Search Results (142)

Introduction: Mpox emerged as a multi-country outbreak in 2022 and disproportionately affected gay, bisexual, and other men who have sex with men (GBMSM). Stigma is known to exacerbate health crises by discouraging testing, treatment, and vaccination. This review aimed to explore stigma associated with Mpox among GBMSM from July 2022, when mpox was declared a public health emergency of international concern. Methods: The PICO framework guided this narrative review. A search was conducted across the following databases from inception to June 2025: PubMed/MEDLINE, Embase, CINAHL, and Web of Science. The literature had to be empirical, peer-reviewed research that focused on mpox-related stigma in GBMSM. Results: Forty-seven studies were included in this review. The following themes were derived: (1) healthcare experiences, (2) media influence, (3) internalised and anticipated stigma, (4) public health messaging, (5) community responses, and (6) psychosocial impact. Healthcare experiences were marked by anticipated discrimination; many GBMSM delayed testing or vaccination for fear of being disclosed or labelled promiscuous. This was especially apparent in contexts where same-sex relationships are criminalised, leading some men to self-medicate or seek clandestine services. Media analyses revealed that social and traditional platforms often amplified blame and homophobia, though community-led counter-messaging helped shift narratives. Internalised and anticipated stigma resulted in shame, concealment of symptoms, avoidance of care, and heightened anxiety. Public health messaging that framed mpox as a behaviour-linked rather than identity-linked risk was more acceptable, and flexible vaccination strategies (e.g., offering less conspicuous injection sites) increased uptake. Stigma contributed to psychosocial distress and may have impeded outbreak control. Conclusions: Mpox-related stigma among GBMSM operates at individual, community, and structural levels, echoing patterns from the HIV era. Effective mitigation requires rights-based, destigmatising communication, culturally competent care, and collaboration. Addressing stigma is vital to controlling future outbreaks and ensuring equitable healthcare access. Full article

Owing to significant advances in HIV treatment and the resultant increase in life expectancy, the number of aging individuals living with HIV and associated comorbidities continues to rise. Consequently, the management of people living with HIV is no longer solely the responsibility of infectious disease or HIV specialists, but requires an integrated and multidisciplinary approach that addresses the prevention, as well as the monitoring and treatment needs of associated conditions. The care of people living with HIV in Romania is largely aligned with international guidelines, particularly those of the European AIDS Clinical Society (EACS). However, guideline implementation requires adaptation to local clinical realities and collaboration across medical specialties. In response to this need, a team of experts in infectious diseases, cardiology, nephrology, diabetes, metabolic disorders, and clinical psychology, convened to develop a national consensus for the interdisciplinary management of people living with HIV. The consensus provides clear and practical recommendations addressed to both infectious disease specialists and healthcare providers from other specialties involved in the care of people living with HIV. Its goal is to offer a unified, up-to-date, and applicable framework to support patient-centered care, facilitate interdisciplinary collaboration, and contribute to improving the quality of life of people living with HIV in Romania. Full article

Background: Human immunodeficiency virus and hypertension increasingly co-occur in South Africa. Despite publicly funded care, patients with multimorbidity face high out-of-pocket costs, yet limited evidence exists from the patient perspective. Purpose: To quantify the economic burden of comorbid HIV and hypertension, assess predictors of monthly out-of-pocket costs, and explore coping mechanisms. Methods: We conducted a cross-sectional analysis using patient-level data from the Mobile Phone Text Messages to Improve Hypertension Medication Adherence in Adults with HIV (MOPHADHIV trial) [Trial number: PACTR201811878799717], a randomized controlled trial evaluating short messages services adherence support for hypertension care in people with HIV. We calculated the monthly direct non-medical, indirect, and coping costs from a patient perspective, valuing indirect costs using both actual income and minimum wage assumptions. Generalized linear models with a gamma distribution and log link were used to identify cost determinants. Catastrophic expenditure thresholds (10–40% of monthly income) were assessed. Results: Among 683 participants, mean monthly total costs were ZAR 105.81 (USD 5.72) using actual income and ZAR 182.3 (USD 9.9) when valuing indirect costs by minimum wage. These time-related productivity losses constituted the largest share of overall expenses. Regression models revealed a strong income gradient: participants in the richest quintile incurred ZAR 131.9 (95% CI: 63.6–200.1) more per month than the poorest. However, this gradient diminished or reversed under standardized wage assumptions, suggesting a heavier proportional burden on middle-income groups. Other socio-demographic factors (gender, employment, education) not significantly associated with total costs, likely reflecting the broad reach of South Africa’s primary health system. Nearly half of the participants also reported resorting to coping mechanisms such as borrowing or asset sales. Conclusions: Comorbid HIV and hypertension impose substantial patient costs, predominantly indirect. Income disparities drive variation, raising equity concerns. Strengthening integrated human immunodeficiency virus—non-communicable diseases care and targeting financial support are key to advancing South Africa’s Universal Health Coverage reforms. Full article

