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During the COVID-19 pandemic lockdown, we deployed a rapid, mobile phone-based survey to assess access and participation rates when using mobile phones to collect data on COVID-19 in Rakai, south-central Uganda. We sampled prior Rakai Community Cohort Study (RCCS) participants based on HIV status using mobile phone contacts. We administered a 30-minute phone-based interview to consenting participants to assess their knowledge about different aspects of COVID-19 and their access to care. Our analysis compares the mobile phone survey participation rates with historic participation rates in regular RCCS face-to-face interviews. We supplemented phone survey data with demographic, behavioral, and HIV status data from prior face-to-face RCCS surveys. Phone access in Round 19 of the RCCS was found to be 90.2%, with lower access among older people, and people living with HIV. When including only individuals who participated in the previous RCCS survey round, participation in the face-to-face survey (81.9%) was higher than participation in our phone survey (74.8%, p  < .001). Survey participation was higher among people living with HIV compared to HIV-negative individuals (84.0% vs 81.4%, p  < .001) in the face-to-face survey, but in the phone survey the reverse was found, with participation rates being higher among HIV-negative individuals compared to people living with HIV (78.0% vs 71.6%, p  < .001). It was possible to collect data from an existing population cohort during the lockdown using phones. Phone access was high. Overall participation rates were somewhat lower in the phone survey, notably in people living with HIV, compared to the face-to-face survey.

Introduction: Although antiretroviral therapy (ART) leads to reduced tuberculosis (TB) incidence in people with HIV (PWH), ART recipients remain at higher risk of TB compared to HIV-seronegative people. With accelerated ART rollout in sub-Saharan Africa, increasing proportions of TB cases among PWH in people receiving long-term ART have been reported., Objective: To determine TB notifications among PWH by ART status in a mainly urban uptake area in Ethiopia during an 8-year period in connection to the introduction of the 'test-and-treat' strategy for HIV., Methods: PWH were identified from registers at health facilities providing ART in Adama and surrounding areas, Ethiopia 2015-2022. Annual TB notifications were compared over time. PWH within TB were categorized by ART status at the time of TB diagnosis (pre-ART TB: TB diagnosed before or ≤6 months after starting ART; ART-associated TB: TB diagnosed >6 months after starting ART)., Results: Among a total of 8,926 PWH, 993 had been diagnosed with TB (11.1%); mean age 40.0 years [SD 11.8], 53.5% were men). Throughout the study period, most TB cases had been notified before ART initiation (617/993; 62.1%). ART-associated TB cases constituted a mean of 37.4% (range 23.8%-44.2%) of all TB cases among PWH annually. Median time from ART initiation to TB diagnosis among ART-associated TB was 6.0 years., Conclusion: TB notifications among PWH in this area did not decrease 2015-2022, implying persistently high risk of TB among PWH in this setting. Most TB cases occurred in ART-naïve persons, illustrating late HIV diagnosis in this population.

Background: A low body mass index (BMI) at the start of treatment for rifampicin- or multidrug-resistant tuberculosis (MDR/RR-TB) is associated with poor treatment outcomes and may contribute to delayed sputum culture conversion, thereby prolonging the period of potential transmission to others. Whether the relative importance of low BMI in predicting treatment outcomes differs by HIV status is unclear., Objectives: We evaluated the association between low BMI and two dependent variables, sputum culture conversion and end-of-treatment outcome, among patients receiving treatment for MDR/RR-TB in Lesotho, a setting with a high prevalence of HIV infection., Methods: Secondary data from a prospective cohort of patients initiating a longer (18-20 months) treatment containing bedaquiline and/or delamanid under routine programmatic conditions in Lesotho were analysed. Risk ratios and differences were adjusted for potential confounders using multivariable logistic regression, and estimates were stratified by HIV status., Results: Of 264 patients, 105 and 250 were eligible for culture conversion and end-of-treatment analyses, respectively. Seventy-one per cent of patients (74/105) experienced culture conversion within six months, while 74% (184/250) experienced a favourable end-of-treatment outcome. Low BMI was associated with a lower frequency of culture conversion at six months among those who were not living with HIV (relative risk [RR]: 0.50 [95% CI: 0.21, 0.79]); this association was attenuated among those living with HIV (RR: 0.88 [95% CI: 0.68, 1.23]). A low BMI was moderately associated with a lower frequency of treatment success (RR = 0.89 [95% CI: 0.77, 1.03]), regardless of HIV status., Conclusions: Low BMI was common and associated with the frequency of six-month culture conversion and end-of-treatment outcomes. The association with culture conversion was more pronounced among those not living with HIV. Addressing the myriad factors that drive low BMI in this setting could hasten culture conversion and improve end-of-treatment outcomes. This will require a multipronged approach focused on alleviating food insecurity and enabling prompt diagnosis and treatment of HIV and TB.

Assessing the risk of cancer among people living with HIV (PLHIV) in the current era of antiretroviral therapy (ART) is crucial, given their increased susceptibility to many types of cancer and prolonged survival due to ART exposure. Our study aims to compare the association between HIV infection and specific cancer sites in Rwanda. Population-based cancer registry data were used to identify cancer cases in both PLHIV and HIV-negative persons. A probabilistic record linkage approach between the HIV and cancer registries was used to supplement HIV status ascertainment in the cancer registry. Associations between HIV infection and different cancer types were evaluated using unconditional logistic regression models. We performed several sensitivity analyses to assess the robustness of our findings and to evaluate the potential impact of different assumptions on our results. From 2007 to 2018, the cancer registry recorded 17,679 cases, of which 7% were diagnosed among PLHIV. We found significant associations between HIV infection and Kaposi's Sarcoma (KS) (adjusted odds ratio [OR]: 29.1, 95% CI: 23.2-36.6), non-Hodgkin lymphoma (NHL) (1.6, 1.3-2.0), Hodgkin lymphoma (HL) (1.6, 1.1-2.4), cervical (2.3, 2.0-2.7), vulvar (4.0, 2.5-6.5), penile (3.0, 2.0-4.5), and eye cancers (2.2, 1.6-3.0). Men living with HIV had a higher risk of anal cancer (3.1, 1.0-9.5) than men without HIV, but women living with HIV did not have higher risk than women without HIV (1.0, 0.2-4.3). Our study found that in an era of expanded ART coverage in Rwanda, HIV is associated with a broad range of cancers, particularly those linked to viral infections., (© 2024 World Health Organization; licensed by UICC and The Author(s). International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

Background: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities experience significant health disparities related to sexual health, including sexually transmitted infections (STIs). Improved access to culturally congruent primary care and sexual health services, including HIV/STI prevention and care, are needed. We describe how we developed a new community-based LGBTQ+ primary care clinic and implemented safety-net sexual health and STI screening and care services in Providence, Rhode Island., Methods: Open Door Health in Providence, Rhode Island, was started in 2020 to improve access to HIV/STI care and prevention services, primary care, and gender- affirming care for the LGBTQ+ community. We reviewed demographics and behaviors of patients presenting for STI screening services from February 2021 to October 2023 at the clinic. Bivariate and multivariate analyses were used to evaluate demographics and behaviors among patients testing positive for HIV and other STIs., Results: A total of N=1,633 people presented for STI screening. Of these, 56% were 30 years or younger, 65% identified as male, 24% as female, and 9% as non-binary or gender diverse. Forty-three percent were MSM, 19% were Black/African American (B/AA), and 22% were Hispanic/Latino (H/L). Seventy-one percent reported two or more partners in the last three months. The prevalence of STIs was 22.3% (4.4% syphilis, 7.5% gonorrhea, and 9.7% chlamydia). Those who tested positive for an STI were more likely to be B/AA (23.3% of B/AA individuals versus 15.9% of White, p<0.05), H/L (23.1% versus 17.4%, p<0.05), and MSM (25% versus 16.9%, p<0.05)., Conclusion: Open Door Health provides important safety-net STI services for the LGBTQ+ community. Individuals presenting for services had a high prevalence of HIV/STIs. Improved approaches are needed for HIV/STI care and prevention in this group, including among B/AA and H/L communities.

The incidence of syphilis has been steadily rising throughout the United States over the past decade, including Rhode Island. Neurosyphilis is a manifestation of syphilis involving the central nervous system and can present with a multitude of symptoms. We evaluated all cases of syphilis at a single healthcare system in Rhode Island over a 10.5-year period and identified 33 cases of neurosyphilis (24 confirmed and 9 diagnosed clinically). Neurosyphilis was more common in females, older patients, White/Caucasian patients, and non-Latino patients. Patients with neurosyphilis confirmed by cerebral spinal fluid analysis were more likely to have a higher RPR than patients who did not have neurosyphilis. Six patients with HIV were diagnosed with neurosyphilis and were similar to those with HIV and syphilis except for lower rates of drug use. Given increasing trends, clinicians should be familiar with the diagnosis and management of neurosyphilis.

