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Introduction: People who inject drugs (PWID) are a key population at risk of HIV in Iran. We measured the prevalence and covariates of HIV-related risk behaviours among PWID in Iran. Methods: We conducted a respondent-driven bio-behavioural surveillance survey among PWID from July 2019 to March 2020 in 11 major cities. We assessed PWID's recent (i.e., last three months) HIV-related risk behaviours using a four-level categorical variable: Only unsafe injection (i.e., sharing needles/syringes or injecting equipment), only unsafe sex (i.e., unprotected sex), dual HIV risk (i.e., both unsafe injection and unprotected sex), and safe injection and sex. Data were summarized using RDS-weighted analysis. Multinomial logistic regression models were built to characterize HIV-related risk behaviours and relative risk ratio (RRR) with 95% confidence interval (CI) were reported. Results: Overall, 2562 men who inject drugs (MWID) were included in the regression analysis. The RDS-weighted prevalence of dual HIV risk was 1.3% (95% CI: 0.8, 1.9), only unsafe injection was 4.5%, and only unsafe sex was 11.8%. Compared to the safe injection and sex group, dual HIV risk was significantly and positively associated with multiple partnership (RRR = 15.06; 3.30, 68.73). Only unsafe injection was significantly associated with homelessness in the last 12 months (RRR: 3.02; 95% CI: 1.34, 6.80). Only unsafe sex was significantly associated with multiple partnership (RRR = 6.66; 4.27, 10.38), receiving free condoms (RRR = 1.71; 1.01, 2.89), receiving free needles (RRR = 2.18; 1.22, 3.90), and self-received risk for HIV (RRR = 2.51; 1.36, 4.66). Moreover, history of HIV-testing in the last three months was significantly associated with only unsafe injection (RRR = 2.71; 1.84, 3.80). Among the 90 women who injected drugs, none reported dual HIV risk behaviours. Discussion and conclusions: While the low prevalence of dual HIV risk among PWID is encouraging, unprotected sexual practices among PWID is concerning. Expanding sexual health education and care services as well as tailored interventions aimed at reducing high-risk sexual activities among PWID are warranted. Additionally, tackling potential misperceptions about risk of HIV transmission among PWID in Iran is warranted. [ABSTRACT FROM AUTHOR]

Abstract Introduction People who inject drugs (PWID) are a key population at risk of HIV in Iran. We measured the prevalence and covariates of HIV-related risk behaviours among PWID in Iran. Methods We conducted a respondent-driven bio-behavioural surveillance survey among PWID from July 2019 to March 2020 in 11 major cities. We assessed PWID’s recent (i.e., last three months) HIV-related risk behaviours using a four-level categorical variable: Only unsafe injection (i.e., sharing needles/syringes or injecting equipment), only unsafe sex (i.e., unprotected sex), dual HIV risk (i.e., both unsafe injection and unprotected sex), and safe injection and sex. Data were summarized using RDS-weighted analysis. Multinomial logistic regression models were built to characterize HIV-related risk behaviours and relative risk ratio (RRR) with 95% confidence interval (CI) were reported. Results Overall, 2562 men who inject drugs (MWID) were included in the regression analysis. The RDS-weighted prevalence of dual HIV risk was 1.3% (95% CI: 0.8, 1.9), only unsafe injection was 4.5%, and only unsafe sex was 11.8%. Compared to the safe injection and sex group, dual HIV risk was significantly and positively associated with multiple partnership (RRR = 15.06; 3.30, 68.73). Only unsafe injection was significantly associated with homelessness in the last 12 months (RRR: 3.02; 95% CI: 1.34, 6.80). Only unsafe sex was significantly associated with multiple partnership (RRR = 6.66; 4.27, 10.38), receiving free condoms (RRR = 1.71; 1.01, 2.89), receiving free needles (RRR = 2.18; 1.22, 3.90), and self-received risk for HIV (RRR = 2.51; 1.36, 4.66). Moreover, history of HIV-testing in the last three months was significantly associated with only unsafe injection (RRR = 2.71; 1.84, 3.80). Among the 90 women who injected drugs, none reported dual HIV risk behaviours. Discussion and conclusions While the low prevalence of dual HIV risk among PWID is encouraging, unprotected sexual practices among PWID is concerning. Expanding sexual health education and care services as well as tailored interventions aimed at reducing high-risk sexual activities among PWID are warranted. Additionally, tackling potential misperceptions about risk of HIV transmission among PWID in Iran is warranted.

In South Africa, the high rate of human immunodeficiency virus (HIV) infection among young people and unplanned pregnancies remains a concern. Using a qualitative approach, this study aimed to explore how young people between 18 and 24 years old perceive the risk of unplanned pregnancy and HIV, and how they give priority to and act to prevent both concerns. Fifty-four young people were recruited from three provinces in South Africa: KwaZulu-Natal, Eastern Cape, and Gauteng. Data collection took place between May and June in 2016. All data collection was carried out in person using a standardised discussion guide and a semi-structured interview guide in English. We conducted eight focus group discussions with young people and three in-depth interviews with young people who had become parents in their teens. We utilised thematic analysis grounded in a social constructionist framework to assess patterns and associations in the data. Respondents reported unplanned pregnancy and HIV as prevalent among their peers, but prioritised both concerns differently. Preventing pregnancy was a greater priority and threat than HIV. Respondents were less concerned about being infected with HIV which was perceived as invisible and not a death sentence because of the efficacy and ease of use of treatment. HIV was considered comparatively more manageable and less burdensome than other chronic illnesses and unplanned pregnancy. Our study suggests unplanned pregnancy and HIV prevention interventions should prioritise responding to young people’s primary desire to control their fertility, but also encourage them to have holistic sexual and reproductive health goals that include HIV prevention. Our findings suggest a pressing need for biomedical therapies that offer combined HIV and pregnancy prevention for young people. Future programmes need to be agile and innovative in addressing young people’s tendency to prioritise HIV and pregnancy differently, and they need to revive the sense of urgency to prevent HIV. [ABSTRACT FROM AUTHOR]

BackgroundPre-exposure prophylaxis (PrEP) prevention-effective adherence is of critical importance but challenging particularly among key populations where periods of high HIV risk are frequent. We assessed the use of PrEP with reference to periods of unprotected sex among female sex workers in the city of Tanga.MethodsThis was part of the pragmatic quasi-experimental trial for HIV PrEP rollout in Tanzania involving a control cohort of 313 female sex workers aged ≥18 years recruited by respondent-driven sampling and followed for 12 months. PrEP use and periods of condomless or unprotected sex were assessed at the 6th and 12th month of follow-up. Prevention-effective adherence was defined as PrEP use of ≥2 pills/week and ≥6 pills/week for anal and vaginal condomless sex. Multivariable modified Poisson regression was conducted to determine factors influencing PrEP use (≥2 pills/week).ResultsOverall, 59.2 and 45.9% of participants had unprotected anal and vaginal sex with a client, respectively. The prevention-effective adherence for anal sex ranged from 8.0% (months 6) to 10.0% (months 12) while that of vaginal sex was from 10.1% (month 6) to 3.8% (month 12). Participants who lived with friends were 25.5 times more likely to use ≥2 PrEP doses per week than those who lived alone (aPR = 25.5; 95%CI: 2.55–255.42, p = 0.006). Compared to self-reporting poor health status, self-reporting good health status significantly increased the use of ≥2 PrEP doses per week (aPR = 17.4; 95%CI: 3.01–101.02, p = 0.001). Refusing condomless sex with a steady partner increased the likelihood of using ≥2 PrEP doses per week than accepting condomless sex with a steady partner (aPR = 11.2; 95%CI: 1.55–80.48, p = 0.017). The prevalence of using ≥2 PrEP doses per week was less among participants accepting condomless sex at high pay than those who refused (aPR = 0.1; 95%CI: 0.03–0.26, p = 0.000).ConclusionUse of PrEP during periods of unprotected sex was rare among female sex workers. Living with friends, self-reporting good health status, and refusing condomless sex with steady partners were associated with increased use of ≥2 PrEP doses per week. However, accepting condomless sex for increased payment was associated with reduced use of ≥2 PrEP doses per week. This calls for an in-depth study to understand the perspectives and circumstances shaping poor adherence during periods of unprotected sex among female sex workers.

