HIV Illness Research Articles

Accelerated Agony

Abstract This case report discusses a 39-year-old male with advanced HIV infection presenting with fever, weight loss, and respiratory symptoms, ultimately succumbing to fulminant pulmonary coccidioidomycosis. Despite initial empirical treatment for bacterial pneumonia and Pneumocystis jirovecii, the patient's condition rapidly deteriorated, highlighting the diagnostic challenges posed by this fungal infection, especially in immunocompromised individuals. Diagnostic confirmation was complicated by nonspecific clinical features, overlapping symptoms with other opportunistic infections, and unreliable serological tests. Radiological findings resembled those of other pulmonary infections, further complicating timely diagnosis. Delayed recognition of disseminated coccidioidomycosis contributed to the patient's poor prognosis. Antifungal therapy, primarily azoles, remains the cornerstone of management, with prognosis worsening with additional dissemination sites and advanced HIV illness. This case underscores the importance of considering pulmonary coccidioidomycosis in immunocompromised patients presenting with respiratory symptoms, particularly in endemic regions.

Ethics of Modern Stem Cell Research and Therapy: Current Critical and Interdisciplinary Perspectives

From an academic and clinical point of view, stem cell therapy represents one of the most promising advances in modern medicine, with the ability to partially induce the regeneration of acutely injured or chronically damaged tissues. Stem cell research provides new opportunities for the treatment of various conditions, among them diabetes mellitus, HIV, cardiovascular diseases, and neurodegenerative illnesses. Stem cell therapy is currently not FDA-approved in the US (except for certain blood cancers). While bioethics and religion have mostly discussed the source of cells, i.e., embryonic cells that require the destruction of embryos versus adult tissue for research purposes, we also discuss the controversies with regard to currently offered therapies, and marketing of unapproved procedures from a scientific, clinical, and religious viewpoint.

Care challenges and silver linings in HIV and behavioral health service delivery for individuals living with HIV and severe mental illness during the COVID-19 pandemic: a qualitative study

BackgroundThere has been a longstanding effort to integrate behavioral health and HIV care for people with comorbid HIV and behavioral health needs, including those with severe mental illness (SMI). As this population frequents both behavioral health and HIV care settings, they were likely to experience new obstacles to the quality and availability of care during the COVID-19 pandemic. This study aims to describe how clinics for HIV services or behavioral healthcare—as well as co-located sites providing both—sought to rapidly shift protocols to maintain a standard of patient care for people with comorbid HIV and SMI while adapting to the unprecedented circumstances of the pandemic.MethodsWe interviewed HIV and behavioral healthcare providers, clinic leaders, and support service agencies that served clients impacted by both HIV and SMI. Seventeen key informants across three settings (HIV care settings, behavioral health care settings, and integrated or co-located care settings) were interviewed in 2022. Interviews focused on changes in clinical services, protocols, and care provision strategies during and at the onset of the COVID-19 pandemic. Interviews were transcribed and coded using thematic analysis.ResultsCommonly endorsed themes included both positive and negative changes in care and care provision during the pandemic. Negative impacts of the pandemic included the loss of physical space, exacerbated mental health needs and disengagement in HIV care, patient barriers to telehealth and the digital divide, and increased healthcare workforce burnout. Positive changes included improved healthcare delivery and care engagement through telehealth, new opportunities to provide a wide range of social services, paradoxical increases in engagement in HIV care for certain patients, and broad institution of workforce wellness practices.ConclusionsThough COVID-19 presented several complex barriers to care for providers serving patients with comorbid HIV and SMI, the increased flexibility afforded by telehealth and a greater focus on collaborative approaches to patient care may benefit this patient population in the future. Additionally, the focus on workforce wellness may serve to increase retention and avoid burnout among providers. The strategies and lessons learned through adapting to COVID-19 may be invaluable moving forward as healthcare systems respond to future pandemics.

Clinical presentation of first episode psychosis in people with and without HIV in KwaZulu-Natal, South Africa.

