Search Results (269)

HIV-related stigma constitutes a critical structural determinant that adversely affects mental health and treatment outcomes among people living with HIV (PLWH) in Tunisia. Rooted in cultural conservatism, legal criminalization, and institutional discrimination, this stigma engenders social exclusion, the systematic removal of individuals from community participation. It further fosters internalized shame, precipitating depression, anxiety, and treatment non-adherence. Evidence was synthesized from English- and French-language literature published between 2014 and 2026, identified through targeted searches of PubMed, Scopus, Web of Science, Google Scholar, and grey literature sources from UNAIDS, WHO, and Tunisian governmental authorities. This narrative review synthesizes recent epidemiological data indicating a 0.1% general population prevalence but 13% among men who have sex with men (MSM), with only 26% testing coverage. Situated within trauma-informed, social determinants of health, and public health frameworks, this analysis identifies specific vulnerabilities for women and older adults living with HIV. Integrated approaches combining healthcare-provider training, legal reform, and culturally tailored mental health services are essential to mitigate the harms of stigma and improve equitable health outcomes in Tunisia. Full article

Objective: Latines in the United States (US) experience disproportionate HIV-related inequities, exacerbated by immigration-related legal precarity and exclusionary policies. This study explores how racialized legal status (RLS), a mechanism by which race-neutral legal classifications disproportionately burden minorities, impacts the lived experiences of Latines with HIV (LWH) across the HIV care continuum. Methods: We conducted a secondary qualitative analysis of in-depth interviews with 21 LWH, 15 healthcare providers, and 10 key informants in Prince George’s County, Maryland. Drawing on RLS framework, data was analyzed thematically, focusing on emergent themes related to immigration, politics, and legal status and their impact on LWH. Results: Policies linking access to health and social services to legal status intensified economic instability and social exclusion, thus leading to suboptimal disease management. Fear of deportation, institutional mistrust, discrimination, and intersectional stigma contribute to healthcare avoidance, disrupting continuity and engagement across the HIV care continuum. Institutions providing services to LWH struggle to circumvent barriers caused by RLS, straining local and community-based resources. Conclusions: RLS erodes whole-person care by creating barriers for healthcare and social services access. Addressing inequities among Latines requires multilevel responses that reduce exclusionary policies and support the well-being of individuals at the intersection of immigration status and chronic disease management. Full article

Infectious diseases remain a major global public health concern, disproportionately causing morbidity and mortality in low- and middle-income countries. Sexually Transmitted Infections (STIs) heavily affect sexually active populations. Sex workers, encompassing female sex workers (FSWs), male sex workers (MSWs), and transgender/gender-diverse individuals, face heightened vulnerabilities due to occupational exposures, structural barriers, stigma, and criminalization. While substantial focus has historically centered on HIV, non-HIV STIs such as Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, and viral hepatitis present significant co-morbidity. Crucially, drug resistance across these pathogens presents distinct biological and epidemiological challenges: bacterial antimicrobial resistance (AMR) in N. gonorrhoeae and C. trachomatis, antiretroviral (ARV) resistance in HIV, and direct-acting antiviral (DAA) resistance in hepatitis B and C. This perspective article synthesizes the current epidemiological landscape, critiques the reliance on syndromic management over molecular diagnostics (e.g., NAATs, point-of-care, and genomic surveillance), highlights diagnostic stewardship, and outlines priority public health strategies aligned with the WHO 2022–2030 Global Health Sector Strategies. Full article

In May 2025, a new and welcome Pandemic Treaty was signed. The success of this treaty for the management of future pandemics depends on a re-evaluation of the importance of previous well-established treaty-based international human rights norms in controlling health crises. During the COVID-19 pandemic, public health responses globally were characterised by poor preparation, uncertainty, and hasty and sometimes perverse decisions. International human rights norms, especially health rights, and other treaty obligations were honoured more in their breach than their observance. The lessons learned from public health strategies that had integrated international human rights norms into the control and management of the HIV/AIDS pandemic were either ignored or forgotten. Early public health attempts to control the HIV/AIDs pandemic were hobbled by data breaches, travel restrictions, compulsory reporting, stigma, and misinformation about how the virus spread. This was replaced by a more successful human rights-based approach (HRBA) that used health rights indicators to identify groups susceptible to the disease but difficult to reach with conventional public health policies. The efficacy of health rights indicators and HRB methodology to remove barriers to treatment and suppress pandemics should have been seriously considered in strategies to control COVID-19. The article claims that failure to do this meant that more lives were lost than necessary and more people were left with serious long-term health effects. This article explores the practical significance of the international human rights legal framework, especially health rights, as trialled during the HIV/AIDS pandemic, for the management of COVID-19 and other pandemics. Full article

