HIV Risk Research Articles

The effect of protecting women against economic shocks to fight HIV in Cameroon, Africa: The POWER randomised controlled trial.

Women in sub-Saharan Africa are disproportionately affected by the HIV epidemic. Young women are twice as likely to be living with HIV as men of the same age and account for 64% of new HIV infections among young people. Many studies suggest that financial needs, alongside biological susceptibility, are a leading cause of the gender disparity in HIV acquisition. New robust evidence suggests women adopt risky sexual behaviours to cope with economic shocks, the sudden decreases in household's income or consumption power, enhancing our understanding of the link between poverty and HIV. We investigated if health insurance protects against economic shocks, reducing the need for vulnerable women to engage in risky sexual behaviours and reducing HIV and sexually transmitted infection (STI) incidence. We conducted a randomised controlled trial to test the effectiveness of a formal shock coping strategy to prevent HIV among women at high risk of HIV (registration number: ISRCTN 22516548). Between June and August 2021, we recruited 1,508 adolescent girls and women over age 15 years who were involved in transactional sex (n = 753) or commercial sex (n = 755), using snowball sampling. Participants were randomly assigned (1:1) to receive free health insurance for themselves and their economic dependents for 12 months either at the beginning of the study (intervention; n = 579; commercial sex n = 289, transactional sex n = 290) from November 2021 or at the end of the study 12 months later (control; n = 568; commercial sex n = 290, transactional sex n = 278). We collected data on socioeconomic characteristics of participants. Primary outcomes included incidence of HIV and STIs and were measured at baseline, 6 months after randomisation, and 12 months after randomisation. We found that study participants who engaged in transactional sex and were assigned to the intervention group were less likely to become infected with HIV post-intervention (combined result of 6 months post-intervention or 12 months post-intervention, depending on the follow-up data available; odds ratio (OR) = 0.109 (95% confidence interval (CI) [0.014, 0.870]); p = 0.036). There was no evidence of a reduction in HIV incidence among women and girls involved in commercial sex. There was also no effect on STI acquisition among both strata of high-risk sexual activity. The main limitations of this study were the challenges of collecting reliable STI incidence data and the low incidence of HIV in women and girls involved in commercial sex, which might have prevented detection of study effects. The study provides to our knowledge the first evidence of the effectiveness of a formal shock coping strategy for HIV prevention among women who engage in transactional sex in Africa, reinforcing the importance of structural interventions to prevent HIV. The trial was registered with the ISRCTN Registry: ISRCTN 22516548. Registered on 31 July 2021.

Investigating the Invisible: Protocol for a Randomized Controlled Pilot Study Testing the Entertainment-Education Model to Provide a PrEP Education Intervention to Kink-Involved Populations.

A growing proportion of the global population engages in alternative sexual behaviors and relationships, which are commonly grouped and known as kink or BDSM (bondage-discipline, dominance-submission, sadism-masochism). Mainstream stigma and provider pathologizing of these behaviors and relationships may make kink-involved populations reticent to seek health care treatment. Moreover, some kink activities appear to expose kink-involved people to higher risks for HIV infection. To date, no studies have explored HIV risk prevention interventions for kink-involved people. The proposed study seeks to address the absence by describing a study designed to address HIV risk prevention with PrEP for this understudied and neglected population by testing an educational-entertainment intervention designed to focus on kink specifically. Using a repeated-measures randomized experimental methodology, this study proposes to include data collection and exposure to intervention materials at 3-month intervals over 12 months.

The HIV Environmental Riskscape: The Roles of HIV Sexual Risk and Resilience Factors among Black Men Who Have Sex with Men: Findings from the Real Talk Project.

