HIV testing is an entry point for both HIV prevention and treatment, and the CDC recommends that all adults of reproductive age undergo HIV testing at least once in their lifetime. However, HIV testing rates remain suboptimal. This study analyzed trends in HIV testing using Behavioral Risk Factor Surveillance System data from 2017 to 2023 across nine Deep South states—Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Texas. Descriptive statistics and Joinpoint linear regression were employed to assess lifetime HIV testing and testing within the past 12 months. Findings showed that the overall trend in having ever tested for HIV rose from 43% in 2017 to 47% in 2019 but declined to 40% in 2022, with a slight increase to 41% in 2023. Significant declines in ever testing were observed in North Carolina and among adults aged 25–44, non-Hispanic Black, non-Hispanic multiracial, and those identifying as lesbian or gay. Furthermore, the overall trend in HIV testing in the past 12 months declined significantly from 48% in 2017 to 42% in 2022, with a slight increase to 43% in 2023. Significant declines were found in Florida, Georgia, Louisiana, North Carolina, and South Carolina, and among adults aged 18–34, non-Hispanic White, non-Hispanic Black, male, female, and heterosexual individuals. These trends, observed largely during the COVID-19 pandemic, underscore the need to scale up HIV prevention and care initiatives, particularly in populations and regions experiencing significant declines. Trends should continue to be monitored and examined post-COVID pandemic.

Background: Microplastics and nanoplastics (MNPs) are ubiquitous environmental contaminants from plastic degradation, leading to human exposure through ingestion, inhalation, and dermal contact. While emerging evidence suggests potential health effects, comprehensive human-specific data remain limited. Objective: To systematically review evidence on MNP exposure and health impacts across human organ systems. Methods: Following PRISMA guidelines, we searched Embase, Environment Complete, MEDLINE, and Scopus for peer-reviewed English-language studies published between 2020 and 2025 that reported MNP exposure in adult human populations and addressed at least one organ system. Thirty studies met inclusion criteria, and all clinical studies were assessed for risk of bias using the Newcastle–Ottawa Scale (NOS) Results: Clinical studies consistently detected MNPs in human blood, thrombi, feces, and respiratory and reproductive tissues. Higher MNP burdens correlated with increased disease severity across cardiovascular, gastrointestinal, respiratory, musculoskeletal, and reproductive systems. In vitro studies using human-derived cell lines demonstrated that MNPs penetrate cells and disrupt cellular processes, inducing oxidative stress, cytotoxicity, mitochondrial dysfunction, inflammation, DNA damage, and apoptosis. Toxic effects were size-, polymer-, and concentration-dependent, with smaller particles exhibiting greater cellular uptake and toxicity. Conclusions: Human MNP exposure is widespread and associated with adverse biological effects across multiple organ systems. Further interdisciplinary research is needed to establish causal relationships and inform risk assessment and regulatory frameworks for plastic-associated contaminants. Other: This research received no external funding. The research protocol was registered with PROSPERO (Registration ID number CRD420261284559).

Substance use and high-risk sexual behaviors remain pressing public health challenges among U.S. adolescents, with tobacco, alcohol, and marijuana being the most used substances. While previous research has shown an association between substance use and risky sexual behavior, there is limited data on how these associations vary based on demographic modifiers such as race, sex, and sexual identity among sexually active adolescents. This study explores the association between current substance use (cigarettes, e-cigarettes, alcohol, and marijuana) and high-risk sexual behaviors (having multiple sexual partners and lack of condom use), examining how these associations vary by race, sex, and sexual identity. The 2023 Youth Risk Behavior Survey (YRBS) data was analyzed for 5420 adolescents attending U.S. public and private high schools. Multiple Logistic regression was used to examine associations, and interaction effects for race, sex, and sexual identity were introduced to the model to determine variations in associations. Overall adjusted analyses revealed current use of cigarette, e-cigarette, and alcohol was associated with higher likelihood of having multiple (2 or more) sexual partners in the past 3 months. Additionally, current marijuana use was associated with a higher likelihood of not using a condom during last sexual intercourse. A statistically significant interaction was observed only for the association between current marijuana use and condomless sex during last sexual intercourse ( p = 0.010). Stratified analyses indicated that this association varied by sexual identity and was stronger among heterosexual students compared to Lesbian, Gay, Bisexual, Queer, and other (LGBQ+) students. Results confirm the link between substance use and high-risk sexual behavior among youth, reinforcing our need for increased programming around substance use prevention and sexual health education. Heterosexual youth may be at increased risk for high-risk sexual behavior associated with their marijuana use, calling for tailored interventions that target the unique needs of this demographic subgroup.

