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Medication adherence is linked to health outcomes among adults with HIV infection. Transgender women living with HIV (TWLWH) in the US report suboptimal adherence to medications and are found to have difficulty integrating HIV medication into their daily routine, but few studies explore the factors associated with medication adherence among transgender women. Thus, the purpose of this paper is to examine demographic and clinical factors related to self-reported medication adherence among transgender women. This secondary analysis is based on data collected from the Symptom and Genetic Study that included a convenience sample of 22 self-identified transgender women, 201 non-transgender men, and 72 non-transgender women recruited in northern California. Self-reported medication adherence was assessed using the AIDS Clinical Trials Group Adherence Questionnaire. Gender differences in demographic and clinical variables were assessed, as were differences between transgender women reporting high and low adherence. Transgender women had lower adherence to medications compared to non-transgender males and non-transgender females (p = .028) and were less likely to achieve viral suppression (p = .039). Within the transgender group, Black/African-Americans reported better adherence than participants who were Whites/Caucasian or other races (p = .009). Adherence among transgender women was unrelated to medication count and estrogen therapy, but consistent with other reports on the HIV population as a whole; transgender women with high adherence were more likely to achieve viral suppression compared to the transgender women with low adherence. Despite the high incidence of HIV infection in the transgender population, few studies focus on TWLWH, either in regard to their adherence to antiretroviral therapies or to their healthcare in general. To address ongoing health disparities, more studies are needed focusing on the transgender population's continuum of care in HIV therapies. [ABSTRACT FROM PUBLISHER]

High levels of HIV stigma are one of the main difficulties in engaging African-American and Latino men who have sex with men (MSM) in HIV testing. The availability of home HIV test and the possibility of self-testing in private may improve uptake and counteract stigma. This paper sought to determine the correlates of requesting home HIV test kits among a sample of MSM social media users. The odds of participants requesting a test kit were significantly associated with using social networks to seek sexual partners (aOR: 2.47, 95% CI: 1.07–6.06) and thinking it is easier to use social networks for seeking sexual partners (1.87, 1.2–3.12), uncertain HIV status (4.29, 1.37–14.4), and having sex under the influence of alcohol (2.46, 1.06–5.77). Participants who had not been tested for more than 6 months were more likely to request a test kit than those who were tested in the past 6 months (2.53, 1.02–6.37). Participants who frequently talked to others about having sex with men online were less likely to request a test kit (0.73, 0.56–0.92). By reaching people over social media and offering them access to test kits, we were able to reach at-risk individuals who were uncertain about their HIV status and had not been regularly tested. The findings of the study will help to inform future HIV testing interventions. [ABSTRACT FROM PUBLISHER]

Strong evidence suggests that patient-reported outcomes (PROs) aid in managing chronic conditions, reduce omissions in care, and improve patient–provider communication. However, provider acceptability of PROs and their use in clinical HIV care is not well known. We interviewed providers (n = 27) from four geographically diverse HIV and community care clinics in the US that have integrated PROs into routine HIV care, querying perceived value, challenges, and use of PRO data. Perceived benefits included the ability of PROs to identify less-observable behaviors and conditions, particularly suicidal ideation, depression, and substance use; usefulness in agenda setting prior to a visit; and reduction of social desirability bias in patient–provider communication. Challenges included initial flow integration issues and ease of interpretation of PRO feedback. Providers value same-day, electronic patient-reported measures for use in clinical HIV care with the condition that PROs are (1) tailored to be the most clinically relevant to their population; (2) well integrated into clinic flow; and (3) easy to interpret, highlighting chief patient concerns and changes over time. [ABSTRACT FROM AUTHOR]

Although poor clinic attendance is associated with increased morbidity and mortality among HIV-infected individuals, less is known about predictors of retention and the acceptability of targeted interventions to increase regular clinic attendance. To better understand which patients are at risk for irregular clinic attendance and to explore interventions to aid in retention to care, we surveyed patients attending two outpatient HIV clinics affiliated with the University of California, San Francisco. A total of 606 participants were surveyed, and the analysis was restricted to the 523 male respondents. Of this group, 45% (N= 299) reported missing at least one visit a year. Missing a clinic visit was associated with being African American (aOR = 1.99; 95%CI 1.12–3.52), being a man who has sex with both men and women (aOR=2.72; 95%CI 1.16–6.37), and reporting at least weekly methamphetamine use (aOR=5.79; 95%CI 2.47–13.57). Participants who reported a monthly income greater than $2000 were less likely to miss an appointment (aOR = 0.56; 95%CI 0.34–0.93). Regarding possible retention interventions, most patients preferred phone calls over other forms of support. These findings support the need for ongoing engagement support with particular attention to at-risk sub-groups. [ABSTRACT FROM PUBLISHER]

