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Background Poor sleep is associated with HIV, particularly among women with HIV (WWH), although mechanisms are unclear. We explored cross-sectional associations between sleep disruption and tryptophan-kynurenine (T/K) pathway activation, measured by the kynurenine-to-tryptophan ratio (K:T). Methods HIV-uninfected women (HIV-) and WWH on stable antiretroviral therapy aged 35-70 were included. Sleep metrics were measured using wrist actigraphy. Plasma T/K pathway metabolites were measured using liquid chromatography-tandem mass spectrometry. Multivariate linear regression models examined relationships between K:T and actigraphy-based sleep metrics by HIV status. Results WWH (N = 153) and HIV- women (N = 151) were demographically similar. Among WWH, median CD4 was 751 cells/mm3; 92% had undetectable HIV RNA. Compared to HIV- women, WWH had higher K:T (p < 0.001) and kynurenine (p = 0.01) levels but similar tryptophan levels (p = 0.25). Higher K:T was associated with more wake bouts (p = 0.001), more time awake after sleep onset (p = 0.01) and lower sleep efficiency (p = 0.03) in WWH only. Conclusions HIV infection was associated with T/K pathway activation; this activation was associated with poorer sleep efficiency and more fragmented sleep. While longitudinal studies are needed to elucidate the directionality of these associations, these findings may help identify treatments to reduce sleep disruption in WWH by targeting residual inflammation and T/K pathway activation.

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Background Globally men who have sex with men (MSM) and transgender women (TGW) encounter many negative experiences when accessing health services compared to the general population. Stigma, discrimination, and punitive laws against same-sex relationships in some sub-Saharan African countries have made MSM and TGW more prone to depression, suicidal ideation, anxiety disorders, substance abuse, non-communicable diseases, and HIV. None of the prior studies in Rwanda on MSM and TGW had explored their lived experience in accessing the health services. Accordingly, this study aimed at exploring the healthcare-seeking experiences of MSM and TGW in Rwanda. Methods Semi-structured interviews were conducted on 16 MSM and 12 TGW, using purposive and snowball sampling approach in 5 districts in Rwanda. Results were summarized using thematic analysis approach. Results Four main themes emerged from the study: 1) The healthcare experiences of MSM & TGW were generally dissatisfactory, 2) MSM & TGW generally hesitate to seek care unless they were severely ill, 3) More services specialized in addressing MSM & TGW’s needs are necessary, and 4) Advocacy and awareness for and among MSM & TGW communities are needed. Conclusion Rwandan MSM and TGW continue to face negative experiences within the healthcare delivery settings. These experiences include mistreatment, refusal of care, stigma, and discrimination. Provision of services for MSM and TGW, and on-the-job training cultural competence in the care of MSM and TGW patients is needed. Including the same training in the medical and health sciences curriculum was recommended. Furthermore, awareness and sensitization campaigns to improve the understanding of the existence of MSM and TGW and to foster acceptance of gender and sexual diversity in society are necessary.