Acceptance and use of condoms among school-aged young people in Australia.

BACKGROUND: Despite availability of vaccines or medical prophylaxis for some sexually transmissible infections (STIs), promoting condom use remains an important public health strategy for the prevention of STIs. Recent research shows that regular condom use among young people in Australia has declined over the past decade, while the rate of common STIs has increased. METHOD: In this paper, we report findings from a large survey of school-aged young people in Australia (14-18years old) in which we looked at the association between condom use and positive feelings about sex, beliefs about social acceptability of condoms and confidence talking with partners about sex and condoms. RESULTS: Communication and relational factors supported more consistent condom use. Participants were more likely to regularly use condoms if they discussed condom use with a sexual partner, perceived condom use to be easy (a measure that included perceived ease of discussing condoms with a partner) and perceived condom use to offer social or relational benefits, including perceiving condom use as a demonstration of care for a partner. Young men were more likely to report positive feelings about sex and regular condom use than young women. Young women were less likely than young men or trans and non-binary young people to report regular condom use. CONCLUSIONS: The study shows the importance of supporting young people to build confidence expressing sexual needs and wants with partners. Public health approaches to STI prevention need to consider condom promotion in the context of young people's contemporary sexual, gendered and relationships cultures.

The risks and benefits of technologised sexual practice scale: a quantitative measure of technology facilitated sex and intimacy.

BACKGROUND: Technologies such as the Internet, smartphones, and sex toys have demonstrated the capacity to facilitate and enhance sexual and intimate practice by offering new ways to meet sexual partners, maintain and establish intimate connections, and providing access to sexual education and exposure to new ways of engaging in sex. They have also afforded novel risks to safety, privacy, and sexual autonomy. Understanding how people perceive and experience both the risks and benefits of using technology to facilitate sex and intimacy is important to understanding contemporary sexual practice, health, and pleasure. However, research in this space is currently hampered by a lack of quantitative measures to accurately and holistically assess both the risks and benefits in the context of technologised sexual practices. METHODS: To facilitate a nuanced quantitative exploration of these concepts, we present the psychometric properties of the newly developed Risks and Benefits of Technologised Sexual Practice Scale . RESULTS: Using an exploratory (Study 1, n =445) and confirmatory factor analysis (Study 2, n =500), this paper presents evidence for a 6-factor scale (Benefits (3): 'sexual gratification', 'connection', and 'access to information and culture'; Risks (3): 'concerns', 'worries', and 'knowledge of rights and ownership'). CONCLUSION: This scale may be used to contribute to research areas including sexual health, sexual behaviour, sexual education, online connection, online safety, and digital literacy with the aim to contribute to a sex- and technology-positive framework for understanding sexual health and pleasure.

Exploring the Experiences of Regional and Rural Revictimized Women in a Group Empowerment Program.

Sexual revictimization can have a negative impact on many facets of women's wellbeing, yet limited evidence exists regarding specific interventions that support healing and the reduction of further revictimization. This paper will explore regional and rural women's experience of a group-based empowerment program, the Shark Cage program, in Victoria, Australia. The "Shark Cage" program aims to address revictimization by empowering women and girls to build personal boundaries and assertiveness within the context of gender equality and human rights. Data were collected via participant observations across the 8-week program, in combination with semi-structured interviews with participants (N = 11) pre and post intervention. All participants had access to therapeutic support outside of the program. Findings indicate that the program fostered connections among women with shared experiences of sexual revictimization, reducing feelings of isolation. Participants detailed the benefit of developing and practicing skills in reducing revictimization, such as assertiveness and boundary setting. Program learning and recovery was embedded within a network of embodied emotions, social connections, cultural norms and place-based relations that influenced how participants recovery could be understood, processed and addressed.

Quality of life among people living with HIV aged 50 years and over in Australia: Identifying opportunities to support better ageing.

