The development of social capital in a peer-led mHealth cognitive behavioral antiretroviral therapy adherence intervention for HIV + adolescents and young adults.

Adherence Connection for Counseling, Education, and Support (ACCESS)-I is a peer-led mHealth antiretroviral therapy adherence intervention for adolescents and young adults living with HIV who are in treatment but have detectable viral loads. Participants received five online sessions with peer health coaches who followed a structured intervention manual. Peers maintained intervention fidelity but also engaged in casual discussion that was not directly related to ART adherence or HIV. We conducted a qualitative analysis of the casual interactions that occurred during the ACCESS I intervention. Sessions were transcribed and coded, and these casual interactions were then coded into 10 subcodes to document their content, and also coded for three types of social capital - emotional, informational, and instrumental. Emotional and Informational social capital codes were the most common, while instrumental codes were rare. Activities was the most common topic overall, while encouragement was more common in emotional social capital narratives and personal experience was more common in informational social capital narratives. These casual interactions may strengthen peer-participant relationships, building social capital that could then be used to encourage positive behavior change. Although social capital was not directly measured, these analyses illustrate the value of attending to seemingly casual interactions in peer-led interventions.

Culture-based stigmatizing attitudes toward condom use among Chinese older adults: An interpretative phenomenological analysis.

OBJECTIVE: To explore their perceptions and attitudes toward condom use and the underlying reasons for the low usage frequency among Chinese older adults. METHODS: A qualitative study design utilizing interpretive phenomenological analysis was employed. Data were collected through field observation and face-to-face in-depth interviews among older adults aged 50 years or above and having engaged in sexual activities within the previous year. RESULTS: Three main themes emerged: perceiving unnecessary due to misconceptions and low awareness, interactive stereotypes rooted in sociocultural beliefs, and stigmatized social norms including gender inequity and economic unbalance. CONCLUSIONS: Tailored interventions focusing on addressing misconceptions, increasing awareness, and reducing culturally ingrained stereotypes and stigma surrounding condom use are essential to promote condom use among older adults in order to prevent HIV transmission in China.

The Impact of Providing Free HIV Self-testing on Sexual Risk Behaviors Among Men who have Sex with Men in Hunan, China: A Randomized Controlled Trial.

HIV self-testing (HIVST) increases testing frequency among men who have sex with men (MSM). However, its impact on sexual risk behaviors is unclear. In a randomized controlled trial conducted in Hunan Province, China, HIV-negative MSM were randomized to receive one of two interventions for one year: (1) facility-based HIV testing, or (2) facility-based HIV testing augmented with free HIVST. From April to June 2018, 230 MSM were enrolled. They self-reported sexual behaviors every 3 months for 12 months. Among 216 MSM with follow-ups (intervention: 110; control: 106), adjusting for potential confounders in Generalized Estimating Equation models, there were no statistically significant differences in consistent condom use with male partners (regular/casual) or female partners, nor on number of male or female sexual partners. Provision of free HIVST kits does not increase risky sex and should be included in comprehensive HIV prevention packages, particularly for sexual minority men in China.

Psychological pathways to HIV-related posttraumatic stress disorder symptoms among people living with HIV in China: the mediating role of rumination.

The occurrence of HIV-related posttraumatic stress disorder (PTSD) compromises the physical and mental health of people living with HIV (PLWH). This study examined the psychological pathways of HIV-related PTSD symptoms considering the influence of rumination in PLWH of China. A cross-sectional survey was conducted in Changsha, China. The data were collected using the PTSD Checklist-Civilian Version, the Ruminative Response Scale, the Multidimensional Scale of Perceived Social Support, and measures of sociodemographic and HIV-related clinic characteristics. A total of 602 PLWH were surveyed. The average score of HIV-related PTSD symptoms was (34.54 ± 13.58). The mediation model showed that perceived social stigma and physical health exhibited direct associations with PTSD symptoms (ß = 0.093, -0.145, respectively), while the direct relations of family support, friend support and significant others support to PTSD symptoms were not significant. Rumination mediated the effect of perceived social stigma (ß = 0.077), physical health (ß = -0.150), family support (ß = -0.144) and friend support (ß = -0.105) on PTSD symptoms. The study findings underscore the importance of routinely assessing PTSD for PLWH, and developing trauma-focused interventions that alleviate HIV-related PTSD symptoms and reduce rumination while improving social support and physical health and reducing social stigma.

