Randolph D. Hubach

Background: Chlamydia infection rates are high among young adults (YA, ages 18-24). Fortunately, vaccines are being developed to target this pathogen, but chlamydia vaccine acceptability has remained largely unaddressed. The purpose of this descriptive study was to assess the acceptability of a prospective chlamydia vaccine and perceived barriers to receiving such a vaccine among YA. Methods: Sexually active YAs in the United States were recruited for an online survey in May 2022. Participants were asked to indicate their likelihood of being vaccinated for chlamydia, receiving the vaccine if recommended by a doctor, researching the vaccine, and asking their provider about the vaccine (5-point Likert scale). Barriers were listed and participants indicated if each barrier would discourage them. Demographic information was collected, and descriptive analyses were conducted in SAS. Results: Approximately 49% of participants were likely to get a chlamydia vaccine (184/379); this increased to 56% if the vaccine was recommended by a physician (211/379). Only 14% were likely to ask their provider about a chlamydia vaccine (42/295) and 16% were likely to seek additional information about the vaccine (50/320). Barriers with a strong influence included vaccine effectiveness (72%, 273/379), cost (68%, 256/379), and for contracting chlamydia because of the vaccine (66%, 251/379). Discussion: Nearly half of YA are accepting of a chlamydia vaccine, with physician influence likely to increase acceptance. Before implementation, studies should identify effective strategies to educate physicians about their role in vaccine uptake and inform the general population on the safety and effectiveness of the chlamydia vaccine.

Background: The growing use of artificial intelligence (AI) chatbots for seeking health-related information is concerning, as they were not originally developed for delivering medical guidance. The quality of AI chatbots’ responses relies heavily on their training data and is often limited in medical contexts due to their lack of specific training data in medical literature. Findings on the quality of AI chatbot responses related to health are mixed. Some studies showed the quality surpassed physicians’ responses, while others revealed occasional major errors and low readability. This study addresses a critical gap by examining the performance of various AI chatbots in a complex, misinformation-rich environment. Objective: This study examined AI chatbots' responses to human papillomavirus (HPV)–related questions by analyzing structure, linguistic features, information accuracy and currency, and vaccination stance. Methods: We conducted a qualitative content analysis following the approach outlined by Schreier to examine 4 selected AI chatbots’ (ChatGPT 4, Claude 3.7 Sonnet, DeepSeek V3, and Docus [General AI Doctor]) responses to HPV vaccine questions. These questions, simulated by young adults, were adapted from items on the Vaccine Conspiracy Beliefs Scale and Google Trends. The selection criteria for AI chatbots included popularity, accessibility, countries of origin, response update methods, and intended use. Two researchers, simulating a 22-year-old man or woman, collected 8 conversations between February 22 and 28, 2025. We used a deductive approach to develop initial code groups, then an inductive approach to generate codes. The responses were analyzed based on a comprehensive codebook, with codes examining response structure, linguistic features, information accuracy and currency, and vaccination stance. We also assessed readability using the Flesch-Kincaid Grade Level and Reading Ease Score. Results: All AI chatbots cited evidence-based sources from reputable health organizations. We found no fabricated information or inaccuracies in numerical data. For complex questions, all AI chatbots appropriately deferred to health care professionals’ suggestions. All AI chatbots maintained a neutral or provaccine stance, corresponding with scientific consensus. The mean and range of response lengths varied [word count; ChatGPT: 436.4 (218-954); Claude: 188.0 (138-255); DeepSeek: 510.0 (325-735); and Docus: 159.4 (61-200)], as did readability [Flesch-Kincaid Grade Level; ChatGPT: 10.7 (6.0-14.9); Claude: 13.2 (7.7-17.8); DeepSeek: 11.3 (7.0-14.7); and Docus: 12.2 (8.9-15.5); and Flesch-Kincaid Reading Ease Score; ChatGPT: 46.8 (25.4-72.2); Claude: 32.5 (6.3-67.3); DeepSeek: 43.7 (22.8-67.4); and Docus: 40.5 (19.6-58.2)]. ChatGPT and Claude offered personalized responses, while DeepSeek and Docus lacked this. Occasionally, some responses included broken or irrelevant links and medical jargon. Conclusions: Amidst an online environment saturated with misinformation, AI chatbots have the potential to serve as an alternative source of accurate HPV-related information to conventional online platforms (websites and social media). Improvements in readability, personalization, and link accuracy are still needed. Furthermore, we recommend that users treat AI chatbots as complements, not replacements, to health care professionals’ guidance on clinical settings.