OBJECTIVES: Improved life expectancy has led to an ageing population of people living with HIV in most countries. Research on ageing among people living with HIV has predominantly focused on physical and health-related quality of life rather than multidimensional quality of life. We measured quality of life among older people living with HIV in Australia and identified opportunities to guide the development and implementation of appropriate interventions. METHODS: In a national health and wellbeing survey of Australian people living with HIV, participants aged ≥50 years completed additional questions relevant to ageing. Quality of life was measured using PozQoL, a validated multidimensional instrument assessing quality of life among people living with HIV (range 1-5). Exploratory bivariate analyses aimed to identify sociodemographic characteristics associated with quality of life. Adjusted linear regressions aimed to assess changes in PozQoL score associated with recent experiences (last 12 months) of four exposures: food insecurity, HIV-related stigma, isolation from the HIV community, and difficulties accessing non-HIV health services. RESULTS: Among 319 older people living with HIV, the mean PozQol score was 3.30 (95% confidence interval [CI] 3.20-3.39). In bivariate analyses, PozQol scores were significantly higher among participants who were older (p = 0.006), had higher educational attainment (p = 0.009), were in a relationship (p = 0.005), were employed (p = 0.005), and had a higher income (p = 0.001). In adjusted regression models, PozQoL scores were lower among participants who reported recent experiences of food insecurity (ß -0.49; 95% CI -0.74 to -0.24), stigma (ß -0.53; 95% CI -0.73 to -0.33), isolation from the HIV community (ß -0.49; 95% CI -0.70 to -0.29), and difficulties accessing non-HIV health services (ß -0.50; 95% CI -0.71 to -0.30). CONCLUSIONS: Overall, older people living with HIV in this study had a moderate quality of life. Our findings suggest that HIV services should integrate programmes to support economic security and foster connections within the HIV community and across health services.

Antiretroviral Therapy Use, Viral Detectability and Fear of Onward Transmission Among People Living with HIV in Australia: Changes Between 1997 and 2018.

This paper examines how antiretroviral therapy (ART) use and fears towards the onward transmission of HIV have changed among people living with HIV (PLHIV) in Australia between 1997 and 2018. Participants were recruited as part of the HIV Futures study, a large cross-sectional survey of PLHIV in Australia, in 1997, 2003, 2012 and 2018 (total n = 3889). ART use, viral load detectability, and fear of onward HIV transmission were compared between years. Predictors of onward transmission fear were assessed among the 2018 subsample. While ART use within our sample decreased between 1997 and 2003, it subsequently increased to 97% in 2018. Self-reported viral load undetectability steadily increased over time, up to 88% in 2018. Notably, fewer PLHIV reported being fearful of transmitting HIV in 2018 compared to all other years. Being unfamiliar with the undetectable = untransmissible health movement, and having a detectable or uncertain viral load at last test, were significant predictors of being fearful of onward HIV transmission. Beyond the immediate medical considerations of HIV treatment, these results suggest that the undetectable = untransmissible movement may play a critical role in attenuating burdens experienced by PLHIV in Australia and that such messaging, in tandem with early and consistent ART use, should remain a salient feature of heath messaging among this population.

Sex on screens: the language of sexting and amateur pornography.

Frequently referred to as 'sexting' or 'amateur pornography', digital sexual images and videos form an increasingly common part of adult sexual relationships. However, the vocabulary available to speak about these practices is limited, with 'sexting' often associated with young people in negative terms. This study is based on 23 interviews with adults in Australia who are 25 years and older. It explores the language adults employ to discuss and comprehend the creation and sharing of sexualised images and videos. Findings show that negative or positive connotations associated with the terms used to discuss sexual images and videos influenced the ways participants drew on, or rejected, terms to align digital practices with their sexual subjectivity. Reticence to engage in active communication about digital sexual practices, and participant's distancing of their own practices from the terms commonly understood to refer to such practices, made it difficult to engage in conversations about consent or desire in the context of digitally mediated sex. Findings provide insight into the ways that -digital sexual subjectivities are discursively framed and extend these implications for sexual health promotion with respect to how to frame messages of digital sexual safety in a sex-positive and open way.

Anxiety about HIV criminalisation among people living with HIV in Australia.

Many countries, including Australia, have laws that enable criminal prosecution of an individual based on reckless or intentional transmission of HIV to another person. Previous research has suggested that criminalisation of HIV may serve to hamper public health efforts by inhibiting HIV status disclosure or testing. Limited research to date has sought to examine the broader impact of criminalisation on the health and wellbeing of people living with HIV, which this paper aims to address. Drawing on cross-sectional data from 895 people living with HIV in Australia, this paper describes associations between standard measures of mental health and resilience with a newly devised scale measuring anxiety about HIV criminalisation. Findings suggest that laws criminalising HIV transmission have a broadly negative impact on wellbeing of people living with HIV, a situation that is exacerbated for gay and bisexual men, and other people living with HIV who may face intersecting forms of marginalisation based on race, gender or class. There is little justification for these laws being applied in Australia and the findings add weight to advocacy seeking to overturn criminalisation across the world.