Integrative Review of Methods From Youth Risk Behavior Survey Secondary Data Analyses Examining HIV Syndemic Factors Among Adolescent Gay and Bisexual Men.

BACKGROUND: Adolescent gay/bisexual men exhibit the highest prevalence of undiagnosed HIV infections. Ascertaining antecedents of behaviorally acquired HIV infections among adolescent gay/bisexual men can be challenging; however, these challenges can be overcome through the utilization of secondary data, such as the Youth Risk Behavior Survey. OBJECTIVE: Syndemics theory suggests that HIV infections are not a singular phenomenon; instead, many infections occur at the intersection of syndemic factors, such as substance use, violence, and mental health. Our objective is to describe and synthesize research methods of secondary data analyses that examine syndemic factors in relation to HIV risk behavior outcomes among subsamples of adolescent gay/bisexual men. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo were systematically searched. Inclusion criteria were (a) peer-reviewed Youth Risk Behavior Survey secondary data analyses conducted in the United States after 1991, (b) subsamples with adolescent gay/bisexual men, (c) one or more syndemic factor(s), and (d) one or more HIV risk behavior outcome(s). We used the National Institutes of Health Quality Assessment Tools for quality appraisal. RESULTS: Of 1,036 citations retrieved, nine studies met inclusion criteria. Results included using logistic regression analysis and data from 2015 to 2017 in six studies and underpinnings with minority stress theory in four studies. Eight studies omitted race/ethnicity in subsamples and six grouped lesbians with adolescent gay/bisexual men. Seven studies examined substance use, six examined violence, and five examined mental health. Condom use and number of partners were the most studied HIV risk behavior outcomes in four studies, whereas intercourse in the last 3 months was an outcome in only one study. Protective factors were not present. CONCLUSION: Limitations found the need to highlight better inclusion of race/ethnicity and sexual orientation. Adding contemporary survey items is also necessary, such as nonbinary sex and gender identity, access to HIV prevention (condoms, HIV testing, and preexposure prophylaxis), and experiences with stigma, to elucidate risk behaviors among populations disproportionately affected by HIV infections, including Blacks/African Americans and Hispanics/Latinos.

Self-efficacy mediates the effect of providing HIV self-testing kits on HIV testing frequency among Chinese men who have sex with men: results from a randomised controlled trial.

BACKGROUND: HIV self-testing (HIVST) could promote HIV tests; however, knowledge about the mechanisms by which providing HIVST kits impacts the uptake of HIV testing is limited. This study aimed to examine how self-efficacy mediates the association between providing HIVST kits and HIV testing frequency. METHODS: In this randomised controlled trial, HIV-negative men who have sex with men (MSM) were recruited in China and randomly assigned 1:1 into intervention and control groups. MSM in the control group could access site-based HIV testing services (SBHT). MSM in the intervention group could access SBHTs plus free HIVST kits. HIV testing self-efficacy, number of SBHTs, number of HIVSTs, and the total number of HIV tests were assessed every 3months for 1year. RESULTS: Data from 216 MSM (intervention group: 110; control group: 106) were included in analysis. Results from Pearson's correlations and point-biserial correlations showed that participants with higher self-efficacy scores underwent a higher number of HIV tests (r =0.241, P <0.001), more HIVSTs (r =0.162, P <0.001), and more SBHTs (r =0.138, P <0.001). Bootstrap tests using PROCESS indicated self-efficacy partially mediated the effect of providing HIVST on the number of HIVSTs (indirect effect: 0.018, 95% bias-corrected confidence interval [BC CI]: 0.003-0.035; direct effect: 0.440, 95% BC CI: 0.366-0.513) and on total HIV tests (indirect effect 0.053 (0.030-0.787); direct effect 0.452 (0.365-0.539)), and completely mediated the effect of providing HIVST on the number of SBHTs (indirect effect 0.035 (0.019-0.056); direct effect 0.012 (-0.059 to 0.083)). CONCLUSIONS: Our findings indicated self-efficacy mediated the effect of HIVST provision on HIV testing frequency, suggesting improving self-efficacy might be an effective way to promote HIV testing among Chinese MSM.

