Risk Factor For HIV Transmission Research Articles

Impact of methamphetamine use on HIV and other health outcomes at an urban HIV medicine clinic.

The methamphetamine epidemic threatens progress towards ending the HIV epidemic in the United States. Further characterizing the prevalence and impact of methamphetamine use among people with HIV (PWH) is necessary to inform integrated HIV and methamphetamine treatment strategies. We conducted a retrospective chart review to characterize methamphetamine use among 3,092 PWH at an urban HIV Medicine clinic between July 1, 2022 and June 30, 2023. The Chi-squared test was utilized to assess for statistically significant differences in demographics and HIV and other health outcomes among PWH who use and do not use methamphetamine. The prevalence of methamphetamine use among PWH in this cohort was 17%. PWH who used methamphetamine were more likely to be < 40 years of age, identify as White race, live in neighborhoods with low Healthy Places Index scores, identify as lesbian, gay, or bisexual, report male sex with men (MSM), MSM and injection drug use (IDU), or IDU as HIV transmission risk factor, miss scheduled HIV primary care visits, and screen positive for hepatitis C virus antibody, gonorrhea, chlamydia, and major depressive disorder. PWH who use methamphetamine were also less likely to be virally suppressed and have a CD4 count ≥ 200 cells/mm3. Methamphetamine use is prevalent among PWH at this urban HIV Medicine Clinic and is associated with worse HIV and other health outcomes which likely increase the risk of HIV transmission. The integration of methamphetamine use disorder treatment into HIV primary care is necessary to work toward ending the syndemics of methamphetamine and HIV.

Profile of HIV/AIDS Patients with Neurological Manifestations in The Tertiary Referral Hospital in Bali

Background: Neurological manifestations in approximately half of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) patients are related to high morbidity and mortality worldwide. Therefore, there is a need for epidemiological data on HIV/AIDS patients with neurological manifestations in Bali, as an international tourism destination. Objective: This study aimed to describe the clinical profile of neurological manifestations among patients with HIV/AIDS in the tertiary referral hospital for Bali and Nusa Tenggara region. Methods: A descriptive-retrospective study was conducted on HIV/AIDS patients presenting with neurological manifestations hospitalized in the Neurology Department of Prof. Dr. I.G.N.G Ngoerah Hospital Denpasar from January 2018 to December 2021. Results: Among the 227 subjects included in this study, the majority were male (69.9%) and HIV positive newly diagnosed (69.2%). Furthermore, out of 126 subjects who had CD4 data, the majority were with CD4 &lt;200 cells/mm3 (85.7%) and 53.1% were &lt;50 cells/mm3, with ages ranging from 18 to 67 years old, at a median of 36 years old. The most common neurological signs and symptoms found were paresis/paralysis (61.7%), headache (54.6%), decreased consciousness (52.9%), and cranial nerve palsy (52%). Cerebral toxoplasmosis (67.4%) and tuberculous meningoencephalitis (20.3%) were the prevalent opportunistic infections, while the mortality rate was 39.6% with sepsis as the major cause. Conclusions: Neurological manifestations are common initial symptoms in diagnosing HIV infection. Therefore, better awareness and earlier detection are required among people with risk factors of HIV transmission, particularly in groups of young and productive age with signs of immunocompromised condition as well as neurological manifestations.

Adverse childhood experiences are associated with HIV risk factors in Agbogbloshie, Ghana

ABSTRACT Adverse Childhood Experiences (ACEs) have been associated with increased risk factors for HIV transmission, but the causal pathway is uncertain. This study documents the prevalence of ACEs by gender and their association with HIV risk factors and assesses depressive symptoms as mediating this relationship. A cross-sectional survey was conducted in 2019 among a representative sample of men and women, aged 18–24 years, living in an informal settlement in Accra, Ghana. Data on sociodemographic characteristics, ACEs, ten HIV risk factors (five sexual behaviors, HIV/AIDS knowledge, sexual assault, three substance use behaviors), and depressive symptoms were collected. Multiple logistic regression models were estimated to assess the independent association between four or more ACEs and each of the ten HIV risk factors. Structural equation models examined depressive symptoms as a mediator in these associations. A third (34.6%) of participants reported four or more ACEs, and among those who experienced four or more ACEs 60% were men and 40% were women. Gender did not modify the effect of the association between four or more ACEs and HIV factors and therefore the multiple regression analysis was not stratified by gender. After controlling for sociodemographic covariates and depressive symptoms, having experienced four or more ACEs was associated with alcohol use (OR = 3.88; 95% CI: 1.34, 11.21), injection drug use (OR = 2.78; 95% CI: 1.15, 6.73), low knowledge of HIV (OR = 3.59; 95% CI: 1.43, 9.00), sexually transmitted infection (OR = 3.70; 95% CI: 1.15, 11.96), and sexual assault (OR = 3.58; 95% CI: 1.07, 12.05). There was some evidence that depressive symptoms could be mediating the association between reporting four or more ACEs and ever having a sexually transmitted infection. The mitigation of ACEs and depressive symptoms has the potential to decrease HIV risk factors and thus reduce the risk for HIV transmission among youth living in informal settlements.