Over the past 10 years, sexually transmitted infections (STIs) have seen a significant resurgence in the United States despite the availability of effective treatments and reliable prevention methods. Rhode Island has experienced a similar uptick in the incidence of syphilis, chlamydia and gonorrhea, with many cases occurring among gay, bisexual, men who have sex with men (GBMSM), which coincides with a recent concerning rise in congenital syphilis cases. We reviewed the most recent STI trends for the state of Rhode Island in 2022. During this year, 6,883 cases of STIs were reported to the Department of Health (N=5,199 chlamydia, 1,444 gonorrhea, and 240 infectious syphilis cases). Compared to 2012, this represented a 21%, 185%, and 253% increase in chlamydia, gonorrhea, and syphilis infections, respectively. Since 2020, eight cases of congenital syphilis have been reported. Prior to 2020, no cases of congenital syphilis were reported since 2009. This resurgence is mainly attributed to shifting social and behavioral trends, particularly among younger individuals and shared sexual networks across diverse groups.1 Further efforts and resources are needed to effectively address these concerning trends in STIs.

Introduction: In the context of key population HIV testing programmes, identifying new HIV acquisitions, tracking incidence, and responding with prevention and treatment interventions will be critical for achieving HIV epidemic control. Laboratory tests for recently acquired HIV used as part of a "recent infection testing algorithm" (RITA), offer a potential tool to support this work. We implemented a RITA for female sex workers (FSWs) in Zimbabwe to explore opportunities and programmatic benefits., Methods: Between October 2021 and January 2023, recency testing was offered to FSWs attending the Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe's key populations programme. Dried blood spot (DBS) samples were taken at 86 clinic sites across 10 provinces and Laboratory LAg Avidity and viral load testing conducted. RITA results were analysed and linked to programme data to explore geographical differences and calculate HIV incidence. We describe concurrent efforts in HIV testing for social (social network testing [SNT]) and sexual (index case testing [ICT]) contacts of those testing HIV positive., Results: Among 24,976 FSWs tested at programme sites, 9.5% (2363/24,976) were confirmed HIV positive. We enrolled 55.5% (1311/2363) of eligible HIV-positive FSWs to our study, of whom 11.7% (153/1311) were identified as having recently acquired HIV. It took a median of 37 days (IQR 20-67) for samples to be processed. Enrolment rates varied between provinces but the proportion of recently acquired HIV was similar (range: 18.4% to 4.0%). Overall HIV incidence was 3.4 (95% CI 2.7-4.0) per 100py. Where results could be linked to routinely collected data, we found no evidence of a difference in test-positivity between the ICT and SNT contacts of those with recently acquired compared to those with long-term HIV., Conclusions: Implementation of a RITA was possible within a nationally scaled sex worker programme, and while challenging to implement, can provide an understanding of transmission dynamics and HIV incidence in this context. Sub-optimal recruitment and data linkage limited the interpretation of our findings and opportunities for strategic gains though focusing on HIV prevention efforts., (© 2024 The Author(s). Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.)

Background: Breast cancer is the most common malignancy diagnosed among women in South Africa, with the aggressive triple-negative subtype comprising approximately 15% of breast cancers in this population. South Africa has the largest population of people with HIV in the world. This study aims to evaluate the association between HIV status and the proportion of patients with breast cancer with the triple-negative subtype., Methods: We did a cross-sectional analysis of case-only data from the South African Breast Cancer and HIV Outcomes (SABCHO) study, a prospective cohort study recruiting patients with newly diagnosed breast cancer at six public hospitals in South Africa. We analysed data from patients who enrolled in SABCHO between Jan 1, 2015, and Jan 18, 2022. Women aged 18 years or older with newly diagnosed and histologically confirmed invasive breast cancer were eligible. Participants were classified as HIV-positive or HIV-negative by use of an ELISA-based HIV test done at the time of enrolment. We developed multivariable logistic regression models to test for an association between HIV status and the proportion of triple-negative relative to non-triple-negative breast cancers while adjusting for demographic and reproductive risk factors., Findings: Of the 4122 patients enrolled in the SABCHO cohort within our study timeframe, 239 patients were excluded due to unknown breast cancer subtype (n=141), HIV status (n=97), or race (n=1). 3883 women with breast cancer were included in the study, of whom 637 (16·4%) had triple-negative breast cancer, 894 (23·0%) were HIV-positive, and 186 (4·8%) had triple-negative breast cancer and HIV. Triple-negative breast cancer accounted for 186 (20·8%) of 894 breast cancers among women who were HIV-positive and 451 (15·1%) of 2989 breast cancers among women who were HIV-negative (p<0·0001). In the fully adjusted logistic regression model, HIV-positive status was associated with an increased proportion of triple-negative breast cancer (adjusted odds ratio [OR] 1·39, 95% CI 1·12-1·74, compared with women who were HIV-negative). When compared with women who were HIV-negative, the association between HIV-positive status and the proportion of triple-negative breast cancer was strongest among the subgroup of women with a duration of HIV infection of 2 years or longer (1·57, 1·23-2·00) and those on antiretroviral therapy (ART; 1·47, 1·16-1·87)., Interpretation: Patients with breast cancer and chronic HIV who are on ART are more likely to have triple-negative breast cancer than patients with breast cancer without HIV. This association is independent of age, race, and reproductive factors., Funding: US National Institutes of Health, University of the Witwatersrand, South Africa Medical Research Council Common Epithelial Cancers Research Center, Conquer Cancer Foundation, and Varmus Global Scholars Fund., Competing Interests: Declaration of interests AIN reports a consulting or advisory relationship with Otsuka, United Biosource Corp, Hospira, Value Analytics, Merck, Organon, and GSK; is on the Scientific Advisory Board for EHE Intl; and received research funding from Otsuka. YSP reports ownership interest in Pfizer and a consulting or advisory relationship with BMS and Janssen. PR reports clinical trial funding to their institution from Merck, Roche, Pfizer, GSK, Jansen, AstraZeneca, ImmunityBio, and Amgen. All other authors declare no competing interests., (Copyright © 2024 World Health Organization. Published by Elsevier Ltd. This is an Open Access article published under the CC BY NC ND 3.0 IGO license which permits users to download and share the article for non-commercial purposes, so long as the article is reproduced in the whole without changes, and provided the original source is properly cited. This article shall not be used or reproduced in association with the promotion of commercial products, services or any entity. There should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.)

Objectives: Recent mpox outbreaks highlight diverse transmission modes, with sexual behavior prominent in China's IIb strain. Nevertheless, despite HPV being a common sexually transmitted pathogen, there is a paucity of research into its coexistence and genotype distribution within this patients population., Methods: We conducted a study at the Third People's Hospital of Shenzhen from May to September 2023. We collected information on mpox patients, including their sociodemographic and clinical characteristics. Anal swabs were collected for HPV genotyping., Results: Among 73 MSM mpox cases, HIV positivity was 56.2 % (41/73) and HPV positivity 80.4 % (41/51). Multiple HPV infections were prevalent (56.9 %, 29/51), especially among HIV-positive (93 %, 27/29). HPV16 (29.3 %, 12/41) was the most common high-risk genotype, followed by HPV59 (26.8 %, 10/41), HPV42 (19.5 %, 8/41), HPV6 (14.6 %, 6/41), and HPV54 (14.6 %, 6/41). HPV infection was significantly associated with HIV infection (p = 0.001). Additionally, HIV infection (p = 0.001) and PCR-detected positive sites for mpox (p = 0.047) were associated with high-risk HPV infection., Conclusions: In this study, most of the mpox patients were found to be infected with HPV, mostly with high-risk types and multiple infections. Therefore, it is strongly recommended that mpox-infected individuals intensify HPV-related screening, prevention, and treatment measures., Competing Interests: Declaration of Competing Interest The authors declared that they have no conflicts of interest to this work. We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Identifying the prevalence and risk factors of secondary human immunodeficiency virus (HIV) transmission from people living with HIV (PLWH) to other people is crucial for ending the HIV epidemic. However, the data among antiretroviral therapy (ART) patients is limited. This study aims to assess the prevalence and risk factors of secondary HIV transmission among PLWH receiving ART by longitudinal molecular networks in China. In this study, the prevalence of secondary HIV transmission was 10.8%. The R 0 was greater than 1 from 2017 to 2021 and peaked in 2019. PLWHs who were male sex, older age, engaged in condomless sex, experienced higher ART follow-up viral load, experienced ART medical omissions, infected with non-CRF01&#95;AE subtype, and self-reported sexually transmitted infections (STIs) at HIV diagnosis increased the risk of secondary HIV transmission. However, those participants with higher education were less likely to be involved in secondary HIV transmission. The diagnostic age of the participants was nonlinearly associated with the risk of secondary HIV transmission, with a cutoff value of 43.13 years indicating a higher risk of secondary HIV transmission for patients diagnosed at or above this age. This study revealed substantial secondary HIV transmission and persistent HIV expansion among local PLWH, highlighting the necessity of enhancing viral load monitor, promoting adherence to ART, and promoting safe sex practices, particularly among older adults with HIV, to mitigate secondary HIV transmission.