Despite advances in the understanding of Kaposi sarcoma (KS), research from resource-limited settings remains limited. This study aimed to estimate the proportion of epidemic visceral KS among Mexican people living with HIV (PLHIV) and to describe their clinical and biochemical characteristics. We included PLHIV with histopathologically confirmed KS who received care at the National Medical Center La Raza between March 2020 and February 2023. We calculated the prevalence of epidemic KS and epidemic visceral KS and analyzed clinical and biochemical variables potentially associated with visceral involvement. The prevalence of epidemic KS was 5.6%. Among these cases, 51.4% had visceral involvement, yielding an overall prevalence of 2.8%. Patients with epidemic visceral KS exhibited significantly higher rates of oral mucosal involvement and lower hemoglobin levels compared with those without visceral disease. These findings highlight the substantial burden of epidemic visceral KS in this population and should be confirmed in future studies with larger cohorts and robust designs aimed at identifying clinical and biochemical predictors of visceral involvement. Full article

Background: Key populations (KPs), particularly female sex workers (FSWs), continue to face significant barriers in accessing HIV-related healthcare services in South Africa. Structural challenges have historically hindered equitable HIV treatment access, worsened by the COVID-19 pandemic. Overburdened clinics, staff shortages, and travel constraints disrupted HIV services and ART adherence. In response, the Differentiated Service Delivery (DSD) model was rapidly scaled up to decentralise care and improve treatment continuity. Objective: To solicit the views of stakeholders regarding their interests, roles and experiences in the implementation of the HIV treatment DSD model among FSWs in South Africa, as well as associated successes and barriers thereof. Methods: We purposively selected and interviewed eight stakeholders, comprising government officials, implementers and sex workers’ advocacy organizations. Thematic analysis was used to explore the perceived impact of DSD models and associated successes and barriers in the current service delivery landscape. Results: The study found that decentralization of DSD models improved access to services for FSWs. However, the criminalization of sex work perpetuates fear and marginalization, while stigma and discrimination within healthcare settings remain significant deterrents to HIV treatment uptake. High mobility among FSWs also disrupts continuity of care, contributing to treatment interruptions and lack of data on loss to follow-up. Participants highlighted the need for legal reform, increased healthcare provider sensitization, and the integration of mental health and psychosocial support in HIV services. Peer-led interventions and digital health innovations, such as biometric systems and electronic medical records, emerged as promising strategies for enhancing patient tracking and retention. Nonetheless, the sustainability of DSD models is threatened by an overreliance on external donor funding and insufficient government ownership. Conclusions: To achieve equitable healthcare access and improved HIV outcomes for KPs, especially FSWs, a multi-pronged, rights-based approach is essential. This must include community engagement, structural and legal reforms, integrated support services, and sustainable financing mechanisms to ensure the long-term impact and scalability of DSD models. Full article

