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While there has been a growth in studies examining sexual violence among sexual minority men, little research attention has been paid to the experience of sexual violence among young sexual minority men (YSMM). In this article we analyze secondary data from the baseline of a pilot randomized control trial with 318 YSMM aged 15 to 24 years in the United States who were in relationships with other males to examine the associations between sexual minority-specific stigma and sociodemographic and relationship characteristics and experiences of intimate partner violence (IPV) and sexual IPV in their relationships. Approximately one-in-five participants reported experiencing any form of IPV and 6% reported sexual IPV in their current relationship. Participants who reported sexual minority-specific familial rejection (Adjusted Odds Rato (aOR) = 2.33, 95% confidence interval [CI] [1.03, 5.26], p < .05), internalized heterosexism (aOR = 3.17, 95% CI [1.45, 6.95], p < .01), and housing insecurity (aOR = 7.22, 95% CI [1.66, 31.34], p < .01) reported higher odds of sexual IPV in their relationship. Study findings point to the role of multiple sexual minority-specific forms of stigma in creating vulnerabilities for the experience of sexual IPV among YSMM, and highlight the need for continued research and interventions that address sexual minority-specific stigma and structural vulnerabilities to guide violence prevention efforts with YSMM. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) perpetrators often deny their actions, limiting opportunities for intervention. Cisgender male couples experience similar IPV rates to mixed-gender couples, yet less is known about how men in same-sex relationships deny or report their IPV behavior. This study aimed to describe perpetration denial across emotional, monitoring/controlling, and physical/sexual IPV, and to identify correlates of perpetration denial, in a convenience sample of male couples (N = 848; United States, 2016-2017). Past-year victimization and perpetration were measured with the IPV-Gay and Bisexual Men (GBM) scale; perpetration deniers were men whose self-reported perpetration contradicted their partner's reported victimization. Individual-, partner-, and dyadic-correlates of perpetration denial, by IPV-type, were identified using actorpartner interdependence models. We identified 663 (78.2%) perpetrators: 527 emotional; 490 monitoring/controlling; 267 physical/sexual. Thirty-six percent of physical/sexual-, 27.7% of emotional-, and 21.43% of monitoring/controlling-perpetrators categorically denied their actions. Depression was negatively associated with denying monitoring/controlling-perpetration (odds ratio 95% confidence interval: 0.91 [0.84, 0.99]) and physical/sexual-perpetration (0.91 [0.83, 0.97]); dyadic differences in depression were associated with emotional-perpetration denial (0.95 [0.90, 0.99]). Recent substance users had 46% lower odds of monitoring/controlling-denial (0.54 [0.32, 0.92]), versus non-users. Partner-race and employment were also significantly associated with emotional perpetration denial. This study highlights IPV denial's complexities, including differences across IPV types. Further investigations into how cisgender men in same-sex couples perceive and report various types of IPV perpetration will provide valuable insight into how an underserved and understudied population experiences IPV. [ABSTRACT FROM AUTHOR]

There has been a growth in research illustrating that gay, bisexual, and other men who have sex with men (GBMSM) experience intimate partner violence (IPV) at rates that are comparable to those among heterosexual women. However, the majority of research on IPV among same-sex male couples has focused on adults, and research on the experience of IPV among younger men (those aged under 18), remains at a nascent stage, despite knowledge that IPV is often common among younger men. This article adds to the growing body of literature on IPV among young GBMSM (YGBMSM) through of an analysis of qualitative data from in-depth interviews (IDI) with GBMSM aged 15–19 (n = 30) in romantic relationships partnerships. The study sought to explore issues of relationship development, relationship contexts, and understandings of IPV. More than one-half of the sample reported experiencing some form of IPV in their current or past relationships. Participants described a range of experiences of IPV, including physical IPV, emotional IPV, sexual IPV, and controlling behaviors. Emotional IPV in the form of negative comments and controlling behaviors such as jealousy were the most commonly reported forms of violence behaviors. Although few participants reported experiencing physical or sexual IPV, several discussed concerns about giving, and partners' acknowledging, sexual consent. Antecedents to IPV included wanting or feeling pressured to participate in normative development milestones, short-lived relationships, and societal stigma. Interventions that develop content on IPV and that reflect the lived realities of YGBMSM who are experiencing their first relationships are urgently needed. Study findings also support the need for training teachers, health care providers, and parents to identify signs of IPV and provide them with the knowledge and skills to talk to YGBMSM about relationships and violence to reduce IPV. [ABSTRACT FROM AUTHOR]

Between one to two-thirds of HIV infections among gay, bisexual, and other men who have sex with men are from primary partners, and there has been increased research attention focused on strategies to increase PrEP adoption among male couples. While there is evidence that partner support is a strong correlate of pre-exposure prophylaxis (PrEP) adoption, there has been a lack of attention on PrEP communication dynamics among male couples. In this paper, we build upon this literature through analysis of dyadic data from a large cross-sectional survey of 543 concordant sero-negative and serodiscordant male couples to examine individual and relationship factors associated with reports of partner communication around PrEP, comfort in discussing PrEP, and perceived partner-level support for PrEP use. PrEP use was relatively low (16.2%), and although 87.5% of men reported their partners would support their PrEP use, only 26.3% had talked to their partner recently about PrEP. PrEP communication and perceived support for PrEP were significantly negatively associated with PrEP stigma and stigma based on sexuality (i.e., internalized homophobia and enacted external stigma based on sexuality), while men with sexual agreements were more comfortable talking about PrEP with their partner. There is a need to adapt current interventions, or develop new dyadic interventions, that provide opportunities for male couples to talk and learn about PrEP together, as a potential pathway to engage them toward PrEP use. [ABSTRACT FROM AUTHOR]

Background Context: Chronic spinal pain is one the most common musculoskeletal disorders. Previous studies have observed microscopic structural changes in the spinal extensor muscles in people with chronic spinal pain. This systematic review synthesizes and analyzes all the existing evidence of muscle microscopic changes in people with chronic spinal pain.Purpose: To assess the microscopy of spinal extensor muscles including the fiber type composition, the area occupied by fiber types, fiber size/cross sectional area (CSA), and narrow diameter (ND) in people with and without chronic spinal pain. Further, to compare these outcome measures across different regions of the spine in people with chronic neck, thoracic and low back pain.Study Design: Systematic review with meta-analysis.Methods: MEDLINE (Ovid Interface), Embase, PubMed, CINAHL Plus, and Web of Science were searched from inception to October 2020. Key journals, conference proceedings, grey literature and hand searching of reference lists from eligible studies were also searched. Two independent reviewers were involved in the selection process. Only studies examining the muscle microscopy of the spinal extensor muscles (erector spinae [ES] and/or multifidus [MF]) between people with and without chronic spinal pain were selected. The risk of bias from the studies was assessed using modified Newcastle Ottawa Scale and the level of evidence was established using the GRADE approach. Data were synthesized based on homogeneity on the methodology and outcome measures of the studies for ES and MF muscles and only four studies were eligible for analysis.Results: All the five studies included were related to chronic low back pain (CLBP). Meta-analysis (inverse variance method for random effect to calculate mean difference and 95% CI) was performed for the ES fiber type composition by numbers for both type I and type II fibers (I2=43% and 0% respectively indicating homogeneity of studies) and showed no difference between the people with and without CLBP with an overall effect estimate Z= 1.49 (p=.14) and Z=1.06 (p=.29) respectively. Meta-analysis was performed for ES fiber CSA for both type I and type II fibers (I2=0 for both) and showed no difference between people with and without CLBP with an overall effect estimate Z=0.08 (p=.43) and Z=0.75 (p=.45) respectively. Analysis was not performed for ES area occupied by fiber types and ND due to heterogeneity of studies and lack of evidence respectively. Similarly, meta-analysis was not performed for MF fiber type composition by numbers due to heterogeneity of studies. MF analysis for area occupied by fiber type, fiber CSA and ND did not yield sufficient evidence.Conclusions: For the ES muscle, there was no difference in fiber type composition and fiber CSA between people with and without CLBP and no conclusions could be drawn for ND for the ES. For the MF, no conclusions could be drawn for any of the muscle microscopy outcome measures. Overall, the quality of evidence is very low and there is very low evidence that there are no differences in microscopic muscle features between people with and without CLBP. [ABSTRACT FROM AUTHOR]