The association between HIV disclosure, spousal testing and unprotected vaginal intercourse within marriage among HIV positive married MSM in China.

Disclosure of HIV status can encourage spouses of people diagnosed with HIV to prioritize HIV prevention. However, few studies have reported the HIV disclosure status of married men who have sex with men (MSM) and their female spouses. The purpose of this study was to describe the prevalence of HIV disclosure, and whether it was associated with spouses' HIV testing uptake and unprotected vaginal intercourse within marriage for MSM living with HIV (HIV + MSM) in China. A cross-sectional study was conducted in three Chinese cities. Of 309 participants, only 31.1% of men had disclosed their HIV status to spouses. About 80% of participants reported that their spouses had been tested for HIV. A small proportion of men (9.1%) had unprotected sex with their spouse after HIV diagnosis. Multivariate analyses indicated HIV disclosure was positively associated with HIV testing uptake of spouses, but there was no significant association between HIV disclosure and unprotected marital sexual behaviors for HIV + MSM. The findings indicated that HIV disclosure to spouses is uncommon among married HIV + MSM in China, and HIV disclosure is associated with increased uptake of HIV testing among spouses of MSM, but it does not decrease the unprotected sexual behaviors in marriage.

"We are in this together:" dyadic-level influence and decision-making among HIV serodiscordant couples in Tanzania receiving access to PrEP.

BACKGROUND: A substantial number of new HIV infections in sub-Saharan Africa occur within stable couples. Biomedical prevention (pre-exposure prophylaxis, PrEP) and treatment (antiretroviral therapy, ART) can provide benefits to sexual partners and can be used to prevent infection within HIV serodiscordant couples. However, research is typically focused on individuals, not dyads, even when the intervention may directly or indirectly impact sexual partners. Gaps remain in understanding best practices for recruitment, informed consent, and intervention implementation in studies involving HIV prevention and treatment among heterosexual serodiscordant couples. This qualitative study was undertaken to understand and describe decision-making and dyadic-level influence among members of serodiscordant couples regarding (1) participation in a dyadic-based research study involving HIV self-testing and access to PrEP, and (2) utilization of PrEP and ART. METHODS: This qualitative study was nested within an observational cohort study assessing the acceptability of home-based couples' HIV self-testing and uptake of dyadic care for serodiscordant couples involving facilitated referral for HIV-positive partners and access to PrEP for HIV-negative partners. Semi-structured in-depth interviews were conducted among a subset of study participants (n = 22) as well as individuals involved in serodiscordant relationships who chose not to participate (n = 9). Interviews focused on couples' decision-making regarding study participation and dyadic-level influence on medication use. Interviews were transcribed verbatim and translated from Kiswahili into English. Data were analyzed using thematic analysis. RESULTS: Three major themes were identified: (1) HIV as "two people's secret" and the elevated role of partner support in serodiscordant relationships; (2) the intersectional role of HIV-status and gender on decision-making; (3) the relational benefits of PrEP, including psychosocial benefits for the couple that extend beyond prevention. CONCLUSIONS: The study found that couples made joint decisions regarding study participation and uptake of HIV-related medication. Relational autonomy and dyadic-level influence should be considered within research and programs involving HIV serodiscordant couples.

