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Men who have sex with men and transgender women in the United States are at increased risk for HIV and may benefit from pre-exposure prophylaxis (PrEP), a once-a-day pill to prevent HIV. Due to stigma and discrimination, sexual and gender minority (SGM) populations are also at risk for depression and anxiety. This scoping review sought to identify literature addressing relationships between the PrEP care continuum, depression, and anxiety among SGM individuals and others at high risk for HIV. We conducted a systematic review of four databases (i.e., PubMed, PsycInfo, Web of Science, Google Scholar) and identified 692 unique articles that were screened for inclusion criteria, with 51 articles meeting the final inclusion criteria. Data were extracted for key study criteria (e.g., geographic location, participant demographics, study design, main findings). Results suggest that while depression and anxiety are not associated with PrEP awareness or willingness to use, they can be barriers to seeking care and to PrEP adherence. However, empirical studies show that taking PrEP is associated with reductions in anxiety. Findings suggest the need to implement mental health screenings in PrEP clinical care. In addition, addressing systemic and structural issues that contribute to mental health disorders, as well as PrEP-related barriers, is critical.

In the 1980s, human immunodeficiency virus (HIV) criminalization laws became widespread across the United States. Today, such laws continue to be used to prosecute people living with HIV for a variety of behaviors though there is limited evidence that doing so curbs HIV transmission. HIV criminalization remains understudied, especially in the Deep South. Therefore, the purpose of this paper was to trace the emergence, maintenance, and enforcement of HIV criminalization laws in South Carolina—a Southern state disproportionately burdened by HIV. Specifically, Nexis Uni and other criminology databases were used to identify HIV-related laws and criminal cases in South Carolina. Results indicate that the state’s criminalization laws have remained nearly unchanged for over 30 years and continue to be used to prosecute individuals, a majority of whom are African–American. Findings support the need to reconsider HIV-related laws and devote more efforts to studying the impact of HIV criminalization on the Southern epidemic.

Objectives. To develop computable phenotype algorithms to identify a transgender and gender-diverse (TGD) cohort by using diverse data sources in All of Us, a national community-engaged program to facilitate health equity in the United States by partnering with 1 million participants. Methods. We identified TGD individuals in All of Us by applying inclusion criteria based on conditions, laboratory measurements, or medications related to being TGD in electronic health record data or confirmed survey responses, using participant data collected between May 31, 2017, and July 1, 2022. Results. Of 413 457 participants, we identified 4781 (1.2%) as TGD. Participants aged 18 to 29 years (26.1% vs 8.2%), who were bisexual (20.7% vs 3.5%), with annual income of less than $25 000 (35.9% vs 24.7%), and with housing security concerns (31.9% vs 16.0%) accounted for a larger proportion of TGD individuals than non-TGD individuals. Conclusions. Combining survey and electronic health record data enables the identification of TGD individuals who have been missed by previous studies that used survey data alone in All of Us to explore health disparities in TGD people. ( Am J Public Health. 2025;115(8):1278–1287. https://doi.org/10.2105/AJPH.2025.308129 )

People living with HIV are at increased risk for experiencing trauma, which may be linked to reduced adherence to antiretroviral therapy (ART), making it more difficult to achieve and maintain viral suppression. The current study sought to assess whether traumatic life experiences were associated with lower ART adherence among a diverse sample of people living with HIV in South Carolina. A cross-sectional survey was completed by 402 individuals receiving HIV care from a large immunology center. Principal component analysis revealed three primary categories of trauma experience (extreme violence/death-related trauma, physical and sexual assault, and accidental/disaster-related trauma). Multivariable logistic regression models using complete case analysis and multiple imputation were used to determine the associations between experiencing each trauma category and ART adherence. Complete case analysis showed that overall, participants who reported exposure to any trauma were 58% less likely to be adherent to their ART (adjusted OR 0.42; 95% CI 0.21–0.86) compared to respondents who did not experience trauma. Participants exposed to extreme violence/death-related trauma were 63% less likely to be adherent to their ART (adjusted OR 0.37; 95% CI 0.15–0.95) compared to respondents who did not experience trauma. Participants exposed to physical and sexual assault were 65% less likely (adjusted OR 0.35; 95% CI 0.16–0.77) and those who reported experiencing accidental/disaster-related trauma were 56% less likely (adjusted OR 0.44; 95% CI 0.21–0.93) to report being ART adherent compared to participants who did not experience trauma. Analyses with multiple imputation yielded similar findings as the complete case analyses. When the data were analyzed separately by gender, the associations between overall trauma, extreme violence/death-related trauma, and physical and sexual assault were statistically significant for men using complete case and multiple imputation analyses. There were no statistically significant associations between trauma and ART adherence among women. Findings highlight the need to adopt trauma-informed approaches and integrate trauma- and gender-specific interventions into HIV clinical care in the Southern United States.

