BackgroundAttrition during the period from HIV testing to antiretroviral therapy (ART) initiation is high worldwide. We assessed whether same-day HIV testing and ART initiation improves retention and virologic suppression.Methods and findingsWe conducted an unblinded, randomized trial of standard ART initiation versus same-day HIV testing and ART initiation among eligible adults ≥18 years old with World Health Organization Stage 1 or 2 disease and CD4 count ≤500 cells/mm3. The study was conducted among outpatients at the Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic infections (GHESKIO) Clinic in Port-au-Prince, Haiti. Participants were randomly assigned (1:1) to standard ART initiation or same-day HIV testing and ART initiation. The standard group initiated ART 3 weeks after HIV testing, and the same-day group initiated ART on the day of testing. The primary study endpoint was retention in care 12 months after HIV testing with HIV-1 RNA <50 copies/ml. We assessed the impact of treatment arm with a modified intention-to-treat analysis, using multivariable logistic regression controlling for potential confounders. Between August 2013 and October 2015, 762 participants were enrolled; 59 participants transferred to other clinics during the study period, and were excluded as per protocol, leaving 356 in the standard and 347 in the same-day ART groups. In the standard ART group, 156 (44%) participants were retained in care with 12-month HIV-1 RNA <50 copies, and 184 (52%) had <1,000 copies/ml; 20 participants (6%) died. In the same-day ART group, 184 (53%) participants were retained with HIV-1 RNA <50 copies/ml, and 212 (61%) had <1,000 copies/ml; 10 (3%) participants died. The unadjusted risk ratio (RR) of being retained at 12 months with HIV-1 RNA <50 copies/ml was 1.21 (95% CI: 1.04, 1.38; p = 0.015) for the same-day ART group compared to the standard ART group, and the unadjusted RR for being retained with HIV-1 RNA <1,000 copies was 1.18 (95% CI: 1.04, 1.31; p = 0.012). The main limitation of this study is that it was conducted at a single urban clinic, and the generalizability to other settings is uncertain.ConclusionsSame-day HIV testing and ART initiation is feasible and beneficial in this setting, as it improves retention in care with virologic suppression among patients with early clinical HIV disease.Trial registrationThis study is registered with ClinicalTrials.gov number NCT01900080

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Although impulsivity is likely to be related to HIV risk-particularly in incarcerated substanceabusing youth-this area of research has been understudied. To investigate the relationship between impulsivity and various HIV/AIDS risk behaviors and attitudes, a sample of court-referred and incarcerated culturally diverse inner-city adolescents (males: N = 266; females: N = 111) were divided into high and low impulsive groups based on the Millon Adolescent Clinical Inventory Impulsivity Scale. Findings showed that compared to the less impulsive group, the highly impulsive adolescents reported more frequent marijuana and alcohol use in the last 3 months as well as a significantly higher proportion of unprotected sex when high on alcohol and marijuana, higher perceived susceptibility to HIV, more AIDS-related anxiety, greater HIV knowledge, less sexual self-efficacy, and less favorable sexual attitudes. Implications for interventions among incarcerated youth are discussed.

The Information-Motivation-Behavioural skills model (Fisher & Fisher, 1992) was used to predict condom use among adolescents residing in a court-ordered inpatient substance abuse treatment programme (N = 271; 181 male and 90 female, primarily of minority ethnicity). In a predictive structural equation model, demographic variables, HIV transmission knowledge, and motivational variables of pro-condom norms and attitudes, and perceived susceptibility predicted condom use skills and condom use self-efficacy. Along with the other variables in the model, condom skills and condom self-efficacy were hypothesized to predict condom use over a three-month period. It was found that condom skills were predicted by greater age, pro-condom attitudes and greater perceived susceptibility. Condom self-efficacy was predicted by gender, pro-condom norms and condom attitudes. Condom use was significantly predicted by pro-condom norms and stronger condom selfefficacy. Both condom skills and knowledge did not significantly predict condom use. Significant demographic predictors of condom use included greater age and gender. Results suggest that changing personal attitudes about condoms and reinforcing the power of pro-condom beliefs among significant others will encourage condom use among adolescents who are at high risk for HIV and other STDs.

A programmatic series of three studies developed and evaluated the Condom Barriers Scale (CBS), an instrument measuring women s perceived barriers to condom use for prevention of HIV and other sexually transmitted diseases. Following item generation and selection, Study 1 evaluated the CBS in a sample of minority women (N = 178), reduced the number of items, assessed the factor structure, evaluated the internal consistency, and explored the convergent validity of the CBS. In Study 2, the CBS was administered to a cross-validation sample (N = 278). Confirmatory factor analysis and internal consistency were compared against the original sample and construct, criterion, and discriminant validity were assessed. In Study 3 (N = 30), temporal stability of the CBS was evaluated. The resulting instrument appears to have sound psychometric properties and can be used to measure a key construct in the leading theoretical models of health behavior for which a measure with known psychometric properties previously has not been available.

Haiti has the highest number of individuals living with HIV in the Caribbean. Due to Haiti's resource-poor environment and inadequate mental health and substance abuse services, adherence to antiretroviral therapy (ART) may be especially difficult. This study examined associations among demographics, maladaptive coping, partner conflict, alcohol problems, depression, and negative attitudes about medications and their impact on adherence among 194 HIV-positive Haitians. In a mediated directional structural equation model, depression and negative attitudes about ART directly predicted poorer adherence. Greater partner conflict, maladaptive coping and alcohol problems predicted more depression. Maladaptive coping predicted a negative attitude about ART. Alcohol problems predicted partner conflict and maladaptive coping. Significant indirect effects on adherence mediated through both depression and negative attitudes about ART include negative effects of female gender, alcohol problems and maladaptive coping. Results highlight the importance of integrated care for depression, alcohol use and other psychosocial problems to increase ART adherence.

Engagement in sexual activity among Haitian youth is increasing. The present cross-sectional study examined the independent correlates of sexual risk behaviors among 200 (108 male/92 female) 13–18 year-old adolescents in Port-au-Prince, Haiti using face-to-face interviews. The majority (60.0 %) had engaged in sexual intercourse. Multivariate modeling found males to be 3.52 times more likely to have had sex, 5.42 times more likely to report sexual debut before age 14, 9.75 times more likely to have>1 sexual partner, and 3.33 times more likely to not have used a condom during last sex. Adolescents living with parents, grandparents, aunts or uncles were less likely to report having unprotected sex compared with those without adult family members in the home (AOR range 0.26–0.51). The high prevalence of risky sex among males and the protective influence of stable family cohesiveness have important implications for HIV prevention efforts.

This article presents a review of literature and concepts linking child sexual abuse history and HIV risk behavior. Correlates of both CSA and HIV risk are reviewed and a proposed model of association is presented. Much of the research on this topic to date is theoretical or correlational in design. Complex and rigorous research designs allowing for further exploration of mediating and moderating variables are warranted to establish the nature of these relationships. Clinical implications include the need to assess: (1) abuse history among high-risk populations and (2) HIV risk behavior among CSA and other trauma survivors.