Impact of providing free HIV self-testing kits on frequency of testing among men who have sex with men and their sexual partners in China: A randomized controlled trial.

BACKGROUND: The HIV epidemic is rapidly growing among men who have sex with men (MSM) in China, yet HIV testing remains suboptimal. We aimed to determine the impact of HIV self-testing (HIVST) interventions on frequency of HIV testing among Chinese MSM and their sexual partners. METHODS AND FINDINGS: This randomized controlled trial was conducted in 4 cities in Hunan Province, China. Sexually active and HIV-negative MSM were recruited from communities and randomly assigned (1:1) to intervention or control arms. Participants in the control arm had access to site-based HIV testing (SBHT); those in the intervention arm were provided with 2 free finger-prick-based HIVST kits at enrollment and could receive 2 to 4 kits delivered through express mail every 3 months for 1 year in addition to SBHT. They were encouraged to distribute HIVST kits to their sexual partners. The primary outcome was the number of HIV tests taken by MSM participants, and the secondary outcome was the number of HIV tests taken by their sexual partners during 12 months of follow-up. The effect size for the primary and secondary outcomes was evaluated as the standardized mean difference (SMD) in testing frequency between intervention and control arms. Between April 14, 2018, and June 30, 2018, 230 MSM were recruited. Mean age was 29 years; 77% attended college; 75% were single. The analysis population who completed at least one follow-up questionnaire included 110 (93%, 110/118) in the intervention and 106 (95%, 106/112) in the control arm. The average frequency of HIV tests per participant in the intervention arm (3.75) was higher than that in the control arm (1.80; SMD 1.26; 95% CI 0.97-1.55; P < 0.001). This difference was mainly due to the difference in HIVST between the 2 arms (intervention 2.18 versus control 0.41; SMD 1.30; 95% CI 1.01-1.59; P < 0.001), whereas the average frequency of SBHT was comparable (1.57 versus 1.40, SMD 0.14; 95% CI -0.13 to 0.40; P = 0.519). The average frequency of HIV tests among sexual partners of each participant was higher in intervention than control arm (2.65 versus 1.31; SMD 0.64; 95% CI 0.36-0.92; P < 0.001), and this difference was also due to the difference in HIVST between the 2 arms (intervention 1.41 versus control 0.36; SMD 0.75; 95% CI 0.47-1.04; P < 0.001) but not SBHT (1.24 versus 0.96; SMD 0.23; 95% CI -0.05 to 0.50; P = 0.055). Zero-inflated Poisson regression analyses showed that the likelihood of taking HIV testing among intervention participants were 2.1 times greater than that of control participants (adjusted rate ratio [RR] 2.10; 95% CI 1.75-2.53, P < 0.001), and their sexual partners were 1.55 times more likely to take HIV tests in the intervention arm compared with the control arm (1.55, 1.23-1.95, P < 0.001). During the study period, 3 participants in the intervention arm and none in the control arm tested HIV positive, and 8 sexual partners of intervention arm participants also tested positive. No other adverse events were reported. Limitations in this study included the data on number of SBHT were solely based on self-report by the participants, but self-reported number of HIVST in the intervention arm was validated; the number of partner HIV testing was indirectly reported by participants because of difficulties in accessing each of their partners. CONCLUSIONS: In this study, we found that providing free HIVST kits significantly increased testing frequency among Chinese MSM and effectively enlarged HIV testing coverage by enhancing partner HIV testing through distribution of kits within their sexual networks. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1800015584.

Potential HIV transmission risk among spouses: marriage intention and expected extramarital male-to-male sex among single men who have sex with men in Hunan, China.

