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INTRODUCTION: Four counties within the Atlanta, Georgia 20-county eligible metropolitan area (EMA) are currently prioritized by the US "Ending the HIV Epidemic" (EHE) initiative which aims for a 90% reduction in HIV incidence by 2030. Disparities driving Atlanta's HIV epidemic warrant an examination of local service availability, unmet needs and organizational capacity to reach EHE targets. We conducted a mixed-methods evaluation of the Atlanta EMA to examine geographic HIV epidemiology and distribution of services, service needs and organization infrastructure for each pillar of the EHE initiative. METHODS: We collected 2021 county-level data (during June 2022), from multiple sources including: AIDSVu (HIV prevalence and new diagnoses), the Centers for Disease Control and Prevention web-based tools (HIV testing and pre-exposure prophylaxis [PrEP] locations) and the Georgia Department of Public Health (HIV testing, PrEP screenings, viral suppression and partner service interviews). We additionally distributed an online survey to key local stakeholders working at major HIV care agencies across the EMA to assess the availability of services, unmet needs and organization infrastructure (June-December 2022). The Organizational Readiness for Implementing Change questionnaire assessed the organization climate for services in need of scale-up or implementation. RESULTS: We found racial/ethnic and geographic disparities in HIV disease burden and service availability across the EMA-particularly for HIV testing and PrEP in the EMA's southern counties. Five counties not currently prioritized by EHE (Clayton, Douglas, Henry, Newton and Rockdale) accounted for 16% of the EMA's new diagnoses, but <9% of its 177 testing sites and <7% of its 130 PrEP sites. Survey respondents (N = 48; 42% health agency managers/directors) reported high unmet need for HIV self-testing kits, mobile clinic testing, HIV case management, peer outreach and navigation, integrated care, housing support and transportation services. Respondents highlighted insufficient existing staffing and infrastructure to facilitate the necessary expansion of services, and the need to reduce inequities and address intersectional stigma. CONCLUSIONS: Service delivery across all EHE pillars must substantially expand to reach national goals and address HIV disparities in metro Atlanta. High-resolution geographic data on HIV epidemiology and service delivery with community input can provide targeted guidance to support local EHE efforts.
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Epidemias , Infecções por HIV , Humanos , Georgia/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Epidemias/prevenção & controle , Masculino , Prevalência , Profilaxia Pré-Exposição/métodos , Feminino , Acessibilidade aos Serviços de SaúdeRESUMO
Although suicide rates are stable or decreasing among White communities, rates are increasing among Black communities, a trend that appears to be disproportionately affecting Black lesbian, gay, bisexual, and queer (LGBQ) people. To understand the structural drivers and mechanisms of these trends, we examined associations between U.S. state-level racist and heterosexist criminal legal policies and policing, discrimination, and suicidality among White and Black, heterosexual and LGBQ, communities. We recruited 5,064 participants in 2021 using online census-driven quota sampling. Structural equation modeling estimated associations from objective indicators of racist and heterosexist criminal legal policies to self-reported police stops, discrimination, and suicidal ideation and behavior. For White heterosexual participants, racist (ß = -.22, SE = 0.03, p < .001) and heterosexist (ß = -.26, SE = 0.03, p < .001) policies were negatively associated with police stops. For White LGBQ participants, racist and heterosexist policies were not significantly associated with police stops. For Black heterosexual participants, racist (ß = .30, SE = 0.11, p = .005), but not heterosexist, policies were positively associated with police stops. For Black LGBQ participants, racist (ß = .57, SE = 0.08, p < .001) and heterosexist (ß = .65, SE = 0.09, p < .001) policies were positively associated with police stops which, in turn, were positively associated with discrimination and suicidal ideation and behavior. Results provide evidence that racist and heterosexist state policies are linked to policing and interpersonal drivers of suicide inequities and suggest that repealing/preventing oppressive policies should be a suicide prevention imperative. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Polícia , Racismo , Minorias Sexuais e de Gênero , Ideação Suicida , População Branca , Humanos , Masculino , Estados Unidos/epidemiologia , Feminino , População Branca/psicologia , População Branca/estatística & dados numéricos , Adulto , Minorias Sexuais e de Gênero/psicologia , Racismo/psicologia , Polícia/psicologia , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Pessoa de Meia-Idade , Adulto Jovem , Política Pública/legislação & jurisprudênciaRESUMO
