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Intimate partner violence (IPV) is associated with pre-exposure prophylaxis (PrEP) acceptability among US women, but whether IPV influences other steps along the PrEP care continuum remains unclear. This study estimated the causal effects of IPV on the early stages of the PrEP care continuum using doubly robust (DR) estimation (statistical method allowing causal inference in non-randomized studies). Data were collected (2017-2018) from a cohort study of 124 US women without and 94 women with IPV experiences in the past 6 months (N = 218). Of the 218 women, 12.4% were worried about getting HIV, 22.9% knew of PrEP, 32.1% intended to use PrEP, and 40.4% preferred an "invisible" PrEP modality. IPV predicts HIV-related worry (DR estimate = 0.139, SE = 0.049, p = 0.004). IPV causes women to be more concerned about contracting HIV. Women experiencing IPV are worried about HIV, but this population may need trauma-informed approaches to help facilitate their PrEP interest and intentions.

Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention method. PrEP uptake has been persistently low among US women, particularly Black women, who account for 61% of new HIV diagnoses among women. Further understanding of barriers to Black women accessing PrEP is needed. This 2017 cross-sectional survey study explored race-based differences in PrEP interest and intention among women and the indirect association between race and comfort discussing PrEP with a healthcare provider through medical mistrust. The sample consisted of 501 adult women (241 Black; 260 White) who were HIV-negative, PrEP-inexperienced, and heterosexually active. Black women reported greater PrEP interest and intention than White women. However, Black women expressed higher levels of medical mistrust, which, in turn, was associated with lower comfort discussing PrEP with a provider. Medical mistrust may operate as a unique barrier to PrEP access among Black women who are interested in and could benefit from PrEP.

Syndemic theory could explain the elevated HIV risk among transgender women (TGW) in India. Using cross-sectional data of 300 TGW in India, we aimed to: identify latent classes of four syndemic conditions (Depression-D, Alcohol use-A, Violence victimization-V, HIV-positive status), test whether syndemic classes mediate the association between stigma and sexual risk, and test whether social support and resilient coping moderate the association between syndemic classes and sexual risk. Four distinct classes emerged: (1) DAV Syndemic, (2) AV Syndemic, (3) DV Syndemic, and (4) No Syndemic. TGW in the DAV Syndemic (OR 9.80, 95% CI 3.45, 27.85, p < 0.001) and AV Syndemic classes (OR 2.74, 95% CI 1.19, 6.32, p < 0.01) had higher odds of inconsistent condom use in the past month than the No Syndemic class. Social support significantly moderated the effect of DAV Syndemic class on inconsistent condom use. DAV Syndemic was found to be a significant mediator of the effect of transgender identity stigma on sexual risk. HIV prevention programs among TGW need to: (a) incorporate multi-level multi-component interventions to address syndemic conditions, tailored to the nature of syndemic classes; (b) reduce societal stigma against TGW; and (c) improve social support to buffer the impact of syndemics on sexual risk.