Mental disorders and HIV are the main contributors to the increase in years lived with disability rates per person in sub-Saharan Africa. A complex inter-relationship exists between HIV and mental illness, especially in a region with a high HIV prevalence. We examined the duration of untreated psychosis (DUP), and the nature of psychotic and cognitive symptoms in people with first episode psychosis (FEP) living with and without HIV. Adults aged between 18 and 45 years were assessed using a clinical interview, physical examination and several psychiatric tools. These included the Mini International Neuro-psychiatric Interview to confirm psychosis, Positive and Negative Syndrome Scale, International HIV Dementia Scale and other scales to measure symptom variables. HIV ELISA was used for HIV serology testing, with measures being carried out within 6 weeks of the first presentation. Of the 172 people presenting with FEP, 36 (21%) had comorbid HIV, those with both being older and more likely to be female (p < .001). Clinically, participants with FEP and HIV scored lower on the positive subscale (p = .008). There were no statistically significant differences for DUP or cognitive screening. Of those living with HIV and FEP (n = 36) comorbidity, nine were newly diagnosed with HIV at the time of the study. Individuals presenting with FEP and comorbid HIV were older, female and reported more mood symptoms. The identification of nine new HIV infections also reflects the ongoing need to test for HIV in people presenting with severe mental illness.

Prevalence and factors associated with viral non-suppression in people living with HIV receiving antiretroviral therapy in sub-Saharan Africa: A systematic review and meta-analysis.

Despite advances in HIV treatment, the burden of viral non-suppression (VNS) remains a treatment success concern, particularly in Sub-Saharan African (SSA) countries. We determined the prevalence and factors associated with VNS for people living with HIV (PLHIV) receiving antiretroviral therapy (ART). This review, registered with PROSPERO (CRD42023470234), conducted an extensive search for evidence, focusing on PLHIV living in SSA on ART from the year 2000 to 19th October 2023, across databases including PubMed/MEDLINE, Embase, Web of Science, and Scopus. A total of 2357 articles were screened, from which 32 studies met the criteria for the final analysis, involving 756,620 PLHIV of all ages. The pooled prevalance for VNS was found to be 20.0% (95% CI: 15.43%-25.52%, I2=100%, p-value <0.01) Children and adolescents demonstrated the highest prevalence of VNS (viral load ≥1000 copies/mL) at 27.98% (95% CI: 21.91%-34.97%, I2=94%, p-value <0.01). The study revealed various factors associated with increased odds (risk) of VNS, p-value <0.05. These factors encompassed socio-demographics such as sex, age, education level, and marital status. Additionally, aspects related to HIV care, such as the facility attended, HIV status disclosure and adherence exhibited higher odds of VNS. Suboptimal ART adherence, longer duration on ART, socio-economic factors, lack of family and social support, presence of co-morbidities, advanced WHO HIV clinical stage, ART regimens, lower CD4+ count, abnormal body mass index, history of treatment interruptions, and progression of HIV illness were associated with VNS. Furthermore, behavioural/psychological factors including depression, substance use, negative perceptions towards ART, experiences of abuse, alcohol use, stigma, and certain patterns of sexual behaviour were also identified as factors for VNS. The occurrence of two VNS to every ten PLHIV on ART poses a threat to the progress made towards reaching the third 95% UNAIDS target in SSA. Additionally, these findings highlight the intricate interplay of various factors, encompassing patient characteristics, behavioural patterns, sociocultural influences, and pharmacological factors, all impacting VNS among PLHIV. Recognising its multifaceted nature, we recommend designing and implementing high impact interventions to effectively address VNS in SSA.

Co-Utilization of HIV, Substance Use, Mental Health Services Among Women With Current Substance Use: Opportunities for Integrated Care?

