Background: Older people with HIV (PWH) live in diverse neighborhoods where community-level factors can impact their HIV health and treatment adherence. However, interventions addressing community challenges for this population are virtually non-existent. To develop and prioritize needs for addressing community-level factors, learning from the lived experiences of older PWH will be integral.

Methods: PWH who were at least 50 years-old (n=20; Mean age=55 years; range 50–60 years) were selected for analysis. Participants who previously established HIV care were recruited through word-of-mouth and flyers posted in community locations. Semi-structured, face-to-face interviews were recorded, transcribed, coded, and triangulated during team meetings.

Results: The majority of participants were male (75%) and Black (80%). Participants voiced the importance of and need for more religious organizations, recreation/fitness centers, substance use support groups, and education on HIV for the public to reduce homophobia and stigma. Participants also reported a need for a safe, clean community where they can participate in social activities and access resources without fear.

Conclusions and Implications: The voices and perceptions of older PWH regarding the most significant needs on their HIV and aging related health should be reflected in policy development and implementation. Such involvement of older PWH allows for a comprehensive service planning and delivery model that will enhance program effectiveness for PWH’s health maintenance and overall quality of life. Addressing community-level resources may allow for better engagement of older PWH, representing a creative method of facilitating effective and efficient linkage to HIV medical care, retention, or (re)engagement in care.

Background: Prior research has examined how emotional health affects the well-being of people with HIV (PWH). An important question to explore is which resources older PWH access and utilize to sustain their emotional health. Lived experiences of participants from community-based participatory research can shed light on how they maintain their emotional well-being.

Methods: PWH who were at least 50 years-old (n=20; Mean age=55 years; range 5060 years) were selected for analysis. Participants, who previously established HIV care, were recruited through word-of-mouth and flyers posted in community locations. Semi-structured, face-to-face interviews were recorded, transcribed, coded, and triangulated during team meetings.

Results: Most participants were male (75%) and Black (80%). Emergent themes identified four types of resources to achieve optimal well-being: spirituality, family support, clinic support, and locus of control. Participants stated that their spirituality provided strength and purpose in life. Family members and a local clinic were noted as a source of social support. Belief that they have control over what happens to them aided participants in maintaining a positive attitude.

Conclusions/implications: Leveraging available community resources can be a means to improve older PWH’s emotional health. Helping professionals should discuss: 1) integration of the practice or regaining of spirituality as an emotional health strategy; 2) enhancement of social support; and 3) methods for assisting older PWH in developing a sense of control over their own lives and HIV health. It is important to assess where older PWH’s strengths lie and to employ a strength-based approach to optimize emotional health.

Background: While older persons with HIV (aged 50+; PWH) advance in age with various challenges and concerns, they may also become a caregiver of their elderly parents, sibling(s), spouse/partner, other family members, or friends. Older PWH’s caregiving responsibilities may hinder them from maintaining their own HIV care and physical, cognitive, and mental health. Yet, little attention has been given to the overlap between older PWH self-care and their caregiving responsibilities. There is an urgent need to fill this gap in the HIV literature.

Methods: Using the Wellbeing of Older People Study (WOPS)–Wave 2 South Africa in collaboration with the World Health Organization (WHO) Study on Global AGEing and Adult Health (SAGE), we conducted univariate and bivariate analyses to describe older PWH who were caregivers (n=247) to either adult-children or children and compared them to older caregivers without HIV (n=159). The WOPS provides information on the roles and health issues of older people (50+ years) who were infected and/or affected by HIV.

Results: Caregivers without HIV were significantly older than caregivers with HIV (OCWH) (67.3 years with max. 98 vs. 59.0 years with max. 87). Over 78% of caregivers were female. Almost half of caregivers had little or no formal education. The mean number of adult-children or children they cared for did not differ between the two groups. Both groups provided financial assistance to about 3.5 children and 3.1 adult-children, and provided caregiving for physical needs to about 3 children and 2.7 adult-children. OCWH were significantly more likely to report no income or reliance on government assistance than their counterparts. In other variables (e.g., chronic conditions, difficulty in cognition, depression), the differences between groups were nonsignificant.

Conclusions/Implications: Considering how OCWH were significantly younger than their counterparts in this study, it is concerning that OCWH did not report better health and/or emotional and cognitive conditions, which may indicate “accelerating aging.” For OCWH, caregiving roles may be more challenging than people without HIV because OCWH may face more strain and lack of resources. These findings urge researchers and practitioners to develop age-appropriate and geographically relevant interventions for HIV-infected and -affected older caregivers.

Background: Physical violence (PV) and sexual violence (SV) are widely reported by men who have sex with men (MSM) in the U.S., which is a serious public health problem. Most research on violence is in the context of intimate relationships, and little is known about violence more broadly and its association with HIV-related sexual risk behaviors among MSM at the population level.