Sexually transmitted infections (STIs) remain a major global public health challenge, while stigma, privacy concerns, and barriers to healthcare access continue to delay diagnosis and treatment. This narrative review summarizes the current evidence on the use of artificial intelligence (AI) to support STI self-assessment and digital sexual healthcare while critically discussing its current applications, challenges, and limitations, based on a PubMed literature search. Existing studies demonstrate the potential of machine-learning algorithms for individualized HIV/STI risk prediction, symptom-based assessment, automated evaluation of genital lesions, and differentiation of sexually transmitted from non-sexually transmitted conditions, with reported diagnostic performance ranging from AUCs of approximately 0.75–0.95 for symptom assessment models up to 0.893 for multimodal image-based lesion classification and validation accuracies of 94.4% for real-world image analysis platforms. Advances in computer vision and radiomics further highlight the ability of image-based AI systems to identify diagnostically relevant lesion characteristics while improving model interpretability. In parallel, generative AI chatbots are increasingly being explored as tools for sexual health education, personalized risk assessment, behavioural support, triage, and linkage to care. These technologies also influence psychological aspects of sexual health by providing private and accessible support, facilitating risk appraisal, and addressing anxiety associated with STI concerns. However, insufficient demographic diversity and the reliance on retrospective training datasets, privacy and data security concerns, limited prospective validation, and uncertainty regarding real-world clinical effectiveness remain important barriers to the widespread adoption of these technologies. To address some of these limitations, future developments are expected to focus on multimodal and explainable AI systems integrated within digital sexual health ecosystems, with clinicians remaining central to the validation, interpretation, and contextualization of AI-generated assessments and the delivery of patient-centred care. Full article

Background: Mental health problems are common among people living with HIV (PLWH); however, the use of mental health services remains inadequate in many low- and middle-income countries. Objectives: This study aimed to explore the perspectives of health professionals on the provision of mental health services for PLWH presenting with mental health problems in primary health care in Lesotho. Methods: A qualitative descriptive approach was adopted, involving semi-structured interviews with 50 health professionals who were purposely selected, including nurses and medical officers, each with a minimum of 2 years’ primary health care experience in the Maseru district. Data were collected between December 2022 and January 2023, audio-recorded, and transcribed verbatim. Data collection continued until thematic saturation was achieved, and analysis was conducted using a thematic framework analysis. Results: The analysis revealed two main themes: (1) limited knowledge of mental health problems, encompassing an inadequate understanding of signs and symptoms, diagnosis, and management, and (2) barriers to the management of mental health problems. Key subthemes included the shortage of qualified mental health specialists and psychiatric medications, the absence of dedicated counselling services for the prevention of mental health problems, lack of a mental health department, time constraints within clinical practice, and limitations in clinical infrastructure. Cultural beliefs, stigma, and discrimination, both among health professionals and in the broader community, were also identified as significant impediments. Participants described a substantial treatment gap, driven by insufficient training and limited resources, which undermines the effective delivery of mental health services. Conclusions: The findings revealed that health professionals working in primary health care in Lesotho experience considerable knowledge gaps and systemic constraints that hinder the provision of adequate mental health services for PLWH who have mental health problems. These challenges can be mitigated through targeted capacity building, the integration of MHS into primary care, improved resource allocation, and strategies to reduce stigma, thereby enhancing health outcomes. Full article

Introduction: The Awareness/Acceptance/Action Model (AAAM) was initially developed by one of the authors to explore stigma and prejudice towards people living with HIV/AIDS. In the present study, the AAAM was examined for its personal and professional relevance to people affected by the Troubles, 30 years of sectarian conflict in Northern Ireland. When unchecked, judgmental or reactive attitudes can undermine intentions to consistently deliver services in line with professional standards and human rights. Methods: Despite a devolved, power-sharing government and steps to address longstanding political and religious grievances, cultural sensitivities and animosity remain on both sides of the divide. A university in Northern Ireland recruited 11 practice teachers and 18 social work students, who participated in one of four focus groups. Mindfulness principles and techniques were used to allow participants to visualise “the other” before exploring how prejudice might impact personal and professional interactions. Thematic analysis of focus group transcripts was conducted using Braun and Clarke to assess the presence and nature of labelling, stereotyping, out-grouping and discriminating against people perceived as “the other”. Findings: Given the potential differences in identity, background, and experiences of social work practitioners and service users, it is important that we critically reflect on how we serve people based on direct or intergenerationally transmitted encounters. The AAAM was then piloted in undergraduate social work degree programmes and shared with practice teachers. Feedback confirmed that it offers a theoretical framework to promote anti-oppressive practice and critical reflection during professional social work training. Using Mindfulness techniques to visualise “the other” prompted participants to listen well and look deeply at the origins of their prejudices or fear, and how these could lead to biased interactions with service users. Full article