The syndemic of HIV, substance use (SU), and mental illness has serious implications for HIV disease progression among women. We described co-utilization of HIV care, SU treatment, and mental health treatment among women with or at risk for HIV. We included data from women with or at risk for HIV (n = 2559) enrolled in all 10 sites of the Women's Interagency HIV Study (WIHS) from 2013 to 2020. Current SU was defined as self-reported, non-medical use of drugs in the past year, excluding use of only marijuana. Tobacco and alcohol were assessed separately. We described co-utilization of SU treatment, tobacco and alcohol use treatment, HIV care, and mental health care in the past year among women who were eligible for each service. We compared service utilization by those who did/did not utilize SU treatment using Wald Chi-square tests. Among women with current SU (n = 358), 42% reported utilizing SU treatment. Among those with current SU+HIV (n = 224), 84% saw their HIV provider, and 34% saw a mental health provider. Among women with current SU+heavy alcohol use (n = 95), 18% utilized alcohol use treatment; among current SU+tobacco use (n = 276), 8% utilized tobacco use treatment. Women who utilized SU treatment had higher utilization of alcohol use treatment (59% vs. 5%; P < .001) and tobacco use treatment (12% vs. 5%; P = .028). HIV care engagement was high regardless of SU treatment. We found high engagement in SU and HIV care, but low engagement in alcohol and tobacco use treatment. Integrated SU treatment services for women, including tobacco/alcohol treatment and harm reduction, are needed to optimize treatment engagement and HIV care continuum outcomes.

Management of the fungal infections and challenges associated with it

Fungal infections are becoming more common at an alarming rate, which poses a significant challenge to medical experts. This growth is directly linked to the rise in the number of people with impaired immune systems as a result of modifications to medical practice, including the use of immunosuppressive medications and intense chemotherapy. HIV and other illnesses that impair immunity have also had a role in this issue. Mucous membranes, keratinous tissues, and the skin are all impacted by superficial and subcutaneous fungal infections. This class includes some of the most common skin conditions that impact millions of people globally. They can have crippling consequences on a person's quality of life and, in certain cases, spread to other people or become invasive, even though they are rarely life-threatening. Fungal pathogens employ several tactics to compromise the immune system of the host and escalate infections. The range of antifungal drugs available is used to treat a number of superficial and systemic diseases. The well-established evidence of fungal resistance to most antifungal medicines complicates antifungal therapy and makes disease control challenging. Fungal resistance is caused by a range of genetic alterations, physiological alterations, and selection in the presence of antifungal drugs. The lack of a wide range of antifungal drugs, resistance building, and biofilm-conferred resistance are the main reasons for the need for novel therapeutics and other approaches to enhance treatment outcomes against mycoses.

INFORMAL SUPPORT NETWORKS AND LONELINESS IN OLDER WOMEN LIVING WITH HIV

Abstract Older adults with HIV are at increased risk for social isolation and poor well-being. Although older women living with HIV (WLWH) are more likely to be embedded in supportive networks than men, they often report inadequate support in meeting their needs. The function of older WLWH’s informal networks, their effectiveness in meeting care needs, and links to well-being are major gaps in the literature. Using a subsample of heterosexual WLWH from The Research on Older Adults with HIV 2.0 Study aged 50 to 77 (Mage = 59; n = 210), we assessed sources of social support, interpersonal strain, and support adequacy, in relation to loneliness. About half the sample reported having ever (i.e., currently or in the past) needed regular assistance due to HIV or other illness, disability, or frailty whereas the rest reported never needed regular assistance. Preliminary regression analyses controlled for age, race, ADLs, partnership, and formal care status. Findings revealed that neither support from family or from friends was associated with loneliness. However, strain from both sources was significantly associated with greater loneliness. In terms of support adequacy, having someone to count on for emotional support was associated with lower loneliness, and needing more emotional support was associated with greater loneliness. Instrumental support (i.e., help with tasks was not significantly associated with loneliness. These findings highlight the importance of considering positive and negative social relations, as well as different dimensions and sources of support. Interventions to improve emotional support resources could help mitigate loneliness among older WLWH.