Sexual network characteristics, condomless anal intercourse, and the HIV care cascade among MSM living with controlled versus uncontrolled HIV infection in Lima, Peru: a population-based cross-sectional analysis

Despite high rates of HIV transmission among men who have sex with men (MSM) in Lima, Peru, limited data exist on the sexual network characteristics or risk factors for secondary HIV transmission among MSM with uncontrolled HIV infection. We report the frequency of serodiscordant, condomless anal intercourse (CAI) and associated sexual network characteristics among MSM in Lima with detectable HIV viremia and compare to those with undetectable viremia. This cross-sectional analysis includes MSM who tested positive for HIV-1 during screening for a trial of partner management and STI control (June 2022-January 2023). Participants were tested for HIV, gonorrhoea, chlamydia, and syphilis, and completed questionnaires on their demographic characteristics, sexual identity and behaviour, sexual network structures and engagement in HIV care. Of 665 MSM, 153 (23%) had detectable (>200 copies/mL) viremia. 75% (499/662) of men living with HIV were previously diagnosed, with 94% (n=469/499) reporting that they were on ART, and 93% (n=436/469) virally suppressed. 96% (n=147/153) of men with detectable viremia reported serodiscordant CAI with at least one of their last three sexual partners, and 74% (n=106/144) reported the same with all three of their recent partners. In contrast, 62% (n=302/489) of men with undetectable viral load reported serodiscordant CAI with all of their last three partners (p<0.01). 23% of men living with HIV in Peru had detectable viremia, of whom almost all (96%) reported recent serodiscordant CAI. The primary gap in the HIV care cascade lies in awareness of HIV serostatus, suggesting that improved access to HIV testing could be a key prevention strategy in Peru. Funding for this study was provided by NIH/NIMH grants R01 MH118973 (PI: Clark) and R25 MH087222 (PI: Clark).

1501. Characterizing Engagement in Care and STI Screenings among DC Cohort Participants with HIV and Mpox

Abstract Background A high proportion of people with HIV (PWH) in the 2022-2023 mpox outbreak (approx. 40% of US cases) has raised questions about the association between HIV and mpox. Increased encounters with the healthcare system may be contributing to this association. This study sought to elucidate whether detection bias drives the relationship between mpox and HIV by determining whether engagement in care and STI screening are associated with having an mpox diagnosis. Methods We conducted a 5:1 matched case-control study among DC Cohort participants, a longitudinal cohort of PWH receiving care in Washington, DC. Cases were matched on age (+/-5 years), gender, race/ethnicity, HIV transmission risk factor, time since HIV diagnosis (+/-5 years), years enrolled (+/-3 years), and HIV care site (community or hospital) with up to 5 controls. Engagement in care was defined as two or more CD4 or HIV RNA tests at least 90 days apart during the last year. STI screening was any test for gonorrhea, chlamydia, or syphilis in the past year. Cases were participants with an mpox diagnosis identified by providers or an ICD10 code in the EHR. We used unadjusted conditional logistic regression to assess the relationship between engagement in care, STI screening, and mpox diagnosis. Results We identified 68 cases of mpox in the DC Cohort and 65 could be matched to 300 controls (n = 365). Participants were majority male (98.9%), Black (70.7%), MSM (89.3%), and 51.5% of participants had an STI diagnosis since cohort enrollment. Cases were significantly more likely to be engaged in care (50.8% vs. 26.3%; OR: 3.24), receive an STI screening (69.2% vs. 41.3%; OR: 3.45), have a historical STI (72.3% vs. 47.0%; OR: 3.58), and have a CD4 count &amp;lt; 500 (40.4% vs. 21.9%; OR: 2.51). Conclusion Among a cohort of PWH, those with an mpox diagnosis were significantly more likely to be engaged in care and received an STI screening in the year prior, suggesting increased encounters for HIV care may account for a higher rate of PWH among mpox cases. The high proportion of CD4 &amp;lt; 500 among mpox cases suggests more clinically evident manifestations in this population. Future analyses should examine unmeasured behavioral factors to explain the association between mpox diagnosis, increased engagement in care and STI screening. Disclosures All Authors: No reported disclosures

