Countries with greater income inequality have more new HIV infections and more deaths from both AIDS and COVID-19, a recent study has found. Governments’ responses to pandemics have often focused heavily on individual behaviour, encouraging or mandating behaviour change to limit the spread of infection. However, much less attention has been paid to how broader social determinants impact health outcomes for these global crises. [GLOSSARY]

Disengagement from HIV care happens for numerous reasons and efforts to promote re-engagement in care should develop strategies that address the multiple patterns of disengagement, a study of people with unsuppressed viral load in Uganda reports. Interrupting treatment, or disengaging from care, is common, although calculating what proportion of people with HIV are not currently engaged in care is complicated by the fact that people may move from one clinic to another.

Around one in ten people with HIV developed limited treatment options – which meant that they could no longer take a standard three-drug antiretroviral combination – during approximately five years of follow-up, a large study has found.

Taking doxycycline as post-exposure prophylaxis after sex – known as doxyPEP – did not reduce the likelihood of sexually transmitted infections (STIs) among cisgender women in Africa as it does for gay and bisexual men, according to recently published study results. Actual use of the antibiotic was found to be low, however, suggesting doxyPEP might still work for women if adherence is higher.

HIV prevention coverage is increasing among gay and bisexual men in Australia, but some men remain less well protected. Gay and bisexual men under the age of 25, bisexual men of all ages, and men living in suburbs with fewer gay residents have higher levels of HIV risk and lower levels of prevention coverage.

A positive diagnosis continues to be a source of isolation and stigma for people living with HIV, especially among trans people, younger people and women. Findings from the UK’s largest survey of people living with HIV show that while knowledge of ‘Undetectable equals Untransmittable’ (U=U) is high and linked to higher self-esteem, women are less likely to know and believe that U=U is true. One in 10 of all survey respondents said they were refused healthcare (4% in the last year) and a further one in 10 felt afraid to access healthcare.

A positive diagnosis continues to be a source of isolation and stigma for people living with HIV, especially among trans people, younger people and women. Findings from the UK’s largest survey of people living with HIV show that while knowledge of ‘Undetectable equals Untransmittable’ (U=U) is high and linked to higher self-esteem, women are less likely to know and believe that U=U is true. One in 10 of all survey respondents said they were refused healthcare (4% in the last year) and a further one in 10 felt afraid to access healthcare.

An implementation project in three African countries that used an algorithm to quickly identify, diagnose, and treat people with HIV-related central nervous system infections during routine care resulted in a significant decrease in mortality, according to a recent publication in The Lancet HIV. Before the intervention, 49% of patients died within two weeks, reducing to 24% during the implementation phase.

Offering statins to people with HIV to lower the risk of heart disease poses particular challenges for low- and middle-income countries and requires investment in order to deliver the benefits identified in a large international clinical trial of the drugs.

Healthcare workers’ negative attitudes towards men prevent them from acknowledging structural barriers and may create hostile environments for men wanting to access healthcare. Dr Kathryn Dovel of the University of California and colleagues did a secondary analysis of data collected with healthcare workers in Malawi and Mozambique. They found that healthcare workers framed men as problematic and “selfish”, which places an unfair responsibility on individual men while minimising barriers and challenges they face.

Zimbabwe has been able to approve two new HIV prevention products within six months and did so before any other African nation. How did it achieve this and what are the lessons for other countries that have urgent needs for new HIV prevention options?

As HIV RNA tests become ever more capable of detecting minute quantities of the virus, health care providers and laboratories should be more mindful of how viral load results can be misinterpreted in the era of ‘Undetectable equals Untransmittable’ (U=U).