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Mpox disproportionately impacts Black people and young adults, yet the beliefs and knowledge of mpox among groups at elevated risk remain unclear. Therefore, we assessed mpox knowledge among Black young adults to inform public health efforts. We surveyed a sample (n = 330) of young Black adults (aged 18–29 years) in Alabama, Georgia, and North Carolina using nine true-or-false questions to assess their mpox knowledge. Correct response rates varied (26%–96%). Approximately 26% were unaware of the mpox vaccine, and almost 21% incorrectly thought the chickenpox vaccine conferred protection against mpox. Females demonstrated statistically significantly higher mpox knowledge than males across 33% of indicators. There were no statistically significant differences between states, suggesting that a regional approach may be suitable to improve knowledge. Findings underscore the importance of education and public health initiatives to address mpox knowledge gaps, particularly among Black young adults, to improve public health preparedness. [ABSTRACT FROM AUTHOR]

In South Africa, adolescent mothers have a three times higher risk of HIV acquisition than nonadolescent mothers. Yet, limited evidence exists regarding how early childbearing may affect HIV risk. A better understanding of adolescent mothers' partnership dynamics and sexual behaviors is critical to tailoring interventions to prevent new infections. Data are from HIV Prevention Trials Network 068, a longitudinal study of adolescent girls and young women (AGYW) aged 13–20 in South Africa who were followed annually for up to 6 years. Log-binomial regression models were used to assess whether adolescent motherhood was associated with partnership dynamics (intimate partner violence, gender inequitable norms, low relationship power, no HIV prevention communication) and if the association between partnership dynamics and sexual behaviors (unprotected sex and transactional sex) varied by adolescent motherhood. Generalized estimating equations, with an exchangeable correlation structure, were used to account for nonindependence. Adolescent mothers were more likely than nonadolescent mothers to be in partnerships characterized by intimate partner violence, low relationship power, gender inequitable norms, and no HIV prevention communication. A higher proportion were also more likely to experience these dynamics, as well as engage in transactional sex, after giving birth. Poor partnership dynamics put AGYW at a higher risk for unprotected sex and transactional sex, regardless of adolescent motherhood status. Engaging adolescent mothers in interventions post birth and developing interventions that address power imbalances in AGYW's sexual partnerships have the potential to reduce engagement in HIV-related sexual behaviors and HIV risk in the long term. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To compare the sexual behaviors of young people in South Africa (SA) and the United States (US) with the aim to better understand the potential role of sexual behavior in HIV transmission in these two countries that have strikingly different HIV epidemics. Methods: Nationally representative, population-based surveys of young people aged 18–24 years from SA (n = 7,548) and the US (n = 13,451) were used for the present study. Results: The prevalence of HIV was 10.2% in SA and <1% in the US. Young women and men in the US reported an earlier age of first sex than those in SA (mean age of coital debut for women: US [16.5], SA [17.4]; for men: US [16.4], SA [16.7]). The median number of lifetime partners is higher in the US than in SA: women: US (4), SA (2); men: US (4), SA (3). The use of condom at last sex is reported to be lower in the US than in SA: women: US (36.1%), SA (45.4%); men: US (48%), SA (58%). On average, young women in SA report greater age differences with their sex partners than young women in the US. Conclusion: Young people in the US report riskier sexual behaviors than young people in SA, despite the much higher prevalence of HIV infection in SA. Factors above and beyond sexual behavior likely play a key role in the ongoing transmission of HIV in South African youth, and thus should be urgently uncovered to develop maximally effective prevention strategies. [Copyright &y& Elsevier]

Interactive stories are a relatively newer form of storytelling with great potential to correct misinformation while increasing self-efficacy, which is crucial to vaccine acceptance. To address COVID-19 vaccine hesitancy and medical mistrust in young Black adults (BYA), we sought to adapt a pre-existing application ("app"; Tough Talks) designed to address HIV disclosure decision-making through choose-your-own adventure (CYOA) narratives and other activities. The adapted app (Tough Talks – COVID) uses a similar approach to situate COVID-19 vaccination decision-making within social contexts and to encourage greater deliberation about decisions. To inform content for the CYOA narratives, we conducted an online survey that was used to elicit the behavioral, cognitive, and environmental determinants influencing COVID-19 vaccine hesitancy among 150 BYA (ages 18–29) in Georgia, Alabama, and North Carolina. The survey included scenario questions that were developed with input from a youth advisory board to understand responses to peer and family influences. In two scenarios that involved discussions with family and friends about vaccination status, most respondents chose to be honest about their vaccination status. However, vaccinated individuals perceived more social pressure and stigma about not being vaccinated than unvaccinated respondents who were not as motivated by social pressure. Personal choice/agency in the face of perceived vaccine risks was a more common theme for unvaccinated respondents. Results suggest that relying on changing social norms alone may not impact barriers to vaccination in unvaccinated young adults without also addressing other barriers to vaccination such as concerns about autonomy and vaccine safety. Based on these findings, CYOA narratives in the app were adapted to include discussions with family and friends but also to touch on themes of personal choice as well as other topics that influence behaviors besides norms such as safety, side effects, and risk of COVID-19 in an evolving pandemic. [ABSTRACT FROM AUTHOR]

