HIV Prevention Measures Research Articles

Developing a youth-friendly internet-enabled HIV risk calculator: A collaborative approach with young key populations, living in Soweto, South Africa.

Although South Africa is the global epicenter of the HIV epidemic, the uptake of HIV testing and treatment among young people remains low. Concerns about confidentiality impede the utilization of HIV prevention services, which signals the need for discrete HIV prevention measures that leverage youth-friendly platforms. This paper describes the process of developing a youth-friendly internet-enabled HIV risk calculator in collaboration with young people, including young key populations aged between 18 and 24 years old. Using qualitative research, we conducted an exploratory study with 40 young people including young key population (lesbian, gay, bisexual, transgender (LGBT) individuals, men who have sex with men (MSM), and female sex workers). Eligible participants were young people aged between 18-24 years old and living in Soweto. Data was collected through two peer group discussions with young people aged 18-24 years, a once-off group discussion with the [Name of clinic removed for confidentiality] adolescent community advisory board members and once off face-to-face in-depth interviews with young key population groups: LGBT individuals, MSM, and female sex workers. LGBT individuals are identified as key populations because they face increased vulnerability to HIV/AIDS and other health risks due to societal stigma, discrimination, and obstacles in accessing healthcare and support services. The measures used to collect data included a socio-demographic questionnaire, a questionnaire on mobile phone usage, an HIV and STI risk assessment questionnaire, and a semi-structured interview guide. Framework analysis was used to analyse qualitative data through a qualitative data analysis software called NVivo. Descriptive statistics were summarized using SPSS for participant socio-demographics and mobile phone usage. Of the 40 enrolled participants, 58% were male, the median age was 20 (interquartile range 19-22.75), and 86% had access to the internet. Participants' recommendations were considered in developing the HIV risk calculator. They indicated a preference for an easy-to-use, interactive, real-time assessment offering discrete and private means to self-assess HIV risk. In addition to providing feedback on the language and wording of the risk assessment tool, participants recommended creating a colorful, interactive and informational app. A collaborative and user-driven process is crucial for designing and developing HIV prevention tools for targeted groups. Participants emphasized that privacy, confidentiality, and ease of use contribute to the acceptability and willingness to use internet-enabled HIV prevention methods.

PrEP Use in a US National Sample of Trans Men and Other Transmasculine People Who Have Sex With Men: A Longitudinal Analysis.

Efforts to improve pre-exposure prophylaxis (PrEP) uptake among gay men, transgender women, and Black cisgender women are evident across the United States, responding to epidemiologic data showing a disproportionate HIV burden in these communities. However, transgender men and other transmasculine people who have sex with men (TMSM)-those assigned female at birth who identify otherwise and have sex with cisgender men-are often excluded from these statistics. This community has unique vulnerabilities and prevention needs. National HIV prevention and planning has yet to include transgender men as a group with increased vulnerability to HIV seroconversion. This study follows a cohort of TMSM to characterize PrEP use longitudinally. Using data from a prospective US national cohort of TMSM not on PrEP, we analyzed annual PrEP uptake, discontinuation, and other HIV prevention measures over 24 months. We also used generalized estimating equations modeling to assess demographic, healthcare access, gender-affirming, and behavioral factors associated with PrEP uptake over time. Our cohort of 196 TMSM was demographic and regionally diverse. 29% of our sample reported uptake of PrEP in 24 months, with about one-third of users discontinuing within 1 year. Health insurance, having had lower surgery, used post-exposure prophylaxis, or recently having a sexually transmitted infection were associated with increased odds of PrEP use. We found low uptake of PrEP and high discontinuation rates in a US national sample of TMSM over 24 months, despite significant need for HIV prevention. It is vital to increase efforts and investments to support this neglected community.

Where do we go from here? Reconciling implementation failure of PrEP for Black women in the South. Leveraging critical realism to identify unaddressed barriers as we move forward.

