Understanding women's decision-making when offered different HIV pre-exposure prophylaxis (PrEP) options is critical for improving uptake. This qualitative study explored factors influencing PrEP choices among Swazi women in 2022-2023. In-depth interviews were conducted with 17 women who accepted or declined oral PrEP or the Dapivirine vaginal ring; and 6 healthcare workers who prescribed PrEP. One focus group discussion (FGD) with eight women eligible for PrEP and three FGDs with six to eight male community members explored attitudes to PrEP. Data were collected in Siswati, transcribed into English, and analyzed thematically. Women's decisions around PrEP use and product preferences were shaped by social norms around sexual relationships, practicalities of use and perceptions of effectiveness. Many preferred "invisible" methods, such as the ring, to avoid stigma or partner violence, while oral PrEP was favored by some women practicing anal sex. Ease of adherence, side-effects and ring insertion practicalities also influenced choices. Some participants questioned PrEP effectiveness or feared it might spread HIV, while some healthcare workers noted that future injectable options could reduce blame in cases of seroconversion. The findings highlight the need to offer women a range of PrEP options, supported by accurate information, to expand coverage in high-incidence settings.

Antiretroviral therapy (ART) is essential for HIV treatment, yet maintaining high adherence remains challenging in resource-limited settings. Mobile health (mHealth) interventions offer a scalable approach to support adherence. This meta-analysis evaluated the effectiveness of mHealth interventions in improving ART adherence and clinical outcomes among people living with HIV (PLHIV) in low- and middle-income countries. Eight databases were searched through February 2025, and randomised controlled trials (RCTs) evaluating mHealth interventions were included. Risk of bias was assessed using the Cochrane tool, and random-effects models were applied. Seventeen RCTs (n = 2172) met the inclusion criteria. mHealth interventions significantly improved ART adherence compared with standard or alternative approaches (OR = 2.03; 95% CI: 1.44-2.86; p<0.0001). Subgroup analyses indicated moderating effects of geographic region (χ² = 8.84, p = 0.01) and country income level (χ² = 6.44, p = 0.04), with the greatest adherence benefits observed in the Americas (OR = 5.46; 95% CI: 2.20-13.57) and in upper-middle-income countries (OR = 3.45; 95% CI: 1.69-7.06). mHealth interventions also improved viral suppression (OR = 2.27; 95% CI: 1.18-4.36). Although CD4 count improvements were noted, sensitivity analysis suggested this effect was not robust. Overall, mHealth interventions show promise for strengthening ART adherence in resource-limited settings, while further research should explore contextual factors influencing effectiveness.

Oral liquid formulations of zidovudine (ZDV) and nevirapine (NVP) are the main antiretrovirals (ARVs) for neonates born to mothers living with HIV, but they have limitations including poor palatability, short shelf-life, frequent dosing and supply challenges. Understanding caregiver and provider preferences for infant ARV formulations is essential to guide the development of acceptable alternatives. Within the PETITE-DTG trial in South Africa (NCT05590325), evaluating the pharmacokinetics, safety and acceptability of novel dolutegravir (DTG) formulations in neonates, we explored ARV preferences among mothers ( = 28) and health workers ( = 6). Participants completed interviews ranking six formulations: existing ZDV and NVP syrups, a DTG dispersible tablet (DTG-DT), a novel DTG oral dispersible film (DTG-film) and two pipeline options (long-acting injectable; transdermal patch). Both groups strongly favoured DTG-film, highlighting ease of administration, confidence in accurate dosing and discreetness. Long-acting injectables were next preferred, viewed as convenient despite concerns about discomfort. DTG-DT, ZDV and NVP ranked lower due to preparation challenges and risk of spillage. Transdermal patches were least favoured, with concerns regarding the comfort of neonates, impact of water exposure and effectiveness. These findings underscore strong support for innovative ARV options, emphasizing usability, ease of administration and reduced dosing frequency for the treatment of neonates.

