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HIV infection rates are increasing among marginalized women in Ontario, Canada. HIV-related stigma, a principal factor contributing to the global HIV epidemic, interacts with structural inequities such as racism, sexism, and homophobia. The study objective was to explore experiences of stigma and coping strategies among HIV-positive women in Ontario, Canada. We conducted a community-based qualitative investigation using focus groups to understand experiences of stigma and discrimination and coping methods among HIV-positive women from marginalized communities. We conducted 15 focus groups with HIV-positive women in five cities across Ontario, Canada. Data were analyzed using thematic analysis to enhance understanding of the lived experiences of diverse HIV-positive women. Focus group participants (n = 104; mean age = 38 years; 69% ethnic minority; 23% lesbian/bisexual; 22% transgender) described stigma/discrimination and coping across micro (intra/interpersonal), meso (social/community), and macro (organizational/political) realms. Participants across focus groups attributed experiences of stigma and discrimination to: HIV-related stigma, sexism and gender discrimination, racism, homophobia and transphobia, and involvement in sex work. Coping strategies included resilience (micro), social networks and support groups (meso), and challenging stigma (macro). HIV-positive women described interdependent and mutually constitutive relationships between marginalized social identities and inequities such as HIV-related stigma, sexism, racism, and homo/transphobia. These overlapping, multilevel forms of stigma and discrimination are representative of an intersectional model of stigma and discrimination. The present findings also suggest that micro, meso, and macro level factors simultaneously present barriers to health and well being--as well as opportunities for coping--in HIV-positive women's lives. Understanding the deleterious effects of stigma and discrimination on HIV risk, mental health, and access to care among HIV-positive women can inform health care provision, stigma reduction interventions, and public health policy.

Background In Korea, approximately 70% of HIV-positive individuals are currently diagnosed in hospitals, while most HIV-positive patients were diagnosed at public health centers in 1980 s and 1990 s. However, there are no reporting systems to identify how many HIV tests are performed in the Korean hospitals different from public health centers and Blood centers. We estimated how many HIV tests were performed in hospitals and analyzed the nationwide hospital-based HIV seroprevalence in the present study. Methods Between 2002 and 2008, data included HIV tests on insurance claims in hospitals and the proportion of computerized insurance claims from the Health Insurance Review and Assessment Services. The number of HIV tests from the survey in the External Quality Assurance Scheme for hospital laboratories was collected to calculate the insurance claim proportion. HIV seroprevalence was estimated using data of tested individuals, including infected individuals. Statistical analysis was confirmed with the 95% confidence interval. Statistical significance was defined at p-values < 0.05. Results The number of HIV tests in hospitals increased from 2.7 million in 2002 to 5.0 million in 2008. The trend of HIV seroprevalence was decrease (1.5-1.3 per 10,000 individuals, P < 0.0028), except in 2002. The number of women tested was greater than men, and the proportion increased in older individuals and in small towns. Men had a higher annual HIV seroprevalence than women (P < 0.0001). The annual seroprevalence decreased in men (P = 0.0037), but was stable in women. The seroprevalence in the 30-39 year age group demonstrated higher than other age groups except 2008. Conclusions The nationwide hospital-based number of HIV tests and seroprevalence were estimated using a new method and seroprevalence trends were identified. This information will facilitate improvement in national HIV prevention strategies.