Background: Indigenous populations worldwide face a disproportionate burden of HIV due to structural inequities, cultural marginalization, and limited access to health services. Despite growing recognition of the need for culturally adapted responses, the effectiveness of combination HIV prevention strategies in these communities remains underexplored. Objectives: This study aimed to evaluate and compare the effectiveness of multiple HIV prevention strategies among Indigenous populations using a systematic review and network meta-analysis (NMA), to inform equity-oriented public health interventions. Methods: Following PRISMA-NMA 2020 guidelines, a comprehensive literature search was conducted across four databases (PubMed, SciELO, LILACS, Science Direct) for quantitative studies published between January 2000 and June 2025. Eligible studies evaluated HIV prevention interventions among Indigenous populations and reported risk or odds ratios. A frequentist NMA model was used to calculate effect estimates (OR, 95% CI) and SUCRA rankings for seven types of interventions, combining biomedical, behavioral, and structural approaches. Results: Four high-to-moderate quality studies enclosing 4523 participants were included. The most effective intervention was home-based counseling and testing for HIV, followed by medical consultation combined with HIV testing. Standalone testing, while effective, was significantly less impactful than when combined with culturally sensitive educational strategies. Information-only strategies showed the least efficacy. The SUCRA analysis ranked home-based testing highest (45.17%), highlighting the importance of decentralization, community participation, and intercultural mediation. Conclusions: Culturally adapted combination prevention strategies—especially those integrating home-based testing and counseling—are more effective than isolated biomedical interventions in Indigenous populations. These findings reinforce the urgent need for participatory, context-driven public health responses that center Indigenous knowledge, reduce stigma, and expand equitable access to HIV care and prevention. Full article

Despite medical advances having made HIV a survivable condition, HIV persists as the 11th leading cause of death among young Black women. Enhancing the quality of care engagement through beneficial patient–provider relationships can close gaps in retention and adherence, enabling long, healthy lives. Using constructivist grounded theory informed by an established framework for patient-centered care in complex cancer settings and insight from local HIV advocates, this work identifies what provider actions retain women in care and why. Through focus groups and interviews, eleven Black women in the Southwestern United States, an understudied population, express that providers who engage them as co-creators in maintaining good health are more likely to retain them. Concurrently, when women are attuned to their own health care and interpersonal needs, they discern which providers are equally committed to their health based upon observed provider actions. These actions, such as listening attentively, taking time, and paying attention to the whole person, in conjunction with women’s motivation and active involvement, create a reciprocal dynamic that increases the likelihood these women will remain virally suppressed. The ideal relationship is one in which the provider empowers and champions women as drivers of their own care. Full article

Background: Right ventricular (RV) dysfunction is associated with poor clinical outcomes in critically ill sepsis patients, but its pathophysiology and predictors are incompletely characterized. We aimed to investigate the predictors of RV dysfunction and its outcomes in sepsis patients admitted to the intensive care unit (ICU). Methods: This is a single-center retrospective cohort study of adult patients admitted to the ICU for sepsis who had echocardiography within 72 h of diagnosis. Patients with acute coronary syndrome, acute decompensated heart failure, or significant valvular dysfunction were excluded. RV dysfunction was defined as the presence of RV dilation, hypokinesis, or both. Demographics and clinical outcomes were obtained from electronic medical records. Results: A total of 361 patients were included in our study—47 with and 314 without RV dysfunction. The mean age of the population was 66.8 years and 54.6% were females. Compared to those without RV dysfunction, patients with RV dysfunction were more likely to require mechanical ventilation (63.8% vs. 43.9%, p = 0.01) and vasopressor support (61.7% vs. 36.6%, p < 0.01). On multivariate logistic regression analysis, increasing age (OR 1.03, 95% C.I. 1.00–1.06), a history of HIV infection (OR 5.88, 95% C.I. 1.57–22.11) and atrial fibrillation (OR 4.34, 95% C.I. 1.83–10.29), and presence of LV systolic dysfunction (OR 14.40, 95% C.I. 5.63–36.84) were independently associated with RV dysfunction. Patients with RV dysfunction had significantly worse 30-day survival (Log-Rank p = 0.023). On multivariate Cox regression analysis, older age (HR 1.02, 95% C.I. 1.00–1.04) and peak lactate (HR 1.16, 95% C.I. 1.11–1.21) were independent predictors of 30-day mortality. Conclusions: Among other findings, our data suggests a possible association between a history of HIV infection and RV dysfunction in critically ill sepsis patients, and this should be investigated further in future studies. Patients with evidence of RV dysfunction had poorer survival in this population; however this was not an independent predictor of mortality in the multivariate analysis. A larger cohort with a longer follow-up period may provide further insights. Full article

