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Several large-scale clinical trials have conclusively demonstrated that voluntary medical male circumcision (VMMC) could provide a 50%–70% reduction in HIV acquisition, but willingness to undergo VMMC has been lowest in Zambia compared to other countries in eastern and southern Africa. This manuscript describes training for “task-shifting” among local healthcare workers at Community Health Centers (CHCs) applying state of the art strategies (e.g., Training of Trainers, i.e., ToT, and Training of Facilitators, ToF) to provide novel clinical services. Staff at 96 CHCs from four Provinces in Zambia were sequentially trained to provide the Spear & Shield intervention. A total of 45,630 men (n = 23,236) and women (n = 22,394) volunteered to participate in the S&S intervention service program when offered in the CHCs. Group session (total = 5313 sessions; 2,736 men’s and 2,582 women’s sessions) were conducted over 4.5 years. Remarkably, both men and women’s groups achieved 97% retention. Of these, 256 sessions recorded from 128 group leaders were assessed and scored for intervention fidelity; fidelity was 80%–90% among the majority of clinics. S&S program sustainment exceeded expectations among 85% of clinics (82/96) in all provinces across the duration of the study. Of note, attendance in the S&S program was encouraged by CHC staff, but no financial incentives were provided to those attending S&S. This study examined the effectiveness of the ToT/ToF model in dissemination of the S&S program, which proved to be feasible even in resource-limited settings. Benefits and challenges are discussed.

Voluntary medical male circumcision (VMMC) has been an effective method for reducing the risk of HIV transmission by 50%–70% in Eastern and Southern Africa. The Spear and Shield (S&S) program is a community health center (CHC)-based biobehavioral VMMC HIV prevention intervention that increased VMMC uptake in male CHC attendees in Lusaka, Zambia. Qualitative data organized using the Consolidated Framework for Implementation Research (CFIR) has been used to characterize factors that may impact S&S/VMMC implementation. This manuscript uses the CFIR to examine S&S implementation across 96 CHCs in four Zambian provinces using a mixed-methods approach to (a) quantify successful S&S implementation; (b) understand how CFIR domains might provide insight into the degree of implemental success; (c) identify major themes among least and most successful CHCs; and (d) help guide future prevention efforts and policy related to VMMC promotion in the Zambian CHC context. In contrast with CFIR quantitative analyses, 12 major qualitative themes associated with the least and most successful CHCs provided unique insight into S&S and VMMC implementation and guidance for future implementation studies. Themes included lack of resources (staff, space, transportation) for the former and strong staff relationships and active community engagement for the latter. The CFIR framework appears extremely useful for the identification of qualitative themes related to intervention implementation, and reduction of qualitative data for quantitative analyses may sacrifice more nuanced information. Consideration of CFIR themes may be useful to inform HIV prevention strategies in Zambia and similar contexts.

This study aimed to examine intimate partner violence (IPV) as it relates to both partners' perceptions of IPV and sexual behaviors, considering how their IPV might be interdependent within the relationship dynamics. The sample consisted of 713 female-male dyads in which women were pregnant and living with HIV in rural South Africa. Using an actor-partner interdependence model (APIM), we examined the interdependent influence of psychological and physical IPV on men by their female partners and psychological and physical IPV on women by their male partners on sexual risk behavior. The APIM model found there were no actor (b = -0.06, SE = 0.05, p = .221) or partner (b = -1.2, SE = 0.06