PrEP, a highly effective HIV prevention measure, provides autonomy to individuals in managing their HIV acquisition vulnerability. Despite its availability in tenofovir-based oral pills and injectable cabotegravir formulations, PrEP uptake among Black cisgender women in the U.S. South, a region with a high HIV burden, remains critically low. This demographic faces a disproportionately high rate of new HIV diagnoses, yet fewer than 10% of women in the US who could benefit from PrEP are currently receiving it. Utilizing a critical realism interpretative framework, this narrative review employed a tri-level analysis strategy to examine the empirical, actual, and real domains influencing PrEP implementation among Black women in the Southern U.S. The empirical level refers to observable events and data (e.g., PrEP uptake rates), the actual level encompasses experiences and actions that may not always be directly observed (e.g., healthcare interactions and community engagement), and the real level involves the deeper structures and mechanisms (e.g., systemic racism and cultural narratives) that shape these outcomes. A comprehensive search of peer-reviewed literature from PubMed and other sources was conducted to identify barriers and facilitators to PrEP uptake in this population. The analysis revealed significant barriers, including structural violence, socioeconomic disparities, medical mistrust, stigma, and inadequate healthcare policies. Empirical data showed variability in PrEP awareness and interest among Black women, while actual experiences highlighted misaligned marketing strategies, financial constraints, and interpersonal dynamics. At the real level, underlying mechanisms such as systemic racism and cultural narratives were identified as critical impediments to PrEP uptake. Addressing these multifaceted barriers requires a comprehensive, multi-level approach that integrates personalized, community-centric strategies. Emphasizing the need for healthcare providers, community leaders, researchers, and policymakers to collaborate, the review proposes actionable strategies to enhance PrEP implementation, focusing on education, structural reforms, and policy changes to improve access and acceptability among Black women in the South.

PREVENTION AND INFECTION BY HIV/AIDS: Perception in a population of university students from northwest paulista

Occupational and sexually transmitted infections represent a major public health problem, as annually more than 1 million people are infected, with about 40 million deaths since the first case of HIV/AIDS. The global implementation of rapid diagnoses and effective antiretroviral therapy has made possible a significant reduction in morbidity and mortality. However, the world literature reveals that it is necessary to improve knowledge of HIV prevention measures among university students. The objective of this study was to analyze the knowledge of nursing students regarding the prevention of these infections. The model followed was prospective observational and transversal, following the STROEBE rules, with a questionnaire to evaluate the knowledge of the academics. We concluded that there was an heterogeneity in the responses of the academic students of nursing course regarding the risks and prevention of infection of university students to HIV and AIDS, being similar to the results found in the international studies that were discussed in this study. Despite this, there were significant correlations between the knowledge of university students and the use of condoms, tests and pre-exposure prophylaxis to HIV. Sexuality must be understood in a comprehensive way and its complexity must be recognized, valuing it as a fundamental experience of the human being.

Viral Suppression among Men Who Have Sex with Men Living With HIV on Risk Reduction Interventions in Mvita Sub-County, Mombasa County, Kenya

