AIDS Patient Care and STDs

Hepatitis C virus (HCV) is transmitted primarily through parenteral exposure to infected blood, and sexual transmission in heterosexual couples has generally been considered inefficient. However, this conclusion is based largely on studies of immunocompetent monogamous couples and may not fully apply to women living with human immunodeficiency virus (HIV). This narrative review integrates biological, virological, and epidemiological evidence relevant to sexual acquisition of HCV in women with HIV, with particular attention to heterosexual exposure, women without injection drug use, genital tract shedding, and partner-related cofactors. Baseline heterosexual transmission risk appears to be very low in low-risk couples, yet the epidemiological evidence in women is sparse, mostly observational, and often underpowered. Even so, converging biological and epidemiological signals suggest that this risk may be underestimated in selected settings. In women living with HIV, chronic cervicovaginal inflammation, sexually transmitted infections, HPV-related cervical abnormalities, genital bleeding, and impaired local immune defenses may create a mucosal environment more permissive to the acquisition of blood-borne viruses during sex. HCV RNA has also been detected in the female genital tract, particularly in the presence of blood. Current evidence does not demonstrate that HIV is a definitive causal risk factor for sexual HCV transmission in women, but it does support the view that HIV may act as a clinically relevant risk modifier in selected exposure settings, particularly when the male partner is coinfected with HIV and HCV and has injection-related risk. In the direct-acting antiviral era, this issue has practical implications for enhanced testing, partner management, and treatment of current HCV infection in discordant partnerships.

Despite the availability of pre-exposure prophylaxis (PrEP) in the Republic of Korea, structural and social barriers continue to hinder its widespread adoption. This study aimed to examine longitudinal changes in PrEP awareness, utilization, and perceived barriers among sexual and gender minorities to inform national HIV prevention strategies. Two independent online cross-sectional surveys were conducted in January 2022 (DB1) and December 2024 (DB2), primarily targeting men who have sex with men; transgender individuals comprised 0.6% of DB1 and 10.6% of DB2. The surveys assessed sociodemographic characteristics, PrEP awareness, usage patterns, perceived barriers, sexual behaviors, and histories of sexually transmitted infections (STIs). PrEP awareness improved significantly, with the proportion of respondents who had “never heard of PrEP” decreasing from 33.8% to 19.0% (p < 0.001). Actual usage remained low (5.5%), and 81.4% of current users relied on informal overseas channels rather than domestic prescriptions. Low-awareness individuals are primarily deterred by an uncertainty of need and situational factors, while high-awareness individuals identify pill burden and high cost as dominant. App-based partner-seeking and a higher number of sexual partners were associated with increased odds of bacterial STIs. PrEP use was not significantly associated with a history of STIs after adjustment for behavioral variables. Overall, PrEP users were more likely to exhibit established HIV risk factors, including use of dating apps, unprotected sex, and a higher number of sexual partners. Despite increased awareness, significant gaps remain in the PrEP care continuum in Korea, particularly in translating awareness into uptake. Targeted implementation strategies are needed to improve PrEP uptake and sustain engagement in care.

Despite major advances in antiretroviral therapy and increased public awareness of HIV transmission routes, people with HIV continue to experience HIV-related stigma, which has been associated with adverse psychosocial outcomes and challenges in health care engagement. This study aimed to assess HIV-related stigma across four dimensions, using Berger’s HIV Stigma Scale. An observational study was conducted at a tertiary hospital in Spain, where adults living with HIV were invited between 2019 and 2024 to complete a validated version of Berger’s stigma scale through an online tool integrated into the electronic medical records system. Stigma dimensions were analyzed overall and compared by age group (≤50 vs. >50 years). The final cohort included 1296 participants, predominantly male (97.3%). The median age was 46 years; 20.5% had previously accessed mental health services. A high burden of stigma was observed across all dimensions, with concerns related to disclosure emerging as the most prevalent: 91.8% of participants reported being very cautious about disclosing their HIV status, and 88.3% concealed their diagnosis in many aspects of their lives. Concerns about public attitudes were also frequent. Participants aged ≤50 years showed higher levels of internalized stigma, particularly negative self-image and personalized stigma. These findings highlight the persistence of HIV-related stigma in routine clinical settings and reinforce the value of its systematic assessment to identify psychosocial vulnerability and inform person-centered care; however, they should be interpreted in light of the observational design, as causal relationships with clinical outcomes cannot be established.

