The global effort to vaccinate people against SARS-CoV-2 in the midst of an ongoing pandemic has raised questions about the nature of vaccine breakthrough infections and the potential for vaccinated individuals to transmit the virus. These questions have become even more urgent as new variants of concern with enhanced transmissibility, such as Delta, continue to emerge. To shed light on how vaccine breakthrough infections compare with infections in immunologically naive individuals, we examined viral dynamics and infectious virus shedding through daily longitudinal sampling in a small cohort of adults infected with SARS-CoV-2 at varying stages of vaccination. The durations of both infectious virus shedding and symptoms were significantly reduced in vaccinated individuals compared with unvaccinated individuals. We also observed that breakthrough infections are associated with strong tissue compartmentalization and are only detectable in saliva in some cases. These data indicate that vaccination shortens the duration of time of high transmission potential, minimizes symptom duration, and may restrict tissue dissemination.

Background The global effort to vaccinate people against SARS-CoV-2 during an ongoing pandemic has raised questions about how vaccine breakthrough infections compare with infections in immunologically naive individuals, and the potential for vaccinated individuals to transmit the virus. Methods We examined viral dynamics and infectious virus shedding through daily longitudinal sampling in 23 adults infected with SARS-CoV-2 at varying stages of vaccination, including 6 fully vaccinated individuals. Results The durations of both infectious virus shedding and symptoms were significantly reduced in vaccinated individuals compared with unvaccinated individuals. We also observed that breakthrough infections are associated with strong tissue compartmentalization and are only detectable in saliva in some cases. Interpretation Vaccination shortens the duration of time of high transmission potential, minimizes symptom duration, and may restrict tissue dissemination.

Retention in care and sustained viral suppression are integral outcomes in the care continuum for people living with HIV (PLWH) and HIV prevention; however, less is known about how substance use predicts sustained viral suppression over time. This study seeks to examine the predictive effects of substance use on sustained viral suppression in a sample of cisgender sexual minority men and gender minority PLWH (n=163) drawn from a longitudinal sample in the Chicago area collected 2015-2019. Using data from 3 visits separated by 6 months, participants were coded persistently detectable, inconsistently virally suppressed, and consistently virally suppressed (<40 copies/mL at all visits). Multinomial logistic regressions were utilized. About 40% of participants had sustained viral suppression. In multinomial logistic regressions, CUDIT-R predicted persistent detectable status and stimulant use was associated with inconsistent viral suppression. Substance use may create challenges in achieving sustained viral suppression, which has important implications for care and prevention.

Minority stress processes have been consistently linked to increased internalizing symptoms among sexual minority individuals. However, very little research has studied the impact of minority stress on the mental health of same-sex couples. The present study examined associations of actor and partner heterosexist microaggressions and internalized heterosexism with internalizing symptoms, moderated by dyadic coping, among male same-sex couples. Participants were 774 men who have sex with men (387 dyads). Results of actor-partner interdependence models showed that actor, but not partner, minority stress was positively associated with internalizing symptoms. Dyadic coping moderated the association of actor heterosexist microaggressions on internalizing symptoms such that for those who engaged in more dyadic coping, the association of heterosexist microaggressions with internalizing symptoms was weaker. Dyadic coping also moderated the association of partner internalized heterosexism on internalizing symptoms. For those who engaged in more dyadic coping, their partner's internalized heterosexism was associated with greater internalizing symptoms. Although dyadic coping may buffer the effects of minority stress on internalizing symptoms, if partners rely too heavily on one another to cope with stress, it may be detrimental to their mental health. Implications for relationship education interventions for same-sex couples are discussed. Public Significance StatementFor same-sex couples, an individual's experience of stress as a result of their marginalized status may impact not only their own mental health but also that of their partner. This study suggests that when male same-sex couples cope with that stress together, it can reduce this impact, but when engaged in very frequently, joint coping can exacerbate the effects of one partner's stress on the other's anxiety and depression.

Research has begun to examine sexual behavior during the COVID-19 pandemic using quantitative methods, but less is known about the context surrounding these changes using qualitative methods, including corresponding changes in risk reduction methods. This qualitative study, guided by the Integrated Behavioral Model, examines the pandemic's impact on PrEP adherence among young men who have sex with men in Chicago. PrEP-using participants from a cohort study were recruited into a 90-day diary study measuring sexual behaviors and PrEP use. Between April and September 2020, a subset of participants was recruited for qualitative interviews (n = 28) exploring prevention strategies, including the impact of the pandemic. Although most were highly adherent pre-pandemic, many took fewer pills or discontinued during the pandemic due to decreased sex. Findings suggest the importance of counseling for PrEP reinitiation as “seasons of HIV risk” increase, as well as use of telehealth as a facilitator of PrEP use throughout the pandemic.