Background: Paediatric tuberculosis leads to more than 200 000 deaths annually. We aimed to investigate the incidence of Mycobacterium tuberculosis infection and tuberculosis disease in the first decade of life in the Drakenstein Child Health Study (DCHS), a South African cohort in a community with high tuberculosis and HIV incidence., Methods: In this prospective birth cohort study, we enrolled pregnant women aged 18 years or older who were between 20 and 28 weeks' of gestation in a peri-urban setting outside of Cape Town, South Africa. We followed up their children for tuberculosis until age 10 years. To measure M tuberculosis infection tuberculin skin tests were administered to children at age 6 months, 12 months, and then annually in children with a negative test, and at the time of a lower respiratory tract infection. Tuberculin skin test conversion was defined by an induration reaction of 10 mm or more. To measure tuberculosis disease, active surveillance was done throughout follow-up. Each episode of presumed tuberculosis disease was investigated using sputum induction, tested with Xpert MTB/RIF and liquid culture for M tuberculosis. Survival analyses were performed and multivariable Cox regression was used to measure factors associated with M tuberculosis infection or disease., Findings: Between March 5, 2012, and March 31, 2015, 1137 women and their 1143 children (248 [21·7%] of 1143 children were HIV-exposed, two [0·2%] children with HIV) were included in the analysis. Children were followed up for 8870 person-years (median follow-up 9·1 years [IQR 8·2-10·2]). The annual risk of tuberculin conversion during follow-up was 6·6 infections per 100 person-years (95% CI 5·8-7·3) but ranged from 4-9 infections per 100 person-years over the follow-up period. 98 children developed tuberculosis (1105 cases per 100 000 person-years; 95% CI 906-1347). The cumulative hazard of tuberculin conversion was 36% (95% CI 32-41) at age 8 years and the cumulative hazard of tuberculosis disease was 10% (8-12) at age 10 years. Preventive treatment was associated with a reduction in tuberculosis disease among children who had tuberculin conversion (adjusted hazard ratio 0·23 [95% CI 0·12-0·47]). Most cases of tuberculosis disease (78 [79%; 95% CI 69-86] of 98 children) occurred among children who had tuberculin skin test conversion but were not administered preventive treatment., Interpretation: In this prospective South African birth cohort, M tuberculosis transmission was consistently high throughout the first decade of life leading to approximately 10% of children developing tuberculosis disease. A multipronged approach to decrease paediatric tuberculosis is needed that combines preventive treatment for children at risk, reducing community M tuberculosis transmission, and active case finding., Funding: Bill & Melinda Gates Foundation, Medical Research Council South Africa, and National Research Foundation South Africa., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Oncogenic human papillomavirus (HPV) types are linked to anal cancer, with elevated risk among men who have sex with men (MSM), especially men with HIV. Data on HPV-related malignancies in the Middle East and North Africa (MENA) region is scarce. This study aims to assess anal HPV strains, dysplasia, and sexually transmitted infections (STIs) among asymptomatic MSM with HIV in Lebanon., Methods: We conducted a cross-sectional study with 38 participants who completed questionnaires on socio-demographics, HIV-related data, and STI history. Anoscopy, anal Pap smears, and PCR for HPV and STIs were performed., Results: HPV was detected in 34 of 38 samples (89%), with 91% having multiple strains. HPV16 was the most common strain (56%). Eighteen percent had a concomitant bacterial anal STI. Most participants lacked awareness of anal dysplasia and cancer risk, with only 29% vaccinated against HPV., Conclusion: This study highlights high HPV prevalence and low awareness among men with HIV in Lebanon. The findings underscore the need for improved HPV education, vaccination, and routine screening in this population. Further research is needed to address barriers to comprehensive HIV and STI care in the region.

Background: We identified the uptake of people living with HIV (PLWH) using health-screening services and compared the screening rate with the general population, to identify factors associated with the use of screening services by PLWH., Methods: This population-based study used data from the Korean National Health Insurance, a single mandatory health insurance system covering all residents. The uptake rates for screening for general health, gastric cancer, and colorectal cancer, which were provided by a national health screening program with free of charge or minimal cost in Korea from 2010-2020. Factors associated with general health, gastric cancer, and colorectal cancer screening were also explored., Results: Screening uptake rates for general health, gastric cancer, and colorectal cancer in PLWH increased from 2010-2019 but decreased in 2020. The standardized screening ratio showed lower screening rates for general health, gastric cancer, and colorectal cancer in PLWH with 0.80 (95 % confidence interval (CI) = 0.77-0.83), 0.64 (95 % CI = 0.61-0.67), and 0.67 (95 % CI = 0.64-0.71) in 2019. Increased age, Charlson Comorbidity Index, and years since HIV diagnosis were associated with increased screening uptake in PLWH. Otherwise, PLWH recipients of medical aid programs received less for each screening compared to PLWH who paid insurance premiums higher than 50 %. An increased medication possession ratio of highly active antiretroviral therapy was associated with decreased general health and gastric cancer screening uptake but increased colorectal cancer screening uptake., Conclusions: Significant disparities in health-screening uptake were observed in PLWH compared to the general population in a nationwide organized screening setting without cost barriers., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to disclose., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

This study investigates the predictors of consistent condom use among male construction workers in South Africa who reported concurrent sexual relationships with regular partners, casual partners, and sex workers over a 3-month period. A cross-sectional survey was used to collect data from a convenience sample of 450 male workers across 18 construction work sites in the Western Cape province. Of these, 245 (54%) indicated that they had engaged in sex with all three partner types during the 3-month study period. Hierarchical multiple linear regression was then used to assess consistent condom use as a function of demographic, experiential, behavioural and cognitive characteristics. Three statistically significant predictors of consistent condom use were identified: perceived control over condom use (β = 0.252, p  < 0.001), positive attitude toward condom use (β = 0.154, p  < 0.05) and fear of HIV infection (β = 0.121, p  < 0.05). These findings highlight the high prevalence of sexual concurrency among study participants. It also suggests that amid declining condom use, interventions which focus on enhancing an individuals' condom application skills and efficacy, that foster positive attitudes toward condom use and that strategically incorporate fear-based messaging within a multilevel framework may potentially increase condom use among individuals in concurrent sexual relationships.

Although new pediatric human immunodeficiency virus (HIV) infections have declined in the Asia-Pacific region, coverage of interventions to prevent vertical HIV transmission remains inconsistent. The TREAT Asia pediatric HIV cohort includes data from ∼7700 children and adolescents with HIV (90% perinatally acquired) who have been under care at 18 centers in six Asian countries. Research on their HIV treatment outcomes has been complemented by studies on coinfections and comorbidities. These studies have shown that greater attention is needed to support and sustain clinical and social outcomes as children with perinatal HIV age into adulthood and transition to adult HIV care., Competing Interests: Disclosure A. H. Sohn receives program funding to her institution from ViiV Healthcare, United States and United Kingdom. The other authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Managing human immunodeficiency virus (HIV) during pregnancy requires attention to psychosocial aspects of maternal health in addition to providing medical and obstetric care. Ideal care plans promote sustained HIV suppression and optimize maternal health prior to conception. Engagement with maternity services creates opportunities to support women with HIV to remain engaged in life-long care, monitor their health frequently, screen for co-morbid conditions, and develop a personalized antiretroviral therapy adherence strategy. This article summarizes antiretroviral drug use in pregnancy, pregnancy outcomes in women with HIV, and the key elements of providing holistic care., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Despite increased uptake of antiretroviral therapy (ART) among pregnant people living with human immunodeficiency virus (HIV), vertical transmission remains the most important route of pediatric HIV acquisition. The numbers of HIV acquisitions in infancy have remained alarmingly stagnant in recent years. It is evident that additional strategies that can synergize with ART will be required to end the pediatric HIV epidemic. In this review, we discuss the potential for immune-based interventions that can be administered in conjunction with current ART-based strategies to the birthing parent for prevention of vertical transmission of HIV-1, and the potential challenges associated with each approach., Competing Interests: Disclosure S.R. Permar serves as a consultant to Moderna, Merck, Pfizer, Dynavax, and GSK vaccine programs for CMV, and leads sponsored research programs with Moderna, United States, Dynavax, and Pfizer, United States on CMV vaccines. All other authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The clinical trial networks that included a maternal-child focus have evolved since first funded by NIH in the 1990s. Since then, US domestic and international sites were combined into one network, with a focused agenda on therapeutics (for both prevention and treatment), human immunodeficiency virus (HIV) cure, tuberculosis, and complications of HIV, largely specific to the brain. Key to the success of the network has been a strong partnership with the community, collaborations with industry and other strategic partners, and recognition that one size does not fit all when it comes to antiretrovirals, diagnosing and treating TB, and other treatments for our populations., Competing Interests: Disclosure Dr S. Nachman has nothing to disclose., (Copyright © 2024 The Author. Published by Elsevier Inc. All rights reserved.)