Stay at home orders–intended to reduce the spread of COVID-19 by limiting social contact–have forced people to remain in their homes. The additional stressors created by the need to stay home and socially isolate may act as triggers to intimate partner violence (IPV). In this article, we present data from a recent online cross-sectional survey with gay, bisexual and other men who have sex with men (GBMSM) in the United States to illustrate changes in IPV risks that have occurred during the U.S. COVID-19 epidemic. The Love and Sex in the Time of COVID-19 survey was conducted online from April to May 2020. GBMSM were recruited through paid banner advertisements featured on social networking platforms, recruiting a sample size of 696 GBMSM. Analysis considers changes in victimization and perpetration of IPV during the 3 months prior to the survey (March-May 2020) that represents the first 3 months of lockdown during the COVID-19 epidemic. During the period March-May 2020, 12.6% of participants reported experiencing any IPV with higher rates of emotional IPV (10.3%) than sexual (2.2%) or physical (1.8%) IPV. Of those who reported IPV victimization during lockdown, for almost half this was their first time experience: 5.3% reported the IPV they experienced happened for the first time during the past 3 months (0.8% physical, 2.13% sexual, and 3.3% emotional). Reporting of perpetration of IPV during lockdown was lower: only 6% reported perpetrating any IPV, with perpetration rates of 1.5% for physical, 0.5% for sexual, and 5.3% for emotional IPV. Of those who reported perpetration of IPV during lockdown, very small percentages reported that this was the first time they had perpetrated IPV: 0.9% for any IPV (0.2% physical, 0.2% sexual, and 0.6% emotional). The results illustrate an increased need for IPV resources for GBMSM during these times of increased stress and uncertainty, and the need to find models of resource and service delivery that can work inside of social distancing guidelines while protecting the confidentiality and safety of those who are experiencing IPV. [ABSTRACT FROM AUTHOR]

Community norms provide social scripts and pathways to accruing social capital that can alter a woman's risk of experiencing sexual intimate partner violence (IPV). These norms are in turn influenced by the structural environment in which they exist. Missing from the literature is an understanding of how an individual's departure from community norms—positive deviance—influences the risk of sexual IPV and how this effect may vary across structural environments. Demographic and Health Survey data from 32 low- and middle-income countries (LMIC) were stratified into six structural environments by two fundamental structural factors: level of gender inequality and prevalence of sexual IPV. To examine how transcending community norms shape the odds of reporting sexual IPV across environments, six identical multilevel models were fit including statistical deviation from 13 community norms as key covariates. Positive deviance from community norms is associated with both increased and decreased odds of reporting sexual IPV and the nature of these relationships vary by structural environment. Positive deviance had a greater effect on reporting sexual IPV in highly unequal societies. Positive deviance from fertility preferences and controlling behavior was associated with increased odds of sexual IPV across contexts. The accrual of social capital and differences in female autonomy across environments may be two ways positive deviance alters sexual IPV risk. A better understanding of how the salience of community norms varies by structural environment and how transcending these norms shapes the risk for sexual violence may help highlight pathways for interventions to change restrictive social norms and increase female empowerment without increasing the risk of sexual IPV. [ABSTRACT FROM AUTHOR]

Background: Central to measuring the impact of the COVID-19 pandemic on HIV is understanding the role of loss of access to essential HIV prevention and care services created by clinic and community-based organization closures. In this paper, we use a comprehensive list of HIV prevention services in four corridors of the US heavily impacted by HIV, developed as part of a large RCT, to illustrate the potential impact of service closure on LGBTQ+ youth. Methods: We identified and mapped LGBTQ+ friendly services offering at least one of the following HIV-related services: HIV testing; STI testing; PrEP/PEP; HIV treatment and care; and other HIV-related services in 109 counties across four major interstate corridors heavily affected by HIV US Census regions: Pacific (San Francisco, CA to San Diego, CA); South-Atlantic (Washington, DC to Atlanta, GA); East-North-Central (Chicago, IL to Detroit, MI); and East-South-Central (Memphis, TN to New Orleans, LA). Results: There were a total of 831 LGBTQ+ youth-friendly HIV service providers across the 109 counties. There was a range of LGBTQ+ youth-friendly HIV-service provider availability across counties (range: 0–14.33 per 10,000 youth aged 13–24 (IQR: 2.13), median: 1.09); 9 (8.26%) analyzed counties did not have any LGBTQ+ youth-friendly HIV service providers. The Pearson correlation coefficient for the correlation between county HIV prevalence and LGBTQ+ youth-friendly HIV service provider density was 0.16 (p = 0.09), suggesting only a small, non-statistically significant linear relationship between a county's available LGBTQ+ youth-friendly HIV service providers and their HIV burden. Conclusions: As the COVID-19 pandemic continues, we must find novel, affordable ways to continue to provide sexual health, mental health and other support services to LGBTQ+ youth. [ABSTRACT FROM AUTHOR]

Background: Brief behavioral interventions are seen as an efficient way to improve knowledge, change behavior, and reduce provider stigma regarding sexual health. When grounded in evidence-based behavioral change techniques and delivered using Brief Sexuality-related Communication (BSC) tools, brief behavioral interventions can address client-driven sexual health goals in a single session with their provider. Evidence for the efficacy of brief interventions for creating gains in sexual health comes largely from resource rich settings, and there is a lack of knowledge of how brief interventions can be implemented in the more resource constrained environments of low- and middle-income countries. As a first step in developing a brief intervention to address sexual health issues in Moldova, this paper reports on qualitative data collected from Moldovan providers to understand their attitudes, willingness and perceived barriers to the brief intervention and its implementation.Methods: Thirty-nine in-depth interviews (IDI) were conducted between February and March 2020, with health providers recruited from three primary health care institutions, two Youth Friendly Health Centers and counselors from three NGOs who work with key populations in Moldova, including health centers selected from two cites - the capital city, Chisinau and from the Comrat Region. The IDI addressed four domains of provider attitudes: 1) attitudes towards the intervention; 2) willingness and motivation to implement the intervention; 3) logistics of providing the intervention and 4) ability to implement the intervention. A coding analysis approach was applied to all interview transcripts.Results: Providers largely reported being willing to be trained in and implement the brief intervention. Willingness to implement the intervention stemmed from two perceptions: that it would improve the ability of providers to talk with their clients about sex, and that vulnerable groups would benefit from these conversations. However, while there were generally positive attitudes towards the intervention, providers consistently reported structural barriers to their perceived ability to implement the intervention.Conclusions: While providers reported high levels of initial acceptance of a brief behavioral intervention, care is needed to ensure that brief interventions, and the training of providers on brief interventions, incorporate cultural attitudes and norms around sex, particularly in highly patriarchal settings, and provide opportunities for providers to practice the intervention in ways that address their assumptions and implicit biases. [ABSTRACT FROM AUTHOR]

