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Background Black and Latinx sexual minority youth are disproportionately affected by HIV. The House Ball and gay family communities encompass sexual and ethnic minority youth who form chosen families that promote protective HIV-related health behaviors. We conducted a small-scale trial of the We Are Family intervention, leveraging these existing social dynamics to address HIV. Methods From September 2018 to September 2019, we enrolled N = 118 for baseline and 6-month follow-up assessments. Eligible participants were 18 years or older, San Francisco Bay Area residents, members of a house or gay family or ball attendees in the past year, smartphone users, and sexually active. The intervention included one 2-hour in-person group session, community-level events, a mobile health app, and a dedicated service provider. Results Ninety-seven percent of our participants were people of color, 94% were retained through follow-up. 73% attended at least 1 group session, 100% used the mobile health app, and 56% attended a community-level event. Modest changes were observed baseline to follow-up: among all participants, any condomless anal intercourse past 3 months (74.6%-66.7%, P = 0.064); among HIV-negative participants (N = 82) HIV testing past 6 months (80.7%-87.2%, P = 0.166); among HIV-positive participants (N = 34) receiving HIV primary care past 6 months (64.5%-78.8%, P = 0.139), and adherent to ART past 30 days (22.6%-28.1%, P = 0.712). 86% would be willing to refer a friend to the app, and 65% found the app to be personally relevant. Conclusions We Are Family reaches and retains its target population, is feasible, acceptable, and shows promise for improving HIV-related health behavior.

PrEP adoption among African-American men-who-have-sex-with-men (AAMSM) remains low. We applied Diffusion-of-Innovations (DOI) theory to understand PrEP adoption processes among young HIV-negative/status unknown AAMSM (AAYMSM; N = 181; 17–24 years). Quantitative and qualitative analyses were used to examine predictors of PrEP diffusion stages. Most AAYMSM were in the persuasion stage (PrEP-aware, hadn’t adopted; 72.4%). Our results suggest that model antecedents are DOI stage-specific. PrEP awareness (knowledge stage) was associated with lower levels of social stigma (p

Minimizing error in self-reported sexual behavior could reduce investigators' likelihood of rejecting truly successful interventions to decrease HIV and STI transmission risk. Sexual behavior assessments can elicit problematic data. This may manifest in the form of elevated levels of non-response, inaccurate point estimates, or misclassification errors resulting in inappropriately answering or, perhaps more importantly, skipping questions. We programed conversational interviewing elements into 20 sexual behavior questions in an exit survey of gay bathhouse patrons (N = 459) administered using ACASI. Those elements, called alternate pathways, included follow-up questions to responses to confirm that operational definitions were applied in the answer (with return to the initial question if confirmation failed), and assurances of confidentiality and requests for best guesses in reaction to non-response (including "don't know"). These elements were invoked in nearly 10% of participants, and approximately 74% of all invocations resulted in a usable numeric response, or 87% if the data need only estimate prevalence. Almost two-thirds of the problematic data issues occurred in answers to sexual contact questions, with others related to follow-up questions about specific sexual behavior. It is at this level of important filtering questions where the benefits of the approach are likely to be maximized.

IntroductionHIV care engagement is lower among black sexual-minority men relative to other racial/ethnic groups of sexual-minority men. Being in a primary relationship is generally associated with more successful HIV care engagement across various populations. However, among black sexual-minority men, the association between primary relationship status and HIV-related outcomes is inconsistent across the HIV care continuum. Given the ubiquity of mobile technology access and use among racial/ethnic minority communities, leveraging mobile technology for HIV care engagement appears a promising intervention strategy. This paper outlines the protocol of the LetSync study, a pilot randomised controlled trial of a mobile health app intervention developed using the Framework of Dyadic HIV Care Engagement to improve care-engagement outcomes among black sexual-minority male couples living with HIV.Methods and analysisEighty black sexual-minority men in couples (n=160) will be enrolled to pilot test the LetSync app. At least one member of each dyad must be both HIV-positive and self-identify as black/African-American. Couples will be randomised to either a waitlist-control arm or an intervention that uses relationship-based approach to improve HIV care engagement. We will assess feasibility and acceptability of trial procedures and intervention protocols based on predefined metrics of feasibility and acceptability. Execution of the study will yield the opportunity to conduct analyses to test the measurement and analysis protocol on antiretroviral therapy adherence by comparing the intervention and waitlist-control arms on self-reported and biological (hair sample) measures of adherence.Ethics and disseminationStudy staff will obtain electronic consent from all participants. This study has been approved by the University of California (UCSF) Institutional Review Board. Study staff will work with the Community Advisory Board at the UCSF Center for AIDS Prevention Studies Board to disseminate results to participants and the community via open discussions, presentations, journal publications and/or social media.Trial registration numberNCT04951544.

Background: HIV care engagement is lower among Black sexual-minority men relative to other racial/ethnic groups of sexual minority men. Being in a primary relationship is generally associated with more successful HIV care engagement across various populations. However, among Black sexual-minority men, the association between primary-relationship status and HIV-related outcomes is inconsistent across the HIV care continuum. Given the ubiquity of mobile technology access and use among racial/ethnic minority communities, leveraging mobile technology for HIV care engagement appears a promising intervention strategy. This paper outlines the protocol of the LetSync study, a pilot randomized-controlled trial of an mHealth app intervention developed using the Framework of Dyadic HIV Care Engagement to improve care-engagement outcomes among Black sexual-minority male couples living with HIV.Methods/Design: Eighty Black sexual-minority men in couples (n= 160) will be enrolled to pilot test the LetSync app. At least one member of each dyad must be both HIV-positive and self-identify as Black/African American. Couples will be randomized to either a waitlist-control arm or an intervention that uses relationship-based approach to improve HIV care engagement. We will assess feasibility and acceptability of trial procedures and intervention protocols based on pre-defined metrics of feasibility and acceptability. Execution of the study will yield the opportunity to conduct analyses to test the measurement and analysis protocol on antiretroviral therapy (ART) adherence by comparing the intervention and waitlist-control arms on self-reported and biological (hair sample) measures of adherence. Discussion: Limited prior research suggests that mobile-health technology could be a promising approach to improving HIV care engagement among Black sexual-minority men. The LetSync intervention harnesses relationship dynamics to facilitate improvement in HIV care engagement by focusing on dyadically developed and jointly executed strategies for dealing with issues related to HIV care engagement among Black sexual-minority men in couples.Trial RegistrationThe study was registered on ClinicalTrials.gov (NCT04951544) on July 7, 2021.