Purpose: The aim of this study was to compare viral load suppression levels among men who have sex with men (MSM) living with HIV who were put on risk reduction interventions versus a control group in Mvita sub-county, Mombasa County, Kenya between December 2020 and June 2021. Methodology: A quasi-experimental study design using quantitative methods was conducted among MSM living with HIV from December 2020 to June 2021. The study involved a questionnaire and various laboratory investigations. The respondent-driven sampling (RDS) was used to obtain the sample of respondents. A total of 114 HIV positive MSM completed the study and were all subjected to a battery of tests. Blood was drawn for alcohol, syphilis, hepatitis B, and viral load tests, while urine was used to screen for drugs and gonorrhoea. Half (57) of the HIV positive MSM were actively followed and risk reduction interventions such as adherence to ARVs, general counselling, and HIV prevention measures such as prompt treatment of STI/OI and condom use were offered after every 2 months. The control group (57) received no risk reduction interventions. Thereafter, both groups were asked to respond to a questionnaire. Since the study was carried out during COVID-19, the risk reduction interventions were conducted over the phone to minimize transmission. Log-binomial univariate and the multivariate regression analysis model was used to identify the variables which were associated with undetectable viral load. Undetectable viral load was defined as having an HIV viral load of less than 50 copies/ml. Data generated from the questionnaires were collected, cleaned, coded and analysed using STATA software, Version 17. Level of significance was fixed at 5% (95% confidence interval). Findings: Majority of MSM living with HIV were between 19-20 years and 49% were actively followed by the researcher and received risk reduction interventions while 54% were in the control group. However, the baseline demographic characteristics were not significantly different (all p>0.05). MSM in the control group who were neither Christian nor Muslim (11%) and had a lower income (35%), were likely to have detectable viral load. However, MSM who had a higher income in both groups (1.8%), were likely to have undetectable viral load. MSM in the control group, who reported ever use of PEP/PrEP (44%), were likely to have detectable viral load while MSM who received interventions, who reported condom break more than once during anal sex (61%), who had more than one regular anal sex partner (61% both groups), and those who drunk more than 2 bottles of beer (33% both groups) were likely to have undetectable viral load. However, MSM who received interventions but used non-prescribed injectables drugs 1 to 2 times in a week (15%), were likely to have detectable viral load. MSM in the control group who reported being always high on alcohol during anal sex (19%), were likely to have detectable viral load but those chewing muguka (type of khat) (79%) were likely to have undetectable viral load. MSM who received interventions who reported feeling uneasy while seeking health services (75%), had detectable viral load while those in the control group who attended private clinics (42%), had undetectable viral load. Overall, after six months, the proportion of MSM achieving viral load suppression was significantly higher in the intervention group as compared to control group by 60% (95% CI 49‒70)), p-value < 0.001. Unique Contribution to Theory, Practice and Policy: The study found out that majority of HIV positive MSM who received risk reduction intervention, had undetectable viral load as compared to those in the control group. HIV viral suppression is the desirable outcome for MSM on ART, since once achieved, MSM cannot transmit the virus to their sex partners. The Government/NGO should encourage peer-led HIV services to run the HIV programmes involving MSM with other stakeholders. Thus, many MSM will be able to access the HIV services where their needs will be addressed and supported in a non-judgemental environment.

Effects of Substance Use on Condomless Anal Sex in a Large Sample of Adolescent Men Who Have Sex with Men: A Within and Between Relationship Design.

Substance use is a significant risk factor for HIV infection among adolescent men who have sex with men (AMSM). Substance use may reduce the use of HIV prevention measures or increase the likelihood of engaging in activities with a higher risk of HIV transmission, but there is a lack of studies dedicated to analyzing these mechanisms in adolescents and young MSM. This study aimed to explore the impact of substance use on condomless anal sex (CAS) in a large, racially diverse sample of AMSM. Additionally, we investigated how an individual's general level of substance use moderated the association between substance use before sex and CAS at the partnership level. Baseline data for an HIV prevention intervention were collected through online surveys from April 2018 to June 2020. The sample consisted of 1624 AMSM (M age, 16.69 years) who reported at least one sexual partner in the previous 3months. Participants provided information about their three most recent sexual partners, including their relationship to the partner, PrEP use, frequency of alcohol, marijuana, and non-prescription drug use before sex, and the number of CAS acts. Participants also completed measures of their substance use frequency. Multilevel modeling in Mplus was used for data analysis, accounting for sexual partnerships nested within participants. All models controlled for PrEP use and relationship status. Results revealed a significant positive association between the frequency of non-prescription drug use before sex and CAS at the partnership level. This indicates that higher non-prescription drug use frequency before sex was associated with a greater number of CAS acts with partners. Moreover, the cross-level interaction between alcohol frequency and non-prescription drug use before sex was statistically significant. Specifically, for participants with high alcohol frequency scores, there was a significant positive association between non-prescription drug use before sex and CAS at the partnership level. AMSM with higher average alcohol consumption were more likely to engage in CAS when using non-prescription drugs prior to sex with a partner, compared to those with lower alcohol consumption. This study's use of multilevel data analysis contributes innovatively to the field by shedding light on how substance use operates within sexual relationships and different partnership dynamics. Tailored interventions targeting substance use should be developed to reduce HIV risk among AMSM.