Coupled gay, bisexual, and other men who have sex with men (GBMSM) are at particularly high risk for HIV, and a clear understanding of behavioral risk is key to effective interventions. Accurate behavioral self-reports are a crucial component of valid sexual health research, yet reliability of these data remains understudied. This study aimed to quantify and identify predictors of dyadic discordance in reported 3-month anal intercourse (AI) occurrence and frequency. Using cross-sectional data from 407 male couples in the U.S. (2016–2017), we calculated proportional dyadic concordance and used dyad-level logistic and linear regression to identify demographic, behavioral, and relationship traits associated with the odds of discordant frequency reports and the relative difference between discordant partner reports. Couples had high levels of concordant reports of 3-month anal AI occurrence (97%) but low interpartner agreement in reported frequency (37%). After adjustment, the odds of discordance were significantly associated with dyadic employment and differences on the Communal Coping to Reduce HIV Threat Scale (CCS) (p <.05). Among frequency-discordant couples, the mean relative difference between partner reports was 52.80% ± 35.91% (M ± SD). After adjustment, relative differences between partners' reported AI frequencies were positively associated with interpartner differences in CCS (p <.05). These results indicate that among GBMSM couples in committed partnerships, self-reported sexual behavior data may be impacted by granularity, recall, and relationship characteristics. Further research in this area is warranted to better understand measurement error in self-reported sexual activity data. [ABSTRACT FROM AUTHOR]

Nearly 32% of women report experiencing physical violence from an intimate partner and more than 8% report being raped by a significant other in their lifetime. Young people's perceptions that their peers perpetrate relationship violence have been shown to increase the odds of self-reported perpetration. Yet, limited research has been conducted on this relationship as individuals begin to age out of adolescence. The present study sought to examine the link between the perception of peer perpetration of intimate partner violence (IPV) and self-reported IPV perpetration among a sample of predominately young adult (21-35 years) males. This study also explored the discordance between the perception of peer IPV behavior and self-reported perpetration. Data from 101 male peer dyads (n = 202) were taken from a study on the effects of alcohol and bystander intervention in Atlanta, Georgia. Thirty-six percent (n = 73) of men reported perpetrating physical IPV and 67% (n = 135) reported perpetrating sexual IPV in the past 12 months. Nearly 35% (n = 55) of the sample reported that none of their peers had perpetrated physical IPV, which contradicted their friend's self-report of physical IPV perpetration. Similarly, 68% (n = 115) of the men perceived none of their peers to have perpetrated sexual IPV, which contradicted their friend's self-report of sexual IPV perpetration. Discordance variables were significantly associated with self-reported perpetration for both physical (χ2 = 152.7, p <.01) and sexual (χ2 = 164.4, p <.01) IPV. These results point to an underestimation of peer IPV perpetration among young adult males. Findings suggest a traditional social norms approach to IPV prevention, which seeks to persuade individuals that negative behaviors are less common than perceived, may not be the best approach given a significant number of men believed their friends were nonviolent when they had perpetrated violence. [ABSTRACT FROM AUTHOR]

Background: Among men who have sex with men, there is now clear evidence that the risk of HIV transmission through condomless sex when the HIV-positive partner is virally suppressed is effectively zero. However, an understanding of the accuracy of reporting of viral load among serodiscordant same-sex male couples is missing from the literature. Setting: This analysis uses data from the baseline sample of Stronger Together, a randomized controlled efficacy trial of an innovative dyadic intervention to enhance antiretroviral therapy adherence for HIV serodiscordant male couples in 3 US cities (Atlanta, Boston, and Chicago). Methods: Biomarker-confirmed and self-reported measures of viral load were used to assess the accuracy of self-report of viral suppression. In this descriptive analysis, the percentage of men who inaccurately reported being virally suppressed is compared across demographic, relationship, and HIV care characteristics. Results: Results confirm those of other recent studies that have shown relatively high levels of inaccuracy in reporting of viral suppression. Although 72.5% of men could accurately report their viral load status, 20% reported that they were virally suppressed when they did not have a biomarker-confirmed measure of viral suppression. Conclusion: These results highlight the need to provide interventions to men who have sex with men living with HIV to support access to care and ensure current knowledge of viral load and to continue to support primary prevention of HIV through condom use and pre-exposure prophylaxis. For couples, particularly serodiscordant male couples, interventions that can teach the couple how to collaborate to achieve and maintain viral suppression for the positive partner are an urgent and pragmatic programmatic priority that can equip couples with the knowledge required to correctly implement U = U strategies. [ABSTRACT FROM AUTHOR]

This pilot study examined the feasibility and acceptability of the HIV/AIDS self-management education program-Thai (HASMEP-T) for HIV-positive Thai men who have sex with men (MSM). HASMEP-T is a group-based adaptation of the evidence-based intervention, HASMEP. Participants were 40 Thai MSM living with HIV aged 18 years or older, recruited from an HIV clinic housed in a hospital in Thailand. Results support the feasibility of recruitment, screening, eligibility, and retention methods. The majority of the participants reported that the intervention was acceptable and met their initial expectations. Furthermore, all recruited participants in the intervention group (n = 20) completed HASMEP-T. Overall, intervention group participants demonstrated significant increases in all aspects of HIV self-management (p <.05), as well as improvement in quality of life in the psychological domain (p <.05). Our findings provide preliminary support for the large-scale, randomized-controlled trial of the efficacy of HASMEPT to promote self-management behaviors among HIV-positive Thai MSM. [ABSTRACT FROM AUTHOR]

The current definition of unmet need for contraception assumes that all women who are using a method have a met need. We argue that without taking into account the level of satisfaction with a method, many women are classified as having a met need, when in fact they have an unmet need. They are using a method that does not meet their preferences, either because it causes side effects they find untenable or has other characteristics they do not like. Given the large number of contraceptive episodes that end in discontinuation, reportedly often due to the experience of side effects, we argue that the current definition of unmet need undercounts the number of women with a true unmet need for contraception as it misses the many women who are using a method that does not meet their preferences. We suggest the addition of satisfaction questions in national surveys such as the Demographic and Health Surveys to more fully assess the level of true met need for contraception. [ABSTRACT FROM AUTHOR]