Disparities in HIV treatment outcomes among youth living with HIV (YLWH) present a challenge for ending the HIV epidemic. Antiretroviral therapy (ART) adherence can be impacted by comorbidities such as mental health and substance use. Use of technology has shown promise in increasing access to mental health and substance use services. Using a mixed-methods approach, we conducted formative research to describe the relationship between mental health, substance use, and medication adherence in 18–29 year-old YLWH, and explored the use of technology as an approach to supporting these services. Among 101 YLWH, ART adherence was significantly negatively associated with measures of mental health such as depression, trauma, and adverse childhood experiences and use of marijuana and stimulants. Depression had the highest level of relative importance in its association with ART adherence. During in-depth interviews with a subset of participants (N=29) barriers to and facilitators of accessing and maintaining mental health services were identified in the context of past experiences with mental health services, relationships with mental health providers, and stability in accessing mental health services. The majority of participants favored the use of technology for the delivery of mental health and substance use services, including videoconferencing with a counselor and noted the convenience. The provision of ongoing mental health and substance use treatment is an important mechanism to achieving HIV treatment engagement. Technology, particularly videoconferencing, may have the capacity to overcome many barriers to care by increasing the accessibility of these critical services.

Purpose This study aimed to determine the association between use of highly effective methods of nonbarrier contraception and condom use in a sample of Latina adolescents and whether the change to a more effective method of nonbarrier contraception is associated with a change in condom use. Methods As part of a larger study, 442 sexually active Latina adolescents aged 14–18 years were surveyed immediately before an appointment with a medical care provider at a school-based health center and 3 months later. Ordinal logistic and linear regression were used in the analysis of cross-sectional and longitudinal data to assess the relationship between patterns of nonbarrier contraception and condom use. Results The use of all types of nonbarrier methods of contraception was significantly associated with decreased condom use. Change over time from a less effective to a more effective nonbarrier method of contraception was also associated with a decrease in condom use. Greater number of sexual encounters was associated with lower the frequency of condom use. Conclusions The use of highly effective methods of nonbarrier contraception was associated with reduced frequency of condom use. This highlights the need to promote condom use concurrently with nonbarrier methods of contraception to improve protection against both pregnancy and STIs.

Although young Black men who have sex with men (YBMSM) are disproportionately affected by HIV, they may be more heterogeneous as a group than is typically appreciated. Thus, the present study used a person-centered data-analytic approach to determine profiles of HIV-related risk among YBMSM and whether these profiles could be distinguished by age, HIV status, and socioeconomic risk (i.e., socioeconomic distress). YBMSM (N = 1808) aged 18 to 29years completed a survey of sociodemographic characteristics, HIV status, and HIV-related behavioral and attitudinal factors (i.e., safer-sex self-efficacy, negative condom attitudes, being in difficult sexual situations, being in difficult sexual relationships, HIV treatment optimism, perceived HIV stigma). Latent profile analysis was used to identify HIV risk profiles and whether age, HIV status, and socioeconomic distress were associated with these profiles. Four profiles emerged: low-, medium-, and high-risk profiles, respectively, and a mixed profile characterized by a tendency to be in difficult sexual situations and relationships while also reporting high safer-sex self-efficacy and low negative attitudes toward condom use. Difficult sexual situations emerged as the key defining indicator of whether a profile reflected higher or lower risk. Younger age, being HIV-positive, and socioeconomic distress were associated with having a higher-risk profile. Given that unique risk profiles emerged that were differentially predicted by sociodemographic characteristics and HIV status, these findings have implications for tailoring interventions to the needs of different subgroups of YBMSM. Also, disempowering or risky sexual situations and relationships among YBMSM must be addressed.

The primary romantic relationship plays a fundamental role in health maintenance, but little is known about its role in HIV care engagement among young Black men who have sex with men (MSM) living with HIV. We examined how HIV care engagement outcomes (i.e., having a primary healthcare provider, receiving HIV treatment, taking antiretroviral medication, and medication adherence) vary by partnership status (single vs. concordant-positive vs. discordant) in a sample of young Black MSM living with HIV. Results showed mixed findings. Partnership status was significantly associated with HIV care engagement, even after adjusting for individual, social, and structural factors. While partnered men were consistently more likely than their single counterparts to have a regular healthcare provider, to receive recent treatment, and to have ever taken antiretroviral medication, they were less likely to report currently receiving antiretroviral therapy. Moreover, men with a discordant partner reported better adherence compared to men with a concordant or no partner. The association between partnership status and HIV care engagement outcomes was not consistent across the stages of the HIV Care Continuum, highlighting the complexity in how and why young Black men living with HIV engage in HIV healthcare. Given the social context of HIV disease management, more research is needed to explicate underlying mechanisms involved in HIV care and treatment that differ by relational factors for young Black MSM living with HIV.

OBJECTIVES. African American men who have sex with men and women (MSMW) are among the populations at highest need for HIV prevention programs in the United States. We tested a theory-based, community participatory behavioral intervention aiming to reduce sexual risk for HIV transmission in this population. METHODS. A randomized clinical trial involving 396 African American MSMW who were assigned to a 4-session intervention involving HIV testing and counseling (n=199) or to a HIV testing and counseling only (n=197) control. In the 4-session intervention program, counselors provided education on HIV and STI risk, condom use, HIV testing, interpersonal sexual dynamics with both male and female partners, and motivational “triggers” of condomless sex. Participants completed baseline, 6-month, and 9-month assessments, and changes in HIV behavioral risk indicators were examined by condition and time. RESULTS. There were no statistically significant differences in sexual risk between the intervention condition and the control condition. Regardless of condition, participants reported significant reductions in mean number of condomless sex events with female casual partners from baseline (6.04) to 6-months (2.58) and 9-months (1.47), and with male casual partners from baseline (2.61) to 6-months (1.18) and 9-months (0.60). Condition-by-time interaction effects and condition main effects were non-significant. CONCLUSIONS. Although there were no significant differences by condition, findings support the effects of brief behavioral counseling and HIV testing on reducing condomless sex with casual female and male partners among African American MSMW. Future research should examine further the potential for brief behavioral counseling to promote biomedical HIV prevention and to reduce co-morbid health issues such as substance use among African American MSMW.