Traversing TechSex: benefits and risks in digitally mediated sex and relationships.

BACKGROUND: Digital technologies play a significant role in people's sexual and intimate lives via smart phones, cameras, dating apps and social media. Although there is a large body of research on the potential risks posed by these technologies, research on benefits and pleasures is limited. METHODS: This study explored digital sexual practices, including perceptions of risks and benefits among a sample of Australian adults (n =445). Data were collected in 2020 via an online survey. Descriptive and bivariate analyses were undertaken to identify significant relationships between demographic variables and the use of technologies in relation to perceived risks and benefits. The mean age of participants was 42 years, over half were women (58.5%) and identified as heterosexual (61.1%). RESULTS: Findings reveal that use of digital media was common in participants' sex lives and relationships; 60.3% of participants had viewed pornography online, 34.9% had used dating apps, and 33.9% had sent sexual or naked self-images to another person. Over one in three reported positive outcomes from this: 38.2% felt emotionally connected to their partners due to online communication; 38.0% agreed that digital technologies facilitated closer connections;however, the majority of participants were aware of potential risks associated with online sexual engagement, particularly non-consensual exposure of their sexual or naked images, with women expressing greater concern. CONCLUSIONS: Policy, legal and educational responses should be based on holistic understanding of digital sexual engagement, acknowledging the ways in which technologies can support sexual relationships while also building people's knowledge and capacity to manage risks.

Social determinants of quality of life among PLHIV in Australia: implications for health promotion.

A cascade of care model is central to contemporary approaches to HIV prevention. The model prioritizes strategies to increase rates of HIV testing and promote early and sustained uptake of antiretroviral treatment (ART) among people living with HIV (PLHIV). The model aims to prevent new HIV transmissions by increasing the number of PLHIV who have achieved HIV viral suppression. However, good quality of life (QoL) among PLHIV has been proposed as an additional goal. This prioritizes the basic right of PLHIV to lead meaningful lives and acknowledges the relationship between better QoL and consistent ART use. A better understanding of factors associated with the QoL can thus inform health promotion programmes for PLHIV. In this study, N=465 Australian participants, recruited through social media and various HIV community organizations, completed an online survey that included a measure of QoL and a range of demographic, health-related and social variables. Overall, social factors accounted uniquely for the most variance in QoL (18%), followed by health-related (11%) and demographic factors (2%). Social support, HIV-related discrimination and treatment convenience were among the strongest determinants of QoL. These findings reinforce the importance of a more holistic approach to health promotion among PLHIV. Specifically, our results indicate that to improve the QoL of PLHIV and to boost related public health benefits, community advocates and healthcare professionals must be responsive to the broader psychological, social and functional needs of PLHIV.

Health literacy, financial insecurity and health outcomes among people living with HIV in Australia.

It is well documented that lower socio-economic status is associated with poorer health outcomes, while health literacy is considered important for improving health. What is less clear, is the extent to which greater health literacy can improve health outcomes among people for whom poverty or financial insecurity are important barriers to health. The paper presents findings from an Australian survey of people living with HIV (PLHIV) (N = 835) in which we explored the relationship between financial insecurity and health outcomes, looking at the extent to which health literacy mediates this relationship. The study drew on a comprehensive definition of health literacy, measuring participant's confidence to communicate with healthcare providers, navigate the health system and take an active stance in relation to their health. Findings showed that financial insecurity was associated with lower health literacy and poorer self-reported physical and mental health. Health literacy mediated 16.2% of the effect of financial insecurity on physical health scores and 16.6% of the effect of financial insecurity on mental health scores. This suggests that programmes which seek to build health literacy among PLHIV may improve health outcomes among PLHIV who are struggling financially. Health literacy programmes are likely to be effective if they build confidence and resourcefulness among people to engage with health information, decision-making and care.

Social inclusion of LGBTQ and gender diverse adults with intellectual disability in disability services: A systematic review of the literature.