Adverse Childhood Experiences and HIV-Related Stigma: A Quantitative Survey of Tanzanian Men, June 2019

Experiencing adverse childhood experiences (ACEs) may impact personal opinions, attitudes, and judgments, which can further result in HIV-related stigma. HIV-related stigma consequentially may impact HIV preventive measures such as HIV testing, pre-exposure prophylaxis uptake, and condom use. The extent to which ACEs influence HIV-related stigma perception has not been well studied. Therefore, the study aimed to examine the association between ACEs and perceived and interpersonal HIV-related stigma among Tanzanian HIV-negative men. Quantitative survey data were obtained from the Tanzania STEP (Self-Testing Education and Promotion) project established in four wards: Mabibo, Manzese, Tandale, and Mwanyanamala. A total of 507 men responded to the ACEs and HIV-related stigma questionnaires. ACEs were operationalized as types of ACEs (environmental, physical/psychological, sexual abuse) and ACE score (0 (reference) vs. 1, 2, 3, ≥ 4). Perceived HIV-related stigma was analyzed both as a binary (HIV stigma vs. no HIV stigma) and a continuous variable. Unadjusted and adjusted multinomial logistic and linear regression models were used to assess the associations between ACEs and HIV-related stigma. ACE types were associated with HIV stigma (b = 0.237, 95% CI [0.122–0.352], p = < .0001). Findings of the adjusted multinomial logistic regression model show that experiencing one ACE (aOR = 1.9; p-value = 0.023), two ACEs (aOR = 1.8; p-value = 0.044), four or more ACEs (aOR = 4.1; p-value = < 0.0001) were associated with greater perceived HIV-related stigma. Moreover, experiencing environmental (aOR = 8.6; p-value = 0.005), physical/psychological (aOR = 2.5; p-value = 0.004), and sexual abuse (aOR = 3.4; p-value = < 0.0001) were associated with higher odds of HIV-related stigma. Our study findings suggest that those who experience childhood trauma are more likely to have a higher perception of HIV-related stigma. Intervention programs targeting HIV stigma should consider addressing ACEs entailing the behavioral and psychological impact of childhood trauma.

Acceptability of the Dapivirine Vaginal Ring and Daily Oral Pre-exposure Prophylaxis (PrEP) during Pregnancy in Malawi, South Africa, Uganda, and Zimbabwe

Pregnant and lactating persons in sub-Saharan Africa face a heightened risk of HIV acquisition, due to biological and behavioral factors, combined with limited access to prevention and treatment services. Oral pre-exposure prophylaxis (PrEP) and the dapivirine vaginal ring are promising tools for HIV prevention, and the ring’s recent approval in multiple African countries represents a significant advancement in expanding access to HIV prevention. In a nested qualitative study within the MTN-042 trial, we explored the acceptability of study products among pregnant persons in the second and early third trimesters. Interviews were conducted privately, using a semi-structured guide with 77 participants, in participants’ preferred language. Topics explored included product acceptability (using the theoretical framework of acceptability), user experience, satisfaction, disclosure, community attitudes, and sexual activity during pregnancy. Interview transcripts were analyzed using Dedoose software. We observed positive attitudes among participants towards the study products, which they found generally user-friendly, despite the added complexities of using them during pregnancy. Participants recognized that consistent and correct use would provide protection for both them and their unborn children. Although initial concerns existed, most of these worries dissipated over time, with study staff support and increased product use experience. These findings emphasize the importance of continued surveillance, support, and education to ensure the successful rollout of new HIV prevention measures during pregnancy.

Women's Perceived HIV Stigma and Testing in Stann Creek District, Belize: A Population-Representing, Mixed-Methods Study.

Stigma affects adversely the HIV prevention continuum and care cascade. Our population-based, mixed-methods study aimed to assess women's perceived HIV stigma and discriminatory attitudes, and their relation with HIV testing in a high-prevalence area in Belize. This population-representing household survey in the mixed urban-rural setting of Stann Creek District, Belize, collected data from 236 women age 15 to 49 years. We analyzed HIV testing rates, HIV prevention and transmission knowledge, perceived stigma manifestations, and participant attitudes. Concurrently, a nested qualitative component of study cognitive interviews with a purposive sample of 23 women explored HIV stigma in their community. A vast majority of women (96%) perceived HIV stigma manifestations in their communities as pervasive and a deterrent to people from testing. Discriminatory attitudes (16% believe children with HIV should not attend school) and HIV misconceptions (53% fear acquiring HIV through saliva) tended to be more common in nonurban areas and among women with less formal education. Stigma persisted even with high HIV testing rates among women. Qualitative findings triangulated survey results and, taken together, suggest that prejudices held against people with HIV led to avoidance of HIV preventive measures such as testing and status disclosure, fueled by a strong distrust of the medical care system regarding confidentiality of HIV test results. Misconceptions about HIV and stigmatizing attitudes remain pervasive among women in Stann Creek, Belize. Health literacy, stigma interventions, and expansion of routine confidential testing to include men are needed to address the HIV and stigma syndemic in Belize.