Pharmacokinetic-Guided Hydroxyurea to Reduce Transfusion Requirements in Ugandan Children with Sickle Cell Anemia: Baseline Data from the Alternative Dosing and Prevention of Transfusions (ADAPT) Trial

Background: Children are the primary recipients of blood transfusions in sub-Saharan Africa where the demand for safe blood far exceeds the supply. Without disease-modifying therapy, sickle cell anemia (SCA) causes excess morbidity, mortality, and healthcare resource utilization, specifically requiring a high reliance on blood transfusions. Hydroxyurea is a safe and effective medication for the treatment of SCA that decreases blood transfusion use in this population, which may offset the costs of improving hydroxyurea access. The widespread use of hydroxyurea in Africa is limited in part by challenges determining an individual's optimal dose; pharmacokinetic (PK) dosing of hydroxyurea may streamline the dosing process, maximizing the clinical benefits and minimizing toxicities. We designed the Alternative Dosing And Prevention of Transfusions (ADAPT) trial to analyze the reduction in transfusion use with hydroxyurea and as a pilot evaluation of the feasibility of PK-guided hydroxyurea dosing in Uganda. Methods: ADAPT (NCT05662098) is a prospective, single-center, open-label cohort study at Jinja Regional Referral Hospital in Uganda. Children 1-10 years old with HbSS were eligible to enroll; those already receiving hydroxyurea or scheduled blood transfusions, or with malignancy, HIV, tuberculosis, or other chronic illnesses were excluded, and those who received a transfusion within 30 days were temporarily excluded. All participants completed a 3-month screening period during which they underwent baseline evaluations and hydroxyurea PK testing. For PK testing, a 500 mg hydroxyurea test dose was administered, and serum was collected 30, 60, and 180 minutes after the dose. Hydroxyurea concentrations were determined via chemical derivatization and high-performance liquid chromatography in Uganda. Area-under-time-concentration-curves (AUC) and Bayesian estimation were then used to calculate the optimal hydroxyurea dose based on target medication exposure. Those for whom hydroxyurea PK evaluation was completed successfully with a dose recommendation between 15-35 mg/kg/day started on their PK-guided hydroxyurea dose; otherwise, participants started on the default dose of 20 mg/kg/day. All participants will be treated on hydroxyurea for a minimum of 12 months during which time both treatment groups will follow the same laboratory monitoring and dose adjustment protocol to achieve the maximum tolerated dose. The primary study endpoint is the incidence rate ratio of blood transfusion use during screening versus treatment. Secondary endpoints include characterization of blood transfusions (indications, risk factors, adverse reactions), feasibility of PK testing, and laboratory and clinical adverse events comparing children started on PK-guided versus default dosing. Results: From June 2022 to January 2023, 106 participants were enrolled, exceeding the projected enrollment pace and goal. The average age (mean ± SD) at enrollment was 4.6 ± 2.3 years, and 50% were female. Per family-reported history, most participants had previously received a blood transfusion (78%) with 15% reporting at least 6 lifetime transfusions. Five percent had a prior stroke. A majority also had a history of pain events (86%), malaria (79%), and dactylitis (74%). Only 2% had previously used hydroxyurea. At enrollment, the median weight-for-height z-score was -0.19 (interquartile range -1.03-0.32), and baseline exam demonstrated a palpable spleen in 20%. Abdominal ultrasonography was completed on all participants, and the spleen was identified in 75% of participants with a mean volume of 132 ± 99 mL. Transcranial Doppler exams were completed on 105 participants (99%) during screening with 13% conditional and 6% abnormal results. Baseline labs (mean ± SD) documented hemoglobin = 7.7 ± 1.3 g/dL and HbF = 10.3 ± 7.1 %. Of 106 children enrolled, 1 died from acute chest syndrome in screening and 2 were withdrawn after moving away from the clinic; 103 successfully initiated hydroxyurea treatment. Conclusion: ADAPT has fully completed enrollment and will prospectively evaluate the effectiveness of hydroxyurea treatment on reducing transfusion use in Ugandan children with SCA, a finding with both individual and public health implications. ADAPT will also provide pilot data regarding the feasibility of PK-guided dosing of hydroxyurea to facilitate safe, effective hydroxyurea use in Africa.

Socio-demographic and clinical characteristics associated with retention in care among adults living with HIV and severe mental illness and reasons for loss to follow-up in Uganda: a mixed-methods study

ObjectiveThis study aimed to determine the socio-demographic and clinical characteristics associated with retention in care and reasons for loss to follow-up (LTFU) among people living with HIV (PLWH) with a...