Although prior research has examined associations between blood pressure (BP), depression, and suicidal ideation, few studies have examined this in high-risk populations such as pregnant women with HIV (WHIV). The current study examined the association of BP with depression and suicidal ideation among pregnant WHIV (n = 217) in rural South Africa. BP data (measured ≤ 1 month before the study visit) was extracted from medical records. Depressive symptomatology and suicidal ideation were assessed using the Edinburgh Postnatal Depression Scale. Diastolic BP was positively associated with both suicidal ideation and depressive symptomatology, even after controlling for demographic variables, gestational age, and intimate partner violence. These findings suggest that WHIV with elevated BP may be at greater risk for antenatal depression and suicidal ideation. Future research should utilize longitudinal designs to examine potential mechanisms and the directionality of the relationship, as well as other contributing factors.Aunque investigaciones anteriores han examinado las asociaciones entre la presión arterial (PA), depresión e ideación suicida, pocos estudios han examinado esto en poblaciones de alto riesgo, como las mujeres embarazadas con VIH. El estudio actual examinó la asociación de la PA con la depresión y la ideación suicida entre mujeres embarazadas con VIH (n = 217) en zonas rurales de Sudáfrica. Los datos de PA (medidos ≤ 1 mes antes de la visita del estudio) se extrajeron de los registros médicos. La sintomatología depresiva y la ideación suicida se evaluaron mediante la Escala de depresión posnatal de Edimburgo. La PA diastólica se asoció positivamente tanto con la ideación suicida como con la sintomatología depresiva, incluso después de controlar variables demográficas, edad gestacional y violencia de la pareja íntima. Estos hallazgos sugieren que mujeres embarazadas con VIH con PA elevada puede tener un mayor riesgo de depresión prenatal e ideación suicida. Las investigaciones futuras deberían aprovechar diseños longitudinales para examinar los posibles mecanismos y la direccionalidad de la relación, así como otros factores contribuyentes.

The authors seek to provide a more holistic, compassionate, and liberatory understanding of Latinx families. This chapter will highlight the importance of understanding families from a historical, culturally centered manner that honors their layered experiences of contextual factors, intergenerational trauma, and strengths-based approach. This chapter seeks to honor ethnic heterogeneity and cultural strengths and expand the notion of what consists of the family constellation. In doing so, the chapter will focus on central aspects of la familia, including child development, parenting, and recommendations focused on engaging Latinx families and improving the assessment and family interventions.

Questions persist in the parenting literature regarding how best to define positive and negative parenting behaviors. Are there optimal parenting behaviors shared by mothers and fathers, or among different racial and ethnic groups? This study draws from a nationally representative sample of US parents of school-age children, testing aspects of measurement invariance in the Alabama Parenting Questionnaire (APQ) full and short forms. Our goal was to highlight psychometric approaches to enhancing cultural sensitivity and inclusivity in parenting research, by assessing whether self-reported parenting behaviors have similar conceptual structure across groups. Tests of measurement invariance revealed that the factor structure of the APQ was the same across parent gender, race, and ethnicity. While partial invariance was found in some instances, we did not find metric and scalar invariance in comparisons among these groups. We conclude with research- and practice-based implications, and provide recommendations for future measurement development and use.

The identification of intermediate mechanisms that account for the intergenerational transmission of child maltreatment can elucidate processes of risk and resilience in families. This study investigated the role of maternal emotion dysregulation; we hypothesized that emotion dysregulation would mediate the relation between mothers’ history of maltreatment in their childhood and their aggressive behavior toward their children. Participants included 110 mothers (range = 20 to 43 years, Mage = 30.81, SDage = 6.08) with preschool-aged children (range = 3 to 5 years, Mage = 3.50, SDage = 0.51; 61% male) in a diverse community sample (46.3% African American; 50.9% had a household income under $30,000). A path analysis showed that maternal history of maltreatment in their childhood was indirectly related to later maternal psychological aggression via maternal emotion dysregulation. The indirect effect of child maltreatment on physical aggression was not statistically significant. Our findings highlight the importance of emotion regulation as a transdiagnostic risk factor for the intergenerational transmission of child maltreatment.