The COVID-19 pandemic has illuminated and intensified pre-existing structural vulnerabilities among older adults living with HIV/AIDS in sub-Saharan Africa, particularly Nigeria. Within already overstretched healthcare infrastructures, these individuals faced heightened economic precarity, disrupted HIV care, and pronounced psychosocial distress. Exploring their lived experiences critically advances an understanding of resilience and informs contextually responsive interventions that can mitigate future health crises. This study employed a narrative qualitative approach to explore the lived experiences of older adults (aged 50 and above) attending the Infectious Diseases Institute (IDI) clinic in Ibadan, Nigeria, during the pandemic lockdown. Purposive sampling guided by maximum variation principles enabled the selection of 26 participants who provided detailed accounts through in-depth interviews. Reflective thematic analysis identified complex narratives illustrating intensified financial hardships, disrupted access to antiretroviral therapy (ART), and heightened psychological distress, including anxiety, depression, and profound isolation. Conversely, participants also articulated experiences of resilience, manifesting in improved medication adherence, strengthened family bonds, and introspective growth fostered by enforced isolation. These nuanced findings highlights the necessity of developing an adaptive, integrated healthcare interventions that addresses economic vulnerabilities, psychosocial wellbeing, and ART continuity, thereby better preparing resource-constrained health systems to support older adults with HIV/AIDS in future public health crises. Full article

Background: Client satisfaction with HIV service delivery reflects the ability of healthcare providers to effectively deliver care and treatment that meets the requirements and expectations of clients, and is associated with improved health outcomes, including increased retention in care and HIV viral suppression. The aim of the study was to conduct a client satisfaction study among PLHIV attending a large HIV clinic in Trinidad to identify the gaps in service delivery and factors associated with reduced HIV viral suppression. Methods: This cross-sectional study was conducted over the period April 2023–March 2024 among 362 clients attending the HIV clinic. A structured, pre-tested questionnaire collected demographic data and factors that affected client clinic experiences, including wait time, communication with staff, confidentiality, physical amenities and HIV viral suppression. Multivariable logistic regression was used to assess the likelihood of reporting satisfaction based on key independent variables. Results: Among participants, 219 (60.5%) were females, 202 (55.8%) were aged 30–49 years and 337 (93.1%) were virally suppressed. Participants reported satisfaction with overall care (95.3%), confidentiality (95.9%) and interactions with doctors (96.1%), nurses (98.6%) and other staff. Dissatisfaction was reported with facility-related, elements including the outdoor/tented waiting area (46.1%), the toilet/washrooms (37.0%) and the clinic wait time (31.8%). Participants were less likely to be satisfied with the amount of medication received if they had unsuppressed viral loads (p = 0.035), were aged 20–29 years old (p = 0.048) or had a tertiary education (p = 0.008). Conclusions: The study showed that 93.1% of the study participants were virally suppressed, and there was a general level of satisfaction with the overall care at the clinic, confidentiality and healthcare workers’ service delivery; however, gaps involving the physical facilities, wait times and medication services should be prioritized. Full article