Background: Globally, street-involved children and youth (SICY) who work and live on/of the streets are at higher risk of increased psychoactive substances and injecting drug use. Objectives: The present study aimed to identify the prevalence, distribution, sociodemographic factors, and risk-taking behaviors associated with psychoactive substances and injecting drug use among SICY. Methods: Studies in English published from December 1 1985 to July 1 2022, were searched for on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on psychoactive substances and injecting drug use among SICY. The pooled-prevalence estimates were obtained using a robust fixed-effects model. Results: The most commonly reported life-time and current psychoactive substance was tobacco followed by cannabis, LSD/ecstasy, cocaine, methamphetamine, heroin and injection drug use. The results showed that life-time and current prevalence of methamphetamine and cannabis use, as well as life-time prevalence of cocaine, LSD/ecstasy, heroin, tobacco, and injecting drug use increased as age rose while current prevalence of cocaine and tobacco use decreased as age rose. SICY who were male, homeless, had parents who had died, had history of substance use among family members or best friends, had experienced violence, had casual sex partners, had a history of working in the sex trade, and had unprotected sex were all related to psychoactive substance use and injecting drug use. Conclusions: Research examining this population suffers from lack of studies, therefore, improving the knowledge for interventions aimed at reducing risk behaviors, particularly those related to the transmission of sexually transmitted infections such as HIV is of great importance. [ABSTRACT FROM AUTHOR]

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Background: In India, premarital partnerships whether involving sex or not are widely unacceptable. Various studies in India have reported heightened premarital sexual activities among youngsters. Objective: The objective of the study was to assess the involvement of youth in premarital sexual practices studying at Panjab University. Methods: The cross-sectional study was conducted at Panjab University situated in Chandigarh, India between February and August 2020. Purposive sampling was used to recruit students. Data was collected using a pre-tested, semi-structured, self-administered questionnaire. The nature of the data was quantitative and was analyzed through SPSS version 20. Results: A total of 211 (female/male: 51.7%/48.3%, mean age: 22.5 years) respondents were enrolled. Prevalence of premarital sex was 68.7% with an average age of sexual debut 18.5 years. 62.1% of respondents were practicing unprotected sex. 91% of respondents were involved in vaginal sex, 61.4% in oral sex, 29% in online sex, and 19.3% in anal sex. 66.8% of respondents were involved in the habit of masturbation. In students having a positive premarital sexual background, 78.2% of respondents had sexting, 38.8% had friends with benefits, 33.9% had one-night stands, 4.8% had a threesome and 2.3% had gay sex. Out of all the respondents involved in premarital sexual practices, 86.9% were satisfied with sexual life. Conclusion: There is a need to empower the younger population involved in risky sexual behavior by accelerating their sexual and reproductive rights education to propagate safe sexual behavior in premarital sexual practices.

South Africa accounts for the largest share of the global HIV epidemic, both in the number of people living with HIV and in new infection rates. In the context of the high prevalence of HIV/AIDS and its ensuing adverse socio-economic impact, in South Africa, this study aimed at examining the factors that impact the sexual risk-taking behaviours of unmarried persons aged 15–34 years in the country. Specifically, the study sought to examine the effects of selected sociodemographic factors on the condom use and sexual partnership behaviours of three age cohorts: 15–19-year-olds (adolescents), 20–24-year-olds (emerging adults), and 25–34-year-olds (young adults). The results showed that being male, wealthy, and living in an urban area generally protected against sexual risk-taking behaviours among respondents. Furthermore, early sexual debut, province of residence, and unemployment are risk factors for unsafe sexual practices among respondents. These demographic predictors showed varied effects depending on the age cohort of respondents. The findings support targeted interventions to improve sex education for adolescents and emerging adults in South Africa. [ABSTRACT FROM AUTHOR]

Introduction: Considering that many new HIV infections are transmitted by homosexual behaviors, gay, bisexual, and other men who have sex with men (GBMSM) are more likely to be infected with HIV than other groups due to the higher risk associated with unprotected anal intercourse. It is important to explore the changes in sexual behaviors and HIV-related knowledge among GBMSM in the last 10 years, which could provide evidence for improving public health interventions to reduce HIV infections., Objectives: The study sought to explore the changes of 3 sexual behaviors and HIV knowledge among men who have sex with men from 2011 to 2021., Methods: Data were collected from national HIV sentinel surveillance among GBMSM in Hangzhou conducted between 2011 and 2021. Univariate and multivariate logistic regression were used to analyze the associated factors of sexual behaviors. The variation trend of variables was evaluated based on the linear trend test in the regression model., Results: A total of 5111 GBMSM with an average age of 32.00 years were incorporated in the analysis. From 2011 to 2021, the HIV-related knowledge score of GBMSM ranged from 6 to 7.5, and it increased significantly (P trend < .001). The rate of homosexual sex in the past 6 months remained at a high level (75.06%-82.75%). Homosexual behavior was associated with a higher HIV-related knowledge score (P = .004). Heterosexual sex was associated with an increase in the old age, married persons, and domicile outside the province (P < .05). Commercial sex was associated with an increase in drug users (P <.001)., Conclusions: In the past 10 years, HIV-related knowledge of GBMSM increased and the rate of unprotected sex was at a high level among GBMSM, especially in heterosexual behaviors. Moreover, the likelihood of having homosexual behaviors is raised with the increasing HIV-related knowledge. Conducting precise behavioral interventions for GBMSM are crucial for preventing HIV infection., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society for Sexual Medicine.)

The Information-Motivation-Behavioral skills (IMB) model has been a useful tool for understanding sexual risk behavior. However, its utility in predicting sexual risk behaviors among bar patrons, for whom the bar setting poses a higher risk of alcohol-related sexual risk behavior, has been underexplored. We assessed (1) the extent to which the IMB predicted number of episodes of unprotected sex in the past six months and (2) whether incorporating sex under the influence of alcohol and alcohol use improved the predictability of the model among bar patrons. Hierarchical regression models were conducted on data from 406 men and women from bars in rural areas of North-West province, South Africa. Behavioral skills were the sole IMB variable to predict unprotected sex with main partners (β = - 0.40; p < .001), explaining 18% of the variance. Variance explained increased to 21% with addition of sex under the influence of alcohol (β = 0.13; p = .019) and further increased to 26% with the addition of alcohol use (β = 0.24; p < .001). Motivation (β = - 0.21; p = .006) and behavioral skills (β = - 0.21; p = .006) were the significant IMB predictors of unprotected sex with casual partners (explaining 15% of the variance). Variance explained increased to 22% with the addition of sex under the influence of alcohol (β = 0.26; p = .001), but alcohol consumption was not an independent predictor of episodes of unprotected sex with casual partners. Interventions for improving HIV prevention behaviors among bar patrons should focus on enhancing individuals' behavioral skills and motivation and reducing their alcohol consumption. [ABSTRACT FROM AUTHOR]

Background: In India, premarital partnerships whether involving sex or not are widely unacceptable. Various studies in India have reported heightened premarital sexual activities among youngsters. Objective: The objective of the study was to assess the involvement of youth in premarital sexual practices studying at Panjab University. Methods: The cross-sectional study was conducted at Panjab University situated in Chandigarh, India between February and August 2020. Purposive sampling was used to recruit students. Data was collected using a pre-tested, semi-structured, self-administered questionnaire. The nature of the data was quantitative and was analyzed through SPSS version 20. Results: A total of 211 (female/male: 51.7%/48.3%, mean age: 22.5 years) respondents were enrolled. Prevalence of premarital sex was 68.7% with an average age of sexual debut 18.5 years. 62.1% of respondents were practicing unprotected sex. 91% of respondents were involved in vaginal sex, 61.4% in oral sex, 29% in online sex, and 19.3% in anal sex. 66.8% of respondents were involved in the habit of masturbation. In students having a positive premarital sexual background, 78.2% of respondents had sexting, 38.8% had friends with benefits, 33.9% had one-night stands, 4.8% had a threesome and 2.3% had gay sex. Out of all the respondents involved in premarital sexual practices, 86.9% were satisfied with sexual life. Conclusion: There is a need to empower the younger population involved in risky sexual behavior by accelerating their sexual and reproductive rights education to propagate safe sexual behavior in premarital sexual practices. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: to understand higher education students’ perceptions of sexual and reproductive health risk behaviours. Methods: a descriptive study following a qualitative approach was conducted, using Pender’s Health Promotion Model as a theoretical and methodological framework. A thematic analysis of the data obtained from different focus groups was performed. Results: participants consider that factors such as communication with their sexual partner, the ability to negotiate and a positive attitude regarding condoms are positive aspects that will encourage consistent use of condom. The embarrassment felt at the time of purchase, the reduction of sexual pleasure and the growing stability of the relationship are usually seen as barriers. Final considerations: the study was crucial to identify some strategies that will be considered in further health promotion programmes, namely peer education, and will help promote personal and social skills and the (re)organisation of healthcare services.