New York City surveillance data document substantial heterosexual transmission of HIV and other sexually transmitted infections (STIs). Existing research provides limited insight into how heterosexual adults approach and use HIV and STI testing, an intervention that can inform the need for treatment and reduce onward transmission. Through in-depth interviews with 50 heterosexually active women and men in New York City conducted in 2023 and 2024, we found that testing for HIV and STIs was widespread and integrated into broader health care routines. Our exploratory study identified three primary approaches that participants used as needed: preemptive testing (used before having sex with new partners or discontinuing condom use); reactive testing (following heightened risk perceptions); and routine screening (as part of ongoing sexual health maintenance). Our findings suggest that for many heterosexually active women and men HIV and STI testing is an accessible and acceptable practice, which public health can promote to reduce transmission.

Young Black sexual minority men (YB-SMM) who are living with HIV not only face numerous challenges to their health but also demonstrate a range of resilience processes that can be augmented to improve HIV care engagement. We adapted a previously developed in-person group intervention, Brothers Building Brothers By Breaking Barriers, into a remotely delivered telehealth program (Tele-B6), with a goal to enhance existing resilience by building social capital and affirming intersectional identities among YB-SMM living with HIV. We enrolled 60 participants in Atlanta, Georgia, into a pilot randomized controlled trial with a waitlist control design, to examine feasibility, acceptability, and safety of Tele-B6. Our evaluation included brief postsession evaluation surveys, fidelity checklists completed by facilitators, and longitudinal in-depth surveys conducted at baseline and 2-month intervals up through 6 months post-enrollment. Overall, we found that Tele-B6 was feasible to implement, highly acceptable to participants, and safe. Exploratory analyses also suggested potential improvement in general well-being and social capital, though interpretation of these results is limited given the small sample size. Tele-B6 is a promising intervention with potential for scalability and impact for supporting YB-SMM in HIV care.

ClinicalTrials.gov registration: NCT05829759.

We examined pre-exposure prophylaxis (PrEP) persistence and associated characteristics among a nationwide sample of US men who have sex with men (MSM). Sexually active, HIV-negative MSM aged ≥15 years were recruited online through the American Men’s Internet Survey, an annual survey; the current analysis uses cross-sectional data collected between December 2023 and August 2024. Participants reported PrEP use and duration. PrEP persistence was defined as continuous PrEP use for ≥12 months. Poisson regression models estimated associations between sociodemographic and behavioral factors and PrEP persistence. Among 3953 MSM, 40% were currently using PrEP, and 72% of those had maintained use for ≥12 months. Most participants were using daily oral PrEP, while 3.2% reported use of long-acting injectable cabotegravir. In multi-variable analyses, MSM aged 25–29 years versus ≥40 years (prevalence ratio [PR]: 0.75, 95% confidence interval [CI], 0.57, 0.98) and those without health insurance versus with private insurance (PR: 0.60, 95% CI, 0.37, 0.96) were less likely to maintain PrEP use. MSM reporting condomless anal sex (PR: 1.41, 95% CI, 1.05, 1.88) and more than one male partner (PR: 2.13, 95% CI, 1.56, 2.92) in the past year were more likely to sustain PrEP use. No associations were observed for race/ethnicity, region, illicit drug use, or mental health. Most current PrEP users reported sustained use for ≥12 months. Findings should be interpreted in light of limitations, including potential selection bias due to online recruitment. Younger and uninsured MSM had lower persistence, highlighting the need for targeted interventions to promote long-term PrEP engagement and reduce HIV risk.