Improving patient-centered care for HIV and mental illness: exploring hospital and community integration through education

ABSTRACT Current models of care delivery are failing patients with complexity, like those living with HIV, mental illness and other psychosocial challenges. These patients often require resource-intensive personalized care across hospital and community settings, but available supports can be fragmented and challenging to access and navigate. To improve this, the authors created a program to enhance integrated, trauma-informed care through an innovative educational role for a HIV community caseworker embedded in an academic HIV Psychiatry clinic, called the Mental Health Clinical Fellowship. Through qualitative interviews with 21 participants (patients, physicians, clinicians and Mental Health Clinical Fellows) from October 2020–March 2023, the authors explore how implementation of this program affects patient experiences and satisfaction with care. Patients described their care experiences as less stigmatizing, more accessible, holistic and coordinated. They often attributed this to the integration between fellow and psychiatrist, and specifically the accessible stance of community organizations embedded within a hospital, which helped build trust. Interchangeable and integrated support by caseworker and psychiatrist improved patient engagement in psychiatric management and patient satisfaction with their care. Cross-context and cross-disciplinary care provision that includes providers from community and hospital working directly together to deliver care can improve care for patients with significant complexity.

Development and internal validation of a risk prediction model for HIV disease severity among people living with HIV and mental illness or substance use disorder

PurposeMental illness (MI) and substance use disorders (SUD) are highly prevalent among people living with HIV (PLWH), and have been linked to poor HIV clinical outcomes. Innovative tools for early risk identification can facilitate timely interventions for PLWH and MI/SUD to improve their health outcomes, however, this is currently lacking in Texas, a state with the 4th largest population of PLWH in the United States. To address this gap, we developed a predictive model to estimate the risk of suboptimal HIV clinical outcomes among PLWH and MI/SUD in Texas. MethodsThe Texas Medical Monitoring Project data obtained from June 2015–May 2020 were used to develop and internally validate the predictive model. Univariate descriptive and bivariate inferential statistics were performed to describe the characteristics of the study population and unadjusted associations with HIV clinical outcomes. Multivariable logistic regression was used to develop the prediction model. Internal validation was performed using the bootstrap method. ResultsA total of 518 respondents aged 18 years and above, representing 27,255 adults living with HIV and mental illness or substance use disorders in Texas were included. Most participants were male (77.0%), less than 50 years of age (60.0%), and had mild diagnosed mental illness and substance use disorder (54.8%). The risk predictive model contained eight predictors, which together yielded an area under the receiver operating characteristic (ROC) curve of 0.727. Non-retention in care appeared to be the strongest risk predictor for having suboptimal HIV clinical outcome (adjusted odds ratio (aOR) = 3.27; 95% confidence interval (CI) = 1.45, 7.42). ConclusionsThe predictive model had good discrimination between persons at risk of poor HIV clinical outcomes and those not at risk.

Understanding clinical outcome measures reported in HIV pregnancy studies involving antiretroviral-naive and antiretroviral-experienced women.

HIV infection is a clinically significant public health disease and contributes to increased risk of maternal and fetal morbidity and mortality. HIV pregnancy studies use outcome measures as metrics to show how people with HIV feel, function, or survive. These endpoints are crucial for tracking the evolution of HIV illness over time, assessing the effectiveness of antiretroviral therapy (ART), and comparing outcomes across studies. Although the need for ideal outcome measures is widely acknowledged, selecting acceptable outcome measures for these HIV pregnancy studies can be challenging. We discuss the many outcome measures that have been implemented over time to assess HIV in pregnancy studies, their benefits, and drawbacks. Finally, we offer suggestions for improving the reporting of outcome measures in HIV in pregnancy studies. Medical professionals can best care for pregnant women living with HIV receiving ART by having a thorough understanding of these outcome metrics.

Prevalence and correlates of internalized stigma among adults with HIV and major depressive disorder in rural Malawi

ABSTRACT Internalized stigma is common among individuals with sexually transmitted infections such as HIV and among those with mental health conditions such as major depressive disorder (MDD). As part of a cluster randomized trial, we investigated the prevalence and correlates of internalized stigma among adults living with comorbid HIV and MDD in rural Malawi (n = 339). We found heightened stigma toward HIV and mental illness among those in the cohort: more than half of respondents (54%) endorsed negative perceptions associated with each health condition. Internalized HIV-related stigma was higher among those with no education (p = 0.04), younger adults (p = 0.03), and those with less social support (p = 0.001). Mental illness-related stigma was elevated among those with no source of income (p = 0.001), and it was also strongly associated with HIV-related stigma (p < 0.001). Our findings highlight potential avenues for reducing internalized stigma associated with high-prevalence health conditions in Malawi. Trial registration: ClinicalTrials.gov identifier: NCT04777006.

