AIDS and Behavior

Graham, Susan M.; Wang, Liying; Jadwin-Cakmak, Laura; Odhiambo, Elijah O.; Bauman, Kenneth; Okall, Duncan; Odero, Wilson; Otieno, Fredrick; Amico, K. Rivet; Harper, Gary W.

doi: 10.1007/s10461-025-04965-8pmid: 41288881

In rights-constrained settings with pervasive stigma, a holistic approach to HIV prevention is needed to ensure knowledge and use of different HIV prevention tools and promote both sexual and mental health. In close collaboration with GBMSM community leaders in Kisumu, we developed a theory-based, culturally-tailored HIV prevention intervention that integrates sexual health and mental health support for young Kenyan GBMSM. We conducted a randomized trial with 6 months of follow-up to assess acceptability, feasibility, and safety of the intervention and explore its potential impact on secondary outcomes, compared to standard care. Among 60 participants, median age was 25 years (inter-quartile range 22–28). Retention at month 6 was 93.1% (27 of 29) in the intervention arm and 87.1% (27 of 31) in standard care. Acceptability was high, with most participants rating each session’s value and relevance at 1 (“strongly agree”). Intervention delivery was feasible and attendance was excellent, with 29 (100%) intervention participants completing all five sessions and 18 (62.1%) attending an optional session to consolidate learning. No social harms occurred. Exploratory analyses suggest improved PrEP knowledge and improved knowledge about healthy relationships and communication, as well as higher condom use at last sex. The intervention was found to be acceptable, feasible and safe in this small study. Future work is warranted to evaluate this intervention in a larger trial, given the need for person-centered, holistic interventions supporting sexual health, mental well-being, and the full range of HIV prevention tools available.Clinical trial registration: NCT04550221, registered on 9/8/2020.

Bleasdale, Jacob; Westmoreland, Drew A.; Hone, Liana S. E.; Carrico, Adam; Grov, Christian

doi: 10.1007/s10461-025-04974-7pmid: 41291296

Men who have sex with men (MSM) experiencing forced sexual encounters (FSE) are at heightened HIV vulnerability. PrEP and PEP are effective HIV prevention strategies; yet, limited research exists exploring the relationships between FSE, PrEP, and PEP use. Primary data were collected from August 2022-July 2023. Among the 21,373 participants, 21% experienced FSE in the last 5 years, 3.26% indicated past-year PEP use, and 24.81% reported current PrEP use. MSM who experienced FSE reported greater odds of past-year PEP use and lower odds of current PrEP use. Communication surrounding HIV prevention is needed among MSM at risk of sexual violence and subsequent HIV acquisition.

Grant, Jeffrey D.; Green, Harold D.; Mutchler, Matt; Kegeles, Susan; Ballan, Elie; Wagner, Glenn J.

doi: 10.1007/s10461-025-04943-0pmid: 41291297

Men who have sex with men (MSM) are disproportionately affected by HIV, particularly in urban Middle Eastern areas like Beirut, Lebanon. Understanding factors influencing HIV prevention, such as condom use and HIV testing is crucial. This study used the Information-Motivation-Behavioral Skills (IMB) Model determinants and explored social environment factors to assess their associations with condomless sex and HIV testing. Model fit was also examined to compare our IMB model alone versus an extended model incorporating social environment factors. A sample of 164 MSM (ages 18–29) in Beirut was analyzed using IMB determinants (e.g., HIV knowledge, motivation, condom use self-efficacy) and social environment determinants (e.g., safer sex peer norms, network engagement in HIV testing and risk discussions). Bivariate associations and multivariate regressions were conducted, and model fit was assessed using likelihood ratio testing. Findings showed that our IMB model alone better predicted condomless anal sex, whereas neither model adequately fit HIV testing outcomes. Within our IMB model, higher HIV knowledge was associated with increased odds of condomless sex, while greater condom use self-efficacy was linked to reduced odds. These results suggest that condom use and HIV testing are influenced by different factors. Interventions should not only increase HIV knowledge but also enhance self-efficacy to reduce condomless sex.

Hurley, Emily A.; Gwokyala, Violet; Nabitaka, Linda Kisaakye; Kashesya, Jolly Beyeza; Agasha, Mercylynn; Namaganda, Florence; Schuetz, Nik; Ross, J. Nalubega; Matovu, Joseph K. B.; Wanyenze, Rhoda; Wagner, Glenn; Goggin, Kathy

doi: 10.1007/s10461-025-04949-8pmid: 41298999

Among heterosexual couples in sub-Saharan Africa, fears of relationship dissolution and inability to bear healthy children following an HIV-positive result remain barriers to HIV testing. Recently expanded availability of pre-exposure prophylaxis (PrEP) affords a critical opportunity to promote HIV testing with reassuring communication that highlights use for relationship preservation and healthy childbearing. We aimed to develop a theoretically-grounded communication intervention to promote partner HIV testing within assisted partner notification (APN) and antenatal care (ANC) programs in Uganda. Through an 18-month iterative co-creation process, we developed the HOPE Clinical Communication Campaign (HOPE-CCC) in collaboration with a project advisory board (PAB) of health workers and the Ugandan Ministry of Health (MoH). We designed gain-framed, patient-facing materials (brochures, poster, invitation cards, self-test kit stickers) that frame PrEP as a family-centered benefit of HIV testing. Multiple cycles of PAB field-testing and feedback informed revisions to enhance relevance and easy integration into clinical workflow. Fifteen qualitative interviews with diverse clients and partners confirmed the relevance and demand for the messaging, supported the acceptability of materials, and guided the development of an accompanying patient-centered counseling strategy (Hear-Offer-Plan-Evaluate). MoH collaboration ensured alignment with national policies and potential for scalability across Ugandan HIV testing settings. HOPE-CCC is well-positioned for further evaluation of its acceptability, feasibility and impact on partner testing in APN and ANC programs. Highlighting the availability of PrEP and its benefits in relationship preservation and healthy childbearing has potential to enhance the effectiveness of HIV testing promotion strategies for heterosexual couples.

