Hannah Kitt

Objectives: This national cross‐sectional observational study aimed to assess mental health, quality of life, supportive network, experiences of HIV‐related stigma in healthcare and unmet service need among trans and gender‐diverse people with HIV, compared to cisgender people with HIV. Methods: Positive Voices 2022 is a questionnaire survey of people accessing HIV care in England, Scotland and Wales carried out in 2022 and 2023 that included measures of depression and anxiety symptoms and suicidal ideation (PHQ‐9 and GAD‐7), health‐related quality of life (EQ‐5D‐5L), supportive network (modified Duke FSSQ), experiences of HIV‐related stigma in healthcare and service needs. Logistic and ordinal logistic regression assessed the association of gender identity with these measures unadjusted and adjusted for age group and ethnicity. Results: Overall, 67 trans or gender‐diverse and 4551 cisgender people with HIV participated. Compared to cisgender participants, trans and gender‐diverse participants were younger, more likely to be Asian and less likely to be black. They were less likely to be in employment, homeowners and financially secure. Trans and gender‐diverse participants had a higher prevalence of depression symptoms (35.5% [22/62] vs. 20.5% [865/4219], adjusted odds ratio [aOR] [95% confidence interval, CI] = 1.96 [1.15, 3.34]; p = 0.014) and suicidal ideation (37.1% [23/62] vs. 14.6% [616/4219]; aOR = 3.09 [1.85, 5.17]; p < 0.001) compared to cisgender participants. They also had poorer health‐related quality of life for three domains (anxiety and depression, usual activities and self‐care) and lower levels of supportive network in unadjusted and adjusted analyses. A higher proportion of trans and gender‐diverse participants than cisgender participants had unmet needs for health services, including mental health services (49.2% [31/63] vs. 30.2% [1310/4343]; aOR = 2.02 [1.22–3.35]; p = 0.007), lifestyle services, and welfare and social services. Conclusions: Trans and gender‐diverse people with HIV have poorer mental health and wellbeing than cisgender people with HIV, and a higher prevalence of unmet service needs, highlighting the need for access to culturally competent mental health and other health and welfare services.

Biomedical interventions to prevent transmission of Human Immunodeficiency Virus (HIV), such as pre-exposure prophylaxis (PrEP), are available in England for free at specialised sexual health services (SSHS). Yet the number of new HIV diagnoses made in England among people exposed to HIV through heterosexual sex and among people of Black ethnicity are increasing. Published research discusses the barriers and facilitators to PrEP among people not living with HIV. We add to this literature by qualitatively exploring the retrospective barriers and facilitators to PrEP use and HIV prevention more broadly among people who are living with HIV now. We interviewed 26 participants between March 2021 and July 2022 from across England with varying backgrounds. We used the COM-B model to systematically extract areas that can inform behaviour change. Capability barriers included gaps in HIV and PrEP knowledge and mental health issues. Opportunity barriers included not being identified as having a PrEP need by healthcare professionals, which then hindered participants to learn more about PrEP, communication gaps with sexual partners and perceptions of (in)accessibility of PrEP. Motivational barriers included a perception of low HIV risk and HIV/ PrEP self-relevance, PrEP stigma, having reservations about taking medications, and perceiving HIV campaigns as too selective regarding the populations they target. Knowledge about PrEP constituted a capability facilitator; and wanting to stay safe and take control of one’s health was a motivational facilitator. Our findings mirror those identified in research conducted with people not living with HIV, but we believe that particularly strong narratives for HIV prevention can arise from learning from people living with HIV. We suggest that structural changes are required to achieve a shift in how sex, HIV and PrEP are discussed societally, allowing for changes in individual and interpersonal behaviours and a sustained decrease in HIV transmission among all groups.