We evaluated the psychometric properties of a modified version of the Vaccine Hesitancy Scale (VHS) among people with HIV (PWH) for COVID-19 vaccination in a cross-sectional study in the US. Self-report data from an online questionnaire were collected from a sample of N = 175 PWH. Participants were surveyed in English or Spanish regarding attitudes towards COVID-19 vaccination using the adapted VHS. Participants were on average 51.55 years of age (SD = 13.90) 55% were women. The reliability of the scale was acceptable (α = 0.72). An exploratory factor analysis showed that "Lack of confidence" and "Risks" explained 45.55% and 12.31% of the variance. Related items showed expected associations with these factors, supporting construct validity. Results illustrate that the modified VHS for COVID-19 vaccination has adequate psychometric properties. We replicated the original factor structure of the VHS and demonstrated adequate internal consistency and construct validity. Validated tools are essential to guide vaccination policy and campaigns towards populations at risk.En este estudio transversal, evaluamos las propiedades psicométricas de la Escala de Reticencia a la Vacunación (VHS, por sus siglas en inglés) para la vacuna contra el COVID-19 en personas con VIH (PCV) en los EE. UU. Los participantes (N = 175) respondieron a una encuesta en línea en inglés o en español, sobre las actitudes hacia la vacuna contra el COVID-19 utilizando una version adaptada de la VHS. La edad promedio de los participantes fue de 51,55 años (DE = 13,90;) y 55% eran mujeres. La fiabilidad de la escala fue aceptable (α = 0,72). Un análisis factorial exploratorio mostró que la “falta de confianza” y los “riesgos” explicaron el 45,55% y el 12,31% de la varianza. Los elementos relacionados mostraron asociaciones esperadas con dichos factores, apoyando la validez de la VHS adaptada para esta población. Los resultados ilustran que la VHS modificada para la vacuna contra el COVID-19 tiene propiedades psicométricas adecuadas. Replicamos la estructura factorial original de la VHS y demostramos una adecuada validez y consistencia interna. La validación de instrumentos de recolección de datos es esencial para orientar las políticas y campañas de vacunación para poblaciones en riesgo, tal como PCV.

Background: This study evaluated COVID-19 risk and burden among people with HIV (PWH) in a US city with high rates of HIV and SARS-CoV-2 transmissions and examined the interrelationship between psychosocial factors and COVID-19 risk and burden. Setting: Participants were drawn from an existing consent to contact database of PWH. Database candidates were PWH, adults older than 18 years, people who had received HIV care at the University of Miami HIV clinics, people who spoke English or Spanish, and people who had agreed to be contacted for future research. Methods: An adapted version of the Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study COVID-19 survey was telephonically administered, requiring 15–30 minutes. Results: Psychological stress was a predictor of COVID-19 burden (financial and social burden) and COVID-19 risk (health factors associated with an increased risk of severe health outcomes due to infection with COVID-19). Having a history of traumatic events was associated with increased COVID-19 risk, and stress was associated with increased COVID-19 burden and COVID-19 risk. Conclusions: Overall, results suggest that the intersection of the HIV and COVID-19 pandemics may be most profound among those who have experienced traumatic events; and traumatic events may be associated with heightened vigilance regarding illness and infection.

Male partner involvement (MPI) during the prenatal and postnatal periods has been proven to have a beneficial effect on infant development. Infants born to HIV seropositive mothers with lacking or no prenatal and postnatal male partner support may be at a higher risk for adverse developmental outcomes. This study examined the effect of MPI on cognitive, communicative, fine, and gross motor development in 160 infants born to HIV seropositive mothers attending Prevention of Mother-to-Child Transmission of HIV (PMTCT) services in rural South Africa. Results of the bivariate logistic regression showed that both prenatal (OR 1.13; 95% CI 1.01, 1.26; p

Introduction This study aimed to investigate the association between Male Partner Involvement (MPI) and maternal health outcomes among women attending Prevention of Mother-to-Child Transmission of HIV (PMTCT) services in rural South Africa. The association between Male Partner Participation in the main study (MPP) and maternal health outcomes among these women was also investigated. Methods The study utilized data collected from 535 HIV infected women in a randomized controlled trial between 2015 and 2016. Maternal health outcome data (delivery mode, pregnancy systolic and diastolic blood pressure, pregnancy body mass index, pregnancy CD4 count, and pregnancy viral load) were collected from the women's antenatal record forms accessed from the primary healthcare facilities. Bivariate and multivariable logistic regression models were used to estimate the association between socio-demographic characteristics of the women, MPI, and MPP with maternal health outcomes. Results The mean age of the women was 29.03 years (SD = 5.89). No significant associations were found between MPI and any of the maternal health outcomes contrary to what was hypothesized. Both the bivariate and multivariate analysis indicated a significant association between MPP and higher pregnancy viral load, contrary to the study hypothesis. Insignificant associations were found between MPP and both pregnancy CD4 count and pregnancy blood pressure. The only significant association between maternal health outcomes and socio-demographic characteristics, was between educational attainment and higher pregnancy CD4 count in both the bivariate and multivariate analysis. Conclusion for Practice The study showed no significant support for MPI in improving maternal health outcomes of women in PMTCT in rural South Africa. Future studies should include additional maternal health outcomes for investigation.