OBJECTIVE: The HIV epidemic in China is shifting from the high-risk groups of men who have sex with men (MSM), injection drug users and sex workers to the general population, and sexual contact among spouses is assumed to be one route of transmission. Our objective was to determine the intention to marry and the expected extramarital male-to-male sex among single Chinese MSM, in order to estimate the potential HIV transmission risk among MSM living with HIV and their female spouses. METHODS: We conducted a web-based, cross-sectional survey between May 2016 and May 2017. A questionnaire covering sociodemographic characteristics, sexual behaviours, HIV-related and homosexuality-related stigma, marriage intention, and expected extramarital sexual behaviours was completed by 556 single MSM in Hunan, China. Descriptive statistics, χ2 test, two-sample t-test and multivariate logistic regression analysis were performed. RESULTS: Currently 48.9% of the participants intended to marry a woman in their lifetime, and 91% of them reported that they would continue to have sex with men after getting married. Those who were living with parents (OR=2.26), self-identified as bisexual (OR=2.57), had at least one heterosexual partner in the previous 6 months (OR=0.33) and perceived a higher level of self-homosexual stigma (OR=1.78) had greater intention to marry a woman. CONCLUSION: Nearly half of Chinese MSM intend to marry women, which has significantly dropped from the estimated percentage more than 10 years ago for Chinese MSM. However, the expectation of extramarital homosexual behaviours was common in these men. Sexual and gender minority stresses especially from family members, homosexual identity assertiveness and related stigma were the main factors for marriage intention, which should be addressed in future studies and practices.

Recruitment of US Adolescents and Young Adults (AYA) into Human Immunodeficiency Virus (HIV)-Related Behavioral Research Studies: A Scoping Review.

PURPOSE OF REVIEW: The objective of this scoping review was to examine the range of published evidence on recruitment approaches and outcomes of US adolescents and young adults (AYA) ages (18-29 years) into human immunodeficiency virus (HIV)-related behavioral research studies during the past 10 years. RECENT FINDINGS: Implementation of effective behavioral research strategies among HIV at-risk and infected AYA is key to ending the HIV epidemic and necessitates successful recruitment strategies. A comprehensive search was executed across four electronic databases. Of the 1697 identified studies, seven met inclusion criteria with six of these seven directed to HIV prevention. Most studies used online recruitment as part of a hybrid strategy, and combined field-based/in-person and online methods. Recruitment strategies and outcomes, resources and compensation, procedures for consent, and timelines varied among all seven studies. Our results highlight the need for development of recruitment models in alignment with behavioral strategies aimed to treat and prevent HIV among US AYA.

Sexual attitudes, sexual behaviors, and use of HIV prevention services among male undergraduate students in Hunan, China: a cross-sectional survey.

BACKGROUND: The dramatic increase in human immunodeficiency virus (HIV) infection among undergraduate students in China, especially among the male students, is alarming. This study aimed to describe sexual attitudes and behaviours and to examine the use of HIV prevention services and related factors among male undergraduate students in Hunan, China. METHODS: A cross-sectional survey was conducted from November 2017 to January 2018 among male students from three universities in Hunan, China. Self-administered questionnaires were uploaded online to collect data anonymously. HIV-related knowledge and sexual attitudes were assessed with the unified National AIDS Sentinel Surveillance Questionnaire and Sexual Attitude Scale, whereas sexual behaviours and use of HIV prevention services were examined with researcher-created questionnaires. HIV-related knowledge, sexual attitudes and behaviours, and use of HIV prevention services were described. Chi-square test and logistic regression were used to analyse the factors associated with the use of HIV prevention education services. P values ≤0.05 were considered significant. RESULTS: Of the 1431 respondents, 1068 (74.6%; 95% CI: 72.4-76.0%) used HIV prevention education services and 105 (7.3%) took HIV testing. The openness of sexual attitudes was moderate overall. About 299 (20.9%) of this sample had active sex partners, and 49 (16.4%) of them had sex with males. The consistent use of condoms was unsatisfactory among the sexually active students, especially among those with homosexual behaviours. Participants who were older in age (OR: 0.77, 95% CI: 0.70-0.86), who were university seniors (OR: 0.80, 95% CI: 0.70-0.91), who drank alcohol (OR: 0.71, 95% CI: 0.55-0.93), and who had open attitude towards paid sex (OR: 0.72, 95% CI: 0.54-0.95), were less likely to use HIV prevention education services. CONCLUSIONS: Although male undergraduate students show open attitude to premarital sex and engage in risky sexual behaviours, their use of HIV prevention education services is unsatisfactory, particularly in terms of HIV testing. More comprehensive and specific education on HIV prevention and testing services should be designed and offered on campus.

