Mental Health as a Key Mediator for Outcomes in Postsecondary Education, Employment, and Everyday Living in Autistic Adults.

HIV continues to disproportionately affect the Southern United States (US). In 2022, the South comprised of 53% of new HIV diagnoses while representing just over one-third of the national population. The South also reports a higher burden of HIV than other regions. Out of the 57 priority jurisdictions identified in the Ending the HIV Epidemic (EHE) initiative, a substantial number of counties and 6 out of 7 states are from the South, as a result of persistently high incidence and ongoing barriers to prevention and care. Moreover, recent estimates from the Centers for Disease Control and Prevention (CDC) indicate that 14% of individuals living with HIV in the South were unaware of their infection. Low awareness of HIV status can lead to unknowing HIV transmission and delay in treatment. Thus, testing for HIV is a critical step in both prevention and treatment. For individuals who test HIV negative, screening offers an important entry point to prevention measures such as pre-exposure prophylaxis (PrEP). In 2022 only 36% of U.S. adults under age 65 reported ever being tested for HIV, despite CDC’s recommendation that all individuals aged 13–64 should undergo HIV testing at least once, and at least annually for those at increased risk. To access HIV testing, people often rely on designated HIV testing locations, sexually transmitted disease (STD) clinics, community health centers, emergency departments, or physician offices. Access to these services can be impeded due to both HIV-related stigma and distance, especially in the rural South. For example, many individuals are uncomfortable walking into an HIV testing location because someone they know may see them and make assumptions about their behavior and/or risk. Novel approaches have been adopted to expand HIV testing and ensure timely linkage to care. One such approach is integration of HIV point-of-care testing (POCT) into community pharmacies. Roughly 90% of the US population lives within a 5-mile distance of a community pharmacy, making these services accessible for most of the population. Pharmacists often maintain long-standing, trust-based relationships with their patients, positioning them to deliver services in a familiar, non-stigmatizing setting where individuals obtain a range of health services. Importantly, research indicates that willingness to use pharmacist-provided services is higher when patients perceive their pharmacist as an active partner in their care, further reinforcing the potential of pharmacies to expand HIV testing and prevention efforts. Growing literature has examined pharmacy staff attitudes toward integrating HIV testing and other prevention services into pharmacy practice, as well as the operational and structural barriers that may hinder their integration. A cross-sectional study of 480 pharmacy staff participating in New York State’s Expanded Syringe Access Program (ESAP) found that nearly 80% supported offering HIV testing in-pharmacy. Support for HIV testing was higher among those who also supported providing other clinical preventive services, such as vaccinations, in the pharmacy setting. In a qualitative study of community pharmacists in Indiana, Ryder et al. found that pharmacy-based rapid HIV testing was broadly accepted by pharmacists. Acceptability was linked to their positive relationships with patients and comfort with consultation, though concerns about staffing, training needs, availability of private space and delivering positive results remained. A multistate survey conducted in the Southeastern US indicated that approximately 78% of pharmacies did not offer HIV testing; 19.7% of those who did not offer HIV testing were willing to do so. In another study conducted among student pharmacists and practicing pharmacists, nearly all participants agreed that HIV screening is important. However, only 9% of practicing pharmacists compared to 86% of student pharmacists felt that pharmacists should be the ones conducting the screenings. This gap points to a notable discomfort among practicing pharmacists in providing HIV testing.