Increasing modern contraceptive use is important for improving maternal and child health and achieving economic growth and development goals. However, pervasive high unmet need for modern contraceptives in sub-Saharan Africa warrants new understandings of the drivers of modern contraceptive use. A deviance approach (i.e., examining how women’s experiences/characteristics differ from other women in their community) provides an innovative framework for capturing heterogeneity among women in a community. This framework can inform public health programming by both exploring how women avoid adverse health outcomes and understanding the needs of harder-to-reach populations who may experience health risks, despite living in communities where others do not experience vulnerability. Using data from Demographic and Health Surveys from 29 sub-Saharan African countries, we examine how a woman’s deviation from community norms around socioeconomic characteristics and gender and fertility norms and behaviors is associated with modern contraceptive use. Random-effects logistic regression models were fitted for each country to examine relationships between modern contraceptive use and deviance. Some deviance factors were associated with modern contraceptive use in only a few countries, while others were significant across many countries. Cross-country consistency in the direction of the relationship between deviance and modern contraceptive use varied by the specific deviance factor, with some relationships being consistent across countries, and other relationships being more varied. For example, having more education than the community norm was associated with increased modern contraceptive use across countries; however, marrying older than other women in the community was associated with an increase in modern contraceptive use in some countries and a decrease in others. More work is needed to understand the role of deviance on modern contraceptive use; however, this study suggests that using context-specific deviance approaches may be important for further elucidating experiences of modern contraceptive use. [ABSTRACT FROM AUTHOR]

Young men who have sex with men (YMSM) between the ages of 13 and 24 account for a disproportionate number of new HIV infections in the U.S. Recognizing the unique developmental circumstances that YMSM face and building on the dual-process model, it is important to consider the role of cognitive and emotional factors as well as self-efficacy to negotiate safer sex when understanding experiences of sexual risk-taking among YMSM. This article used structural equation modeling to examine how the decisional balance to use condoms (a cognitive factor) and limerence (an emotional factor) are both directly and indirectly associated with sexual risk-taking behaviors (the number of insertive and receptive condomless anal intercourse partners), with indirect effects occurring via limited self-efficacy to negotiate safer sex. Data were from a cross-sectional online survey of YMSM (aged 18-24) in the U.S. who did not report being in a romantic relationship. Analysis included a sample of 1084 single YMSM who had never tested positive for HIV and who had engaged in anal intercourse in the previous 2 months. Results indicated that the decisional balance to use condoms was both directly and indirectly associated with reduced sexual risk-taking behaviors. Limerence was not directly associated with sexual risk-taking behaviors; however, it was indirectly associated with sexual risk-taking behavior through limited self-efficacy to negotiate safer sex. These findings highlight the importance of considering both cognitive and emotional factors, as well as self-efficacy to use condoms, in the development and implementation of HIV prevention interventions for YMSM. [ABSTRACT FROM AUTHOR]

Societal gender inequality and a preference for male children has been shown to be detrimental to girls' health. This is despite females' innate biological advantage early in life. The negative effects of gender inequity on female health are most pronounced in resource-poor countries, where cultural norms supporting a preference for male children are strongest. However, most of what is known about gender inequality and child health comes from studies of singleton births. There is little evidence for how, or if, the disadvantages associated with gender bias and son preference extend to multiple births, a population inherently at risk for a number of health challenges. This analysis examines whether gender bias in health outcomes exists for twins. Data on live twin births from 38 Demographic and Health Surveys were compiled (n=11,528 individuals) and twins were categorized as girl/girl, girl/boy, boy/girl or girl/girl. Gender inequality was measured via the Gender Inequality Index. Multilevel logistic regression models examined associations between twin sex composition, gender inequality and eight outcomes of infant and child morbidity, mortality and mother's treatment-seeking behaviours. Twin pairs containing girls had significantly lower odds of first-year mortality. Higher country-level gender inequality was associated with higher odds of reporting diarrhoea and fever/cough, as well as an increased odds of post-neonatal mortality. Results suggest that the biological advantage for females may be stronger than son preference and gender inequality in the first year of life. Understanding these relationships has the potential to inform efforts to curb the influence of gender preference on the health of female children in resource-poor settings. [ABSTRACT FROM AUTHOR]

Targeting reductions in fertility remains a key development goal, as too-high fertility hampers the economic and health prosperity of low- and middle-income countries. However, critical to the success of gaining reductions in fertility is the ability to understand the factors that are shaping fertility, and to understand the factors that are acting to keep fertility levels high. To contribute to this understanding, this study applied the Bongaarts (2015) adjusted proximate determinants of fertility model to 33 low- and middle-income countries using data collected from the Demographic and Health Survey (DHS) programme between 2000 and 2016. Results from the analysis indicate that there has been a universal decrease in the duration of breast-feeding and postpartum abstinence, which has contributed to stalling and increasing fertility rates in countries of Central Africa. In other regions of the world, such as Southern Africa, Latin America & Caribbean and Asia, increased contraceptive use and increased age at marriage, or sexual debut, has been able to offset this, leading to substantial decreases in fertility rates. These findings should serve as a guide to where additional development policy and programmatic attention should focus to reduce too-high fertility in resource-poor settings. [ABSTRACT FROM AUTHOR]

Abstract: HIV testing is an important HIV prevention strategy for young men who have sex with men (YMSM) in the United States, but the relationships between community‐ and individual‐level aspects of sexuality‐related stigma and HIV testing among YMSM are unknown. Data from a cross‐sectional survey included 334 HIV‐negative YMSM in Detroit. Multinomial logistic regression was used to determine if place‐based community prejudice perceptions, internalized homonegativity, and sexuality‐related discrimination were associated with HIV testing. Increased perceptions of community prejudice were associated with lower odds of never testing, while increased internalized homonegativity was associated with greater odds of never testing. Experiences of discrimination had no association with HIV testing. Understanding the influence of sexuality‐related stigma (and especially place‐specific, community‐level stigma) on HIV testing could help improve public health messaging to increase HIV testing among YMSM. [ABSTRACT FROM AUTHOR]

The article discusses a study that investigated relationships between women's deviation from community characteristics with use of maternal care services in Bangladesh. Deviance variables associated with service use include women's employment, exposure to family planning messages, and husband's employment. Findings showed that understanding association between deviation from community norms and receipt of maternal care may provide deeper understanding on how women use maternal care services.

The article discusses a literature review study on the link of intimate partner violence (IPV) including controlling behavior, with reduced number of women seeking antenatal care in low to middle income countries. Findings showed that in all 16 studies, IPV was negatively associated with initiation of antenatal care, number of visits or use of skilled providers. It suggests that these women who experienced IPV may benefit from interventions to mitigate barriers to care.

This formative research aimed to describe the use of the ADAPT-ITT framework to modify the HASMEP for use with HIV-positive Thai men who have sex with men (MSM). We selected, adapted, and tested the acceptability and feasibility of the HASMEP intervention for delivery in an HIV clinic in Thailand. We chose to base our adaptation on the HASMEP that was initially developed in South Africa. The ADAPT-ITT framework was used to guide the study. Our adaptation was informed by qualitative data collected during focus groups from 48 participants (40 HIV-positive Thai MSM and 8 health care providers) and online surveys of Thai MSM. Findings of focus groups indicate that the HASMEP is feasible and acceptable when administered to the participants. The result of this work is an adapted HASMEP intervention and training materials. This study provides a strong foundation for further research on HIV/AIDS self-management in HIV-positive MSM. [ABSTRACT FROM AUTHOR]