Parenting provides many positive experiences for mothers and fathers but also presents them with many challenges, such as regulating their emotions during interactions with their children. While emotion regulation (ER) has emerged as an important predictor of parenting behavior and a transdiagnostic target of parenting interventions, measures specifically targeting ER in the parenting context are lacking. This study describes the development and evaluation of the Regulating Emotions in Parenting Scale (REPS). Study 1 used an exploratory factor analysis and supported a 3-factor (Adaptive Strategies, Suppression, and Rumination) structure of the REPS in a sample of 331 parents (73% women) recruited from Amazon MTurk (parent Mage = 36.02, SDage = 9.27). This factor structure was confirmed in Study 2 using confirmatory factor analysis in an independent sample of 662 parents (61% women; parent Mage = 36.81, SDage = 14.18). Tests of measurement invariance and differential item functioning provided evidence of invariance of the REPS by gender. Correlations between REPS factors and related measures of parenting, psychopathology, and general ER were in the expected direction; correlations between the REPS and parenting and psychopathology were significantly higher in magnitude than correlations between general measures of ER and parenting and psychopathology. The REPS also explained more of the variance in parenting measures than general measures of ER. These findings indicated that the REPS may provide greater specificity than general measures of ER. Future studies should replicate these findings in other populations and establish invariance by race and ethnicity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Intimate partner violence (IPV) has been highlighted as one of the challenges to the effectiveness of the Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs in rural areas in South Africa. This study aimed at assessing the prevalence of prenatal and postnatal physical as well as psychological IPV, and corresponding time-invariant and time-varying predictors, among HIV-positive women attending PMTCT services in rural South Africa. The Conflict Tactics Scale (CTS) was used to assess IPV at four time points prenatal and postnatal. This study highlighted high levels of physical and psychological IPV experienced by HIV-infected women during pregnancy and in the first year after childbirth. Time-invariant predictors and time-varying predictors of physical IPV and psychological IPV were individual, social, and behavioral factors. Multi-dimensional evidence-based interventions are needed to deal with the high levels of prenatal and postnatal physical as well as psychological IPV experienced by these women.

‘Mother-to-child transmission of HIV’ can occur during the period of pregnancy, childbirth, or breastfeeding. ‘Prevention of mother-to-child transmission of HIV’ (PMTCT) in Mpumalanga Province, South Africa, is especially vital as the prevalence of HIV is 28.2% in women aged 15–49. PMTCT interventions resulted in a drop of MTCT rates in Mpumalanga from ∼2% in 2015 to 1.3% in 2016. This randomised controlled trial in Mpumalanga examined the potential impact of a lay healthcare worker administered intervention, ‘Protect Your Family’, on maternal and infant adherence, and to assess the relative influence of male partner involvement on infant and maternal adherence. This cluster randomised controlled trial used a two-phase and two-condition (experimental or control) study design where participants (n = 1399) did assessments both during pregnancy and post-postpartum. Only women participated in Phase 1, and both female and male partners participated in Phase 2. Results indicated that male involvement was associated with self-reported maternal or infant antiretroviral therapy (ART) adherence, but the intervention was not associated with ART adherence. Self-reported adherence was associated with depression, age, and partner HIV status. The study results provide support for the involvement of men in the antenatal clinic setting during pregnancy. Results also support further research on the meaning and assessment of male involvement and clarification of the constructs underlying the concept in the sub-Saharan African context. Outcomes provide support for male involvement and treatment of depression as adjuncts to improve uptake of both maternal and infant medication as part of the PMTCT protocol.