Background Access to psychiatric care is critical for patients discharged from hospital psychiatric units to ensure continuity of care. When face-to-face follow-up is unavailable or undesirable, telepsychiatry becomes a promising alternative. This study aimed to investigate hospital- and county-level characteristics associated with telepsychiatry adoption. Methods Cross-sectional national data of 3475 acute care hospitals were derived from the 2017 American Hospital Association Annual Survey. Generalized linear regression models were used to identify characteristics associated with telepsychiatry adoption. Results About one-sixth (548 [15.8%]) of hospitals reported having telepsychiatry with a wide variation across states. Rural noncore hospitals were less likely to adopt telepsychiatry (8.3%) than hospitals in rural micropolitan (13.6%) and urban counties (19.4%). Hospitals with both outpatient and inpatient psychiatric care services (marginal difference [95% CI]: 16.0% [12.1% to 19.9%]) and hospitals only with outpatient psychiatric services (6.5% [3.7% to 9.4%]) were more likely to have telepsychiatry than hospitals with neither psychiatric services. Federal hospitals (48.9% [32.5 to 65.3%]), system-affiliated hospitals (3.9% [1.2% to 6.6%]), hospitals with larger bed size (Quartile IV vs. I: 6.2% [0.7% to 11.6%]), and hospitals with greater ratio of Medicaid inpatient days to total inpatient days (Quartile IV vs. I: 4.9% [0.3% to 9.4%]) were more likely to have telepsychiatry than their counterparts. Private non-profit hospitals (− 6.9% [− 11.7% to − 2.0%]) and hospitals in counties designated as whole mental health professional shortage areas (− 6.6% [− 12.7% to − 0.5%]) were less likely to have telepsychiatry. Conclusions Prior to the Covid-19 pandemic, telepsychiatry adoption in US hospitals was low with substantial variations by urban and rural status and by state in 2017. This raises concerns about access to psychiatric services and continuity of care for patients discharged from hospitals.

Background People living with HIV (PLHIV) in the southern United States (US) are at high risk for poor outcomes across the HIV care continuum leading to low rates of viral suppression. Understanding structural barriers to care—including transportation vulnerability—is critical to improve HIV outcomes. This study investigated relationships between travel time to HIV care, transportation vulnerability, and HIV care disruptions to inform future transportation interventions for PLHIV residing in South Carolina and other southern US states. Methods A total of 160 PLHIV ( N  = 160) were recruited from a large immunology center in South Carolina. Participants reported on transportation experiences, transportation vulnerabilities, and residence. Differences in sociodemographic characteristics, transportation vulnerabilities, and HIV care disruptions were compared across travel time groups (< 15, 15–30, and > 30 min from residential location to the HIV clinic) using Mantel-Haenszel Chi-Square tests. Multivariable logistic regression tested our a priori hypothesis that travel time would predict HIV care disruptions. Results A majority of participants were aged 45–64 years old (54.4%), single (77.0%), male (63.8%), and Black (77.5%). Nearly 20% of participants lived < 15 min from their HIV clinic, 59.1% lived 15–30 min, and 21.4% lived > 30 min away. PLHIV who had to travel > 30 min to HIV care were more likely than those living < 15 min away to report transportation vulnerability (73.5% vs. 51.6%, p  = 0.048), missed HIV care appointments (64.7% vs. 41.9%, p  = 0.049), and transportation challenges that prevented them from seeing HIV care providers (67.7% vs. 39.4%; p  = 0.014). Adjusted odds ratios (AOR) show that PLHIV who had to travel > 30 min were more likely to experience transportation-related disruptions to HIV care, including being late to appointments (AOR 5.25, 95% CI:1.06–25.92), missing appointments (AOR 3.85, 95% CI:1.04–15.89), and being unable to see HIV providers (AOR 7.06, 95% CI:0.59–14.89). Conclusions In South Carolina—a rural southern state with a disproportionate burden of HIV—long travel time (> 30 min) to HIV care is associated with care disruptions, including more missed visits. Transportation interventions, as well as other efforts to expand rural access to HIV care, are urgently needed to ensure that all PLHIV are able to engage in consistent HIV care in order to reach and maintain viral suppression.

Abstract Background Individuals with ulcerative colitis (UC) seek complementary treatment methods, including diet and physical activity, to manage the burden of living with UC. This study examined associations between diet-associated inflammation, physical activity (PA), and UC-related health outcomes. Methods Data were obtained from 2052 IBD Partners e-cohort participants with UC. To quantify the inflammatory potential of food intake, dietary data were converted into Dietary Inflammatory Index (DII) and energy adjusted (E-DII) scores. Physical activity data were collected using the Godin-Shephard Leisure Time Activity Index. Outcome variables included the Simple Clinical Colitis Activity Index, Short Inflammatory Bowel Disease Questionnaire, and psychosocial PROMIS domains. Results Higher E-DII scores, as indicator of increased dietary inflammatory potential, were associated with increased disease activity (β = 0.166; P < .001), anxiety (β = 0.342; P = .006), depression (β = 0.408; P = .004), fatigue (β = 0.386; P = .005), sleep disturbance (β = 0.339; P = .003), and decreased social satisfaction (β = -0.370; P = .004) and quality of life (β = −0.056; P < .001). Physical activity was inversely associated with disease activity (β = −0.108; P < .001), anxiety (β = −0.025; P = .001), depression (β = −0.025; P = .001), fatigue (β = −0.058; P < .001), and sleep disturbance (β = −0.019; P = .008), while positively associated with social satisfaction (β = 0.063; P < .001) and quality of life (β = 0.005; P < .001). Beneficial effects were generally greater for strenuous PA intensity. Conclusions An anti-inflammatory diet and increased PA are associated with decreased disease activity, anxiety symptoms, depression symptoms, and fatigue, and associated with improved quality of life, sleep, and social satisfaction for patients with UC. Such modalities may reduce the daily burden of illness and aid in managing systemic and localized inflammation associated with UC.