BACKGROUND In the United States, any man who discloses having had sex with another man (MSM) even once since 1977 is currently deferred from donating blood. A study was conducted to assess noncompliance with the policy at four geographically dispersed blood centers. STUDY DESIGN AND METHODS Male donors 18+ years of age with e-mail addresses were randomly selected and invited to complete a confidential online survey between August and October 2013. No additional recruitment e-mails were sent. Survey content included demographics, sexual history, donation history, compliance with the policy, and opinions about current and modified policies. RESULTS Response rate was 11.5% but varied by center (6.3% to 21.7%). Of 3183 completed surveys, 2.6% of respondents (95% confidence interval, 2.1%-3.2%) reported donation after male–male sex. Noncompliance was not statistically different among the centers (p = 0.1), but was related to age with 5.7, 4.6, 2.5, and 1.0% of donors 18 to 24, 25 to 34, 35 to 54, and 50+ years of age, respectively, reporting noncompliance (p

The House Ball Community (HBC) is an understudied network of African American men who have sex with men and transgender women, who join family-like houses that compete in elaborate balls in cities across the United States. From 2011 to 2012, we surveyed 274 recent attendees of balls in the San Francisco Bay Area, focusing on social networks, social support, and HIV-related behaviours. Participants with a high percentage of alters who were supportive of HIV testing were significantly more likely to have tested in the past six months (p = .02), and less likely to have engaged in unprotected anal intercourse (UAI) in the past three months (p = .003). Multivariate regression analyses of social network characteristics, and social support, revealed that testing in the past six months was significantly associated with social support for safer sex, instrumental social support, and age. Similarly, UAI in the past three months was significantly associated with social support for safer sex, homophily based on sexual identity and HIV status. HIV-related social support provided through the HBC networks was correlated with recent HIV testing and reduced UAI. Approaches utilising networks within alternative kinship systems, may increase HIV-related social support and improve HIV-related outcomes.

Introduction Teen pregnancy rates in the USA remain higher than any other industrialised nation, and pregnancies among Hispanic adolescents are disproportionately high. Computer-based interventions represent a promising approach to address sexual health and contraceptive use disparities. Preliminary findings have demonstrated that the Health-E You/Salud iTu, computer application (app) is feasible to implement, acceptable to Latina adolescents and improves sexual health knowledge and interest in selecting an effective contraceptive method when used in conjunction with a healthcare visit. The app is now ready for efficacy testing. The purpose of this manuscript is to describe patient-centred approaches used both in developing and testing the Health-E You app and to present the research methods used to evaluate its effectiveness in improving intentions to use an effective method of contraception as well as actual contraceptive use. Methods and analysis This study is designed to assess the effectiveness of a patient-centred computer-based clinic intervention, Health-E You/Salud iTu, on its ability to reduce health disparities in unintended pregnancies among Latina adolescent girls. This study uses a cluster randomised control trial design in which 18 school-based health centers from the Los Angeles Unified School District were randomly assigned, at equal chance, to either the intervention (Health-E You app) or control group. Analyses will examine differences between the control and intervention group’s knowledge of and attitudes towards contraceptive use, receipt of contraception at the clinic visit and self-reported use of contraception at 3-month and 6-month follow-ups. The study began enrolling participants in August 2016, and a total of 1400 participants (700 per treatment group) are expected to be enrolled by March 2018. Ethics and dissemination Ethics approval was obtained through the University of California, San Francisco Institutional Review Board. Results of this trial will be submitted for publication in peer-reviewed journals. This study is registered with the US National Institutes of Health. Trial registration number NCT02847858.

The National HIV/AIDS Strategy emphasizes the importance of bringing prevention to the most at risk populations. Interventions targeting all men who have sex with men (MSM) fail in that respect because only a minority engages in behavior that is likely to lead to HIV infection. Previous studies have shown that MSM who seek male sexual partners in more than one venue type (e.g., bathhouse, cruising area, online) are most likely to engage in unprotected anal intercourse (UAI), compared to men who only meet partners in any one of these setting types or who do not use venues. The present study reports differences in prevalence of UAI among MSM by their use of venue sites to meet sexual partners. A probability sample of 459 bathhouse patrons completed exit surveys. In the 3 months before the current bathhouse visit, 63.5 % visited a bathhouse (not including the visit at which they were recruited), 46.7 % visited a cruising area, 46.5 % used online cruise sites to find sex partners, and 30.9 % reported UAI. While UAI was associated with online cruise site use, prevalence of UAI with men met online was relatively low. The odds of UAI among men who used all three venues were significantly higher compared to men using zero [odds ratio (OR) = 4.4; 95 % confidence interval (CI) 1.6, 12.1)] one (OR = 5.3; 95 % CI 2.2, 12.8) or two venues (OR = 4.3; 95 % CI 1.9, 9.6). The findings suggest that prevention would benefit from screening for venue use to help identify men with the greatest behavioral risk.

Purpose To explore parental beliefs and attitudes about confidential services for their teenagers; and to develop an instrument to assess these beliefs and attitudes that could be used among English and Spanish speakers. The long-term goal is to use this research to better understand and evaluate interventions to improve parental knowledge and attitudes toward their adolescent's access and utilization of comprehensive confidential health services. Methods The instrument was developed using an extensive literature review and theoretical framework followed by qualitative data from focus groups and in-depth interviews. It was then pilot tested with a random sample of English- and Spanish-speaking parents and further revised. The final instrument was administered to a random sample of 1,000 mothers. The psychometric properties of the instrument were assessed for Spanish and English speakers. Results The instrument consisted of 12 scales. Most Cronbach alphas were >.70 for Spanish and English speakers. Fewer items for Spanish speakers "loaded" for the Responsibility and Communication scales. Parental Control of Health Information failed for Spanish speakers. Conclusions The Parental Attitudes of Adolescent Confidential Health Services Questionnaire (PAACS-Q) contains 12 scales and is a valid and reliable instrument to assess parental knowledge and attitudes toward confidential health services for adolescents among English speakers and all but one scale was applicable for Spanish speakers. More research is needed to understand key constructs with Spanish speakers.