Background Public health centers (PHCs) in South Korea provide free anonymous and named HIV testing and serve as an essential component of the national testing infrastructure, particularly for populations underserved by conventional healthcare settings. Identifying temporal shifts in testing behavior and positivity is vital for targeted prevention and diagnostic strategies. Methods We analyzed HIV testing data from 260 PHCs nationwide between 2011 and 2023. Temporal trends in the number of tests, testing purposes, and HIV seroprevalence were assessed. Multivariable logistic regression analysis was used to identify independent predictors of HIV positivity, and temporal changes were evaluated using the Mann–Kendall trend test. Results Over the 13-year study period, approximately 4.7 million HIV screening tests were completed at PHCs. Annual testing volume sharply declined during the COVID-19 pandemic, reaching 104,621 tests in 2021 (about 24% of the pre-COVID annual average of 443,609), but rebounded to 255,051 tests by 2023. In that year, the overall HIV seroprevalence at PHCs was 0.17%, with elevated positivity among foreign nationals (0.68%), men (0.43%), individuals in their 20s (0.25%), and those undergoing voluntary anonymous (1.15%) or named (0.71%) testing. Multivariable logistic regression revealed that male sex (adjusted odds ratio [aOR] = 9.48, 95% CI: 6.52–13.80), foreign nationality (aOR = 6.22, 95% CI: 4.27–9.07), voluntary testing (aOR = 7.67, 95% CI: 5.67–10.40), and residence in metropolitan areas (aOR = 2.50, 95% CI: 1.93–3.24) were significant independent predictors of HIV positivity ( p  < 0.001 for all). Trend analysis demonstrated significant increases in testing among individuals aged 30–39 years (Kendall’s tau = 0.821, p  < 0.001) and in antenatal care screening (Kendall’s tau = 0.897, p  < 0.001), reflecting expanded maternal health services and changing demographic patterns in test uptake. Conclusions Throughout the study period, PHCs performed fewer than 5% of national HIV tests but consistently contributed a disproportionately large share of new diagnoses—28.3% in 2023—particularly among vulnerable groups such as men, foreign nationals, young adults, urban residents, and individuals undergoing voluntary anonymous testing. Strengthening PHC-based services and expanding outreach tailored to these populations will be essential for enhancing early diagnosis and achieving national HIV prevention goals.

Sub Saharan Africa continues to be the epicenter of HIV with 70% of people living with HIV globally. Women form nearly 60% of those living with HIV. Studies have shown disclosure of one's HIV status is important in HIV prevention, in increasing partners who are tested and getting into care early as well as in improving retention in PMTCT and ART programs. This study aimed to determine the prevalence, factors and outcomes of HIV status disclosure to partners among HIV-positive women attending HIV care-and-treatment clinics (CTCs) at Kilimanjaro region, northern Tanzania. A cross-sectional study was conducted from January to June 2014 in 3 out of the 7 districts of Kilimanjaro region. The study population was HIV-positive women aged 15-49, who were attending for routine HIV care at 19 selected clinics. Face-to-face interviews were conducted with consenting women to collect necessary information. Multivariate logistic regression analyses were used to determine the independent predictors of HIV status disclosure to partner. A total of 672 HIV-positive women in Moshi municipal, Hai and Mwanga districts were enrolled. Of them, 609 HIV-positive women reported to have a regular partner. Prevalence of serostatus disclosure to partners was 66%. Of the 400 who had disclosed; 56% did so within the first month of knowing their HIV status. In a multiple logistic regression model, HIV serostatus disclosure was higher among women who: were married/cohabiting (AOR = 4.16, 95% CI: 2.39-7.25; p<0.001), currently on ART (AOR = 2.06, 95% CI: 1.11-3.82; p = 0.020), and who reported had ever communicated with partners on number of children (AOR = 1.85, 95% CI: 1.15-2.98; p = 0.010) and contraceptives use (AOR = 2.01, 95% CI: 1.27-3.20; p = 0.208). Most of the women (81%) who disclosed their HIV status to did not reported negative outcomes. In this setting still a third of the HIV-positive women (34%) fail to disclose their HIV- serostatus to partners. Interventions to impart skills in communication and negotiation between partners may help in improving disclosure of HIV. Efforts to involve men in general sexual and reproductive health including couple counseling and testing will contribute in improving disclosure and communication on HIV among partners.

Abstract Background Women-specific factors exist that increases vulnerability to drug-related harms from injection drug use, including blood-borne viruses (BBVs), but gender-based differences in BBV prevalence have not been systematically examined. Methods We conducted meta-analyses to estimate country, regional, and global prevalence of serologically confirmed human immunodeficiency virus (HIV), hepatitis C virus (HCV; based on detection of anti-HCV antibody), and hepatitis B virus (HBV; based on detection of HBV surface antigen) in people who inject drugs (PWID), by gender. Gender-based differences in the BBV prevalence (calculated as the risk among women relative to the risk among men) were regressed on country-level prevalence and inequality measures (Gender inequality index, Human development index, Gini coefficient, and high, low or middle income of the country). Results Gender-based differences varied by countries and regions. HIV prevalence was higher among women than men in sub-Saharan Africa (relative risk [RR], 2.8; 95% confidence interval [CI], 1.8–4.4) and South Asia (RR, 1.7; 95% CI, 1.1–2.7); anti-HCV was lower among women in the Middle East and North Africa (RR, 0.6; 95% CI, .5–.7) and East and Southeast Asia (RR, 0.8; 95% CI, .7–.9). Gender-based differences varied with country-levels of the BBV prevalence in the general population, human development, and income distribution. Conclusion HIV was more prevalent in women who inject drugs as compared to their male counterparts in some countries, but there is variation between and within regions. In countries where women are at higher risks, there is a need to develop gender-sensitive harm-reduction services for the particularly marginalized population of women who inject drugs. Relative to men, women had a higher human immunodeficiency virus prevalence in sub-Saharan Africa and South Asia and a lower anti–hepatitis C virus antibody prevalence in Middle East and North Africa and East and Southeast Asia, compared with men. Gender-based differences varied with country levels of human development and income distribution.