BACKGROUND: Lesbian, gay, bisexual, transgender, queer (LGBTQ) and gender diverse adults with intellectual disability experience exclusion within disability services. OBJECTIVE: This review explores the experiences of social inclusion/exclusion of this cohort in the context of disability services. SEARCH METHOD: A systematic search was conducted of peer-reviewed research published between January 2014 and April 2019. Five databases returned 66 articles plus three from hand searches. APPRAISAL AND SYNTHESIS: Nine articles were included in this review. The Critical Appraisal Skills Programme tool was used to assess the quality of the research. NVivo 12 was used as a tool to organise the articles. RESULTS: Marginalisation of LGBTQ adults with intellectual disability in western societies is mirrored in disability organisations. There remains a dearth of research into experiences of transgender people with intellectual disability who use disability services. CONCLUSIONS: Research into interventions that support the inclusion of this cohort in disability support services is needed.

Bisexual Men Living with HIV: Wellbeing, Connectedness and the Impact of Stigma.

Social research with people living with HIV (PLHIV) rarely distinguishes between gay men and bisexual men. However, bisexual men may have unique experiences of HIV-related stigma and distinct support needs. In this paper, findings are presented from a cross-sectional survey of Australian PLHIV, which included the Berger (HIV) stigma scale. A total of 872 PLHIV completed the survey, of which 48 (6.0%) were bisexual men. Bisexual men reported higher levels of internalised HIV-related stigma, greater negative self-image and poorer emotional wellbeing than gay men. Bisexual men also reported less social support, less connection with lesbian, gay, bisexual, transgender and queer (LGBTQ) communities, and less connection with other PLHIV. Analysis of data from an open-text question revealed feelings of social isolation and fear of rejection was associated with participant's HIV diagnosis. Study findings suggest that existing social supports for PLHIV may not adequately address the unique support needs of bisexual men.

Hierarchical Study of the Reactions of Hydrogen Atoms with Alkenes: A Theoretical Study of the Reactions of Hydrogen Atoms with C2-C4 Alkenes.

The present study complements our previous studies of the reactions of hydrogen atoms with C5 alkene species including 1- and 2-pentene and the branched isomers (2-methyl-1-butene, 2-methyl-2-butene, and 3-methyl-1-butene), by studying the reactions of hydrogen atoms with C2-C4 alkenes (ethylene, propene, 1- and 2-butene, and isobutene). The aim of the current work is to develop a hierarchical set of rate constants for H atom addition reactions to C2-C5 alkenes, both linear and branched, which can be used in the development of chemical kinetic models. High-pressure limiting and pressure-dependent rate constants are calculated using the Rice-Ramsperger-Kassel-Marcus (RRKM) theory and a one-dimensional master equation (ME). Rate constant recommendations for H atom addition and abstraction reactions in addition to alkyl radical decomposition reactions are also proposed and provide a useful tool for use in mechanisms of larger alkenes for which calculations do not exist. Additionally, validation of our theoretical results with single-pulse shock-tube pyrolysis experiments is carried out. An improvement in species mole fraction predictions for alkene pyrolysis is observed, showing the relevance of the present study.

Understanding the Prevalence of Smoking Among People Living with HIV (PLHIV) in Australia and Factors Associated with Smoking and Quitting.

Understanding contributors to smoking and quitting cigarettes is important to developing effective cessation programs and addressing smoking related morbidity and mortality among people living with HIV (PLHIV). Using data from a large cross-sectional study of Australian PLHIV we provide a smoking prevalence estimate and explore the relationship between socio-demographic variables and smoking status. We also explore the relationship between HIV diagnosis and antiretroviral therapy (ART) initiation and quitting smoking. Of the 1011 respondents included in the analysis, 30.6% were current smokers. The strongest predictor of smoking was regular cannabis use (AOR 6.2, 95% CI 3.6-10.8) while the strongest predictor of being a past smoker was receiving ART (AOR 2.4, 95% CI 1.2-4.7). Quitting also increased around the time of diagnosis and ART initiation, highlighting the potential for these events to be optimal times to address smoking among PLHIV.

Theoretical Study of the Reaction of Hydrogen Atoms with Three Pentene Isomers: 2-Methyl-1-butene, 2-Methyl-2-butene, and 3-Methyl-1-butene.