Unmet need for modern contraception is a major public health concern in resource-constrained countries. Recent research supports the application of social-ecological theories to explain how characteristics of a woman's community shape modern contraception use. However, this research focuses largely on individual countries and uses a limited number of community-level effects. We fitted three random-effects logistic regression models to examine associations between 13 community-level variables and the odds of reporting unmet need, unmet need for spacing, and unmet need for limiting for all parous, female respondents in 44 DHS surveys collected in 2010-2015 (n=528,101). Community variables explain significant variance in unmet need between communities. Associations between community variables and unmet need differ by urban and rural residence. The results highlight several commonalities in how the community shapes unmet need across resource-constrained settings and may help in designing structural-level interventions. [ABSTRACT FROM AUTHOR]

With the growing realisation that sexual violence poses pressing health and human rights concerns for men who have sex with men (MSM) and individuals on the trans-feminine spectrum, research has focused on the context in which sexual violence takes place. Rape myths and other perceptions of sexual violence affect the prevalence of perpetration and the availability of services and support for survivors. Little research has been conducted on rape myths among sexual and gender minority groups, especially in low- and middle-income countries. Two focus groups and 30 in-depth interviews were conducted with MSM and individuals on the trans-feminine spectrum in Ulaanbaatar, Mongolia. A number of rape myths previously noted to be prevalent among Western, heterosexual men, and women were expressed by participants, including the myth that males are never raped, rape as a cause of homosexuality or transgenderism, conceptualisations of prototypical rape as requiring overwhelming force, and victim blaming. However, many of these perceptions appeared to have different origins and effects in these populations. This study illustrates interesting similarities and differences compared to rape myths explored in Western, heterosexual male samples, and draws attention to the need to address community perceptions of sexual violence in sexual health and violence intervention programming. [ABSTRACT FROM PUBLISHER]

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) persons often receive end-of-life care incongruent with wishes. Evidence with heterosexual samples supports associations among end-of-life documentation (do not resuscitate [DNR] orders, durable power of attorney for health care orders [DPOAH], living wills [LW]), and care consistent with wishes. However, little is known about the knowledge, attitudes, and willingness regarding utilization of these documents among LGBTQ persons. Of 107 participants, most had heard of each document (95% DNR, 91% DPOAH, 97% LW), but had not procured them (26% DNR, 50% DPOAH, 51% LW). Answers above 4 on a 5-point Likert scale indicated willingness to pursue these documents and belief documents would be enforced. However, approximately one-third of respondents believed documents would be enforced more for heterosexual persons than themselves. This result indicates sexuality or gender minority-related stigma may be a barrier to document utilization. Future research, policies, and guidelines should address these concerns. [ABSTRACT FROM AUTHOR]

There is a general paucity of research concerning the sexual health of transgender individuals, and most existing research focuses on transgender women. A scoping review concerning the sexual health of transgender men was conducted to identify gaps in the literature and to highlight opportunities for future research and intervention. A comprehensive search of seven databases was conducted.The Joanna Briggs Institute Reviewers’ Manualwas used as a framework. Some 7,485 articles were initially identified using a search strategy applied to seven online databases: 54 articles were identified as relevant to the research questions and reviewed in detail; of those, 33 were included in the final analysis. Studies were conceptualized into four broad themes: sexual behaviors, sexual identity, sexual pleasure and sexual function, and transactional sex. Besides an overall lack of research, existing studies were often characterized by small convenience samples that do not allow for generalization to the larger population of transgender men. Significant gaps in the literature regarding sexual coercion, sexual and intimate partner violence, and relationship quality and functioning among transgender men exist. There is a need to improve the scope and depth of research examining the sexual health of this population, especially concerning sexual risk behaviors and structural barriers to sexual health care access. [ABSTRACT FROM PUBLISHER]

This study examined the relationships of HIV/AIDS beliefs, self-efficacy for AIDS preventive behaviors, perception of HIV as a chronic disease, and HIV risk behaviors among young Thai men who have sex with men. Participants were recruited for a self-administered anonymous survey through Facebook. Logistic regression analysis was used to identify factors associated with each of four HIV risk behavior outcomes. Factors associated with sexual risk behaviors included age (18 and 21 years), having a current regular male partner, self-efficacy for AIDS preventive behaviors (self-efficacy in refusing sexual intercourse, self-efficacy in questioning potential sex partners, and self-efficacy in condom use), AIDS health belief (perceived susceptibility to HIV/AIDS, perceived severity of HIV/AIDS, perceived barriers to condom use, and cues to action for HIV/AIDS prevention), and perception of HIV/AIDS as a chronic disease (perceived HIV sero-status disclosure). Knowledge generated from this study has the potential to inform prevention messages for young Thai MSM. [ABSTRACT FROM AUTHOR]

Sexuality-based stigma is associated with increased rates of depression for urban sexual minority persons. However, this relationship has not been explored specifically for rural sexual minority populations. This study examined the association between self-reported external and internal sexuality-based stigma and depression among an online sample of 771 rural sexual minority persons. Two regression outcomes were modeled, representing continuous depression scores and clinically significant depression. Anticipated, enacted, and internalized sexuality-based stigma were all significantly associated with increased depression scores and clinically significant depression. Interventions sensitive to the unique stigmas experienced by sexual minority populations in rural areas are needed. [ABSTRACT FROM PUBLISHER]

Intimate partner violence research has focused almost exclusively on physical and sexual intimate partner violence in opposite-sex relationships, paying little attention to the intimate partner violence experienced by men in same-sex relationships. Emerging research focusing on intimate partner violence among male-male couples has focused largely on physical and sexual violence, with little consideration of the unique forms of emotional violence experienced by gay men. Ten focus-group discussions with gay and bisexual men were conducted to examine perceived typologies, antecedents and experiences of emotional violence that occur between male partners. Participants described emotional violence as the most threatening form of intimate partner violence, driven largely by factors including power differentials, gender roles and internalised homophobia. Results indicate that gay and bisexual men perceive emotional intimate partner violence to be commonplace. A better understanding of emotional violence within male-male relationships is vital to inform intimate partner violence prevention efforts and the more accurate measurement of intimate partner violence for gay men. [ABSTRACT FROM PUBLISHER]

In countries such as the USA, gay and bisexual men experience high rates of intimate partner violence. However, little is known about the factors that contribute to this form of violence. In this study, we examine gay and bisexual men’s perceptions of sources of tension in same-sex male relationships and how these may contribute to intimate partner violence. We conducted seven focus-group discussions with 64 gay and bisexual men in Atlanta, GA. Focus groups examined men’s reactions to the short-form revised Conflicts Tactics Scale to determine if each item was considered to be intimate partner violence if it were to occur among gay and bisexual men. Analysts completed a thematic analysis, using elements of grounded theory. The sources of tension that men identified included: gender role conflict, dyadic inequalities (e.g. differences in income, age, education), differences in ‘outness’ about sexual identity, substance use, jealousy and external homophobic violence. Results suggest that intimate partner violence interventions for gay and bisexual men should address behavioural factors, while also focusing on structural interventions. Interventions that aim to reduce homophobic stigma and redefine male gender roles may help to address some of the tension that contributes to intimate partner violence in same-sex male relationships. [ABSTRACT FROM PUBLISHER]