Joint modeling of correlated binary outcomes using multivariate logistic regression: contraception and HIV knowledge in Sri Lanka

Reproductive health significantly contributes to the overall well-being and social welfare of women. Within the spectrum of modern and traditional contraceptive methods in use, condoms have been strongly advocated by numerous HIV programs as a primary means of preventing HIV infection in Sri Lanka. Given the intrinsic relationship between contraceptive utilization and HIV awareness, our study aims to concurrently analyze the patterns of contraceptive usage and HIV knowledge, while accounting for their potential correlation. In this study, we introduced the application of the Gumbel type II distribution to effectively capture the interdependence of these joint probabilities, accounting for various covariates. The outcome of simulation studies demonstrated the superior performance of the integrated joint model, in comparison to the separate univariate models. Our findings highlighted several noteworthy risk factors associated with both contraceptive usage and HIV prevention knowledge. These included variables such as residence, level of education, wealth quintile, husband's education level, number of children, engagement with the newspapers, television viewership, and mobile phone usage. The Result indicates a positive association between the adoption of contraception and the awareness of HIV prevention measures, suggesting that individuals who actively embrace contraception are more likely to possess knowledge about preventing HIV transmission.

Interest in I-PrEP and Willingness to Participate in Clinical Trials Among Men and Transfeminine Persons Who have Sex with Men in Sub-Saharan Africa: Quantitative and Qualitative Findings from HPTN 075.

This study explored interest in injectable PrEP (I-PrEP) and willingness to participate in clinical trials testing new biomedical HIV prevention strategies among men and transfeminine persons who have sex with men (MSM & TGP), using data collected in the HIV Prevention Trials Network (HPTN) 075 study, which took place at sites in Kenya, Malawi, and South Africa. Data result from a survey among 267 18-44years old HIV negative participants, complemented with semi-structured interviews with 80 purposively recruited persons. Correlations coefficients were calculated to identify demographic and psychosocial factors associated with interest in I-PrEP. Qualitative interviews were analyzed using concept-driven and subsequent data-driven coding. Most surveyed participants expressed an interest in I-PrEP. Quantitatively, only being interested in other HIV prevention measures was associated with interest in I-PrEP. Qualitatively, most participants preferred I-PrEP to O-PrEP and remained interested in I-PrEP despite barriers such as the somewhat invasive nature of the procedure and potential side effects of I-PrEP. Interest in I-PrEP was driven by the possibility of avoiding sexual or HIV stigma. Access to healthcare and altruism-such as assisting in the development of new HIV prevention methods-positively impacted willingness to participate in clinical trials. With I-PrEP favored by most participants, it is potentially a critical tool to prevent HIV infection among MSM & TGP in sub-Saharan Africa, with the mitigation of stigma as a major advance. Recruitment of MSM & TGP in biobehavioral clinical trials seems feasible, with altruistic reasons and receiving I-PrEP and free medical care as major motivators.

The relationship between anti-LGBTQ+ legislation and HIV prevention among sexual and gender minoritized youth.

