This paper examines the potential for, and the contradictions inherent in, voluntary sector health service providers acting as consumer representatives. The paper examines a U.K. gay men’s HIV prevention organization to consider whether members are united by their experiences of using services, whether their work involves consumerist strategies, if so whether these are influential, and what tensions emerge from the dual provider/consumer role. Fieldwork was carried out in 1997-98, examining, via documents and interviews, activity between 1992 and 1997. Qualitative analysis was performed. Consumer action is shown to emerge not so much from abstract constructions of consumer interest, but more from the particularities of consumption, which become politicized more powerfully through their attachment to other interests and ideologies.

HIV civil society advocacy in Vietnam is shaped by a unique fusion of historic and contemporary influences, resulting in nuanced ways in which advocacy is practised. In this study, we interviewed representatives from civil society, the Government of Vietnam, international NGOs, multilateral and research organisations and commercial consultancies to identify the influences on advocacy practice today. Aspects of Confucianism, Buddhism, Communism and changes to international funding were all identified as shaping HIV civil society policy advocacy practice directed towards government. These influences have resulted in a strong respect for hierarchy, non-confrontational and collaborative working relationships between civil society and the government, decision-making by consensus and changes in advocacy practice corresponding to fluctuations in international funding. This study shows how, as civil society continues to develop its role in the HIV sector in Vietnam, it is critical to understand these complex influences so that program designers, funders and evaluators can appropriately support HIV civil society policy advocacy.

This commentary discusses research workforce programs designed to enhance the representation and engagement of Latinos in HIV research, highlighting key challenges and proposing actionable strategies for improvement. Mentorship education and cultural inclusivity are identified as the most salient issues because the former leads to stronger health-related outcomes and is linked to cognitive-and career-related factors while the latter offers the potential to directly dismantle structures of inequity. This commentary suggests recasting of Diversity, Equity, and Inclusion (DEI) initiatives from eligibility as Latino self-identification, to all individuals’ lived experiences and/or prior experience in service/research activities. Some issues and constructs (i.e., heterogeneity, perseverance, acculturation, cultural values), typically important for certain underrepresented minoritized groups in diversity workforce programs, are reinterpreted for their relevance to all potential participants. This commentary proposes a holistic approach to trainee eligibility, creating a more inclusive environment that respects both individuality and diversity, and, importantly, contributing to DEI does not require being a member of an underrepresented minoritized population group.

Female genital schistosomiasis (FGS) remains a neglected sexual and reproductive health (SRH) condition, predominantly affecting women and girls in sub‐Saharan Africa. Infection with Schistosoma haematobium, resulting in trapped parasite eggs in the genital tract, causes lesions that mimic sexually transmitted infections and cervical neoplasia, often leading to misdiagnosis, stigma and delayed treatment. This review summarises current developments on FGS burden, prevention, diagnostics, integration, policy, community engagement and identifies critical threats to progress. Ongoing surveys show promise in ensuring robust burden estimates and age‐related risk data. Diagnostic advances include portable colposcopy, digital image analysis techniques and molecular assays, although limitations persist in resource‐limited settings. Praziquantel remains the cornerstone of treatment, yet single‐dose regimens inadequately reverse established lesions; repeated dosing shows improved parasite clearance but limited lesion regression, highlighting the necessity for early, life‐course preventive chemotherapy including access to paediatric praziquantel. Successful programmatic pilots have developed training curricula, minimum service packages, community engagement tools and have integrated FGS care into SRH platforms. Policy momentum is building through World Health Organization taskforces and national strategies, yet sustainable financing remains a challenge. Key threats include bilateral aid reductions, climate change, emerging infections, rising healthcare costs and persistent gender inequities. To address these challenges, we propose seven priority actions, encompassing all health system building blocks, for the global community. Nationally coordinated, multisectoral efforts are urgently required to embed FGS prevention, diagnosis and management within broader health systems, thereby improving outcomes for affected women and girls.

Dioecious species that reproduce by internal fertilization typically carry an associated risk of exposure to sexually transmitted parasites and pathogens. When hosts intermingle for procreation, certain protist and helminth parasites, for example, transfer successfully between individuals and then navigate across various life history traits of their hosts, often probing dimensions in both sex and gender, respectively. In humans, there are many sexually transmitted infections as well as sexually transmitted diseases. A well-known sexually transmitted infection is the flagellated protist Trichomonas vaginalis that causes trichomoniasis, with over 150 million new cases reported annually. By contrast, the schistosome blood fluke Schistosoma haematobium, though not a sexually transmitted infection, causes significant damage to the male and female genital tracts. Such overt damage raises risks of spreading and acquiring Human Immunodeficiency Virus and Human Papilloma Virus. In Africa, over 50 million women continue to suffer from female genital schistosomiasis, alongside a poorly quantified global burden of travel-related infections. In conjunction with male genital schistosomiasis, urogenital schistosomiasis causes much suffering, within and between afflicted households, inclusive of stigmatization. Both trichomoniasis and schistosomiasis expose several public health needs currently addressed inadequately by routine sexual and reproductive health services. This preface to the Parasitology Special Issue entitled ‘Parasites of the genital tract: short- and long-term consequences’, introduces 19 papers that explore the short – and long-term impacts of parasitic infections within the genital tract. While current parasitological research is weighted towards human medicine, we encourage future studies that explore veterinary contexts and analogous parasitic diseases within wildlife.