Risky sexual behaviors, such as not using a condom for preventing sexually transmittable diseases and unwanted pregnancies, are associated with emotional and psychological problems in adolescence, including higher levels of depression, anxiety, stress, and low self-esteem. Adolescents with a history of violence victimization are also at increased risk of engaging in sexual risk behaviors. In this study, we examined the associations between mental health disturbances and partner violence victimization and the non-use of condoms among young people in Spain. We also examined self-esteem as a mediator of mental health problems and unprotected sexual relationships. A cross-sectional study was conducted on a sample of 831 adolescents randomly selected from 25 high schools in Spain. From the initial sample, 285 students (144 men and 141 women) from high schools in Alicante (Spain) who reported having experienced sexual activity with at least one partner were approached. The results showed that one in three adolescents between 14 and 19 years old did not use condoms during sexual intercourse. The factors associated with the non-use of condoms in the estimated models of Poisson robust variance were having a history of physical, psychological, or sexual violence; having been expelled from school because of behavioral problems; and having higher levels of depression, anxiety, and stress and lower levels of self-esteem. Self-esteem was independently associated with the non-use of condoms. Having lower levels of self-esteem increased the risk of not using a condom during participants' last sexual intercourse. These findings suggest the importance of developing public health strategies for mental health promotion to increase condom use among adolescents. [ABSTRACT FROM AUTHOR]

Insecure romantic attachment style has been associated with greater substance use and higher risk sexual behavior, but the temporal nature of these associations is not well-understood. This study examined whether having a more insecure attachment style was associated with greater engagement in higher-risk sexual behavior over time and, if so, whether this was mediated by more frequent alcohol use. We used three annual waves of survey data from a diverse California cohort (N = 2371) who were assessed from ages 19 to 21–22 years. Separate cross-lagged models examined temporal associations of insecure romantic attachment style (anxious and avoidant), past month alcohol use frequency, and sexual behavior (number of sex partners, condomless sex with casual and steady partners). Attachment anxiety was not directly associated with sexual behavior. Rather, a consistent pattern across waves showed that greater attachment anxiety was associated with more frequent alcohol use at the next wave, which, in turn, was associated with having more sex partners and condomless sex with casual and steady partners one year later. In contrast, greater attachment avoidance was directly associated with having fewer sex partners, and its associations with condomless sex differed across partner type and assessment waves. Attachment avoidance was unrelated to alcohol use frequency. Results indicated that both anxious and avoidant attachment styles were associated with higher-risk sexual behavior, but in different ways and through different mechanisms. Future research may want to examine whether the effectiveness of sexual risk reduction programs for young people is enhanced by discussing attachment style and tailoring the curriculum accordingly. [ABSTRACT FROM AUTHOR]

BackgroundsLittle was known about the impact of HCV prior infection on HIV transmission and acquisition. We aimed to explore whether HCV prior infection and its interactions with unprotected sex affected HIV acquisition.MethodsThis study was conducted among HIV heterosexual serodiscordant couples whose index cases were receiving treatment during 2008–2014 in Zhumadian. At baseline, we collected information on demographics and medical history of ART use, CD4 count, and HIV viral load for index partners, and also HIV and HCV status for non-index partners. For each year's visit, we followed up on sexual behaviors among couples in the recent year and HIV seroconversion of non-index partners. Analyses of the Cox model and synergistic interaction were performed.ResultsWe identified 81 HIV seroconversions over 18,370.39 person-years, with the overall HIV seroconversion rate of 0.44 per 100 person-years. Couples, whose index cases were aged 50 years and above, had a baseline viral load >400 copies per ml and no AIDS-defining illness, and newly-initiated ART in the study period had a higher risk of HIV seroconversion. Unprotected sex and HCV prior infection showed a synergistic association with HIV acquisition risk (RERI = 3.65, SI = 0.48, AP = 2.24).ConclusionUnprotected sex and HCV infection were independent risk factors associated with HIV acquisition. The coexistence of them might have a synergistic effect on the risk which needs further research.

Background: College students represent the huge section of teenagers in Ethiopia, and a growing number of them practice unsafe sex and hence face unwanted sexual health outcomes. Despite this, little has been explored about the college students' knowledge, attitude, and practice toward risky sexual behaviors (RSBs) in the study area. Therefore, this study aimed to assess the knowledge, attitude, and the practice of Jimma teacher training college students toward RSBs, Jimma town, southwest Ethiopia, in 2018. Methods: An institution-based quantitative cross-sectional study was conducted. Data were collected through a pretested, structured, and self-administered questionnaire. A total of 395 respondents were selected using a simple random sampling technique. The collected data were checked manually for completeness and consistency, entered into Epi-data, version 3.1, data entry software, and exported to SPSS, version 20, statistical software for analysis. Descriptive statistics were used to summarize the outcome and explanatory variables. Results: Among the total 360 respondents, 140 (38.9%) had poor knowledge of RSBs. The majority 78 (36.6%) of the respondents described radio as their main source of information about RSBs. More than three-quarters, 163 (76.6%) respondents define practicing oral and/or anal sex as RSBs and 194 (91%) reported sexually transmitted infections including HIV/AIDS as the main consequence of RSBs. This study also revealed 156 (43.4%) participants had an unfavorable attitude toward RSBs. 60 (16.7%) participants disagree with the idea that condoms prevent HIV/AIDS and nearly all respondents (340 [94.5%]) agreed homosexuality brings sexual risks. Among those who had sexual experience, 83 (32.4%) had 2 or more sexual partners, more than two-third (176 [68.8%]) had sexual practice after drinking alcohol, and 90 (35.1%) participants reported they did not use a condom when they had sex. Conclusion: A significant percentage of the students have poor knowledge, attitude, and practice toward RSBs.Tesfaye Y, Agenagnew L. Knowledge, Attitude, and Practices of Jimma Teacher Training College Students Toward Risky Sexual Behaviors, Jimma, Ethiopia. Sex Med 2020;8:554–564.

Abstract Background Hepatitis C diagnosis could be a gateway to behavioral change and subsequent decline in transmission among people who inject drugs (PWIDs). We assessed the association between the social determinants of PWID, their risk behaviors and hepatitis C testing. Methods We searched for studies in English published before May 1, 2020, on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on the factors associated with hepatitis C virus (HCV) testing among PWID. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria. i) population: individuals who report injecting drugs; ii) intervention: HCV testing in the past year; iii) comparator: PWIDs who did not have an HCV test; iv) outcome: HCV testing among PWIDs and v) study type: cross-sectional, cohort, and case-control studies. Two independent reviewers (author BA and AB) chose the references in a two-phased monitoring process. The authors gathered data from selected papers, including the surname of the first author, publication date, participant demographic data (age, sex, and level of education) and other characteristics like previous HCV testing, past treatment attempts, duration of injecting drug use and condomless sex. We used fixed and random-effects meta-analysis models to estimate the pooled prevalence, pooled odds ratio (OR), and 95% confidence intervals. The data were analyzed using Stata 12.0 software. Results After a detailed assessment of over 12,000 articles, a total of 16 studies containing 38,952 participants met the eligibility criteria. Our findings showed a pooled prevalence rate of 61.01% (95% CI, 34.65–84.32%) for recent HCV testing among PWIDs. Being female (OR = 1.69, 95%CI = 1.13, 2.26), aged > 30 years, (OR = 2.61, 95%CI = 1.66–3.56) having past treatment attempt (OR = 2.24, 95%CI = 1.80–2.68), and reporting a previous test (OR = 2.03, 95%CI = 1.23–2.82). were significantly associated with having a recent HCV test.,,. Finding of present study was that unprotected sex had a negative association with HCV testing. Those PWIDs who had unprotected sex were 0.56 times less likely to have completed HCV testing during last year (OR = 0.56, 95%CI = 0.33–0.78). Conclusion Prevention programs that address age > 30 years, being female, past treatment attempt, previous testing of safe sexual practices, are strongly recommended to prioritize HCV risk reduction strategies.