Disparities in HIV Testing among Adults with Adverse Childhood Experiences

Abstract Background It is estimated that more than 13% of persons 13 years and older living with HIV are unaware of their status. 80 percent of new HIV infections are transmitted by people who are not aware they have HIV or not receiving any HIV care in the US, presenting a major public health concern and stressing the importance of enhanced HIV screening. Adverse Childhood Experiences (ACEs) have been shown to be risk factors for HIV transmission and studying the relationship of ACEs and the likelihood of HIV screening is thus important to explore. Methods Using combined data (2019-2021) from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) dataset, adjusted analyses models were constructed to determine the likelihood of adults receiving HIV testing and their past history of ACEs. Results Overall, compared to individuals reporting no ACES, individuals reporting 1 to 3 ACEs were significantly more likely to be tested for HIV. However, despite higher prevalence of ACEs, significantly higher prevalence of men who have sex with men (MSM) remained unaware of their HIV status. Significant disparities in HIV testing were also observed by socio demographic characteristics. Conclusions Healthy People 2030 aims to increase the proportion of persons who know their HIV status to at least 95% by 2025. Our findings highlight the urgent need for targeted interventions that target high risk groups, promote testing benefits, and encourage increased testing among individuals with a history of ACEs. Given the importance of testing to HIV prevention outcomes, more research is needed to unpack the relationship between HIV risk and HIV testing for individuals with a history of childhood adversity. Key messages • New trauma-informed training programs for health care providers are needed to facilitate targeted HIV testing. • Ongoing research is critical to unpack the relationship between HIV risk and HIV testing for individuals with a history of childhood adversity.

Characterizing Persons With HIV/HCV Coinfection Who Remain Untreated for Hepatitis C at Four HIV Clinics in Connecticut (CT): Role of Multiple Overlapping Barriers at the Individual and Clinic System Levels.

Introduction. Direct-acting antiviral medications have made hepatitis C virus (HCV) cure possible for >95% of persons with chronic HCV infection, including those coinfected with HIV. Achieving strategic HCV elimination targets requires an understanding of system, provider, and patient-level barriers to treatment. We explored such barriers among persons with HIV/HCV coinfection who remained untreated for HCV. Methods. Among four primary care HIV clinics in CT with high rates of HCV cure, 25 patients with HIV/HCV coinfection were eligible (no HCV treatment as of March 31, 2021). We conducted retrospective chart reviews of demographics, clinical practice patterns, patient-specific issues such as housing, transportation, food security, and presence of mental health and substance use problems. Results. Among untreated patients, 13 (51%) were female; 17 (68%) were Black; median age was 62 years old. The majority (84%) had injecting drug use (IDU) as HIV transmission risk factor; 14 (56%) were prescribed medication-assisted treatment. Median time since HIV and HCV diagnosis was 25 and 19 years, respectively. Clinic-level barriers were noted in 19 (76%) and included lack of evaluation, treatment not recommended or implemented. Concomitant structural barriers included unstable housing for 11 (44%) and lack of transportation for eight (32%). Most patients had history of illicit substance use (84%) and mental health issues (68%). Many (76%) had multiple potential barriers. Conclusions. Multiple overlapping barriers spanning clinic and patient level domains including social determinants of health were the norm in persons with long-standing HIV/HCV coinfection who have not received HCV treatment. Interventions will require innovative, multi-disciplinary and personalized approaches.

Risk Factors for Human Papillomavirus-Associated Cancers Among People Living with HIV in Washington, District of Columbia.