Black and African American men who have sex with men (Black MSM) experience the greatest proportion of new HIV infections in the United States. To address this challenge, a better understanding of the HIV environment riskscape including both risk and resilience factors is warranted among Black MSM. Research indicates that stress is associated with increased HIV sexual risk behaviors. Further, behavioral factors such as serosorting and community level factors including social support and community connection are resilience factors that protect against risk behaviors. The present study examines whether everyday stress is associated with HIV sexual risk behavior, as well as the role of risk and resilience factors among 125 Black MSM recruited in the Real Talk study. The Real Talk project examined the relationships between resilience, HIV risk behaviors, and HIV prevention strategy among a sample of Black MSM. Using generalized estimating equations, our results indicate a positive association between everyday stress and engaging in condomless anal intercourse only after adjusting for risk, resilience, and correlate variables. Similarly, having multiple sex partners and using substances during sex also show positive associations with condomless anal intercourse. Resilience factors of engaging in serosorting and being connected to both the Black and gay communities were negatively associated with condomless anal intercourse. Future prevention research and programming should focus on both risk and resilience factors to mitigate new HIV infections among Black MSM.

Condomless anal intercourse among HIV-positive and HIV-negative men who have sex with men in Zimbabwe.

Men who have sex with men (MSM) are disproportionately impacted by HIV in sub-Saharan Africa (SSA), where condomless anal intercourse (CAI) is a major driver of HIV transmission among this hidden subpopulation. To determine CAI drivers and prevalence among HIV-positive and HIV-negative MSM. Data from 1538 MSM who participated in a biobehavioural survey in Zimbabwe were used. Secondary statistical data analysis methods were used to determine prevalences and drivers of CAI. A high prevalence of CAI, of at least 30%, among HIV-positive and HIV-negative MSM was found. Factors that led to a statistically significant higher CAI among HIV-positives compared to HIV-negatives included drunkenness (35% vs. 25%, P = 0.01), fear of partner (13% vs. 9%, P = 0.017), trusting the partner (10% vs. 6%, P = 0.008), and being offered more money (10% vs. 6%, P = 0.003). Our findings indicate that economic, socio-behavioural and perceptual dimensions increase men's likelihood to engage in risky sexual behaviour, suggesting the need for HIV prevention efforts that provide tailored education regarding HIV risk among MSM in SSA. This is the first large biobehavioural survey that generated valuable information useful for analysing condomless anal sex among MSM in Zimbabwe.

Characterizing syndemic HIV risk profiles and mHealth intervention acceptability among patients in the emergency department

ABSTRACT Syndemic theory proposes that co-occurring, mutually reinforcing psychosocial challenges (mental health, substance use, minority stress [discrimination/stigma], abuse, unmet basic needs) drive HIV risk behavior and create barriers to care for marginalized populations. It is thus necessary to address this holistic, complex picture in HIV prevention. Emergency department (ED) visits are a prime opportunity to engage key risk groups, given their low engagement in regular clinic-based care and high utilization of drop-in care via EDs. Yet, EDs are overburdened and under-resourced; mHealth may be a vehicle for intervention delivery in this context. This study aimed to 1) characterize demographics, syndemic profiles, and HIV risk behavior among ED patients and 2) assess the acceptability of addressing syndemic issues, particularly via an mHealth approach, in the ED. A sample of N = 198 ED patients with an indication of HIV risk completed a cross-sectional psychosocial assessment. Descriptive statistics and bivariate correlations between syndemic issues were examined. Patients presenting to the ED reported marginalized identities and complex syndemic profiles including mental health issues (77%), at risk substance use (30%), childhood abuse (35%), adult abuse (31%), minority stress (63%), and unmet basic needs (37%). Over half the sample reported at least three syndemic issues (54%). All syndemic issues were significantly correlated with each other, supporting a synergistic nature. The sample reported indicators of HIV risk including lack of PrEP awareness (33%)/uptake (94%), condomless sex (37%), and not testing for HIV (41%). Majority reported syndemic profiles have never been addressed in the ED (71%), think it would be helpful (88%), and willing to utilize mHealth during an ED visit (76%). The current study provides information to guide next steps for ED-based point-of-care HIV prevention, and more broadly, working towards equitable HIV prevention services reaching those missed by existing interventions.