CD4 T follicular helper cells (Tfh) are essential for establishing serological memory and have distinct helper attributes that impact both the quantity and quality of the antibody response. Insights into Tfh subsets that promote antibody persistence and functional capacity can critically inform vaccine design. Based on the Tfh profiles evoked by the live attenuated measles virus vaccine, renowned for its ability to establish durable humoral immunity, we investigated the potential of a Tfh1/17 recall response during the boost phase to enhance persistence of HIV-1 Envelope (Env) antibodies in rhesus macaques. Using a DNA-prime encoding gp160 antigen and Tfh polarizing cytokines (interferon protein-10 (IP-10) and interleukin-6 (IL-6)), followed by a gp140 protein boost formulated in a cationic liposome-based adjuvant (CAF01), we successfully generated germinal center (GC) Tfh1/17 cells. In contrast, a similar DNA-prime (including IP-10) followed by gp140 formulated with monophosphoryl lipid A (MPLA) +QS-21 adjuvant predominantly induced GC Tfh1 cells. While the generation of GC Tfh1/17 cells with CAF01 and GC Tfh1 cells with MPLA +QS-21 induced comparable peak Env antibodies, the latter group demonstrated significantly greater antibody concentrations at week 8 after final immunization which persisted up to 30 weeks (gp140 IgG ng/ml- MPLA; 5500; CAF01, 2155; p<0.05). Notably, interferon γ+Env-specific Tfh responses were consistently higher with gp140 in MPLA +QS-21 and positively correlated with Env antibody persistence. These findings suggest that vaccine platforms maximizing GC Tfh1 induction promote persistent Env antibodies, important for protective immunity against HIV.
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Vacinas contra a AIDS , HIV-1 , Animais , Macaca mulatta , Quimiocina CXCL10 , Anticorpos Anti-HIV , DNARESUMO
Route of immunization can markedly influence the quality of immune response. Here, we show that intradermal (ID) but not intramuscular (IM) modified vaccinia Ankara (MVA) vaccinations provide protection from acquisition of intravaginal tier2 simian-human immunodeficiency virus (SHIV) challenges in female macaques. Both routes of vaccination induce comparable levels of serum IgG with neutralizing and non-neutralizing activities. The protection in MVA-ID group correlates positively with serum neutralizing and antibody-dependent phagocytic activities, and envelope-specific vaginal IgA; while the limited protection in MVA-IM group correlates only with serum neutralizing activity. MVA-ID immunizations induce greater germinal center Tfh and B cell responses, reduced the ratio of Th1 to Tfh cells in blood and showed lower activation of intermediate monocytes and inflammasome compared to MVA-IM immunizations. This lower innate activation correlates negatively with induction of Tfh responses. These data demonstrate that the MVA-ID vaccinations protect against intravaginal SHIV challenges by modulating the innate and T helper responses.
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Síndrome de Imunodeficiência Adquirida dos Símios , Vírus da Imunodeficiência Símia , Vacínia , Animais , Humanos , Feminino , Síndrome de Imunodeficiência Adquirida dos Símios/prevenção & controle , Vacínia/prevenção & controle , Macaca mulatta , Vaccinia virus , Vacinação , HIV , Anticorpos AntiviraisRESUMO
CD4 T follicular helper cells (Tfh) are essential for establishing serological memory and have distinct helper attributes that impact both the quantity and quality of the antibody response. Insights into Tfh subsets that promote antibody persistence and functional capacity can critically inform vaccine design. Based on the Tfh profiles evoked by the live attenuated measles virus vaccine, renowned for its ability to establish durable humoral immunity, we investigated the potential of a Tfh1/17 recall response during the boost phase to enhance persistence of HIV-1 Envelope (Env) antibodies in rhesus macaques. Using a DNA-prime encoding gp160 antigen and Tfh polarizing cytokines (interferon protein-10 (IP-10) and interleukin-6 (IL-6)), followed by a gp140 protein boost formulated in a cationic liposome-based adjuvant (CAF01), we successfully generated germinal center (GC) Tfh1/17 cells. In contrast, a similar DNA-prime (including IP-10) followed by gp140 formulated with monophosphoryl lipid A (MPLA)+QS-21 adjuvant predominantly induced GC Tfh1 cells. While the generation of GC Tfh1/17 cells with CAF01 and GC Tfh1 cells with MPLA+QS-21 induced comparable peak Env antibodies, the latter group demonstrated significantly greater antibody concentrations at week 8 after final immunization which persisted up to 30 weeks (gp140 IgG ng/ml- MPLA; 5500; CAF01, 2155; p <0.05). Notably, interferon γ+ Env-specific Tfh responses were consistently higher with gp140 in MPLA+QS-21 and positively correlated with Env antibody persistence. These findings suggest that vaccine platforms maximizing GC Tfh1 induction promote persistent Env antibodies, important for protective immunity against HIV.