This study sought to determine whether the presence of HIV testing inside a gay bathhouse reduced sexual risk behavior among patrons. A two-stage, time probability, cluster sample design recruited men exiting a northern California bathhouse in the last 5 weeks of 2001 (N = 440), when no HIV testing was offered inside the bathhouse, and again in the last 5 weeks of 2002 (N = 412), when HIV testing was offered 5 days a week. Separate logistic regression analyses compared a 2002 HIV testing exposure subgroup with both a 2001 nonexposure subgroup and a 2002 nonexposure subgroup for differences in sexual risk behavior during the bathhouse visit. Prevalence of unprotected insertive anal intercourse was significantly lower in the 2002 exposure subgroup than in the 2002 nonexposure subgroup. Similar results obtained when HIV-positive respondents were excluded. These results indicate onsite HIV testing has a preventive effect on some sexual risk behavior inside the bathhouse.

Background There is little research regarding the ability of Black men who have sex with men and women (BMSMW) to access and maintain HIV-related health care and treatment adherence. This population, who often insist on secrecy about their same-sex desire, may experience unique barriers to seeking regular care and treatment. Methods From March 2011-April 2014, we recruited 396 BMSMW in the San Francisco Bay Area to be enrolled in our randomized controlled trial. At baseline we administered a behavioral survey assessing: demographics, homelessness, employment, history of incarceration, HIV status and disclosure practices, care and treatment adherence. 64 men reported living with HIV at intake. To learn more about their experiences, we recruited N = 25 to participate in qualitative interviews, which were conducted April-December 2014. Topics included: current living situation, diagnosis story, disclosure practices, experiences of accessing and maintaining care and treatment, and HIV-related stigma. Recordings were transcribed and coded for major themes. Results Despite being located in an area where treatment is plentiful, men faced social and economic barriers to maintaining regular care and treatment adherence. Several findings emerged to shed light on this quandary: (1) Competing needs particularly around attaining stable housing, food security, and money created barriers to treatment and care; (2) Side effects of HIV medications discouraged men from adhering to treatment; (3) Provider and Institutional level characteristics influenced care engagement; (4) Disclosure and social support made a difference in care and treatment behaviors; and (5) Participants expressed a desire for group-based intervention activities to support treatment and care among HIV+ BMSMW. Inadequate engagement in the continuum of care for HIV was born out in the quantitative data where 28% of participants did not know their Viral Load. Conclusions A holistic approach to HIV health for BMSMW would appear to translate to better outcomes for men living with HIV, where a goal of viral suppression must also include attending to their basic social and economic support needs.

HIV prevalence estimates from bathhouse testing programmes differ widely, ranging from 3% to 11%. The observed difference may be a consequence of whether the programme was part of a research project or a community-based programme. A research-funded testing programme was offered at a bathhouse between May 2001 and December 2002. A local community-based organization began a testing programme in July 2006 at the same bathhouse; the data for this analysis cover the period July 2006 through December 2007. County-wide HIV prevalence estimates were available across the two time periods (i.e. 2001–2002 and 2006–2007). The research-funded testing programme recruited fewer men but identified more positive individuals (10.7% of those testing in the research programme) than were identified among men who tested in the area clinics (3.8% of those men who have sex with men [MSM] testing throughout the county in the same time period). However, the community-based testing programme identified about the same proportion of positive MSM (2.6%) as county clinics (2.7%) in the same time period. In conclusion, results confirmed that even in the same venue, a community-based HIV testing programme identified a similar proportion of positive MSM as the area clinics; however, the research-funded programme identified appreciably more. Incentives may contribute to the difference.

In a national survey of institutions with federally assured human research protection programs, we obtained workload and other relevant data on their Institutional Review Boards (IRBs) and management organizations. The number of IRBs increased substantially from 1995 to 2005/06 (491 to 2,728 IRBs) with a further increase in 2008 to 3,853 IRBs. Nationally, IRBs reviewed over a quarter million research applications in the year prior to our survey, of which 35% were new applications requiring full committee review. Compared to estimates from 1995, current IRBs review more new and full committee review applications, but the relative percentage of new and full committee applications remained about the same. High volume research institutions have IRBs with a substantially larger per person workload, relative to smaller volume IRBs (i.e., members spent nearly seven times more hours reviewing new applications outside formal committee meetings). Virtually all IRBs included community representatives as members (92%); however, a small number may not be compliant with federal regulations. The present findings suggest the need for research to (a) examine workload and its effects on review quality, research costs, and faculty morale, (b) develop methods for determining optimal fit between IRB workload demands and institutional labor and financing requirements, (c) construct benchmarks for judging reasonable workload for individual IRB members, and (d) examine if the need to recruit IRB scientific expertise from outside the institution, particularly true for smaller research institutions, causes delays in IRB review, and if a more effective way of locating and recruiting experts would improve quality and time to completion.

Gay and bisexual men carry the burden of HIV infections in the United States and have high rates of childhood sexual abuse that predict HIV and other health outcomes. This study examined differential effects of forced, consensual, and no childhood sexual experiences (CSE) on health outcomes among a probability sample of adult men who have sex with men (MSM). The forced sex group had the highest levels of psychological distress, substance use, and HIV risk. There were no differences in rates of depression and suicidal ideation between the consensual- and no-sex groups. The consensual- and forced-sex groups had higher rates of substance use and transmission risk than the no-sex group. The forced-sex group, however, had significantly higher rates of frequent drug use and high-risk sex than the consensual group. Findings suggest that forced CSEs result in a higher-risk profile than consensual or no childhood sexual experiences, the kind of risk pattern differs between forced and consensual childhood sexual experiences, and the underlying mechanisms that maintain risk patterns may vary. It is important to clarify risk patterns and mechanisms that maintain them differentially for forced and consensual sex groups so that interventions may be tailored to the specific trajectories related to each experience.