Introduction Screening for developmental delays during critical periods of infant development is essential for early detection and intervention. Among high-risk infants in resource-limited settings, including those who are HIV exposed, there is a greater need for screening. This study expanded on previous analyses of the Bayley Infant Neurodevelopmental Screener (BINS) by providing psychometric properties to evaluate the appropriateness of using the BINS in a sample of HIV-exposed infants in rural South Africa. Method A total of 160 mothers with HIV, their infants, and their male partners were recruited. The BINS was administered to the infants, and their weights were recorded. Mothers completed measures of depression, intimate partner violence, male involvement, and adherence. Male partners reported their own involvement in perinatal care. Results Results demonstrated support for a 5-factor structure consistent with previous transcultural adaptations of the BINS, demonstrating construct validity, and adequate reliability. Convergent validity was partially supported, as shown by associations with intimate partner violence and male involvement as reported by men and women and maternal adherence, although not with birth weight or maternal depression. The BINS showed adequate discriminating power, with only a few low-performing items. Conclusion In rural South Africa, a resource-limited setting, the BINS seems to be an adequate screening tool for developmental delays in children that may be used to identify those in need of intervention. Considering the high prevalence of delays identified in this study, antiretroviral therapy-exposed and HIV-exposed infants may benefit from further assessment to determine a need for intervention in community-based clinics.

Cumulative burden of multiple mental health conditions may worsen physical health outcomes in vulnerable populations. Accordingly, identifying cumulative burdens of mental health conditions that may affect HIV treatment and care can guide public health strategies to reduce their impact on HIV-related health outcomes. This study examined the relationship between the cumulative burden of mental health conditions and factors associated with engagement in HIV care in Argentina. Data for this study was obtained at baseline from Conexiones y Opciones Positivas en la Argentina 2 (COPA2). Participants (N = 360) were cisgender patients living with HIV who were lost to care, recruited from seven clinics serving people living with HIV in four Argentine urban centers. Cumulative burden of mental health conditions (i.e., depressive symptoms, problematic substance use, unhealthy alcohol use, and psychotic symptoms) was assessed. Every one-point increase in the number of mental health conditions present was associated with a decrement in patient-provider communication (b = − 0.22, p

Male involvement in the prevention of mother to child transmission of HIV (PMTCT) during pregnancy is encouraged, but the accuracy of its measurement has not been established. The purpose of this cross-sectional study was to establish the factor structure of an index of male involvement in PMTCT. Using a structured questionnaire, 1369 HIV positive pregnant women and 522 male partners were recruited in rural Mpumalanga, South Africa. A principal component analysis with varimax rotation yielded two components accounting for 49.9% of the variance. The first factor, named Communication-Based Male Involvement and addressing partner discussions about prenatal, HIV, birth and postnatal issue, accounted for 39.8% of the variance. The second, named Action-Based Male Involvement and addressed partner awareness and actions, and information provided during antenatal visits, financial support, and attendance to visits, accounted for 10.1% of the variance. Given the low rates of male involvement participation in antenatal care, interventions are needed to increase male involvement. However, a method of quantifying male partner participation was needed to assess the effectiveness of such interventions. We hope that the Revised Male Involvement Index will stimulate further research in this area, thus increasing the effectiveness of PMTCT programs aimed at increasing male partner involvement.

Measuring perinatal depression in women with HIV poses a challenge to accurate assessment. South Africa has particularly high rates of perinatal depression, with antenatal depression rates ranging from 21 to 47% and postnatal depression rates ranging from 17 to 50%. With the goal of providing an examination of the psychometric properties of the Edinburgh Postnatal Depression Scale (EPDS) in a population at greater risk for depression, the current manuscript examined the factor structures and reliability of the English and Zulu versions of the EPDS among pre- and postnatal women with HIV in South Africa.This study included n = 1179 women who completed the EPDS in Zulu (n = 709) and English (n = 470) antenatally, and n = 866 women were analyzed at 12-months after birth (n = 494 in Zulu and n = 372 in English).Using factor analytic and item response theory approaches, the English and Zulu versions of the EPDS were compared. Although a few items performed poorly, particularly item 4, the construct validity of the English and Zulu versions of the pre- and postnatally administered EPDS was supported; the reliability of the scale was also supported, with adequate reliability in Zulu and English ante-natally (α = .78), and postnatally (α = .82 and α = .77 respectively).This study contributes to improved measurement of depressive symptoms among vulnerable women in a resource constrained setting. The early and accurate detection of depressive symptoms ante- and postnatally among perinatal women living with HIV can facilitate increased treatment which may in turn help prevent the negative maternal and neonatal outcomes associated with depression.