Streptococcus pneumoniae is a leading cause of bacterial pneumonia, meningitis, and sepsis in children worldwide. However, many countries lack national estimates of disease burden. Effective interventions are available, including pneumococcal conjugate vaccine and case management. To support local and global policy decisions on pneumococcal disease prevention and treatment, we estimated country-specific incidence of serious cases and deaths in children younger than 5 years. We measured the burden of pneumococcal pneumonia by applying the proportion of pneumonia cases caused by S pneumoniae derived from efficacy estimates from vaccine trials to WHO country-specific estimates of all-cause pneumonia cases and deaths. We also estimated burden of meningitis and non-pneumonia, non-meningitis invasive disease using disease incidence and case-fatality data from a systematic literature review. When high-quality data were available from a country, these were used for national estimates. Otherwise, estimates were based on data from neighbouring countries with similar child mortality. Estimates were adjusted for HIV prevalence and access to care and, when applicable, use of vaccine against Haemophilus influenzae type b. In 2000, about 14·5 million episodes of serious pneumococcal disease (uncertainty range 11·1–18·0 million) were estimated to occur. Pneumococcal disease caused about 826 000 deaths (582 000–926 000) in children aged 1–59 months, of which 91 000 (63 000–102 000) were in HIV-positive and 735 000 (519 000–825 000) in HIV-negative children. Of the deaths in HIV-negative children, over 61% (449 000 [316 000–501 000]) occurred in ten African and Asian countries. S pneumoniae causes around 11% (8–12%) of all deaths in children aged 1–59 months (excluding pneumococcal deaths in HIV-positive children). Achievement of the UN Millennium Development Goal 4 for child mortality reduction can be accelerated by prevention and treatment of pneumococcal disease, especially in regions of the world with the greatest burden. GAVI Alliance and the Vaccine Fund.

Understanding the impact of natural disasters on the HIV epidemic in populations with high HIV burden is critical for the effective delivery of HIV control efforts. We assessed HIV risk behaviors, seroprevalence, and viral suppression in a high HIV prevalence Lake Victoria fishing community before and after COVID-19 emergence and lockdown and a severe lake flooding event, both of which occurred in 2020. We used data from the largest Lake Victoria fishing community in the Rakai Community Cohort Study, an open population-based HIV surveillance cohort in south-central Uganda. The data were collected both prior to (September-December 2018) and after (October-December 2021) COVID-19 emergence and a severe flooding event. Households impacted by flooding were identified via drone data and through consulting village community health workers. The entire study population was subject to extensive COVID-19-related lockdowns in the first half of 2020. Differences in HIV-related outcomes before and after COVID, and between residents of flooded and non-flooded households, were assessed using a difference-in-differences statistical modeling approach. A total of 1,226 people participated in the pre- and post-COVID surveys, of whom 506 (41%) were affected by flooding. HIV seroprevalence in the initial period was 37% in flooded and 36.8% in non-flooded households. After the COVID-19 pandemic and lockdown, we observed a decline in HIV-associated risk behaviors: transactional sex declined from 29.4% to 24.8% (p = 0.011), and inconsistent condom use with non-marital partners declined from 41.6% to 37% (p = 0.021). ART coverage increased from 91.6% to 97.2% (p<0.001). There was 17% decline in transactional sex (aPR = 0.83, 95% CI: 0.75-0.92) and 28% decline in the overall HIV risk score (aPR = 0.83, 95% CI: 0.75-0.92) among HIV-seronegative participants. We observed no statistically significant differences in changes of HIV risk behavior, seroprevalence, or viral suppression outcomes when comparing those affected by floods to those not affected by floods, in the periods before and after COVID-19, based on difference-in-differences analyses. Despite a high background burden of HIV, the COVID-19 pandemic, and severe flooding, we observed no adverse impact on HIV risk behaviors, seroprevalence, or virologic outcomes. This may be attributed to innovative HIV programming during the period and/or population resilience. Understanding exactly what HIV programs and personal or community-level strategies worked to maintain good public health outcomes despite extreme environmental and pandemic conditions may help improve HIV epidemic control during future natural disaster events.

