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Numerous barriers to clinic-based HIV testing exist (e.g., stigmatization) for African American youth. These barriers may be addressed by new technology, specifically HIV self-implemented testing (SIT). We conducted a series of formative phase 3 translation studies (49 face-to-face interviews, 9 focus groups, 1 advisory panel review) among low-income African American youth (15-19 years) and providers of adolescent services in two US cities to identify potential translation difficulties of the OraQuick SIT. Based on content analysis, we found that providers and African American youth viewed SITs positively compared to clinic-based testing. Data suggest that SITs may reduce social stigma and privacy concerns and increase convenience and normalization of HIV testing. Challenges with SIT implementation include difficulties accessing confirmatory testing, coping with adverse outcomes, and instructional materials that may be inappropriate for low socioeconomic status (SES) persons. Study results underscore the need for translation studies to identify specific comprehension and implementation problems African American youth may have with oral SITs.

Southeast Michigan accounts for over 70 % of all HIV/STI cases in the state, with young men who have sex with men (YMSM) between the ages of 13 and 24 encumbering the largest burden in HIV/STI incidence. Using community-based participatory research principles, we developed and pilot tested a web-based, randomized control trial seeking to promote HIV/STI testing ("Get Connected!") among YMSM (N = 130; ages 15-24). Randomized participants completed a baseline assessment and shown a test-locator condition (control) or a tailored, personalized site (treatment). At 30-day follow-up, we found high acceptability among YMSM in both conditions, yet higher credibility of intervention content among YMSM in the treatment group (d = .55). Furthermore, 30 participants reported testing by following, with the majority of these participants (73.3 %; n = 22) completing the treatment condition, a clinically meaningful effect (d = .34) suggesting preliminary efficacy for the intervention. These results demonstrate the potential of the intervention, and suggest that a larger efficacy trial may be warranted.

Young men who have sex with men (YMSM) are at increased risk for HIV and STI infection. While encouraging HIV and STI testing among YMSM remains a public health priority, we know little about the cultural competency of providers offering HIV/STI tests to YMSM in public clinics. As part of a larger intervention study, we employed a mystery shopper methodology to evaluate the LGBT cultural competency and quality of services offered in HIV and STI testing sites in Southeast Michigan (n = 43).We trained and deployed mystery shoppers (n = 5) to evaluate the HIV and STI testing sites by undergoing routine HIV/STI testing. Two shoppers visited each site, recording their experiences using a checklist that assessed 13 domains, including the clinic's structural characteristics and interactions with testing providers. We used the site scores to examine the checklist's psychometric properties and tested whether site evaluations differed between sites only offering HIV testing (n = 14) versus those offering comprehensive HIV/STI testing (n = 29). On average, site scores were positive across domains. In bivariate comparisons by type of testing site, HIV testing sites were more likely than comprehensive HIV/STI testing clinics to ascertain experiences of intimate partner violence, offer action steps to achieve safer sex goals, and provide safer sex education. The developed checklist may be used as a quality assurance indicator to measure HIV/STI testing sites' performance when working with YMSM. Our findings also underscore the need to bolster providers' provision of safer sex education and behavioral counseling within comprehensive HIV/STI testing sites.

Introduction: Minority stress processes have been shown to have significant associations with negative mental health outcomes among sexual minority populations. Given that adversity may be experienced growing up as a sexual minority in heteronormative, if not heterosexist, environments, our research on resilience among sexual minority male youth proposes that positive identity development may buffer the effects of a range of minority stress processes., Methods: An ethnically diverse sample of 200 sexual minority males ages 16-24 (mean age, 20.9 years) was recruited using mixed recruitment methods. We developed and tested two new measures: concealment stress during adolescence and sexual minority-related positive identity development. We then tested a path model that assessed the effects of minority stressors, positive identity development, and social support on major depressive symptoms., Results: Experience of stigma was associated with internalized homophobia (β=.138, p<.05) and major depressive symptoms (β=1.076, OR=2.933, p<.001), and internalized homophobia partially mediated experience's effects on major depression (β=.773, OR=2.167, p<.001). Concealment stress was associated with positive identity development (β=.155, p<.05) and internalized homophobia (β=.418, p<.001), and positive identity development partially mediated concealment stress's effects on internalized homophobia (β=-.527, p<.001). Concealment stress demonstrated a direct effect on major depression (β=1.400, OR=4.056, p<.001), and indirect paths to social support through positive identity development., Conclusions: With these results, we offer an exploratory model that empirically identifies significant paths among minority stress dimensions, positive identity development, and major depressive symptoms. This study helps further our understanding of minority stress, identity development, and resources of resilience among sexual minority male youth.