HIV-tuberculosis (HIV-TB) co-infection remains a leading cause of morbidity and mortality among people living with HIV and disproportionately affects immigrant and refugee communities in the United States. While antiretroviral therapy has improved HIV outcomes, cultural, social, and psychological barriers hinder timely diagnosis and sustained HIV-TB co-infection care in these populations. This integrative review aims to synthesize evidence on cultural, social, and psychological factors influencing access to diagnosis, treatment, and management of HIV, TB, and HIV-TB co-infection among immigrant and refugee populations in the United States. This study is an integrative review guided by Whittemore and Knafl’s framework. We conducted a systematic search of PubMed, Scopus, and CINAHL for peer-reviewed, mixed-methods, quantitative, qualitative, and review articles published in English between 2015 and 2025. After duplications were removed and dual screening of 107 retrieved records, 16 articles met inclusion criteria for this study. Findings were thematically categorized and synthesized. The themes generated were placed into three main categories: cultural factors including stigma and misperceptions about disease transmission; social factors such as limited healthcare access, lack of insurance, and socioeconomic marginalization; and psychological factors including fear of deportation, trauma, and mistrust of healthcare systems. Addressing HIV-TB co-infection in immigrant and refugee populations requires holistic, trauma-informed, and community-engaged strategies that integrate mental health support, culturally and linguistically tailored education, and policy reforms to remove structural obstacles. Future research should employ culturally validated measures to co-create sustainable interventions and advance health equity. Full article

Background/Objectives: HIV testing is essential for early HIV diagnosis, timely treatment initiation, and HIV prevention. Despite Thailand’s long-standing HIV prevention programs and universal access to HIV testing services, nationally representative evidence on lifetime HIV testing among Thai adults remains limited. This study aimed to estimate the prevalence of lifetime HIV testing and identify factors associated with lifetime HIV testing among Thai adults. Methods: This study was a secondary analysis of data from the 6th Thai National Health Examination Survey. A total of 11,843 Thai adults aged 20–59 years were included. Descriptive statistics were used to estimate the prevalence of lifetime HIV testing. Survey-weighted logistic regression analyses were performed to examine factors associated with lifetime HIV testing. Results: The overall prevalence of lifetime HIV testing was 41.9%, with a prevalence of 42.4% among males, and 41.4% among females. Individuals aged 30–39 years (AOR = 1.64, 95% CI: 1.43–1.87) and 40–49 years (AOR = 1.67, 95% CI: 1.41–1.99), those with secondary education (AOR = 1.64, 95% CI: 1.43–1.87) or certificate/higher education (AOR = 1.74, 95% CI: 1.48–2.05), those currently living with a partner (AOR = 1.60, 95% CI: 1.43–1.79), participants with higher monthly income (10,000–24,999 THB: AOR = 1.13, 95% CI: 1.01–1.27; ≥25,000 THB: AOR = 1.39, 95% CI: 1.13–1.70), residents in the Northern region (AOR = 1.74, 95% CI: 1.45–2.09), and those who had a relative or acquaintance living with HIV/AIDS (AOR = 1.46, 95% CI: 1.34–1.59) were more likely to have lifetime HIV testing. In contrast, Muslim participants (AOR = 0.72, 95% CI: 0.57–0.90), residents of rural areas (AOR = 0.88, 95% CI: 0.79–0.97), residents in the Central (AOR = 0.82, 95% CI: 0.69–0.98) and Southern regions (AOR = 0.83, 95% CI: 0.72–0.94), and those with higher HIV-related stigma (AOR = 0.91, 95% CI: 0.84–0.99) were less likely to have lifetime HIV testing. Conclusions: Lifetime HIV testing among Thai adults remained suboptimal, with geographic and sociodemographic disparities. Full article