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OBJECTIVES: This uncontrolled pilot study examined the feasibility, acceptability, and preliminary HIV and psychological health effects of iTHRIVE 365, a multicomponent intervention designed by and for Black same gender loving men (SGLM) to promote: health knowledge and motivation, Black SGLM social support, affirming health care, and housing and other economic resources. DESIGN METHODS: We conducted a 14-day daily diary study with 32 Black SGLM living with HIV connected to THRIVE SS in Atlanta, GA. Daily surveys assessed intervention engagement, antiretroviral medication (ART) use, depressive symptoms, anxiety symptoms, and emotion regulation difficulties. App paradata (ie, process data detailing app usage) assessed amount of intervention engagement via page access. Participants began receiving access to the intervention on day 7. After the 14-day daily diary period, participants responded to follow-up items on the user-friendliness, usefulness, helpfulness, and whether they would recommend iTHRIVE 365 to others. Chi-square analyses examined associations between intervention engagement and ART use, and dynamic structural equation modelling assessed longitudinal associations from intervention engagement to next-day psychological health. This intervention trial is registered on ClinicalTrials.gov (NCT05376397). RESULTS: On average, participants engaged with iTHRIVE 365 over once every other day and accessed intervention pages 4.65 times per day. Among participants who engaged with the intervention, 78% reported it was helpful to extremely helpful, 83% reported it was moderately to extremely useful, and 88% reported it was user-friendly and they would recommend it to others. On intervention engagement days, participants had higher odds of ART use, χ 2 (1) = 4.09, P = 0.04, than intervention nonengagement days. On days after intervention engagement, participants showed non-null decreases in depressive symptoms (τ = -0.14; 95% CI : = [-0.23, -0.05]) and emotion regulation difficulties (τ = -0.16; 95% CI : = [-0.24, -0.02]). CONCLUSIONS: Findings suggest iTHRIVE 365 is feasible, acceptable, and positively affects daily ART use, depressive symptoms, and emotion regulation difficulties.
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Infecções por HIV , Humanos , Masculino , Antirretrovirais/uso terapêutico , Estudos de Viabilidade , Infecções por HIV/tratamento farmacológico , Motivação , Projetos PilotoRESUMO
The Counter Narrative Project (CNP) was founded to shift narratives and shatter stereotypes about Black gay, bisexual, and queer men to advance social justice. This paper describes three programs CNP implemented that were organized around collective memory as a strategy to respond to collective trauma experienced by this community.
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Negro ou Afro-Americano , Minorias Sexuais e de Gênero , Justiça Social , Humanos , Masculino , Negro ou Afro-Americano/psicologia , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/etnologia , Minorias Sexuais e de Gênero/psicologiaRESUMO
Although health inequities among Black same gender loving men (SGLM) are well documented (e.g., chronic psychological disorders, HIV, suicide), there are few accessible, culturally affirming, and community-led interventions designed to reduce these inequities. The present manuscript describes the process through which we developed iTHRIVE 365, a multicomponent health-promotion intervention designed by Black SGLM for Black SGLM. We utilized a community-based participatory research approach (CBPR) that included collaboration between THRIVE SS, a Black SGLM-run community-based organization, and a multisectoral team of public health, research, and digital design professionals to develop the intervention. A five-phase development process included four phases of focus groups and a technical pilot to assess community priorities and incorporate input on each feature of the intervention. Directed content analysis indicated that participants wanted a multicomponent and technology-mediated intervention that promotes health knowledge and motivation, Black SGLM social support, access to affirming healthcare, and housing and economic resources. iTHRIVE 365 combines multilevel and culturally affirming intervention features to combat the effects of oppression and ultimately promote Black SGLM's biopsychosocial health.