Abstract Background Young people experiencing homelessness have alarmingly high rates of alcohol and other drug (AOD) use, which is associated with sexual risk behaviors such as unprotected sex, trading sex, and sex with multiple casual partners. Few risk reduction programs for this population have been developed and rigorously evaluated, particularly those that address both of these interrelated behaviors, use a collaborative and non-judgmental approach, and are feasible to deliver in settings where homeless young people seek services. This paper describes the protocol of a study evaluating a four-session Motivational Interviewing (MI)-based group risk reduction intervention for this population. The protocol has been shown to be efficacious in pilot work over 3 months with 200 homeless young adults [1]. The current study seeks to refine the intervention protocol and evaluate the program on a larger scale. Methods/design In a cluster-cross-over randomized controlled trial, 18–25 year olds will receive the AWARE risk reduction program (n = 200) or standard care (n = 200) at one of three drop-in centers serving homeless youth in the Los Angeles area. We will evaluate intervention effects on primary outcomes of AOD use and sexual risk behavior, as well as secondary outcomes of health-related quality of life and social stability, over a 12-month period. Discussion This project has the potential to fill a significant gap in prevention services by demonstrating that a brief intervention, feasible to deliver within settings where young people experiencing homelessness typically seeks services, can significantly reduce the interrelated problems of AOD use and sexual risk behavior. Trial registration ClinicalTrials.gov Identifier: NCT03735784. Registered November 18, 2018, https://clinicaltrials.gov/ct2/show/record/NCT03735784 (retrospectively registered)

Background: Pre-exposure prophylaxis (PrEP) prevention-effective adherence is of critical importance but challenging particularly among key populations where periods of high HIV risk are frequent. We assessed the use of PrEP with reference to periods of unprotected sex among female sex workers in the city of Tanga., Methods: This was part of the pragmatic quasi-experimental trial for HIV PrEP rollout in Tanzania involving a control cohort of 313 female sex workers aged ≥18 years recruited by respondent-driven sampling and followed for 12 months. PrEP use and periods of condomless or unprotected sex were assessed at the 6th and 12th month of follow-up. Prevention-effective adherence was defined as PrEP use of ≥2 pills/week and ≥6 pills/week for anal and vaginal condomless sex. Multivariable modified Poisson regression was conducted to determine factors influencing PrEP use (≥2 pills/week)., Results: Overall, 59.2 and 45.9% of participants had unprotected anal and vaginal sex with a client, respectively. The prevention-effective adherence for anal sex ranged from 8.0% (months 6) to 10.0% (months 12) while that of vaginal sex was from 10.1% (month 6) to 3.8% (month 12). Participants who lived with friends were 25.5 times more likely to use ≥2 PrEP doses per week than those who lived alone (aPR = 25.5; 95%CI: 2.55-255.42, p  = 0.006). Compared to self-reporting poor health status, self-reporting good health status significantly increased the use of ≥2 PrEP doses per week (aPR = 17.4; 95%CI: 3.01-101.02, p  = 0.001). Refusing condomless sex with a steady partner increased the likelihood of using ≥2 PrEP doses per week than accepting condomless sex with a steady partner (aPR = 11.2; 95%CI: 1.55-80.48, p  = 0.017). The prevalence of using ≥2 PrEP doses per week was less among participants accepting condomless sex at high pay than those who refused (aPR = 0.1; 95%CI: 0.03-0.26, p  = 0.000)., Conclusion: Use of PrEP during periods of unprotected sex was rare among female sex workers. Living with friends, self-reporting good health status, and refusing condomless sex with steady partners were associated with increased use of ≥2 PrEP doses per week. However, accepting condomless sex for increased payment was associated with reduced use of ≥2 PrEP doses per week. This calls for an in-depth study to understand the perspectives and circumstances shaping poor adherence during periods of unprotected sex among female sex workers., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Mikomangwa, Moen, Mmbaga, Metta, Kibusi, Leshabari, Kamuhabwa and Kwesigabo.)

This study aimed to evaluate the influence of bareback sexually explicit media (SEM) consumption on anal sex without a condom by men who have sex with men (MSM). To this end, a page was created on the Facebook® social network with a link that directed interested parties to a questionnaire. Cisgender men, aged 18 years and over, who had sex with other men in the last 12 months, were included. Data were collected in 2017 and analyzed using univariate and bivariate inferential statistics and multivariate logistic regression. A total of 2,248 MSM participated in the research, with a mean age of 24.4 years and a mean number of 3.9 partners in the last 30 days. Having multiple sexual partners (ORa: 9.4; 95% CI 3.9-22.4), preferring movies with bareback scenes (ORa: 2.6; 95% CI 1.5-4.6), considering this practice a fetish and realizing it (ORa: 3.52; 95% CI 2.3-5.4), having casual partnerships (ORa: 1.8; 95% CI 1.5-1.9) and being aware of the partner’s negative serological status for HIV (ORa: 1.4; 95% CI 1.1-2.3) were factors that increased the likelihood of engaging in anal sex without a condom. Thus, we found an association between the consumption of bareback SEM and sex without a condom among MSM. [ABSTRACT FROM AUTHOR]

Introduction: female sex workers (FSWs) are the key vulnerable populations since they carry the high burden of HIV and sexually transmitted infections (STIs). However, the vulnerability of street-based FSWs to HIV/STIs is much higher than that of the establishment-based FSWs. The study aimed to explore street-based FSWs' condom negotiation skills, barriers to condom use as well as the challenges and predicaments they face on a daily basis. Methods: an exploratory qualitative approach using focus group discussions was conducted among FSWs working in a major provincial road in a district of Gauteng Province. Thematic content analysis using NVivo version 10 software was conducted. Results: the age range of the FSWs was 19 to 44 years. The themes that emerged from the data on challenges to negotiation and condom use among FSWs revealed the ways condoms are used in early sex work and over time, ways of enforcing condom used, preferred types of condoms and the predicaments to working in the sex trade. FSWs gained experience of negotiating condom use over time in their work. Both female and male condoms were available and accurate insertion of condoms was reported. Male condom was preferred. Condom use strategies included direct request; using health-information messages; charging more for condomless sex; and refusing condomless sex. The FSW reported the risks of violent attacks of unregulated street-based environment. Conclusion: condom negotiation strategies illustrated that peer-education and sharing experiences among themselves were beneficial for protective sexual behaviours. Peer-education benefits and peer-interactions yielded assertive attitudes and behaviours of demanding and/or enforcing condom use. [ABSTRACT FROM AUTHOR]

Background We examined links among face visibility on dating-profile pictures, self-perceived attractiveness, condom use self-efficacy, and unprotected receptive anal intercourse (URAI) in 223 young men who have sex with men (YMSM; ages 18-24 years) using online dating applications (e.g. Grindr).Methods: Participants reported their face visibility on their main dating-profile picture, attractiveness, condom use self-efficacy, and frequency of URAI in the past 3 months. Number of casual sex partners and pre-exposure prophylaxis (PrEP) use were statistically controlled in all analyses.Results: Using a mediated moderation model, we found that a significant attractiveness-by-face-visibility interaction for URAI was fully mediated by condom use self-efficacy. Specifically, lower face visibility on profile pictures related to lower condom use self-efficacy, which in turn related to higher URAI, but only among highly attractive YMSM.Conclusions: Our findings suggest that attractive YMSM who show less-visible faces on their dating profiles could be at particularly high risk for sexually transmissible infections. This study has potentially important clinical implications because dating applications have become one of the most common ways for YMSM to find sexual partners. [ABSTRACT FROM AUTHOR]

