Search Results (628)

Introduction: Racially and ethnically diverse women experience sub-optimal outcomes on both the HIV treatment and prevention cascade when compared to their white counterparts due to factors including racism, sexism, and xenophobia. While PrEP is a promising biomedical tool that can narrow this gap, similar trends are observed in PrEP utilization among culturally diverse women. We sought to explore the differences in diverse women’s preferences, challenges, and facilitators of PrEP uptake. Methods: From January 2022 to July 2023, thirty-one diverse women who could benefit from PrEP in Miami, FL, completed qualitative interviews with trained research staff to discuss their willingness, perceptions, and access to PrEP. Women also completed a demographic survey via Research Electronic Data Capture (REDCap). Semi-structured interviews were analyzed via NVivo using a hybrid inductive–deductive thematic analysis approach. Results: The majority of participants were Black (81%) and ethnically diverse (41.9% African American, 25.8% Hispanic/Latina, 16.1% Afro-Caribbean Black (non-Haitian) and 16.1% Haitian/Haitian American). Qualitative coding revealed numerous themes common across ethnic groups on (a) HIV transmission risk, reasons for prevention, and protective factors, (b) PrEP awareness, acceptability and willingness, (c) access to healthcare, and (d) relationships. Conclusions: To develop culturally sound interventions to increase PrEP uptake among women most impacted by HIV, an understanding of their perspectives and experiences is needed, as well as interventions/strategies informed by their insights. Full article

Background/Objectives: Anal squamous cell carcinoma (SCCA) is a rare Human Papillomavirus (HPV)-related disease in the general population but its incidence is increasing among high-risk populations, i.e., men who have sex with men (MSM), HIV+ patients and women with a history of cervical/vulvar dysplasia. The objectives of this study were: (i) to investigate the prevalence of high-risk (HR) and low-risk (LR) anal HPV infections in a high-risk cohort; (ii) to correlate specific HPV genotypes with cytological and histological outcomes; and (iii) to assess the impact of cumulative HPV genotype burden. Methods: A retrospective study (2017–2022) was conducted on 550 high-risk patients. All patients underwent anal Pap tests (ThinPrep, Hologic) and HPV genotyping (Anyplex II HPV 28, Seegene), according to our screening protocol. High-Resolution Anoscopy (HRA) was performed on 430 patients; biopsy was performed in all cases with suspicious lesions. Results: The overall HR-HPV prevalence was 57.3%. Men showed a significantly higher prevalence of HR-HPV (59.9% vs. 47.4%) and cytological abnormalities (35.8% vs. 20.2%) compared to women. Notably, HPV 16, 58 and 45 accounted for 79% of AIN2+ (Anal Intraepithelial Neoplasia of grade 2 or higher) lesions. A significant cumulative HPV genotype burden effect, i.e., the number of HPV genotypes detected, was observed: patients with ≥3 HR-HPV types showed an increased risk of AIN2+ lesions (aOR 34.72; 95% CI 4.07–296.10) and AIN1+ lesions (aOR 16.26; 95% CI 4.54–58.30) respectively. The presence of ≥3 LR-HPV genotypes in HR-HPV-positive patients is associated with an increased risk of AIN1 lesions. Conclusions: HPV 16, 58 and 45 positivity and the cumulative HPV genotype burden could represent new potential indicators for risk stratification in high-risk populations. Future larger-scale prospective studies are needed to validate these preliminary results. Full article