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BACKGROUND: HIV-focused organizations, care providers and research programs often hire Black gay, bisexual and other men who have sex with men (GBMSM) in their efforts to reach highly affected communities. Due to their unique social position within and outside of organizations, Black GBMSM are ideally situated to contribute to HIV care and prevention programming targeting their own communities, but may also be at risk for stress and burnout in these settings. Despite this critical role for Black GBMSM in efforts to end the epidemic, little is known about subjective experiences of Black GBMSM who work in the HIV field. METHODS: We conducted qualitative interviews with 19 Black GBMSM who were identified as key informants. All were working in community-based organizations, clinical or academic settings in the area of HIV prevention and treatment in Atlanta, Georgia. We used a thematic analysis approach to identify salient themes with respect to the workplace experiences of Black GBMSM as well as the role of their identities in their work in the field. RESULTS: Participants discussed: (1) Shared experiences and growth; (2) Work-related stressors; (3) Worker burnout; and (4) Commitment to continue working in the HIV field. On the whole, Black GBMSM derived meaning from their work, and found their intersectional identities to be a strength in fulfilling job duties. At the same time, Black GBMSM described multiple stresses faced as they balanced their personal and professional connections to this work, while also dealing with their own challenges related to discrimination, socioeconomic status, and health. Participants repeatedly described sacrificing their own well-being for the greater good of their communities, highlighting contributors to burnout within and outside of the workplace. CONCLUSIONS: Our participants derived meaning from their work in the HIV field and were affirmed by professional interactions with other Black GBMSM. At the same time, they also faced work-related and other psychosocial stressors that predisposed them to frustration and burnout. To promote workplace equity and wellness for Black GBMSM, we share recommendations for HIV-focused organizations that employ and serve men in this demographic.
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Bissexualidade , Esgotamento Psicológico , Infecções por HIV , Homossexualidade Masculina , Síndrome da Imunodeficiência Adquirida , Bissexualidade/psicologia , Infecções por HIV/tratamento farmacológico , Homossexualidade Masculina/psicologia , Humanos , Masculino , Pesquisa Qualitativa , Comportamento Sexual , Minorias Sexuais e de GêneroRESUMO
Researchers are increasingly recognizing the importance of studying and addressing intersectional stigma within the field of HIV. Yet, researchers have, arguably, struggled to operationalize intersectional stigma. To ensure that future research and methodological innovation is guided by frameworks from which this area of inquiry has arisen, we propose a series of core elements for future HIV-related intersectional stigma research. These core elements include multidimensional, multilevel, multidirectional, and action-oriented methods that sharpen focus on, and aim to transform, interlocking and reinforcing systems of oppression. We further identify opportunities for advancing HIV-related intersectional stigma research, including reducing barriers to and strengthening investments in resources, building capacity to engage in research and implementation of interventions, and creating meaningful pathways for HIV-related intersectional stigma research to produce structural change. Ultimately, the expected payoff for incorporating these core elements is a body of HIV-related intersectional stigma research that is both better aligned with the transformative potential of intersectionality and better positioned to achieve the goals of Ending the HIV Epidemic in the United States and globally. (Am J Public Health. 2022;112(S4):S413-S419. https://doi.org/10.2105/AJPH.2021.306710).
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Infecções por HIV , Transtornos Mentais , Infecções por HIV/epidemiologia , Humanos , Estigma Social , Estados UnidosRESUMO
AbstractPurpose: We extended the focus on body image research beyond cisgender, White sexual minority men (SMM) by describing body image concerns among Black and Latinx SMM and transgender/gender nonconforming (TGNC) adults and by examining protective effects of community connection. Methods: From 2016 to 2020, 447 Black and Latinx SMM (94%) and TGNC (6%) individuals in Los Angeles provided data semiannually. Participant endorsement of any body image concerns was determined by five body image codes (weight, fitness, appearance, body area dissatisfaction, and general body image) applied to participants' open-ended lists of health and body concerns. Fixed effects multivariable logistic regression was performed to examine the association between gay and racial/ethnic community connection and odds of any body image concerns, accounting for multiple records per person. An interaction term between gay and racial/ethnic community connection approximated the protective effect of connection to multiple, intersecting communities. Results: The majority of participants (51%) reported a body image concern, most commonly weight concerns, at least once across three years. Body image concerns were more common among Latinx participants (χ2 = 17.79, p < 0.001) and participants experiencing food insecurity (χ2 = 4.11, p = 0.04) and unmet basic financial needs (χ2 = 10.56, p = 0.001). Gay community connection was protective against body image concerns, but only for participants who had high racial/ethnic community connection (adjusted odds ratio = 0.87, p = 0.05). Conclusion: Body image concerns were notable, especially among those with low community connection and higher socioeconomic burden. These findings suggest that building connections within SMM/TGNC and racial/ethnic communities may aid in building a support network that buffers against body image concerns.