Bacterial vaginosis (BV) is the most common genital infection in women and is associated with an increased risk of sexually transmitted infections and HIV. This study uses a syndemic approach to evaluate factors associated with BV. Non-pregnant, HIV-negative, sexually active, cis-gender women aged 18-45 years living in Miami, Florida were recruited from Nov.2018- Jun.2021. Participants completed a sociodemographic and behavioral questionnaire along with gynecological examinations. BV was diagnosed by Amsel criteria and confirmed by a Nugent score ≥ 4. A syndemic score was calculated as the sum of factors associated with BV. The association between syndemic score and BV was assessed using logistic regression. Of 166 women included, 60.2% had BV. Race, ethnicity, education, vaginal sex, recent cannabis use, and reasons for intravaginal practices were included in the syndemic score. Higher odds of BV were found in women with a score of ≥ 3 compared to women with a score of 0/1. A higher syndemic score was associated with increased odds of having BV. Multilevel interventions to decrease BV are needed to decrease women's risk of acquiring HIV.La vaginosis bacteriana (VB) es la infección genital más común en mujeres y está asociada con un mayor riesgo de enfermedades de transmisión sexual (ETS) y de VIH. Este estudio utilizó un enfoque sindémico para evaluar factores asociados con VB. Entre noviembre del 2018 y junio del 2021, se reclutaron mujeres cisgénero de entre 18–45 años, que no estuvieran embarazadas, que fueran VIH negativas y sexualmente activas, y que vivieran en Miami, Florida. Las participantes completaron un cuestionario sociodemográfico y de comportamiento junto con un examen ginecológico. Se diagnosticó VB empleando los criterios de Amsel y se confirmó empleando el criterio de Nugent con una puntuación ≥ 4. La puntuación sindémica fue calculada como la suma de factores asociados con VB utilizando. La asociación entre la puntuación sindémica con VB se evaluó mediate una regresión logística. De 166 mujeres incluidas, 60.2% fueron diagnosticadas con VB. Los factores incluidos en la puntuación sindémica fueron la raza, etnia, educación, sexo vaginal, consumo reciente de cannabis, y el uso de prácticas intravaginales. Se encontraron mayores probabilidades de VB en mujeres con una puntuación ≥ 3 en comparación con aquellas con una puntuación de 0/1. Una puntuación sindémica alta se asoció con una mayor probabilidad de tener VB. Son necesarias intervenciones multinivel para disminuir la VB y disminuir el riesgo de que las mujeres contraigan ETS y VIH.

The present study assessed how attributions of everyday discrimination typologies relate to all-cause mortality risk among older Black adults.This study utilized data from a subsample of older Black adults from the 2006/2008 Health and Retirement Study (HRS). Attributions for everyday discrimination (i.e., ancestry, age, gender, race, physical appearance, physical disability, sexual orientation, weight, and other factors) were based on self-reports, while their vital statuses were obtained from the National Death Index and reports from key informants (spanning 2006-2019). We applied latent class analysis (LCA) to identify subgroups of older Black adults based on their attributions to everyday discrimination. Cox proportional hazards models were used to analyze time to death as a function of LCA group membership and other covariates.Based on fit statistics, we selected a four-class model that places respondents into one of the following classes: Class One (7%) attributed everyday discrimination to age, race, and physical disability; Class Two (72%) attributed everyday discrimination to few/no sources, Class Three (19%) attributed everyday discrimination to race and national origin; and Class Four (2%) attributed everyday discrimination to almost every reason. After adjusting for sociodemographic, behavioral, multisystem physiological dysregulation, and socioeconomic characteristics, we found that the relative risk of death remained higher for the respondents in Class One (Hazard Ratio [H.R.]: 1.80, 95% Confidence Interval [C.I.]: (1.09-2.98) and Class Four (H.R.: 3.92, 95% C.I.: 1.62-9.49) compared to respondents in Class Two.Our findings illustrate the utility of using attribution for everyday discrimination typologies in research on the psychosocial dimensions of mortality risk among older Black adults. Future research should assess the mechanisms that undergird the link between everyday discrimination classes and all-cause mortality risk among older Black adults.