The Penta Network has made significant strides in pediatric human immunodeficiency virus (HIV) research, initially focusing on clinical trials for children in Europe, before expanding globally to countries with high HIV prevalence. Key contributions include the ODYSSEY trial, which established dolutegravir as a superior treatment for children and the Early-treated Perinatally HIV-infected Individuals: Improving Children's Actual Life with Novel Immunotherapeutic Strategies consortium, aimed at developing strategies for HIV remission. The ongoing empirical and thrive projects address advanced HIV disease, particularly severe pneumonia and postdischarge mortality in children. Going beyond clinical trials, the Penta Network also plays a key role in bringing stakeholders and industry together to achieve better antiretroviral formulations for children., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Since the first reported cases of perinatally acquired human immunodeficiency virus (HIV) in 1982, a generation born with HIV has reached adulthood. The authors conducted a scoping review of PubMed and Google Scholar for articles published between January 2000 and June 2023 to assess the long-term, multisystem health outcomes of this population. Long-term health outcomes studied in this population pertain to the effects of perinatal HIV (PHIV) infection and life-long antiretroviral therapy on the endocrine, reproductive, psychosocial, neurobehavioral, immunologic, and cardiovascular systems. Holistic health of all body systems should be considered in the long-term care of people with PHIV., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Despite advances in human immunodeficiency virus (HIV) prevention, new pediatric HIV infections continue, necessitating optimized and simplified antiretroviral treatment (ART) regimens tailored for children. Advances in treatment options have been made possible by the availability of child-friendly fixed-dose formulations with decreased dosing frequency, especially in low- and middle-income countries. Ongoing work to improve ART options for neonates and supporting the shift toward long-acting ART for children and adolescents remains a priority. Achieving the UNAIDS goal of 95:95:95 for children will require a comprehensive and holistic approach that addresses both the biomedical and social challenges of managing children with HIV., Competing Interests: Disclosure We wish to confirm that there are no known conflicts of interest associated with this publication, and there has been no significant financial support for this work that could have influenced its outcome., (Copyright © 2024 Elsevier Inc. All rights reserved.)

While tuberculosis (TB) is an ancient disease, its global prevalence and concomitant human immunodeficiency virus (HIV)-1 infection have hampered efforts at effectively controlling TB in children in many countries where these 2 pandemics coexist. This review briefly discusses the current status of TB prevention strategies including preventative regimens designed to prevent the progression of latent TB infection to active disease, current recommendations regarding treatment of TB disease, and the problematic nature of diagnosing TB in children living with HIV. Promising recent data regarding novel diagnostic techniques that rely upon detecting Mycobacterium tuberculosis molecular components in blood will be reviewed., Competing Interests: Disclosure The author has nothing to disclose. Nanopin Biotechnologies: Research funding., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: This study aims to predict the number of undiagnosed HIV cases at the ZIP Code-level in Atlanta, Georgia, based on publicly available information., Study Design: Statistical modeling., Methods: We fitted a Bayesian hierarchical Binomial model to county-level estimates of the passive-surveillance-system. The denominator was the true total HIV cases arising from a Negative Binomial distribution. The trial probability, known as ascertainment probability, depended on socio-economic determinants of HIV, retained via feature-selection algorithms. Data were obtained from CDC's HIV report for End of the HIV Epidemic and the American Community Survey. The prediction model was assessed out-of-sample in Georgia counties. We combined socio-economic data with the posterior predictive distribution of the coefficients to predict the mean ascertainment probability and total HIV cases at the ZIP Code-level. These estimates were spatially smoothed and aggregated at the county-level for secondary validations., Results: The county-level model showed good mixing properties and predictive accuracy. The mean ascertainment probability calibrated to the ZIP Code-level varied from 78.4% (95% credible interval: 24.4%-99.3%) to 93.8% (95%CI: 80.6%-99.8%). Further, the predicted undiagnosed HIV cases ranged between 12 (95%CI: 6-19; ZIP Code 30322) to 1603 (95%CI 1209-1968; ZIP Code 30318)., Conclusions: Our findings provide a more complete picture of the relative burden of HIV across ZIP codes. Such information can be used by Local Health Departments to identify underserved areas and allocate resources accordingly. Furthermore, our methodological approach can be applied to complement the information obtained from passive surveillance, especially when more resource-intensive approaches are not available or are unfeasible to employ., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: Opt-out Emergency Department blood borne virus (EDBBV) screening was introduced at the Royal Free Hospital under the NHSEI (NHS England and NHS Improvement) programme to expand opt-out testing in local authority areas with high HIV prevalence. This initiative was part of the "Toward Zero" policy towards ending HIV transmission in England by 2030., Methods: All patients attending the Royal Free Hospital Emergency Department (ED) aged 16 and over were screened for blood borne viruses (HIV/HBV/HCV) unless they opted out. We looked at HIV data from patients seen in ED between the initiation of EDBBV testing on the 12 th of April and 12 th of August 2022. Hepatitis B and C data was reviewed in a separate study., Outcome: A total of 12,208 samples from 10,641 patients were screened for HIV. Amongst these samples there were 88 which were positive, giving a seroprevalence of 0.84 %. There were 48 patients who were already known to local HIV services, 35 were known to HIV services outside of our Trust and 5 were new diagnoses., Conclusion: Our results confirmed our local HIV prevalence to be very high, as per the UK Health Security Agency and supports the need for HIV testing. Opt-out ED BBV screening has been a highly effective method for identifying people living with HIV who are unaware of their status., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Research has found that offering HIV self-testing (HIVST) to truckers in Kenya increased testing rates at baseline but not over 6-month follow-up. We explored possible explanations based on the Health Belief Model by assessing HIV risk perception, self-efficacy, and fatalism as possible effect modifiers of the impact of offering HIVST (intervention n = 150) versus standard of care (SOC n = 155) on 6-month testing on the multiplicative and additive scales using log binomial and linear binomial regression and stratifying on significant modifiers. We found significant interaction between the intervention and fatalism on both the multiplicative (p = 0.020) and additive (p = 0.020) scales. In the stratified models, the HIVST intervention was associated with higher HIV testing among participants with low fatalism but lower testing among those with high fatalism (risk ratio [RR] = 1.30, p = 0.065 versus RR = 0.74, p = 0.072; risk difference [RD] per 100 = 14.00, p = 0.080 versus RD=-14.69, p = 0.086). Truckers in Kenya are described as being highly fatalistic, feeling lack of control over their lives and health. We found that fatalistic views negated the potential benefit of offering HIVST to truckers. For HIVST to have an impact among truckers, psychosocial interventions may be needed that address fatalistic views., Competing Interests: Declarations. Competing Interests: The authors have no competing interests to declare. Ethical Approval: The study protocol was reviewed and approved by the City University of New York Institutional Review Board, the Kenya Medical Research Institute Ethics Committee, and the University of KwaZulu-Natal Biomedical Research Ethics Committee. Consent to Participate: All study participants provided signed informed consent prior to data collection. Declaration of generative AI in scientific writing: Generative artificial intelligence (AI) and AI-assisted technologies were NOT used in the writing process., (© 2024. The Author(s).)

Objectives: The prevalence and risk factors of SARS-CoV-2 infection among unvaccinated people living with HIV (PWH) are not well understood, and the protective role of tenofovir remains controversial. This study aimed to assess the SARS-CoV-2 prevalence and associated risk factors among unvaccinated PWH, and to evaluate the impact of tenofovir., Methods: We conducted as a cross-sectional study between November 2020 and May 2021. Plasma samples from 4,400 of 5,476 PWH were tested for total antibodies, IgG, IgM, and IgA., Results: Among the participants (median age 48 years, 84% male), 92% had undetectable HIV viral loads and 5% had syphilis. The prevalence of SARS-CoV-2 infection was 18% (95% CI 17-19), with 1,180 individuals showing antibodies (IgG 13%, IgA 10%, IgM 11%). Of those seropositive for SARS-CoV-2, 67.5% were asymptomatic, 29% had mild disease, and 3.5% had severe/critical conditions. Risk factors included younger age, being female, men who have sex with men (MSM) status, non-European origin, and a history of syphilis. Neither antiretrovirals nor tenofovir provided protection against SARS-CoV-2 infection or COVID-19 disease., Conclusion: Ongoing surveillance and tailored interventions are crucial for at-risk PWH amid evolving SARS-CoV-2 variants. Tenofovir did not prevent SARS-CoV-2 infection or COVID-19., Competing Interests: Declaration of competing interests JMM has received consulting honoraria and/or research grants from Angelini, Contrafect, Cubist, Genentech, Gilead Sciences, Jansen, Lysovant, Medtronic, MSD, Novartis, Pfizer, and ViiV Healthcare, all outside the current work. DKN received consultation fees from OPIS and is an employee of Aetion Iberia, both outside the current work. All other authors declared no conflicts., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Investigation of explainable deep learning methods for graph neural networks to predict HIV infections with social network information and performing domain adaptation to evaluate model transferability across different datasets., Methods: Network data from two cohorts of younger sexual minority men (SMM) from two U.S. cities (Chicago, IL, and Houston, TX) were collected between 2014 and 2016. Feature importance from graph attention network (GAT) models were determined using GNNExplainer. Domain adaptation was performed to examine model transferability from one city dataset to the other dataset, training with 100% of the source dataset with 30% of the target dataset and prediction on the remaining 70% from the target dataset., Results: Domain adaptation showed the ability of GAT to improve prediction over training with single city datasets. Feature importance analysis with GAT models in single city training indicated similar features across different cities, reinforcing potential application of GAT models in predicting HIV infections through domain adaptation., Conclusion: GAT models can be used to address the data sparsity issue in HIV study populations. They are powerful tools for predicting individual risk of HIV that can be further explored for better understanding of HIV transmission.

