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Purpose: Despite reportedly high rates of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) among transgender people, laboratory-proven prevalence of these infections in this population has not been systematically reviewed. We performed a systematic review and meta-analysis of the medical literature involving laboratory-proven HIV and STI diagnoses among transgender people. Methods: A systematic review of the English literature regarding laboratory-proven HIV and/or STI testing in transgender populations within the last 50 years was performed. Preliminary meta-analyses assessing the prevalence of HIV and STIs among both transgender men and transgender women were performed. Given the heterogeneity of included studies, these analyses were difficult to interpret and not included in our results. Results: Our literature review identified 25 studies, representing 11 countries. All of these studies included transgender women, with 9 (36%) including data on transgender men. HIV was the most commonly studied STI, with prevalence ranging from 0% to 49.6% in transgender women and 0% to 8.3% in transgender men. For syphilis, gonorrhea, and chlamydia, respectively, prevalence ranged from 1.4% to 50.4%, 2.1% to 19.1%, and 2.7% to 24.7% in transgender women and from 0% to 4.2%, 0% to 10.5%, and 1.2% to 11.1% in transgender men. Site-specific testing practices for gonorrhea and chlamydia were variable. No studies reported prevalence data on trichomoniasis. Conclusion: The literature describing STIs and transgender people primarily focuses on transgender women and HIV. Data involving HIV and STIs among transgender men are lacking. These findings highlight opportunities for the future study of epidemiology of HIV/STIs in transgender men and the relevance of STIs in transgender people.

Food insecurity is highly prevalent among people with HIV. Traditional calorie-rich, nutrient poor food assistance programs may improve food security but increase risk for other chronic diseases. This case study describes the process evaluation of a novel clinic/community partnership to provide nutritionally adequate, tailored food assistance to adults with HIV in Alabama. Methods used include semi-structured interviews with program staff at Birmingham AIDS Outreach and the University of Alabama at Birmingham’s 1917 HIV/AIDS Clinic, and analysis of descriptive characteristics of individuals enrolled in the food program for a minimum of one year between 2017-2019. The new program served 1,311 patients and enabled more than 300 previously lost-to-follow-up patients to re-engage in HIV care. The program implementation reviewed here can serve as a roadmap to develop clinic/community partnerships focused on a variety of health outcomes and quality of life among food insecure patients.

Background Client-Centered Representative Payee (CCRP) is an intervention modifying implementation of a current policy of the US Social Security Administration, which appoints organizations to serve as financial payees on behalf of vulnerable individuals receiving Social Security benefits. By ensuring beneficiaries’ bills are paid while supporting their self-determination, this structural intervention may mitigate the effects of economic disadvantage to improve housing and financial stability, enabling self-efficacy for health outcomes and improved antiretroviral therapy adherence. This randomized controlled trial will test the impact of CCRP on marginalized people living with HIV (PLWH). We hypothesize that helping participants to pay their rent and other bills on time will improve housing stability and decrease financial stress. Methods PLWH (n = 160) receiving services at community-based organizations will be randomly assigned to the CCRP intervention or the standard of care for 12 months. Fifty additional participants will be enrolled into a non-randomized (“choice”) study allowing participant selection of the CCRP intervention or control. The primary outcome is HIV medication adherence, assessed via the CASE adherence index, viral load, and CD4 counts. Self-assessment data for ART adherence, housing instability, self-efficacy for health behaviors, financial stress, and retention in care will be collected at baseline, 3, 6, and 12 months. Viral load, CD4, and appointment adherence data will be collected at baseline, 6, 12, 18, and 24 months from medical records. Outcomes will be compared by treatment group in the randomized trial, in the non-randomized cohort, and in the combined cohort. Qualitative data will be collected from study participants, eligible non-participants, and providers to explore underlying mechanisms of adherence, subjective responses to the intervention, and implementation barriers and facilitators. Discussion The aim of this study is to determine if CCRP improves health outcomes for vulnerable PLWH. Study outcomes may provide information about supports needed to help economically fragile PLWH improve health outcomes and ultimately improve HIV health disparities. In addition, findings may help to refine service delivery including the provision of representative payee to this often-marginalized population. This protocol was prospectively registered on May 22, 2018 with ClinicalTrials.gov (NCT03561103).