This study investigates sexual risk-taking among young men testing for sexually transmitted infections (STI). 452 participants (aged 18–30) completed surveys concerning their backgrounds, sexual risk-taking, and experience with STI. Over one-third had used alcohol during their last sexual encounter, one-fifth were reluctant to use condoms due to concerns about erection difficulties, 14.7% had experienced sexual coercion and one-fifth reported having had contracted the most common STI, chlamydia trachomatis (CT). Older participants (aged 25–30) were more reluctant to use condoms because of erection worries and to report having had CT. Immigrant men reported more unprotected sex while men who have sex with men (MSM) were more exposed to sexual coercion than others, but less likely to use alcohol when having sex. There are important differences in sexual risk-taking within the group of young men testing for sexually transmitted infections which need to be taken into account in developing effective counselling and promotion strategies in sexual and reproductive health care. Further research on young men's sexual risk-taking is needed to broaden understanding of factors associated with young men's sexual health. [ABSTRACT FROM AUTHOR]

INTRODUCTION: ART significantly increases the life expectancy of HIV positive people by improving quality of life as well as enabling them to resume sexual activity. A growing number of people living with HIV became a source of exposure to sexually transmitted infections, including other strains of HIV that place others at risk unless they consistently use condoms. This study assessed the magnitude of unprotected sexual practices and associated factors among adult people living with HIV on ART in public hospitals of the Kembata Tembaro Zone, Southern Ethiopia. METHODS: A facility-based cross-sectional study was conducted among adult people living with HIV on ART in public hospitals of the zone from March 1-30, 2016. Data were collected by a pretested and structured questionnaire. Binary logistic regression was used to investigate variables, independently associated with the outcome variable. The adjusted odds ratio with 95% CI used to show the strength of the association and a P-value =0.05 was used to declare the cut-off point in determining the level of significance. RESULTS: The study revealed that 40.9% of respondents practiced unprotected sexual intercourse. On multivariate logistic regression analyses, being females, having more than one sexual partner, mean monthly income of 530 Ethiopian birrs/ month, those who had a seropositive partner, a partner of unknown serostatus, and respondents who had insufficient knowledge of HIV transmission and prevention were statically significant with the outcome variable. CONCLUSION: The scarcity of knowledge on HIV transmission, negative attitude towards condom use, non-disclosure status and having more than one sexual partnership increased likelihood of have unprotected sex among the respondents.

Introduction: Antiretroviral therapy (ART) significantly increases the life expectancy of HIV positive people by improving quality of life as well as enabling them to resume sexual activity. A growing number of people living with HIV became a source of exposure to sexually transmitted infections, including other strains of HIV that place others at risk unless they consistently use condoms. This study assessed the magnitude of unprotected sexual practices and associated factors among adult people living with HIV on ART in public hospitals of the Kembata Tembaro Zone, Southern Ethiopia. Methods: a facility-based cross-sectional study was conducted among adult people living with HIV on ART in public hospitals of the zone from March 1-30, 2016. Data were collected by a pretested and structured questionnaire. Binary logistic regression was used to investigate variables, independently associated with the outcome variable. The adjusted odds ratio with 95% CI used to show the strength of the association and a P-value < 0.05 was used to declare the cut-off point in determining the level of significance. Results: the study revealed that 40.9% of respondents practiced unprotected sexual intercourse. On multivariate logistic regression analyses, being females, having more than one sexual partner, mean monthly income of <530 Ethiopian birrs/ month, those who had a seropositive partner, a partner of unknown serostatus, and respondents who had insufficient knowledge of HIV transmission and prevention were statically significant with the outcome variable. Conclusion: the scarcity of knowledge on HIV transmission, negative attitude towards condom use, non-disclosure status and having more than one sexual partnership increased likelihood of have unprotected sex among the respondents. [ABSTRACT FROM AUTHOR]

In South Africa, the high rate of human immunodeficiency virus (HIV) infection among young people and unplanned pregnancies remains a concern. Using a qualitative approach, this study aimed to explore how young people between 18 and 24 years old perceive the risk of unplanned pregnancy and HIV, and how they give priority to and act to prevent both concerns. Fifty-four young people were recruited from three provinces in South Africa: KwaZulu-Natal, Eastern Cape, and Gauteng. Data collection took place between May and June in 2016. All data collection was carried out in person using a standardised discussion guide and a semi-structured interview guide in English. We conducted eight focus group discussions with young people and three in-depth interviews with young people who had become parents in their teens. We utilised thematic analysis grounded in a social constructionist framework to assess patterns and associations in the data. Respondents reported unplanned pregnancy and HIV as prevalent among their peers, but prioritised both concerns differently. Preventing pregnancy was a greater priority and threat than HIV. Respondents were less concerned about being infected with HIV which was perceived as invisible and not a death sentence because of the efficacy and ease of use of treatment. HIV was considered comparatively more manageable and less burdensome than other chronic illnesses and unplanned pregnancy. Our study suggests unplanned pregnancy and HIV prevention interventions should prioritise responding to young people's primary desire to control their fertility, but also encourage them to have holistic sexual and reproductive health goals that include HIV prevention. Our findings suggest a pressing need for biomedical therapies that offer combined HIV and pregnancy prevention for young people. Future programmes need to be agile and innovative in addressing young people's tendency to prioritise HIV and pregnancy differently, and they need to revive the sense of urgency to prevent HIV.

Introduction: Valid causal inferences are necessary to use developmental research to improve adolescent outcomes. What type of change should be analyzed to approximate causal inferences from longitudinal data? Difference-score and ANCOVA-type analyses often produce contradictory results, a problem known as Lord's paradox. This study investigates 2-group, 2-wave difference-score analyses and ANCOVA, and introduces a method that produces consistent results, namely dual-centered ANCOVA, which is compared to pretest matching.Methods: These methods are tested first on two datasets simulated to fit each of Lord's contrasting results. The methods are then applied to data investigating the longitudinal associations of parent-adolescent discussions about sexual risks on subsequent unprotected sexual behaviors in 4753 American adolescents (62.2% whites).Results: The results replicate Lord's contradictory results for all datasets. Dual-centered ANCOVA and pretest matching both produce consistent results, but dual-centered ANCOVA replicates the original results for difference-score analyses, whereas pretest matching replicates the original ANCOVA results. Thus, the two sets of consistent results differ from each other as much as the original discrepancy rather than reducing bias.Conclusion: The least biased analysis is the one whose null hypothesis best approximates a plausible change pattern to represent a no-treatment effect. When difference-score analyses are thought to approximate valid causal inferences as closely as ANCOVA-type analyses, dual-centered ANCOVA estimates the difference-score effect while retaining the advantages of ANCOVA in statistical power and covariate inclusion. These findings are widely applicable to longitudinal analyses that incorporate one or both of these basic methods to analyze change. [ABSTRACT FROM AUTHOR]

Introduction: Studies indicate that 20% to 25% of women and 7% to 8% of men will experience sexual assault during college, ranging from unwanted sexual contact through completed penetration. However, data on repeat victimization during college (i.e., exposure to two or more assaults) are scarce, with few studies examining correlates of repeat victimization and its prevalence by gender. Method: Data were drawn from a representative survey (N = 2,500 invited to participate; 67% enrolled) conducted in the spring of 2016 at 2 interrelated institutions of higher education in the northeast United States. Among the 350 participants who reported a sexual assault, data were available on 336 (Mage = 20.5) who indicated the number of separate assaults since starting college. Results: Among students who experienced sexual assault at college, 64% reported repeat victimization. Although repeat victimization did not differ significantly by gender, seven of the nine gender diverse students were repeatedly victimized. The median number of assaults was 3. Compared to those with only one sexual assault experience, repeat victims reported more hazardous alcohol use, more unprotected sex while drinking, more past-month marijuana use, and a greater number of recent sexual partners. Repeat victims were less likely than singly victimized students to engage in alcohol harm reduction behaviors. Conclusion: The prevalence of repeat victimization was high and associated with concerning substance use and unprotected sex patterns. Integrated alcohol and sexual risk harm reduction efforts may be important to mitigate risk for exposure to multiple assaults, alcohol problems, and unprotected sex during the college period. [ABSTRACT FROM AUTHOR]