To date, no studies comparing the prevalence of hepatitis E virus (HEV) infection between the general and human immunodeficiency virus 2 (HIV-2) populations are available. With the purpose of filling this gap, this prevalence was assessed in the HIV-2 population from central Portugal. HEV seropositivity was 19.4%, which did not differ significantly from that found in the matched control population, and was not associated with CD4 cell count, HIV-2 viral load, and geographic origin or travel history to regions considered highly endemic for HEV. The results suggest that HIV-2 is not a risk factor for HEV infection, neither for an increased occurrence of chronic HEV infection., Competing Interests: Declarations. Ethical approval: The study was approved by the Ethics Committee of the Faculty of Medicine of the University of Coimbra (062-CE-2019). Consent to participate: All individual participants included in the study provided written informed consent. Consent to publish: All individual participants consented to study data analysis for the purpose of publication. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Diabetes affects 4.5% of people living with HIV in Mexico. This study aims to describe the diabetes cascade of care (DMC) in people with HIV in a tertiary center in Mexico City., Methods: We conducted a single-center review of people with HIV aged over 18, using medical records of active people enrolled at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) HIV Clinic (HIVC). Our analysis focused on their last visit to describe the DMC, aiming to identify gaps in control goals. We included people who had a consultation within the 12 months preceding May 2020., Results: Out of the 2072 active people, medical records were available for 2050 (98.9%). Among these, 326 people (15.9%) had fasting glucose (FG) abnormalities, of which 133 (40.7%) had diabetes. The prevalence of diabetes among people with HIV was of 6.4% (133/2050). Regarding the DMC, the following proportions of people achieved control goals: 133/133 (100%) received medical care in the last 12 months, 123/123 (100%) had blood pressure (BP) <140/90 mmHg, 73/132 (55.3%) had LDL cholesterol (c-LDL) <100 mg/dl, 63/132 (47.7%) had FG <130 mg/dl, 50/116 (43.1%) had glycosylated hemoglobin (HbA1c) <7%. ABC goals (HbA1c <7%, c-LDL <100 mg/dl, BP <140/90 mmHg) were met in 28/109 (25.6%) people. 126/133 (94%) people with HIV achieved HIV-viral load <50 copies/mL., Conclusions: Despite the high rate of viral suppression among people with HIV and diabetes, significant challenges remain in achieving comprehensive diabetes control. These findings highlight the need for targeted interventions to improve metabolic outcomes and the overall management of diabetes in people with HIV.

There is a growing population of older people with HIV (PWH) in Uganda. Sleep problems disproportionately affect older people and PWH. This study aimed to estimate correlates of sleep health among older Ugandans (aged ≥ 50 years) with and without HIV, using data from the Quality of Life and Aging with HIV in Rural Uganda Study. We used the Pittsburgh Sleep Quality Index to assess sleep quality, duration, and efficiency. We fitted multivariable linear and logistic regression models to estimate the associations between sleep outcomes and variables selected based on the Senescent Sleep Model: age, HIV serostatus, loneliness, urbanicity, symptoms of depression and anxiety, and perceived stress. Of 556 participants, 271 were PWH and 285 were people without HIV (PWoH). There were no statistically significant differences in sleep outcomes by HIV serostatus. Of the total sample, most reported very good (32.79%) or fairly good sleep quality (49.37%). The mean sleep duration was 6.46 h (SD = 1.74). The mean sleep efficiency was 73.98% (SD = 19.52%) with 36.69% having optimal (≥ 85%) sleep efficiency. A positive depression screen was associated with worse sleep quality (adjusted odds ratio [aOR] = 0.21; 95% CI [0.12, 0.36]), shorter sleep duration (b=-0.44; 95% CI [-0.60, -0.28]), and worse sleep efficiency (aOR = 0.51; 95% CI[0.31, 0.83]). Interventions targeting depression may improve sleep among older Ugandans, independent of HIV serostatus. Longitudinal studies are needed to determine the potential bidirectionality of this relationship and elucidate pathways to support sleep health among older Ugandans., Competing Interests: Declarations. Conflicting Interests: ACT reports receiving a financial honorarium from Elsevier, Inc. for his work as Co-Editor in Chief of the Elsevier-owned journal SSM-Mental Health. The other authors declare no conflicts of interest., (© 2024. The Author(s).)

Poor mental health significantly impacts people with HIV (PWH) and those who drink alcohol. Limited data exist on the combined effects of social determinants of health (social vulnerability) on mental health in PWH with unhealthy substance use. We investigated the relationship between social vulnerability and poor mental health in PWH and whether this relationship differed by race/ethnicity. We conducted a cross-sectional analysis using data from the Boston ARCH Cohort among PWH with current or past unhealthy substance use. We created a 23-item social vulnerability index (SVI) using a deficit accumulation approach comprised of social determinants of health indicators. We estimated whether higher SVI score is associated with anxiety and depressive symptoms using logistic regression analysis. Among 251 participants with a mean age of 52 (SD = 10) years, 67.3% were male, 52% Black, 21% Hispanic, 19% White, and 73% unemployed. The SVI had a mean of 9.30 (SD = 3.4) with a 1.5-18 range. Nearly two in five persons reported past month heavy alcohol use and 35% illicit drug use. The prevalence of anxiety and depressive symptoms was 34.4% and 54.2% respectively. Higher SVI score was associated with anxiety symptoms (adjusted odds ratio [aOR] = 2.01, 95% confidence interval [CI] 1.46, 2.76, p ≤ 0.001), and depressive symptoms (aOR = 2.42, 95% CI 1.74, 3.36, p ≤ 0.001). Race/ethnicity did not moderate the relationship between SVI and each mental health outcome. SVI was significantly associated with poor mental health across racial/ethnicity groups in this cohort. Interventions that address social vulnerability may improve well-being and quality of life for PWH., Competing Interests: Declarations. Competing Interests: The authors have not disclosed any competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Rapid Start ensures that persons with HIV initiate antiretroviral therapy in less than seven days after diagnosis. Benefits of Rapid Start include timely linkage to medical care, viral suppression in a shorter time and improved retention to medical care. Despite these benefits, there is a slow uptake of Rapid Start, in New Jersey., Objective: Identify barriers to Rapid Start among New Jersey providers., Methods: An electronic survey, consisting of 28 questions, with the following domains was administered to New Jersey providers, using Qualtrics: provider and practice characteristics (10), knowledge (1), barriers (8) and attitudes to diverse patient types (9). The results were analyzed using descriptive statistics due to small numbers over strata. Approval to conduct the survey was obtained from the William Paterson University Institutional Review Board., Results: There were 69 responses to the survey. Providers were at least 45 years old (48%), female (44/60, 73%), nurse practitioners or physician assistants (41/59, 69%). Overall, 44/63 (70%) providers did not correctly identify that integrase inhibitors had the lowest prevalence of transmitted drug resistance. Newly diagnosed patients were referred for medical care in 37 (65%) of the medical sites. Only providers from Ryan White (federally funded clinics for persons with HIV) (64%) and non-Ryan White (73%) public sites reported co-located HIV testing sites. Seventy percent of medical sites offered same-day medical appointments. However, a lower proportion of private (62%), public Ryan White (55%), and other medical sites (36%) offered same-day appointments compared to public non-Ryan White sites (82%). Despite having staff available 40 h per week (91%), only 55% of Ryan White sites offered extended office hours in the early morning, evenings, or on Saturdays. When compared to providers in public non-Ryan White sites, a lower proportion of providers in Ryan White sites were comfortable doing Rapid Start either on the day of or within one week of diagnosis, 82% and 72%, respectively, or starting antiretroviral therapy before genotype results were available, 55% and 46%, respectively. Overall, providers were not comfortable with Rapid Start for persons engaging in condomless sex (60%)., Conclusions: Policy and administrative decisions are needed to eliminate barriers at the clinic level. An HIV clinical scholar program, to increase providers knowledge, may increase uptake of Rapid Start.

Cluster analysis of HIV sequence can provide insights into viral transmission patterns in border regions. This study aims to illuminate the HIV-1 subtype distribution and transmission dynamics among newly diagnosed individuals in Dehong prefecture, a region along the China-Myanmar border. Among 948 participants with pol gene sequences, 36 HIV-1 subtypes were identified, with URFs (18.8%, 178/948) being the dominant strain, followed by CRF01&#95;AE (18.5%, 175/948) and CRF07&#95;BC (10.9%, 103/948). Additionally, 287 sequences (30.3%, 287/948) were grouped into 91 clusters, 31 of which contained both Chinese and Burmese individuals. Multivariable logistic regression indicated that men who have sex with men (MSM), CD4 + cell count of 200∼499, and 500 cells/μl and above, and CRF01&#95;AE were risk factors for entering the network. Through the Chord diagram, we found frequent transmission relationships among heterosexual China male group, especially those over 35 years of age. Additionally, the correlation between heterosexual Myanmar female group and heterosexual China male group among cross-risk groups deserved to be emphasized. Furthermore, the network exhibited a growing trend over time, with the largest active transmission cluster identified in Ruili county. In conclusion, the HIV-1 subtype landscape in Dehong has become increasingly complex, and the region has faced risks of transmission from both domestic and international sources. Targeted intervention strategies should be implemented for MSM, heterosexual Chinese middle-aged and elderly men, and heterosexual Burmese young adults to mitigate these risks. These findings provided evidence-based insights for local government to formulate coordinated transnational intervention approaches.