Background/Objectives: Men who have sex with men (MSM) carry a disproportionate share of the HIV burden in Portugal, yet the psychosocial characteristics of MSM living with HIV remain insufficiently described. This cross-sectional study examined how compulsive sexual behavior, internalized homonegativity, psychological distress, emotion regulation difficulties, and substance use relate to HIV serostatus, independent of sociodemographic characteristics. Methods: A convenience sample of 480 cisgender MSM (66 living with HIV) completed validated self-report measures online. Because the measures departed from normality, group differences were tested with Mann–Whitney U tests, and associations with serostatus were estimated with a parsimonious binary logistic regression, re-estimated with Firth penalization and evaluated with discrimination diagnostics. Results: Participants living with HIV showed small but significant differences on four indicators: higher compulsive sexual behavior and internalized homonegativity and lower scores on one emotion regulation subscale; depression, anxiety, and stress did not differ. In the adjusted model, compulsive sexual behavior, internalized homonegativity, and problematic substance use were associated with higher odds and the emotion regulation subscale with lower odds of living with HIV. In sensitivity analyses, the substance use association depended on how the construct was defined and was specific to chemsex with core drugs. Model discrimination was limited. Conclusions: HIV serostatus was associated with a small set of psychosocial and behavioral correlates rather than sociodemographic characteristics. These group-level associations describe correlates of serostatus, not a clinical profile of men living with HIV; they cannot establish direction and generate hypotheses, for longitudinal and structurally informed research, about stigma and social context. Full article

Despite significant biomedical advances in the prevention of mother-to-child transmission (MTCT) of HIV, residual transmission and suboptimal maternal outcomes persist across Europe. The challenge is no longer primarily virological but structural: aggregated ART coverage indicators mask important discontinuities across the perinatal care pathway. This scoping review maps evidence on clinical and psychosocial dimensions of the perinatal HIV pathway among adult women living with HIV (WLHIV) in Europe, and identifies key gaps in their integration across the continuum of care. Following PRISMA-ScR guidelines, five databases were searched for studies published between 2010 and 2026. Of 1881 records identified, 109 met inclusion criteria. Findings were synthesized thematically using an inductively developed framework spanning preconception through long-term postpartum outcomes. MTCT rates declined from approximately 1–1.2% in the mid-2000s to below 0.5% in recent data, and vaginal delivery rates increased markedly with sustained viral suppression. However, persistent inequalities remain among younger women, migrants, and those with histories of injecting drug use. Stigma, migration-related vulnerability, mental health difficulties, constrained disclosure, and socioeconomic insecurity shape engagement with care, influencing treatment continuity, retention, and virological outcomes, particularly during the postpartum period. Equitable perinatal HIV outcomes require integrated care models that combine clinical HIV and obstetric services with mental health support, social needs screening, and migration-sensitive services to address the structural conditions shaping care trajectories. A substantial proportion of WLHIV in Europe originate from high-prevalence regions, making perinatal HIV in this context a direct interface between global infectious disease burden and migration health. Addressing care in European settings therefore contributes to broader global health equity goals in HIV elimination. The protocol was pre-registered on Open Science Framework with registration number: 10.17605/OSF.IO/9BZGY. Full article

Hepatitis B virus (HBV) infection remains a major driver of liver-related morbidity and mortality among people living with HIV (PLWH), yet vaccine-induced protection is frequently suboptimal. HIV-associated immune dysfunction, including CD4⁺ T-cell depletion, altered antigen presentation, impaired T follicular helper cell support, and B-cell dysregulation, reduces seroprotection after standard recombinant HBV vaccines and may limit durability of antibody responses. Vaccine response is further influenced by HIV viral suppression, age, comorbidities, prior vaccine history, and baseline HBV serologic status, including isolated hepatitis B core antibody (anti-HBc) and occult HBV infection (OBI) considerations. Although antiretroviral therapy (ART) improves vaccine responsiveness, many PLWH fail to achieve protective hepatitis B surface antibody (anti-HBs) titers (≥10 mIU/mL) after conventional schedules, or experience antibody waning over time. Current guidelines recommend HBV vaccination for all susceptible PLWH with post-vaccination serologic testing and revaccination for nonresponders. Persistent implementation barriers, including incomplete series, vaccine hesitancy, stigma, and logistical constraints, continue to limit real-world impact. Emerging clinical trial data support CpG-adjuvanted HBV vaccines (HepB-CpG/Heplisav-B) and intensified dosing and schedules (double-dose or four-dose regimens) to improve seroprotection and generate higher peak anti-HBs titers, which may enhance durability. This review synthesizes guideline recommendations, immunologic mechanisms of hyporesponsiveness, predictors of vaccine response, and practical strategies to optimize HBV vaccination in PLWH. Full article