This comparative study analyzed changes in caregiver-related factors known to influence pediatric HIV disclosure using baseline data from two clinical trials in Ghana - (recruitment 2013-2016) and (recruitment 2021-2023). Changes in caregiver characteristics and psychosocial domains were measured using validated instruments: social support (Social Provisions Scale), HIV knowledge (Brief HIV Knowledge Questionnaire), illness perception (Brief Illness Perception Questionnaire) and HIV stigma (HIV Stigma Scale). Caregivers of children aged 7-18 years who had not disclosed the child's HIV status completed the same structured questionnaires at baseline. Changes from to baseline periods in psychosocial domains were modeled using multivariable linear regressions. Compared to , caregivers in were more likely to be female (85.6% vs. 81.6%), single (19.7% vs. 13.9%), without formal education (20.5% vs. 16.3%), HIV positive (66.0% vs. 60.2%) and earn higher incomes (47.1% vs. 27.6% > 300 GHS/month). From to , social support changed only modestly (mean difference: 0.89, 95% Confidence Interval [CI]: - 0.15, 0.92), illness perception worsened (4.48, 95% CI: 3.16, 5.80), stigma increased (2.25, 95% CI: 1.54, 2.95) and HIV knowledge declined (-1.02, 95% CI: -1.29, -0.74). HIV status and younger age were consistently linked to higher stigma. ClinicalTrials.gov identifier: NCT01701635. ClinicalTrials.gov identifier: NCT04791865.

Primary care providers (PCPs) in Canada frequently report limited knowledge and confidence in prescribing HIV pre-exposure prophylaxis (PrEP). To address this gap, we developed and evaluated an online educational module designed to enhance PCPs' knowledge and PrEP-related clinical skills. Pre- and post-training surveys ( = 38 and  = 20, respectively) showed substantial improvements: understanding of PrEP eligibility increased by 46%; knowledge of medications and monitoring by 55-180%; skills in medication management by 57-68%; skills in client monitoring by 47-84%; and knowledge regarding PrEP discontinuation by 84%. All participants (100%) agreed that the module met their expectations and was highly valuable, applicable, and useful to their clinical practice. Qualitative feedback highlighted the need for audio narration, more downloadable materials, and more inclusive, patient-centered content. Overall, these findings indicate that the online module effectively enhances PCPs' readiness to prescribe oral PrEP and addresses key gaps in HIV prevention training.

HIV/AIDS remains a significant concern in sub-Saharan Africa (SSA), where women face heightened vulnerability due to biological, structural, cultural, and socioeconomic factors. HIV testing is central to prevention and control, yet uptake remains suboptimal. This study examined the association between participation in sexual and reproductive health (SRH) decision-making and HIV testing in Ghana.

This study aimed to compare the neurocognitive function and neuropsychiatric symptoms of individuals living with HIV and HIV-negative controls, and to evaluate their associations with clinical markers of disease activity. The study included 111 HIV-positive individuals followed at Ankara City Hospital and 54 HIV-negative controls matched for age, sex, and educational level. All participants were assessed using the Montreal Cognitive Assessment (MoCA), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). Vitamin D levels were significantly higher in the control group than in the HIV-positive group ( = 0.043). Using a MoCA cut-off score of 21, the proportion of participants scoring ≥21 was significantly higher among controls ( = 0.036). No significant differences were observed between the groups in depression or anxiety scores ( > 0.05). Additionally, neurocognitive performance and psychiatric symptoms were not significantly associated with CD4 count or HIV RNA levels. These findings indicate that neurocognitive impairment remains prevalent among individuals living with HIV despite effective antiretroviral therapy. Although depression and anxiety levels did not differ between groups, regular neurocognitive and psychiatric assessments remain essential components of comprehensive HIV care, emphasizing the importance of multidisciplinary management.