Purpose: The decision and ability of primary care clinician to make recommendations for routine human immunodeficiency virus (HIV) testing and hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccines are shaped by knowledge of their patient's risk behaviors. For men who have sex with men, such knowledge requires disclosure of same-sex sexual behavior or sexual identity.Methods: Data were analyzed from a national survey of rural men who have sex with men (N = 319) to understand whether the disclosure of sexual identity to clinicians was associated with increased uptake of HIV testing and hepatitis vaccinations.Results: We found that disclosure of sexual identity to clinicians was significantly associated (OR = 1.26; 95% CI, 1.08-1.47) with uptake of routine HIV testing and HAV/HBV vaccination.Conclusion: Our finding reinforces the need for safe, nonjudgmental settings for patients to discuss their sexual identities freely with their clinicians. [ABSTRACT FROM AUTHOR]

The high prevalence of domestic violence (DV) among married women in India and associated negative health repercussions highlight the need for effective prevention strategies and tools to measure the efficacy of such interventions. Literature supporting differing manifestations of DV by culture underscores the need for a culturally-tailored scale to more effectively measure DV in the Indian context. We therefore aimed to develop and validate such a tool, the Indian Family Violence and Control Scale (IFVCS), through a mixed-methods study. The psychometric development of IFVCS is herein discussed. After field pre-testing and expert review, a 63-item questionnaire was administered to a random sample of 630 married women from May-July 2013 in Pune, India. The item response theory approach for binary data to explore the IFVCS structure suggested that IFVCS is reliable, with the majority of items having high (>0.5) and significant factor loadings. Concurrent validity, assessed by comparing responses to IFVCS with the validated, abridged Conflict Tactics Scale-2, was high (r = 0.899, p<0.001) as was the construct validity, demonstrated by its significant association with several established DV correlates. Therefore, initial assessment of the IFVCS psychometric properties suggests that it is an effective tool for measuring DV among married women in India and speaks to its capacity for enhancing understanding of DV epidemiology and for evaluating the effectiveness of future DV interventions. [ABSTRACT FROM AUTHOR]

Stemming from recent evidence that between one- and two-thirds of new HIV transmissions among men who have sex with men (MSM) occur within main partnerships, research and programmatic efforts have begun to recognize the role of the male-male dyad in shaping HIV risk. Central to this new focus has been studies detailing the presence of sexual agreements, which provide guidelines governing permissions around sex with partners outside of the relationship. Using a Facebook-recruited sample of US-partnered MSM ( n = 454), this study examines the associations between reporting of sexual agreements and perceptions of HIV prevalence among male sex partners, friends, and local and national MSM populations. Men who perceived that 10-20 % (OR 6.18, 95 % CI 1.28-29.77) and >20 % of their male sex partners were HIV positive (OR 2.68, 95 % CI 1.02-7.08) had significantly higher odds of reporting having an open agreement with their current main partner than men who perceived that less than 10 % of their male sex partners were HIV positive. Partnered men with open sexual agreements may have more sexual partners than those who report monogamy, possibly leading to heightened perceptions of HIV risk, which may result in reporting of perceptions of greater local HIV prevalence. Additionally, men who have made agreements with their partners may have done so due to concerns about HIV risks, and may also be more aware of increased risks of HIV infection, or may have greater knowledge of HIV prevalence through discussions of serostatus with sex partners. Attention is needed to develop prevention efforts, such as toolkits and resources that enable men to form sexual agreements that are based on comprehensive knowledge of the potential risks for acquisition of HIV. [ABSTRACT FROM AUTHOR]

Little is known about sexual and gender minority youth (SGMY) who have sex with men's unique patterns of substance use, even though they are at risk for substance use and adverse mental and other health outcomes. We used latent class analysis to examine typologies of substance use and multinomial logistic regression to investigate mental health outcomes (depression and anxiety) and HIV/STI testing correlates associated with different classes of substance use in a sample of SGMY who have sex with men in the USA and use substances (n = 414) who participated in an online survey. The average age was 22.50 years old (SD = 3.22). A four-class solution was identified representing: 'depressant and stimulant use' (3.4%), 'high polysubstance use' (4.6%), 'low substance use with moderate cannabis use' (79.2%), and 'high cannabis, stimulant and alcohol use' (12.8%). Membership to a specified substance use class varied by age, previous arrest, gender identity, anxiety, and lifetime HIV testing. Multivariate logistic regression results indicated that participants in the high polysubstance use (AOR = 5.48, 95% CI 1.51, 19.97) and high cannabis use class (AOR = 3.87, 95% CI 1.25, 11.94) were significantly more likely than those in the low substance use with moderate cannabis use class to report previous arrest. Those in the high polysubstance use class were also significantly less likely to have been tested for HIV than those in the low substance use with moderate cannabis use class (AOR = 0.21, 95% CI 0.05, 0.93). Findings will guide the development and implementation of tailored approaches to addressing the intersection of substance use and HIV risk among SGMY. [ABSTRACT FROM AUTHOR]

Background: In Bihar, India, high maternal anemia prevalence and low iron and folic acid supplement (IFA) receipt and consumption have continued over time despite universal IFA distribution and counseling during pregnancy. Purpose: To examine individual and facility-level determinants of IFA receipt and consumption among pregnant women in rural Bihar, India. Methods: Using District Level Household Survey (2007–08) data, multilevel modeling was conducted to examine the determinants of two outcomes: IFA receipt (any IFA receipt vs. none) and IFA consumption (≥90 days vs. <90 days). Individual-level and facility-level factors were included. Factor analysis was utilized to construct antenatal care (ANC) quality and health sub-center (HSC) capacity variables. Results: Overall, 37% of women received any IFA during their last pregnancy. Of those, 24% consumed IFA for 90 or more days. Women were more likely to receive any IFA when they received additional ANC services and counseling, and attended ANC earlier and more frequently. Significant interactions were found between ANC quality factors (odds ratio (OR): 0.37, 95% confidence interval (CI): 0.25, 0.56) and between ANC services and ANC timing and frequency (OR: 0.68, 95% CI: 0.56, 0.82). No HSC factors were significantly associated with IFA receipt. Women were more likely to consume IFA for ≥90 days if they attended at least 4 ANC check-ups and received more ANC services. IFA supply at the HSC (OR: 1.37, 95% CI: 1.04, 1.82) was also significantly associated with IFA consumption. Conclusions: Our findings indicate that individual and ANC factors (timing, frequency, and quality) play a key role in facilitating IFA receipt and consumption. Although HSC capacity factors were not found to influence our outcomes, significant variation at the facility level indicates unmeasured factors that could be important to address in future interventions. [ABSTRACT FROM AUTHOR]

Men who have sex with men (MSM) remain disproportionately affected by the HIV epidemic in the US and estimates suggest that one to two-thirds of new infections occur among main partners. Previous research has focused on individual MSM and their risk for HIV, yet couples' ability to manage risk has been largely understudied. In particular, the role that homophobia plays in shaping the ability of gay male couples to cope with HIV risk is currently understudied. A sample of 447 gay/bisexual men with main partners was taken from a 2011 survey of gay and bisexual men in Atlanta. Linear regression models were fitted for three couples' coping outcome scales (outcome efficacy, couple efficacy, communal coping) and included indicators of homophobia (internalized homophobia and homophobic discrimination). Findings indicate that reporting of increased levels of internalized homophobia were consistently associated with decreased outcome measures of couples' coping ability regarding risk management. The results highlight the role that homophobia plays in gay male couples' relationships and HIV risk, extending the existing literature in the field of same-sex relationships as influenced by homophobia. [ABSTRACT FROM AUTHOR]