The aim of this study was to estimate the longitudinal associations of state-level anti-LGBTQ+ policies and county-level politics with individual HIV prevention outcomes among sexual and gender minoritized (SGM) youth. Keeping it LITE-1 prospectively enrolled 3330 SGM youth and young adults (ages 13-34) at increased risk of HIV throughout the United States from 2017 to 2022. Semiannual surveys collected self-reported HIV prevention measures [current preexposure prophylaxis (PrEP) use, weekly PrEP adherence, HIV/STI testing in the past 6 months]. Geolocation was linked with state-level LGBTQ+ policy data and county-level election data. Generalized linear models with GEE estimated the single and joint longitudinal associations for two exposures [state-level policy climate (more discriminatory vs. less discriminatory) and county-level political majority (Democratic/swing vs. Republican)] with each outcome. Among participants living in a state with more discriminatory laws, those in a Democratic/swing county had a 6-percentage point increase in PrEP use (95% confidence interval: 0.02, 0.09) compared to those in a Republican county. Those living in a Republican county but a state with less discriminatory laws saw a similar increase (0.05; -0.02,0.11). Residing in both a Democratic/swing county and a state with less discriminatory laws, relative to a Republican county and a state with more discriminatory laws, was associated with a 10-percentage point increase in PrEP use (0.10; 0.06,0.14) and a 5-percentage point increase in HIV/STI testing (0.05; 0.00,0.09). More progressive state and local policies were each associated with increased PrEP use, and together, doubled the magnitude of this association. PrEP is underutilized among SGM youth, and anti-LGBTQ+ policies may exacerbate this gap in coverage.

The Relationship Between HIV Testing and HIV Transmission Risk Behaviors among Men in Cameroon

HIV testing stands out as a pivotal HIV preventive measure in the face of increasing HIV transmission risk behaviors. This study examined the relationship between HIV transmission risk behaviors and HIV testing among men aged 15 to 64 years in Cameroon. The dataset from the 2018 Cameroon Demographic and Health Survey (N=6978) were utilized. Chi-square tests examined the prevalence and association between HIV testing and HIV transmission risk behaviors. Multivariate logistic regression was fitted to predict the odds of HIV testing. About 58.7% had tested for HIV. Specifically, 55.8% of men who never tested for HIV were aged 15 and 24 years and 73% who never tested for HIV did not use a condom during their most recent sex. Remarkably, 27.3% of men aged 15-64 years who have never been tested for HIV also had multiple sexual partners, while 26.7% that never tested for HIV also did not use condom when engaging in paid sex. Regression results indicated that men aged 15-59 years who had multiple sexual partners (AOR=1.83, 95% CI=1.57-2.14, p&lt;.001), a recent STI (AOR=1.40, 95% CI=1.18-1.66, p&lt;.001), condom use during sex (AOR=1.30, 95% CI=1.10-1.53, p=.022) and paid for sex (AOR=1.19, 95% CI=1.01-1.41, p=.037), were associated with higher odds of testing for HIV compared to those who did not. HIV prevention efforts should focus on addressing the public health implications of unsafe sexual practices among men, devising innovative strategies for scaling up HIV testing among the vulnerable younger age groups and regions with lower HIV testing rates in Cameroon.

Multiply robust generalized estimating equations for cluster randomized trials with missing outcomes.

Generalized estimating equations (GEEs) provide a useful framework for estimating marginal regression parameters based on data from cluster randomized trials (CRTs), but they can result in inaccurate parameter estimates when some outcomes are informatively missing. Existing techniques to handle missing outcomes in CRTs rely on correct specification of a propensity score model, a covariate-conditional mean outcome model, or require at least one of these two models to be correct, which can be challenging in practice. In this article, we develop new weighted GEEs to simultaneously estimate the marginal mean, scale, and correlation parameters in CRTs with missing outcomes, allowing for multiple propensity score models and multiple covariate-conditional mean models to be specified. The resulting estimators are consistent provided that any one of these models is correct. An iterative algorithm is provided for implementing this more robust estimator and practical considerations for specifying multiple models are discussed. We evaluate the performance of the proposed method through Monte Carlo simulations and apply the proposed multiply robust estimator to analyze the Botswana Combination Prevention Project, a large HIV prevention CRT designed to evaluate whether a combination of HIV-prevention measures can reduce HIV incidence.

Sexual Practices and HIV Risk Perception Among Men Who Have Sex with Men in Brazil.