The COVID-19 pandemic abruptly altered the way HIV care was accessed and delivered. We sought to assess HIV care indicators during the COVID-19 pandemic in relation to pre-pandemic HIV care patterns in North Carolina. Using statewide HIV surveillance data and group-based trajectory models, we identified pre-pandemic HIV care trajectories in two partially overlapping populations: (1) newly HIV-diagnosed from March 2014 through February 2018, followed from diagnosis to pandemic start (March 1, 2020); and (2) previously HIV-diagnosed before March 2016, followed from March 2016 to pandemic start. We analyzed pandemic-period HIV care indicators in both populations. In newly diagnosed persons, pre-pandemic HIV care attendance trajectories comprised "consistently high," "slowly fluctuating," "steadily decreasing," and "low U-shaped" groups. Trajectories in previously diagnosed persons were similar, although two distinct low groups replaced the "low U-shaped" group. In both populations, the "consistently high" groups had the highest predicted percentages of persons, while the "low" care groups had the lowest. HIV care indicators in the first pandemic year corresponded with pre-pandemic care patterns: most persons with high and fluctuating pre-pandemic care had an HIV laboratory record in the pandemic year, while most persons in the low care groups had no record in that year.

Antiretroviral therapy has markedly increased life expectancy among people living with human immunodeficiency virus (HIV), yet the long-term impact of chronic HIV infection on women's quality of life (QoL) and sexual functioning remains poorly understood. Female sexual dysfunction (FSD) is common in women and may impair psychological well-being and social relationships. Understanding how HIV infection intersects with FSD and QoL could inform holistic care for women in resource-limited settings. To compare QoL and FSD between women living with HIV and HIV-negative women and to identify socio-demographic predictors of poor QoL. We conducted a hospital-based cross-sectional study in 2024 among 200 women on antiretroviral therapy and 200 age-matched HIV-negative women attending the general outpatient clinic at Aminu Kano Teaching Hospital, Kano, Nigeria. Participants were recruited through systematic sampling; research assistants provided study information and obtained written informed consent. Quality of life was assessed with the World Health Organization Quality of Life 26-item Brief questionnaire (WHOQOL-BREF). Female sexual function was screened with the 19-item Female Sexual Function Index (FSFI); a total score ≤26.55 denoted FSD. Data were analyzed using chi-square tests, independent t-tests and multivariable logistic regression. The mean (±SD) age of participants was 37.1 ± 9.4 years. Overall QoL was significantly worse among women with HIV than HIV-negative women (53% vs 63% reporting good QoL,  = 0.043). Mean QoL scores were lower in the HIV-positive group for the psychological (61 ± 18 vs 54 ± 14;  < 0.001) and environmental domains (69 ± 20 vs 65 ± 16;  < 0.001), while physical and social domain scores were comparable. FSD was highly prevalent in both groups (96% in HIV-positive and 98% in HIV-negative participants;  = 0.40), and FSFI scores were not associated with QoL. In multivariable analysis, rural residence (adjusted odds ratio 3.30, 95% CI 1.31-8.98) and primary-level education (aOR 3.06, 95% CI 1.50-6.38) independently predicted poor QoL. Women living with HIV experience poorer overall QoL than HIV-negative peers, particularly in psychological and environmental domains. Interventions that improve living conditions, strengthen psychosocial support and integrate sexual and mental health services into HIV care, are needed to improve the well-being of women in North-western Nigeria.

Despite substantial advancements in HIV/AIDS treatment and prevention, HIV-related stigma remains a key barrier to achieving the UNAIDS global goal of ending AIDS by 2030. This study examined the pervasive stigma experienced by people living with HIV (PLHIV) in a secondary health facility in Ghana, exploring its manifestations and impact on mental health. A qualitative exploratory research design was used, involving in-depth interviews with 27 purposively selected PLHIV (aged 25-50 years) between July and November 2024. Participants were recruited from antiretroviral therapy unit of the secondary health facility. Thematic analysis was conducted using Atlas.ti (Version 12), with independent coding and categorization of emerging themes following Braun and Clarke's six-phase framework. Multiple stigma dimensions were identified, including enacted, felt, and self-stigma. Participants reported discrimination from healthcare providers, social isolation, and self-stigmatization, which intensified mental health challenges such as anxiety and depression. Fear of judgment discourages healthcare engagement, reduces adherence to ART, and worsens health outcomes. Stigma negatively affects the mental health of PLHIV. Addressing stigma requires targeted interventions, including stigma-reduction training for healthcare providers, mental health support programs, and policy measures to foster inclusive healthcare environments. By mitigating stigma, health systems can improve both psychological well-being and ART adherence among PLHIV.