Trajectories of Adherence to Oral Pre-exposure Prophylaxis and Risks of HIV and Sexually Transmitted Infections.

Pre-exposure prophylaxis (PrEP) effectiveness is highly dependent on medication adherence, which is associated with differential HIV risks and possibly sexually transmitted infection (STI). This retrospective cohort study of PrEP users (01/01/2012-12/31/2021) used the MarketScan database of commercially insured enrollees to examine PrEP adherence trajectory groups' associations with HIV and STI acquisition risks. Distinct PrEP adherence trajectories were identified by group-based trajectory modeling among individuals who used oral PrEP. The primary outcome was HIV acquisition incidence, and secondary was STI rate, compared among trajectory groups. Inverse probability treatment weighting time-varying Cox proportional hazards models assessed HIV acquisition, and Poisson regression models assessed STI. Among 23 258 oral PrEP users, 4 distinct PrEP adherence patterns were identified: minimal use (10.5% of the cohort), rapidly declining (25.4%), gradually declining (24.3%), and consistently high (39.8%). Compared with the minimal use group, the gradually declining (adjusted hazard ratio [AHR], 0.53; 95% CI, 0.31-0.90) and consistently high (AHR, 0.50; 95% CI, 0.30-0.84) PrEP adherence groups showed decreased HIV incidence risks. Compared with the minimal use group, the rapidly declining (adjusted incidence rate ratio [AIRR], 1.35; 95% CI, 1.07-1.72), gradually declining (AIRR, 1.73; 95% CI, 1.38-2.18), and consistently high (AIRR, 2.06; 95% CI, 1.64-2.58) groups were associated with increased STI risk. These findings underscore the benefits of continuing and remaining adherent to PrEP and may also inform public health strategies, clinical guidelines, and interventions aimed at maximizing the effectiveness of PrEP in reducing new HIV infections while developing targeted strategies to prevent STIs with PrEP use.

Treatment Outcomes of Tuberculosis Among Artisanal and Small-Scale Miners in Zimbabwe: A Follow-Up Observational Study Using Secondary Data.

In Zimbabwe, artisanal and small-scale miners (ASMs) are a key vulnerable group with high risk for tuberculosis (TB), HIV, and silicosis. The main purpose of this study was to investigate treatment outcomes of TB among ASMs. We conducted a follow-up observational study using secondary data. We analyzed data from 208 ASMs treated for TB at two occupational health clinics. We found a high treatment success rate of 87%, comparable to the national average for drug-sensitive TB. Unsuccessful outcomes were due to death (5%) and loss to follow-up (7%). Over a quarter of ASMs had unknown HIV status. Our study is the first to document treatment outcomes of TB among ASMs in Zimbabwe. Encouragingly, this study demonstrates the possibility of achieving good TB treatment outcomes even among highly mobile populations like ASMs. Further research is needed to analyze leakages across the whole TB patient pathway among ASMs. Additionally, addressing the high rate of unknown HIV statuses among ASMs is crucial to further improve overall TB treatment outcomes in this population.

Intimate Partner Violence Among Three Key Populations at Risk of HIV in Panama

This study aims to estimate the prevalence of interpersonal personal violence (IPV) among three key populations at an increased risk of HIV in Panama (namely, transgender women, sex workers, and men who have sex with men [MSM]) and to estimate the positivity rate of four sexually transmitted infections (STIs), including HIV. Participants from the 2018 PEMAR study with a stable primary partner completed a 31-item survey with demographic data, the Spanish version of the four-item HITS questionnaire (being physically Hurt, Insulted, Threatened, or Screamed at; Cronbach’s α = .816), and an optional blood draw for STI testing. Prevalence rates of IPV were estimated with their respective 95% CIs after imputing 3.93% of missing values. The analytic sample (N= 356) included 76.0% MSM, 15.5% sex workers, and 9.3% transgender women, most of whom were in their 30s, married, and Latinx; completed some college; and worked full time. The most frequent forms of IPV were screams and insults. The IPV prevalence rates were estimated for transgender women (19.05%), sex workers (10.53%), and MSM (2.36%). Among participants who consented to blood samples (n= 291), transgender women who experienced IPV had a significantly (P= .03) higher syphilis positivity rate and MSM who did not experience IPV had a significantly (P< .001) higher HIV positivity rate. Among key populations, transgender women experienced the highest rate of IPV and significantly higher syphilis rates. Paradoxically, HIV rates were higher among MSM who do not experience IPV. While societal roles and other contextual factors play a partial role in these syndemic findings, more studies are warranted.