Background/Objectives: Multipurpose prevention technologies (MPTs) that combine protection against HIV and unintended pregnancy can improve women’s health outcomes by simplifying use and enhancing adherence. We developed a long-acting (LA) implant for the simultaneous and sustained delivery of the antiretroviral islatravir (ISL) and the contraceptive hormone etonogestrel (ENG). Methods: Using extruded poly-ε-caprolactone (PCL) tubing, reservoir-style implants were fabricated and evaluated in three configurations: (Group 1) a two-segment implant formed by joining separate ISL- and ENG-containing tubes; (Group 2) a single tube divided into two drug compartments by a heat-sealed PCL spacer; (Group 3) separate single-drug implants. In vitro release was assessed in phosphate-buffered saline at 37 °C, and safety and pharmacokinetic (PK) profiles were evaluated in New Zealand White rabbits (n = 4/group) over approximately 90 days. Results: The average ISL daily in vitro release rates for Groups 1, 2, and 3 were 29 ± 5 µg/day, 18 ± 5 µg/day, and 47 ± 8 µg/day, respectively, and ENG daily in vitro release rates were 39 ± 9 µg/day, 41 ± 8 µg/day, and 33 ± 7 µg/day. From day 28 through the end of the study, median (IQR) plasma concentrations were 0.22 (0.18–0.27) ng/mL, 0.28 (0.24–0.33) ng/mL, and 0.31 (0.28–0.33) ng/mL for ISL in Groups 1, 2, and 3, respectively, and 0.26 (0.21–0.31) ng/mL, 0.25 (0.16–0.47) ng/mL, and 0.30 (0.23–0.38) ng/mL for ENG in Groups 1, 2 and 3, respectively. Implants across all groups were well tolerated and demonstrated favorable local tolerability over the 90-day dosing period. Conclusions: Integration of multiple indications into a single platform capable of sustained release over an extended duration holds potential to address persistent gaps in women’s sexual and reproductive health needs. Full article

The success of HIV treatment is primarily measured through viral load suppression. However, little is known regarding the association between sexual union status and viral suppression among older adults. This study aimed to assess the association between sexual union status and HIV viral load suppression among adults aged 40 years and older living with HIV in rural Mpumalanga, South Africa. An observational analytical study design was followed, utilising data from the HIV After 40 study in Mpumalanga. The study focused on 4637 older men and women aged 40 years and above, living with HIV. Four nested unadjusted and adjusted binary logistic regression models assessed the association between sexual union status and HIV viral load suppression. All statistical analyses were done using SPSS Version 29.0; the significance level was set at p < 0.05. Viral suppression rates significantly differed by sexual union status (p = 0.003), with married/cohabiting participants showing lower suppression (40.6%) than single (45.1%) and divorced/widowed participants (45.9%). The fully adjusted logistic regression model showed a non-significant association between viral load suppression and sexual union status (p = 0.066); however, a significant association was found in the unadjusted (p = 0.020) and partially adjusted models. Having a primary education (p < 0.001), South African citizenship (p < 0.001), being aged ≥66 years (p < 0.001), and being female (p = 0.003) were independently associated with lower odds of being virally suppressed. Sexual union status was not significantly associated with viral suppression in the fully adjusted regression model. This underscores the need for gender-responsive, age-sensitive HIV treatment interventions in rural South Africa. Full article

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

The 2022–2024 mpox outbreak in Europe was dominated by MPXV Clade IIb and generally mild, but recent Clade I/Ib detections and early local transmission have changed preparedness needs. We performed a PRISMA-ScR scoping review of European mpox evidence from 2022 to 2026, supplemented by global and African data where regional evidence was sparse, covering clades, host determinants of severe disease, and antiviral efficacy and resistance, and ranking the evidence gaps. European Clade IIb surveillance showed very low mortality (10 deaths among 22,662 cases; case fatality 0.04%), contrasting with 3–11% estimates for Clade I/Ib in affected African settings, although comparisons are confounded by age, health-system access and comorbidity. Severe European disease was driven mainly by immune compromise: non-HIV immunosuppression, uncontrolled HIV and CD4 counts < 200 cells/µL were the most consistent markers, while women were a small minority of cases, with higher hospitalisation risk, especially in pregnancy. Tecovirimat failed to improve outcomes in four randomised trials, F13L-associated resistance was reported in advanced HIV, and its European mpox use was subsequently restricted. The evidence base is strongest for mild Clade IIb infection in immunocompetent adults and weakest for the groups most likely to need treatment. Preparedness should prioritise harmonised genomic surveillance, severity-stratified cohort data and adaptive therapeutic trials enrolling immunocompromised, paediatric, pregnant and older patients. Full article