District of Columbia (DC) has high rates of HIV infection and human papillomavirus (HPV)-associated cancers. People living with HIV (PLWH) are at risk for developing HPV-associated cancers. Previous studies identified factors that may further increase the risk of HPV-associated cancer among PLWH such as age, race/ethnicity, sex, risk factor for HIV transmission, stage of HIV infection, and age at HIV diagnosis. The extent to which PLWH in DC are affected by HPV-associated cancers has not previously been well described, and to our knowledge, the relationship between bacterial sexually transmitted infections (STIs) and subsequent development of HPV-associated cancer among PLWH in DC has not been explored. This was a retrospective case-control analysis of surveillance data on cancer, STIs, and HIV in Washington, DC from 1996 to 2015. There were 20,744 PLWH included in this study, of whom 335 (1.6%) had been diagnosed with an HPV-associated cancer. Among males living with HIV (MLWH), for every additional STI per 10 person-years, risk of developing an HPV-associated cancer increased by 11%. Exposure to STIs was not a significant risk factor for HPV-associated cancer among females. Ever being diagnosed with stage three HIV infection increased risk of HPV-associated cancers among males by 109% and females living with HIV by 111%. STI exposures were associated with HPV-associated cancers among MLWH in DC and ever being diagnosed with advanced HIV infection was associated with HPV-associated cancers among all PLWH. Clinicians treating MLWH should ensure their patients receive primary HPV infection prevention and HPV-associated cancer screenings.

An Analysis on the Risk Factor of HIV Transmission in Adolescents in DKI Jakarta

Background: HIV is a big problem that until now has not been handled properly. Children and adolescents become victims of parental indifference to their children. This study aims to determine the risk factors for HIV transmission to adolescents in DKI Jakarta. Methods: This study uses an analytic observational design with case control. The location of this research was carried out in DKI Jakarta (Pelita Ilmu Foundation). Results: The study found risk factors that influenced the incidence of HIV transmission among adolescents in DKI Jakarta, namely a family history of HIV/AIDS (p = 0.000; OR = 227.167; 95% CI = 28.495-1810.989). Conclusion: Family history of HIV/AIDS is the most influential factor in the incidence of HIV transmission among adolescents in DKI Jakarta.

2061. High Rates of Viremic HIV, Risky Sexual Behaviors, and Interest in Gender Affirming Hormone Therapy among Transgender Individuals Who Engage in Transactional Sex

Abstract Background In the U.S., HIV transmission persists largely through sexual transmission in gender and sexual minorities. Transactional sex (TS) is a known risk factor for HIV transmission, yet risk behaviors and engagement in HIV treatment and other medical services among transgender (TG) individuals who have TS are poorly understood. Methods PATCH is a natural history study of TG individuals in Washington, DC. Participants complete laboratory testing and surveys, including assessment of TS – defined as previous year sex in exchange for drugs, money or shelter. Fisher’s exact test was used for statistical analysis. Results Of 54 participants assigned male at birth (AMAB), 21(39%) endorsed TS, the majority of whom were female (81%), Black (95%), median age 35, and HIV+ (76%; Table 1). Of those with HIV, 12 (75%) were prescribed ART, though only 8 (50%) had HIV VL &amp;lt; 200. The majority of TG people with TS had sex weekly or more (75%), with &amp;gt; 5 partners/year (62%) and used their penis (80%) and anus (90%) during TS. A minority consistently used condoms in receptive anal sex (29%), penetrative anal sex (25%), penetrative vaginal sex (17%), and chem sex (8%). While 95% had ever taken gender affirming hormone therapy (GAHT), 62% were not prescribed GAHT at screening, of whom, 54% were interested in seeing a provider for GAHT. When compared to non-TS participants, TG individuals with TS were more likely to have chem sex (p&amp;lt; 0.01), use drugs daily or more (p=0.04), use amphetamines (p&amp;lt; 0.01) and cocaine (p&amp;lt; 0.01), and less likely to have GAHT prescribed by a provider (p=0.03). HIV+ patients with TS were less likely to have HIV VL&amp;lt; 200 (p=0.02). Table 1:Participant Characteristics and Associations with Transactional Sex Conclusion This cohort of AMAB TG individuals with TS had high rates of viremic HIV, and multiple risk factors for HIV transmission, including frequent condomless sex with multiple partners. Additionally, those with TS were more likely to have high risk drug use, indicating that novel strategies to decrease risk associated with chem sex, particularly stimulant use, should be prioritized. Further, nearly all TG participants with TS had taken GAHT, yet were less likely to get GAHT from a provider. As many had interest in seeing a provider for GAHT, co-locating GAHT with HIV treatment and prevention services could help providers engage this population and address HIV-related risks. Disclosures Shyam Kottilil, MD, PhD, Arbutus Pharmaceuticals: Grant/Research Support|Gilead: Grant/Research Support|Merck: Grant/Research Support|Regeneron Pharmaceuticals: Advisor/Consultant|Silverback Therapeutics: Advisor/Consultant|The Liver Company: Advisor/Consultant|Yufan Biotechnologies: Advisor/Consultant Sarah Kattakuzhy, MD, Gilead: Grant/Research Support Elana S. Rosenthal, MD, Gilead: Grant/Research Support|Merck: Grant/Research Support.