An innovative mobile app for educating teens and young adults about reproductive health and wellness including sexually transmitted infections, pregnancy and contraception

Objective: The authors studied the use of a new mobile app technology platform to offer easy access to accurate, evidence-based comprehensive reproductive health information with links to resources for teens and young adults to enhance wellness and reduce the risks of HIV, other STIs, pregnancy, and complications such as infertility and pelvic inflammatory disease.Methods: The Healthy Teens Mobile App was designed, developed, tested, and implemented to deliver up-to-date sexual and reproductive health education based on science and written by experts. Initial testing was done for useability, readability and ease of navigation of the app.Results: Beta testing among teens, young adults, parents, health educators, and nurse clinicians (n = 32) revealed the app was valuable, engaging, and could be revised to improve flow and functionality. 60% strongly agreed and 40% agreed the app was valuable, with important information and resources on sexual health and wellbeing. 55% strongly agreed and 45% agreed the images improved the experience of using the app and the text size was adequate for readability. Other comments were utilized to enhance the app, add more images, and decrease the amount of white space on certain sections of the app. The app was released in June 2024 in both the Apple & Google App Stores.Conclusions: Utilizing a mobile app to delivery evidence-based sexual and reproductive health information for teens and young adults is practical and well accepted by teens, young adults, parents, health educators, and nurse clinicians. Plans are underway to disseminate the app widely. Future plans include translating the app into Spanish, French and other languages to promote global sexual and reproductive health and wellness and reduce the risks of HIV, other STIs, pregnancy, and complications such as infertility and pelvic inflammatory disease.

HIV Knowledge, Risk Behaviors And Motivation For HIV Testing Among Women Of Childbearing Age In Morocco

HIV Knowledge, Risk Behaviors And Motivation For HIV Testing Among Women Of Childbearing Age In Morocco

A Scoping Review of Factors Associated with HIV Acquisition in the Context of Humanitarian Crises.

Humanitarian crises-natural or human-made events that can threaten communities' health, safety, security, and well-being-may affect the HIV epidemic dynamics. Common aspects of humanitarian crises such as poverty, powerlessness, disruptions to the health systems, and social instability can contribute to a person's vulnerability to HIV infection through increased risk behaviors and limited access to health services. Guided by the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) reporting guidelines, we conducted a scoping review of literature published in English between January 1990 and March 2022 to characterize the global evidence of modifiable and non-modifiable factors for HIV acquisition in the context of humanitarian crises. We systematically searched, screened, and synthesized literature from MEDLINE, Embase, Global Health (all accessed via Ovid), and Scopus, and also grey literature through websites of humanitarian agencies and relevant non-government organizations, the International AIDS Society's abstract databases, and Google Scholar. We considered studies presenting empirical data on HIV prevalence, incidence, or risk factors in humanitarian crises-affected populations, including refugees, asylum seekers, and internally displaced persons. Forty-nine studies met the inclusion criteria. The majority of studies were quantitative (n = 43, 87.8%) and cross-sectional (n = 37, 75.5%) in design. Most were single-country studies (n = 43, 87.8%) and conducted in Sub-Saharan Africa (n = 31, 63.3%). We identified 5 non-modifiable factors for HIV acquisition (i.e., age, gender, location, place of birth or origin, and ethnicity) and 60 modifiable factors that we further classified into five categories, namely 18 policy and structural, 9 sociocultural, 11 health and mental health, 16 sexual practice, and 6 humanitarian crisis-related traumatic event factors. Within the modifiable categories, factors that were most often investigated were education level, marital status, sexually transmitted infection diagnosis, condom use, and experience of rape or sexual trauma, respectively. Informed by the findings, we applied the social-ecological model to map the identified multidimensional factors associated with HIV acquisition at the levels of individual, social and sexual networks, community, public policy, and the context of humanitarian crises. The current review provides a comprehensive, global analysis of the available evidence on HIV prevalence, incidence, and risk factors in humanitarian crises and implications for potential programs and research. Future research is warranted to further understand the directionality of the non-modifiable and modifiable factors affecting HIV acquisition, and the multilevel barriers and facilitators to the uptake of HIV prevention strategies in the context of humanitarian crises. Such research can generate actionable evidence to inform the development of ethical, trauma-informed, and culturally appropriate HIV prevention interventions in humanitarian settings.