While university students are potential human resources, this population group is particularly involved in health risk behaviours. Preventing risky sexual behaviours among them would contribute to prevention of HIV, sexually transmitted infections (STIs), and unwanted pregnancies, which have posed a great burden on population health. This study was therefore conducted to identify social and behavioural factors associated with risky sexual behaviours among university students in nine ASEAN countries. A multi-country, cross-sectional study was conducted in 2015 among university students by a network of researchers in the selected countries. A convenient sampling method and stratified random sampling procedures were employed to select universities and students, respectively. A structured questionnaire was translated into national languages of the participating countries and used to collect data from the selected students in the classrooms. Using STATA, Chi-square test was used to test differences in proportions, and multinomial logistic regression analyses were performed to obtain relative risk ratios and 95% confidence intervals. Multivariate logistic regression analysis was performed with to identify independent social and behavioural factors associated with non-condom use at last sexual intercourse. In total, 8,836 students with a mean age of 20.6 (SD = 2.0) participated in the study. Most of them (98.5%) were unmarried. In all countries, male students were significantly more likely to have two or more sexual partners in the past 12 months compared to female students (4.8% vs. 1.1%, p

Background: Young people experiencing homelessness have alarmingly high rates of alcohol and other drug (AOD) use, which is associated with sexual risk behaviors such as unprotected sex, trading sex, and sex with multiple casual partners. Few risk reduction programs for this population have been developed and rigorously evaluated, particularly those that address both of these interrelated behaviors, use a collaborative and non-judgmental approach, and are feasible to deliver in settings where homeless young people seek services. This paper describes the protocol of a study evaluating a four-session Motivational Interviewing (MI)-based group risk reduction intervention for this population. The protocol has been shown to be efficacious in pilot work over 3 months with 200 homeless young adults [1]. The current study seeks to refine the intervention protocol and evaluate the program on a larger scale. Methods/design: In a cluster-cross-over randomized controlled trial, 18–25 year olds will receive the AWARE risk reduction program (n = 200) or standard care (n = 200) at one of three drop-in centers serving homeless youth in the Los Angeles area. We will evaluate intervention effects on primary outcomes of AOD use and sexual risk behavior, as well as secondary outcomes of health-related quality of life and social stability, over a 12-month period. Discussion: This project has the potential to fill a significant gap in prevention services by demonstrating that a brief intervention, feasible to deliver within settings where young people experiencing homelessness typically seeks services, can significantly reduce the interrelated problems of AOD use and sexual risk behavior. Trial registration ClinicalTrials.gov Identifier: NCT03735784. Registered November 18, 2018, https://clinicaltrials.gov/ct2/show/record/NCT03735784 (retrospectively registered) [ABSTRACT FROM AUTHOR]

Objective: To analyze the sexual practices and the behavior of university students regarding Sexually Transmitted Infections. Methodology: This is a descriptive, cross-sectional, quantitative study conducted at a private university in Rio de Janeiro. A total of 768 students, aged 18 to 29 years, and regularly enrolled in the institution participated in the study. Results: University students were mostly single (58.72%), heterosexual (85.80%), sexually active (85.16%), had initiated sexual life in the age group of 12-17 years (76.9%), reported having a steady partnership (77.83%), did not use condoms (54.62%), reported multiplicity of sexual partners (50.31%), and did not use condoms in all sexual intercourses (62.84%). The students reported using alcohol (66.41%), although sporadically (50.39%), but they had not used before the last sexual intercourse (69.42%). Regarding health care, 57.81% sought care in the last 12 months, and the occurrence of sexually transmitted infections was reported by 4.82% of them. Conclusion: The adoption of risky behaviors by young people makes them vulnerable to STIs. Health education actions and encouragement of self-care are relevant to reduce the sexual health problems of this population contingent. [ABSTRACT FROM AUTHOR]

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Background: Risky sexual behavior (RSB), addiction, and aggression are three important personal and social factors which influence each other. Objective: To overview the potential relationship among RSB, addiction, and aggression to conduct an interactive model for the pathology and management of human behavior. Methods: This review article was carried out by searching studies in PubMed, Medline, Web of Science, Ebsco, IEEE, Scopus, Springer, MagIran, and IranMedex databases from the year 1993 to 2013. The search terms were violence, aggression, drug abuse, substance abuse, illicit drug, psychoactive drug, intravenous drug users, addiction and high-risk sexual relationships, unprotected sex, high risk sexual behavior, and sexual risk-taking. In this study, forty-nine studies were accepted for further screening, and met all our inclusion criteria (in English or Persian, full text, and included the search terms). Results: Forty-nine articles were included; 17 out of 26 studies showed a significant correlation between addiction and risky sexual behavior, 15 out of 19 articles indicated a statistically significant correlation between aggression and addiction, and 9 out of 10 articles reported significant correlation between aggression and risky sexual behavior. Conclusion: According to the results, the triangle hypothesis of sex, addiction, and aggression led to the definition of the relationship among the variables of the hypothetical triangle based on the reviewed studies; and the proposed dual and triple relationship based on the conducted literature review was confirmed. This is not a meta-analysis, and there is no analysis of publication bias

Background: The first step in health education is awareness of the people and their acceptance to change their behavior. Therefore, the aim of this study was to investigate the effects of empowerment program towards the concept of self-care and prevention of sexually transmitted diseases (STDs) in women at risk of STDs. Materials and Methods: The present study was conducted as a qualitative approach (step of action and observation of an action) by using conventional content analysis method. An empowerment program regarding STDs (Action) was performed among 32 (with convenient sample) drug user women with addicted husbands referring to the counseling center for vulnerable women (drop in enter) in Isfahan in 2015. The knowledge of quiddity, transmission, and prevention of STDs, as well as some items of life skills such as self-awareness, interpersonal communication, and assertive behavior were taught in an educational program. Teaching methods were lectures, group, and individual training and role play. The impact of the program on modified belief and behavior change regarding STDs was evaluated with structured interviews. Results: Analysis of the obtained results yielded three categories. The categories were awareness of STD, believing in being at risk, and decision and change. Conclusions: Promoting self-care and prevention through education programs based on action research can make a significant reduction in the incidence of problems and cause a behavior change in women with the disease or those at risk for STDs.

The aim of the article was to test the efficacy of an HIV risk reduction intervention for African American mothers in reducing condomless vaginal intercourse among mothers and their adolescent sons. In a randomized controlled trial design, mother–son dyads residing in public housing developments in Philadelphia, PA, were allocated to one of two four-session interventions: HIV risk reduction targeting sexual risk behaviors or attention-matched control targeting other health behaviors. Only mothers received the interventions; mothers and sons completed self-report measures preintervention, immediately postintervention, and 3, 6, 12, 18, and 24 months postintervention. The primary outcome was frequency of condomless vaginal intercourse in the past 3 months. A total of 525 mother–son dyads participated, with 523 included in primary outcome analyses. Generalized estimating equations analyses revealed that condomless sex was reduced in the HIV risk reduction intervention compared with the attention control group, adjusting for baseline self-reports and time of postintervention assessment. The intervention's efficacy did not differ between mothers and sons or among the postintervention periods. Mother–son interventions are an effective strategy to reduce sexual risks among African American mothers and their adolescent sons residing in public housing. [ABSTRACT FROM AUTHOR]