Biomedical interventions to prevent Human Immunodeficiency Virus (HIV) infection, such as pre-exposure prophylaxis (PrEP), are available in England for free at specialised sexual health services (SSHS). Yet the number of new HIV diagnoses made in England among people exposed to HIV through heterosexual sex and among people of Black ethnicity are increasing. Published research discusses the barriers and facilitators to PrEP for use among HIV-negative people. We add to this literature by qualitatively exploring the retrospective barriers and facilitators to PrEP use and HIV prevention more broadly among people who are living with HIV now. We interviewed 26 participants from across England, including gay men, heterosexual people, Black and female people. We used the COM-B model to systematically extract areas that can inform behaviour change. Capability barriers included gaps in HIV and PrEP knowledge and mental health issues. Opportunity barriers included not being identified as having a PrEP need in healthcare services, which then hindered participants to learn more about PrEP, communication gaps with sexual partners and perceptions of (in)accessibility of PrEP. Motivational barriers included a perception of low HIV risk and HIV/ PrEP self-relevance, PrEP stigma, having reservations about taking medications, and perceiving HIV campaigns as too selective regarding the populations they should appeal to. Knowledge about PrEP constituted a capability facilitator; and wanting to stay safe and take control of one’s health was a motivational facilitator. Our findings mirror those identified in research conducted with HIV-negative people, but we believe that particularly strong narratives for HIV prevention can arise from hearing from people living with HIV. We suggest that structural changes are required to achieve a shift in how HIV and PrEP are discussed societally, allowing for changes in individual and interpersonal behaviours and a sustained decrease in HIV transmission among all groups.

Objectives: We assessed the impact of COVID‐19, and the prevalence and factors associated with a history of COVID‐19 infection, long COVID and incomplete COVID‐19 vaccine uptake among people with HIV.Methods: Positive Voices 2022 is a questionnaire study of people accessing HIV care in the United Kingdom (March 2022–April 2023). Logistic regression assessed factors associated with a history of COVID‐19 (previous positive test), long COVID among those with a history of COVID‐19 (ongoing symptoms, with COVID‐19 onset >3 months previously) and incomplete COVID‐19 vaccine uptake (less than three doses of vaccine), adjusted for: age; gender; ethnicity; and year of HIV diagnosis.Results: In all, 4188 participants were included. Commonly reported negative impacts of the pandemic were on social contact (44% of participants), mental health (30%), healthcare access (26%) and financial security (25%). Overall, 2068 of 4188 (49.4%) participants had a history of COVID‐19. Of these, 10.8% met criteria for long COVID, associated with female gender, unemployment, financial hardship, earlier HIV diagnosis date, diabetes diagnosis, asthma/chronic obstructive pulmonary disease diagnosis, obesity and symptoms of depression and anxiety. Overall, 95.8% reported having at least one vaccine dose, but 649 (15.7%) participants had incomplete vaccine uptake, associated with younger age, female gender, Black African ethnicity, lower education, financial hardship, unemployment, multioccupancy household, more recent HIV diagnosis, detectable HIV viral load and symptoms of depression and anxiety.Conclusions: About half of participants had a history of COVID‐19, of whom 11% had persistent symptoms (long COVID). COVID‐19 vaccine uptake was high, but incomplete uptake was apparent for 16% of participants and was more common among women, younger people, Black African individuals and those with socio‐economic disadvantage.

[This corrects the article DOI: 10.2196/58531.].