A PrEP decision aid for women survivors of intimate partner violence: Task-shifting implementation to domestic violence service settings.

Women exposed to intimate partner violence (IPV) experience multiple social and structural barriers to accessing HIV pre-exposure prophylaxis (PrEP), despite being at increased risk for HIV. In addition, few existing HIV prevention interventions address IPV. A recently developed PrEP decision aid for women has the potential to reach IPV survivors at risk for HIV if it could be integrated into existing domestic violence agencies that prioritize trust and rapport with female IPV survivors. Leveraging non-traditional service delivery mechanisms in the community could expand reach to women who are IPV survivors for PrEP. We conducted qualitative interviews and online qualitative surveys with 33 IPV survivors and 9 domestic violence agency staff at two agencies in Connecticut. We applied the Consolidated Framework for Implementation Research (CFIR) to understand barriers and facilitators to delivering a novel PrEP decision aid to IPV survivors in the context of domestic violence service agencies. Most IPV survivors and agency staff thought the PrEP decision aid intervention could be compatible with agencies' existing practices, especially if adapted to be trauma-responsive and delivered by trusted counselors and staff members. PrEP conversations could be packaged into already well-developed safety planning and wellness practices. Agency staff noted some concerns about prioritizing urgent safety needs over longer-term preventive health needs during crisis periods and expressed interest in receiving further training on PrEP to provide resources for their clients. IPV survivors and agency staff identified key intervention characteristics of a PrEP decision aid and inner setting factors of the service agencies that are compatible. Any HIV prevention intervention in this setting would need to be adapted to be trauma-responsive and staff would need to be equipped with proper training to be successful.

Low HIV Testing and PrEP Uptake of Adolescent and Young Men who have Sex with Men in Vietnam.

Little is known about HIV testing, pre-exposure prophylaxis (PrEP) awareness and uptake among adolescent and young men who have sex with men (AYMSM) in Vietnam. We conducted an online survey among AYMSM in Vietnam to determine the prevalence of HIV testing, PrEP awareness, uptake and their correlates. From December 2022-March 2023, 120 HIV-negative AYMSM from 15 to 19 years old in Hanoi and Ho Chi Minh city, Vietnam were recruited through peer referral to complete an online survey, which included questions on demographics, sexual behaviors, HIV risk perception and knowledge, HIV and sexually transmitted infections (STI) testing, PrEP awareness and uptake. Separate multivariable models were used to determine the correlates of HIV testing, PrEP awareness and uptake. Only 58% of participants had ever been tested for HIV. The majority of participants had heard of PrEP before (82%), but only 36% had ever used PrEP. HIV knowledge (aPR (adjusted prevalence ratio) = 1.59; 95%CI:1.06-2.39), a history of STI testing (aPR = 1.32; 95%CI:1.06-1.64), having had anal sex with another man (aPR = 4.49; 95%CI:1.40-14.38) and lower HIV risk perception (aPR = 0.62; 95%CI:0.47-0.83) were associated with HIV testing. HIV knowledge (aPR = 1.38; 95%CI:1.06-1.78) and a history of STI testing (aPR = 1.16; 95%CI:1.03-1.32) were also associated with PrEP awareness. Higher HIV risk perception was negatively associated with PrEP use (aPR = 0.59; 95%CI:0.35-0.99). Our findings underscored the urgent need for further research to explore the causes of the gaps in HIV testing and PrEP use as well as to design innovative interventions tailored to the needs of AYMSM to support HIV testing and PrEP use.