This brief report examined correlations between Korean men's interest in gonzo pornography, perceptions of pornography's functional value, and use of condoms. Neither a higher interest in gonzo pornography nor the perception that pornography is a source of sexual information were directly related to condom utilization. However, interest in gonzo pornography interacted with pornography perceptions to account for variability in condomless sex. Simple-slope tests indicated that there was no association between gonzo interest and condom use when men disagreed that pornography is a source of sexual information. Conversely, gonzo interest became increasingly associated with a lower likelihood of using condoms as agreement that pornography is a source of sexual information strengthened. This finding supports the hypothesis that consumers will be most likely to reference pornographic scripts to inform their own sexual behavior when they perceive pornography as a form of sexual pedagogy. It also supports calls for increased efforts at pornography literacy education. [ABSTRACT FROM AUTHOR]

Unprotected sexual activity increases the risk of pregnancy and HIV and AIDS. More than three decades into the AIDS pandemic, the condom remains the most effective strategy for protecting against the dual risks of pregnancy and HIV and AIDS, but data from national surveys suggest that condom use among young people aged 15–24 is on the decline in South Africa. This study uses qualitative data from 20 in-depth interviews and one focus group to examine the risk behaviours of university students aged 18–24 years old, with particular emphasis on understanding the decline in the use of condoms. It is well documented that South Africa has one of the highest prevalence rates of HIV and AIDS in the world, however the findings of this study suggest that even though students were well informed about the perceived risks associated with unsafe sexual behaviours, they continue to engage in risk behaviours including unprotected sexual intercourse, multiple sexual partners and the use of alcohol. Male students were more likely than female students to report risky sexual behaviours. Condom use is occurring but not consistently. The majority of students did not use condoms during their first sexual encounter because of a lack of preparedness. Negative attitudes towards condoms continue to discourage students from using them consistently, especially those provided by the government. In light of this, it is recommended that rigorous efforts are directed towards challenging inaccurate perceptions about, and attitudes towards, condom use to promote consistency. [ABSTRACT FROM AUTHOR]

Background: Substance use and unprotected sex are prevalent among adolescents. The link between substance use and unprotected sex is well-established. Research has also highlighted how adolescents' attitudes and risk perceptions regarding unprotected sex, including concerns about pregnancy ("Getting pregnant would force me to grow up too fast"), are associated with unprotected sex and unplanned pregnancy. However, less research has examined the potential relationship between pregnancy concerns and substance use among adolescents. Objectives: The study prospectively examined (1) differences in pregnancy concerns across patterns of substance use and (2) whether pregnancy concerns mediate the relationship between substance use and later unprotected sex among a sample of middle and high school students. Method: 98 adolescents [M(SD) age = 14.28(1.68), 59.4% female, 59.4% black/African American] completed self-report measures of marijuana and alcohol use, pregnancy concerns, and unprotected sex across three time points over 6 months (T1–T3). Results: Substance users (alcohol/marijuana) reported fewer pregnancy concerns compared to non-substance users (t = 2.99, p =.04). Pregnancy concerns at T2 mediated the relationship between T1 lifetime substance use and later unprotected sex (T3) (indirect effect: b = 0.10, CI[.01–.41]; direct effect: b = 0.15, p =.32), controlling for gender, age, and race. More frequent substance use (T1) was related to fewer pregnancy concerns at T2 (b = −0.10, p =.04); fewer pregnancy concerns were related to increased likelihood of later unprotected sex (b = −1.02, p =.02). Conclusions: Findings offer new insight into associations between substance use and unprotected sex and suggest that substance use and sexual health interventions should target pregnancy concerns. [ABSTRACT FROM AUTHOR]

Abstract This report presents data on pornography consumption, perceptions of pornography, and condom use among a sample of 140 women in South Korea. Three key findings emerged. First, perceiving pornography as a source of sexual information was a more reliable correlate of less consistent condom use than the frequency with which pornography was viewed. Second, consuming pornography more frequently only predicted using condoms less frequently when pornography was perceived as a source of sexual information. Third, the interaction between the rate of pornography consumption and perceiving pornography as a source of sexual information maintained even after adjusting for pertinent demographic characteristics. Taken together, these findings suggest that while perceiving pornography as a source of sexual information in and of itself is a risk-factor for engaging in unprotected sex, the combination of regular pornography consumption and perceiving pornography as a source of sexual information is more problematic in terms of sexual risk than either variable in isolation. Sampling specifics and methodological singularity, however, point to a need for replication studies from other locales and using additional designs. [ABSTRACT FROM AUTHOR]

Background In recent years, high-risk sexual behaviors due to their negative consequences both for the individual and society have received more attention than other high-risk behaviors. Objective The aim of this study was to review the influencing factors of high-risk sexual behaviors among young people from an ecological point of view. Methods This review was conducted through searching databases including PubMed, Web of Science, Scopus, Google Scholar and the Cochrane Library with keywords such as sexual risk-taking behavior, high-risk sex, unprotected sex and unsafe sex. The relevant papers published between 1995 and 2016 were extracted. After reviewing the abstract and full text of the articles, 45 papers were used to write this article. Results From an ecological theory approach, factors which influence high-risk sexual behaviors are divided into three categories - the microsystem, the mesosystem and the macrosystem. The microsystem includes factors such as age, gender, race, marital status, place of residence, religion, level of education, personality traits, psychological problems, childhood experiences, body image and coincidence of high-risk behaviors; the mesosystem includes factors such as family structure, peers and sex education; in the macrosystem, the impact of culture and traditions of the society, economic status and the media are presented. Conclusion Given that high-risk sexual behaviors often have multiple causes, it seems that health policymakers must consider multi-dimensional interventions to influence high-risk sexual behaviors based on the ecological approach. [ABSTRACT FROM AUTHOR]

We sought to identify the prevalence and independent correlates of condomless sex within a cohort of community-recruited homeless and unstably housed cisgender adult women who were followed biannually for 3 years (N = 143 HIV+ , N = 139 HIV−). Nearly half (44%) of participants reported condomless sex in the 6 months before baseline, which increased to 65% throughout the study period. After adjusting for having a primary partner, longitudinal odds of condomless sex among women with HIV were significantly higher among those reporting < daily use of alcohol or cannabis (AOR = 2.09, p =.002, and 1.88, p =.005, respectively) and PTSD (AOR = 1.66, p =.034). Among women without HIV, adjusted longitudinal odds of condomless sex were significantly higher for those reporting < daily methamphetamine use (AOR = 2.02, p =.012), panic attack (AOR = 1.74, p =.029), and homelessness (AOR = 1.67, p = .006). Associations were slightly attenuated when adjusting for sex exchange. Targeted HIV/STI programs for unstably housed women should address anxiety and trauma disorders, infrequent substance use, and housing challenges. [ABSTRACT FROM AUTHOR]

While university students are potential human resources, this population group is particularly involved in health risk behaviours. Preventing risky sexual behaviours among them would contribute to prevention of HIV, sexually transmitted infections (STIs), and unwanted pregnancies, which have posed a great burden on population health. This study was therefore conducted to identify social and behavioural factors associated with risky sexual behaviours among university students in nine ASEAN countries. A multi-country, cross-sectional study was conducted in 2015 among university students by a network of researchers in the selected countries. A convenient sampling method and stratified random sampling procedures were employed to select universities and students, respectively. A structured questionnaire was translated into national languages of the participating countries and used to collect data from the selected students in the classrooms. Using STATA, Chi-square test was used to test differences in proportions, and multinomial logistic regression analyses were performed to obtain relative risk ratios and 95% confidence intervals. Multivariate logistic regression analysis was performed with to identify independent social and behavioural factors associated with non-condom use at last sexual intercourse. In total, 8,836 students with a mean age of 20.6 (SD = 2.0) participated in the study. Most of them (98.5%) were unmarried. In all countries, male students were significantly more likely to have two or more sexual partners in the past 12 months compared to female students (4.8% vs. 1.1%, p < 0.001). Female students were significantly more likely to report unprotected sex compared to male students (50.5% vs. 58.8%, p = 0.01). Results of multivariable logistic regression analyses showed that students who reported having two or more partners in the past 12 months were significantly more likely to be male, be aged between 20-30, be current tobacco smokers, be binge drinkers, have severe depressive symptoms, and have been in a physical fight in the past 12 months, compared to students who reported having less than two sexual partners in the past 12 months. Health intervention programmes to prevent and control STIs, especially HIV infection, should focus on university students having the social and behavioural characteristics that are associated with risky sexual behaviours. [ABSTRACT FROM AUTHOR]