Background Traditional risk factors associated with cardiovascular disease (CVD) include older age, smoking, poor diet, lack of exercise, obesity, high blood pressure, high cholesterol, and family history. Young-to-middle age adults (YMAA) are less often identified as being at risk of CVD, but traditional risk scores primarily target older adults and do not accurately estimate risk among YMAA. Methods This study examined biomarkers associated with CVD risk in YMAA in the context of HIV and cocaine use; risk was assessed by two methods: (1) a relative cardiovascular (CV) risk score that includes several factors and (2) carotid atherosclerotic plaque. Associations between CVD risk (CV risk score and carotid atherosclerotic plaque) and proinflammatory cytokines, markers of immune activation, HIV status, and cocaine use were examined. Participants ( N = 506) included people with and without HIV and people who use or do not use cocaine. Results Participants’ mean age was 36 (SD = 9.53); half (51%) were men. Cocaine use and C-reactive protein were associated with greater relative CV risk scores, but no associations between biomarkers and CV risk emerged. Age and CV risk scores were associated with carotid atherosclerotic plaque, but biomarkers were not. HIV was not associated with CV risk scores or carotid atherosclerotic plaque. Conclusions Among YMAA, CV risk scores may help providers identify lifestyle changes needed among those at risk for CVD before more advanced risk (e.g., atherosclerotic plaque) is identified. Implications are discussed.

Immigrants are at greater risk for mental health concerns but are less likely to use mental health services than their U.S.-born counterparts. Efforts to understand these disparities have focused on demographic characteristics while largely ignoring the role of immigrants' beliefs and values. This review synthesizes the research on the mental health-related beliefs and values associated with the mental health service underutilization of each major U.S. immigrant group. Results revealed two overarching attitudinal themes common to several immigrant groups and several attitudinal barriers unique to individual groups. They also elucidated several areas for additional research and highlighted the need to target these beliefs and values in public health efforts promoting MHS use among U.S. immigrants.

This study of people with HIV (PWH) and those without HIV conducted during the COVID-19 pandemic in the United States in 2020 examines the impact of posttraumatic stress disorder (PTSD) on COVID-19 burden, defined as pandemic-related disruptions.Data consisted of survey responses on PTSD among participants (N = 2434) enrolled in the Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV (WIHS) cohorts. Unadjusted and adjusted regression models were used to examine the association of PTSD with COVID-19 burden (overall and domain-specific burdens). Quasi-Poisson regression models were used to assess associations with the COVID-19 burden score and 2 domain-specific burdens: (1) changes in resources and (2) interruptions in health care. Analyses was adjusted for age, race/ethnicity, HIV serostatus, current smoking status, number of comorbidities, education, and study regions.Study participants were a median age of 58 (interquartile range, 52-65) years. In both bivariate and multivariable models, PTSD severity was associated with greater overall COVID-19 burden. PTSD severity was associated with the number of resource changes and number of interruptions in medical care. These findings were also consistent across cohorts (MACS/WIHS) and across HIV serostatus, suggesting a greater risk for COVID-19 burden with greater PTSD severity, which remained significant after controlling for covariates.This study builds on emerging literature demonstrating the impact of mental health on the burden and disruption associated with the COVID-19 pandemic, providing context specific to PWH. The ongoing pandemic requires structural and social interventions to decrease disruption to resources and health resource needs among these vulnerable populations.