Background: Transgender women are disproportionately incarcerated in the US relative to the general population. A dearth of research has explored the factors that predict incarceration among transgender women or the longitudinal impact of incarceration on the health of this population., Methods: Between 2012 and 2015, 221 transgender women ages 16-29 from Boston, MA and Chicago, IL were prospectively assessed at baseline, 4, 8 and 12 months. Mixed effects models were used to identify risk factors for incarceration and examine whether incarceration predicts somatic, anxiety and depressive symptoms, illicit drug use, and binge drinking over time, controlling for baseline psychiatric and substance use disorders., Results: Overall, 38% experienced incarceration, before (33%) and during (18%) the study period. Significant independent predictors of recent incarceration included sex work, recent homelessness, school dropout and number of times incarcerated prior to enrollment while recent incarceration significantly predicted somatic symptoms and illicit drug use over time., Conclusions: Incarceration burden is high in young transgender women. Both structural and individual risk factors predict incarceration and poor health, suggesting the need for multilevel interventions to prevent incarceration and support young transgender women during incarceration and upon release., (© The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The purpose of this research was to assess the association between Gender Inequality Index and prevalence of lifetime intimate partner violence (IPV) among women and men at the state-level. Recently developed 2017 state-level prevalence estimates of IPV among a nationally-representative sample of U.S. non-institutionalized adults between 2010 and 2012 from the National Intimate Partner and Sexual Violence Survey was combined with calculated indexes for state-level gender inequality. Gender Inequality Index, created by the United Nations, reflects gender-based disadvantage in reproductive health, empowerment, and labor market participation. Correlations and linear regressions were used to examine associations between gender inequality and IPV. Gender Inequality Index values ranged from 0.149 to 0.381. The lifetime prevalence of IPV ranged between 27.8% and 45.3% for women and between 18.5% and 38.6% for men. Across states, the Gender Inequality Index was positively correlated with the prevalence of any form of IPV (r = 0.28, p < .05) and psychological IPV among women (r = 0.41, p < .01). The adjusted regression model showed a positive association between gender inequality and psychological IPV among women (B = 1.61, SE = 0.57, p = .007). Structural changes to gender inequality may help to reduce occurrences of IPV and improve the wellbeing and livelihood of women and girls., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The current study compares the effectiveness of interventions that attempted to uniquely influence hypothesized determinants of behavior in the Theory of Planned Behavior versus some optimal combination of constructs (three constructs vs. four) to increase condom use among intentions and behavior college students. 317 participants (M age  = 19.31; SD age  = 1.31; 53.3% female; 74.1% Caucasian) were randomly assigned to one of seven computer-based interventions. Interventions were designed using the Theory of Planned Behavior as the guiding theoretical framework. 196 (61.8%) completed behavioral follow-up assessments 3-month later. We found that the four construct intervention was marginally better at changing intentions (estimate = - .06, SE = .03, p = .06), but the single construct interventions were more strongly related to risky sexual behavior at follow-up (estimate = .04, SE = .02, p = .05). This study suggests that these constructs may work together synergistically to produce change (ClinicalTrials.gov Number NCT# 02855489).

Interpersonal violence victimization and perpetration have been associated with sexual risk behaviors among adolescents and young adults, but research is lacking on: (1) how patterns of interpersonal polyvictimization and polyperpetration are associated with sexual risk among young pregnant couples, and (2) how individual and partner experiences of violence differentially impact sexual risk. The current analyses used baseline data from a longitudinal study that followed 296 pregnant young couples from pregnancy to 12 months postpartum. Couples were recruited at obstetrics and gynecology clinics, and an ultrasound clinic in the U.S. Latent class analysis identified subgroups based on polyvictimization and polyperpetration. Using the Actor-Partner Interdependence Model, path analyses assessed actor-partner effects of class membership on sexual risk. Three latent classes were used for women: Class 1: Polyvictim-Polyperpetrator; Class 2: Nonvictim-Nonperpetrator; and Class 3: Community and Prior IPV Victim. Four latent classes were used for men: Class 1: Community and Prior IPV Victim; Class 2: Polyvictim-Nonpartner Perpetrator; Class 3: Prior IPV and Peer Victim; and Class 4: Nonvictim-Nonperpetrator. Path analyses revealed that females in Class 2 and their male partners had higher condom use than females in Class 3. Males in Class 2 had more sexual partners than males in Class 1. Among nonmonogamous couples, males in Class 2 were less likely to be involved with a female partner reporting unprotected sex than males in Class 1. Among nonmonogamous couples, females in Class 2 had more acts of unprotected sex than females in Class 1. Males in Class 4 were less likely to have concurrent sexual partners compared to males in Class 1. Risk reduction interventions should address both victimization and perpetration. Additional research is needed to understand how mechanisms driving differential sexual risk by patterns of interpersonal polyvictimization and polyperpetration.