Background: Over a million people globally acquire sexually transmitted infections (STI) every day mainly through unprotected sexual contact. While the consequences of risky sexual behaviour are well documented, the literature on young educated women's perceptions of, and narratives about risky sexual behaviour is limited, and thus, it is difficult to fathom from available sources why such behaviour persists. This study examined the prevalence of sexual risk-taking and assessed female University students' knowledge of the consequences of unprotected sex and reasons why such behaviour persists. Paradoxes between their narratives and risky sexual behaviour were discussed. Methods: The study adopted a mixed study design involving a survey of 420 students selected using cluster random sampling, 20 in-depth interviews and 5 focus group discussions. The analysis of the quantitative data involves the use of descriptive and inferential statistics, while thematic content analysis was used to analyse the qualitative data. Results: High prevalence of unprotected sexual intercourse was reported and was not associated with age, year of study, place of residence and religion. The narratives of participants indicate that female university students were aware of the risks associated with unprotected sex. Participants generally condemned sexual risk-taking and asserted that freedom, peer influence, poverty, ignorance, lack of sex education, civilisation, promiscuity, and satisfying sexual urge were the reasons for the persistent risky sexual behaviour among female university students. Also, perceived reduced fun associated with condom use, nourishment of marital expectations, and equivalence of unprotected sex with trust are among the reasons for persistent sexual risk-taking among female university students. Conclusion: Our findings show that female students practice risky sexual behaviour despite having knowledge of its consequences. Change in sexual behaviour of this cohort will require multi-faceted strategies targeting socio-cultural norms and empowerment of women to develop skills in negotiating safe sex.

While alcohol is a known risk factor for HIV infection in sub-Saharan Africa (SSA), studies designed to investigate the temporal relationship between alcohol use and unprotected sex are lacking. The purpose of this study was to determine whether alcohol used at the time of a sexual event is associated with unprotected sex at that same event. Data for this study were collected as part of two longitudinal studies of HIV-infected Ugandan adults. A structured questionnaire was administered at regularly scheduled cohort study visits in order to assess the circumstances (e.g., alcohol use, partner type) of the most recent sexual event (MRSE). Generalized estimating equation logistic regression models were used to examine the association between alcohol use (by the participant, the sexual partner, or both the participant and the partner) and the odds of unprotected sex at the sexual event while controlling for participant gender, age, months since HIV diagnosis, unhealthy alcohol use in the prior 3 months, partner type, and HIV status of partner. A total of 627 sexually active participants (57% women) reported 1817 sexual events. Of these events, 19% involved alcohol use and 53% were unprotected. Alcohol use by one's sexual partner (aOR 1.70; 95% CI 1.14, 2.54) or by both partners (aOR 1.78; 95% CI 1.07, 2.98) during the MRSE significantly increased the odds of unprotected sex at that same event. These results add to the growing event-level literature in SSA and support a temporal association between alcohol used prior to a sexual event and subsequent unprotected sex. [ABSTRACT FROM AUTHOR]

The paper examines the multi-dimensional relationship between substance abuse and unprotected sex among street children of the Harare Central Business District. The child rights Ubuntu or unhu and child agency perspectives were adopted in analysing the circumstances of these children. The substance abuse and unprotected sex among street children of the Harare Central Business District, demonstrate agency of these children. The behaviours could be the only viable options of these children in a resource constrained super structure thus thin agency. The behaviours also constitute ambiguity of agency. Drawing from a child rights concept, substance abuse and unprotected sex of the street children illustrates huge child rights violations prevalent on the streets of the Harare Central Business District. In addition, from an ubuntu or unhu perspective, the unprotected sex and abuse of substances among street children could be viewed as an abomination and lack of morals prevalent on the streets of the Harare Central Business District. The study used street ethnography approach and qualitative research methodology using informal conversations, in depth interviews and life historical interviews with eight street children. The paper concludes by offering a number of recommendations to reduce risks associated with substance abuse and unprotected sex among street children. [ABSTRACT FROM AUTHOR]

Emerging evidence has shown a gradual increase in sexually transmitted infections among elderly. This study explores the views of elderly Yoruba men and women (60+) on condoms use and its suitability against sexual infections. The research design was a sequential exploratory mixed method that consisted of vignettes based focus group discussion and a structured questionnaire. Twelve vignettes based Focus Group Discussion and a survey of 252 elderly Yoruba people (aged 60+) were carried out. The findings revealed limited awareness and experience with condoms. Few of the male (20.4%) and 2.8% of the female respondents felt condom use can prevent sexually transmitted infections. A marginally proportion of the females (29.2%) than the males (25.0%) perceived condom as more useful for younger people. Condom use as a preventive measure against sexual infections varies by gender and marital status (p = .000). Gender and marital status also had an influence on whether condom use could reduce sexual pleasures (p = 0.000). These findings offer strong support of the sexual pleasure hypothesis which is often invoked to explain attitude toward condom use in a variety of social and cultural contexts. Social marketing of condoms is urgently required to address misconceptions around condom use and encourage uptake among sexually active elderly people. [ABSTRACT FROM AUTHOR]

Approximately 71% of HIV-infected individuals live in sub-Saharan Africa. Alcohol use increases unprotected sex, which can lead to HIV transmission. Little research examines risky sex among HIV-infected individuals in East Africa who are not sex workers. The study purpose was to examine associations with unprotected sex in a high-risk sample of 507 HIV-infected sexually active drinkers in western Kenya. They were enrolled in a trial to reduce alcohol use. Past-month baseline alcohol use and sexual behavior were assessed using the Timeline Followback. A zero-inflated negative binomial model examined associations with occurrence and frequency of unprotected sex. Results showed heavy drinking days were significantly associated with unprotected sex occurrence across gender, and with unprotected sex frequency among women. Among women, transactional sex, alcohol-related sexual expectations, condom use self-efficacy, drinking-and-protected-sex days and age were associated with unprotected sex occurrence while alcohol-related sexual expectations, depressive symptoms and condom use self-efficacy were associated with unprotected sex frequency. Among men, alcohol-related sexual expectations, condom use self-efficacy, and age were associated with unprotected sex occurrence, while drinking-and-protected-sex days were associated with unprotected sex occurrence and frequency. Findings suggest robust relationships between heavy drinking and unprotected sex. Further research is needed elucidating the temporal relationships between drinking and unprotected sex in this population. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) and its association with HIV infection among men who have sex men (MSM) in China are not understood. In this study, 732 MSM recruited from Shanghai, China between March and August 2015 were administered with a questionnaire survey and HIV blood testing. IPV victimization was measured by 25 forced-choice items capturing lifetime experience of physical, sexual, psychological, deprivation or neglect, and other forms of violence. Of them, 179 (24.3%) reported having experienced at least one type of IPV victimization. In separate multivariable analyses, sexual violence was associated with age over 35 years (AOR = 0.26, 95% CI: 0.07-1.02), ever had male-to-male commercial sex (AOR = 2.53, 95%CI: 1.19-5.39), and diagnosis of a sexually transmitted infection (STI) (AOR = 2.14, 95%CI: 0.98-4.66). Both psychological violence (AOR = 2.53, 95%CI: 1.25- 5.12) and deprivation or neglect violence (AOR = 1.75, 95%CI: 1.14-2.68) were associated with ever had sex with a casual male partner(s). Having experienced at least one type of IPV victimization was significantly associated with ever had sex with a causal partner(s) (AOR = 1.72, 95%CI: 1.15-2.57) and ever had a diagnosis of a STI (AOR = 1.80, 95% CI: 1.12- 2.88). HIV infection was marginally associated with having experienced any form of IPV victimization. IPV victimization is common among MSM, especially young MSM, in China, although its association with HIV infection is not conclusive in our sample. Nonetheless, our findings highlight the importance of the needs of individualized IPV interventions for certain target risk groups of MSM. [ABSTRACT FROM AUTHOR]