Pre-exposure prophylaxis (PrEP) has contributed significantly to stabilizing HIV incidence rates across most populations. However, significant disparities in HIV incidence and PrEP uptake persist among Black men who have sex with men (BMSM). This study delved into the individual, sociocultural, and structural factors associated with PrEP access and uptake among 28 BMSM residing in designated HIV hotspots. Participants were recruited from communities identified as “high priority” by the US Department of Health and Human Services’ Ending the HIV Epidemic in the US initiative. Participants completed semi-structured interviews focusing on PrEP awareness, access, and barriers to uptake. Guided by the Socioecological Model, key themes were identified and organized into individual, sociocultural, and structural (systemic) factors that affect PrEP access and health behaviors. Participants described individual barriers related to misinformation, potential side effects, adherence, and low perceived risk for acquiring HIV. Participants described sociocultural and structural barriers to PrEP uptake associated with stigma and PrEP shaming, affordability, the lack of physical access to providers, or non-affirming provider interactions. Overall, misconceptions, negative provider experiences, and stigma significantly limited PrEP access for the BMSM in this study. These findings underscore the need for multi-level public health approaches that address these intersecting barriers. Such strategies must be adaptable to the unique social and geographic characteristics of the BMSM population being served to optimize PrEP access and reduce HIV disparities.

BACKGROUND The growing use of artificial intelligence (AI) chatbots for seeking health-related information is concerning, as they were not originally developed for delivering medical guidance. The quality of AI chatbots’ responses relies heavily on their training data and is often limited in medical contexts due to their lack of specific training data in medical literature. Findings on the quality of AI chatbot responses related to health are mixed. Some studies showed the quality surpassed physicians’ responses, while others revealed occasional major errors and low readability. This study addresses a critical gap by examining the performance of various AI chatbots in a complex, misinformation-rich environment. OBJECTIVE This study examined AI chatbots' responses to human papillomavirus (HPV)–related questions by analyzing structure, linguistic features, information accuracy and currency, and vaccination stance. METHODS We conducted a qualitative content analysis following the approach outlined by Schreier to examine 4 selected AI chatbots’ (ChatGPT 4, Claude 3.7 Sonnet, DeepSeek V3, and Docus [General AI Doctor]) responses to HPV vaccine questions. These questions, simulated by young adults, were adapted from items on the Vaccine Conspiracy Beliefs Scale and Google Trends. The selection criteria for AI chatbots included popularity, accessibility, countries of origin, response update methods, and intended use. Two researchers, simulating a 22-year-old man or woman, collected 8 conversations between February 22 and 28, 2025. We used a deductive approach to develop initial code groups, then an inductive approach to generate codes. The responses were analyzed based on a comprehensive codebook, with codes examining response structure, linguistic features, information accuracy and currency, and vaccination stance. We also assessed readability using the Flesch-Kincaid Grade Level and Reading Ease Score. RESULTS All AI chatbots cited evidence-based sources from reputable health organizations. We found no fabricated information or inaccuracies in numerical data. For complex questions, all AI chatbots appropriately deferred to health care professionals’ suggestions. All AI chatbots maintained a neutral or provaccine stance, corresponding with scientific consensus. The mean and range of response lengths varied [word count; ChatGPT: 436.4 (218-954); Claude: 188.0 (138-255); DeepSeek: 510.0 (325-735); and Docus: 159.4 (61-200)], as did readability [Flesch-Kincaid Grade Level; ChatGPT: 10.7 (6.0-14.9); Claude: 13.2 (7.7-17.8); DeepSeek: 11.3 (7.0-14.7); and Docus: 12.2 (8.9-15.5); and Flesch-Kincaid Reading Ease Score; ChatGPT: 46.8 (25.4-72.2); Claude: 32.5 (6.3-67.3); DeepSeek: 43.7 (22.8-67.4); and Docus: 40.5 (19.6-58.2)]. ChatGPT and Claude offered personalized responses, while DeepSeek and Docus lacked this. Occasionally, some responses included broken or irrelevant links and medical jargon. CONCLUSIONS Amidst an online environment saturated with misinformation, AI chatbots have the potential to serve as an alternative source of accurate HPV-related information to conventional online platforms (websites and social media). Improvements in readability, personalization, and link accuracy are still needed. Furthermore, we recommend that users treat AI chatbots as complements, not replacements, to health care professionals’ guidance on clinical settings. CLINICALTRIAL