Traditional approaches to researching family planning in developing countries utilize surveys, focus group discussions, key informant interviews, or some combination thereof. However, these methods are limited in their ability to measure community-level influences on family planning behavior. In this article, we assess the benefits of applying community mapping, a participatory research technique, to understand social and cultural influences on family planning in rural Ethiopia and Kenya. In gender-segregated focus groups, participants collaboratively created a map of their district or zone, which they subsequently used to anchor discussion of local supports, barriers, and targets for change. Qualitative analysis of the transcripts revealed that community mapping is a powerful tool with which to understand community-level factors that influence family planning. By facilitating reflection on and discussion of local assets and issues, the mapping exercise identifies relevant factors from the perspective of community members and defines priority points for intervention. [ABSTRACT FROM AUTHOR]

Introduction: The United States Centers for Disease Control and Prevention currently recommends HIV screening at least annually among sexually active gay, bisexual and other men who have sex with men (MSM), but only half report being tested in the past year in the United States. As HIV self‐test kits are becoming more available around the United States via web and app‐based interventions, it is important to understand who is willing and able to order them. This analysis sought to better understand predictors of free HIV self‐test kit utilization among MSM in M‐cubed, an HIV prevention mobile app intervention trial in Atlanta, Detroit and New York City. Methods: We conducted an exploratory secondary analysis of self‐report and in‐app data collected from the intervention arm of the M‐Cubed study from 24 January 2018 to 31 October 2019. Behavioural, demographic and other potential predictors of HIV self‐test ordering were identified from Social Cognitive Theoretical underpinnings of the app, and from the literature. Significant predictor variables in bivariate analyses were considered for inclusion in the empiric multivariable model. Demographic variables chosen a priori were then added to a final model estimating adjusted prevalence ratios (aPR). Results: Over half of the 417 intervention participants ordered an HIV self‐test kit during the study. In bivariate analyses, ordering a kit was associated with HIV testing history, plans to get tested and reported likelihood of getting tested. In the final model, participants were more likely to order a kit if they reported plans to get tested in the next 3 months (aPR = 1.58, 95% CI: 1.18–2.11) or had not tested for HIV in the past 3 months (aPR = 1.38, 95% CI: 1.13–1.70). There was no difference in HIV self‐test kit ordering by income, race/ethnicity or age. Conclusions: HIV testing is an important tool in ending the HIV epidemic and must be accessible and frequent for key populations. This study demonstrates the effectiveness of HIV self‐test kits in reaching populations with suboptimal testing rates and shows that self‐testing may supplement community‐based and clinical testing while helping overcome some of the structural barriers that limit access to annual HIV prevention services for MSM. [ABSTRACT FROM AUTHOR]

Empirical findings on the relationship between women's employment and intimate partner violence (IPV) in low- and middle-income countries (LMICs) are mixed. These varied findings may arise because research thus far has given insufficient attention to how individual attributes and community context shape the pathways between women's employment and IPV. Using publicly available Demographic and Health Survey (DHS) data from 20 LMIC settings (n = 168,995), we investigate (1) how women's employment is associated with past-year IPV and (2) if associations differ by household- or community-level structural drivers of IPV: women's attitudes toward IPV, women's participation in household decision-making, and relative wealth. We fit mixed-effects logistic regression models exploring the total, individual, community, and contextual effects of women's employment on past-year IPV; effect measure modification by structural drivers; and cross-level interactions between community-level structural drivers and individual employment. Our analyses reveal positive associations between total (odds ratio [OR] = 1.31; 95% CI [1.27, 1.35]), individual (OR = 1.23; 95% CI [1.19, 1.27]), community (OR = 1.06; 95% CI [1.06, 1.07]), and contextual effects (OR = 1.04; 95% CI [1.03, 1.05]) of women's employment for IPV. Only individual wealth demonstrated statistically significant effect measure modification for the relationship between individual employment and past-year IPV (ratio of OR = 0.95; 95% CI [0.92, 0.99]). These findings suggest interventions that focus only on increasing women's employment may be associated with harmful increases in the occurrence of IPV, even when these interventions enable a large proportion of women in a community to be employed. Structural interventions that change norms of women's autonomy or attitudes toward IPV at the household or community levels may be insufficient to ameliorate these negative effects, whereas interventions that increase household wealth partly may buffer these effects. [ABSTRACT FROM AUTHOR]

Using data from the National Survey of Adolescents (2004), we examine the community-level factors associated with early age at first sex among adolescents 14-19 years old in four African countries. Regression models are fitted separately by sex for each country for an outcome measuring early age at first sex, with a focus on community-level factors as potential influences of age on sexual debut. The community-level factors associated with adolescents' sexual debut vary widely by both country and gender. Community influences that emerge as risk or protective factors of early sexual debut include community levels of adolescent marriage, wealth, religious group affiliation, sex education, parental monitoring, reproductive health knowledge, media exposure, membership in adolescent social group, and use of alcohol. Results indicate the importance of context-specific understanding of adolescents' sexual behaviour and suggest how elements of place should be harnessed in the development of effective HIV and sexual health interventions. [ABSTRACT FROM AUTHOR]

Men who have sex with men in sub-Saharan Africa are known to experience high levels of violence, yet little research has focused on their perceptions of intimate partner violence (IPV). This study examines the perceived typologies and sources of multiple forms of violence, including IPV, family/community violence and discrimination from healthcare workers, among men who have sex with men in Namibia. Focus-group discussions and in-depth interviews were conducted with a 52 men residing in five cities across Namibia. Results indicate that violence, in varying forms, is commonplace in the lives of men who have sex with men in this community, and may be associated with HIV testing patterns. [ABSTRACT FROM AUTHOR]

The willingness of male-male dyads to use couples voluntary HIV counseling and testing (CVCT) has not been previously investigated globally among men who have sex with men (MSM). Using online advertisements, data were collected from 3245 MSM in seven countries who were ≥18 years of age and had ≥1 male sex partner in the previous 12 months. The analysis examined associations between individual characteristics and willingness to utilize CVCT. The willingness to utilize CVCT was compellingly high, ranging from 79% in Australia and UK to 90% in Brazil. Older MSM and those who reported not knowing their sero-status reported lower odds of willingness to use CVCT. The relationship between being in a relationship and willingness to use CVCT varied across countries, perhaps reflecting varied local understandings of the nature and content of CVCT. Further work is required to examine willingness to use CVCT among a more heterogeneous population of MSM, and to examine how CVCT services are locally perceived in order to provide information vital for the development of locally appropriate messages to promote CVCT for MSM. [ABSTRACT FROM PUBLISHER]

CONTEXT: The literature on intimate partner violence in resource-poor contexts relies primarily on cross-sectional studies. Because changes in women's status and empowerment are hypothesized to influence violence vulnerability, longitudinal studies are needed to determine the potential benefits and harms associated with such changes. METHODS: Data were collected prospectively from a representative cohort of 4,749 married women in rural areas of four socially and demographically diverse states in India in 1998-1999 and 2002-2003. A multinomial regression model including social and demographic characteristics and intersurvey changes and events related to functional autonomy and reproduction was fitted to a categorical outcome measuring the absence (reference), initiation, cessation and continuation of intimate partner violence. RESULTS: Continued freedom of movement, increased freedom of movement and continued financial autonomy between baseline and follow-up were associated with a lower risk of violence initiation rather than no violence (relative risk ratio, 0.7 for each). Having a first child was associated with lower risk of violence initiation and continuation rather than no violence (0.6 and 0.2, respectively). Women who reported that their relative economic contribution to the household decreased or increased and women who experienced an unwanted pregnancy had a higher risk of violence continuation rather than no violence (1.8, 1.8 and 1.5, respectively). The death of a child was associated with higher risk of violence initiation rather than no violence (1.4). CONCLUSION: Future research to inform interventions to reduce intimate partner violence should consider how changes in women's reproductive experiences and functional autonomy may be linked to changes in intimate partner violence. [ABSTRACT FROM AUTHOR]

