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Background and Objective Overweight and obesity influence cognitive health, and measured during midlife, may be associated with declining neuropsychological performance (NP) and late-onset dementia in older adults. Few studies have considered these associations in women living with HIV (WLWH). We examined associations cross-sectionally and up to 10 years longitudinally between body mass index (BMI) and waist circumference (WC) and NP in middle-aged WLWH and women without HIV (HIV-).Methods.BMI and WC were measured in 432 virologically-suppressed WLWH and 367 HIV- women, >40 years, who participated in the Women’s Interagency HIV Study (WIHS) and with NP assessments every two years from 2009-2019. Demographically-adjusted T-scores were calculated for six NP domains: learning, memory, executive function, processing speed, attention and working memory, and motor function. Multivariable linear regression models stratified by HIV serostatus were used to examine cross-sectional associations of BMI and WC with each NP domain; repeated measures analyses assessed baseline BMI and WC in association with longitudinal change in NP. Results were outputted as beta-coefficients (b) and 95% Confidence Intervals (95%CI). Covariates included sociodemographic, behavioral, and HIV-related characteristics.ResultsAt baseline, obese WLWH (BMI>30.0 kg/m2) had poorer executive function (β=-2.27, 95%CI [-4.46, -0.07], p=0.043) compared to normal (BMI 18.5–24.9 kg/m2). Longitudinally over ~8 years follow-up, obese versus overweight WLWH improved on learning (β=1.88, 95%CI [0.24, 3.51], p=0.025).Among HIV- women, an overweight versus normal BMI was associated with declining memory (β=-3.13, 95%CI [-5.75, -0.51], p=0.019); however, obese versus overweight HIV- women improved on memory (β=2.47, 95%CI [0.47, 4.46], p=0.015). Among HIV- women, increasing WC was associated with decreasing executive (β=-0.07, 95%CI [-0.11, -0.02], p=0.058), processing speed (β=-0.05, 95%CI [-0.10, -0.01], p=0.044), and motor (β=-0.05, 95%CI [-0.10, -0.01], p=0.033) performance during follow-up.ConclusionsCross-sectional and longitudinal associations of BMI and central adiposity and NP were mixed among WLWH and HIV- women during midlife. However, HIV- women may experience greater NP decline in association with higher adiposity compared to WLWH.

Background SARS-CoV-2 infection among People Living With HIV (PLWH) is not well-described. Objective To study COVID-19 symptoms and SARS-CoV-2 PCR-based swab testing among participants of the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS). Methods A telephone survey was collected April-June 30, 2020. Symptom and testing prevalence were explored. Multivariable logistic regression was used to examine the factors associated with SARS-CoV-2 positivity. Results The survey was completed by 3411 participants, including 2078 (61%) PLWH and 1333 HIV-seronegative (SN) participants from across the US. Thirteen percent (n = 441) were tested for SARS-CoV-2 infection (13.4% of PLWH vs 12.2% of SN). Among those tested, positivity was higher in PLWH than SN (11.2% vs 6.1%, p = 0.08). Reasons for not being tested included testing not being available (30% of participants) and not knowing where to get tested (16% of participants). Most symptoms reported since January 2020 were similar in PLWH and SN, including headache (23% vs. 24%), myalgias (19% vs 18%), shortness of breath (14% vs 13%), chills (12% vs 10%), fever (6% vs 6%) and loss of taste or smell (6% vs 7%). Among PLWH who tested positive for SARS-CoV-2 DNA, the most common symptoms were headache (71%), myalgia (68%), cough (68%) and chills (65%). In multivariable analysis among those tested, the odds of SARS-CoV-2 positivity were higher among PLWH than SN (aOR = 2.22 95%CI = 01.01-4.85, p = 0.046) and among those living with others versus living alone (aOR = 2.95 95%CI = 1.18-7.40). Conclusion Prevalence and type of COVID-19 symptoms were similar in PLWH and SN. SARS-CoV-2 infection may be elevated among PLWH.

Despite dramatic gains in longevity, older women living with HIV (OWLH) continue facing substantial health challenges and little is known whether they can achieve successful aging (SA). This is among the first studies examining prevalence and correlates of self-rated SA (SRSA) among OWLH and counterparts at risk of HIV. SRSA was measured on a 10-point scale (higher scores=better outcomes) used by previous research. Our sample included 298 OWLH and 110 HIV- older (50+) WIHS participants enrolled in the ongoing “From Surviving to Thriving” (FROST) study between 10/01/2017 and 02/12/18 -- mean age 57 years (SD=5.1), 76% Black, and 66% reporting annual income ≤$12,000. Among OWLH, mean CD4 count was 754 cells/ml and 95% were on antiretroviral therapy. Compared to OWLH, HIV- women were more likely to be uninsured, have annual income ≤ $6000, and have hypertension, and were less likely to live in own house/apartment. We found no significant differences in SRSA prevalence or mean scores by HIV status: 89% of OWLH and 87% of HIV- women reported SRSA >5 [mean SRSA: OWLH 8.1 (SD=1.7), HIV- 8.0 (SD=1.8)]. Regardless of HIV status, SRSA did not correlate with sociodemographics or comorbidities. SRSA was positively associated with resilience, optimism, personal mastery, coping, and spirituality; and inversely associated with anxiety and depression (for all, p