Purpose: The burden of syndemics-which are clusters of overlapping risk factors that adversely impact health-has been previously evaluated among high-risk individuals, yet little is known regarding syndemics within the relationship context., Methods: We evaluated concordant and discordant syndemic profiles among 296 pregnant couples and their actor-partner effects longitudinally from pregnancy to 1-year postpartum., Results: Syndemic score and severity were correlated across all time points for men and women. There was a significant difference in syndemic score (β Men - Women  = .2736, p = <.0001) and severity (β Men - Women  = .4282, p = <.0001) during pregnancy. For actor effects, we found score (β T1 - T2  = .273, p = .002; β T2  = .172, p = .066). For partner effects, we found women's syndemic risk to influence men's syndemic risk, while men had no significant effect on women's syndemic risk.- T3  = .300, p = .005) and severity (β T1 - T2  = .253, p = .004; β T2 - T3  = .418, p = .001) were significantly associated across all time points for women. For men, only syndemic score predicted subsequent score at later time points (β T1 - T2  = .393, p = <.001; β T2 - T3  = .421, p = <.001). Severity was not significantly associated across time (β T1 - T2  = .043, p = .566; β T2 - T3  = .172, p = .066). For partner effects, we found women's syndemic risk to influence men's syndemic risk, while men had no significant effect on women's syndemic risk., Conclusions: Pregnancy provides an opportunity to reduce syndemic burden among men and women. Couples-based prevention programs may serve to reduce syndemic risk for both partners, particularly during the postpartum period., (Copyright © 2018 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Previous research suggests that intimate partner violence (IPV) is associated with acceptability of and adherence to pre-exposure prophylaxis (PrEP). However, very few studies have examined whether the type (i.e., physical, sexual, and psychological IPV) and timing (i.e., lifetime, past-year) of IPV experiences differentially relate to PrEP awareness, interest, and perceived PrEP coercion. Therefore, the objective of this study is to examine associations between lifetime and past-year physical, sexual, and psychological IPV experiences on PrEP awareness, interest, and perceived PrEP coercion. Data were collected from an online survey administered to 210 women and men. Past-year physical IPV experiences (AOR 4.53, 95% CI 1.85, 11.11) were significantly associated with being interested in using PrEP. Lifetime sexual (AOR 3.69, 95% CI 1.62, 8.40), psychological IPV (AOR 4.70, 95% CI 1.01, 21.89), and past-year sexual IPV experiences (AOR 3.01, 95% CI 1.10, 8.27) were also significantly associated with believing a recent partner would attempt to control the participant's use of PrEP, if she or he were currently using it. Understanding that engaging in PrEP care is influenced differently by the type and timing of IPV has potential implications for PrEP candidacy guidelines and interventions.

Social biases among healthcare providers could limit PrEP access. In this survey study of 115 US medical students, we examined associations between biases (racism and heterosexism) and PrEP clinical decision-making and explored prior PrEP education as a potential buffer. After viewing a vignette about a PrEP-seeking MSM patient, participants reported anticipated patient behavior (condomless sex, extra-relational sex, and adherence), intention to prescribe PrEP to the patient, biases, and background characteristics. Minimal evidence for racism affecting clinical decision-making emerged. In unadjusted analyses, heterosexism indirectly affected prescribing intention via all anticipated behaviors, tested as parallel mediators. Participants expressing greater heterosexism more strongly anticipated increased risk behavior and adherence problems, which were associated with lower prescribing intention. The indirect effect via condomless sex remained significant adjusting for background characteristics. Prior PrEP education did not buffer any indirect effects. Heterosexism may compromise PrEP provision to MSM and should be addressed in PrEP-related medical education.