Background: Given the high rates of HIV infection among young Black men who have sex with men in Jackson, Mississippi, and the underuse of pre-exposure prophylaxis (PrEP) in this population, there is a critical need for innovative interventions to promote PrEP use. Acceptance and commitment therapy (ACT) is a promising intervention for health behavior change. Objective: This study aims to develop and test an intervention, ACTPrEP, to increase PrEP use among young Black men who have sex with men. Methods: We conducted in-depth interviews with 20 young Black men who have sex with men and 10 PrEP staff to inform the development of ACTPrEP, an intervention that uses ACT to improve PrEP use. Specific ACTPrEP adaptations from the qualitative interviews included service settings (interventionists should be PrEP informed and well-integrated), target audiences (provide check-in calls, be caring, and authentically relate), modes of delivery (flexible delivery), and cultural adaptation (normalize PrEP use). A pilot randomized controlled trial will evaluate the feasibility and acceptability of ACTPrEP compared to that of Enhanced Standard of Care in promoting PrEP use among young Black men who have sex with men (N=66). We will specifically evaluate group differences in the proportion of participants who initiate PrEP, PrEP adherence, and PrEP persistence. Measures will be collected at baseline, 6 weeks, and 12 weeks. Results: Research activities began in September 2023 and will be ongoing through June 2026. Preliminary findings are anticipated to be available in late 2026. Conclusions: This study will inform the development of a larger randomized controlled trial to evaluate the efficacy of ACTPrEP for increasing PrEP use among young Black men who have sex with men. Trial Registration: ClinicalTrials.gov NCT05087680; https://clinicaltrials.gov/study/NCT05087680 International Registered Report Identifier (IRRID): DERR1-10.2196/65921

In the United States (U.S.), the highest burden of new HIV diagnosis continues to occur in Southern states. Healthcare access among at-risk populations is crucial to mitigate HIV transmission, yet data on the association between HIV risk and healthcare access is limited. This study examined the association between HIV risk, (i.e., injecting any drug other than those prescribed, engaging in transactional sex, receiving treatment for a sexually transmitted infection, having condomless anal sex, or having four or more lifetime sexual partners—all within the past year) and healthcare access among adults in the South, adjusting for covariates. The 2022 Behavioral Risk Factor Surveillance System for Southern states was analyzed, and 191,266 respondents participated. Rao-Scott Chi-square tests and weighted logistic regression analyses using complex sampling design were performed in SAS v. 9.4. Findings suggest that U.S. adults in the South at risk for HIV had higher odds of not having health insurance coverage (OR=1.55; 95% CI: 1.34–1.79), not having a personal doctor (OR=2.00; 95% CI: 1.78–2.25), delaying routine check-ups for a year or more (OR=1.75; 95% CI: 1.57–1.96), and being unable to afford medical care in the past year (OR=2.26; 95% CI: 2.00–2.56), compared to those not at risk, for unadjusted analyses. After adjusting for covariates, findings suggest that adults in the South at risk for HIV had 1.69 higher odds of being unable to afford medical care in the past year due to financial constraints (95% CI: 1.45–1.97) compared to those not at risk. Among adults at risk for HIV in the South, enhancing access to HIV preventive services, particularly during public health emergencies, has the potential to mitigate HIV transmission risks and reduce the associated financial burden. This association warrants reevaluation in the post-pandemic era to guide future prevention efforts effectively.