The iCARE Nigeria study is evaluating a daily text message medication reminder intervention (TXTXT) to improve viral suppression and medication adherence among youth living with HIV (YLH), aged 15–24 years. In this sub-study, we evaluated text message responsiveness (text-back) at 24 weeks of the intervention as an indicator of engagement, as well as barriers and facilitators at one of six clinical study sites. Differences in responses by age group, birth sex, schooling status, education, mode of infection, and weekend/weekday and holiday/non-holiday periods were analyzed using t-test and multiple linear regression. Focus group discussions were conducted among three groups (low, average, and high text message responsiveness) and analyzed using a rapid content analysis approach. Overall, TXTXT responsiveness was 26.5% (4606/17,367); older age (18–24 years) and weekdays (versus weekends) were significantly associated with higher responsiveness. Facilitators included being comfortable receiving personalized text messages. Barriers included a lack of airtime and messages received late. Overall, text-back responsiveness to daily medication adherence messages among YLH was low, better among older participants, and higher on weekdays. Addressing barriers and promoting facilitators may improve responsiveness. Full article

Background: Understanding immune response is essential for preparing for public health crises. COVID-19 vaccination provides robust immunity against SARS-CoV-2, but immunocompromised populations may have weaker immune responses. We assessed SARS-CoV-2 spike (trimer) total IgG/IgM/IgA (total Ig) to investigate immune response to COVID-19 vaccination in people living with HIV (PLWH), considering CD4⁺ T cell count, viral load, substance use, and comorbidities. Methods: This cross-sectional study was conducted in Miami, Florida, between May 2021 and December 2021 as part of the NIH Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) initiative (3U01DA040381-05S1) and the Miami Adult Studies on HIV (MASH) cohort (U01DA040381). Blood samples were collected and SARS-CoV-2 spike (trimer) total Ig was quantified. HIV serostatus, viral load, CD4⁺ T cell count, and COVID-19 vaccinations were abstracted from medical records. Substance use (tobacco, alcohol, and drug use [marijuana, cocaine, heroin, fentanyl, methamphetamine, amphetamine, hallucinogens, ecstasy, or misuse of prescription drugs]), and comorbidities (hypertension, diabetes, autoimmune disease, obesity, chronic kidney disease, and substance use disorders) were assessed via validated questionnaires. Drug use was confirmed via urine toxicology. Multivariable linear regression was conducted. Results: Median age (n = 1317) was 57.8 years, 49.8% were male, 50% were Black non-Hispanic, 66.2% had received ≥1 dose of a COVID-19 vaccine, and 29.6% were PLWH (71.3% virally suppressed and median CD4⁺ T cell count > 500 cells/µL). PLWH, compared to people without HIV, were more likely to have received ≥1 dose of a COVID-19 vaccine (76.2% vs. 62.0%, p < 0.001) and present with substance use (77.2% vs. 42.9%, p < 0.001) and comorbidities (72.8% vs. 48.2%, p < 0.001). Vaccinated PLWH, compared to unvaccinated PLWH, had higher CD4⁺ T cell counts (577.5 vs. 517.5, p = 0.011) and were more likely to be virally suppressed (76.4% vs. 54.8%, p < 0.001). A lower CD4⁺ T cell count (<200 vs. ≥500, β = −0.400, p = 0.033) and higher HIV viral load (≥200–<5000 vs. <200, β = −0.275, p < 0.001) were associated with lower spike (trimer) total Ig titers, indicating a diminished response to COVID-19 vaccination. Conclusions: A lower CD4⁺ T cell count and higher HIV viremia were linked to reduced SARS-CoV-2 immunogenicity in racial/ethnic minority PLWH, a population underrepresented in vaccine clinical trials. HIV care providers should target efforts to maintain viral suppression to avoid diminished responses to COVID-19 vaccination. Full article

