Gender differences in reported number of sexual partners are observed consistently across many African nations, yet factors driving these disparities have yet to be thoroughly examined. The purpose of this study is to investigate the role of engagement with paid sex workers in explaining these differences. We used data from the Population-based HIV Impact Assessment from Columbia University collected from four African nations with historically high HIV incidence. We employed linear regression models to examine relationships between reported use of paid sexual services and number of lifetime sexual partners, controlling for age, age at sexual debut, gender, rural/urban residence, and relationship status. Engagement with sex workers was a significant predictor of a greater gender gap in reported sexual partners in each nation studied, but relationships differed notably between nations. Differences were greatest in Tanzania and Ethiopia, with males who participated in sex work having on average 9.52 more sexual partners than their female counterparts (p<0.001). These findings suggest that the use of paid sexual services is a key factor contributing to observed gender disparities in sexual partner numbers in the nations studied. These results highlight the need for targeted interventions focusing on both sex workers and their partners, especially in locations where efficient allocation of resources may be important. Such interventions might include enhanced HIV testing services among sex workers and their partners or improved access to sexual health educational resources. Appropriately tailored efforts may more effectively address drivers of sexual health disparities and guide the use of public health resources.

Background: Adolescent girls and young women (AGYW) in Eastern and Southern Africa remain disproportionately affected by HIV. Researchers have consistently demonstrated the effect of HIV-related partner communication on sexual risk behavior, such as consistent condom use and increased HIV testing. While many HIV prevention efforts primarily focus on individual-level behavior change, the role of social support networks may play a critical role in shaping AGYW’s health-related decisions. Understanding these influences is essential for promoting safer sexual practices and reducing HIV risk among AGYW. Objective: This study examined the impact of family and peer communication about sex and HIV on HIV-related partner communication among AGYW in rural South Africa. Methods: We analyzed baseline data from the HIV Prevention Trials Network (HPTN) 068, a randomized trial of a cash transfer intervention among young women aged 13 to 20 (n=688) enrolled in school in rural South Africa. Data was collected from March 2011 to December 2012. HIV-related partner communication (HPC) was defined as discussions between sexual partners about HIV prevention, testing, and condom use. Descriptive statistics and inferential statistical analyses were conducted, including Chi-Square tests and multivariable logistic regression analysis. Results: The majority of participants (83.74%) reported engaging in HPC. Significant associations were recorded between HPC and self-efficacy for condom use (p=0.001), any sex in the last 3 months (p=0.05), peer communication (p=0.001), and family communication (p=0.001). AGYW who reported discussing sex and HIV with peers (aOR=2.13, 95% CI: 1.31–3.45, p =0.002) and family (aOR=2.00, 95% CI: 1.17–3.43, p=0.011) were twice as likely to engage in HPC compared to those who did not have such discussions. Similarly, AGYW who had sex in the last 3 months had higher odds of HPC (aOR=1.95, 95% CI: 1.07-3.56, p=0.0282). Additionally, those with greater self-efficacy for condom use were significantly more likely (aOR=1.89, 95%CI: 1.19-2.99, p=0.007) to engage in HPC compared to individuals with low self-efficacy for condom use. Conclusions: These results underscore the need for HIV prevention programs to incorporate family- and peer-based strategies that enhance communication skills and empower AGYW to engage in open discussions about HIV prevention, ultimately contributing to reduced sexual risk behaviors.

Background: Individuals experiencing mobility face significant barriers to accessing and adhering to antiretroviral therapy (ART), increasing the risk of treatment interruptions and suboptimal viral suppression. They endured complex socio-economic challenges that further exacerbate these risks. The USAID-funded BRIDGE project, implemented since December 2019, aims to improve HIV care access and continuity for mobile populations in Haiti. This analysis explores the outcomes related to international migration inside the project.
Description: To assist ART clients migrating outside the country BRIDGE implemented multiple interventions including: collaboration with HIV service providers in the Dominican Republic (DR) to facilitate referrals and ensure continuity of care, establishment of HIV service delivery points at two major border entry points (providing services for both returning deportees and individuals migrating to the DR), development and dissemination of a referral list of HIV service providers in five key destination countries, implementation of differentiated service delivery models, including ART pick-up options by family members.
Lessons learned: From January 2020 to December 2024, 3,880 individuals were enrolled on ART within the BRIDGE project from which 762 are not currently on ART. 126 (3%) of enrolled clients migrated outside of Haiti, 74 males and 52 females. Thirty-one (25%) are not currently on ART (24 transferred, 4 interrupted treatment, 3 died) representing 4% of total project ART attrition. Among the 95 emigrants who remained on treatment, 87% are residing in the DR (N=83). ART pick-up strategies varied: 20 clients used DR-based clinics, 49 utilized family/friend pick-up (including 15 at border sites), 25 picked up medication during their return trips to Haiti at the clinic or border sites and one is deserved via DHL. 54 (57%) out the 95 migrants have a 12-month viral load result available with 52 achieving viral suppression (96%).
Conclusions: This analysis showed international migration had a low impact on our overall ART attrition, and highlights the importance of tailored interventions to address the needs of those populations. Continued collaboration with partner organizations in destination countries, expansion of differentiated service delivery models, and strengthening of data collection systems are crucial to improve treatment adherence and viral load monitoring for Haitian migrants.