To examine factors associated with weight dissatisfaction, a risk factor for eating disorders, among female Marine recruits.A diverse adolescent/young adult sample of 2157 female recruits completed a questionnaire upon entering Marine Corps training. Weight dissatisfaction was the main variable of interest.Body mass index (BMI), disordered eating history, and worry about meeting military "weight" were related highly to weight dissatisfaction. Women with BMIs near the upper limit of the Marine Corps weight standard (23.5 kg/m2) reported the highest rates of weight dissatisfaction. Those who reported vomiting, binging or pill use, or being worried about "making weight" were four and five times, respectively, more likely to report weight dissatisfaction.New female Marine recruits with higher BMIs, disordered eating histories, and worries about "making weight" are significantly more likely to be weight dissatisfied. Such findings may identify those at risk for developing eating disorders when exposed to strict military weight standards.

Objectives. We assessed differences in HIV prevalence and sexual risk behavior among men who have sex with men (MSM) between 1997 and 2002 in San Francisco. Methods. We used 2 population-based random-digit-dial telephone surveys of MSM households in San Francisco in 1997 (n=915) and 2002 (n=879). Results. Estimated HIV prevalence increased from 19.6% in 1997 to 26.8% in 2002. Measures of sexual risk also increased. Unprotected anal intercourse with a partner of different or unknown HIV serostatus increased from 9.3% to 14.6%. Mean number of male partners increased from 10.7 to 13.8. The largest reported increase was 18.9% to 26.8% for “serosorting,” or choosing unprotected anal intercourse partners believed to have the same HIV serostatus as oneself. Men aged 30 to 50 reported the largest increase in unprotected anal intercourse, whereas men aged 18 to 29 reported the largest increase in serosorting. Changes in the age distribution did not explain the increase in risky behavior. Conclusions. Both HIV prevalence and sexual risk increased substantially among MSM in San Francisco between 1997 and 2002. Serosorting is being adopted more frequently than condom use by young MSM, but its effectiveness as a harm reduction strategy is not known.

Objectives. We conducted a large, population-based study to assess tobacco use in California’s lesbian, gay, and bisexual (LGB) population. Methods. Standard measures of tobacco use from 2 separate, statewide household-based studies were used to compare basic prevalence rates in the LGB population and the general population in California. Data were derived from a 2003–2004 survey of LGB individuals living in California as well as from the 2002 version of the California Tobacco Survey, which gathered data on the state’s general population. Results. Smoking prevalence rates were higher in our sample of lesbians, bisexual women, and women who have sex with women than among women in the general California population. In the case of men, the only significant difference was that rates were higher among gay men than among men in the general population. Disparities in tobacco use between the LGB population and the general population were still evident after we controlled for key demographic variables and in comparisons with other tobacco use indicators such as average cigarette consumption. Conclusions. Tobacco control efforts targeting the LGB population are needed to reduce this group’s high rate of cigarette smoking.

Objective To determine the congruence between patients’ preferred style of clinical decision-making and the style they usually experienced and whether this congruence was associated with socio-economic status and/or the perceived quality of care provided by the respondent's regular doctor. Methods Cross-sectional survey of the American public using computer-assisted telephone interviewing. Results Three thousand two hundred and nine interviews were completed (completion rate 72%). Sixty-two percent of respondents preferred shared decision-making, 28% preferred consumerism and 9% preferred paternalism. Seventy percent experienced their preferred style of clinical decision-making. Experiencing the preferred style was associated with high income (OR, 1.59; 95% CI, 1.16–2.16) and having a regular doctor who was perceived as providing excellent or very good care (OR, 2.39; 95% CI, 1.83–3.11). Conclusion Both socio-economic status and having a regular doctor whom the respondent rated highly are independently associated with patients experiencing their preferred style of clinical decision-making. Practice implications Systems which promote continuity of care and the development of an on-going doctor–patient relationship may promote equity in health care, by helping patients experience their preferred style of clinical decision-making.

To determine the association between domestic partnership status and risk behaviors for sexually transmitted diseases, including HIV infection, we analyzed data from a population-based interviewer-administered telephone survey of 2,881 gay men in San Francisco, Los Angeles, New York and Chicago conducted in November 1996 to February 1998. Men in domestic partnerships had a statistically significantly lower prevalence of multiple partnerships, "one-night stands," and unprotected anal intercourse with a non-primary partner than either men with steady partners not identified as domestic partners or men without a steady partner. These findings were independent of age. Men in domestic partnerships had decreased risk behaviors for sexually transmitted diseases, including HIV infection, suggesting but not proving, that conferring legal status to same-sex unions might decrease sexual risk behavior.

A household probability sample of 879 adult gay and other men who have sex with men in San Francisco underwent phone interviews. Approximately, half reported recent unprotected anal intercourse (UAI). Yet, lubricant use was high, a behavior that may facilitate future adoption of topical microbicide delivered by a lubricant gel. Despite warnings against Nonoxynol-9 (N-9), 26% of respondents reported still using it. Microbicide awareness was higher among men reporting UAI than among consistent condom users. Scenarios presenting microbicides "as effective as condoms," "nearly as effective," or "less effective but better than nothing" produced wide variability in willingness to use them, which may have implications for microbicide acceptability. HIV-infected men and those who reported UAI showed greater microbicide acceptance.

The Centers for Disease Control and Prevention is embarking on a program of biannual venue-based time-space sampling surveys to monitor prevalence and incidence of HIV among men who have sex with men (MSM).We examine the efficacy of the suggested methodology in terms of population coverage, sample period, range of venues, and representativeness.The 2002 Urban Men's Health Study (N = 879) is a telephone interview of a household probability sample of adult MSM living in San Francisco.A 6-month bar/club sample would capture 79% of the adult MSM population and yield an accurate estimate of HIV prevalence. Using a longer sample period or sampling other less-frequented venues yields marginal improvement. Risk behavior, when broadly defined, is overestimated.The National HIV Behavioral Surveillance of MSM protocol may be satisfactory for sampling urban MSM within defined limits, but could be conducted at significantly less cost by reducing the types of venues and fielding time. However, bias in the venue sample with respect to risk behavior and other key correlates argues for validity checks based on household probability samples conducted at infrequent intervals.