CULTURAL SUSTAINABILITY OF DIPO PUBERTY RITE AND ITS ASSOCIATED HIV RISKS IN THE LOWER MANYA KROBO MUNICIPALITY IN GHANA

&lt;p&gt;&lt;em&gt;Dipo&lt;/em&gt; is a puberty rite performed for adolescent girls with an average of 18 years and above into adulthood in Lower Manya Krobo Municipality. &lt;em&gt;Dipo &lt;/em&gt;rite inculcates cultural values into the initiates and preserves cultural heritage. However, the reduction in age and nudity associated with the practice could put initiates at high risk of STDs including HIV transmission. The purpose of the study was to examine the cultural sustainability of &lt;em&gt;Dipo &lt;/em&gt;and associated HIV risk in the Lower Manya Krobo Municipality in Ghana. A purposive sampling technique was used to select participants and interviewed them with the guide of an interview schedule. The findings of the study revealed that risk factors of HIV transmission include cultural, social, individual, and institutional risks. The study also found that cultural sustainability indicators associated with &lt;em&gt;Dipo&lt;/em&gt; puberty rites include cultural heritage, vitality, diversity, locality, eco-resilience, and eco-education and civilization. While cultural heritage, vitality, diversity, locality and eco-education, and civilisation were found to sustain &lt;em&gt;Dipo&lt;/em&gt; rite, eco-cultural resilience poses a risk of HIV transmission. The implication of this finding is that the performance of &lt;em&gt;Dipo&lt;/em&gt; rite is a worthy cultural practice. It is recommended that innovative ways should be adopted to sustain the rite and reduce its associated HIV risk.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/edu_01/0261/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

Breastfeeding and women living with HIV: Is it possible to move beyond the avoidance?

The risk of mother-to-infant transmission of HIV 1 during breastfeeding ranges from 10% to 15% in the absence of maternal Antiretroviral Therapy (ART) and infant Antiretroviral (ARV) prophylaxis. WHO guidelines 2016 recommend women living with HIV and fully supported for ART adherence should breastfeed for at least 12 months and up to 24 months or longer. Anyway, in high-income settings, women living with HIV are suggested to avoid breastfeeding, regardless of maternal viral load or antiretroviral therapy status. The advantages of breastfeeding in low and middle-income settings are well recognized. This brief narrative review aims to summarize existing evidence on mechanisms and risk factors for HIV transmission during breastfeeding and the possible prevention strategies in the context of ART adherence.

Situating HIV risk in barbershops: accounts of knowledge and practices from barbers in Nigeria

This study explores the contextual factors mediating HIV transmission risk in barbershops using qualitative data from in-depth interviews with barbers (n = 16) in Nigeria. Barbers were aware of individual-level risk factors for HIV transmission. Accounts highlighted individualisation of risk responsibility, wherein the decisions and actions of individual barbers were seen as primary determinants of risk, while overlooking the role of factors beyond the individual in the production of risk. The implementation of HIV prevention measures (such as sterilisation of barbering equipment) was impeded by social and structural factors such as income insecurity and pressure and demands from clients. These exogenous factors interacted with individual-behavioural ones (fatigue, delay in restocking disinfectants) to create a risk environment for HIV transmission in barbershops. Barbers chose between competing risks when making decisions about HIV prevention. Concerns about maximising income by serving more clients often trumped HIV prevention through sterilisation of equipment. These findings contribute further insights and nuances to an existing literature which shows that risk is a highly contextualised phenomenon that reflects the different impacts of structural forces on lived experiences. The findings highlight a need for models that bridge cognitive and lived dimensions of risk understanding to optimise HIV prevention in barbershops.