This paper presents a comprehensive potential energy surface (PES) for hydrogen atom addition to and abstraction from 2-methyl-1-butene, 2-methyl-2-butene, and 3-methyl-1-butene and the subsequent ß-scission and H atom transfer reactions. Thermochemical parameters for species on the C5H11 potential energy surface (PES) were calculated as a function of temperature (298-2000 K), using a series of isodesmic reactions to determine the formation enthalpies. High-pressure limiting and pressure-dependent rate constants were calculated using Rice-Ramsperger-Kassel-Marcus theory with a one-dimensional master equation. A number of studies have highlighted the fact that C5 intermediate species play a role in polyaromatic hydrocarbon formation and that a fuel's chemical structure can be key in understanding the intermediate species formed during fuel decomposition. Rate constant recommendations for both H atom addition to, and H-atom abstraction by H atoms from, linear and branched alkenes have subsequently been proposed by incorporating our earlier work on 1- and 2-pentene, and these can be used in mechanisms of larger alkenes for which calculations do not exist. The current set of rate constants for the reactions of H atoms with both linear and branched C5 alkenes, including their chemically activated pathways, are the first available in the literature of any reasonable fidelity for combustion modeling and are important for gasoline mechanisms. Validation of our theoretical results with pyrolysis experiments of 2-methyl-1-butene, 2-methyl-2-butene, and 3-methyl-1-butene at 2 bar in a single pulse shock tube (SPST) were carried out, with satisfactory agreement observed.

Acceptability, motivation and the prospect of cure for people living with HIV and their healthcare providers in HIV cure-focused treatment interruption studies.

BACKGROUND: Analytical treatment interruptions (ATI) are commonly used clinical endpoints to assess interventions aimed at curing HIV or achieving antiretroviral therapy (ART)-free HIV remission. Understanding the acceptability of ATI amongst people living with HIV (PLHIV) and their HIV healthcare providers (HHP) is limited. METHODS: Two online surveys for PLHIV and HHP assessed awareness and acceptability of ATI, and understanding of the prospect for HIV cure in the future. Responses were collected from July 2017-January 2018. A descriptive analysis was performed and similar questions across the two surveys were compared using χ squared test. RESULTS: 442 PLHIV and 144 HHP completed the survey. 105/400 (26%) PLHIV had ever interrupted ART, 8% of which were in a clinical trial. Altruistic motivations were drivers of participation of PLHIV in cure related research. 81/135 (60%) HHP would support their patients wishing to enrol in an HIV cure-focused trial, but fewer would promote and allow such participation (25% and 31% respectively). Compared to HHP, PLHIV were more likely to believe that an HIV cure would be achievable within 10 years (55% vs. 19%, p < 0.001), had less awareness of ATI (46% vs. 62%, p < 0.001) and were less likely to have had experience of either participation or enrolment in an ATI study (5% vs. 18%, p < 0.001) CONCLUSION: PLHIV were more optimistic about the potential for HIV cure. HHP had more direct experience with HIV cure-focused studies. Educational strategies are required for both groups to increase understanding around ATIs in HIV cure research but should be tailored specifically to each group.

Use of fertility services in Australian lesbian, bisexual and queer women's pathways to parenthood.

BACKGROUND: It is estimated that up to one in three lesbian, bisexual or queer (LBQ) women in Australia have children. In the past decade, it has become common for LBQ women to pursue pregnancy using clinic-acquired donor sperm. AIMS: The aims of this paper are to explore pathways to parenthood among Australian LBQ women in the context of increased access to fertility clinics and identify the type of clinical fertility services being used. MATERIALS AND METHOD: This paper reports on female LBQ parents and expectant/prospective parents who participated in a 2016/2017 online survey of Australian lesbian, gay, bisexual, transgender and queer (LGBTQ) adults exploring reproductive choices, pathways to parenthood, conception method and use of clinical fertility services. RESULTS: More than half the children reported on by current parents (52%) had been conceived using clinical fertility services. When asked what factors influenced a parent respondent's decision to use fertility services: 80% indicated access to donor sperm, 41% indicated fertility problems. Of respondents who had accessed donor sperm, over half (57%) had used in vitro fertilisation (IVF) services. CONCLUSIONS: These findings indicate that use of fertility clinics to access donor sperm is common for LBQ women, including those with no known fertility problems, and that most women who access donor sperm conceive using IVF rather than intrauterine insemination. More needs to be known about the context and reasons for this, including factors that influence LBQ women's decision making on their pathway to parenthood.

