During the 1970s and 1980s, over 30,000 people in the UK were infected with HIV and/or hepatitis C because of treatment with blood and blood products for conditions such as haemophilia or through blood transfusion. We used the social harms perspective to understand the experiences of those affected. We conducted in-depth interviews with 41 infected people and 11 family members and analysed the data according to five dimensions of social harm: physical harms, psychological harms, cultural harms, economic harms, and harms of misrecognition. We found that people were harmed by the medical system, the social context that perpetuated stigma and shame against them, and successive governments being largely unwilling to address the many health, social, and economic impacts of infection on families. What stood out were the many reports of harms of misrecognition, which were often experienced as more irreconcilable than the circumstances of infection itself. They were also harms that have been largely ignored.

While patient safety encompasses a broad field of work, much of the research focuses on physical harm and medical error. The social harms lens can provide important insights into patient safety incidents as it can help explain the complexity of the different dimensions of harm that individuals and their families experience.

Anonymous online surveys using financial incentives are an essential tool for understanding sexual networks and risk factors including attitudes, sexual behaviors, and practices. However, these surveys are vulnerable to bots attempting to exploit the incentive. We deployed an in-person, limited audience survey via QR code at select locations in North Carolina to assess geolocation application use among men who have sex with men to characterize the role of app usage on infection risk and behavior. The survey was unexpectedly posted on a social media platform and went viral. Descriptive statistics were performed on repeat responses, free-text length, and demographic consistency. Between August 2022 and March 2023, we received 4,709 responses. Only 13 responses were recorded over a 6-month period until a sharp spike occurred: over 500 responses were recorded in a single hour and over 2,000 in a single day. Although free-text responses were often remarkably sophisticated, many multiple-choice responses were internally inconsistent. To protect data quality, all online surveys must incorporate defensive techniques such as response time validation, logic checks, and IP screening. With the rise of large language models, bot attacks with sophisticated responses to open-ended questions pose a growing threat to the integrity of research studies.

Group interpersonal therapy (IPT) was introduced to Senegal to treat depression in people living with HIV (PLWH), using a task-shifting approach. Following successful implementation at a tertiary-level hospital in Dakar, we evaluate IPT’s acceptability, feasibility and benefits in primary and secondary-level suburban health facilities. We assess the impact of IPT adaptations and organizational changes and identify sustainability requirements. PLWH with depression received group IPT following the World Health Organization protocol. Acceptability, feasibility and implementation aspects were assessed quantitatively and qualitatively following specific conceptual frameworks. Depressive symptoms severity (PHQ-9) and functioning (WHODAS) were measured pre-, post-treatment and at 3-month follow-up. General linear mixed models were used to describe changes in outcomes over time. Qualitative data were analyzed thematically. Of 84 participants (median age: 45, female>50%), 81 completed group IPT. Enrolment refusal and dropout rates were 7% and 4%. Ninety-seven percent attended at least seven sessions out of eight. Depressive symptoms and functioning significantly improved by therapy’s end (β = 12,2, CI 95% [11.6, 12.8] and β = 8.5, CI 95% [7.3, 9.7], respectively) with gains being sustained 3 months later (p = 0.94 and 0.99, respectively). Adaptations and organizational changes proved successful, but depression screening and diagnosis communication to patients remained challenging. Emerging needs included a tailored patient care pathway and confidentiality. Participants advocated for depression care integration into HIV services. Group IPT’s successful implementation in various ecological and organizational contexts in Senegal indicates high acceptability and feasibility. Sustainability may be enhanced by addressing specific needs at multiple levels (individual, organizational, systemic). A comprehensive reflection on strategies to sustain and scale up group IPT is the next logical step.

People living with HIV/AIDS (PLWH) often experience co-morbid/co-occurring mental health conditions, e.g., depression, anxiety, and post-traumatic stress disorder (PTSD). In resource-limited settings, where provider shortages are common, task shifting and task sharing (i.e., service delivery by non-professionals) are recommended strategies to promote access to and utilization of mental health and psychosocial support (MHPSS) services among PLWH. We conducted a global scoping review of the literature on MHPSS task shifting and sharing intervention studies for PLWH. Data extracted and summarized included study characteristics, intervention components, whether trauma informed study design, how lay health workers (LHWs) were identified and trained to deliver MHPSS services, and findings related to mental health outcomes. Results indicated that from 2013 through 2022, published intervention research concerning task shifting and sharing approaches was much more prolific in low- and middle-income countries than in high-income countries. MHPSS interventions delivered by a variety of LHWs yielded promising associations on an array of mental health outcomes, including PTSD/trauma and suicidality, though understudied. Underreported details regarding LHW recruitment/selection, compensation, supervision and assessment made it difficult to identify common or best practices. Further research is needed to facilitate the adoption and implementation of MHPSS task shifting and sharing interventions.