Purpose Little is known about how adolescent sexual behaviors develop and the influence of personal or perceived social attitudes. We sought to describe how personal, perceived peer, and perceived family attitudes toward adolescent sexual activity influence sexual behaviors of adolescent females' over time. Methods Between the years of 1999 and 2006, 358 English-speaking female adolescents, aged 14–17 years, were recruited from three urban adolescent clinics. Participants completed quarterly and annual questionnaires over a span of 4 years. Primary outcomes included engagement in any of the following eight sexual behaviors: kissing, having breasts touched, having genitals touched, touching partners' genitals, oral giving, oral receiving, anal, or vaginal sex. Three attitudinal scales assessed personal importance of abstinence, perceived peer beliefs about when to have sex, and perceived family beliefs that adolescent sex is negative. We used generalized estimating equations to identify predictors of each sexual behavior and compared whether personal, perceived peer, or perceived family attitudes predicted sexual behaviors over time. Results The odds of reporting each sexual behavior increased with age but were lower among those whose personal or perceived family attitudes were less positive. Participants' personal attitudes toward adolescent sex were the strongest predictor of engagement in all eight sexual behaviors even after controlling for perceived peer and perceived family attitudes. Conclusions Female adolescent's personal attitudes toward abstinence appear to be the strongest predictor of engagement in a variety of sexual behaviors. Efforts to influence adolescent attitudes toward abstinence may be an important approach to reducing sexual behaviors that increase the risk of pregnancy and sexually transmitted infections.

This study aimed to examine perceptual factors associated with condom use, and the relationship between condom use and the timing of sexual debut, among male secondary-school students in Nairobi, Kenya. Data are from the TeenWeb study, a school-based project that used the World Wide Web to assess the health needs of secondary-school students, and tested the web's utility as a teaching and research modality. Analyses are based on 214 sexually experienced males aged 14 to 20 years who completed web-based questionnaires about their sexual attitudes and behaviour. Results indicate that students did not see themselves as susceptible to HIV/AIDS and believed condom effectiveness in preventing HIV to be low. Consequently, only a marginal association was found between agreeing that buying condoms is embarrassing and condom use at first sexual intercourse. However, contrary to expectation, agreeing that condoms often break (almost half of participants) was associated with a higher likelihood of condom use at first sex. Each year of delay in sexual debut increased the likelihood of using a condom at first sex by 1.44 times. In turn, having used a condom at first sex increased the likelihood of using one at the most recent sex by 4.81 times, and elevated general condom use (“most or all the time”) by 8.76 times. Interventions to increase awareness about the role of condoms in preventing HIV, delay sexual initiation, and teach proper condom use among secondary-school students in Nairobi are needed.

Background HIV prevention efforts have given limited attention to the relational schemas and scripts of adult heterosexual women. These broader schemas and scripts of romantic and other sexual liaisons, partner selection, relationship dynamics, and power negotiations may help to better understand facilitators and barriers to HIV risk-reduction practices. Methods We conducted exploratory qualitative interviews with 60 HIV-uninfected heterosexual African-American women from rural counties in North Carolina and Alabama, and Hispanic women from an urban county in southern Florida. Data were collected for relationship expectations; relationship experiences, and relationship power and decision-making. Interview transcripts underwent computer-assisted thematic analysis. Results Participants had a median age of 34 years (range 18–59), 34% were married or living as married, 39% earned an annual income of $12,000 or less, 12% held less than a high school education, and 54% were employed. Among the Hispanic women, 95% were foreign born. We identified two overarching relationship themes: contradictions between relationship expectations and desires and life circumstances that negated such ideals, and relationship challenges. Within the contradictions theme, we discovered six subthemes: a good man is hard to find; sex can be currency used to secure desired outcomes; compromises and allowances for cheating, irresponsible, and disrespectful behavior; redefining dating; sex just happens; needing relationship validation. The challenges theme centered on two subthemes: uncertainties and miscommunication, and relationship power negotiation. Gender differences in relationship intentions and desires as well as communication styles, the importance of emotional and financial support, and the potential for relationships to provide disappointment were present in all subthemes. In examining HIV risk perceptions, participants largely held that risk for HIV-infection and the need to take precautions were problems of women who differed from them (i.e., abuse drugs, are promiscuous, exchange sex). Conclusion Underlying women’s relational schemas was a belief that relationship priorities differed for men and women. Consequently, expectations and allowances for partner infidelity and negligent behaviors were incorporated into their scripts. Moreover, scripts endorsed women’s use of sex as currency in relationship formation and endurance, and did not emphasize HIV risk. Both couple- and gender-specific group-level interventions are needed to deconstruct (breakdown) and reconstruct (rewrite) relationship scripts.