Substance use, intimate partner violence, and depression contribute to sexual risk individually, yet have not been evaluated as a syndemic for adolescents. Using data from 772 pregnant Latina adolescents, we evaluated these factors as a syndemic and tested the moderating role of immigration. Bivariate analyses showed syndemic score (OR = 1.40, p = 0.02) and severity (OR = 1.68, p = 0.006) were predictors for multiple sex partners, and syndemic score predicting STIs (OR = 1.15, p = 0.05). Syndemic severity remained significant in multivariate analyses for multiple sex partners (OR = 1.53, p = 0.04). Moderation analyses showed higher syndemic severity was associated with more condom use among immigrants (OR = 1.75, p = 0.04) and less condom use (OR = 0.07, p = 0.011) among those with separated orientation. Higher syndemic severity also predicted greater odds for multiple partners (OR = 2.40, p = 0.01) among immigrants. This evidence suggests a sexual risk syndemic exists among Latina adolescents. Research should continue exploring this phenomenon, particularly exploring the role immigration plays for sexual health.

Strategic framing of public messages about HIV pre-exposure prophylaxis (PrEP) may influence public support for policies and programs affecting access. This survey study examined how public attitudes toward PrEP differed based on the social group PrEP was described as benefiting ("beneficiary") and the moderating effect of prejudice. Members of the general public (n = 154) recruited online were randomly assigned to three beneficiary conditions: general population, gay men, or Black gay men. All participants received identical PrEP background information before completing measures of PrEP attitudes (specifying beneficiary), racism, and heterosexism. Despite anticipating greater PrEP adherence among gay men and Black gay men and perceiving PrEP as especially beneficial to the latter, participants expressed lower support for policies/programs making PrEP affordable for these groups vs. the general population. This disparity in support was stronger among participants reporting greater prejudice. Inclusive framing of PrEP in public discourse may prevent prejudice from undermining implementation efforts.

Objective: To assess the risk for neurodevelopmental delays for children of mothers who were obese (≥200 pounds) prior to pregnancy, and to characterize delays associated with maternal obesity among children referred to and found eligible to receive Early Intervention Program services., Methods: We conducted a retrospective cohort study (N = 541,816) using a population-based New York City data warehouse with linked birth and Early Intervention data. Risks for children suspected of a delay and 'significantly delayed', with two moderate or one severe delay, were calculated. Among the group of children eligible by delay for Early Intervention, analyses assessed risk for being identified with a moderate-to-severe delay across each of five functional domains as well as risks for multiple delays., Results: Children of mothers who were obese were more likely to be suspected of a delay (adjusted RR 1.19 [CI 1.15-1.22]) and borderline association for 'significantly delayed' (adjusted RR 1.01 [CI 1.00-1.02). Among children eligible by delay, children of mothers who were obese evidenced an increased risk for moderate-to-severe cognitive (adjusted RR 1.04 [CI 1.02-1.07]) and physical (adjusted RR 1.04 [CI 1.01-1.08]) delays and for global developmental delay (adjusted RR 1.05 [CI 1.01-1.08])., Conclusion: Maternal obesity is associated with increased risk of developmental delay in offspring. Among children with moderate or severe delays, maternal obesity is associated with increased risk of cognitive and physical delays as well as with increased risk for global developmental delay. While causation remains uncertain, this adds to the growing body of research reporting an association between maternal obesity and neurodevelopmental delays in offspring.

Rates of STIs, HIV, and pregnancy remain high among adolescents in the US, and recent approaches to reducing sexual risk have shown limited success. Future expectations, or the extent to which one expects an event to actually occur, may influence sexual risk behavior. This prospective study uses longitudinal data from the National Longitudinal Survey of Youth 1997 (n = 3,205 adolescents; 49.8% female) to examine the impact of previously derived latent classes of future expectations on sexual risk behavior. Cox regression and latent growth models were used to determine the effect of future expectations on age at first biological child, number of sexual partners, and inconsistent contraception use. The results indicate that classes of future expectations were uniquely associated with each outcome. The latent class reporting expectations of drinking and being arrested was consistently associated with the greatest risks of engaging in sexual risk behavior compared with the referent class, which reported expectations of attending school and little engagement in delinquent behaviors. The class reporting expectations of attending school and drinking was associated with having greater numbers of sexual partners and inconsistent contraception use but not with age at first biological child. The third class, defined by expectations of victimization, was not associated with any outcome in adjusted models, despite being associated with being younger at the birth of their first child in the unadjusted analysis. Gender moderated specific associations between latent classes and sexual risk outcomes. Future expectations, conceptualized as a multidimensional construct, may have a unique ability to explain sexual risk behaviors over time. Future strategies should target multiple expectations and use multiple levels of influence to improve individual future expectations prior to high school and throughout the adolescent period.