Cannabis use and sexual risk among MSM who drink: Understanding why more frequent cannabis users may engage in higher rates of condomless sex

BackgroundCondomless anal intercourse (CAI) is the major risk factor for HIV transmission among men who have sex with men (MSM). MSM who are heavier cannabis users engage in CAI more frequently. However, little is known about the processes that may underlie this association. This study sought to understand the potential role of condom attitudes and condom-related planning in the association between cannabis use and CAI. MethodsThis is a secondary data analysis of a study on alcohol use and sexual decision-making among MSM. Two hundred and fifty-eight MSM with moderate to heavy drinking were enrolled. Measures included CAI, cannabis use, attitudes about the influence of condoms on sexual pleasure, condom use planning, age, heavy episodic drinking, and use of pre-exposure prophylaxis (PrEP). ResultsWe conducted a negative binomial regression analysis controlling for age, PrEP, and heavy episodic drinking. Cannabis use frequency was a significant predictor of CAI (b =.333, p < .001). Indirect effects showed that while heavier cannabis users exhibited less condom-related planning (b = −0.106, p = 0.015) and more negative attitudes toward the impact of condom use on pleasure (b= −0.177, p = 0.004), cannabis use had a significant indirect effect on CAI only through attitude ratings. ConclusionsMSM who are heavier cannabis users engage in more frequent CAI and exhibit an indirect effect on CAI through negative attitudes toward the impact of condoms on pleasure. These findings suggest the potential importance of addressing these condom attitudes in HIV-prevention interventions among MSM who use cannabis.

The contribution of unstable housing to HIV and hepatitis C virus transmission among people who inject drugs globally, regionally, and at country level: a modelling study

SummaryBackgroundA considerable proportion of people who inject drugs are unstably housed. Although unstable housing is associated with HIV and HCV infection among people who inject drugs, its contribution to transmission is unknown. We estimated the global and national proportions of incident HIV and HCV infections among people who inject drugs attributed to housing instability from 2020 to 2029.MethodsIn this modelling study, we developed country-level models of unstable housing and HIV and HCV transmission among people who inject drugs in 58 countries globally, calibrated to country-specific data on the prevalences of HIV and HCV and unstable housing. Based on a recently published systematic review, unstably housed people who inject drugs were assumed to have a 39% (95% CI 6–84) increased risk of HIV transmission and a 64% (95% CI 43–89%) increased risk of HCV transmission. We used pooled country-level estimates from systematic reviews on HCV and HIV prevalence in people who inject drugs. Our models estimated the transmission population attributable fraction (tPAF) of unstable housing to HIV and HCV transmission among people who inject drugs, defined as the percentage of infections prevented from 2020 to 2029 if the additional risk due to unstable housing was removed.FindingsOur models were produced for 58 countries with sufficient data (accounting for >66% of the global people who inject drugs population). Globally, we project unstable housing contributes 7·9% (95% credibility interval [CrI] 2·3–15·7) of new HIV infections and 11·2% (7·7–15·5) of new HCV infections among people who inject drugs from 2020 to 2029. Country-level tPAFs were strongly associated with the prevalence of unstable housing. tPAFs were greater in high-income countries (HIV 17·2% [95% CrI 5·1–30·0]; HCV 19·4% [95% CrI 13·8–26·0]) than in low-income or middle-income countries (HIV 6·6% [95% CrI 1·8–13·1]; HCV 8·3% [95% CrI 5·5–11·7]). tPAFs for HIV and HCV were highest in Afghanistan, Czech Republic, India, USA, England, and Wales where unstable housing contributed more than 20% of new HIV and HCV infections.InterpretationUnstable housing is an important modifiable risk factor for HIV and HCV transmission among people who inject drugs in many countries. The study emphasises the importance of implementing initiatives to mitigate these risks and reduce housing instability.FundingNational Institute for Health Research and National Institute of Allergy and Infectious Diseases and National Institute for Drug Abuse.