ObjectivesThis study examined the association of self-reported HIV status with history of oral pre-exposure prophylaxis (PrEP) use among reproductive-age women from Lesotho.MethodsThis study analysed a sample of 6413 women from the 2023–24 Lesotho Demographic and Health Survey (LDHS) data. The data were collected between November 2023 and February 2024. Categorical data were analysed with percentages and χ2 tests. In addition, ever use of oral PrEP and covariates of self-reported HIV infection were investigated using binary multivariable multilevel logistic regression. HIV infection data were self-reported by the women based on their most recent HIV test.ResultsThe weighted prevalence of self-reported HIV infection among women was 22.1% (95% CI 20.6% to 23.7%). Among women who ever used oral PrEP, the prevalence of self-reported HIV infection was 13.4% (95% CI 9.9% to 17.9%), but was 24.0% (22.0% to 26.1%) among women who have never used. History of oral PrEP use was associated with 62.0% reduction in the odds of self-reported HIV infection (adjusted OR (aOR) 0.38; 95% CI 0.28 to 0.51). Respondents who have heard of a sexually transmitted infection (STI) have 27.0% reduction in the odds of self-reported HIV infection when compared with those who have not heard of an STI (aOR 0.73; 95% CI 0.59 to 0.90). Women aged 25+ years at first sex had 60.0% reduction in the odds of self-reported HIV infection, when compared with those <18 years at first sex (aOR 0.40; 95% CI 0.19 to 0.84). Women with multiple total lifetime number of sexual partners had higher odds of self-reported HIV infection, when compared with those with single lifetime number of sexual partner.ConclusionsHIV infection among women in Lesotho remains high. Having a history of oral PrEP use was associated with lower odds of self-reported HIV infection. Stakeholders in healthcare should promote oral PrEP interventions and design programmes for HIV prevention among women.

Exposure to HIV-related stigma and mental health problems have both been reported by HIV-positive individuals. We analyzed the role of social support as a mediator in the relationship between HIV-associated stigma and mental health among adults living with HIV. A total of 303 people aged 18 years and over (M = 40.5; SD = 11.2) with an HIV diagnosis who were selected using a non-probability convenience sampling method in Trujillo, Peru, participated in this study. The Macro PROCESS program for SPSS was used for data analysis. We found that stigma exerts an indirect effect on the mental health among adults living with HIV, mediated through social support (β = −0.05, SE = 0.02; 95% CI [−0.09; −0.02]). However, stigma does not exert a direct effect on mental health (β = −0.08; p = 0.21). It is concluded that social support negatively and fully mediates the relationship between HIV-linked stigma and mental health among adults living with HIV. A higher stigma was associated with lower social support, and lower social support negatively affects mental health. For this reason, strengthening social support networks in adults with HIV may have a positive impact on public health.

Thirty years since the discovery of HIV, the HIV pandemic in sub-Saharan Africa accounts for more than two thirds of the world’s HIV infections. Southern Africa remains the region most severely affected by the epidemic. Women continue to bear the brunt of the epidemic with young women infected almost ten years earlier compared to their male counterparts. Epidemiological evidence suggests unacceptably high HIV prevalence and incidence rates among women. A multitude of factors increase women’s vulnerability to HIV acquisition, including, biological, behavioral, socioeconomic, cultural and structural risks. There is no magic bullet and behavior alone is unlikely to change the course of the epidemic. Considerable progress has been made in biomedical, behavioral and structural strategies for HIV prevention with attendant challenges of developing appropriate HIV prevention packages which take into consideration the socioeconomic and cultural context of women in society at large.