Heavy Alcohol Use Among Migrant and Non-Migrant Male Sex Workers in Thailand: A Neglected HIV/STI Vulnerability.

BACKGROUND: There is scarce research on male sex workers in the context of alcohol use. While heavy alcohol use has been established as a risk factor for HIV and STI infections among men who have sex with men (MSM), men who engage in sex work with other men, particularly from the Global South, have not been included in these studies. Moreover, studies among male sex workers in Asia often do not explore migration contexts of these men. OBJECTIVES: The objective of this exploratory study is to examine the prevalence and correlates of heavy alcohol use among migrant and non-migrant male sex workers in Bangkok and Pattaya, Central Thailand. METHODS: Between August and October 2015, 18-24 year-old migrant and non-migrant male sex workers (n = 212) were recruited from various male sex work-identified venues (bars, clubs, massage parlors, and go-go bars) to take an interviewer-administered cross-sectional survey in Bangkok and Pattaya, Thailand. Measures were adapted from previous studies in similar populations and included structured questions across four domains, including demographic characteristics, alcohol use, stimulant use, and sexual behaviors. Multivariable logistic regression assessed the independent associations between heavy alcohol use (heavy versus not heavy) and demographic characteristics, stimulant use and sexual behavior. RESULTS: Heavy alcohol use was prevalent among one-third of participants. Heavy alcohol use was positively associated with male sex workers who were non-migrant and Thai, currently using stimulants, having 15 or more male clients in the past month and having first consumed alcohol at age 15 years or younger. CONCLUSIONS: Current HIV prevention efforts should consider subpopulations of MSM, including male sex workers and migrants, as well as other risk behaviors like alcohol, as important contexts for HIV and STI risks.

Implementation of Online Opioid Prevention, Recognition and Response Trainings for Laypeople: Year 1 Survey Results.

BACKGROUND: This article reports on the first implementation of an online opioid-overdose prevention, recognition and response training for laypeople. The training was disseminated nationally in November 2014. Between 2000 and 2014, U.S. opioid deaths increased by 200%. The importance of complementary approaches to reduce opioid overdose deaths, such as online training, cannot be overstated. OBJECTIVES: A retrospective evaluation was conducted to assess perceived knowledge, skills to intervene in an overdose, confidence to intervene, and satisfaction with the training. MEASUREMENTS: Descriptive statistics were used to report sample characteristics, compare experiences with overdose and/or naloxone between subgroups, and describe participants' satisfaction with the trainings. Z-ratios were used to compare independent proportions, and paired t-tests were used to compare participant responses to items pre- and posttraining, including perceived confidence to intervene and perceived knowledge and skills to intervene successfully. RESULTS: Between January and October 2015, 2,450 laypeople took the online training; 1,464 (59.8%) agreed to be contacted. Of these, 311 (21.2% of those contacted) completed the survey. Over 80% reported high satisfaction with content, format and mode of delivery and high satisfaction with items related to confidence and overdose reversal preparedness. Notably, 89.0% of participants felt they had the knowledge and skills to intervene successfully posttraining compared to 20.3% pretraining (z = -17.2, p <.001). Similarly, posttraining, 87.8% of participants felt confident they could successfully intervene compared to 24.4% pretraining (z = -15.9, p <.001). CONCLUSIONS: This study demonstrates the effectiveness of the GetNaloxoneNow.org online training for laypeople.