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Minorias Sexuais e de Gênero , Pessoas Transgênero , Imagem Corporal , Identidade de Gênero , Humanos , Masculino , Razão de Chances , Adulto JovemRESUMO
Ongoing SARS-CoV-2 vaccine development is focused on identifying stable, cost-effective, and accessible candidates for global use, specifically in low and middle-income countries. Here, we report the efficacy of a rapidly scalable, novel yeast expressed SARS-CoV-2 specific receptor-binding domain (RBD) based vaccine in rhesus macaques. We formulated the RBD immunogen in alum, a licensed and an emerging alum adsorbed TLR-7/8 targeted, 3M-052-alum adjuvants. The RBD+3M-052-alum adjuvanted vaccine promoted better RBD binding and effector antibodies, higher CoV-2 neutralizing antibodies, improved Th1 biased CD4+T cell reactions, and increased CD8+ T cell responses when compared to the alum-alone adjuvanted vaccine. RBD+3M-052-alum induced a significant reduction of SARS-CoV-2 virus in respiratory tract upon challenge, accompanied by reduced lung inflammation when compared with unvaccinated controls. Anti-RBD antibody responses in vaccinated animals inversely correlated with viral load in nasal secretions and BAL. RBD+3M-052-alum blocked a post SARS-CoV-2 challenge increase in CD14+CD16++ intermediate blood monocytes, and Fractalkine, MCP-1, and TRAIL in the plasma. Decreased plasma analytes and intermediate monocyte frequencies correlated with reduced nasal and BAL viral loads. Lastly, RBD-specific plasma cells accumulated in the draining lymph nodes and not in the bone marrow, contrary to previous findings. Together, these data show that a yeast expressed, RBD-based vaccine+3M-052-alum provides robust immune responses and protection against SARS-CoV-2, making it a strong and scalable vaccine candidate.
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Adjuvantes Imunológicos/administração & dosagem , Compostos de Alúmen/administração & dosagem , Vacinas contra COVID-19 , COVID-19/prevenção & controle , SARS-CoV-2 , Saccharomycetales/genética , Glicoproteína da Espícula de Coronavírus/genética , Administração por Inalação , Administração Intranasal , Animais , Anticorpos Neutralizantes/imunologia , Anticorpos Antivirais/imunologia , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD8-Positivos/imunologia , COVID-19/imunologia , COVID-19/patologia , COVID-19/virologia , Linhagem Celular , Citocinas/imunologia , Humanos , Imunoglobulina G/imunologia , Pulmão/patologia , Macaca mulatta , Masculino , Ligação Proteica , Domínios Proteicos , Glicoproteína da Espícula de Coronavírus/imunologia , Carga ViralRESUMO
BACKGROUND: People who inject drugs (PWID) lag behind other key populations in HIV care continuum outcomes. The impacts of criminal justice reform and increasing drug treatment access on HIV have been underexplored. METHODS: We developed agent-based models (ABM) of sexual partnerships among PWID and non-PWID, and injection equipment-sharing partnerships among PWID in five US cities (Baltimore, Boston, Miami, New York City, San Francisco) over 3 years. The first set of ABM projected changes in partnership discordance among PWID as a function of decreasing ZIP code-level incarceration rates. The second set projected discordance as a function of increasing ZIP code-level drug treatment access. ABM were parameterized and validated overall, and by city and PWID race/ethnicity (Black, Latino, White) using National HIV Behavioral Surveillance data, administrative ZIP code-level data, surveillance reports and prior literature. Informed by research on prisoner release and community-level HIV prevalence, reductions in incarceration rates were fixed at 5% and 30% and respectively projected to increase ZIP code-level HIV prevalence by 2% and 12%. Increases in drug treatment access were fixed at 30% and 58%. RESULTS: In each city, a 30% reduction in ZIP code-level incarceration rates and 12% increase in ZIP code-level HIV prevalence significantly increased sero-discordance among at least one racial/ethnic group of PWID by 1-3 percentage points. A 5% reduction in incarceration rates, and 30% and 58% increases in drug treatment access, led to isolated significant changes in sero-discordance among Black and White PWID that were less than 1 percentage point. CONCLUSION: Reductions in incarceration rates may lead to short-term increases in sero-discordant partnerships among some PWID by increasing community-level HIV prevalence. Efforts to increase HIV testing, engagement in care and community reintegration post release, should be strengthened in the wake of incarceration reform. Additional research should confirm these findings and explore the lack of widespread impacts of drug treatment in this study.