Background: We compared the performance of self-reported adherence (SR), pill counts, and electronic adherence monitoring (EAM) in monitoring antiretroviral therapy (ART) adherence and predicting viral suppression among adolescents living with HIV (ALHIV).

Methods: We used data from 702 ALHIV at 39 clinics in Uganda. Participants were aged 10 to 16 years, and receiving ART. We compared the performance of the adherence measures using Kappa and agreement coefficient. We also determined the sensitivity, specificity, and area under the curve (AUC) for each adherence measure in predicting viral suppression (<200 copies/mL). In addition, we fit multilevel logistic regression models to determine the association between each adherence measure and viral suppression.

Results: Overall, 73% of ALHIV reported good ART Adherence, while 67.1% achieved viral suppression. There was disagreement between the adherence measures with kappa <0.10 and agreement coefficient ranging between 0.410 (SR vs. EAM) and 0.545 (pill counts vs. EAM). When we categorized adherence at 90% cut-off, sensitivity was high (ranging between 74.9% for SR and 87.1% for pill counts) and low specificity ranging between 11.9% and 30.7% for pill counts and SR, respectively. The AUCs ranged between 0.560 for pill counts and 0.616 for SR. Only SR was significantly associated with viral suppression, OR = 2.16 (95% CI: 1.25 – 3.81), p=0.006.

Conclusion: Different methods measure ART adherence with significant discrepancies. All three adherence measures had a low ability to predict viral suppression, with only SR being associated with viral suppression. Our results highlight the need for refining existing adherence measures.

Background: The Zarit Burden Interview (ZBI-22) has been widely used to assess caregiver burden, yet its applicability among family members of people with HIV (PWH) in China remains understudied. This study aims to evaluate the psychometric properties of the Chinese version of ZBI-22 in this specific population.

Method: Items of the ZBI-22 in English version were adapted to reflect HIV care in China and translated into Chinese using the back-translation procedure. A total of 793 family members of PWH from Guangxi Province completed the survey regarding ZBI-22 and other related measures, with 709 providing valid data. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed on randomly split samples to identify and confirm the factor structure. Convergent validity was assessed using correlation with other burden measures (e.g., BSFC-s). Criterion validity was assessed using hierarchical regression and path analysis with psychiatric measures (e.g., PSS-10 [stress], PHQ-4 [psychological distress]). Internal consistency analysis was conducted to assess reliability, and the ROC analysis was used to determine the benchmark value. ANOVA was performed to examine group differences.

Result: EFA suggested a four-factor structure: Emotional and Social Strain, Caregiver Guilt, Caregiver Overload, and Uncertainty About the Future, and CFA showed a good model fit for this structure (CFI = 0.921, TLI = 0.906, RMSEA = 0.064). The scale showed good convergent validity with BSFC-s (r = 0.580, p < 0.001) and criterion validity with both stress and psychological distress (β = 0.205; β = 0.070; respectively, both p < 0.001). Reliability was excellent (Cronbach’s α = 0.93), with subscale Cronbach’s αs ranging from 0.82 to 0.94. A cut-off score of 18 was identified to indicate clinically meaningful burden. ANOVA indicated significant differences in caregiver burden across gender, age, caregiver relationship, and patients’ demographics and clinical outcomes.

Conclusion: The Chinese version of ZBI-22 demonstrates sound psychometric properties and is a valid and reliable tool for assessing caregiver burden among caregivers of PWH in China. Our findings regarding its four-factor construct and group differences inform tailored intervention and support strategies for HIV caregivers.

Keywords: caregiver burden, HIV, Zarit Burden Interview, validation study, psychometric properties, China

Introduction

Religious institutions are significant social and cultural resources in many neighborhoods throughout the United States. The density of religious institutions has been linked to lower rates of poor health and mortality outcomes in the U. S. population. The distribution of religious institutions and other aspects of the religious landscape, such as the prevalence of church members (i.e., adherents), may be associated with HIV incidence. Empirical findings on this topic remain scant.

Methods

We used geospatial and multivariate ecological analyses to test the associations between three religious environment variables and new HIV diagnoses in 2022 across N = 2020 counties with available HIV data. The three variables were: (1) rates of churches that closed in specific windows (e.g., between 2009 and 2014). A church is classified using Standard Industry Classification code 8661.07; (2) change in the rates of adherents between 2010 and 2020; and (3) change in the rates of congregations in the U.S. between 2010 and 2020. We conducted zero-inflated binomial regression, adjusting for the percentage of Black individuals, the percentage of Hispanic individuals, the GINI coefficient, mobility, percentage of overcrowding, socioeconomic deprivation (including income, education, unemployment, and poverty), and whether the county was prioritized for the Ending the HIV Epidemic initiative.