The aim was to examine gender differences in sexual risk communication among young couples and factors influencing communication. Sample consisted of 296 young pregnant couples. We assessed individual, interpersonal, and community factors on sexual risk communication. The Actor-Partner Independence Model was used to assess actor and partner effects on sexual risk communication. For actor effects, being female, older, not being Hispanic, and higher condom use self-efficacy was associated with sexual risk communication. The significant partner effect was avoidant romantic attachment. Gender interactions were significant for high risk behaviors and family functioning. High risk behaviors and family functioning were associated with sexual risk communication for females but not for males. The study emphasizes the need to promote sexual risk communication among young high risk couples, particularly for males. Family support could serve as a catalyst for sexual risk communication and other sexual protective behaviors among young couples.

The study assessed the relationship between postpartum intimate partner violence (IPV) and postpartum health risks among young mothers over time. Data were collected from 2001 to 2005 on young women aged 14-25 attending obstetrics and gynecology clinics in two US cities. Postpartum IPV (i.e., emotional, physical, sexual) was assessed at 6 and 12 months after childbirth (n = 734). Four types of postpartum IPV patterns were examined: emerged IPV, dissipated IPV, repeated IPV, and no IPV. Emerged IPV occurred at 12 months postpartum, not 6 months postpartum. Dissipated IPV occurred at 6 months postpartum, not 12 months postpartum. Repeated IPV was reported at 6 months and 12 months postpartum. Postpartum health risks studied at both time points were perceived stress, depression, fear of condom negotiation, condom use, infant sleeping problems, and parental stress. Repeated measures analysis of covariance was used. The proportion of young mothers reporting IPV after childbirth increased from 17.9 % at 6 months postpartum to 25.3 % at 12 months postpartum (P < 0.001). Emerged and/or repeated postpartum IPV were associated with increased perceived stress, depression, fear of condom negotiation, and infant sleeping problems as well as decreased condom use (P < 0.05). Dissipated postpartum IPV was associated with decreased depression (P < 0.05). IPV screening and prevention programs for young mothers may reduce health risks observed in this group during the postpartum period.

Background: Herpes simplex virus type 2 (HSV-2) is a common sexually transmitted infection (STI) that is the main cause of genital herpes. Studies have found racial/ethnic disparities in HSV-2 prevalence, but there have been few studies of racial/ethnic differences in the proportion of infections that go without a genital herpes diagnosis., Methods: Data from 1396 HSV-2-seropositive participants of the National Health and Nutrition Examination Survey 1999-2004 were used to examine racial/ethnic differences in the odds of reporting being diagnosed previously with genital herpes., Results: The proportion of participants who reported not being diagnosed previously with genital herpes was 85.5%. In adjusted analysis, non-Hispanic blacks had twice the odds of reporting being undiagnosed as non-Hispanic whites (adjusted odds ratio = 2.0, 95% CI = 1.37, 2.87). Being undiagnosed was also significantly associated with less than high school education, no prior STI history or HIV test, no current health insurance, and residence in the Midwest and South., Conclusions: The low proportion of genital herpes diagnosis among non-Hispanic blacks with HSV-2 is not accounted for by other sociodemographic factors or health insurance. Combined with the high prevalence of HSV-2, the low proportion of diagnosis in this population is more likely to contribute to ongoing HSV-2 transmission than among non-Hispanic whites or Mexican Americans. More research is needed to assess the role that lack of diagnosis plays in ongoing HSV-2 transmission, and whether targeted HSV-2 screening, counseling and treatment could be part of a more effective prevention strategy for non-Hispanic blacks.