The introduction of the undetectable equals untransmittable (U = U) statement significantly reduces HIV stigma and provides an empirical basis for achieving "zero transmission." U = U messaging has gained increasing support and is well-developed in several countries. However, the current status of accurate knowledge of U = U and its associated factors among men who have sex with men (MSM) in China remians unclear. We conducted a cross-sectional survey among MSM recruited in Chengdu, China, from March to May 2022 to investigate the percentage of those who knew U = U accurately and to explore associations between sexual risk behaviors, HIV testing, socio-behavioral measures, and accurate knowledge of U = U. Of 497 MSM included in our study, 23.4% (116/497) had accurate knowledge of U = U. More than half of the participants (63.2%, 314/497) reported multiple sexual partnerships, 15.7% (78/497) used substance during sex, 37.4% (186/497) reported inconsistent condom use, and 76.1% (378/497) took HIV testing in the past six months. Factors associated with accurate knowledge of U = U among MSM included substance use during sex (multivariate odds ratios ORm = 1.96; 95%CI: 1.13-3.41), HIV status tested in the last six months (ORm = 2.07; 95%CI: 1.14-3.77), HIV-related literacy (ORm = 1.41; 95%CI: 1.14-1.74) and perceived higher risk of HIV infection (ORm = 1.11; 95%CI: 1.02-1.21). The findings indicate that great challenges need to be conquered for U = U achievement among the MSM population in Chengdu, China. Intervention strategies should be prioritized in health education on high-risk behaviors such as group sex and substance use, information provision and counseling of U = U in HIV testing services, and encouraging U = U knowledge sharing among MSM with their partners in China., Competing Interests: Declarations. Ethics Approval: This study was approved by the Ethics Committee of Health Science Center of Peking University (Ethics approval number: IRB00001052-22167). Consent to Participate: Informed consent was obtained from all individual participants included in the study. Competing Interests: The authors have no competing interests to declare that are relevant to the content of this article., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Much of the research on the effects of syndemics on HIV outcomes has utilized an additive approach. However, interaction effects may better account for syndemic synergy than an additive approach, but it remains difficult to specify interaction effects without empirical guidance. We sought to systematically compare additive and interaction effects approaches to modeling the effects of syndemic problems on antiretroviral therapy (ART) using empirically specified interaction terms. Participants were 194 people with HIV (PWH) who received HIV care in Khayelitsha, South Africa. In a series of linear regression models, we examined ten syndemic problems: depression, alcohol use, intimate partner violence (IPV), post-traumatic stress, social anxiety, substance use, food insecurity, poverty, housing instability, and structural barriers to care. Depression, substance use, and food insecurity were selected for interaction terms based on a prior network analysis, which found these problems to be most central. The additive models did not produce statistically significant findings. However, the interaction effects models yielded significant interaction terms in both the full model and a parsimonious model. There was a statistically significant effect of the interaction between depression and food insecurity on ART adherence (b = 0.04, Robust SE = 0.02, 95%CI [0.001-0.08], p = .012). This pattern of results was replicated in the parsimonious model. Findings suggest that when feasible, interaction effects approaches may be a helpful syndemic modeling technique. Results may inform future intervention targets, such as depression and food insecurity, and the importance of addressing both structural and psychosocial syndemic problems., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Female sex workers (FSWs) face a significant and persistent risk of contracting HIV. While evidence indicates high rates of pregnancy among FSWs in sub-Saharan Africa, studies on the coverage of HIV testing during pregnancy among them are sparse. The objective of this study was to estimate the prevalence of prenatal HIV testing and determine the associated factors among FSWs in Nigeria., Methods: This study was a secondary data analysis of the 2020 Integrated Biological & Behavioural Surveillance Survey (IBBSS) among key populations in Nigeria. We performed weighted descriptive statistics and multivariable binary logistic regression to assess the associations between prenatal HIV testing and sociodemographic characteristics, risk behaviours, HIV knowledge and risk awareness, stigma, and access to healthcare., Results: Of the 1598 FSWs included in the study, 71.0% (95%CI = 68.7%-73.1%) had HIV testing during their last pregnancy. In the regression model, tertiary education (aOR = 2.98, 95%CI = 1.48-6.01), consistent condom use (aOR = 1.95, 95%CI = 1.39-2.75), and receipt of antenatal care (aOR = 35.52, 95%CI = 23.40-53.92) were associated with higher odds of prenatal HIV testing. Compared with the South South geopolitical zone, FSW residing in South East (aOR = 3.38, 95%CI = 1.80-6.35), South West (aOR = 2.97, 95%CI = 1.88-4.68), North Central (aOR = 4.43, 95%CI = 2.80-7.01), North East (aOR = 4.22, 95%CI = 1.64-10.34), North West (aOR = 4.40, 95%CI = 2.59-7.48) had higher odds of reporting prenatal HIV testing. However, being a non-brothel-based FSW (aOR = 0.66, 95%CI = 0.47-0.92), and engaging in sex work during pregnancy (aOR = 0.45, 95%CI = 0.31-0.66) were significantly associated with lower odds of prenatal HIV testing., Conclusions: The prenatal HIV testing among FSWs in this study was suboptimal. The results highlight the need to improve access to antenatal care and implement regional and typology-specific interventions to bridge the gap in prenatal HIV testing among FSWs., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Humanitarian crises-natural or human-made events that can threaten communities' health, safety, security, and well-being-may affect the HIV epidemic dynamics. Common aspects of humanitarian crises such as poverty, powerlessness, disruptions to the health systems, and social instability can contribute to a person's vulnerability to HIV infection through increased risk behaviors and limited access to health services. Guided by the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) reporting guidelines, we conducted a scoping review of literature published in English between January 1990 and March 2022 to characterize the global evidence of modifiable and non-modifiable factors for HIV acquisition in the context of humanitarian crises. We systematically searched, screened, and synthesized literature from MEDLINE, Embase, Global Health (all accessed via Ovid), and Scopus, and also grey literature through websites of humanitarian agencies and relevant non-government organizations, the International AIDS Society's abstract databases, and Google Scholar. We considered studies presenting empirical data on HIV prevalence, incidence, or risk factors in humanitarian crises-affected populations, including refugees, asylum seekers, and internally displaced persons. Forty-nine studies met the inclusion criteria. The majority of studies were quantitative (n = 43, 87.8%) and cross-sectional (n = 37, 75.5%) in design. Most were single-country studies (n = 43, 87.8%) and conducted in Sub-Saharan Africa (n = 31, 63.3%). We identified 5 non-modifiable factors for HIV acquisition (i.e., age, gender, location, place of birth or origin, and ethnicity) and 60 modifiable factors that we further classified into five categories, namely 18 policy and structural, 9 sociocultural, 11 health and mental health, 16 sexual practice, and 6 humanitarian crisis-related traumatic event factors. Within the modifiable categories, factors that were most often investigated were education level, marital status, sexually transmitted infection diagnosis, condom use, and experience of rape or sexual trauma, respectively. Informed by the findings, we applied the social-ecological model to map the identified multidimensional factors associated with HIV acquisition at the levels of individual, social and sexual networks, community, public policy, and the context of humanitarian crises. The current review provides a comprehensive, global analysis of the available evidence on HIV prevalence, incidence, and risk factors in humanitarian crises and implications for potential programs and research. Future research is warranted to further understand the directionality of the non-modifiable and modifiable factors affecting HIV acquisition, and the multilevel barriers and facilitators to the uptake of HIV prevention strategies in the context of humanitarian crises. Such research can generate actionable evidence to inform the development of ethical, trauma-informed, and culturally appropriate HIV prevention interventions in humanitarian settings., Competing Interests: Declarations. Conflict of interest: The authors have no conflicts of interest to disclose. Ethical Approval: Not applicable. Consent to Participate: Not applicable., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Despite wide availability of prevention and treatment services, including the ongoing roll-out of pre-exposure prophylaxis (PrEP), the HIV epidemic is not under control in Belgium. Hence, there is a recognized need to improve case finding and early diagnosis to curb the further spread of HIV more effectively. The objective of the present study was to improve insight into the profiles of persons recently infected with HIV-1 and on their prevention trajectory. Between May 2018 and December 2022, we selected persons diagnosed in Belgium within three months of the presumed infection date. We then analyzed information collected using a questionnaire covering topics on HIV testing, sexually transmitted infections (STIs), PrEP use, sexual behavior, partner notification and substance use. The data obtained were analyzed alongside information derived from phylogenetic cluster analysis of the viral source of infection. A total of 93 persons with a recent HIV-1 infection completed the questionnaire, the majority (74%) being MSM, 14% were heterosexual women and 12% were heterosexual men. Nearly one-third of participants engaged in sexual activity with an average of 2 to 5 casual partners around the presumed time of infection. A significant percentage reported frequent substance use during sexual activity (65%), being previously diagnosed with STI (65%) and using condoms infrequently (44%). 63% reported a testing frequency of at least one HIV test per year before being diagnosed and 46% notified their previous sex partner(s) after being diagnosed. Over 20% of respondents (including 11 MSM, 4 heterosexual men and 5 heterosexual women) reported exclusive sexual activity with their steady partner. Eight participants (9%, all MSM, 75% born outside of Belgium) reported PrEP use in the past. No significant differences in behavioral characteristics were found between persons who were part of a local transmission cluster (48%) and persons that were not part of a cluster (47%). The study results revealed that the majority of persons diagnosed early with HIV-1 infection in Belgium exhibited characteristics corresponding to a high-at-risk population and were aware of this risk, as evidenced by a high testing frequency. However, partner notification rates were low and use and awareness of PrEP limited. A notable group of persons not corresponding to the high-risk profiles was also identified. This information may help to expose missed opportunities for prevention and contribute to enhancing the implementation of future prevention measures., Competing Interests: Declarations. Conflict of Interest: The authors declare no conflict of interest, (© 2024. The Author(s).)