Adolescents in sub-Saharan Africa are highly vulnerable to HIV, other sexually transmitted infections (STIs) and unintended pregnancies. Evidence for the effectiveness of individual behaviour change interventions in reducing incidence of HIV and other biological outcomes is limited, and the need to address the social conditions in which young people become sexually active is clear. Adolescents' peers are a key aspect of this social environment and could have important influences on sexual behaviour. There has not yet been a systematic review on the topic in sub-Saharan Africa. We searched 4 databases to find studies set in sub-Saharan Africa that included an adjusted analysis of the association between at least one peer exposure and a sexual behaviour outcome among a sample where at least 50% of the study participants were aged between 13 and 20 years. We classified peer exposures using a framework to distinguish different mechanisms by which influence might occur. We found 30 studies and retained 11 that met quality criteria. There were 3 cohort studies, 1 time to event and 7 cross-sectional. The 11 studies investigated 37 different peer exposure-outcome associations. No studies used a biological outcome and all asked about peers in general rather than about specific relationships. Studies were heterogeneous in their use of theoretical frameworks and means of operationalizing peer influence concepts. All studies found evidence for an association between peers and sexual behaviour for at least one peer exposure/outcome/sub-group association. Of all 37 outcome/exposure/sub-group associations tested, there was evidence for 19 (51%). There were no clear patterns by type of peer exposure, outcome or adolescent sub-group. There is a lack conclusive evidence about the role of peers in adolescent sexual behaviour in Sub-Saharan. We argue that longitudinal designs, use of biological outcomes and approaches from social network analysis are priorities for future studies. [ABSTRACT FROM AUTHOR]

Alcohol use contributes to morbidity and mortality in developing countries by increasing the risk of trauma and disease, including alcohol dependence. Limited research addresses determinants of alcohol use beyond the individual level in sub-Saharan Africa. We test the association of community collective efficacy and alcohol outlet density with young men's drinking in a cross-sectional, locally representative survey conducted in rural northeast South Africa. Informal social control and cohesion show protective associations with men's heavy drinking, while alcohol outlet density is associated with more potential problem drinking. These findings provide initial support for intervening at the community level to promote alcohol reduction. [ABSTRACT FROM AUTHOR]

Cash transfers can reduce adolescent girls and young women's (AGYW) risk of intimate partner violence (IPV). In our own cash transfer intervention (HPTN 068), AGYW who received a cash transfer were less likely to experience IPV than non-recipients, in part because the cash reduced their engagement in sexual partnerships. This mixed-methods study builds on earlier findings to examine whether the protective effects were sustained after the cash ended and when the cash transfer was the most impactful. HPTN 068 was an experimental HIV prevention intervention trial. AGYW who participated completed 3 annual surveys during the intervention and an additional survey 2.5 years post-intervention. We used log-binomial regression models to assess the durability of the cash transfer on outcomes and included an interaction term in models to examine when effects were largest. We analyzed qualitative interviews conducted after the cash ended to contextualize findings. Post-intervention, the relative risk of physical IPV was lower among AGYW who received it compared to those who did not, but not statistically significant (RR: 0.83, 95% CI: 0.62, 1.10). AGYW who received the cash transfer also had a lower relative risk of ever having had sex and of having any sexual partner in the last 12 months (RR: 0.94, 95% CI: 0.88, 1.01; RR: 0.94; 95% CI: 0.88, 0.99, respectively). The protective effect of the cash transfer on physical IPV was highest in Years 1 and 2 (RR: 0.64; 95% CI: 0.55–0.75 and RR: 0.65; 95% CI: 0.55–0.77, respectively). Qualitative data corroborated the quantitative findings. The cash transfer reduced AGYW's risk of IPV, though effects were attenuated after the cash ended. Provision of cash during adolescence – a period when AGYW are highly susceptible to IPV and HIV – may empower them in their current relationship and yield long term health benefits. • We lack understanding of whether cash transfers have long-term benefits for AGYW. • We examined the durability of a cash transfer on AGYW's risk of IPV and HIV. • AGYW were the most protected from IPV when they were receiving the cash transfer. • The cash continued to reduce AGYW's number of sexual partners after it ended. • Provision of cash during adolescence may empower AGYW in their relationships. [ABSTRACT FROM AUTHOR]