Objectives: To investigate sexual practices and HIV risk perception among MSM, identifying associated risk factors and determinants. Methods: A cross-sectional epidemiological study was conducted with 144 MSM in Teresina, Piauí, Brazil, using the snowball sampling technique. Participants were recruited via snowball sampling and underwent rapid HIV testing, in addition to completing questionnaires on sexual practices, risk perception, and illicit drug use. Results: The majority of participants showed an unsatisfactory perception of HIV risk. Factors associated with this perception include non-penetrative sex as an HIV preventive measure, which increased the chances of having an unsatisfactory risk perception by 1.45 times (P = .04), engaging with known HIV-positive individuals without knowledge of their viral load (ORa = 2.70; P = .043), and using illicit drugs before/during sex (ORa = 0.29; P = .048). Conclusions: The results indicate a high prevalence of risky sexual practices and an unsatisfactory HIV risk perception among the MSM studied.

The Role of Education and Demographic Factors in Condom Use among Male Drug Users in Malaysia

Introduction: The rising prevalence of human immunodeficiency virus (HIV) among people who inject drugs is a major public health issue. This study intends to explore education and demographic correlates of use of condoms among male drug users in Malaysia. Methods: Data were extracted from the Integrated Biological and Behavioral Surveillance Survey 2017. Pearson’s chi-square tests and a logistic regression were used to examine the associations between condom use and education, and demographic factors. Results: Only a small proportion of drug users used condoms (25.7%). Educational backgrounds, age, ethnicity and marital status were associated with condom use. The likelihood of using condoms was lower among less educated drug users (aOR: 0.308–0.339). There was an interaction effect of education and age on condom use (aOR: 0.116–0.308). Chinese (aOR: 3.117) and those of other ethnicities (aOR: 2.934) were more likely to use condoms when compared with Malays. Being married (aOR: 0.291) or divorced/widowed (aOR: 0.346) was associated with reduced odds of using condoms. Conclusion: Education and demographic factors play an important role in influencing the decisions of Malaysian drug users to use condoms. Therefore, HIV-preventive measures targeting drug users could benefit by paying special attention to these factors.

Pre-exposure prophylaxis implementation during incarceration: Perspectives of formerly incarcerated men and women.

The HIV prevalence is higher among individuals involved in the United States (U.S.) correctional system than those in general population. Despite this, people in prisons or other closed settings have poor access to the most effective biomedical prevention tool, HIV pre-exposure prophylaxis (PrEP). The purpose of this study was to explore the attitudes and beliefs of PrEP initiation in correctional facilities amongst individuals formerly in prisons or other closed settings. We conducted 13 in-depth qualitative interviews with recently released (from incarceration) clients participating in a formerly incarcerated transition program in the southern United States. We identified several themes from our interviews. These themes were 1) PrEP information during incarceration; 2) Risky behaviors during incarceration and post-release; 3) Anticipated post-release challenges to accessing PrEP. Individuals formerly in prisons or other closed settings desire more education about PrEP during incarceration. They also want to learn more about HIV prevention measures. They believe that initiating PrEP in prison would allow a seamless transition to post-release PrEP programs. In conclusion, initiating PrEP during incarceration is one strategy to increase access to PrEP among the medically underserved criminal-justice population.

Facilitating Access to Art and Pre-exposure Prophylaxis for LGBTQ Individuals in Combating HIV in Malaysia: An Analysis from a Shariah Perspective

The increasing rate of new HIV infections poses a significant public health challenge, particularly among young individuals engaging in high-risk sexual behaviours, including male-to-male interactions. Effectively addressing HIV prevention and management within the LGBT community in Malaysia necessitates a comprehensive approach that considers both medical and socio-cultural aspects. This academic inquiry seeks to comprehensively evaluate the progress in HIV preventive measures and therapeutic interventions in the Malaysian context, examining their effectiveness within the affected communities and their adherence to Sharia principles despite religious barriers to modern medical approaches. The findings of this study indicate that the implementation of Antiretroviral Therapy (ART) and Pre-Exposure Prophylaxis (PrEP) measures, supported by the Ministry of Health, align with Sharia principles, underscoring the importance of disease prevention, treatment, and harm reduction. Nonetheless, the research emphasises the vital role of integrating Islamic practices as a preventive measure against HIV transmission. Consequently, this study advocates for improving HIV prevention and treatment strategies pursued by the Ministry of Health by integrating Islamic ethical considerations into Malaysia’s public health policies.