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Infecções por HIV , Preparações Farmacêuticas , Abuso de Substâncias por Via Intravenosa , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Assunção de Riscos , Comportamento Sexual , Abuso de Substâncias por Via Intravenosa/epidemiologia , Análise de SistemasRESUMO
CD4 T follicular helper (Tfh) cells are important for the generation of durable and specific humoral protection against viral infections. The degree to which SARS-CoV-2 infection generates Tfh cells and stimulates the germinal center (GC) response is an important question as we investigate vaccine induced immunity against COVID-19. Here, we report that SARS-CoV-2 infection in rhesus macaques, either infused with convalescent plasma, normal plasma, or receiving no infusion, resulted in transient accumulation of pro-inflammatory monocytes and proliferating Tfh cells with a Th1 profile in peripheral blood. CD4 helper cell responses skewed predominantly toward a Th1 response in blood, lung, and lymph nodes. SARS-CoV-2 Infection induced GC Tfh cells specific for the SARS-CoV-2 spike and nucleocapsid proteins, and a corresponding early appearance of antiviral serum IgG antibodies. Collectively, the data show induction of GC responses in a rhesus model of mild COVID-19.
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COVID-19/imunologia , Centro Germinativo/imunologia , SARS-CoV-2/imunologia , Células T Auxiliares Foliculares/imunologia , Células Th1/imunologia , Animais , Anticorpos Antivirais/sangue , COVID-19/terapia , Linhagem Celular , Chlorocebus aethiops , Proteínas do Nucleocapsídeo de Coronavírus/imunologia , Modelos Animais de Doenças , Feminino , Humanos , Imunidade Humoral/imunologia , Imunização Passiva , Imunogenicidade da Vacina/imunologia , Imunoglobulina G/sangue , Macaca mulatta , Masculino , Fosfoproteínas/imunologia , SARS-CoV-2/isolamento & purificação , Glicoproteína da Espícula de Coronavírus/imunologia , Células Vero , Soroterapia para COVID-19RESUMO
New modalities of Pre-exposure Prophylaxis (PrEP) such as long-acting injectable PrEP (LAI-PrEP) promise increased prevention of HIV transmission; however, similar biomedical interventions have not been met with universal adoption by healthcare providers or populations most affected by HIV. This qualitative study explores healthcare provider considerations for the rollout of LAI-PrEP. Eleven key-informant in-depth interviews were conducted with clinicians who prescribe daily oral PrEP. Participants reviewed a currently proposed LAI regimen and were asked to reflect on its implications for their clinical practice. Interviews were transcribed verbatim and thematically coded, with results organized using the Consolidated Framework for Implementation Research (CFIR). All participants expressed interest in prescribing LAI-PrEP and anticipated that at least some patients would be interested. Participants identified characteristics of the intervention, inner intervention setting, and outer intervention setting that will be influential in bringing LAI-PrEP to scale. Clinicians in the South have unique insights into the challenges of and opportunities for successful rollout of future PrEP regimens. Bringing these insights into a CFIR framework highlights the nuances surrounding LAI-PrEP, including structural concerns such as cost barriers and access to in-person healthcare services. It is critical to address these challenges to ensure successful implementation of new PrEP formulations.
