David Jackson-Perry

Background: Immediate antiretroviral therapy (ART) initiation after HIV diagnosis is a clinical and public health priority. The “treat all” strategy—ART initiation irrespective of CD4+ cell count—improves health outcomes and curtails further transmissions. Using data from the Swiss HIV Cohort Study, we assessed time from HIV diagnosis to ART initiation and associated sociodemographic and clinical characteristics to evaluate how rapidly and equitably it was adopted at a national level. Methods: We analyzed participants diagnosed in 1996–2025. Time from HIV diagnosis to ART initiation was assessed by Kaplan-Meier estimates, and associated characteristics were evaluated by fitting time-updated Cox proportional hazards models. Results: Among 7525 participants diagnosed between 1996 and 2025, 93.1% initiated ART. Median time to ART initiation declined steeply from 983 days (2005) to 63 days (2010), reaching 12 days by 2025; 42.2% initiated ART within 1 week in 2025. CD4+-based differences disappeared, with median ART initiation times falling below 3 weeks across all strata by 2025. Higher viral load remained associated with faster ART initiation, although absolute differences in ART timing among viral load strata were small. Participants from Africa and the Americas showed significantly lower initiation hazards than Europeans in 2017–2025, with absolute differences of at most 1 week by 2025. By transmission mode, people who inject drugs consistently showed the lowest ART initiation hazard. Conclusions: Universal treatment was rapidly implemented in Switzerland, with a shift toward rapid and equitable ART initiation. Residual differences for viral load, region of origin, and people who inject drugs warrant continued monitoring.

Introduction: Global awareness to chemsex, a specific form of sexualized psychoactive substance (“chems”) use among gay, bisexual and other men who have sex with men (gbMSM), is increasing. We aimed to assess prevalence, patterns and implications of “chems” use on chemsex‐related outcomes. Methods: We conducted a Swiss‐wide longitudinal study using individual‐level data from April 2019 to December 2024 of adult gbMSM with HIV, enrolled in the Swiss HIV Cohort Study (SHCS), or taking HIV pre‐exposure prophylaxis (PrEP), enrolled in SwissPrEPared. Determinants of “chems” (methamphetamine, new psychoactive stimulants, GHB/GBL) use and clinical implications were analysed using logistic regression. Longitudinal “chems” use patterns were distinguished by rule‐based classification. Point‐prevalences of “chems” use, including COVID‐19 and mpox periods, were analysed using interrupted time series analysis. Results: We analysed 107,855 follow‐up visits from 13,304 gbMSM. “Chems” were used by 17.2% of gbMSM (21.4% in SwissPrEPared vs. 11.2% in the SHCS). Age below 26 (compared to 26−37, adjusted odds ratio [aOR]: 0.82, 95%‐confidence interval: 0.68−0.96), over 37 (aOR for 38−48: 0.84, 0.75−0.94; aOR for over 48: 0.54, 0.47−0.62) and bisexual orientation showed lower odds (aOR: 0.78, 0.66−0.90), while participation in French‐speaking SwissPrEPared centres (aOR compared to SHCS Eastern Switzerland: 1.41, 1.22−1.64) and sex with non‐steady partners showed higher odds for “chems” use (aOR: 12.44, 8.85−18.17). “Chems” use was associated with depression, inconsistent condom use, high non‐steady partner count and sexually transmitted infections (STIs). Comparing longitudinal use patterns, temporally restricted use, that is, recovering from stable use, reported “chems” use only once, or for a single episode shorter than 1 year, showed the lowest risk for STIs and high partner count, whereas intermittent use showed lower risk only for syphilis. “Chems” use decreased marginally during COVID‐19 and mpox, with a quick return and no difference to levels before COVID‐19. Conclusions: A large proportion of gbMSM use “chems,” with congruent determinants across both cohorts but heterogeneous impact on sexual and mental health that varies by specific substance and longitudinal use patterns. Further understanding of underlying mechanisms driving this heterogeneity is needed before delivering mechanism‐informed interventions tailored to “chems” use patterns, like STI and depression screening, harm‐reduction counselling and linkage to addiction care.

Introduction: Tobacco smoking is an insufficiently addressed health burden among people living with HIV. The Reduce tobacco use in people living with HIV in Switzerland (RETUNE) trial tests the effectiveness of offering a menu of nicotine substitute products, including e-cigarettes, nicotine...