Methods: We analyzed 2017 weighted data from National HIV Behavioral Surveillance (NHBS) that used venue-based sampling methods to interview MSM in 23 U.S. cities. We estimated prevalence of PV and SV and assessed violence and HIV-related sexual risk behaviors among MSM. P-values were calculated using Rao-Scott chi-square tests for categorical data and Wilcoxon rank-sum tests for continuous data.

Results: Among 9,326 MSM, 13% reported PV and 6% reported SV in the past 12 months. MSM who experienced PV or SV were more likely to be younger (18-29 years), uninsured, unemployed, and homeless.

MSM who reported PV were more likely than those who did not report PV to have higher median number of partners (5 vs. 4, p<0.001) and exchange sex for money or drugs (15% vs. 7%, p<0.001).

MSM who reported SV were more likely than those who did not report SV to have higher median number of partners (7 vs. 4, p<0.001) and exchange sex for money or drugs (20% vs. 7%, p<0.001).

Conclusions: MSM who reported violence tended to be young and report low socioeconomic status. Violence was associated with HIV-related sexual risk behaviors, which may increase HIV risk. Increased awareness of violence toward MSM, violence screening in health care and services settings, and interventions focused on the syndemic of violence and HIV are needed.

Background: eHealth-based strategies are increasingly being developed to support advances in HIV testing, prevention, and treatment. Understanding the best ways to use eHealth to increase uptake and adherence to novel biomedical technologies, including HIV self-testing and pre-exposure prophylaxis (PrEP), is critical to the development of feasible, acceptable, and effective eHealth approaches. We conducted online focus groups to explore feedback on eHealth HIV testing and PrEP intervention strategies among a nationwide sample of young sexual minority men (YSMM).

Methods: In 2020, HIV-negative YSMM (n=41; M_age=21.0; 85.4% cisgender; 56.1% Black or Latino; 65.9% gay-identified) who met CDC criteria for PrEP were recruited via social media and men-for-men geosocial networking apps to participate in 9 synchronous online focus groups, eliciting preferences and opinions about eHealth HIV prevention modalities (video-based, computer-assisted, virtual simulation, and multimedia-based intervention). Data were analyzed using inductive and deductive thematic analysis with constant comparison.

Results: We identified five key themes related to eHealth HIV interventions including interest in: (1) mobile and online virtual simulation of prevention scenarios; (2) interactive software with individually-tailored videos and quizzes; (3) real-time connection to additional services (e.g., mental health, HIV testing, PrEP services), (4) non-stigmatizing language and imagery inclusive of all gender and sexual identities; and (5) access to HIV self-testing, especially in the context of COVID-19.

Conclusions: YSMM requested eHealth interventions with video-based content, real-time connection to additional services, and creative strategies to build more inclusive virtual and mobile-friendly content. Findings provide a key direction to build, adapt, and connect HIV prevention to YSMM.

Background: Association between cigarette smoking and substance abuse and other health outcomes is well documented. Electronic cigarette (e-cigarette) use is a major public health concern and its relationship with HIV risk behavior has not been investigated yet among adults (18 to 64 years of age) in large population-based studies. Using data from the 2016 and 2017 Behavioral Risk Factor Surveillance System (BRFSS), this study examined the association between e-cigarette use and HIV risk behavior and if the association is moderated by age, race, and gender.

Methods: Data from the 2016 and 2017 BRFSS consisted of 515,737 US adults. E-cigarette use was categorized into two groups (Yes vs. No); HIV risk behavior is ascertained as a binary response (Yes vs. No). Weighted prevalence estimates and corresponding 95% confidence intervals were computed to describe the study population. Association between e-cigarette use and HIV risk behavior was examined using logistic regression models adjusting for all potential confounders. Statistical analysis accounted for complex sampling design of the BRFSS.

Results: Overall, the prevalence of e-cigarette use among US adults (18 to 64 years of age) was 25.0% (95% CI: 24.7% – 25.2%) and HIV risk behavior was 7.7% (95% CI: 7.5% – 7.8%). The prevalence of HIV risk behavior among e-cigarette users was significantly higher, 16.0% (95% CI: 15.5% – 16.4%), compared to non-users, 4.9% (95% CI: 4.8% – 5.1%). After adjusting for potential confounders in the logistic regression model, e-cigarette use was significantly associated with HIV risk behavior: Odds Ratio (OR) 1.83 (95% CI: 1.73 – 1.93). Age and race significantly modified the association between e-cigarette use and HIV risk behavior.

Conclusions: E-cigarette use is significantly associated with HIV risk behavior. This association was much augmented in young adults (18 to 34 years) and Asians. Community and evidence-based health promotion programs are needed to target adults who smoke e-cigarettes.

