Background: Sexual and gender minority (SGM; i.e., non-heterosexual and transgender or gender-expansive, respectively) people experience physical health disparities attributed to greater exposure to minority stress (experiences of discrimination or victimization, anticipation of discrimination or victimization, concealment of SGM status, and internalization of stigma) and structural stigma. Purpose: To examine which components of minority stress and structural stigma have the strongest relationships with physical health among SGM people. Methods: Participants (5,299 SGM people, 1,902 gender minority individuals) were from The Population Research in Identity and Disparities for Equality (PRIDE) Study. Dominance analyses estimated effect sizes showing how important each component of minority stress and structural stigma was to physical health outcomes. Results: Among cisgender sexual minority women, transmasculine individuals, American Indian or Alaskan Native SGM individuals, Asian SGM individuals, and White SGM individuals a safe current environment for SGM people had the strongest relationship with physical health. For gender-expansive individuals and Black, African American, or African SGM individuals, the safety of the environment for SGM people in which they were raised had the strongest relationship with physical health. Among transfeminine individuals, victimization experiences had the strongest relationship with physical health. Among Hispanic, Latino, or Spanish individuals, accepting current environments had the strongest relationship with physical health. Among cisgender sexual minority men prejudice/discrimination experiences had the strongest relationship with physical health. Conclusion: Safe community environments had the strongest relationships with physical health among most groups of SGM people. Increasing safety and buffering the effects of unsafe communities are important for SGM health.

Introduction: Long-acting injectable antiretroviral therapy (LAI-ART) is one of the latest advancements in HIV control with the potential to overcome oral ART barriers to adherence. The objective of this paper is to anticipate and examine implementation considerations for LAI-ART using components of the PRISM model, a Practical, Robust Implementation and Sustainability Model for integrating research findings into practice. Methods: We conducted a scoping review from January to August 2020 of the growing literature on LAI-ART implementation and other fields employing long-acting injectable therapies. Key considerations regarding LAI-ART were parsed from the searches and entered into the PRISM implementation science framework. Discussion: The PRISM framework posed multiple questions for consideration in the development of an optimal implementation strategy for LAI-ART in the United States. These questions revealed the necessity for more data including acceptability of LAI-ART among many different sub-groups of people living with HIV (PLWH), cost effectiveness, patient satisfaction, and patient-reported outcomes, as well as more detailed information related to the external environment for optimal LAI-ART implementation. Ethical considerations of LAI-ART will also need to be considered. Conclusion: The anticipation of and excitement for LAI-ART represent the hope for a new direction for HIV treatment that reduces adherence barriers and improvements in prognoses for PLWH. We have a unique window of opportunity to anticipate implementation considerations for LAI-ART so this new therapy can be used to its fullest potential. Outstanding questions remain, however, that need to be addressed to help achieve HIV suppression goals in diverse populations.

Background: Despite disproportionate incidence and prevalence of HIV among transgender individuals, cisgender women, and racial and ethnic minority groups, all remain under-represented in HIV cure research. As HIV cure trials are scaled up, there is emerging research on ways to mitigate risks of HIV acquisition for sexual partners of analytical treatment interruption (ATI) trial participants. As such, it is imperative that HIV cure researchers consider the implications of implementing ATIs in populations that are disproportionately affected by HIV but largely under-represented in trials to date. Methods: In this qualitative study, we sought to derive triangulated perspectives on the social and ethical implications regarding ATIs and partner protection strategies during ATIs among under-represented populations. We conducted 21 in-depth interviews with five types of informants: bioethicists, community members (people living with HIV (PLWH) and their advocates), biomedical HIV cure researchers, socio-behavioral scientists, and HIV care providers. We analyzed the data using conventional content analysis and reduced the data to important considerations for implementing ATI trials in diverse communities and settings. Results: Our study revealed the following key themes: 1) attention must be paid to gender and power dynamics in ATI trials; 2) ATI trials should be designed and implemented through the lenses of intersectionality and equity frameworks; 3) ATI trials may have both positive and negative effects on stigma for PLWH and their partners; and 4) partnership dynamics should be considered when designing ATI protocols. Conclusion: Our study generated actionable considerations that could be implemented in ATI trials to promote their acceptability to communities that have been under-represented in HIV cure research to date. Research teams must invest in robust community and stakeholder engagement to define best practices. Paying attention to representation and equity will also promote better and more equitable implementation of HIV cure strategies once these become ready for roll-out.

This study tested depression as a mediator between childhood sexual abuse and adherence to antiretroviral therapy, an effect moderated by resilience. In total, 149 HIV+ Latino men who have sex with men were recruited for this study. Using a regression-based bootstrap approach, depression mediated the relationship between childhood sexual abuse and antiretroviral therapy adherence, with worse adherence for participants at lowest percentiles of the resilience index. The prevalence of childhood sexual abuse and depression in HIV+ men who have sex with men is high and must be addressed to better prevent disease progression and reduce transmission, especially in expanding Latino populations.

Introduction: End-of-life (EOL) HIV cure-related research provides a novel approach to studying HIV reservoirs. The Last Gift is a rapid autopsy research study at the University of California San Diego, which enrolls terminally-ill people living with HIV (PLWHIV) with a desire to contribute to HIV cure-related research. Methods: We conducted in-depth baseline and follow-up interviews with Last Gift study participants. We analyzed interview data applying conventional content analysis. Results: Since summer 2017, 13 participants have been enrolled (n = 11 males and 2 females; aged 45– 89 years) and 8 participants interviewed. Terminal illnesses included cancers, heart diseases and neurodegenerative illnesses. Our analysis revealed five key themes: 1) The Last Gift study has tremendous meaning for participants at the end of their life. 2) HIV-specific altruism was a primary motivator to join the Last Gift study, nested within the context of community, scientific advancement, and moral obligation. 3) Participants did not expect physical benefits yet they perceived emotional/psychological, financial, and societal/scientific benefits. 4) There were minimal participant-perceived risks and concerns. 5) Last Gift participants expressed immense gratitude toward study staff. Discussion: The Last Gift study provides a framework for ethical HIV cure-related research at EOL and highlighted participants’ perspectives, motivations, and experiences. Knowing how PLWHIV understand and experience such studies will remain critical to designing ethical, fully informed HIV cure research protocols that are acceptable to PLWHIV.

Background: Engagement in care is critical to achieving and sustaining optimal benefits of efficacious antiretroviral therapies for HIV infection. Current metrics of engagement in care, including problematic patterns of retention in care, adherence to treatment, and viral suppression, are often detected late in the disengagement process. We sought to develop and validate a patient-centered screener of engagement in care that can be used to identify deficits in patient perceptions of engagement before the development of poor outcomes, including loss to follow-up, treatment nonadherence, virologic failure, and the resulting increased likelihood of HIV-associated morbidity and mortality and onward transmission of HIV. Setting and Methods: Using input from patients, providers, and researchers through in-person focus groups and an online Delphi process, we developed a self-report measure of engagement in care that was validated with 3296 patients from 7 clinics across the United States. Results: Results supported a single dimension of engagement in care measured by 10 items. Lower scores on the HIV Index were related to higher depression and anxiety symptoms, greater use of alcohol and stimulants, and increased likelihood of reporting internalized HIV stigma. Higher Index scores were positively associated with self-report measures of antiretroviral therapy adherence, corroborative clinic records documenting appointment attendance, and increased likelihood of recent viral load suppression. Conclusions: The HIV Index offers promise as a patient-centered diagnostic and prognostic screener for engagement in care that can be used to trigger interventions to promote better clinical outcomes for persons living with HIV.