Background The transgender (TG) population is under-researched. Despite reportedly high rates of HIV and sexually transmitted infections (STIs) among TGs, prevalence of these in TGs has not been systematically reviewed. Our primary objective was to perform a systematic review of the literature for studies reporting laboratory test proven prevalence data of HIV and other STIs among male-to-female (MTF) and female-to-male (FTM) TGs. Given the sexual risk factors traditionally associated with MTFs (e.g. commercial sex work), we hypothesized that HIV/STI prevalence would be higher among MTFs compared to FTMs. Methods A systematic review of the literature on original English-language research involving HIV and/or STI laboratory testing in TG populations within the last 50 years was performed. Results Of 32 eligible studies, most focused on MTFs, with only 10 (31%) including data on FTMs. MTFs were exclusively investigated in 22 (69%) of studies. The majority of studies including MTFs were focused on sex workers, with 7 (22%) exclusively evaluated sex workers. HIV data was reported in 31 (97%) of studies. Syphilis data was presented in 18 (56%) studies. Regarding gonorrhea and chlamydia, 15 (47%) studies presented testing data, but only 7 reported urogenital and extragenital results. No studies evaluated trichomoniasis. In MTFs, prevalence of HIV, syphilis, gonorrhea, and chlamydia ranged from 0%–70.3%, 1.4%–50.4%, 0%–29.4%, and 2.7%–24.7%, respectively. In FTMs, prevalence of HIV, syphilis, gonorrhea, and chlamydia ranged from 0%–8.3%, 0%–4.2%, 0%–10.5%, and 0–11.1%, respectively. Conclusion Literature involving STIs in TG people focuses on the MTF community and HIV. Testing patterns for bacterial STIs are variable, especially for gonorrhea and chlamydia. Per current literature, STIs appear to be more prevalent in MTFs compared to FTMs. Data for STIs in FTMs is limited. These gaps present opportunities for further study involving the epidemiology of STIs in the FTM population and the relevance of extragenital bacterial and parasitic STIs in all TGs. Disclosure No significant relationships.

Background We have previously identified PrEP adherence as a risk factor for STIs in an academically affiliated Deep South PrEP clinic. In this analysis of a community-based Deep South PrEP clinic, we hypothesized that PrEP adherence and high risk sexual behaviors would be associated with STI. Methods This was a retrospective analysis of men who have sex with men (MSM) aged ≥18 years receiving PrEP at a community-based clinic in Birmingham, AL from 2016 to 2018. HIV negative patients were included if they completed ≥1 sexual behavior and PrEP adherence survey and were prescribed PrEP. Screening for gonorrhea, chlamydia, and syphilis and patient-reported outcomes (PROs) were performed at quarterly clinic visits. The outcome of interest was incident bacterial STI. We evaluated the association of sexual behavior and PrEP adherence PROs with STI using logistic regression. Results Of 119 eligible participants, 48% were ≥35 years, 21% reported no condom use, and 75% reported ≥2 sexual partners. Over the study period, 29 cases of STI were detected including 18 chlamydia, 10 gonorrhea and 1 syphilis case. However, 14 participants declined STI testing. Of 85 patients who completed ≥1 PRO (initial visit plus follow-up), 74% reported excellent PrEP adherence. By univariate and multivariable analysis neither condom use, number of sexual partners, or PrEP adherence were significantly associated with STIs, though consistent condom use approached significance. Conclusion In a community-based PrEP clinic in the Deep South, adherence was high and high-risk sexual behaviors were common. Neither adherence nor sexual behaviors were associated with STIs. Although it did not meet statistical significance, there was a trend toward STI for those reporting condomless anal sex. Surprisingly, many patients declined recommended STI testing, leaving missing data and suggesting an overall lack of awareness of STI risk in this community. These results highlight the need for vigorous STI screening and education Disclosure No significant relationships.

Currently, the Southern United States has the highest rates of new HIV diagnoses, the largest percentage of people living with HIV (PLWH), and the most people dying from the disease in the United States. Given the rise of the HIV epidemic in the Deep South and the availability of evidence-based self-management tools for PLWH, we conducted an in-person survey in Birmingham, Alabama, to understand the symptom profile and the use of technology by PLWH. Muscle aches or joint pain was the most frequently (67%) reported symptom followed by fatigue, sleep difficulties, neuropathy, and depressive symptoms. We also assessed mobile technology use and ownership and found that 83.7% of persons own a smartphone with most of these (79.9%) being Android users. Given these findings, there is strong scientific premise to support the feasibility of a mobile-delivered symptom self-management tool in the Deep South for improving health outcomes for PLWH.

By 2015, it is estimated that nearly half of those living with HIV in the US will be 50 years of age and older. This dramatic change in the demographics of this clinical population represents unique challenges for patients, health care providers, and society-at-large. Fortunately, because of highly active antiretroviral therapy (HAART) and healthy lifestyle choices, it is now possible for many infected with HIV to age successfully with this disease; however, this depends upon one’s definition of successful aging. It is proposed that successful aging is composed of eight factors: length of life, biological health, cognitive efficiency, mental health, social competence, productivity, personal control, and life satisfaction. Unfortunately, HIV and medication side effects can compromise these factors, thus diminishing one’s capacity to age successfully with this disease. This article explores how HIV, medication side effects from HAART, and lifestyle choices can compromise the factors necessary to age successfully. Implications for practice and research are posited.