Background Few cognitive–behavioral interventions have focused on preventing sexually transmitted infections (STIs) and unintended pregnancies (UPs) in young, sexually active women in a single study. Military recruit training provides a well-defined, national, nonclinic sample in which to evaluate such an intervention. Methods All female Marine recruits ( N = 2,288) in training were approached. Of these, 2,157 (94.3%) voluntarily agreed and were randomly assigned, by platoons, to participate in cognitive–behavioral interventions to prevent STIs or UPs or to prevent physical training injuries and cancer. Participants completed self-administered questionnaires and were screened for pregnancy, Chlamydia trachomatis , Neisseria gonorrhoeae , and Trichomonas vaginalis at baseline and, on average, 1 and 14 months postintervention. Results A higher proportion of the control group had a postintervention STI or UP [odds ratio (OR) = 1.41, 95% confidence interval (CI) = 1.01–1.98]. Among participants who had no history of STIs or pregnancy, but who engaged in risky sexual behaviors just before recruit training, the control group was more likely to acquire a postintervention STI (OR = 3.24, CI = 1.74–6.03). Among participants who were not sexually experienced at baseline, the control group was more likely to have casual (OR = 2.05, 95% CI = 1.04–4.08) and multiple (OR = 1.87, 95% CI = 1.01–3.47) sexual partners postintervention. Conclusions This randomized controlled trial indicates that cognitive–behavioral interventions are effective for reducing behavioral risk and preventing STIs and UPs in young, sexually active women who are not seeking health care.

Objective: The prevalence of childhood sexual abuse among Latino adult men who have sex with men who live in the US was estimated because a history of childhood sexual abuse increases HIV sexual risk behaviors and other negative health outcomes in adulthood. Method: The Urban Men's Health Study is a random-digit telephone probability survey of 2881 adult men who have sex with men (MSM) aged 18 years or older residing in San Francisco, New York, Los Angeles, and Chicago. Self-reported history of childhood sexual abuse was the main outcome measure gathered from 2692 MSM. Results: A significantly higher proportion of Latino MSM reported sexual abuse before age 13 (22%) than did non-Latino MSM (11%). Conclusions: Latino MSM are twice as likely to report a history of childhood sexual abuse than are non-Latino MSM. Given the association between childhood sexual abuse and increased risk for HIV and other negative health outcomes, health providers must remain vigilant to the possibility of childhood sexual abuse histories among their Latino patients.

Objectives. We measured the extent to which a set of psychosocial health problems have an additive effect on increasing HIV risk among men who have sex with men (MSM). Methods. We conducted a cross-sectional household probability telephone sample of MSM in Chicago, Los Angeles, New York, and San Francisco. Results. Psychosocial health problems are highly intercorrelated among urban MSM. Greater numbers of health problems are significantly and positively associated with high-risk sexual behavior and HIV infection. Conclusions. AIDS prevention among MSM has overwhelmingly focused on sexual risk alone. Other health problems among MSM not only are important in their own right, but also may interact to increase HIV risk. HIV prevention might become more effective by addressing the broader health concerns of MSM while also focusing on sexual risks.

Objectives. This report investigates differences in risk behaviors among men who have sex with men (MSM) who went to gay bathhouses, public cruising areas, or both. Methods. We used a probability sample of MSM residing in 4 US cities (n = 2881). Results. Men who used party drugs and had unprotected anal intercourse with nonprimary partners were more likely to go to sex venues than men who did not. Among attendees, MSM who went to public cruising areas only were least likely, and those who went to both public cruising areas and bathhouses were most likely to report risky sex in public settings. Conclusions. Distinguishing between sex venues previously treated as a single construct revealed a significant association between pattern of venue use and sexual risk. Targeting HIV prevention in the bathhouses would reach the segment of men at greatest risk for HIV transmission.

Based on national level surveys, we examined data relevant to the United States' overall effort to prevent the spread of HIV among heterosexual adults. We examined changes in condom use among at-risk heterosexuals over the past decade. The observed increases over time in condom use across all heterosexual at-risk population segments are consistent with the observed (declines) trends in HIV and syphilis in the 1990s. These results and findings from prior studies suggest that U.S. efforts to facilitate condom use and contain HIV and related sexually transmitted disease (STD)-cofactors among adult at risk heterosexuals was succeeding over most of the 1990s. The absence of national level behavioral trend data after 1996, and the ambiguities of HIV spread suggest some caution in projecting trends into this century. National and local efforts need to be directed at sustaining behavioral change and conducting more rigorous studies on population trends in HIV/STD-related behaviors/pathogens.

OBJECTIVES: This study investigated the limitations of probability samples of men who have sex with men (MSM), limited to single cities and to the areas of highest concentrations of MSM ("gay ghettos"). METHODS: A probability sample of 2881 MSM in 4 American cities completed interviews by telephone. RESULTS: MSM who resided in ghettos differed from other MSM, although in different ways in each city. Non-ghetto-dwelling MSM were less involved in the gay and lesbian community. They were also less likely to have only male sexual partners, to identify as gay, and to have been tested for HIV. CONCLUSIONS: These differences between MSM who live in gay ghettos and those who live elsewhere have clear implications for HIV prevention efforts and health care planning.

OBJECTIVES: This study characterized the AIDS epidemic among urban men who have sex with men (MSM). METHODS: A probability sample of MSM was obtained in 1997 (n = 2881; 18 years and older) from New York, Los Angeles, Chicago, and San Francisco, and HIV status was determined through self-report and biological measures. RESULTS: HIV prevalence was 17% (95% confidence interval = 15%, 19%) overall, with extremely high levels in African Americans (29%), MSM who used injection drugs (40%), "ultraheavy" noninjection drug users (32%), and less educated men (< high school, 37%). City-level HIV differences were non-significant once these other factors were controlled for. In comparing the present findings with historical data based on public records and modeling, HIV prevalence appears to have declined as a result of high mortality (69%) and stable, but high, incidence rates (1%-2%). CONCLUSIONS: Although the findings suggest that HIV prevalence has declined significantly from the mid-1980s, current levels among urban MSM in the United States approximate those of sub-Saharan countries (e.g., 14%-25%) and are extremely high in many population subsegments. Despite years of progress, the AIDS epidemic continues unabated among subsegments of the MSM community.

