have explored HIV risk prevention interventions for kink-involved people. The proposed study seeks to address the absence by describing a study designed to address HIV risk prevention with PrEP for this understudied and neglected population by testing an educational-entertainment intervention designed to focus on kink specifically. Using a repeated-measures randomized experimental methodology, this study proposes to include data collection and exposure to intervention materials at 3-month intervals over 12 months.
Zapata JP, Rojas E, Durán P
… +6 more, Martínez AJ, Zea MC, Schrode K, Khawcharoenporn T, Ayala G, Del Pino HE
AIDS Educ Prev
· 2024 Oct · PMID 39509257
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This study explored the feasibility and acceptability of Entre Herman@s, a novel sibling-based intervention designed to engage siblings to increase PrEP utilization among Latino men who have sex with men (LMSM). Siblings...This study explored the feasibility and acceptability of Entre Herman@s, a novel sibling-based intervention designed to engage siblings to increase PrEP utilization among Latino men who have sex with men (LMSM). Siblings were trained in rudimentary motivational interviewing skills to uncover, evoke, and strengthen their brother's motivation to use PrEP, using the constructs of the Information-Motivation-Behavioral Skills (IMB) model for health behavior change. This pilot demonstrated high feasibility, meeting recruitment, retention, and intervention completion targets. Of the 23 LMSM enrolled, 16 (70%) commenced PrEP, with 12 (75%) continuing at the 3-month follow-up. Initially, 15 participants (65%) were open to PrEP, with 9 (39%) ready to start within the next month. Those who began PrEP use reported a significantly higher degree of closeness to their siblings ( = .019) than those who did not. All LMSMs affirmed that their decision to use PrEP was influenced to some degree by their sibling.
Zimmerman RS, Wonderly K, Abdul-Kadr H
… +4 more, DiClemente RJ, Turner MM, Xu M, Rosenberger JG
AIDS Educ Prev
· 2024 Oct · PMID 39509256
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In the United States, Black men who have sex with men (BMSM) represent the most vulnerable population for HIV infection. A potential vaccine could ultimately be the most effective HIV prevention strategy. Understanding t...In the United States, Black men who have sex with men (BMSM) represent the most vulnerable population for HIV infection. A potential vaccine could ultimately be the most effective HIV prevention strategy. Understanding the factors that may adversely affect HIV vaccine acceptance among BMSM is critical. We conducted two online surveys with BMSM; one recruited 432 respondents, and another recruited 204. Respondents completed a demographic assessment and questions derived from health behavior change theories and the relevant empirical literature. The two surveys yielded similar results. The findings indicate that vaccine uptake self-efficacy, perceived likelihood of important others receiving the vaccine, and susceptibility to HIV were related to intentions to receive a future HIV vaccine. Other potentially important variables include perceived HIV stigma, response efficacy, how much one conceals one's sexual orientation, and perceived HIV discrimination. Future research and health communication campaigns should consider these factors in potential HIV vaccine programs.
DeMaio DM, Barerra EP, Post J
… +2 more, Boskey ER, Guss CE
AIDS Educ Prev
· 2024 Aug · PMID 39189961
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Many transgender young adults are unaware of the role of pre-exposure prophylaxis (PrEP) in HIV prevention. Our aim was to understand where transgender and gender-diverse young adults receive health information about HIV...Many transgender young adults are unaware of the role of pre-exposure prophylaxis (PrEP) in HIV prevention. Our aim was to understand where transgender and gender-diverse young adults receive health information about HIV and PrEP and their preferences for future learning. Semistructured, qualitative individual and group interviews were done with 14 transgender and gender-diverse young adults. Interviews were transcribed verbatim and analyzed using thematic analysis. Four themes emerged from the interviews related to (1) making trustworthy education materials, (2) the importance of communities, (3) knowledge needed about PrEP, and (4) a lack of early and diverse classroom education. Transgender and genderdiverse persons are at higher risk for HIV than their cisgender peers, yet they have information gaps and hold misconceptions about preventative measures like PrEP. Such misconceptions may be addressed by early, inclusive conversations about HIV transmission and prevention.