In South Africa (SA), women are disproportionately affected by HIV, with increased risk during the peripartum period. Despite the availability, efficacy, and safety of oral PrEP to prevent HIV, uptake and adherence rates remain low. This study assessed the association of intrapersonal, partner-related, and community-referenced psychosocial factors with willingness to use PrEP among pregnant persons in SA. PrEP-naïve pregnant persons receiving antenatal care in Cape Town were recruited. Hierarchical regression models examined the associations among willingness to (a) initiate and (b) continue PrEP with intrapersonal (PrEP awareness, depression, alcohol use, PTSD, internalized HIV-related shame/blame, perceived HIV risk), partner-related (relationship power, reproductive autonomy, dyadic trust), and community-level (social support, HIV-related community shame/blame, enacted stigma) factors. Increased willingness to initiate and continue PrEP was associated with reduced alcohol use, increased internalized HIV-related blame, increased HIV-related shame at the community level, and decreased HIV-related blame at the community level. Decreased enacted stigma increased willingness to initiate PrEP, while previous pregnancies increased willingness to continue PrEP. Attending to multi-level psychosocial factors through tailored interventions may support PrEP initiation and continuation among pregnant people in SA. Further research is needed to develop and adapt culturally meaningful interventions that address these factors within antenatal care settings.

There is a high prevalence of poor mental health among people with HIV, intersecting with structural inequalities, stigma and co-morbidities. A new person-centred approach to care that utilises health coaching to prioritise health and well-being and connects people to existing sources of support or voluntary sector organisations (social prescribing) could benefit people with HIV.

Demographic, behavioral, and clinical characteristics have been found to be associated with willingness to use and preferences for different HIV pre-exposure prophylaxis (PrEP) modalities. Limited data are available, however, describing how sexual behavior characteristics affect willingness to use and preferences for PrEP. Given the different clinical characteristics of available PrEP modalities (i.e., daily oral, on-demand oral, long-acting injectable), an individual's sexual behavior (i.e., number of partners, partner characteristics) might affect their preferences for PrEP. We conducted a cross-sectional study among men who have sex with men (MSM) who are not living with HIV to assess the association between willingness to use PrEP and preferences for three different PrEP modalities with key sexual behavior characteristics. We found that willingness to use PrEP was not strongly associated with sexual behavior; however, for each sexual behavior characteristic we examined, preferences were higher for each modality of PrEP compared to no PrEP. As the number of sexual partners in the past 12 months increased, so did preferences for each modality of PrEP compared to no PrEP. Preferences were consistently stronger for injectable compared to oral PrEP. These results indicate that PrEP preferences are responsive to sexual behavior.

The Women-Centred HIV Care (WCHC) Model addresses women living with HIV's multifaceted healthcare needs, but its delivery remains unclear. This environmental scan examines the delivery of the WCHC Model in Canadian HIV clinics. Clinics were surveyed on health service delivery, then scored out of 10 in the six domains of the WCHC Model using a service-based score system. Generally, on-site services were assigned more value than off-site referrals. Of 59 clinics, 35 (59%) were surveyed, representing all Canadian regions except Alberta, Northwest Territories and Nunavut. The highest scoring domains were HIV care (median [interquartile range] 9.3 [8.6-9.9]) and sexual health care (9.0 [7.0-10.0]), while the peer support/leadership/capacity building domain scored lowest (2.1 [0.0-5.3]). Scores varied between regions in trauma/violence-aware care (7.5 [1.3-10.0]), person-centred care (6.7 [5.0-10.0]), women's healthcare (7.5 [6.3-8.8]) and mental health/addiction care (6.7 [5.0-8.3]). On-site mental health and addiction services were largely unavailable. Our findings demonstrate that WCHC Model delivery varies between regions, with Canada-wide strengths in HIV and sexual health care. Increasing the availability of peer support/leadership/capacity building opportunities and on-site mental health and addiction services at HIV clinics would enhance comprehensive care for women living with HIV.