OBJECTIVE: The prevalence and characteristics of childhood sexual abuse (CSA) among men who have sex with men (MSM), and links with sexual risk are explored. A model linking CSA and sexual risk among MSM is proposed. METHOD: A telephone probability sample of urban MSM (n = 2881) was recruited and interviewed between November 1996 and February 1998. The interview covered numerous health issues, including history of sexual victimization. RESULTS: One-fifth reported CSA, primarily by non-family perpetrators. Initial CSA experiences are characterized by high levels of force (43% involved physical force/weapons), and penetrative sex (78%; 46% reported attempted or actual anal intercourse). Such men are more likely than nevercoerced men to engage in high risk sex (unprotected anal intercourse with a non-primary partner or with a serodiscordant male). In multivariate analyses, the effect of childhood sexual coercion on sexual risk is mediated by substance use, patterns of sexual contacts, and partner violence, but not by adult sexual revictimization or by depression. CONCLUSIONS: Findings are interpreted within the context of social learning theory and prior research on sexual risk-taking. The high risk for CSA among MSM, which can predispose such men to patterns of HIV sexual risk, warrants new approaches in HIV prevention. Language: en

Objectives: To test the feasibility of obtaining HIV test results by home collection kit from a probability telephone sample of men who have sex with men (MSM). Methods: A quota sample of 615 MSM previously interviewed by the Urban Men's Health Study phone survey in Chicago, Los Angeles, New York City, and San Francisco were re-contacted and offered an HIV test using an oral specimen (Orasure) home collection kit. Results: Eighty percent consented to be mailed a kit, and 84% returned a specimen, for a 67% participation rate. All self-reported HIV-positive persons tested positive (77 of 77); 4 of 266 (1.5%) with a prior negative test and 2 of 69 (2.9%) with no prior positive HIV test result. Participation was associated with self-reported prior HIV test status-HIV-positive (83%), HIV-negative (68%), or no prior HIV test result (54%)-and marginally associated with New York City residence after adjustment for HIV status (odds ratio = 0.7; 95% confidence interval, 0.4-1.1; p = .08). Conclusions: These results suggest that urban MSM identified and interviewed by telephone will participate in home collection HIV testing. This methodology could be used to produce population-based estimates of HIV seroprevalence and seroincidence in MSM and could probably be extended to other populations and other viral infections.

The objective was to develop implement and evaluate a community-level HIV prevention program (the Mpowerment Project) for young gay men in two US communities. Using a multiple baseline design a cohort of young gay men was recruited independently of the intervention in each community and surveyed twice (1 year apart) regarding sexual risk behavior and psychosexual variables. The intervention was then implemented sequentially in each community. The cohorts were resurveyed immediately post- and 1-year post-intervention. Since there were few differences between the two communities data were pooled to increase statistical power. The program had four components: peer outreach whereby young gay men encouraged other men to engage in safer sex; peer-led small groups; a publicity campaign; and a young mens center. Baseline rates of unprotected anal intercourse were stable. Following intervention the proportion of men who engaged in unprotected anal intercourse decreased from 38.3 to 30.9% (-19.3% relative reduction) with a reduction from 19.2 to 13.6% (-29.2% relative reduction) with non-primary partners and a reduction from 57.7 to 41.8% (-27.6% relative reduction) with boyfriends. Reductions were sustained 1 year later with non-primary partners but mixed results were found regarding sex with boyfriends. Mobilizing young gay men to support each other about safer sex is an effective approach to HIV prevention but programs must be sustained. To reach young gay men HIV prevention activities must be embedded into the satisfaction of needs for social and community belonging. (authors)

CORRELATES OF CONSISTENT USE OF EFFECTIVE CONTRACEPTIVE METHODS AMONG MALE AND FEMALE ADOLESCENT AND YOUNG ADULT SOLDIERS IN TRAINING Stephanie Adrianse, MD, Lance M. Pollack, PhD, Cherrie B. Boyer, PhD. University of California, San Francisco. Purpose: Over 50% of pregnancies among adolescents and young adults in the US are unintended. Similar to civilians, the high rates of unintended pregnancy (UIP) in Army soldiers are, in part, attributed to ineffective and inconsistent use of contraceptive methods. This study aimed to identify the sociodemographic, psychosocial, and behavioral factors associated with consistent use of effective contraceptive methods (consistent-effective use) in male and female soldiers in training. Methods: This cross-sectional study reflects baseline data of a randomized-controlled intervention trial to prevent sexually transmitted infections and UIP in Army soldiers, aged 17-36 years, during their first year of military service. Participants completed a self-administered baseline questionnaire, including measures on sociodemographic factors (gender, age, race/ethnicity, marital status, education), psychosocial factors (condom and UIP knowledge, condom and UIP attitudes, perceptions of vulnerability for UIP, and perceptions of self-efficacy, behavioral skills and behavioral intentions for preventing UIP) and behavioral risk factors (age at coitarche, number of sexual partners, history of prior unintended or intended pregnancies, and type and frequency of contraceptive method(s) used). Bivariate logistic regression analyses were performed to determine variables for entry into the multivariate analyses. Iterative implementation of a two-block hierarchical logistic regression model identified statistically significant correlates of consistent-effective use (i.e., use of any of the following during each sexual encounter: condoms, contraceptive pills, contraceptive patch, contraceptive ring, contraceptive implant, contraceptive injection, intrauterine device, sterilization, avoidance of vaginal sex, and sex with only same-sex partner). Results: Only participants who reported a history of sexual experience (n ¼ 672, 93.5%) were included in this research. Participants were young (mean age ¼ 21), male (86.2%), racially/ethnically diverse (51.8% white, 22.2% black, 16.4% Hispanic, 9.6% other) and unmarried (87.2%). Overall, 26.6% reported a prior pregnancy of which 76.9% reported an UIP and 22.2% were consistent-effective users. Compared with non-consistent-effective users, consistenteffective users were significantly more likely to report: higher condom (OR ¼ 1.90, CI ¼ 1.16-3.12) and UIP knowledge (OR ¼ 1.82, CI ¼ 1.18-2.80), more positive condom attitudes (OR ¼ 1.36, CI ¼ 1.05-1.75), disagreement that their sexual behaviors place them at high UIP risk (OR ¼ 0.36, CI ¼ 0.14-0.95), neutral agreement that UIP would hurt their career (OR ¼ 1.85, CI ¼ 1.09-3.15), higher levels of behavioral skills (OR ¼ 2.53, CI ¼ 1.42-4.51), greater behavioral intentions for preventing UIP (women only; OR ¼ 7.91, CI ¼ 1.86-33.65), and no prior unintended (OR ¼ 0.30, CI ¼ 0.10- 0.93) or intended pregnancies (OR ¼ 0.56, CI ¼ 0.32-0.97). Conclusions: Consistent-effective contraceptive use is associated with having knowledge, positive condom attitudes, lower perceived UIP risk, and behavioral skills to prevent UIP. With the exception of behavioral intentions for preventing UIP, no gender differences were found. UIP prevention interventions to increase consistent-effective use in adolescents and young adults are still warranted. Sources of Support: U.S. Army Medical Research and Material Command, Fort Detrick, MD, and the Health Resources and Services Administration/Maternal and Child Health Bureau, Leadership Education in Adolescent Health Training Grant.