In August 2024, the Africa Centres for Disease Control and Prevention (Africa CDC) declared mpox a Public Health Emergency of Continental Security (PHECS), and the World Health Organization (WHO) followed with a second Public Health Emergency of International Concern (PHEIC), in response to the rapid expansion of clade Ib monkeypox virus (MPXV) across eastern Democratic Republic of the Congo (DRC) and neighboring countries. Both declarations have since been lifted (September 2025 and January 2026), yet clade Ib transmission and severe outcomes in pregnant women and children persist. We argue that closing these emergency mechanisms marks not the end of the epidemic but the start of a harder phase: sustaining surveillance, care, and research amid shrinking donor support, including the dissolution of the United States Agency for International Development (USAID). We contend that integrating mpox into existing HIV, sexually transmitted infection (STI), and reproductive health platforms is the most realistic route to durable routine care, while pregnancy, paediatric disease, severe cases, and zoonotic spillover still need dedicated pathways. Sustainable management ultimately depends on domesticated financing, stronger institutions, genuine community engagement, and action on the ecological drivers of spillover. Full article

The cervicovaginal microflora plays a vital role in maintaining vaginal health, and disturbances can predispose women to opportunistic infections and sexually transmitted infections (STIs). This study examined the prevalence and associated factors of Candida species, bacterial vaginosis (BV), and their co-occurrence among women in the Eastern Cape province of South Africa. A cross-sectional design was employed, enrolling 325 women aged 18–60 years from a health facility in the Eastern Cape, South Africa. Candida species were identified in cervical specimens using a Seegene Allplex™ Candidiasis Assay. BV status and BV-associated bacteria were identified via Seegene Allplex™ Bacterial Vaginosis Plus assays. Overall, 64.51% of participants were HIV-positive, 15.74% tested positive for Candida species, 52.85% tested positive for BV, and 7.10% were positive for BV–Candida species co-occurrence. The highest prevalence of Candida species (23.60%; R² = 0.913; p = 0.015), BV (85.39%; R² = 0.931; p = 0.003), and Candida–BV co-occurrence (7.10%; R² = 0.903, p = 0.041) was observed in the 18–29 age group and declined significantly with age. Women with four to six lifetime sexual partners had higher odds of testing positive for Candida species (AOR: 2.42, 95% CI: 1.21–4.82, p = 0.012). Currently presenting with STI symptoms (AOR: 4.66; 95% CI: 1.29–16.87; p = 0.019), increased (four to six) lifetime sexual partners (AOR: 5.58; 95% CI: 1.16–26.82; p = 0.032), and being HPV-positive (AOR: 7.28; 95% CI: 1.17–45.26; p = 0.033) were independent predictors of Candida–BV co-occurrences. In this current study, having multiple lifetime sexual partners was independently associated with Candida species positivity, while current STI symptoms, HPV infection, and having four to six lifetime sexual partners significantly increased the likelihood of Candida–BV co-occurrence, highlighting the role of sexual behaviour in the vaginal microbial profile. This underscores the need for continued surveillance and longitudinal investigation. Longitudinal studies to further investigate these associations are warranted. Full article

Background: Sexually transmitted infections (STIs) remain a major global health concern, with over one million new curable cases reported daily and limited long-term treatment options. Additionally, there are limited treatment options for women with bacterial vaginosis (BV), a dysbiotic condition predisposing them to STIs. Computationally designed human-milk-inspired antimicrobial peptides (AMPs) are promising candidates for novel antiviral and antibacterial therapies. This study evaluated the cervicovaginal mucosal safety and antiviral activity of three human-milk-inspired AMPs (MAT-006, UCD-MAT-001, and UCD-MAT-002) previously shown to exhibit antimicrobial activity against BV-causing pathogens. Methods: AMP cytotoxicity and inflammatory responses were assessed in relevant genital tract cell lines and cervicovaginal tissues in vitro. AMP anti-HIV-1 and anti-HSV-2 activities were characterized in female genital tract cell lines, TZM-bl cells and HEC-1-A cells, respectively, and in time-of-addition (pre-, co-, and post-HIV-1 challenge; and post-HSV-2 challenge) experiments. The impact of seminal plasma on AMPs’ activity was also evaluated. Results: At the concentrations tested, all three AMPs showed minimal cytotoxicity and no pro-inflammatory responses in cellular and ectocervical tissue explant models. In both co- and post-exposure models, all three AMPs inhibited HIV-1 and HSV-2 replication with IC₅₀ values ranging from 0.78 to 7.72 mg/mL. MAT-006 further showed pre-exposure anti-HIV-1 activity after 6 h (IC₅₀ = 1.07 ± 0.515 mg/mL) and 24 h (IC₅₀ = 0.69 ± 0.152 mg/mL) of incubation. Seminal plasma did not significantly impair MAT-006 and UCD-MAT-001 antiviral activity under experimental conditions. Conclusions: These findings demonstrate the antiviral activity of human-milk-inspired AMPs against HIV-1 and HSV-2 at concentrations that are safe to the cervicovaginal mucosa in vitro, warranting further preclinical evaluation as microbicide candidates with dual antibacterial and antiviral properties. Full article