Purpose: Providing cost effective, evidence based, targeted health promotion education within the faith based organization may be the best, most appropriate way to access and encourage many women to attend a Human Immunodeficiency Virus (HIV) prevention program and start a candid, open dialogue about the prevalence, transmission risk factors, and ways to decrease the acquisition of HIV. Based on numerous studies, retention is an issue when conducting multiple session community based health interventions. A single session intervention using the best targeted intervention may provide the basic knowledge and strategies needed by women. For this pilot study, the preliminary testing of validity and reliability of two instruments include HIV Knowledge Assessment Tool© and Knowledge of Sexual Risk Behaviors Assessment Tool©.

Methods: A preliminary study was completed to determine the reliability of the instruments. Participants included 55 senior nursing students enrolled in the Population Health course.

Results: The HIV Knowledge Assessment Tool© produced a Cronbach’s alpha of .396. This was based on eight items since two items were answered correctly by all participants in the preliminary study and therefore have zero variance. The HIV Knowledge Assessment Tool produced a KR-20 of 0.371. The KR-20 would increase to .481 with the deletion of one question.

The Knowledge of Sexual Risk Behaviors Assessment Tool© produced a Cronbach’s alpha of .671 for the 14 items in the preliminary study. This was based on 11 items since 3 items were answered correctly by all participants in the preliminary study and therefore have zero variance. This meets the reliability coefficient of .70 for a newly developed instrument, as defined by Burns and Grove (2009). The Knowledge of Sexual Risk Behaviors Assessment Tool produced a KR-20 of 0.657. KR-20 scores are 0-1, with scores above .50 being acceptable for teacher made tests. The KR-20 would increase to .672 with the deletion of one question.

Conclusion: The newly developed instruments show promise. With deletion of the above noted questions and further study, these instruments could be used by the health care system and community based nursing to determine HIV knowledge and knowledge of sexual risk behaviors.

The characteristics of justice involved individuals overlap with groups experiencing the highest rates of new HIV infections. Once released from prison or jail, these individuals face additional challenges, including triple stigma of HIV, incarceration, substance use and mental health disorders. As a part of the HRSA/SPNS Initiative: “Improving HIV Health Outcomes through the Coordination of Supportive Employment and Housing Services”, twelve demonstration sites across the U.S. implemented interventions to connect people living with HIV/AIDS (PLWHA) to medical, housing, and employment services. Longitudinal surveys were conducted with a total of 1,086 participants, 68% of whom were justice-involved PLWHA. These surveys assessed participant care needs and examined barriers that can impede progress along the HIV treatment cascade, including barriers related to internalized or anticipated stigma.

On average, composite stigma scores in the six-month assessment period were lower than those taken at baseline, for both justice-involved and non-justice involved participants. HIV stigma scores were slightly higher amongst individuals who had no previous history of incarceration for both baseline and six-month assessments, though justice-involved individuals were more likely to agree when asked at baseline if they felt ashamed of having HIV. This difference decreased when the same question was asked six months later.

It is important for service providers and advocates to consider the unique needs and concerns of justice-involved PLWHA. The results of this study can help guide future programming that will be better tailored to address stigma and help recently released PLWHA improve health and quality of life outcomes.

Background Continuous engagement in care is vital to ensuring ideal outcomes among people living with HIV (PLWH). Unfortunately, many months pass before loss to follow-up is realized by providers. PLWH who have fallen out of care might even have moved out of a caregiver’s area before this discontinuity is realized, preventing the individual from being located. An important predictor of retention in care (RIC) is poverty which is also a predictor of high emergency department (ED) utilization and justice interaction. This study aimed to link ED utilization and justice interaction to identify whether re-engagement efforts in EDs should be prioritized.

Methods To evaluate RIC and ED utilization pre and post-justice interaction, we used linked person-level justice (arrest, jail, juvenile, and prison) and eHARS data covering Marion County, Indiana for the period 2014-2018. We conducted retrospective analyses including all PLWH with their first known justice interaction not exceeding 6 months in duration with a Marion County address for at least one year prior to and after justice interaction (N=596). We used logistic regression analysis to evaluate main effects and 2-way interactions of demographics, HIV exposure category and status, pre-justice interaction RIC, and justice interaction on post-justice RIC. We used a paired t test to compare ED visits pre and post-justice incarceration and a Mann-Whitney test to evaluate ED visits pre and post-justice interaction by RIC status.

Results After adjustment for all variables, the only significant predictor for post-justice RIC was pre-justice RIC (χ2=10.66, p<0.01), with those RIC prior to justice interaction being 1.8 times (95% CI: 1.3-2.6) more likely to be RIC post-release than those who were not. There was no difference in distribution of ED visits prior to or following justice interaction (t=-1.69, p=.09), regardless of RIC status (pre-justice z=-1.60, p=0.11; post-justice z=-0.66, p=0.51). PLWH and not RIC visited an ED 2.4 ± 1.7 times in the first year following their justice interaction.

Conclusion PLWH and not RIC visited an ED nearly five times as often as the average Hoosier in their first year following justice interaction. This presents an excellent opportunity to re-link them to care.