Anal cancer, primarily caused by persistent high-risk HPV infection, is increasing worldwide. Men who have sex with men (MSM) and men with HIV (MWH) have incidence rates over ten-fold the rate among the general population. We explored health beliefs related to anal cancer, and perceived benefits, barriers, and facilitators to screening among MWH and their HIV care providers in the U.S. South, where HIV incidence remains high. We conducted in-depth interviews and thematic analyses to identify themes related to health beliefs (i.e., perceived knowledge of HPV and cancer, benefits of screening, and self-efficacy), barriers and facilitators to screening. Among MWH (N=12), benefits of screening included early detection to prevent negative outcomes and awareness about one's body. Among providers (N=4), suggestions for overcoming barriers to screening included access to standard screening guidelines, patient education, inclusion of screening into routine care, social work services, and self-collection. Among MWH that were aware of HPV-associated cancers, perceived risk of cancer and a desire to receive HPV vaccination were common. In conclusion, improving patient education about HPV-associated cancer, inclusion of screening as part of routine care, and access to self-collection kits could facilitate anal cancer screening uptake among MWH in the South.

HIV remains a persistent global health challenge, emphasizing the urgent need for an effective cure. Meaningful engagement of affected communities is essential for advancing HIV cure efforts. Using stage theories of behavior change, this paper investigated engagement as a dynamic process. Engagement was highlighted with five interconnected stages: awareness, perceived relevance, decision-making, participation, and sustained involvement. These stages were used to understand how individuals and communities engage with HIV cure efforts across diverse contexts. Drawing predominantly, but not exclusively, on our own work in the Netherlands, France, Australia, and plans for work in Sub-Saharan Africa, we identified common patterns and local variations in engagement. Previous research underscored the importance of tailoring engagement strategies to lived experiences and sociohistorical contexts, moving beyond one-way information sharing to foster deeper, more meaningful involvement and engagement. Applying social and behavioral stage models in further interdisciplinary research may help pinpoint key opportunities for intervention and promote sustainable engagement with affected communities. Thus, this structured lens of engagement holds potential to advance the ethical and effective development of HIV cure efforts, ensuring that diverse perspectives shape its future trajectory.

Male circumcision is often undertaken to reduce the spread of HIV/AIDS and other sexually transmitted infections. However, there has been a shift in the motivation to undergo the procedure, as many perceive it as improving their sexual performance. This study investigates factors that influence decision-making about male circumcision. This qualitative study used a combination of in-depth and focus group interviews with men and women to investigate factors that influence the decision to circumcise among Zambian men. In general, both men and women were aware of the protective benefits of male circumcision. Attitudes to medical male circumcision were favourable. However, women emphasised that circumcision should not be considered the only HIV prevention method. The interviews suggest that men perceive circumcision to improve their sexual performance. There was also a greater preference for circumcised partners among women due to the perception that intercourse with uncircumcised men is less pleasurable. These reasons may potentially overshadow the main reasons for which circumcision was initially advocated. The dangers of undergoing circumcision for sexual enhancement at the expense of reducing the risk of HIV and other STIs may have longstanding consequences and must be addressed.