This clinical trial examined the individual and combined effects of three different approaches to reducing alcohol misuse among a sample of sexual minority men (SMM) with HIV. Specifically, we used a 2 × 2 × 2 randomized factorial design to compare: (a) behavioral intervention based in motivational interviewing (MI) vs. brief intervention (BI), (b) interactive text messaging (ITM) for alcohol use vs. no ITM, and (c) extended intervention (EI) length of nine months vs. a one-month intervention duration. Participants (N = 188) were SMM with HIV and alcohol misuse recruited in Miami, FL, and Boston, MA. Participants were randomized to one of eight intervention combinations and assessed at 6- and 12-month follow-ups. Large reductions of over 50% in drinks per week and heavy drinking days were observed in all conditions at follow-up. Those who received ITM, compared to those who did not, reported significantly lower drinks consumed per week at 6 and 12 months (incidence rate ratios = 0.73 [95% CI = 0.57, 0.90] and 0.72 [95% CI = 0.56, 0.87], respectively), and increased odds of cessation of alcohol misuse at 12 months, odds ratio = 1.46, 95% CI = 1.03, 2.08. Results provided no evidence of better alcohol use outcomes for either MI or EI relative to their comparison conditions, and no specific combination of intervention components demonstrated a notable benefit. This study suggests a two-session BI can effectuate substantial reductions in alcohol use in SMM with HIV and that adding one month of ITM can yield further improvements. Clinical Trials Number: NCT02709759., Competing Interests: Declarations. Ethical Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed Consent: Informed consent was obtained from all individual participants included in the study. Competing Interests: Each of the authors declare that they have no conflict of interest., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Treatment of opioid use disorder (OUD) with buprenorphine improves outcomes and mortality among people with HIV (PWH). However, engagement is low and is influenced by comorbidities. We examined the impact of patterns of co-occurring pain, substance use disorders (SUDs), and mental health diagnoses on buprenorphine initiation and retention in PWH. The Veterans Aging Cohort Study contained 7,875 patients (2,702 PWH and 5,173 without HIV) with new OUD clinical encounters (2008-2017). Buprenorphine initiation and retention were derived from prescription data. We identified patterns of co-occurring diagnoses (via ICD codes) and assessed the effects of class membership on both outcomes using latent class analysis and regression analyses. The mean age of patients was 55, 98% were male, 58% Black, 8% Hispanic, and only 8% initiated buprenorphine within 12 months of OUD diagnosis. Four classes of co-occurring diagnoses were identified: "Few Co-occurring Diagnoses" (42.3%); "Multiple Pain Conditions" (21.3%); "Pain + SUD" (18.4%) and "Pain + SUD + Mental Health" (18.0%). Patients in the "Pain + SUD" class and "Pain + SUD + Mental Health" class were significantly less likely to initiate buprenorphine and had 59% and 45% lower odds, respectively, of initiating buprenorphine compared with patients in the "Few Co-occurring Diagnoses" class; this effect did not vary by HIV status. Buprenorphine retention was not significantly associated with HIV status or class membership. However, Black Veterans were less likely to initiate or be retained in buprenorphine treatment. Higher comorbidity burden was negatively associated with buprenorphine initiation but not with retention. More research is warranted to determine other factors that may influence treatment retention., Competing Interests: Declarations. Competing Interests: Termeh Feinberg was supported as a contractor with the National Institutes of Health National Center for Complementary and Integrative Health. All other authors declare no potential conflicts of interest. Preliminary findings of this research study were presented at the American Society of Clinical Pharmacology and Therapeutics (ASCPT) Annual Meeting in Atlanta, GA in March 2023., (© 2024. The Author(s).)

Objectives: Campylobacter spp. has been reported to be a sexually transmissible enteric infection in men who have sex with men (MSM) since the 1980s causing an acute severe diarrhoeal illness and rarely an acute demyelinating polyneuropathy (Guillain-Barré syndrome). The aim of this review was to explore the factors seen in MSM with Campylobacter spp., Methods: We conducted a systematic review following PRISMA guidelines by searching 7 bibliographical databases in August 2024 for manuscripts in English. Initial screening was conducted by a primary author and then two authors conducted independent full-text reviews to determine the final eligible manuscripts. We only included manuscripts which explored factors seen in MSM with Campylobacter spp.. Two authors independently used the Joanna Briggs Institute critical appraisal tools to assess risk for bias. This review was registered with PROSPERO (CRD42023464803)., Results: 25 manuscripts met the inclusion criteria that included 265 MSM with Campylobacter spp.. This review has highlighted demographic factors (living with HIV, living in urban MSM districts, HIV negative MSM using HIV-PrEP), biological factors (antimicrobial resistant Campylobacter spp., having a concurrent or previous sexually transmitted infection [ Neisseria gonorrhoeae , Chlamydia trachomatis, Herpes simplex virus, Hepatitis C, Mpox] current/previous enteric infection including non-pathogenic parasites [ Shigella spp. , Giardia duodenalis , Cryptosporidium , Entamoeba histolytica, Salmonella spp. , Entamoeba hartmanii, Entamoeba coli, Endolimax nana, Iodamoeba butchlii ]) and behavioural factors (condomless receptive anal sex, oral-anal sex, oral genital sex, multiple/new sexual partners, using sex on premises venues and the internet to meet sexual partners) seen in MSM with Campylobacte r spp., Conclusion: This review has highlighted some important demographic, biological and behavioural risk factors seen in MSM with Campylobacter spp.. These data can be used to inform future public health interventions and clinical guidelines., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: To tackle the issue of late HIV diagnosis in the country, the Ministry of Health (MOH) in Oman introduced a national policy of routine opt-out HIV in medical admission units in September 2022. We hereby report the implementation and outcomes of this policy., Method: All patients aged 16-65 years admitted to a medical ward in secondary and local hospitals were offered an HIV test regardless of their symptoms by medical doctors, with training and support from HIV teams. A retrospective review for the period from September 2022 to September 2023 was conducted to determine the HIV testing rate and outcomes of those testing HIV seropositive., Result: Over 12 months, there were 23,399 admissions; 6889 had HIV tests. Thirty-two patients (0.46 %) were diagnosed with HIV; all of them were new diagnoses. Two cases were diagnosed during seroconversion. 12 cases had AIDS-defining illnesses. Four contacts were tested HIV positive. Twenty-five out of 28 alive patients are on ART., Conclusion: This is the first national policy of a routine opt-out HIV in medical admission units in the MENA region. Our experience showed that, even in low HIV prevalence and high HIV stigma settings, this policy is feasible, acceptable, and effective., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

HIV and substance abuse are common among young men, associated with a cluster of risk behaviors. Yet, most services addressing these challenges are delivered in setting underutilized by men and are often inconsistent with male identity. This cluster randomized controlled trial aimed to reduce multiple risk behaviors found among young men township areas on the outskirts of Cape Town, South Africa. Young men aged 18-29 years (N = 1193) across 27 neighborhoods were randomized by area to receive HIV-related skills training during either: (1) a 12-month soccer league (SL) intervention; (2) 6-month SL followed by 6 months of vocational training (VT) intervention (SL/VT, n = 9); or 3) a control condition (CC). Bayesian longitudinal mixture models were used to evaluate behaviors over time. Because we targeted multiple outcomes as our primary outcome, we analyzed if the number of significantly different outcomes between conditions exceeded chance for 13 measures over 18 months (with 83%, 76%, and 61% follow-up). Only if there were three significant benefits favoring the SL/VT over the SL would benefits be significant. Outcome measures included substance use, HIV-testing, protective sexual behaviors, violence, community engagement and mental health. Consistent participation in the SL was typically around 45% over time across conditions, however, only 17% of men completed SL/VT. There were no significant differences between conditions over time based on the number of study outcomes. These structural interventions were ineffective in addressing young men's substance abuse and risk for HIV.Clinical Trial Registration: This trial was prospectively registered on 24 November 2014 with ClinicalTrials.gov (NCT02358226)., Competing Interests: Declarations. Competing Interests: The authors declare that they have no competing interest. Ethical Approval and consent to participate:: The Institutional Review Boards (IRB) of the University of California, Los Angeles (UCLA; IRB no.14–001587) and Stellenbosch University (N14/08/116) approved the current study protocol (Version 3.0, 1 June 2018) and the study was registered with www.clinicaltrials.gov (NCT02358226)., (© 2024. The Author(s).)