Abstract P193: Sexual Minority Men of Color With HIV Suggest a Virtual Environment May Be Promising to Support Cardiovascular Health: Findings From an Intervention Mapping Study

Introduction: Black and Latinx sexual minority men are disproportionately impacted by chronic conditions, such as HIV. Persons with HIV have a 1.5 to 2 times risk of cardiovascular disease (CVD) when compared to White, HIV-negative persons. By the year 2030, it is estimated that 78% of persons with HIV will have CVD. Patient teaching in the clinical setting has been the traditional modality for prevention education. However, persons at the highest risk, and who are based in the community, may not have access to clinic-based prevention education. Objective: To use mixed methods to assess HIV illness perceptions, HIV-related comorbid conditions of concern, and understand perspectives on the use of an online virtual environment (VE) for CVD prevention education. Methods: The Gaming Protocol Study is a mixed methods study that used Life’s Simple 7 as a framework to map an intervention to support cardiovascular health in sexual minority men of color with HIV, ages 30-65. Data were collected in English, Spanish, and Creole. Using validated measures, HIV illness perceptions, nicotine exposure, and physical activity were assessed. Qualitative interviews explored chronic illnesses of concern outside of HIV and also perceptions about the use of an online VE for CVD prevention education. Results: Thirty participants completed the validated measures and interviews. Quantitative findings suggested that greater than 90% of participants had a strong understanding of their HIV status. More than 50% of participants reported they experienced feelings of anxiety or fear by having HIV. Close to 30% reported having used nicotine and/or e-cigarettes. Less than half of participants met the criteria for engaging in vigorous or moderate physical activity. Qualitative findings suggested concerns about existing and potential future conditions, such as hypertension, diabetes, asthma, obesity, and mental health. Additionally, COVID-19 and Monkeypox were highlighted as important considerations because they pose high risk in the community. Perceptions about using a VE were mostly positive. Concerns were focused on online engagement and digital privacy. Conclusions: Sexual minority men of color are concerned about health conditions beyond HIV. They desire accessible, culturally relevant information to manage their health. Findings provide early evidence about health communication and education preferences for technology tools so they are meaningful and actionable as CVD prevention education.

Heroin use and neuropsychological impairments: comparison of intravenous and inhalational use.

Injection and inhalational heroin use are associated with different levels of brain exposure to heroin and its metabolites and differences in the severity of dependence, which might lead to differential impacts on neuropsychological functions. We examined the difference and the magnitude of difference in the neuropsychological functions between inhalational and injection heroin-dependent subjects and also compared them with healthy controls. The study sample comprised three groups: 73 subjects with injection heroin dependence, 74 with inhalational heroin dependence, and 75 healthy controls (HC). We excluded patients with HIV, head injury, epilepsy, and severe mental illness. Neuropsychological assessments were done by Standard Progressive Matrices, Wisconsin Card Sorting Test (WCST), Iowa Gambling Task, Trail-Making Tests A and B (TMT), and Verbal and Visual Memory 1 and 2 Backtests (NBT). We estimated independent effects of the groups on various neuropsychological test parameters, adjusted for age and duration of dependence. In the WCST, the inhalational heroin-dependent group took more trials to complete the first category and had higher scores in the failure to maintain set than controls. The intravenous group had higher total errors than controls in verbal working memory tests and Visual Working Memory 2 Backtest. This group scored higher commission errors in the Verbal 2 Backtest than the controls. The two groups of heroin users differed in failure to maintain set and Verbal Working Memory 2 Backtests. The effect sizes of the group differences were modest. Either route of heroin use is associated with cognitive impairments; inhalational and injection use involve different cognitive domains.