Background: The last decade has witnessed increased funding for malaria control. Malaria experts have used the opportunity to advocate for rollout of such interventions as free bed nets. A free bed net distribution strategy is seen as the quickest way to improve coverage of effective malaria control tools especially among poorest communities. Evidence to support this claim is however, sparse. This study explored the effectiveness of targeted free bed net distribution strategy in achieving equity in terms of ownership and use of bed nets and also reduction of malaria prevalence among children under-five years of age. Methods: National malaria indicator survey (MIS) data from Angola, Tanzania and Uganda was used in the analysis. Hierarchical multilevel logistic regression models were used to analyse the relationship between variables of interest. Outcome variables were defined as: childhood test-confirmed malaria infections, household ownership of any mosquito net and children's use of any mosquito nets. Marginal effects of having free bed net distribution on households with different wealth status were calculated. Results: Angolan children from wealthier households were 6.4 percentage points less likely to be parasitaemic than those in poorest households, whereas those from Tanzania and Uganda were less likely to test malaria positive by 7 and 11.6 percentage points respectively (p < 0.001). The study estimates and present results on the marginal effects based on the impact of free bed net distribution on children's malaria status given their socio-economic background. Poorest households were less likely to own a net by 21.4% in Tanzania, and 2.8% in Uganda, whereas both poorer and wealthier Angolan households almost achieved parity in bed net ownership (p < 0.001). Wealthier households had a higher margin of using nets than poorest people in both Tanzania and Uganda by 11.4% and 3.9% respectively. However, the poorest household in Angola had a 6.1% net use advantage over children in wealthier households (p < 0.001). Conclusion: This is the first study to use nationally representative data to explore inequalities in bed net ownership and related consequences on childhood malaria infection rates across different countries. While targeted distribution of free bed nets improved overall bed net ownership, it did not overcome ownership inequalities as measured by household socioeconomic status. Use of bed nets was disproportionately lower among poorest children, except for Angola where bed net use was higher among poorest households when compared to children in wealthier households. The study highlights the need for malaria control world governing bodies and policy makers to continue working on finding appropriate strategies to improve access to effective malaria control tools especially by the poorest who often times bears the brunt of malaria burden than their wealthier counterparts. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess the association of 3 types of intimate partner violence (IPV)—verbal, physical, and sexual—with self-reported symptoms of reproductive tract infections (RTIs) among married Indian women. Methods: A cross-sectional analysis of population-based data from the 2005–2006 Indian National Family Health Survey-3 was conducted. The sample comprised 65610 married Indian women of reproductive age (15–49years). Results: Overall, 23.9% of women experienced at least 1 type of IPV, and 9.6% reported at least 1 RTI symptom in the year preceding the survey. Verbal, physical, and sexual IPV each demonstrated a significant independent effect on the reporting of genital sores and abnormal genital discharge. Additionally, the more types of IPV a woman experienced, the higher her odds of also reporting genital sores and abnormal genital discharge. Conclusion: No single type of IPV explains women’s risk of RTIs; rather, there are multiple pathways by which women’s experience of IPV can result in RTIs. Sexual and reproductive healthcare that incorporates IPV support services is needed to meet the special needs of abused women. Additionally, RTI screening should be considered by non-governmental organizations providing care for women who have experienced IPV, especially those who report multiple types of violence. [Copyright &y& Elsevier]

Objectives: The paper describes the creation of a new scale to measure intimate partner violence (IPV) among gay and bisexual men. Methods: Seven focus group discussions were held with gay and bisexual men, focusing on defining intimate partner violence: 30 forms of IPV were identified. A venue-recruited sample of 912 gay and bisexual men was surveyed, examining definitional understanding and recent experiences of each of the 30 forms of IPV. Participants were also asked questions from the CDC definition of intimate partner violence and the short-form of the Conflicts Tactics Scale (CTS2S). Factor analysis of responses to the definitional questions was used to create the IPV-GBM scale, and the prevalence of intimate partner violence was compared with that identified by the CDC and CTS2S measures of intimate partner violence. Results: A 23-item scale, with 5 unique domains, was created, with strong internal reliability (Cronbach Alpha >.90). The IPV-GBM scale mirrored both the CDC and CTS2S definitions of intimate partner violence, but contained additional domains such as controlling violence, monitoring behaviors, emotional violence, and HIV-related violence. The new scale identified a significantly higher prevalence of IPV than either of the more commonly used measures. Conclusions: The results presented here provide encouraging evidence for a new, more accurate measure of intimate partner violence among gay and bisexual men in the U.S. [ABSTRACT FROM AUTHOR]

Transactional sex, or the exchange of sex for material goods or money, is a risky sexual behavior that has been linked to HIV/AIDS and gender-based violence. Throughout sub-Saharan Africa, transactional sex remains a common practice, putting men and women at risk of HIV. However, little is known of how community environments shape men's participation in risky transactional sex. This analysis examines community-level influences on participation in risky transactional sex among sexually active men in three African countries (Malawi, Tanzania, and Nigeria). The analysis uses Demographic and Health Survey (DHS) data to examine the association between men's report of risky transactional sex and community characteristics including economic, gender norms, HIV behavior and knowledge, and demographic factors. The results show that men residing in communities with more female education and later age of first birth are less likely to report risky transactional sex, while men who live in communities where men report higher number of sexual partners are more likely to report risky transactional sex. While programmatic interventions should continue to improve women's status individually and relative to men, such efforts should be extended to recognize that many community and cultural influences also affect men's sexual behavior. Programs that understand, discuss, and challenge community factors that influence men's sexual behavior may be able to provide a more effective intervention resulting in opportunities for communities to initiate behavioral change. [ABSTRACT FROM AUTHOR]

This article presents results from a systematic review of the literature on intimate partner violence (IPV) among U.S. men who have sex with men (MSM). From 576 reviewed studies, a total of 28 met inclusion criteria and were included in the analysis. The population characteristics of each study, definitions of IPV, prevalences of different forms of IPV, and statistically tested correlates of IPV are summarized for each study. The results indicate that all forms of IPV occur among MSM at rates similar to or higher than those documented among women, although data on perpetration rates of IPV are scant, and consensus as to IPV correlates among MSM is absent. This review also finds significant limitations in the reviewed literature, notably the lack of a standardized, validated definition of IPV among MSM; use of unspecific recall periods for IPV; a lack of attention to nonphysical, nonsexual forms of IPV; and near-universal use of cross-sectional, convenience samples of urban MSM. Researchers should develop and validate an MSM-specific definition of IPV, use more rigorous epidemiological methods to measure IPV and its effects, and clarify the mental and physical health outcomes associated with both receipt and perpetration of IPV. [ABSTRACT FROM PUBLISHER]