Assessment of Awareness, Willingness, and Practice of Human Immunodeficiency Virus Pre-Exposure Prophylaxis Among Female Sex Workers in Uyo, Akwa Ibom, Nigeria

This study investigated the awareness, willingness, and practice of HIV Pre-Exposure Prophylaxis (PrEP) among female sex workers (FSWs) in Uyo, Akwa Ibom State, Nigeria. Conducted between June and August 2020, the cross-sectional research engaged 344 HIV-negative FSWs attending services at Uyo's One-Stop Shop for key populations services. Through a semi-structured questionnaire, data were collected on awareness, willingness, and practice of PrEP, and subsequently analyzed using statistical methods. The study's participants had a mean age of 29.06±5.20 years, with 68.6% falling between 25-34 years old. Notably, 76.5% were adequately aware of PrEP, while 8.1% expressed willingness to use it, and 42.4% had practiced PrEP. Factors like age, marital status, and years engaged in sex work were found to significantly influence awareness of PrEP. Participants aged 25-34 years, those previously married, and those with fewer years in sex work exhibited greater PrEP awareness. The frequency of first-time and boyfriend clients per week impacted willingness and practice of PrEP, with the former positively influencing willingness and the latter negatively affecting practice. Engaging in unprotected sex was also found to negatively correlate with PrEP practice. These findings highlight that while awareness of PrEP is relatively high among FSWs, willingness to use and actual practice of PrEP remain low. The study underscores the importance of tailored health education programs targeting FSWs, to enhance awareness and encourage adoption of effective HIV preventive measures. By addressing factors like age, marital status, and specific aspects of sex work, interventions could be designed to increase PrEP utilization, thereby contributing to the reduction of HIV transmission in this population. Keywords: Female sex workers, HIV, Key Populations, One Stop Shop, Pre-exposure prophylaxis, Uyo.

Factors associated with retention on pre-exposure prophylaxis among female sex workers in Kigali, Rwanda.

Pre-Exposure Prophylaxis (PrEP) is recommended as an additional HIV prevention measure for persons at substantial risk of HIV acquisition. Although uptake of PrEP among female sex workers (FSW) has increased, retention remains low, resulting in suboptimal benefits. This study aimed at determining PrEP retention rates and associated factors among FSW in Kigali, Rwanda. We retrospectively studied records of 309 FSW abstracted from five (5) health centers for the period between April-June 2020 and April-June 2021. PrEP retention was defined as presenting for a scheduled follow-up visit. We used Kaplan-Meier survival analysis to estimate survival probabilities at months 1,3,6,9, and 12 post-PrEP initiation and Cox regression to determine factors associated with 12-month PrEP retention. Data was analyzed using STATA (version 14.0). Out of 309 FSW whose records were reviewed, data for 268 (87%) were complete. One half (50%, n = 133) of the respondents were aged 25-34 years; slightly more than half (52%, n = 136) were single; nearly three-quarters (73%, n = 196) had completed primary school; majority (88%, n = 236) lived alone; while 69% (n = 184) had no formal employment besides sex work. PrEP dropout rates were 228, 65, 29, 49, and 36 per 100-persons years at months 1, 3, 6, 9 and 12 respectively, with 81%, 72%, 67%, 59% and 53% of FSW that started PrEP retained at these time periods. Multivariable Cox regression revealed that compared to FSW opposed to additional children, the desire to have two or more children (adjusted Hazard Ratio [aHR] = 1.654; 95% Confidential Interval [95%CI]: 1.008, 2.713); and using hormonal (aHR = 2.091, 95%CI: 1.181, 3.702) or no method of contraception other than condoms (aHR = 2.036, 95%CI: 1.006, 4.119) were factors positively associated with PrEP retention. Conversely, compared to consistent condom-use, not using (aHR = 0.329; 95%CI: 0.149, 0.726) or inconsistently using condoms (aHR = 0.413; 95%CI: 0.228, 0.749), and accessing PrEP from ultra-urban clinics (aHR = 0.290; 95%CI: 0.183, 0.458) compared to clinics in the outskirts of the city, were factors negatively associated with PrEP retention. The study found a continuous decline in PrEP retention among FSW with slightly more than half retained at 12 months. To improve outcomes, PrEP retention monitoring should target FSW enrolled in ultra-urban clinics and those not or inconsistently using condoms.