Background: Abortion is a public health problem in Latin America and is more common among women living with HIV., Objective: to verify the incidence and factors associated with induced abortion in a cohort of women living with HIV assisted in a reference service for care for individuals with HIV/AIDS in Rio de Janeiro/Brazil., Methods: Prospective cohort during the period 1996-2016. We estimated the incidence of induced abortions during follow-up in the cohort by calculating person-time incidence rates [per 100 persons-years (PY)] and investigated the factors associated with the outcome "induced abortion" using a generalized linear mixed model., Results: 753 women and 210 pregnancies were included in the present analysis. We estimated an induced abortion incidence rate of 0.68/100 persons-years (95% confidence interval [CI]: 0.47; 0.94) in the study period, with a significant reduction after 2006. The main factors associated with an induced abortion were currently living with a partner (adjusted OR [AdjOR] 0.32 95% CI: 0.10-0.98), number of children (2 children AdjOR 0.12, 95% CI: 0.02-0.95) and the type of antiretroviral treatment used (regimen without Efavirenz: AdjOR: 0.11, 95% CI 0.02-0.70)., Conclusions: We showed a significant reduction in the incidence of induced abortions in a cohort of women living with HIV in Rio de Janeiro, Brazil, probably due to a decrease in the incidence of pregnancies observed in the same period. The factors associated with a lower occurrence of induced abortion suggest a good integration between the clinical and reproductive assistance offered to those women.

Social networks expand rapidly in adolescence, increasing HIV status disclosure considerations and concerns for young people living with HIV, especially in settings where HIV-related stigma is prevalent. This study examines HIV disclosure and enacted stigma among adolescents and young adults living with HIV in South Africa. This study uses survey data from a sample of 1186 youth living with HIV, aged 14-24, and enrolled in peer support groups led by community-based organizations in KwaZulu Natal and Gauteng provinces, South Africa. Study participants completed a questionnaire on sociodemographic details, physical health, school attendance, who knew the individual's HIV status, and experiences of HIV-related mistreatment. Mixed effects logistic regression examined the association between experiences of HIV-related mistreatment and factors that may inadvertently disclose one's status, such as poor physical health and missed school, and knowledge of an individual's HIV-positive status by their caregiver, household, friends, educators, and most recent sexual partner. Almost a quarter of the sample reported an experience of HIV-related mistreatment in the past six months. After controlling sociodemographic characteristics, missed school due to illness (AOR = 1.75, 95% CI = 1.27-2.43), and knowledge of HIV status by non-family members (AOR = 2.19, 95% CI = 1.60-3.00) were significantly associated with HIV-related mistreatment. Findings suggest that experiences of enacted stigma are common among youth and linked to poor physical health and knowledge of HIV status outside the family. Effective community-level stigma reduction interventions are urgently needed. In the meantime, adolescents need individualized disclosure counseling and support managing their physical health to prevent further inadvertent disclosure and discrimination., Competing Interests: Declarations. Ethical Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Social Behavioral Institutional Review Board at Tulane University in the U.S. (study reference no: 2018 − 1736) and the Pharma Ethics Independent Research Ethics Committee in South Africa (study reference no: 181021579). Consent to Participate: Informed consent was obtained from all individual participants included in the study. Competing Interests: The authors have no competing interests to declare that are relevant to the content of this article., (© 2024. The Author(s).)

Background: Resistance to antiretrovirals against human immunodeficiency virus (HIV) poses a threat to zero transmission of HIV by 2030. Few studies have been conducted on HIV drug resistance (HIVDR) mutations targeting adolescents. We determined the prevalence, pattern of HIVDR mutations, and factors associated with unsuppressed HIV viral load among adolescents on antiretroviral therapy (ART)., Methods: From March to June 2020, we conducted a cross-sectional study at the Infectious Disease Clinic in Dar es Salaam, Tanzania. HIV-1 viral load was tested using m2000rt Real-Time HIV-1 assay. A sample with a viral load equal or more than 1,000 copies/ml was tested for HIVDR mutations. We determined the factors associated with unsuppressed viral load using logistic regression. A p -value less than 0.05 was considered significant., Results: We enrolled 131 participants with a median age (interquartile range) of 15 (13-18) years. Of all, 24(18.3%) had a viral load above 1000 copies/ml. HIVDR mutations were found in 19/24(68.4%). Mutation to protease inhibitors, nucleotide reverse transcriptase inhibitors, and non-nucleoside reverse transcriptase inhibitors were 1(5.2%), 9(47.4%), and 11(57.9%), respectively. Non-antiretroviral therapy and orphanages were independently associated with unsuppressed viral load., Conclusion: The prevalence of HIVDR and unsuppressed HIV viral load among adolescents are relatively high. The use of non-antiretroviral therapy and orphanage influenced the persistence of high viral load. Strategies for surveillance of HIVDR early warning signs should be devised among adolescents.

Safer conception strategies can minimize HIV acquisition during periconception periods among women living in HIV-endemic areas. We examined uptake and predictors of persistent use of the same safer conception strategy among a cohort of HIV-uninfected South African women ages 18-35 years planning for pregnancy with a partner living with HIV or of unknown HIV-serostatus. The safer conception strategies we evaluated included oral PrEP, condomless sex limited to peak fertility, and waiting for a better time to have a child (until, for example, the risks of HIV acquisition are reduced and/or the individual is prepared to care for a child); persistence was defined as using the same safer conception strategy from the first visit through 9 months follow-up. Modified Poisson regression models were used to examine predictors of persistent use of the same strategy. The average age of 227 women in our cohort was 24.6 (range: 18.0, 35.7) years. In this cohort, 121 (74.2%) women reported persisting in the same strategy through 9 months. Employment and HIV knowledge were associated with the persistent use of any strategy. Our results highlight the need to provide safer conception services to women exposed to HIV during periconception periods. Findings also offer some insights into factors that might influence persistent use. Further research is needed to better understand how to involve male partners and how their involvement might influence women's consistent use of safer conception strategies during periconception periods., Competing Interests: Declarations. Conflict of interest: Matthews has received operational support from Gilead Sciences. Hurwitz and Bennett are employed by and own equity in Target RWE, which has received fees from Amgen, Baxter International, Gilead Sciences, Janssen Research & Development (Janssen R&D), and Merck outside the submitted work. Haberer has been a consultant for Merck and owns stock in Natera. Ethical Approval: Ethics approval was obtained from the Human Research Ethics Committee at the University of the Witwatersrand (Johannesburg, South Africa), the Institutional Review Board of the University of Alabama at Birmingham (Birmingham, Alabama, USA), and the Institutional Review Board of Partners Healthcare (Boston, Massachusetts, USA). Consent to Participate: Informed consent was obtained from all individual participants included in the study. Consent to Publication: Not applicable., (© 2024. The Author(s).)

Bacterial sexually transmitted infections (BSTIs) are largely preventable, yet their rates remain high across the U.S., particularly among sexual minority men (SMM) living with HIV (LWH). We explored longitudinal factors associated with BSTI acquisition in a national online sample of SMM LWH with recent suboptimal adherence to antiretroviral therapy (ART) or virologic non-suppression, such as spread within sexual networks, drug use in a sexual context (chemsex), and mental health issues. Participants completed online surveys over 12 months as part of an eHealth intervention. Over 12 months, 30% of participants self-reported at least one BSTI, with 28-45% reporting recurrent infections in consecutive surveys. Using generalized estimating equations with a binomial distribution and an exchangeable correlation structure, we found that BSTI accumulation was associated with chemsex, a higher number of anal sex partners, participation in exchange sex, and depressive symptoms. To reduce the burden of BSTIs among SMM LWH, public health initiatives and clinical settings should adopt a comprehensive sexual health approach, addressing chemsex, exchange sex, and associated mental health conditions. Addressing these factors can mitigate BSTI recurrence and improve overall sexual health among SMM LWH., Competing Interests: Declarations. Conflict of interest: Dr. Rozenberg declares no conflict of interest. Mr. Preciado declares that he has no conflict of interest. Mr. Silver declares that he has no conflict of interest. Dr. Hirshfield declares that she has no conflict of interest. Ethical Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed Consent: Informed consent was obtained from all individual participants included in the study., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Despite advances in prevention and treatment, the transmission of human immunodeficiency virus remains a significant problem in the United States, especially among men who have sex with men (MSM). Alcohol use can promote risky sexual decisions, and alcohol expectancies may influence the role of alcohol in decision making. The present secondary analysis tests the moderating role of sexual alcohol expectancies (SAEs) in the relation between daily alcohol intoxication and sexual behavior in a sample of 248 moderate- to heavy-drinking MSM. SAEs were assessed with the Sexual Alcohol Expectancies Questionnaire at baseline, followed by two 23-day bursts of ecological momentary assessment including self-initiated morning assessments of sexual behavior and the prior night's perceived intoxication, as well as nine daily random alcohol assessments. Multilevel modeling showed that SAEs moderated a curvilinear association between intoxication and anal intercourse with a condom such that the relation between daily intoxication and anal intercourse with a condom is a more pronounced inverted u-shape among individuals with strong SAEs, and this moderation effect was not seen for condomless anal intercourse (CAI). While SAEs do appear to influence the association between intoxication and sexual behavior in MSM, they do not appear to moderate the association between alcohol intoxication and CAI., Competing Interests: Declarations. Competing Interests: We have no known conflicts of interest to disclose., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)