Successful community partnerships for youth are based on the premise that reciprocity exists between all parties, but to what extent is equal power actually present? The current investigation examines the benefits and contributions associated with partnerships from community partners' perspectives. Respondents from 15 different Connect to Protect® coalitions initiated by the Adolescent Medicine Trials Network for HIV/AIDS Interventions were interviewed at the onset of their partnerships. Community partners asserted that their contributions to partnerships are more varied than researchers', yet they perceived that researchers acquire more kinds of benefits. Findings indicate nuances regarding reciprocity and power inequities between partners. Community partners' insights have implications for defining best practices within partnerships that benefit youth.

Purpose: The fear of negative reactions from friends and family members affects many human immunodeficiency virus (HIV)-positive adolescents' decisions regarding disclosure of their HIV status. The complex relationships and interplay among social support, fear of stigma, and disclosure of HIV status need to be better understood among youth living with HIV (YLHIV)., Methods: Social support from friends and family members and HIV status disclosure were examined among 402 youth, aged 12-24 years, living with HIV., Results: In separate analyses, (1) HIV-positive youth who reported more than one close friend and (2) HIV-positive youth who reported that friends and family members continued to socialize with them after disclosure of their HIV diagnosis, had higher levels of perceived social support overall (both p < .05). Furthermore, perceived social support did not differ significantly between those participants for whom no family member knew their HIV status and those for whom at least one family member knew their status (p = .13). Race/ethnicity, sexual orientation, education level, and current living situation were not associated with family's knowledge of the participants' HIV infection status (p > .07)., Conclusion: This investigation adds important information concerning YLHIV, whose early disclosure experiences may influence their resilience and future coping mechanisms regarding experienced stigma, and thus influence the length of time they conceal their HIV status, their decision to disclose their status, and potentially their decisions regarding treatment. Interventions and support systems to assist YLHIV with disclosure, as well as medical care, may improve their overall quality of life., (Published by Elsevier Inc.)

We examined the potential for increasing the reach of HIV testing to African American youths through the dissemination of oral-HIV testing. From 2012 through 2013 we examined the perceptions of alternatives to pharmacy dissemination of SITs in African American youths (5 focus groups) and service providers (4 focus groups), and conducted an ethnographic study of pharmacies (n = 10). Participants perceived significant advantages to delivering SITs through community health and services for adolescents (e.g., increased confidentiality, reduced stigma) over pharmacy dissemination. Given proper attention to fit, SIT dissemination could be facilitated through distribution by health and social service sites, and by improving elements of pharmacy dissemination.

Few studies have examined the relationship between young gay and bisexual men (YGBM) and their fathers. Based on a phenomenological framework, this study investigated the role of fathers in YGBM's coming-out experience, focusing on how fathers responded to disclosure of same-sex attraction, how fathers' responses compared with sons' expectations, and what sons perceived as having influenced their fathers' responses. Semistructured in-depth interviews with 30 gay and bisexual men aged 18 to 24 years were conducted as part of a larger study; topics explored in the interview included experiences coming out to family and others. Nineteen participants' narratives included discussion about their fathers and were included in the current analyses. The YGBM who were interviewed perceived a complex range of responses upon coming out to their fathers, ranging from enthusiastic acceptance to physical violence. Participants spoke of fathers who were accepting in different manners and who often held contradictory attitudes about same-sex attraction. Fathers' responses commonly differed from sons' expectations, which were informed by homophobic talk and gendered expectations. Sons spoke about what informed their expectations as well as what they perceived as influencing their fathers' responses, including gender norms, beliefs regarding the cause of same-sex attraction, religious and sociopolitical views, and concerns about HIV/AIDS. Particularly striking was the pervasive influence of hegemonic masculinity throughout the YGBM's stories. The implications of these findings for future research and intervention development are discussed, as well as study strengths and limitations., (© The Author(s) 2014.)