Results

Church closings, religious adherence, and congregation change were significantly clustered. Counties with the highest/5^th quintile of church closings (compared to the lowest) had lower rates of HIV (Incidence Rate Ratio (IRR)= 0.26, 95% CI = 0.18- 0.37, p = 0.000. An increase in adherence rate was associated with 21% higher rates of new HIV diagnoses (IRR=1.21, 95%CI=1.07-1.37, p=0.002. The highest quartile of increase in congregations (compared to no or low change) was also associated with higher rates of new HIV diagnoses IRR=1.32, 95%CI=1.03-1.76, p=0.03).

Conclusions

Specific aspects of the religious environment shape HIV differently, possibly, through multiple complex social mechanisms, including stigma, community norms, and access to information. Interrogating this relationship is crucial for developing effective HIV prevention strategies. Public health practitioners should reconsider assumptions about religious contexts when designing community-based approaches to HIV prevention and testing, particularly in areas with strong religious participation.

Background

HIV/AIDS remains a public health concern affecting millions of people across the world. Although the health-related quality of life (HR QoL) of patients living with HIV significantly improves after treatment, it is important to understand all that is required to ensure optimal care and better health outcomes among the people Living with HIV/AIDS which still remains a challenge in Nigeria with a mix of socioeconomic, cultural and ethnic diversity among other factors which plays a significant role in the wellbeing of individuals. Highly active antiretroviral therapy (HAART) no doubt plays a very critical role in ensuring positive health related quality of life (HR QoL) but not sufficient to maintain the desired health related quality of Life.

Method

A cross sectional study in which 216 PLWHA who had been on treatment and enrolled in the ART program for at least 24 months between (October 2021 and September 2023)were selected using convenient sampling (random Sampling) across four comprehensive Antiretroviral Therapy sites in Southwest ,Nigeria were questioned using Quantitative method, self -administered short structured questionnaires to determine the Quality of life and what factors were responsible including their adherence to ART and other medications to prevent co-morbidities. The WHO QoL-HIV BREF (questionnaire) was used to assess HR QoL. Data was analyzed using descriptive statistics, Chi-square and linear logistic regression at p=0.05.

Result

198 of the 216 selected PLWHA (92%) were respondents. The mean age of respondents was 38.4±8.5 years with M:F ratio of 1:2. About two-third (65.7%) of respondents were married, 86.1% were currently employed, 27.0% were in the high occupational class and 53.8% earned below the minimum wage. Over two-third (67.1%) came from functional families. Sixty-two percent perceived their HR QoL as being good and 72.2% were generally satisfied with life. The predictors of HR QoL were marital status, employment status, average monthly income and family functionality, healthy lifestyle, reduced stigma and discrimination in addition to ART adherence

Conclusion

Social factors are largely determinants for HR QoL of PLWHA regular on ART. Understanding these factors and dynamics is critical to better health outcomes among PLWHA

Background: HIV continues to ravage communities in western Kenya. The proportion of women living with HIV in Kakamega County is significantly higher than that of men. Over a number of years, women living in the county have been more vulnerable to HIV infection than men due to cultural practices, chauvinistic society, men relying on women’s HIV test results, low male involvement and early marriage among others. This study aims to highlight cultural factors that influence the risk of HIV infection among women.

Methods: This was part of a larger mixed methods study that collected survey data (n=810) women of reproductive age (18-49) and conducted key informant interviews (n=16), Focus group discussions (n=4) selected from among clan elders; reproductive health officers; religious leaders (Christians; Muslims; African Traditional Religion); and health workers. The study was carried out in fifty-four (54) villages under the twelve (12) sub-counties in Kakamega. Summary statistics were generated using frequency and contingency tables. The views from participants were summarised verbatim under the research questions and emerging themes.

Results: The most frequently mentioned cultural factors that influence the risk of HIV infection among women include, wife/widow inheritance; disco “matanga” (funeral discos); and acceptability of multiple sexual partners. Study participants indicated that clan elders supported and encouraged these cultural practices. Participants suggested abolishing negative cultural practices such as widow cleansing; “disco matanga”; forced wife inheritance. They further suggested that HIV testing should be done before “makhola” (wife inheritance); maximize the use of “baraza’s” (community gatherings) to promote cultural practices that enforce family values; mutual respect and modesty.

Conclusion: There exist cultural practices that put women at risk of HIV infection. Further research should be undertaken to assess the barriers that prevent community members from speaking against negative cultural practices. Reinforce transmission of cultural values that created harmony within the community from clan elders to the younger generation.