Background: Among people living with HIV, there has been a shift of focus from HIV-related health issues to cardiovascular diseases and cancer. For both, tobacco smoking is a major but insufficiently addressed etiological factor. Evidence from randomized trials suggests that nicotine substitute products such as e-cigarettes and nicotine patches can reduce tobacco smoking and its associated health burden. However, most previous smoking cessation trials primarily included people who are motivated to quit smoking and focused on testing a single nicotine substitute product. The effectiveness of offering a menu of nicotine substitute products to tobacco smokers regardless of their willingness to quit smoking (“opt-out” approach) is unknown. Methods: Reduce tobacco use in people living with HIV in Switzerland (RETUNE, NCT06789692) is a pragmatic, 1:1 randomized, multicenter, superiority clinical trial using the Trials within Cohorts (TwiCs) design within the Swiss HIV Cohort Study. RETUNE assesses the effectiveness of offering a menu of different nicotine substitute products, namely electronic cigarettes, nicotine pouches, and nicotine patches, versus usual care. Cohort participants are eligible if they smoke more than one tobacco cigarette per day, do not use any of the substitute products, and have signed the randomization consent following the TwiCs design. Participants randomized to the intervention may choose any of the offered substitutes to be used free of charge for 6 months or decline the offer. Overall, we plan to recruit 972 participants. The primary outcome is tobacco abstinence at 6 months measured as participant-reported past 7-day prevalence abstinence. The primary outcome will be assessed in the intention-to-treat set using a logistic regression model adjusted for region, men having sex with men, current drug users, and number of cigarettes per day at baseline. Secondary outcomes are long-term smoking cessation rates and tobacco-associated health outcomes. Discussion: RETUNE started recruitment in February 2025 and is currently ongoing. RETUNE using the TwiCs design will clarify the effectiveness of a preference-based opt-out smoking cessation intervention among people living with HIV. Trial registration: Clinicaltrials.gov NCT06789692. Registered on January 17th, 2025. The manuscript is aligned with the registry. https://clinicaltrials.gov/study/NCT06789692?cond=NCT06789692&rank=1

Feelings have long run high between many autistic advocates and behavior analysts. The former often experience and perceive ABA as harmful and traumatic in its methods, and prejudicial and stigmatizing in its objectives, with some of the latter retorting that criticisms reflect misunderstandings of the science rather than areas of true concern. The result? A deep and contentious conceptual divide, leaving little room for dialogue or progress. Recent months, though, have seen a tentative shift. Alongside recognition that behavioral interventions are so deeply entrenched that they are here to stay, some critical autism scholars are gingerly initiating public conversations with behavioral practitioners in a spirit of taking a pragmatic approach to meaningful reform. Further, a new generation of behavior analysts—including some autistic practitioners—is emerging, recognizing problems in their field, and considering how to address them. Interest in such developments is spreading and signals an opportunity for behavior analysts to follow other academic and advocate communities that recognize the importance of interdisciplinarity and critical self-reflection to evolve as a field. We—an interdisciplinary team of critical autism, neurodiversity, and behavior analysis scholars—feel that formalizing a broad field for scholars and practitioners sharing these ambitions holds potential. This field—let’s call it Critical Behavioral Studies —would favor profound social, cultural, and historical understanding, a commitment to extend the scope of training to better contextualize practice in relation to the group served, and the self-examination that would bring meaningful change to the field.

I started studying autism a decade ago as a neurotypical, non-disabled graduate student with a clear idea of what autism is. Since then, pretty much everything I thought I knew about autism, and indeed myself, has largely unravelled. A sense of lacking legitimacy in researching autism as a non-autistic academic – particularly within Critical Autism Studies with its commitment to experiential knowledge – further made for a research journey exemplified by a near-paralysing sense of discomfort, failure and uncertainty. Initially experiencing these sensations as barriers to working in the field, I gradually came to see them as productive and necessary elements of ‘unknowing’, a potential methodological and ethical approach to autism and Neurodiversity Studies. Here, I describe how I came to this way of thinking before briefly sketching out a tentative notion of what unknowing might be and do. While a few scholars have pointed to the ethical and methodological interest of forms of unknowing, none to my knowledge has suggested in simple, concrete terms some ways it might be operationalised in research. For this article, I therefore lean largely on personal experience and focus more on practice than on theory.