Despite the recognized need for structural-level HIV prevention interventions that focus on economic empowerment to reduce women's HIV risks, few science-based programs have focused on securing women's land ownership as a primary or secondary HIV risk reduction strategy. The current study focused on a community-led land and property rights model that was implemented in two rural areas of western Kenya where HIV prevalence was high (24–30%) and property rights violations were common. The program was designed to reduce women's HIV risk at the community level by protecting and enhancing women's access to and ownership of land. Through in-depth interviews with 50 program leaders and implementers of this program we sought to identify the strategies that were used to prevent, mediate, and resolve property rights violations. Results included four strategies: (1) rights-based education of both women and men individually and at the community level, (2) funeral committees that intervene to prevent property grabbing and disinheritance, (3) paralegal training of traditional leaders and community members and local adjudication of cases of property rights violations, and (4) referring property rights violations to the formal justice system when these are not resolved at the community level. Study participants underscored that local mediation of cases resulted in a higher success rate than women experienced in the formal court system, underscoring the importance of community-level solutions to property rights violations. The current study assists researchers in understanding the steps needed to prevent and resolve women's property rights violations so as to bolster the literature on potential structural HIV prevention interventions. Future research should rigorously test property rights programs as a structural HIV prevention intervention. [ABSTRACT FROM AUTHOR]

We analyzed HIV surveillance data on white, black, and Latino males diagnosed with HIV between 2000 and 2004 in Los Angeles County (LAC) to identify associations between individual- and community-level factors and late HIV detection by race/ethnicity. We defined late HIV detection as an AIDS diagnosis within 6 months of HIV diagnosis. We conducted multilevel analysis to determine individual- and community-level risk factors associated with late HIV detection stratified by race/ethnicity. We mapped HIV-positive males with late HIV detection by race/ethnicity at the zip code level within LAC to determine high burden areas. Overall, 38% of all males met the definition of late HIV detection. By race/ethnicity, 44% of Latinos, 38% of blacks, and 30% of whites were detected late in their course of HIV infection. Latinos and whites had multiple individual-level risk factors associated with late HIV detection. Among black males, only older age at HIV diagnosis was associated with late HIV detection. The only community-level risk factor associated with late HIV detection was among Latinos living in communities with less than 6% of men who have sex with men (proxy for stigma). Mapping the distribution of late HIV detection showed late detection areas generalized across LAC for Latino males in comparison with white and black males whose maps showed clustered areas of late HIV detection. Analysis and mapping of individual- and community-level risk factors associated with late HIV detection provides an important tool for targeting prevention resources to areas and populations with the highest burden of disease. [ABSTRACT FROM AUTHOR]

Between 1999 and 2003, Asian Americans and Pacific Islanders (APIs) in the US experienced more rapid growth in the number of AIDS cases than any other racial or ethnic group. In addition, the prevalence of HBV and HIV co-infection is estimated to be significantly higher among APIs in the US than in other racial/ethnic groups. High rates of HIV and hepatitis B or C (HBV and/or HCV) co-infection, in concert with language and cultural barriers, create significant challenges to effective coordination of treatment. The purpose of this study is to identify barriers to care and treatment in APIs with HIV with and without hepatitis co-infection. Specifically, we analyze results from semi-structured interviews with health care providers (N=23) and Asian Americans who are HIV and hepatitis (HBV and/or HCV) co-infected (N =17) in order to clarify how stigma in particular may impede/limit access to coordinated health care provision. Providers and clients recognize the need for integrated, culturally and linguistically appropriate access to care while simultaneously acknowledging that stigma is a severe barrier to access to care. This article sheds light on the complexities of the stigma experienced by HIV and hepatitis co-infected Asian Americans and suggests a need for further research and renewed efforts by caregivers to reduce stigma in these communities. [ABSTRACT FROM AUTHOR]

HIV-positive Latino and African-American young men who have sex with men (YMSM) have low rates of engagement and retention in HIV care. An evaluation of a youth-focused case management intervention (YCM) designed to improve retention in HIV care is presented. HIV-positive Latino and African-American YMSM, ages 18-24, who were newly diagnosed with HIV or in intermittent HIV care, were enrolled into a psychosocial case management intervention administered by Bachelor-level peer case managers at two HIV clinics in Los Angeles County, California. Participants met weekly with a case manager for the first two months and monthly for the next 22 months. Retention in HIV primary care at three and six months of follow-up was evaluated as were factors associated with retention in care. From April 2006 to April 2009, 61 HIV-positive participants were enrolled into the intervention (54% African-American, 46% Latino; mean age 21 years). At the time of enrollment into the intervention, 78% of the YMSM had a critical or immediate need for stable housing, nutrition support, substance abuse treatment, or mental health services. Among intervention participants (n=61), 90% were retained in primary HIV care at three months and 70% at six months. Among those who had previously been in intermittent care (n=33), the proportion attending all HIV primary care visits in the previous six months increased from 7% to 73% following participation in the intervention (p<0.0001). Retention in HIV care at six months was associated with increased number of intervention visits (p=0.05), more hours in the intervention (p=0.02), and prescription of HAART. These data highlight the critical needs of HIV-positive African-American and Latino YMSM and demonstrate that a clinic-based YCM can be effective in stabilizing hard-to-reach clients and retaining them in consistent HIV care. [ABSTRACT FROM AUTHOR]