Higinio Fernández-Sánchez

Background: Bone marrow abnormalities in people living with HIV may reflect infectious, neoplastic, or inflammatory processes, particularly in advanced disease presenting with fever of unknown origin or unexplained cytopenias. In Latin America, contemporary data on the causes and diagnostic contribution of bone marrow evaluation remain limited, especially in resource-constrained settings. Aim: To characterize the etiologies, histopathological patterns, and diagnostic contribution of bone marrow evaluation in adults living with HIV at a tertiary referral center in Venezuela. Methods: We conducted a cross-sectional study with retrospective and prospective case ascertainment among adults with confirmed HIV infection who underwent bone marrow aspiration, biopsy, or both for suspected infiltrative disease between January 2019 and April 2024. We analyzed clinical, laboratory, histopathological, microbiological, and molecular data at the index bone marrow evaluation. Test-specific denominators are reported because diagnostic investigations were not uniformly available. Results: Forty-two patients were included (35 retrospectively and 7 prospectively); 59.5% were male and the median age was 39 years (IQR: 31.75–50.0). At presentation, 67% were newly diagnosed with HIV and 79% were ART-naive; the median CD4+ T-cell count was 98.5 cells/mm³. Histopathology was evaluable in 37/42 patients; 31/37 (83.8%) showed findings compatible with infectious involvement and 6/37 (16.2%) showed malignancy. Histoplasma capsulatum was isolated in 17/35 fungal cultures (48.6%), Mycobacterium tuberculosis in 13/33 mycobacterial cultures (39.4%), and CMV PCR on bone marrow aspirate was positive in 2/3 patients tested. The final etiologic classification was infectious in 36/42 patients (85.7%) and neoplastic in 6/42 (14.3%). Conclusions: In this highly selected cohort of adults with advanced HIV disease, infectious etiologies-particularly histoplasmosis and tuberculosis-predominated. Bone marrow aspiration and biopsy, interpreted together with microbiological and molecular testing, provided clinically relevant diagnostic information in patients with prolonged fever, cytopenias, or otherwise inconclusive investigations. The findings support earlier HIV diagnosis and ART initiation and improved access to fungal, mycobacterial, and molecular diagnostics in resource-limited settings.

Background: Youth experiencing homelessness (YEH) face elevated risk for sex trafficking due to interconnecting structural, interpersonal, and psychological vulnerabilities. Despite growing recognition of this link, regional data from the southern United States remain limited. This study examines the proportion of YEH reporting experiences consistent with sex trafficking and describes associated characteristics among a sample of YEH in Houston, TX. Methods: Baseline data (September 2019–May 2023) from a randomized controlled trial of a nurse-led HIV prevention intervention were analyzed. Participants (N = 450; ages 16–25) completed self-administered surveys. Sex trafficking was defined as endorsing ≥1 of five Commercial Sexual Exploitation items from the Urban Institute Human Trafficking Screening Tool. Adjusted and unadjusted modified Poisson regression models with robust variance estimation were used to examine relationships between sex trafficking and age, gender, race/ethnicity, sexual orientation, foster care history, past-30-day drug use, and last permanent residence in Houston. Results: Within this sample of YEH, 23.1% (104/450) reported experiences consistent with sex trafficking. In adjusted models, those who identified as female vs. male (aPR = 2.341, 95% CI: 1.530–3.582) were more likely to report being trafficked. Conclusions: Among YEH in Houston, study findings showed that trafficking disproportionately impacted those who identify as female. Findings suggest a need for routine, trauma-informed trafficking screening; service strategies to reach impacted youth; and longitudinal research to clarify causal pathways and guide tailored prevention and care for diverse youth populations. Trial registration: ClinicalTrials.gov NCT03910218

This autoethnography examines how scholar-activism is formed when scholarship emerges from illegality, exile, and forced return. Drawing on a longitudinal archive of public media interviews, professional documents, nonprofit materials, and structured reflexive writing (2026), I trace cyclical migrations from undocumented youth in Texas to return migrant in Mexico, doctoral student in Canada, and nurse scientist back in Texas. Across these stages, intersecting identities as a gay, Latino, working-class migrant shaped how I navigated institutions and linked research with advocacy. The analysis identifies three formations: exile as a structural and epistemic formation; nursing as redistribution and structural intervention; and scholar-activism as dual infrastructure connecting evidence-building with community solidarity. From these, I develop acompañamiento científico (scientific accompaniment) as a praxis framework for scholars working in contexts of criminalized migration and health inequity, offering guidance for integrating scientific rigor with relational accountability in community-engaged and policy-oriented research.