Background: HIV pre‐exposure prophylaxis (PrEP) is a highly effective intervention to prevent HIV transmission among men who have sex with men (MSM). Despite its effectiveness, PrEP uptake and adherence among MSM in the United States remain suboptimal, particularly in rural areas. Objective: The present study presents a scoping review of the self‐reported barriers and facilitators of PrEP use among MSM living in rural areas of the United States. Design: Preferred Items for Systematic Reviews—Extension for Scoping Reviews (PRISMA‐ScR) guidelines informed this review. Seven online databases were searched to identify papers published from 2012 to 2023 in English with keywords related the concepts of MSM, rural, and HIV PrEP. Results: From an initial 340 articles, nine were selected. Awareness significantly impacts PrEP uptake in rural areas, with challenges including limited dissemination of information through mainstream channels and low perceived HIV risk among rural MSM. However, nonmainstream information sources can enhance PrEP awareness and use. Several barriers hinder rural residents from accessing PrEP, such as a lack of competent providers, geographic isolation, cost, and stigma. High PrEP care costs, lack of financial assistance for lab work, and limited telePrEP options are key challenges in retaining individuals in PrEP care. Conclusions: Suboptimal PrEP uptake in rural areas with high HIV burden remains a concern, hindered by limited information dissemination, low perceived HIV risk, geographic isolation, nonaffirming medical providers, and expensive PrEP care. Leveraging telePrEP, co‐pay assistance, 340B drug pricing, and geospatial networking apps can enhance PrEP use. Multilevel interventions are crucial to combat the HIV epidemic in rural regions.

The mpox virus outbreak (formerly known as monkeypox) in the United States created an urgent need to inform vaccination acceptance and uptake interventions. We quantitatively examined the association of the Health Belief Model, demographic, and sexual behavioral factors with men who have sex with men (MSM) getting the mpox vaccine. We qualitatively explored MSM’s perceived barriers to obtaining the mpox vaccine. A convenience sample of MSM in the United States (n = 554) completed a mixed-method online cross-sectional survey. A series of chi-square tests of independence, t-tests, and multivariable logistic regressions were used to analyze associations between participants who were and were not vaccinated against mpox. Inductive content analysis was used to investigate perceived barriers. Participants who perceived the barriers that the mpox vaccine is expensive and troublesome had lower odds of getting the mpox vaccine. The content analysis revealed that the most cited barrier was vaccine unavailability and inaccessibility. Health campaigns can increase perceived susceptibility to mpox and the perceived benefits of the mpox vaccine. Still, structural interventions are necessary to ensure that vaccine delivery is adequate, accessible, and equitable.

Purpose: This study examined the consumption of, attitudes toward, and preferences for mpox media among U.S. sexual and gender minority (SGM) people assigned male at birth (AMAB). Methods: A total of 496 SGM people AMAB completed an online cross-sectional survey between August 6 and 15, 2022. Data were analyzed with descriptive statistics and logistic regressions. Results: Approximately two-thirds of participants overall agreed that media-related content about mpox targeted (66.3%) and stigmatized gay, bisexual, and other men who have sex with men (69.2%). The three most preferred mpox content were the destigmatization of SGM people (44.2%), mpox vaccine accessibility (25.2%), and mpox transmission and prevention (19.2%). Rural participants had a lower likelihood of consuming mpox-related media than urban participants. Conclusion: SGM people AMAB prefer mpox messaging campaigns to be grounded in stigma-reduction to ensure that messages do not perpetrate stigma against them. Stigmatizing content might foster SGM people AMAB to distrust mpox interventions.