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Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Fármacos Anti-HIV/uso terapêutico , Georgia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Pessoal de Saúde , HumanosRESUMO
CD4 T follicular helper (T fh ) cells are important for the generation of long-lasting and specific humoral protection against viral infections. The degree to which SARS-CoV-2 infection generates T fh cells and stimulates the germinal center response is an important question as we investigate vaccine options for the current pandemic. Here we report that, following infection with SARS-CoV-2, adult rhesus macaques exhibited transient accumulation of activated, proliferating T fh cells in their peripheral blood on a transitory basis. The CD4 helper cell responses were skewed predominantly toward a T h 1 response in blood, lung, and lymph nodes, reflective of the interferon-rich cytokine environment following infection. We also observed the generation of germinal center T fh cells specific for the SARS-CoV-2 spike (S) and nucleocapsid (N) proteins, and a corresponding early appearance of antiviral serum IgG antibodies but delayed or absent IgA antibodies. Our data suggest that a vaccine promoting Th1-type Tfh responses that target the S protein may lead to protective immunity.
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BACKGROUND: To examine trends in state-level policy support for sexual minorities and HIV outcomes among men who have sex with men (MSM). METHODS: This longitudinal analysis linked state-level policy support for sexual minorities [N = 94 metropolitan statistical areas (MSAs) in 38 states] to 7 years of data (2008-2014) from the Centers for Disease Control and Prevention on HIV outcomes among MSM. Using latent growth mixture modeling, we combined 11 state-level policies (eg, nondiscrimination laws including sexual orientation as a protected class) from 1999 to 2014, deriving the following 3 latent groups: consistently low policy support, consistently high policy support, and increasing trajectory of policy support. Outcomes were HIV diagnoses per 10,000 MSM, late diagnoses (number of deaths within 12 months of HIV diagnosis and AIDS diagnoses within 3 months of HIV diagnosis) per 10,000 MSM, AIDS diagnoses per 10,000 MSM with HIV, and AIDS-related mortality per 10,000 MSM with AIDS. RESULTS: Compared with MSAs in states with low policy support and increasing policy support for sexual minorities, MSAs in states with the highest level of policy support had lower risks of HIV diagnoses [risk difference (RD) = -37.9, 95% confidence interval (CI): -54.7 to -21.0], late diagnoses (RD = -12.5, 95% CI: -20.4 to -4.7), and AIDS-related mortality (RD = -33.7, 95% CI: -61.2 to -6.2), controlling for time and 7 MSA-level covariates. In low policy support states, 27% of HIV diagnoses, 21% of late diagnoses, and 10% of AIDS deaths among MSM were attributable to the policy climate. CONCLUSION: The state-level policy climate related to sexual minorities was associated with HIV health outcomes among MSM and could be a potential public health tool for HIV prevention and care.
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Infecções por HIV/terapia , Política de Saúde , Homossexualidade Masculina , Minorias Sexuais e de Gênero , Infecções por HIV/epidemiologia , Humanos , Masculino , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: Emerging literature shows that racialised police brutality, a form of structural racism, significantly affects health and well-being of racial/ethnic minorities in the USA. While public health research suggests that structural racism is a distal determinant of sexually transmitted infections (STIs) among Black people, no studies have empirically linked police violence to STIs. To address this gap, our study measures associations between police killings and rates of STIs among Black residents of US metropolitan statistical areas (MSAs). METHODS: This cross-sectional ecological analysis assessed associations between the number of Black people killed by police in 2015 and rates of primary and secondary syphilis, gonorrhoea and chlamydia per 100 000 Black residents of all ages in 2016 in 75 large MSAs. Multivariable models controlled for MSA-level demographic and socioeconomic characteristics, police expenditures, violent crime, arrest and incarceration rates, insurance rates and healthcare funding. RESULTS: In 2015, the median number of Black people killed by police per MSA was 1.0. In multivariable models, police killings were positively and significantly associated with syphilis and gonorrhoea rates among Black residents. Each additional police killing in 2015 was associated with syphilis rates that were 7.5% higher and gonorrhoea rates that were 4.0% higher in 2016. CONCLUSIONS: Police killings of Black people may increase MSA-level risk of STI infections among Black residents. If future longitudinal analyses support these findings, efforts to reduce STIs among Black people should include reducing police brutality and addressing mechanisms linking this violence to STIs.