Background: Hematologic abnormalities are common in people living with human immunodeficiency virus (HIV) and may reflect underlying infectious, neoplastic, or inflammatory processes involving the bone marrow. In patients with advanced HIV infection, these abnormalities frequently prompt bone marrow evaluation, particularly in the presence of fever of unknown origin or unexplained cytopenias. However, data describing the etiologic spectrum of bone marrow disease in resource-limited settings remain limited. In Latin America, where approximately 2.5 million people are living with HIV [1], late diagnosis and limited access to diagnostic infrastructure remain significant barriers. Yet, contemporary data on the etiologic spectrum of bone marrow involvement in this region are scarce. Aim: To describe the etiologic distribution, histopathological findings, and clinical characteristics of infiltrative bone marrow disease among adults living with HIV who underwent bone marrow evaluation at a tertiary referral center in Venezuela. Methods: We conducted a descriptive cross-sectional study with retrospective and prospective case inclusion among adults with confirmed HIV infection who underwent bone marrow aspiration and/or biopsy for suspected infiltrative disease between January 2019 and April 2024. Clinical, laboratory, histopathological, microbiological, and molecular data were collected. Descriptive analyses and exploratory comparisons were performed. Continuous variables were compared using the Mann-Whitney U test, and categorical variables were analyzed using chi-square or Fisher's exact test, as appropriate. Results: A total of 42 patients were included; 60% were male, and the median age was 39 years (IQR: 31.75–50.0). At presentation, 67% were newly diagnosed with HIV, and 79% were antiretroviral therapy naïve. Severe immunosuppression was common, with a median CD4+ T-cell count of 98.5 cells/mm³. Bone marrow histopathology most frequently demonstrated granulomatous inflammation and hypocellularity (each 38%). Infectious etiologies were identified in 85% of cases, with Histoplasma capsulatum (49%) and Mycobacterium tuberculosis (39%) being the most common pathogens among those tested. Malignancies accounted for 16% of evaluable biopsies. Denominators varied across analyses because not all patients had complete microbiological or histopathological data available. This study provides one of the few contemporary datasets on bone marrow pathology in HIV in Latin America. Conclusions: In this biopsy-selected cohort of adults with advanced HIV infection, infectious etiologies, particularly histoplasmosis and tuberculosis, were the predominant causes of infiltrative bone marrow disease. Bone marrow evaluation provided clinically relevant diagnostic information in patients with fevers of unknown origin and cytopenias when noninvasive investigations were inconclusive. These findings highlight the need for earlier HIV diagnosis, timely initiation of antiretroviral therapy, and improved access to microbiological and molecular diagnostic tools in resource-limited settings. Evidence contributes to the limited body of evidence on bone marrow pathology in people living with HIV in Latin America. It may inform diagnostic and public health strategies in similar resource-limited settings.

Migrants during their transit, passage, or reception face multiple risks that make them vulnerable to being victims of trafficking and subsequently survivors. This article seeks to understand the structural barriers and facilitating conditions in health care for this population, which affect their well-being. To this end, a qualitative examination was conducted of the experiences of 17 interviewed individuals involved in issues of trafficking and migration, through document review, semi-structured interviews, and thematic analysis. The information was processed with Quirkos software (v.2.5.3), where the following themes were identified: (1) Structural violence and denial of care; (2) Institutional gaps and mismatches; (3) Facilitating conditions: trust, communication, and support networks. It was observed that this population faces structural barriers: legal, cultural, and economic. However, there are also enabling conditions such as education and communication. This shows us that, for this study population, it is necessary to address these barriers and preserve the enabling conditions, contributing to them no longer being violated. It is expected that the results will help implement public policies aimed at preventing trafficking.

This study examines the impact of COVID-19 on the lives of youth experiencing homelessness (YEH) using a concurrent mixed-methods approach. We recruited individuals aged 18–25 ( n = 314) who were homeless and unstably housed (e.g., living in the streets with friends, hotels, or shelters). We measured COVID-19 fear and impact quantitatively and analyzed it using descriptive statistics. Concurrently, we conducted in-person or phone interviews to examine the experiences of YEH ( n = 40). Thematic analysis was used to organize the findings. YEH identifying as LGBTQ+ youth within this community confronted exacerbated challenges. LGBTQ+ youth had significantly higher fear and impact scores when compared to non- LGBTQ+ youth ( p = .02). Qualitative narratives illuminated the profound impact of the COVID-19 pandemic, revealing systemic inequities that disproportionately affected LGBTQ+. Distinct vulnerabilities emerged, encompassing economic strains, restricted healthcare access, and intensified social disconnections. Findings underscores the intricate layers of vulnerability within YEH populations during global health crises. The research accentuates the urgent need for systemic reforms and targeted interventions by integrating insights from a Social Determinants of Health framework. The findings offer invaluable knowledge for policymakers, service providers, and stakeholders, advocating for strategies that address disparities and promote equitable health outcomes among YEH.

The recent shift in United States immigration policies has led to heightened enforcement measures, expedited deportations, and increased surveillance of migrant communities. These policies have exacerbated fear and distrust among migrant populations, particularly undocumented individuals, and have negatively impacted their well-being and willingness to engage in research. This methodological article synthesizes ethical challenges, safety concerns, and field-informed strategies for conducting qualitative, community-engaged research with migrant populations during periods of heightened immigration enforcement. It highlights approaches that ensure ethical engagement, build trust, and safeguard participants while advancing intersectional and policy-oriented research to improve health. Drawing on the authors’ collective experience across multiple community-engaged qualitative projects (including HIV prevention, human trafficking, and violence research) conducted in the United States and informed by parallel work in Canada and Mexico, this methodological article proposes three strategies for ethical research in restrictive immigration climates: (1) building trust through community engagement and partnerships with nonprofits, advocacy groups, and faith-based organizations; (2) prioritizing safety and confidentiality by implementing secure data practices, pivoting research when necessary, and reducing dependency on the collection of identifiable information; and (3) employing intersectional and policy-oriented analysis to address the compounded vulnerabilities migrants face. In times that challenge the well-being of migrant communities and create barriers to public health research, a strong commitment to ethical engagement, safety, and advocacy is needed. Scholars can contribute to knowledge production that centers on migrants’ voices and advances social and physical well-being by forging meaningful partnerships, ensuring participant protection, and leveraging research for policy transformation.