Due to the widespread availability of effective antiretroviral therapy regimens, average lifespans of persons with HIV (PWH) in the United States have increased significantly in recent decades. In turn, the demographic profile of PWH has shifted. Older persons comprise an ever-increasing percentage of PWH, with this percentage expected to further increase in the coming years. This has profound implications for HIV treatment and care, as significant resources are required not only to manage HIV itself, but also associated age-related comorbidities and health conditions that occur in ageing PWH. Effective management of these challenges in the coming years requires accurate modelling of the PWH age structure. In the present work, we introduce several novel mathematical approaches related to this problem. We present a workflow combining a PDE model for the PWH population age structure, where publicly available HIV surveillance data are assimilated using the Ensemble Kalman Inversion algorithm. This procedure allows us to rigorously reconstruct the age-dependent mortality trends for PWH over the last several decades. To project future trends, we introduce and analyse a novel variant of the dynamic mode decomposition (DMD), nonnegative DMD. We show that nonnegative DMD provides physically consistent projections of mortality and HIV diagnosis while remaining purely data-driven, and not requiring additional assumptions. We then combine these elements to provide forecasts for future trends in PWDH mortality and demographic evolution in the coming years.

Human immunodeficiency virus (HIV) and mental health have complex, bidirectional impacts. Integrated service delivery, especially in low- and middle-income countries (LMICs) where resources are most limited and the burden of HIV is heaviest, may help to improve both HIV and mental health outcomes. While the integration of mental health and HIV services has been studied in various settings, previous reviews on this topic have primarily focused on the integration processes rather than health outcomes. In this systematic review, we evaluated the effectiveness of interventions in LMICs that integrated mental health and HIV services. We searched PubMed, CINAHL, Sociological Abstracts, PsycINFO and EMBASE and conducted backward and forward citation searches. We included studies conducted in LMICs that evaluated the integration of services for HIV and mental health conditions using pre-post or multi-arm study designs, published in a peer-reviewed journal from January 2000 through January 2024. Studies on substance use services were excluded. Risk of bias for included studies was assessed using the Evidence Project tool. We summarized findings narratively, including both mental health-related and HIV-related outcomes. Eighteen studies with a total of 9,729 participants were included in the analysis, among which 17 studies were conducted in sub-Saharan Africa and 10 were randomized controlled trials. Seventeen studies used a task-sharing approach, where nonspecialists provided mental health interventions. The low follow-up rate and lack of random participant selection suggested the increased risk of bias in most studies. Overall, interventions that integrated mental health and HIV services provided greater improvement in recipients’ mental health symptoms (e.g., depression and post-traumatic stress disorder) than HIV services alone, often reducing symptom scores by more than 50%. While the evidence on HIV-related outcomes (e.g., antiretroviral therapy adherence, viral suppression and HIV stigma) was more limited, most studies that reported these outcomes showed positive effects of integrated interventions, especially community-based ones. These findings suggest the benefit of the interventions that integrate mental health and HIV services in LMICs, although further evaluations are warranted.

Microbial dysbiosis has been linked to environmental enteropathy (EE) and alterations in nutrient absorption; however, compositional modifications following exposure to supplementary nutrients are poorly understood. Here, we report the effect of amino acid and micronutrient supplementation on the gut microbiome of adults with EE.

In the AMAZE trial, adults with EE were randomized to amino acids (AA) and/or micronutrients (MM) for 16 weeks in a 2 × 2 factorial design against placebo. Endoscopy was performed before and after intervention, during which duodenal aspirates were collected as well as fecal samples. 16S rRNA amplicon sequencing was performed on both these samples, and differences in bacterial community composition before and after interventions were investigated using differential abundance analysis, corrected using false discovery rate, plus alpha and beta diversity measurements.

HIV seropositive participants exhibited lower alpha and beta diversity at baseline. AA and/or MM supplementation did not show significant changes in abundance or diversity of genera post-intervention compared to placebo. Micronutrient supplementation resulted in an increase in the pyruvate fermentation to acetone MetaCyc pathways compared to the placebo arm.

This study provides insights into the responsiveness of the gut microbiome to micronutrient and amino acid supplementation in adults with EE.

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.