Sabuncu, Beren Crim; Meng, Zhuo; Xavier Hall, Casey D.; Taylor, Taylor; Hanley, Adam; Trang, Kathy; Wang, Liying; Okada, Lorie; Millender, Eugenia; Gillespie, Avrum; Simoncini, Gina; Barile, John P.; Ma, Grace X.; Wong, Frank Y.

Mulholland, Grace E.; Matoga, Mitch; Chen, Jane S.; Mathiya, Esther; Bell, Griffin J.; Ndalama, Beatrice; Munthali, Tapiwa; Nyirenda, Naomi; Bonongwe, Naomi; Pedersen, Claire; Jere, Edward; Hosseinipour, Mina C.; Mphande, Zakaliah; Hoffman, Irving F.; Rutstein, Sarah E.

doi: 10.1007/s10461-025-04937-y

Dickson-Gomez, Julia; Tarima, Sergey; Twaibu, Wamala; Katende, Dan; Kyeswa, Latifah; Glasman, Laura; Kiconco, Arthur; Krechel, Sarah; Johnston, Bryan; Ogwal, Moses; Mutamba, Brian Byamah; Mudiope, Peter; Alamo, Stella; Wanyenze, Rhoda; Musinguzi, Geofrey

doi: 10.1007/s10461-025-04978-3

Enriquez Canto, Yordanis

doi: 10.1007/s10461-025-04980-9pmid: 41331210

Peru’s already concentrated HIV epidemic confronted an unprecedented shock with the arrival of SARS-CoV-2. With a natural experiment design, leveraging 96 months (2017–2024) of aggregate national death-certificate data (n = 9,917), we applied join-point regression, attributable-fraction calculations of deaths excess, and Newey-West–corrected interrupted time series models to disentangle indirect service disruptions from direct viral coinfection on HIV/AIDS mortality. Using population-level data, we estimated both relative and absolute measures of disparity, providing novel insights into population-level differences. A sharp inflection occurred in March 2020, producing an immediate monthly surge of 56.3 additional HIV/AIDS deaths (95% CI 42.81–69.93). Across the pandemic biennium 2020–2021, deaths rose from 2,258 to 3,357—an excess of 48.7% versus the 2018–2019 baseline. Co-occurring HIV/COVID-19 accounted for 38% of the excess, while HIV/AIDS-only deaths evidenced the heavier burden, underscoring collateral damage from disrupted testing, ART refills, and inpatient capacity. Analysis of population subgroups revealed substantial disparities: relative rate ratios peaked at 80.5 for adults ≥ 50 years, 4.7 for secondary-versus-university education, and 141 for users of the public Seguro Integral de Salud compared with private insurance. Although mortality declined after mass vaccination and service adaptations, 2024 levels remained above pre-pandemic trajectories. Findings reveal a dual pathway—biological vulnerability plus health-system failure—that nearly erased a decade of progress, disproportionately harming socially marginalized Peruvians. Safeguarding HIV programs within pandemic preparedness plans and targeting equity gaps are therefore urgent to avert similar reversals in future crises.

Chwastiak, Lydia A.; Reichman, Mira; Sylla, Laurie; Hutcheson, Rebecca; Clayton, Christina; Dombrowski, Julia C.; Katz, David A.

doi: 10.1007/s10461-025-04966-7pmid: 41335325

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

Kiirya, Stephen Kisembe; Visser, Maretha; Masenge, Andries

doi: 10.1007/s10461-025-04940-3pmid: 41345280

We examined the psychosocial factors that predict sexual risk behaviour of adolescents who reside in HIV affected homes in Uganda, to provide evidence for developing suitable interventions. Structured questionnaires were used to collect data about these adolescents’ psychosocial and sexual experiences. The scales and data were verified for precision and reliability using factor analyses, while the predictors of sexual risk behaviour were examined using general linear models. Results showed that having been female, in the younger adolescence stage and a Muganda or Lango, living with one caregiver, being a recipient of HIV/psychosocial care and vulnerable to negative peer influence, personal threats, interpersonal problems, psychosocial distresses (e.g. psychosis and delinquency) and coping by deflecting problems, significantly enabled sexual risk behaviour in these adolescents. However, attending school, religious conviction, experiencing orphanhood especially of the mother, living with two caregivers, and experiencing poverty, judgmental HIV stigma, distress (e.g. inattention and depression), self-control and social support significantly deterred it. These results highlight the centrality of gender, age, HIV care, family situations, sociocultural and peer norms, community stressors, psychosocial distresses, and negative coping methods in influencing sexual risk behaviour of adolescents who reside in HIV affected homes. Interventions by families, schools and agencies are needed to prevent or mitigate these risk factors.