Sexual Initiation and Complex Recent Polydrug Use Patterns Among Male Sex Workers in Vietnam: A Preliminary Epidemiological Trajectory.

Little is known about the age of onset of sexual and drug risk and their association with complex patterns of recent drug use among male sex workers (MSW) in a developing country, such as Vietnam. The aim of this study was to determine whether latent class analysis (LCA) would aid in the detection of current individual and polydrug use combinations to predict how different trajectories of sexual and drug initiation contribute to different patterns of current illicit drug use. Data were collected from a cross-sectional survey administered to young MSWs between 2010 and 2011 in Vietnam (N = 710). LCA clustered participants into recent drug use groups, incorporating both the specific types and overall count of different drugs used. Men reported drug use within a 1 month period from an 11-item drug use list. LCA identified three distinct drug use classes: (1) alcohol use, (2) alcohol and tobacco use, and (3) high polydrug use. The current drug use classes are associated with sex worker status, housing stability, income level, educational attainment, marital status, sexual identity, and sexual preferences. High levels of drug use are strongly associated with being a recent sex worker, not having recent stable housing, higher than median income, more than a high school education, less likely to be currently in school and more likely to have non-homosexual preferences and heterosexual partners. An event history analysis approach (time-event displays) examined the timing of the age of onset of drug and sexual risks. Early ages of drug and sexual initiation are seen for all three classes. High current drug users show earlier onset of these risks, which are significantly delayed for moderate and low current drug users. LCA incorporating an overall count of different drugs detected three distinct current drug use classes. The data illustrates that the complexity of drug factors that must be accounted for, both in advancing our epidemiological understanding of the complexity of drug use and the use of drug and sexual risk initiation data to predict current drug use subtypes among high-risk populations.

Injection and sexual risk practices among young heroin users in Hanoi, Vietnam.

Epidemiological data in Vietnam shows high HIV prevalence rates among injection drug users, especially in urban centres. However, there are limited data on specific practices used to prepare and inject drugs or on sexual practices among Vietnamese injectors. A street-based cross-sectional interview was conducted with 862 heroin injectors in Hanoi, Vietnam, to collect such data. Variability was seen in both injection and sexual risk, with 12.9% of current injectors reporting at least one unsafe method of drug sharing and 57.1% reporting unsafe sex in the past 30 days. These risks were strongly associated with those who engaged in unsafe injection significantly more likely to engage in unsafe sex (69.4% vs. 55.3%) and those engaging in unsafe sex significantly more likely to engage in unsafe injection (15.7% vs. 9.2%). These findings highlight the overlap of injection and sexual risk practices among Vietnamese heroin users and suggest the need for strong, broadly targeted HIV prevention activities among this population.

Risk factors for suicide attempts in a clinic-based sample of people living with HIV in Puerto Rico.

Puerto Rico (PR) has a large and rapidly growing population of people living with HIV. However, relatively little behavioral or clinical research has been done in this population. As treatment for HIV increasingly moves into a chronic condition model, it is becoming increasingly important to understand the needs of this population so critical social and behavioral interventions can be developed, thus enabling the individual and community-level benefits of antiretroviral (ARV) treatment to be fully realized. To date, however, there has been very little research on the mental health needs of people living with HIV in PR, a fact that constrains intervention development and implementation. This paper describes data from a public sexually transmitted infection (STI) and HIV clinic study in the San Juan metropolitan area between April 2010 and December 2012 (n = 1185), roughly a third (36%) of whom are living with HIV. Descriptive statistics, chi-square, t-tests, and binary logistic regressions were used to assess associations between HIV status and a history of suicide attempt. The overall prevalence of a history of suicide attempt was 20.4%. No statistically significant relationship was found between a history of suicide attempt and being HIV positive, although people with HIV infection did evidence a higher prevalence of attempts than HIV-negative subjects (23.4% vs. 19.0%). Factors associated with having a history of suicide attempt within the overall sample included gender, current employment status, a lifetime history of drug use, and a lifetime history of sex work. Similar patterns were seen in the HIV-positive subsample. There was a nonsignificant trend toward increased risk for a post-diagnosis suicide attempt. These findings suggest that additional research on mental health risks among populations at risk for HIV in PR is needed.

