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Hope is a concept that may mediate between the structural constraints people live under and their HIV-acquisition risk behaviours/experiences. Drawing on data collected as the baseline for an intervention trial between September 2015 and September 2016, among young (18–30-year-old), out-of-school women and men in urban informal settlements in Durban, South Africa, we assess whether hope, assessed by the Snyder Hope Scale, is associated with HIV-risk behaviours/experiences. 677 women (35.5%; 33.7%; 30.9%; low, medium, and high hope scores respectively) and 668 men (40.6%; 32.8%; 26.7%; low, medium, and high hope scores respectively) were included. Among women, adjusted analyses showed high levels of hope, compared to low levels, were associated with greater modern contraceptive use (aOR1.57, 1.04–2.37). For men, medium or high levels of hope, compared to low levels, were associated with reduced physical and/or sexual IPV perpetration (med: aOR0.55, 0.38–0.81, high: 0.38, 0.25–0.57), emotional IPV perpetration (med: aOR0.54, 0.36–0.80, high: aOR0.62, 0.41–0.94) and transactional sex (med: 0.57, 0.38–0.84, high: aOR0.57, 0.39–0.86) respectively. For men, hope potentially captured a pathway between an individual's structural context and their HIV-risk behaviour. Yet this was not the case for women. It may be the Snyder Hope Scale does not adequately capture localised meanings of hope. [ABSTRACT FROM AUTHOR]

Little is known about how the co-occurrence of psychosocial factors affect sub-populations of people living with HIV (PLWH). We used cross-sectional data from 999 PLWH, aged ≥19, accessing antiretroviral therapy (ART) in British Columbia, Canada (2007–2010) to examine associations between psychosocial factors and ART-related outcomes separately for trans/cis inclusive women; heterosexual men; and gay, bisexual, and other men who have sex with men (gbMSM). Multivariable logistic regression examined associations between psychosocial factors (0–3): any violence in the past 6 months, depressive symptoms in the past week, and current street drug use (heroin, crack, meth or speedball) with sub-optimal adherence (outcome 1: average annual ART adherence <95% from interview until end of follow-up, death, or December 31st, 2018) and ever viral rebound (outcome 2) adjusting for potential confounders. Of 999 PLWH (264 women, 382 heterosexual men, and 353 gbMSM), women and heterosexual men had significantly higher median counts than gbMSM. Overall, higher counts were associated with sub-optimal adherence (adjusted odds ratio [aOR] = 1.26/1-unit increase, 95%CI = 1.07–1.49). All effect estimates were of a greater magnitude among gbMSM, but not significant for women or heterosexual men, highlighting the need for population (e.g., gender and sexual orientation)-centered care and research. [ABSTRACT FROM AUTHOR]

Transactional sex increases sub-Saharan African women’s risk of HIV acquisition. We quantitatively explored the pathways contributing towards women’s future engagement in transactional sex with casual partners and khwapheni (secret concurrent sex partners). We conducted secondary data analysis from a cluster randomised controlled trial in urban informal settlements in eThekwini Municipality., South Africa. Data were collected at enrolment (t0) and 24 months’ later (t2) using self-completed questionnaires. Structural equation modelling (SEM) assessed pathways leading to transactional sex over two years. 677 women 18–35 years were enrolled and 80.5% (n = 545) were followed up. At t2, 44.6% of respondents reported transactional sex with a casual partner or khwapheni. The SEM demonstrated a small effect (d = 0.23) between transactional sex at t0 and at t2. Controlling for past transactional sex, main partner relationship control had a large effect size on future transactional sex (d = 0.60). Hazardous drinking had a medium effect size (d = 0.45) and food insecurity a small effect (d = 0.24), (RMSEA 0.03, 90%CI 0.02–0.04; CFI 0.97; TLI 0.96). HIV prevention programming should highlight current transactional sex but also address structural issues predicting future transactional sex, including food insecurity and alcohol misuse. Gender transformative interventions to reduce controlling behaviours in main relationships are worth investigating. [ABSTRACT FROM AUTHOR]

Women's experiences of emotional intimate partner violence (IPV) and economic IPV are rarely considered in research on women's HIV-risk. Using cross-sectional data of young women (18-30) in Durban, South Africa, we assessed whether women's experiences of emotional IPV and economic IPV were independently associated with six HIV-risk behaviours. Amongst 680 women enrolled between September 2015 and September 2016, past year emotional IPV (78.1%) and economic IPV (52.2%) were common. In adjusted logistic regressions, women reporting past year emotional IPV were less likely to report condom use at last sex, and those reporting past year economic IPV were more likely to report transactional sex with a main partner, or casual partner. Overlaps between economic IPV and transactional sex, suggests economic IPV may be part of male economic coercion of women. Association between emotional IPV and condom use suggests complex inter-personal and psychodynamic relationships shape condom use. [ABSTRACT FROM AUTHOR]