Experiences of Bisexual Identity, Attraction, and Behavior and Their Relationship With Mental Health Findings From the Who I Am Study.

Approximately one in 10 Australian individuals report bisexual attraction, and this group has repeatedly been found to experience high rates of poor mental health. Despite this finding, our understanding of who is most at risk within this group remains limited. The current article presents findings of an online survey conducted in Australia with one of the largest samples of bisexual adults to date (N = 2,651). Chi-square and regression analyses identified significant associations between the three dimensions of bisexuality (i.e., identity, behavior, and attraction) and mental health. Participants who reported identifying as bisexual were found to be especially vulnerable to poor mental health compared to those who reported bisexual attraction and/or sexual experiences without a bisexual identity. These findings provide a significant contribution to the lacking literature on the complexities of bisexual orientation and mental health. [Journal of Psychosocial Nursing and Mental Health Services, 58(3), 28-37.].

Theoretical, Experimental, and Modeling Study of the Reaction of Hydrogen Atoms with 1- and 2-Pentene.

Alkyl radicals are prominent in combustion chemistry as they are formed by hydrocarbon decomposition or from a radical attack on hydrocarbons. Accurate determinations of the thermochemistry and kinetics of their unimolecular isomerization and decomposition reactions and related addition reactions of alkenes are therefore important in simulating the combustion chemistry of virtually all hydrocarbon fuels. In this work, a comprehensive potential energy surface (PES) for H-atom addition to and abstraction from 1- and 2-pentene, and the subsequent C-C and C-H ß-scission reactions, and H-atom transfer reactions has been considered. Thermochemical values for the species on the C5H11 PES were calculated as a function of temperature (298-2000 K), with enthalpies of formation determined using a network of isodesmic reactions. High-pressure limiting and pressure-dependent rate constants were calculated using the Rice-Ramsperger-Kassel-Marcus theory coupled with a one-dimensional master equation. As a validation of our theoretical results, hydrogen atomic resonance absorption spectrometry experiments were performed on the H-atom addition and abstraction reactions of 1- and 2-pentene. By incorporating our calculations into a detailed chemical kinetic model (AramcoMech 3.0), excellent agreement with these experiments is observed. The theoretical results are further validated via a comprehensive series of simulations of literature data. Our a priori model is found to reproduce important absolute species concentrations and product ratios reported therein.

Development and validation of PozQoL: a scale to assess quality of life of PLHIV.

BACKGROUND: Advances in medical treatment for HIV are driving major changes in HIV policy and practice, including the encouragement of intake and adherence to HIV antiretroviral treatment (ART) by people living with HIV (PLHIV) for both personal and public health benefits. However, there is increasing recognition that achieving these goals will require a concurrent focus on the broader psychological and social wellbeing of PLHIV. Increasingly calls are being been made to incorporate a stronger focus on quality of life (QoL) of PLHIV into HIV prevention policy. In order to achieve this goal, HIV community, support and healthcare services need a valid, short and practical way to evaluate QoL of PLHIV accessing their programs. Current QoL measures are either long, complex, restricted in their use, or expensive. To address these shortcomings, the PozQoL study aimed to develop, test and validate a short and freely available scale assessing QoL among PLHIV. METHODS: Drawing on a literature review, the prioritisation of domains and development of the initial pool of items was conducted in consultation with PLHIV community organisations in Australia. The items covered health concerns, psychological, social, and functional wellbeing. Testing involved a baseline and a follow-up survey of 465 adult Australians living with HIV. Participants were recruited through social media and various community organizations nationwide. The survey included the pilot PozQoL scale and other validated measures of health and wellbeing. RESULTS: Guided by an Exploratory Factor Analysis and conceptual considerations, a 13-item scale was developed. The PozQoL scale demonstrated high levels of fit in a Confirmatory Factor Analysis, very good internal consistency, test-retest reliability, and concurrent validity with other measures that approximated different aspects of QoL. CONCLUSION: The PozQoL scale has been tested in a diverse sample of adult PLHIV living in Australia, demonstrating very good reliability and validity. The insights from PLHIV and other stakeholders supported the balancing of statistical rigour and conceptual accuracy. The scale is now ready to be implemented and field-tested across a range of community, support and healthcare programs for PLHIV. This will make a significant contribution to the evaluation and enhancement of programs for PLHIV.