A NEEDS ASSESSMENT FOR SOCIAL WORK INTERVENTIONS FOR CHILDREN AFFECTED BY HIV AND AIDS

Children are often left orphaned and without adult supervision when the parent or caregiver dies from HIV and AIDS-related illnesses. There is very little information available in South Africa on the type of interventions to reinforce the care and support provided to children affected by HIV and AIDS (CABHA). This study aimed to explore existing interventions provided to CABHA and the experiences of social workers in implementing interventions. Findings indicate that interventions are a continuous and collaborative process between social workers and stakeholders. A proper needs assessment should be done before implementing interventions to ensure that they benefit the children identified as needing intervention. Community-based interventions should not be underestimated as a significant source of support for CABHA. Keywords: children affected by HIV and AIDS, HIV and AIDS, intervention, needs assessment, orphaned and vulnerable children, social work

SUPPORT NEEDS AND RESOURCES OF OLDER WOMAN LIVING WITH HIV

Abstract People living with HIV are at increased risk for social isolation and sparse support networks, making it difficult to navigate complex caregiving needs as they age. This study aimed to identify the support needs and resources of older women living with HIV, an understudied population in this field, and their association with well-being. Participants included 217 heterosexual women aged 50 to 77 (Mage=59) from the ROAH 2.0 Study. Almost half of the sample (47.7%) had never required assistance because of HIV or other illness or disability, whereas the remainder required current or past assistance. Preliminary findings controlling for sociodemographics indicated that availability of emotional support, but not practical support (i.e., having someone to count on for activities of daily living), was associated with lower depressive symptomology. Identifying sources and types of support will help older women leverage existing social ties or form new ones to promote successful aging with HIV.

The Role of Nursing in Loosening the Pervasive Grip of Intersectional Stigma.

Stigma is a key driver of inequity and affects myriad health behaviors and outcomes, especially those related to substance use disorder, HIV, and mental illness. Intersectionality, theorized by Black feminist scholars, emphasizes the intersecting, structural processes that place people at risk for harm. As people's multiple identities are inseparable and non-additive, their experiences of stigma are complex and multifaceted. Nurse educators, scholars, and clinicians form the foundation of patient care and scientific advancements to improve the health and well-being of diverse patient populations. The nursing profession must contend with the underlying drivers of intersectional stigma, including systemic racism and White supremacy, classism, and gender inequality. Centering equity, strengthening recruitment/retention of minoritized nursing students, implementing stigma training in curricula, improving the nursing leadership pipeline, moving beyond implicit bias training and deficit models, and incorporating intersectional and implementation science approaches in research can help advance equity for clinicians and patient populations. [Journal of Psychosocial Nursing and Mental Health Services, 60(12), 9-15.].

Update on treatment as prevention of HIV illness, death, and transmission: sub-Saharan Africa HIV financing and progress towards the 95-95-95 target.

After over 40 years, the HIV pandemic is amongst the deadliest in history - 100% fatal without treatment, HIV has infected over 84 million people, and has caused over 40 million deaths. Global HIV spending between 2000 and 2015 totaled over a half trillion dollars. Delays in harnessing scientific advances, including 'test and treat' and treatment as prevention of illness, death, and transmission (TasP) provide a cautionary tale applicable to other pandemics. Resource allocation has also been problematic with many highest burden countries spending less than 50% on care and treatment. Between 2002 and 2021, over $94 billion was budgeted for HIV in 40 sub-Saharan African countries, with 19 countries over $1 billion. In 2021, 8.1 million (32%) People Living with HIV (PLHIV) are still not on treatment; viral suppression data, the most important programme success indicator, is unavailable for 50% of countries. Of 19 countries with at least one billion dollars budgeted, seven have below 80% ART coverage, leaving 3.5 million (29%) of PLHIV off treatment and vulnerable to illness, death, and transmitting the virus to partners and children. With additional funding and improved efficiency, achieving the 95-95-95 target to diagnose 95% of all HIV-positive individuals, provide antiretroviral therapy (ART) for 95% of those diagnosed and achieve viral suppression for 95% of those treated by 2030 is feasible and the humane pathway towards ending the HIV pandemic.