Examining the impact of social distancing and methamphetamine use on sexual risk and intimate partner violence in sexual and gender minority young adults during the COVID-19 pandemic

BackgroundDuring the COVID-19 pandemic in 2020, concerns were raised about the potential impact of pandemic-related social distancing measures on existing health disparities among sexual and gender minority (SGM) young adults, including HIV transmission risk and intimate partner violence (IPV). Another concern was the potential for increased methamphetamine use during the pandemic, which is a known risk factor for HIV transmission and IPV. MethodsThe present analysis examines the impact of COVID-19 social distancing (social distancing and quarantining) and methamphetamine use on HIV risk and IPV in a combined dataset from 3 cohort studies of SGM young adults (two in Los Angeles and one in Chicago) from May 2020 to April 2021 (n = 1142). Bivariate analyses and multivariable logistic regressions were estimated. ResultsThe median age was 26. All participants were assigned male at birth and most participants were men (93.8%). The largest racial groups were Hispanic/Latinx (44.6%) and Black (29.0%). In adjusted models methamphetamine use was consistently associated with having a new sex partner, higher numbers of sex partners, and experience of IPV, during the pandemic. Reporting no social distancing and reporting one social distancing behavior, were associated with experience of IPV relative to reporting 2 social distancing behaviors. Social distancing was not associated with sexual risk behavior or Pre-exposure Prophylaxis use. ConclusionsSGM young adults live at the intersection of multiple vulnerabilities during the COVID-19 pandemic. Addiction services, HIV prevention services, and violence support services should be prepared to support young adult SGM needs, particularly those who use methamphetamine.

844. High Risk Behaviors, Suboptimal HIV Viral Suppression, and Limited PrEP Use among People Who Engage in Transactional Sex

Abstract Background In the United States, high rates of HIV transmission persist, particularly due to sexual transmission in marginalized populations. Transactional sex (TS) is a known risk factor for HIV transmission, yet risk behaviors and engagement in HIV treatment and prevention among those who have TS are poorly understood. Methods GRAVITY is cross-sectional investigation of people living with HIV (PLWH) or HCV in Washington, DC and Baltimore, MD. Epidemiologic survey data were collected at a single timepoint. Patients who endorsed previous year sex in exchange for drugs, money, or shelter were considered positive for TS. Fisher’s exact test was used for statistical analysis. Results Of 500 participants, 81(16%) endorsed TS, the majority of whom were HIV+ (51, 63%) and used drugs daily or more (57,70%; see Table 1). PLWH with TS were more likely to be Black (44, 86%, p= 0.05) and Trans female (17, 33%, p&amp;lt;0.01) than HIV- participants with TS. In the TS cohort, PLWH were more likely to engage in anal sex (38, 75%, p&amp;lt; 0.01), have sex weekly or more (46, 90%; p&amp;lt; 0.01), have sex with more than 2 partners (27, 77%, p=0.03), and have a history of syphilis (14, 27% p= 0.04) compared to HIV- participants. Only 21% and 35% of PLWH and 17% and 22% of HIV- always used condoms in vaginal sex and anal sex, respectively (p &amp;gt;0.05). Though 41 (80%) PLWH took ART, only 19 (41%) reported viral suppression. Of HIV- participants, 59% had interest in starting Pre-Exposure Prophylaxis (PrEP), but few had been offered (3,10%), or ever taken PrEP (2,7%). Table 1: Participant Characteristics and Associations with Transactional Sex and HIV Status Conclusion In this cohort of people with TS, there were high rates of HIV and racial, sexual, and gender minorities. Notably, PLWH had higher rates of frequent sex, multiple partners, and anal sex, as well as suboptimal viral suppression and condom use during anal sex. As such, PLWH +TS may be a consequential part of HIV transmission networks. While those without HIV also had frequent sex and suboptimal condom use, PrEP experience was limited. As the majority had interest in PrEP, targeted strategies to initiate and maintain PrEP in people with TS may be critical in preventing HIV acquisition. Interventions to identify TS, address high-risk behaviors, achieve and maintain viral suppression amongst +TS PLWH, and connect +TS HIV- individuals to PrEP are key to a comprehensive strategy to end the HIV epidemic. Disclosures Sarah Kattakuzhy, MD, Gilead Sciences (Scientific Research Study Investigator, Research Grant or Support) Elana S. Rosenthal, MD, Gilead Sciences (Research Grant or Support)Merck (Research Grant or Support)

Comparing Social Media and In-Person Recruitment: Lessons Learned From Recruiting Substance-Using, Sexual and Gender Minority Adolescents and Young Adults for a Randomized Control Trial.