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Background: Due to advances in treatment, HIV is now a chronic condition with near-normal life expectancy. However, people with HIV continue to have a higher burden of mental and physical health conditions and are impacted by wider socioeconomic issues. Positive Voices is a nationally representative series of surveys of people with HIV in the United Kingdom. It monitors the physical, mental, and social health, well-being, and needs of this population so that they can be addressed. Objective: This paper aimed to describe the methodology, recruitment strategies, and key demographic features of participants recruited for the second national round of Positive Voices (PV2022). Methods: PV2022 was a national, cross-sectional questionnaire study that included people attending HIV care at 101 of the 178 clinics in the United Kingdom between April 2022 and March 2023. Data from the HIV and AIDS reporting system (HARS), a national surveillance database of people with HIV and attending care that is held at the UK Health Security Agency (UKHSA), was used as a sampling frame. The information collected in PV2022 included demographic and socioeconomic factors, HIV diagnoses and treatment, mental and physical health, health service use and satisfaction, social care and support, met and unmet needs, stigma and discrimination, quality of life, lifestyle factors, and additional challenges experienced due to the COVID-19 pandemic. Data linkage to HARS enabled the extraction of clinical information on antiretroviral therapy (ART), HIV viral load, and CD4 lymphocyte counts. Probabilistic sampling was used to provide a randomly selected, representative sample of people attending HIV care who could be invited to complete a paper or online questionnaire. At the start of 2023, due to under-recruitment mainly due to the impact of the monkeypox (Mpox) outbreak, a separate sequential recruitment strategy was initiated in 14 of the largest clinics to increase participant numbers. Results: Of the 4622 participants who completed the questionnaire, 3692 were recruited through probabilistic recruitment and 930 through sequential recruitment. The overall response rate (measured as the number of people who completed a questionnaire of those who either accepted or declined) was 50%. Survey respondents represented approximately 1 in 20 people diagnosed with HIV in England, Wales, and Scotland. The median age of participants was 52 years, 3428 of participants were men, 2991 were White, and 1121 were Black. Conclusions: PV2022 is currently the largest survey of people with HIV in the United Kingdom (as of September 2024). The PV2022 findings will be used to explore the health and well-being of the HIV population and examine associations with demographic, socioeconomic, lifestyle, and other HIV-related factors. International Registered Report Identifier (IRRID): RR1-10.2196/58531

BACKGROUND Due to advances in treatment, HIV is now a chronic condition with near-normal life expectancy. However, people with HIV continue to have a higher burden of mental and physical health conditions and are impacted by wider socioeconomic issues. Positive Voices is a nationally representative series of surveys of people with HIV in the United Kingdom. It monitors the physical, mental, and social health, well-being, and needs of this population so that they can be addressed. OBJECTIVE This paper aimed to describe the methodology, recruitment strategies, and key sociodemographic features of participants recruited for the second national round of Positive Voices (PV2022). METHODS PV2022 was a national, cross-sectional questionnaire study that included people attending HIV care at 101 of the 178 clinics in the United Kingdom between April 2022 and March 2023. Data from the HIV and AIDS reporting system (HARS), a national surveillance database of people with HIV and attending care that is held at the UK Health Security Agency (UKHSA), was used as a sampling frame. The information collected in PV2022 included demographic and socioeconomic factors, HIV diagnoses and treatment, mental and physical health, health service use and satisfaction, social care and support, met and unmet needs, stigma and discrimination, quality of life, lifestyle factors, and additional challenges experienced due to the COVID-19 pandemic. Data linkage to HARS enabled the extraction of clinical information on antiretroviral therapy (ART), HIV viral load, and CD4 lymphocyte counts. Probabilistic sampling was used to provide a randomly selected, representative sample of people attending HIV care who could be invited to complete a paper or online questionnaire 'on the web' to online. At the start of 2023, the study was underrecruiting, mainly due to the mpox outbreak, and a separate sequential recruitment strategy was initiated in 14 of the largest and most demographically diverse clinics to increase participant numbers. RESULTS Of the 4622 participants who completed the questionnaire, 3692 were recruited through probabilistic recruitment and 930 through sequential recruitment. The overall response rate (measured as the number of people who completed a questionnaire of those who either accepted or declined) was 50%. Survey respondents represented approximately 1 in 20 people diagnosed with HIV in England, Wales, and Scotland. The median age of participants was 52 years, 3428 of participants were male, 2991 were of White ethnicity, and 1121 were of Black ethnicity. CONCLUSIONS PV2022 is currently the largest survey of people with HIV in the United Kingdom (as of September 2024). The PV2022 findings will be used to explore the health and well-being of the HIV population and examine associations with demographic, socioeconomic, lifestyle, and other HIV-related factors. INTERNATIONAL REGISTERED REPORT RR1-10.2196/58531