Women account for 59% of human immunodeficiency virus (HIV) infection cases in sub-Saharan Africa. This impacts the increase in mother-to-child HIV transmission rates and presents challenges to preventive care for mother-to-child transmission. A scoping review of the scientific evidence was then developed to identify the barriers and facilitators faced by health professionals in providing services to prevent mother-to-child transmission of this virus in sub-Saharan Africa. The PubMed and CINAHL databases were accessed, and the keywords "barriers, facilitators, HIV, prevention of mother-to-child transmission of HIV, health professionals" and their synonyms were used. A total of 22 studies were included in the review, and common points between barriers and facilitators related to women, health professionals, and health services were identified. We understand that training healthcare professionals is necessary, and creating welcoming environments for users is crucial.

Despite Georgia having one of the highest rates of new HIV diagnoses in the United States, uptake of HIV pre-exposure prophylaxis (PrEP) remains critically low. We assessed the psychosocial correlates associated with PrEP awareness among persons who inject drugs (PWID) living in Northeast Georgia. Data were collected from 173 adult (≥18 years) HIV-negative PWID. PrEP awareness was elicited by the question, "Have you ever heard of PrEP?" (Yes/No). Covariates include age, gender, sexual orientation, race/ethnicity, education, health insurance, HIV testing, syringe services program (SSP) attendance, psychological stress, resilience, risky sexual and injection behaviors, HIV information seeking, and primary drugs used. Less than half (47.4%) of participants were aware of PrEP. Most participants were interested in asking for PrEP information from providers, obtaining prescriptions, and taking PrEP. In the multivariable analysis, the odds of PrEP awareness were higher among PWID who had higher resilience (adjusted OR: 1.06, 95%CI: 1.02-1.10), ever attended an SSP (adjusted OR: 2.53, 95%CI: 1.21-5.63) and performed sexualized drug use in the last year (adjusted OR: 2.38, 95%CI: 1.01-5.63). PrEP awareness is the first step in the HIV prevention continuum, influencing initiation, use, and persistence. A resilience-based approach in SSP settings may effectively increase PrEP awareness among PWID.

In the US and other high-income countries, national guidelines traditionally recommended against breastfeeding infants born to women living with HIV (WLHIV), due to the risk of HIV transmission to the infant. In 2023, US guidelines were changed to recommend collaborative decision-making and support for WLHIV who choose to breastfeed. Little is known regarding how WLHIV make the decision of how to feed their babies, leaving clinicians lacking guidance on how to provide effective counseling. We therefore conducted a semi-structured interview study of pregnant and recently postpartum WLHIV in the US. A diverse cohort of 19 WLHIV described weighing multiple considerations against one another based on their preferences and beliefs, with risk of HIV transmission being just one of many interconnected and often conflicting motivations. While some considerations were always associated with a specific feeding choice, others, such as fear of HIV disclosure, influenced some mothers to breastfeed and others to formula feed. In the context of both breastfeeding and formula-feeding, mothers were faced with a continuum of additional feeding-related choices throughout the child's infancy. WLHIV stressed the importance of receiving personalized infant feeding counseling that acknowledges that their priorities and beliefs may be different from those of their health providers.

Self-disclosure represents a pivotal challenge for older people living with HIV (PLWH) in China, who are frequently impacted by HIV-related stigma. As such, the current study aims to explore the relationship between HIV-related stigma and self-disclosure, and specifically examine the chain-mediating roles of perceived social support and acceptance of illness. A cross-sectional study was conducted among 282 older PLWH, recruited from Wuxi, China. AMOS 24.0 was used for model drawing and mediation path testing, and SPSS 26.0 was used for data analysis. Structural equation modeling (SEM) showed a satisfactory model fit (CMIN/DF = 1.744, CFI = 0.966, GFI = 0.906, AGFI = 0.853, IFI = 0.972, RMSEA = 0.051). We found that the mediated effect values of perceived social support and acceptance of illness were - 0.128 and - 0.055, respectively, while their chain mediated effect value was - 0.015. It suggests that interventions enhancing perceived social support and acceptance of illness may mitigate the negative impact of HIV-related stigma on self-disclosure behavior.