BackgroundRecruiting large samples of diverse sexual and gender minority adolescent and young adults (AYAs) into HIV intervention research is critical to the development and later dissemination of interventions that address the risk factors for HIV transmission among substance-using, sexual and gender minority AYAs.ObjectiveThis paper aimed to describe the characteristics of the samples recruited via social media and in-person methods and makes recommendations for strategies to recruit substance-using, sexual and gender minority AYAs, a hardly reached population that is a priority for HIV prevention research.MethodsUsing data from a randomized control trial of an HIV and substance use intervention with sexual and gender minority AYAs, aged 15 to 29 years in southeastern Michigan (n=414), we examined demographic and behavioral characteristics associated with successful recruitment from a range of virtual and physical venues.ResultsWe found that paid advertisements on Facebook, Instagram, and Grindr offered the largest quantity of eligible participants willing to enroll in the trial. Instagram offered the largest proportion of transgender masculine participants, and Grindr offered the largest proportion of Black/African American individuals. Although we attempted venue-based recruitment at clubs, bars, community centers, and AIDS service organizations, we found it to be unsuccessful for this specific hardly reached population. Social media and geobased dating applications offered the largest pool of eligible participants.ConclusionsUnderstanding factors associated with successful recruitment has the potential to inform effective and efficient strategies for HIV prevention research with substance-using, sexual and gender AYAs.Trial RegistrationClinicalTrials.gov NCT02945436; https://clinicaltrials.gov/ct2/show/NCT02945436International Registered Report Identifier (IRRID)RR2-10.2196/resprot.9414

The Role of Gender Power Imbalances in the Spread of HIV among Women in Intimate Relationships: Guidelines for Social Work Practice

Gender power imbalances and HIV are concerns that affect women globally. Social workers are ethically committed to help people affected with HIV and thereby promote gender equality. Although the literature has documented the nexus between gender imbalances and HIV, scant research explores these problems concurrently within the social work profession. Drawing on the resource theory and gender and power theory, this article undertook a qualitative exploratory to gain insights into women's perspectives on gender power imbalances as a risk factor for HIV transmission in rural communities of Ngaka Modiri Molema District, North West Province. Purposive sampling was used to recruit participants while data was collected through semi-structured interviews. The findings demonstrate that unequal power relations between men and women in intimate relationships negatively affect women’s lives in diverse ways. This gendered impact of HIV infections for women remains intact due to the rooted gender norms that limit their ability to protect themselves against risky sexual behavior by their male partners. Disclosure of one's status remains a complex stigma attached to HIV. Social work empowerment interventions that seek to enhance equality in intimate relationships are recommended.

The HIV transmission risk factors and opportunities for use of mHealth in HIV prevention among emerging adult population in the Sub-Saharan Africa context: a review of the literature

ABSTRACT The purpose of this literature review was to understand the current practices and gaps in HIV prevention for the emerging adult population in Sub-Saharan Africa (SSA) and to review the current state of mHealth in SSA and how this innovative approach can be tapped to enhance HIV awareness and prevention among emerging adults. Peer reviewed articles about HIV prevention in emerging adults in SSA were searched in PubMed, Global Health, CINAHL, PsycInfo and Web of Science databases. Specific criteria for eligibility included studies that were published over the last decade spanning from 2009 to 2019. A total of 114 articles were found, which met the preliminary search criteria, which was then followed by a quality check, and finally, 20 articles were synthesized. The review followed the scientific process of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four themes were identified included factors that place emerging adults at increased risk for HIV, the social and structural drivers of acquisition and transmission of HIV, current gaps in understanding HIV prevention and the current state of mHealth in SSA. Our discussion includes how mHealth can be tapped to enhance HIV awareness and prevention among emerging adults. HIV is still the leading cause of morbidity and mortality among SSA emerging adults. Addressing this burden will require renewed efforts to implement effective prevention strategies across multiple sectors, including educational, information technology, social, policy and health care systems that influence prevention knowledge, services and treatment options for emerging adults. .