Background: Despite substantial progress in prevention of mother-to-child transmission (PMTCT) programmes and widespread access to antiretroviral therapy (ART), maternal HIV infection remains associated with adverse maternal and neonatal outcomes in many high HIV-burden settings. This study compared maternal and perinatal outcomes among women living with HIV and HIV-negative women delivering at a tertiary referral hospital in the Eastern Cape Province, South Africa. Methods: A retrospective comparative cohort study was conducted using routinely collected clinical records of 600 women (300 HIV-positive and 300 HIV-negative) who delivered at Nelson Mandela Academic Hospital between January and December 2019. Maternal, obstetric, and neonatal characteristics were compared according to maternal HIV status. Associations were evaluated using chi-square tests, multivariable logistic regression, Kaplan–Meier survival analysis, and Cox proportional hazards regression models. Results: Women living with HIV were older, had higher parity, and were more likely to have documented anaemia and delayed antenatal care attendance than HIV-negative women. HIV-exposed pregnancies had higher frequencies of preterm birth (26.3% vs. 20.3%) and low birthweight (LBW). In adjusted analyses, maternal HIV-positive status remained independently associated with increased odds of LBW (AOR = 1.88; 95% CI: 1.18–3.00; p = 0.008). LBW was independently associated with neonatal intensive care unit (NICU) admission (AOR = 2.45; 95% CI: 1.46–4.11; p < 0.001) and an increased hazard of in-hospital neonatal mortality (HR = 2.40; 95% CI: 1.55–3.70; p < 0.001). Maternal HIV-positive status (HR = 1.75; 95% CI: 1.12–2.71; p = 0.015) and unsuppressed maternal viral load (HR = 2.05; 95% CI: 1.13–3.73; p = 0.018) were also associated with increased hazards of neonatal mortality. However, these findings should be interpreted cautiously, given the limited number of neonatal mortality events (n = 32). Among HIV-exposed infants with documented HIV test results, the observed mother-to-child transmission rate was 1.7%. However, incomplete infant follow-up and HIV testing data limited the precision of this estimate. Among women living with HIV, birthweight did not differ significantly according to the timing of ART initiation. Conclusions: In this tertiary referral hospital cohort, maternal HIV infection was associated with adverse maternal and neonatal outcomes, particularly anemia, preterm birth, and LBW. LBW emerged as an important predictor of neonatal morbidity and mortality. These findings support continued efforts to strengthen integrated HIV and maternal healthcare services, promote early antenatal care engagement, maintain maternal viral suppression, and improve monitoring and care of high-risk neonates. Given the retrospective observational design, incomplete follow-up for selected outcomes, limited numbers of neonatal mortality events, and the tertiary referral setting, the findings should be interpreted as associations rather than evidence of causal relationships and may not be generalizable to lower-level healthcare facilities or community-based obstetric populations. Full article