Background: The validated Screening Tool of Older People’s Prescriptions (STOPP) identifies potentially inappropriate prescribing (PIP)—treatments where potential risk outweighs potential benefit. STOPP is particularly important for people aging with HIV and comorbidities, since PIP may exacerbate symptoms and decrease adherence. Methods: We analyzed data from the DC Cohort, a longitudinal cohort of people with HIV (PWH). We applied STOPP criteria to identify PIP among DC Cohort participants aged ≥ 50 years who completed a Patient Reported Outcomes (PROs) survey. All medications prescribed in the 2 years prior to PROs survey completion were considered. Negative binomial models were used to evaluate factors associated with PIP and structural equation modeling was used to evaluate whether symptom burden mediates the relationship between PIP and quality of life. Results: Of 1048 eligible DC Cohort participants, 486 (46%) had at least one PIP. The most common systems implicated were musculoskeletal (23%), analgesic drugs (16%), and the central nervous system (13%). Age, race/ethnicity, HIV transmission factor, social determinants of health, and type of HIV care site were significantly associated with number of PIP in the crude models. In the multivariable model with just demographic variables, the association between age (aIRR: 1.03 (95% CI: 1.02, 1.04)), intravenous drug use (aIRR: 1.68 (95% CI: 1.20, 2.35)), White, non-Hispanic race (aIRR: 0.67 (95% CI: 0.50, 0.92)), site type (aIRR: 0.75 (95% CI: 0.62, 0.92)), and the expected number of PIPs remained significant. In the fully adjusted multivariable model with demographics and SDOH, the association between age, intravenous drug use, White, non-Hispanic race, and expected number of PIPs remained significant. Statistical evidence that symptom burden mediates the relationship between PIP and each of the QOL dimensions was present. Conclusions: Future interventions should work to decrease PIP among these high-risk groups, especially for PIP associated with increased symptom burden. Full article

In 2022, scientific societies agreed on a document with recommendations for a comprehensive diagnosis of viral hepatitis (B, C, and D). The aim was to evaluate the situation in Spain regarding the comprehensive diagnosis of viral hepatitis in a single blood draw before it is recommended. A panel of experts prepared a structured survey directed at hospitals (public or private with teaching accreditation) with ≥200 beds (sent 20 October 2022, closed 1 December 2022). The response rate was 61% (79/129; 52 hospitals with >500 beds). Among the participating hospitals, all could perform tests for HBsAg, anti-HCV, and HIV serology; 94% could perform PCR testing for HCV, 63% could test for anti-HDV, and 28% could test for HDV-RNA (67% [53/79] outsourced this testing). Point-of-care (POC) testing availability was low (24%), with 84% of these tests being supervised by the reference microbiological laboratory and the results being registered in the patients’ medical history. Ninety percent of the centers carried out the diagnosis in a single step (99% HCV, 70% HBV, 48% HDV, and 44% HBV-HDV). In addition, 77% used some communication strategy when an active infection was encountered (100% HCV, 49% HBV, and 31% HDV). Only 20% had an automated system for scheduling a specialist physician appointment. Most hospitals had the means for a comprehensive diagnosis of viral hepatitis in a single sample, but <50% could test for HBV/HDV. Alerts for continuity of care were available for HCV, but not HBV or HDV. POC device implementation is important for decentralized testing. Full article

Background/Objectives: HIV-related stigma and fear among healthcare professionals represent significant barriers to effective patient care, contributing to delayed diagnosis and suboptimal treatment for people living with HIV (PLHIV). Although these issues have been studied in various settings, there is a lack of evidence on how they manifest among general practitionersin Colombia—a key group in the healthcare system. This study investigated the prevalence of stigma and fear among Colombian general practitioners and identified associated factors. Methods: A cross-sectional, observational study was conducted between February and May 2024, using a self-administered online survey targeting general practitioners. A validated 28-question instrument adapted from the Health Policy Project assessed fear, stigma, and related factors. Results: Among 579 participants, 68.6% exhibited low fear levels; however, specific clinical tasks, such as taking blood samples, elicited greater concern. Stigmatizing beliefs—such as associating HIV with irresponsible behavior—were reported by 25% of participants. Prior training in HIV care was inversely associated with stigma (OR = 0.681; 95% CI: 0.489–0.949), while older age and heterosexual orientation correlated with higher stigma levels. Conclusions: Despite generally low levels of fear and stigma, gaps in HIV-related training among physicians highlight the need for targeted educational initiatives. Promoting comprehensive HIV education in medical curricula and continuing professional development can reduce stigma, enhance confidence in care, and foster a more inclusive healthcare environment. Full article