Knowledge about HIV and level of HIV-related stigma have been considered the main indicators of the community’s readiness to combat and bring the HIV epidemic to an end. Of all Serbia, the northern Kosovo province is especially vulnerable to the HIV spread because the infrastructure and the entire regulatory system had to be rebuilt after the ethnic conflict. The study objective was to examine the association between HIV-related knowledge level and attitudes towards people living with HIV (PLHIV) among university students from northern Kosovo using the quantile regression. A total of 1,017 students filled in an anonymous questionnaire. The questionnaire examined socio-demographic characteristics, HIV-related knowledge, attitudes towards PLHIV, sources of information about HIV, past experiences with PLHIV, and health behaviours. The dependent variable in the model was the attitude score (ATS) divided into quantiles (Q) in quantile regression analysis: Q0.10, Q0.25, Q0.50, Q0.75, and Q0.90. The independent variable was the knowledge score (KNS). The model was adjusted for relevant covariates. The majority of students had adequate HIV-related knowledge (89.6%) and 10.4% had lower knowledge. Most students also had a positive attitude (83.9%), while 16.1% were indecisive towards PLHIV. No students exhibiting wrong knowledge and negative attitudes were observed. The KNS and ATS significantly correlated with one another (ρ = 0.383; p = 0.001). The quantile regression model adjusted for variables associated with both KNS and ATS showed a negative association between KNS and ATS in the lowest quantile (Q0.10) of the ATS. In all other quantiles (Q0.25–Q0.90), a higher KNS was associated with having stronger positive attitudes towards PLHIV. This study confirmed that higher knowledge about HIV was associated with stronger positive attitudes towards HIV. Still, some students remain indecisive despite being knowledgeable about HIV. These students could benefit the most from continuing educational programmes to reduce the HIV-related stigma.

Low vitamin D associated with high parathyroid hormone (PTH) is common in HIV infection. We determined the association between total 25(OH)D and PTH in adolescents living with HIV, in Zambia and Zimbabwe. Adolescents (11–19 years) perinatally infected with HIV and established on antiretroviral therapy for ≥ 6 months were recruited into a cross-sectional study. Socio-demographic and clinical characteristics were recorded, anthropometry measured and fasted serum concentrations of 1,25(OH)2D, total 25(OH)D and intact PTH measured. The association between total 25(OH)D and PTH was examined using natural cubic spline regression. 842 participants (female: 53·2%) with a median age of 15·5 (IQR: 13·2–17·9) years were enrolled. Median antiretroviral therapy duration was 9·8 (IQR: 6·3–12·3) years, and 165/841 had an HIV viral-load >60 copies/ml. Stunting (height-for-age z-score <–2) and underweight (weight-for-age z-score <–2) were observed in 29·9 and 30·0%, respectively. Three-quarters reported daily Ca intakes <150 mg/d. The mean (sd) concentrations of total 25(OH)D and 1,25(OH)2D were 66·1(16·5) nmol/l and 210·6 (70·4) pmol/l, respectively, and median PTH level was 4·3 (IQR: 3·3–5·5) pmol/l. There was an inverse non-linear relationship between total 25(OH)D and PTH, 25(OH)D levelling off at 74·6 nmol/l (95 % CI: 74·5, 75·2). Results were consistent in those taking tenofovir disoproxil fumarate and virally unsuppressed participants. In this population with extremely low habitual Ca intakes, the lack of association between 25(OH)D and PTH when 25(OH)D exceeded 75 nmol/l potentially suggests that levels of 25(OH)D >75 nmol/l may need to be achieved to improve bone health; investigation is needed in future research studies.

This reflection considers the contribution of Prof Larry Gostin to global health law and the lessons for climate action.

In 2023 the Supreme Court of Mauritius cited human rights and public health arguments to strike down a colonial-era law criminalizing consensual same-sex sex. The parliament of Singapore recently did the same through legislative means. Are these aberrations or a shifting global consensus? This article documents a remarkable shift international legal shift regarding LGBTQ+ sexuality. Analysis of laws from 194 countries across multiple years demonstrates a clear, ongoing trend toward decriminalization globally. Where most countries criminalized same-sex sexuality in the 1980s, now two-thirds of countries do not criminalize under law. Additionally, 28 criminalizing countries in 2024 demonstrate a de facto policy of non-enforcement, a milestone towards legal change that all of the countries that have fully decriminalized since 2017 have taken. This has important public health effects, with health law lessons for an era of multiple pandemics. But amidst this trend, the reverse is occurring in some countries, with a counter-trend toward deeper, harsher criminalization of LGBTQ+ sexuality. Case studies of Angola, Singapore, India, Botswana, Mauritius, Cook Islands, Gabon, and Antigua and Barbuda show many politically- and legally-viable pathways to decriminalization and highlight actors in the executive, legislative, and judicial arenas of government and civil society engaged in legal change.

The prevalence of poor linear growth among African children with perinatally acquired HIV remains high. There is concern that poor linear growth may to lead to later total and central fat deposition and associated non-communicable disease risks. We investigated associations between height-for-age Z score (HAZ) and total and regional fat and lean mass measured by dual-energy X-ray absorptiometry, expressed as internal population Z scores, among 839 Zimbabwean and Zambian perinatally HIV-infected male and female adolescents aged 11–19 years. Stunting (HAZ < –2) was present in 37 % of males and 23 % of females. HAZ was strongly positively associated with total, trunk, arm and leg fat mass and lean mass Z scores, in analyses controlling for pubertal stage, socio-economic status and HIV viral load. Associations of linear growth with lean mass were stronger than those with fat outcomes; associations with total and regional fat were similar, indicating no preferential central fat deposition. There was no evidence that age of starting antiretroviral therapy was associated with HAZ or body composition. Non-suppressed HIV viral load was associated with lower lean but not fat mass. The results do not support the hypothesis that poor linear growth or stunting are risk factors for later total or central fat deposition. Rather, increased linear growth primarily benefits lean mass but also promotes fat mass, both consistent with larger body size. Nutritional and/or HIV infection control programmes need to address the high prevalence of stunting among perinatally HIV-infected children in order to mitigate constraints on the accretion of lean and fat mass.