BackgroundThe concentration and duration of antibodies (Ab) to SARS-CoV-2 infection predicts the severity of the disease and the clinical outcomes. Older people and those with HIV have impaired immune responses, worse outcomes after SARS-CoV-2 infection, and lower antibody responses after viral infection and vaccination. This study evaluated an Ab response to SARS-CoV-2 in people with HIV (PWH) and without HIV (HIV-) and its association with age.MethodsA total of 23 COVID+PWH and 21 COVID+HIV- participants were followed longitudinally for 6 months post-mild COVID-19. Immunoglobin G (IgG) and immunoglobin M (IgM) Ab responses were measured by an in-house developed ELISA. Time points and HIV status interaction were analyzed using Poisson generalized estimating equations, and correlations were analyzed using non-parametric tests.ResultsMedian age in PWH was 55 years with 28.6% women, while in the HIV- group was 36 years with 60.9% women. The mean time from COVID-19 diagnosis to study enrollment was 16 days for PWH and 11 days for HIV-. The mean CD4+ T-cell count/μl for PWH was 772.10 (±365.21). SARS-CoV-2 IgM and IgG were detected at all time points and Ab response levels did not differ by HIV status (p > 0.05). At entry, age showed a weak direct association with IgG responses (ρ = 0.44, p < 0.05) in HIV- but did not show any association in PWH. Similar associations between age, IgG, and HIV status emerged at day 14 (T1; ρ = 0.50, p < 0.05), 3 months (T3; ρ = 0.50, p < 0.05), and 6 months visit (T4; ρ = 0.78, p < 0.05) in the HIV- group.ConclusionThe Ab responses in the 6-month post-SARS-CoV-2 infection did not differ by HIV status, though a positive association was found between age and Ab response in older PWH. Results suggest that immune protection and vaccine responses are similar for PWH than for those without HIV infection.

We evaluate the impact of a multi-session cognitive behavioral prevention of mother to child transmission (PMTCT) intervention on antiretroviral therapy (ART) adherence. A total of 683 women were enrolled into a randomized control trial conducted at twelve community health centres (CHCs) in Mpumalanga Province. Participants were randomized to Standard Care or Enhanced PMTCT Intervention (EI). EI received three group and three individual intervention sessions. EI impact was ascertained on ART adherence (baseline vs 12 months post-partum). Women in the intervention groups were less likely to remain stable with regards to ART adherence over time compared to the control groups. In predicting if women become adherent over time, the intervention condition had no impact. However, the intervention condition was significantly positively associated with change to non-adherence. The enhanced cognitive-behavioral PMTCT intervention did not show any improvement in relation to maternal ART adherence relative to standard PMTCT care.Trial registration Clinicaltrials.gov: number NCT02085356.

Argentina has one of the highest suicide rates in Latin America and the Caribbean. Though people living with HIV are at increased risk for suicidal behavior, little research on suicide risk has been conducted among HIV-positive people in this region. This study examined risk factors for suicidal ideation among HIV-infected adults (N = 360) re-engaging in care in Argentina. Overall, 21% of participants reported suicidal ideation in the past week. In adjusted logistic regression models, younger age, increased depressive symptomatology, and drug abuse were associated with suicidal ideation (p

Mobility and alcohol abuse increase vulnerability to HIV among itinerants in Zambia. Itinerants face unique challenges to accessing HIV counselling, testing, and treatment. Zambian districts (Chingola, Mazabuka, Mufulira) were selected, and focus group discussions (FGDs = 12; n= 72) and key informant interviews (n = 71) were held. HIV risk and strategies to address barriers and facilitators of condom use, voluntary counselling and testing (VCT) and HIV-treatment were explored. Mobility increased sexual networks. Local bars, lodges, and truck stops were locations for sexual solicitation. Cheap lodgings were hot spots for HIV risk behavior. Difficulty accessing condoms and HIV treatment due to transience placed itinerants at elevated risk. Lack of clinics in rural areas further exacerbated itinerant risk. Initiatives to reduce these risks included implementation of border-clinics and employer-driven medical support for itinerants. Uptake of HIV prevention tools, health-education initiatives supporting itinerants, as well as health-care initiatives tailored to itinerant needs, are needed.