Occupational Exposure and HIV Prevalence among Healthcare Workers: Risks, Prevention, and Management Strategies

Healthcare workers (HCWs) are at heightened risk of occupational exposure to HIV due to their frequent interaction with blood and bodily fluids. This exposure led to potential HIV transmission if not managed promptly and effectively. This review provided a comprehensive examination of the risks associated with HIV exposure among HCWs, exploring the prevalence of such incidents, and evaluating current prevention and management strategies. Key risks included needlestick injuries and blood splashes, with prevalence varying significantly by region, particularly in areas with high HIV burden. Prevention strategies encompassed adherence to standard precautions, use of safety-engineered devices, comprehensive training, and the provision of post-exposure prophylaxis (PEP). Effective management involved immediate post-exposure assessment, timely administration of PEP, regular follow-up care, and access to counseling services. The review synthesizes recent research and clinical evidence, utilizing a systematic analysis of literature and guidelines to inform best practices in HIV risk management for HCWs. By addressing these strategies, the review aimed to enhance safety protocols and improve health outcomes within healthcare settings. Keywords: Occupational Exposure, Healthcare Workers, HIV Prevention, Post-Exposure Prophylaxis (PEP), Infection Control.

Dynamic HIV risk differentiation among youth: Validation of a tool for prioritization of prevention in East Zimbabwe.

Differentiating risk for HIV infection is important for providing focussed prevention options to individuals. We conducted a longitudinal study to validate a risk-differentiation tool for predicting HIV or HSV-2 acquisition among HIV-negative youth. Population-based household survey in east Zimbabwe. HIV and HSV-2 status and HIV behavioural risk factors were assessed in two surveys conducted 12 months apart among young people. Associations between risk-behaviours and combined HIV/HSV-2 incident infection were estimated using proportional hazards models. We calculated the sensitivity and specificity of risk-differentiation questions in predicting HIV/HSV-2 acquisition and quantified changes between surveys among low, medium, and high-risk categories. In total, 44 HIV/HSV-2 seroconversions were observed in 1812 person-years of follow up (2.43/100PY, 95%CI: 1.71-3.15); 50% of incident cases reported never having had sex at baseline. Risk of HIV/HSV-2 acquisition was higher for those reporting non-regular partners (women: HR=2.71, 95% CI:1.12-6.54, men: HR=1.37, 95%CI: 0.29-6.38) and those reporting having a partner with a sexually transmitted infection (STI) (HR=7.62 (1.22-47.51). Adding a question on non-regular partnerships increased tool sensitivity from 18.2% to 38.6%, and further to 77.3% when restricted to those who had ever had sex. Individual risk category increased for 28% of men and 17% of women over 12-months. The refined risk differentiation tool identified a high proportion of youth at risk of HIV acquisition. Despite this, half of incident infections were among individuals who reported no prior sexual activity. The shifting patterns of risk behaviours underscore the need for dynamic prevention engagement strategies in high HIV prevalence or incidence settings.

School-Based Protective Factors for HIV Prevention in the United States: Secondary Analysis of the Youth Risk Behavior Survey 2015-2019.