Background: Human papillomavirus (HPV) continues to cause an estimated 4000 preventable cancer deaths each year in the United States. Given the prevalence of HPV-related disease and suboptimal vaccination rates, this study explores perceptions of HPV vaccination among HIV-negative females and females living with HIV in Tennessee. Methods: This prospective, observational qualitative study consisted of narrative interviews which were conducted with HIV-negative and HIV-positive participants, focusing on their perceptions of HPV and its vaccine. Interviews were conducted by phone, and the verbatim transcripts were inductively coded by three researchers. The inductive codes were then grouped into categories based on similarities which facilitated the emergence of themes. Results: A total of 40 participants were interviewed between July 2024 and December 2024. Narrative analysis revealed three themes: (1) “I had never heard of it until I saw the flier.” Gaps in Understanding of HPV and Its Health Implications, (2) Navigating Adolescent Health Decisions and Emotional Influence, and (3) Barriers to Uptake—Skepticism, Trust, and the Need for Tailored Information. Two subthemes emerged: Cohort-Specific Skepticism, and Parental Influence and Communication Gaps. Conclusions: This study revealed significant gaps in HPV knowledge and vaccination uptake among HIV-negative women and women living with HIV in Tennessee. Provider communication was key to vaccine decisions, but clear recommendations were often missed in clinical encounters. Full article

Colorism is a skin-tone stratification system that privileges proximity to Eurocentric features and disadvantages darker skin tones and Afrocentric features. Although colorism is increasingly recognized as a gendered social determinant of health, its role in shaping sexual health among Black and Brown girls and women remains understudied. This rapid review synthesized peer-reviewed empirical evidence on the relationship between colorism, skin tone, and sexual health outcomes among girls and women. Searches were conducted in PsycINFO and PubMed between April and May 2026. After removing duplicates, 114 unique records were screened in Covidence, yielding eight eligible studies. Five studies were quantitative, two were qualitative, and one was mixed methods. The included studies were synthesized narratively due to heterogeneity in study design, measurement, and outcomes. Findings suggest that colorism is associated with sexual risk behaviors, sexual agency and desirability, sexual development, and HIV-related sexual functioning. Across studies, colorism appeared to shape sexual health through three interrelated pathways: internalization and self-esteem, colorist desirability hierarchies that influence sexual agency and relationship dynamics, and differential sexualization experiences that shape girls’ sexual development and vulnerability across the life course. One study also highlighted parental support as a potential protective factor. Collectively, the findings position colorism as a potentially important social determinant of sexual health and underscore the need to integrate colorism into future sexual health research, prevention, and intervention frameworks. 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

Introduction: Long-term real-world data on bictegravir/emtricitabine/tenofovir alafenamide (BIC-STR), particularly in key subgroups, remain limited. The primary endpoints of the study were changes in CD4+ cell count and viral load after BIC-STR introduction. The secondary endpoints were the impact of the therapy on metabolic profile and body mass index. Methods: Retrospective observational cohort study including people living with HIV (PLWH) receiving BIC-STR with more than 6 months of follow-up at a tertiary Infectious Diseases clinic (Perugia, Italy). Immunovirological outcomes (HIV-RNA, CD4 count, CD4/CD8 ratio) and metabolic parameters were assessed up to 48 months, with subgroup analyses (treatment-naïve/experienced, >60 years, women, and foreign nationals). Results: 425 patients were included (median follow-up 37.7 months, IQR, 22.1–55.8 months). Most were treatment-experienced (367/425, 86.4%) and viral suppression improved after switching, reaching 90.7% with HIV-RNA < 50 cp/mL; HIV-RNA declined mainly within the first 6 months and then remained stable. CD4 count and CD4/CD8 ratio increased significantly over time, with similar immunovirological trends in older patients (>60 years; 138/425, 32.3%), women (94/425, 22.1%), and foreign nationals (143/425, 33.7%). In treatment-experienced patients not on statins, HDL and LDL did not change significantly, while triglycerides decreased (median from 110 mg/dL, IQR 78.0–164.0, to 103 mg/dL, IQR 70.3–147.8; p = 0.007). In ART-naïve patients (58/425, 13.6%), HDL (median from 41, IQR, 33.0–47.0 to 47, IQR 39.0–54.7, p = 0.0003) and BMI (median from 23.2, IQR 21.7–26.3 to 25.7, IQR 23.4–29.0, p < 0.0001) increased, whereas other lipid changes were not significant. BMI increased only in underweight and normal-weight naïve patients, not in overweight/obese individuals. Conclusions: BIC-STR showed sustained effectiveness, immunological benefit, and favourable metabolic outcomes in routine practice, including, PLWH > 60 years, women, and foreign nationals subgroups. Full article