Women in midlife and older represent over 25% of all women with AIDS and 4% of all reported AIDS cases in the United States. We present prevalence estimates and demographic correlates of AIDS-related risk behavior and safer sex practices among women in midlife and older from the National AIDS Behavioral Surveys (NABS). Data are of women aged 40 to 75 in the (a) NABS 1 national sample (n = 887), (b) NABS 1 urban sample (n = 2,111), and (c) NABS 2 national sample (n = 624). Data from the baseline survey (NABS 1) revealed that approximately 8% or 4.5 million women aged 40 to 75 engaged in behaviors that might expose them to HIV. Data from the follow-up survey (NABS 2) indicated that the proportion of women who reported a risk factor remained at about 8%. Overall safer sex practices among older women who reported sexual risk behaviors were minimal. Between 90% and 100% had not used condoms in the previous 6 months. Moreover, almost 90% of the women who reported a risk behavior did not perceive themselves to be at risk.

BACKGROUND: Research on the relationship between sexual risk behavior and perceived risk for contracting a sexually transmitted infection (STI) has yielded mixed results. The objective of this study is to investigate the extent to which 3 measures of perceived risk accurately reflect 5 sexual risk behaviors in a sample of healthy, sexually active young adult women. A positive monotonic relationship between sexual risk behavior and perceived risk for STIs is hypothesized. METHODS: A sample of 1192 female US Marine Corps on their first duty assignment 10 to 11 months (on average) after graduation from recruit training answered a self-administered paper-and-pencil questionnaire as part of a larger study evaluating an intervention to prevent STIs and unintended pregnancy that was administered during recruit training. RESULTS: All but 1 of the 15 bivariate associations between sexual risk behavior and perceived risk for STIs was statistically significant. The expected positive monotonic relationship was observed except for condom use. Women who never used condoms during intercourse reported lower levels of perceived risk than occasional users and, in some subgroups, consistent condom users. Multivariate analyses further explored the relationship between condom use and perceived risk. CONCLUSIONS: The results suggest that interventions directed at raising awareness of susceptibility to STIs should emphasize how the individual's own behavior puts them at risk, regardless of situation or context. Copyright © 2013 American Sexually Transmitted Diseases.

The authors describe psychosocial outcomes of a group randomized controlled trial of a friendship-based HIV/sexually transmitted infection (STI) prevention intervention grounded in the AIDS Risk Reduction Model (ARRM). A total of 264 African American adolescent girls were randomized to a single-session Project ÒRÉ HIV/STI prevention intervention or a nutrition/exercise health promotion intervention with their friendship group. At posttest, Project ÒRÉ participants scored higher on knowledge of HIV/STI prevention and protection (p

OBJECTIVES. The National AIDS Behavioral Survey (1990-1992) of heterosexual adults (18-49 years) measured human immunodeficiency virus (HIV) risk factors, condom use, and HIV antibody testing, with a focus on major "high-risk" cities. METHODS. A longitudinal survey was conducted. RESULTS. There was little reduction in the overall prevalence of HIV risk factors in the national or high-risk cities cohorts over time. Despite this picture of stability, approximately 39% of the population at risk for HIV because of multiple sexual partners turns over annually. There was little change in HIV test-seeking or in consistent condom use with primary sexual partners. Although the majority of at-risk respondents used condoms sporadically or not at all (65%), a significant increase in condom use was found among those reporting multiple sexual partners in both waves, particularly among Black heterosexuals. Data from other surveys and condom sales nationally support the findings. CONCLUSIONS. There is a need for a series of surveys in this area to assess the reliability of the present findings and to monitor the general US population's response to prevention programs.

To examine parental acceptability of contraceptive methods offered confidentially to their adolescent daughter.A random sample of 261 parents/guardians with a daughter aged 12-17 years completed a telephone survey examining the relationship between parental acceptability of seven contraceptive methods and adolescents' likelihood to have sex, parenting beliefs, parents' sexual health as teens, sexually transmitted infection knowledge, and demographic factors.Acceptability was highest for oral contraceptive pills (59%) and lowest for intrauterine device (18%). Parental acceptance of teens' autonomy was significantly associated with increased acceptability of all methods. Parental knowledge of sexually transmitted infections was poor, and 51% found it acceptable for clinicians to provide their sexually active teen with condoms.Parents were more accepting of oral contraceptive pills and condoms compared with intrauterine devices and implants. Parental recognition of their teen's autonomy was associated with greater parental acceptability of clinicians providing their adolescent with contraceptives (regardless of the specific type of method being offered).

Implementing HIV voluntary counselling and testing (VCT) in bathhouses is a proven public health strategy for reaching high-risk men who have sex with men (MSM) and efficiently identifying new HIV cases. However, some bathhouse managers are concerned that VCT programmes could adversely affect business. This study examined whether offering VCT on the premises of a bathhouse changed patterns of patron visits. A collaborating bathhouse provided electronic anonymized patron data from their entire population of attendees. VCT was offered on premises with varying frequencies over the course of three years. Club entrances and exits were modelled as a function of intensity of VCT programming. Club entrances did not differ as a function of how many days per week testing was being offered in a given month. Additionally, club entrances did not decrease, nor did club exits increase, during specific half-hour time periods when testing was offered. Implementing bathhouse-based VCT did not have any demonstrable impact on patronage. Public health officials can leverage these results to help alleviate club managers’ concerns about patron reactions to providing testing on site, and to support expanding sexual health programmes for MSM in these venues.