This secondary analysis of the National Youth Risk Behavior Survey (years 2015-2019) examines associations between school-based protective factors (i.e., safe school environments and academic achievement) and HIV risk behaviors among sexually experienced adolescent gay and bisexual men ( n = 644), a population with the highest prevalence of undiagnosed HIV infections. Demographics included Hispanics/Latinos (25%, n = 158), Other race/ethnicity (14%, n = 88), and non-Hispanic Blacks/African Americans (13%, n = 81). Adjusted models showed that protective factors reduced odds for early sexual debut, multiple sexual partners, sex under the influence of drugs/alcohol, and condomless sex, with an additive effect demonstrated when two protective factors were present. Hispanics/Latinos had greater odds of reporting multiple sexual partners and HIV testing, indicating opportunities for school-based HIV prevention and further research. Our findings provide support for school-based programs that aim to improve social and structural determinants of health and ultimately reduce adolescent HIV burdens.

Multi-level correlates of oral pre-exposure prophylaxis discontinuation among English and Spanish-speaking transgender women of color in New York City: the TURNNT cohort study

Background Transgender women of color in the US are disproportionately vulnerable to HIV risks. Pre-Exposure Prophylaxis (PrEP) has demonstrated effectiveness in preventing HIV transmission among transgender women of color. However, factors across multiple levels can hinder oral PrEP adherence. Methods We analyzed the baseline data from The Trying to Understand Neighborhoods and Networks Among Transgender Women of Color (TURNNT) Cohort Study of women not living with HIV. We analyzed questionnaire responses to identify why participants stopped using PrEP and if they would consider taking it again. To identify multi-level determinants that were associated with PrEP discontinuation, we conducted bivariate analysis and created multivariable modified Poisson models comparing factors between former users and current users. Results Among 140 transgender women of color included in this analysis, 44.3% were currently on PrEP, 25.0% were on formerly on the regimen, and 30.7% had never used it. Participants reported many reasons for discontinuing PrEP, notably, 22.9% reported being concerned about interactions with hormones. 60.0% reported that they were likely to take PrEP again in the future. Discontinuation was positively associated with history of sexual assault (Prevalence Ratio: 1.78; 95% CI: 1.01, 3.14) and negatively with having a primary care provider (PR: 0.43; 95% CI: 0.25, 0.73). Conclusion Many factors can influence PrEP discontinuation among transgender women of color. A majority of those who discontinued PrEP were interested in restarting it again, indicating a potential for reengagement. We recommend a holistic approach to HIV prevention to reduce PrEP discontinuation.

The Effect of Age on Human Immunodeficiency Virus Risk Related Behaviors among Undergraduate Students at a Historically Black College and University in the United States of America

Objective: HIV infections have taken a heavy toll on young adults in the USA. Most undergraduate students fall within the age group who are at high risk of HIV infections. The effect of age on HIV risk related behaviors among African American undergraduate students has never been investigated before. Thus, this study assessed the effect of age on HIV risk related behaviors among African American undergraduate students at a Historically Black College and University. Methods: A total of 400 respondents were randomly selected from Jackson State University of the USA, a Historically Black College and University. A cross-sectional study design was utilized from January to September, 2016. Data were collected using a validated self-administered standardized questionnaire. Chi-square test was used to see the association between age and HIV risk related behaviors. Results: Over seventy five percent of the study participants have had at least one risk behavior related to HIV infection transmission and there was significant statistical difference between students aged 18-24 years and students aged 25 years and above (p<0.05). The students aged 18-24 years were more likely to participate in risk behaviors that could predispose them to HIV infections (P = 0.02). Conclusions: As the HIV related risk behaviors was higher among students aged 18-24 years old, age appropriate HIV preventive programs that are appealing to young people will be required to effectively prevent HIV infection among this vulnerable population.

Developmental Trajectories of Transactional Sex and Age-Disparate Relationships During Adolescence: An HPTN 068 Analysis.