This study aimed to examine how trust in institutions and changes in household finances were associated with healthcare utilization and preventive behaviors during and immediately after the COVID-19 pandemic. The COVID-19 pandemic worsened health disparities, ignited distrust in healthcare systems, and contributed to household economic shifts for many United States (US) residents. To examine these issues, we surveyed a nationally representative sample of US residents in July 2020 (n = 1,085) and May 2023 (n = 2,189). These repeated cross-sectional surveys enabled investigation of how trust in key stakeholders (e.g., federal government, the healthcare system) and household finances were linked with various types of healthcare utilization (e.g., annual preventive visits, receipt of pharmacy-based healthcare), preventive health care (e.g., influenza vaccination), and preventive behaviors (e.g., exercise, healthy eating). In 2023, the likelihoods of using some types of healthcare (annual health check and pharmacy-based healthcare) and engaging in preventive health behaviors increased relative to 2020. Improved household finances were associated with greater odds of healthy eating, exercising, and receiving annual preventive visits. Trust in the healthcare system was positively associated with all healthcare use types examined including preventive care such as influenza immunization and the individual prevention behavior of healthy eating but not exercise. Findings highlight the important role healthcare systems can have as trusted entities in potentially supporting healthcare utilization and prevention in the post-pandemic environment. Policy implications of these findings include increased efforts by payers and healthcare systems to facilitate positive health behaviors for US residents via specific strategies, such as making annual preventive health checks more accessible. At the same time, it is critical to support maintaining and building trust in healthcare systems to promote appropriate healthcare utilization.

Prescription opioid misuse (POM) among people living with HIV (PLWH) is a serious concern due to risks related to dependence and overdose, and PLWH may be at higher risk for POM due to psychosocial stressors including psychological distress. However, scant POM research has examined the role of HIV-related stigma (e.g., internalized stigma, enacted stigma) in POM among PLWH. Guided by minority stress theory, this study examined a hypothesized serial mediation among enacted stigma, internalized stigma, psychological distress, and POM within a sample of Chinese PLWH with pain symptoms enrolled in a wave (between November 2017 and February 2018) of a longitudinal cohort study in Guangxi (n = 116). Models were tested individually for six enacted stigma experiences, controlling for key demographic and health-related variables (e.g., CD4 + count). Results showed HIV-related workplace discrimination was the most common stigma experience (12%,) and 10.3% of PLWH reported POM. Indirect effect analyses showed that internalized stigma was indirectly associated with POM through psychological distress. Internalized stigma and psychological distress mediated the association between workplace discrimination and POM. Family discrimination, gossip, and healthcare discrimination were directly associated with POM. This study suggests that Chinese PLWH may engage in POM to cope with psychological distress that is rooted in HIV-related stigma and highlights the important context of workplace discrimination for PLWH. Implications for interventions to reduce POM among PLWH are discussed.

Background: In 2007, an Expert Committee recommended that dietary patterns be assessed at each wellness visit and that counseling on diet and nutrition be provided to all children. Few studies have examined the “uptake” of obesity prevention practices into pediatric primary care. This study aimed to describe patterns of nutrition counseling among children at wellness visits in South Carolina between 2008 and 2017 and determine whether sociodemographic disparities existed. Methods: The sample included 123,864 children 2–18 years of age who had a wellness visit at one of South Carolina's four major health care systems between January 1, 2008, and December 31, 2017. Documentation of nutrition counseling was defined by the International Classification of Diseases (ICD)-9/10 codes. A matched sample design and conditional logistic regression were used to examine sociodemographic disparities in children who did and did not receive nutrition counseling. Results: Nutrition counseling was documented at 3.55% of wellness visits. Significant sociodemographic disparities were found, including that African American and Hispanic children were less likely to receive counseling than white or non-Hispanic children. Differences were also found by urban/rural residence, health insurance, and BMI. Despite guidelines, ICD 9/10 code indicating diagnosis of overweight or obesity was documented for only 12.2% of children. Conclusions: Nutrition counseling was rarely documented in a large sample of electronic medical record (EMR) data from pediatric wellness visits in South Carolina—a state heavily burdened by childhood obesity. Children's BMIs were infrequently recorded, which may be a barrier to tracking BMI over time. Sociodemographic and geographic differences in nutrition counseling may exacerbate disparities in childhood obesity.