Background/Objectives: Sexualized drug use (SDU) and chemsex have emerged as a growing public health concern globally, reflecting complex intersections between sexual practices, psychoactive substance use, and structural vulnerabilities. In Brazil, however, evidence on healthcare access among individuals who engage in SDU/chemsex remains limited and fragmented. This scoping review aimed to map and analyze the available literature on healthcare access in this population, identifying barriers, facilitators, and gaps in care. Methods: The review followed the Arksey and O’Malley framework and Joanna Briggs Institute recommendations, with searches conducted in six databases (MEDLINE/PubMed, Embase, Scopus, SciELO, LILACS, and PsycINFO) for studies published between 2014 and 2025. Results: Eleven studies met the inclusion criteria, predominantly quantitative and concentrated in large urban centers. Findings indicate that healthcare access is shaped by persistent structural and symbolic barriers, including stigma, discrimination, fear of disclosure, and limited professional preparedness. Care remains largely centered on human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) services, with insufficient integration of primary care, mental health, and substance use services, contributing to fragmented care. Significant gaps were identified, including the underrepresentation of women, transgender, and non-binary populations, and the absence of studies focusing on healthcare professionals. Conclusions: Substance use patterns reflect both global trends and local specificities, particularly the prominence of alcohol and cocaine in Brazil. This review provides the first synthesis of Brazilian evidence on chemsex from a healthcare access perspective. The findings highlight critical inequities and support the need for integrated, stigma-free, and context-sensitive care within the Brazilian Unified Health System. Based on these findings, the VIP-SDU/Chemsex Model is proposed as a multilevel framework to explain how structural, symbolic, and programmatic factors shape access and health outcomes. Full article

Chosen family caregivers assume caregiving roles by choice rather than by blood or legal relation. Chosen family caregivers play a critical yet often invisible role in supporting older adults living with HIV. Unlike traditional family caregivers, many chosen family members are themselves living with HIV or other chronic health conditions, creating unique dynamics of mutual support, resilience, and vulnerability. Older LGBTQ adults are disproportionately reliant on chosen family, often due to stigma, estrangement from biological family, or social marginalization, highlighting distinct challenges in caregiving relationships. Women in chosen family roles frequently experience compounded burdens, balancing emotional, physical, and logistical care responsibilities alongside broader social and structural pressures. Despite their essential contributions, chosen family caregivers remain largely unrecognized within healthcare systems, limiting their access to formal support, respite, and decision-making authority. This commentary synthesizes the existing literature and conceptual perspectives to examine the social, gendered, and health-related dimensions that distinguish chosen family caregiving. It highlights key gaps in recognition and support and outlines implications for policy, research, and practice aimed at strengthening care for older adults living with HIV. Full article

Background: Although pre-exposure prophylaxis (PrEP) is highly effective for HIV prevention, identifying individuals who may benefit from PrEP and delivering personalized prevention recommendations remain challenging in routine and digital health settings. Objective: This study aimed to develop and preliminarily evaluate an integrated artificial intelligence framework combining machine learning (ML) for HIV risk stratification and generative artificial intelligence (GenAI) for personalized PrEP recommendation support. Methods: A curated dataset of 2000 de-identified client profiles from Love2Test platform was used for proof-of-concept model development. Profiles were labeled as low or high HIV acquisition risk by domain experts based on structured behavioral information. Multiple ML classifiers were trained and compared using PyCaret. The selected model was integrated with a generative AI model through structured prompting to generate personalized PrEP recommendation content. The integrated framework was evaluated through structured physician assessment by four independent medical doctors. Results: The selected model showed strong internal discrimination for classifying high versus low HIV acquisition risk. The integrated framework also received favorable physician evaluation for clinical accuracy, explanation validity, contextual relevance, and error minimization across fixed and randomly selected profiles. However, because expert labeling was based on structured behavioral indicators closely related to the model inputs, the high internal performance should be interpreted within the context of this proof-of-concept study. Conclusions: The proposed framework provides a structured approach to support HIV risk stratification and personalized PrEP recommendations in a clinician-aligned manner. However, this study was an offline proof-of-concept and did not directly evaluate patient interaction, PrEP uptake, stigma, adherence, or clinical outcomes. Prospective studies using larger and more representative real-world datasets are needed to assess implementation, generalizability, and impact on service engagement and PrEP initiation. Full article