Increasing faculty capacity: findings from an evaluation of simulation clinical teaching.

AIM: To compare how the use of different "doses" of simulation in undergraduate clinical teaching affect faculty capacity. BACKGROUND: Since 2008, the NYU College of Nursing has used a "high dose" of simulation to substitute for 50 percent of the clinical hours in core medical-surgical courses to address a shortage of faculty and clinical sites. Johns Hopkins University School of Nursing has used limited, "low-dose" simulation hours to supplement clinical hours. METHOD: The evaluation included program data and surveys and qualitative interviews with faculty and students in each program. RESULTS: Implementing "high-dose" clinical simulation resulted in a nearly 50 percent increase in faculty capacity at NYU, expanding undergraduate enrollment from 613 students in 2007 to 900 in 2012, with no negative impacts on faculty work life or student outcomes. CONCLUSION: Substituting simulation for traditional clinical hours can be a sustainable and educationally sound option to increase faculty capacity.

Developing and testing a web-based platform for antiretroviral therapy (ART) adherence support among adolescents and young adults (AYA) living with HIV.

Objective: Describe the development and testing of a web-based platform for antiretroviral treatment (ART) adherence support among HIV+ adolescents and young adults (AYA) in a randomized controlled trial (RCT). Methods: A seven-member multi-disciplinary team operationalized the flat, password protected, web-based platform. Manualized protocols guided the objectives and content for each of the eight web-based sessions. Team members evaluated usability and content validity. Client satisfaction and perceived ease of use was evaluated with the first ten HIV+ AYA participants. Results: The web-based platform was developed, evaluated, refined, implemented and pilot tested between September 2020 to April 2022. Usability was rated as high; the evaluation of content validity showed an excellent fit between session content and objectives. HIV+ AYA participants (mean age = 24.2 years) were satisfied with the quality, type, and amount of support/education received, and found the platform easy to use, operate, and navigate. Average time spent per session was 6.5 min. Conclusion: Findings support the usability, validity, acceptability, and feasibility of this web-based platform for ART adherence support among HIV+ AYA. Innovation: Our research and findings are responsive to research gaps and the need for transparency in the methodological development and testing of web-based control arms for ART adherence support among HIV+ AYA.

HIV Syndemic Factor Associations Among Adolescent Gay and Bisexual Men in the Youth Risk Behavior Survey 2015-2019: A Secondary Data Analysis.

ABSTRACT: This analysis of the Youth Risk Behavior Survey examined HIV syndemic factor associations (substance use, violence, mental health, and HIV risk behaviors) among adolescent gay, bisexual, and other men who have sex with men-a population with the highest prevalence of undiagnosed HIV infections. The representative sample ( n = 644) exhibited low condom use (52%) and HIV testing (21%). Adjusted multivariate logistic regression models showed that Blacks were less likely to report HIV testing (adjusted odds ratio [aOR] = 0.06, 95% confidence interval [CI] [0.01-0.44], p < .01), whereas Hispanics were more likely to report four or more lifetime sexual partners (aOR = 3.75, 95% CI [1.49-9.44], p < .01), compared with Whites. A syndemic of substance use and intimate partner violence (sexual, sexual dating, and/or physical dating violence) was associated with early intercourse, multiple sexual partners, and drugs/alcohol before intercourse. Multiple syndemic factor exposures were associated with additive risk, suggesting multilevel approaches for HIV prevention.