Transactional sex and sexual relationships with older partners increase HIV risk in adolescent girls and young women (AGYW), yet little is known about how these behaviors co-evolve over time. We characterize temporal patterns of transactional sex and age-disparate relationships among AGYW in South Africa. Longitudinal data are from a randomized controlled trial (HPTN 068) of school-aged, HIV-negative, AGYW who attended ≥ 3 study visits. We used group-based trajectory modeling to identify trajectories of transactional sex and age-disparate relationships (partner ≥ 5 years older) in the last year and assessed the interrelationship (conditional probability) between both trajectories. At baseline, median age was 14 years, 14.5% of girls were sexually active, and transactional sex (2.1%) and age-disparate relationships were uncommon (2.7%). We identified two trajectories for transactional sex ("low" [81.9%] and "increasing" [18.1%]) and two for age-disparate relationships ("low" [91.7%] and "increasing" [8.3%]). In a separate joint trajectory analysis, nearly a third (28%) had increasing trajectories for both transactional sex and age-disparate relationships, but most (53%) had a low trajectory of both outcomes. Baseline reporting of early sexual debut, depression, and inequitable gender norms were highest in the increasing transactional sex group. Prior pregnancy, early sexual debut, and IPV were highest among those with increasing age-disparate relationships. AGYW who engage in transactional sex or age-disparate partnerships in early adolescence are more likely to experience sustained engagement in both behaviors as they transition to adulthood, increasing HIV risk. Engaging girls early may maximize effectiveness of behavioral and biomedical HIV prevention efforts.

Sexually transmitted infections and bacterial vaginosis among adolescent girls and young women in the early postpartum period: a cross-sectional study

BackgroundUniversal antiretroviral treatment (ART) for pregnant women has reduced mother-to-child transmission risk significantly. However, not all women on ART are virally suppressed during pregnancy and lactation. In addition to poor adherence to ART, co-infections particularly other sexually transmitted infections (STIs) are known to increase the risk of HIV acquisition and HIV transmission. While the prevalence of STIs during pregnancy has been well studied, the prevalence of STIs in the postpartum period and its association with HIV viral suppression are underreported.MethodsIn this cross-sectional study, we determined the prevalence of STIs among adolescent girls and young women (AGYW) living with HIV (WLHIV) and without HIV (WNLHIV) at their 6–14 week postnatal clinic visit in a high HIV prevalence district in South Africa. All women were examined for STI-related symptoms and had vaginal swabs collected and stored for later STI testing. Vaginal swabs were tested for Trichomonas vaginalis (T.vaginalis), Chlamydia trachomatis (C. trachomatis), Neisseria gonorrhoeae (N. gonorrhoea) and herpes simplex virus-2 (HSV-2) using PCR. All women were tested for bacterial vaginosis (BV) using the Nugent scoring criteria. WLHIV had a blood sample collected for HIV viral load, Hepatitis B and syphilis.ResultsIncluded in this analysis were 82 WLHIV and 102 WNLHIV. Between 6 and 14 weeks postpartum, 40 (21.7%) AGYW tested positive for any STI and among these 15 (37.5%) were symptomatic and received empirical treatment. C. trachomatis was most commonly detected (10.9%), followed by HSV-2 (7.7%), T. vaginalis (3.8%) and N. gonorrhoea (1.6%). WLHIV were more likely to test positive for an STI (OR 2.0; 0.96–3.96) and BV (OR 4.2; 95%CI 2.1–8.1) compared to WNLHIV. Among WLHIV on ART, 70.5% had an undetectable plasma viral load (PVL) and 20.5% had a PVL > 1000 copies/ml. Testing positive for any STI or BV at the postpartum visit was not associated with PVL > 1000 copies/ml (OR 1.33; 95%CI 0.38–4.64).ConclusionWe report a high prevalence of largely asymptomatic STIs and BV in the early postpartum period and STIs in WLHIV were not associated with unsuppressed PVL.The high STI positivity rate among WNLHIV has implications for HIV risk during the postpartum period, and subsequently breastfeeding transmission.