Relationship dynamics develop early in life and are influenced by social environments. STI/HIV prevention programs need to consider romantic relationship dynamics that contribute to sexual health. The aim of this study was to examine monogamous patterns, commitment, and trust in African American adolescent romantic relationships. The authors also focused on the differences in these dynamics between and within gender. The way that such dynamics interplay in romantic relationships has the potential to influence STI/HIV acquisition risk. In-depth interviews were conducted with 28 African American adolescents aged 14 to 21 living in San Francisco. Our results discuss data related to monogamous behaviors, expectations, and values; trust and respect in romantic relationships; commitment to romantic relationships; and outcomes of mismatched relationship expectations. Incorporating gender-specific romantic relationships dynamics can enhance the effectiveness of prevention programs.

This study determined the prevalence and patterns of psychological symptoms in adolescents and young adults living with HIV (YLWH) in medical care and relationships between psychological symptoms, route and duration of infection, and antiretroviral treatment (ART). A clinic-based sample of 2032 YLWH (mean age 20.3 years), recruited from 20 adolescent medicine HIV clinics, completed a cross-sectional survey of health behaviors and psychological symptoms using the Brief Symptom Inventory (BSI). Overall, 17.5% of youth reported psychological symptoms greater than the normative threshold on the Global Severity Index. A wide variety of symptoms were reported. The prevalence of clinical symptoms was significantly greater in youth with behaviorally acquired HIV compared to those with perinatally acquired infection (20.6% vs. 10.8%, OR=2.06 in Multiple Logistic Regression (MLR)), and in those not taking ART that had been prescribed (29. 2% vs. 18.8%, OR=1.68 in MLR). Knowing one's HIV status for more than one year and disclosure of HIV status were not associated with fewer symptoms. A large proportion of YLWH have psychological symptoms and the prevalence is greatest among those with behaviorally acquired infection. The high rate of psychological symptoms for youth not taking ART that is prescribed is a cause for concern. Symptoms do not appear to be a transient reaction to diagnosis of HIV.

Sexually explicit material (SEM) (including Internet, video, and print) may play a key role in the lives of Black same-sex sexually active youth by providing the only information to learn about sexual development. There is limited school- and/or family-based sex education to serve as models for sexual behaviors for Black youth. We describe the role SEM plays in the sexual development of a sample of Black same-sex attracted (SSA) young adolescent males ages 15-19. Adolescents recruited from clinics, social networking sites, and through snowball sampling were invited to participate in a 90-min, semi-structured qualitative interview. Most participants described using SEM prior to their first same-sex sexual experience. Participants described using SEM primarily for sexual development, including learning about sexual organs and function, the mechanics of same-gender sex, and to negotiate one's sexual identity. Secondary functions were to determine readiness for sex; to learn about sexual performance, including understanding sexual roles and responsibilities (e.g., "top" or "bottom"); to introduce sexual performance scripts; and to develop models for how sex should feel (e.g., pleasure and pain). Youth also described engaging in sexual behaviors (including condom non-use and/or swallowing ejaculate) that were modeled on SEM. Comprehensive sexuality education programs should be designed to address the unmet needs of young, Black SSA men, with explicit focus on sexual roles and behaviors that may be inaccurately portrayed and/or involve sexual risk-taking (such as unprotected anal intercourse and swallowing ejaculate) in SEM. This work also calls for development of Internet-based HIV/STI prevention strategies targeting young Black SSA men who may be accessing SEM.

Importance: With the emphasis on structural-level interventions that target social determinants of human immunodeficiency virus (HIV) transmission to curb the HIV epidemic, there is a need to develop evaluation models that can detect changes in individual factors associated with HIV-related structural changes., Objective: To describe whether structural changes developed and achieved by community coalitions are associated with an effect on individual factors associated with the risk of contracting HIV., Design, Setting, and Participants: In this serial cross-sectional survey design, data were collected from 8 cities during 4 rounds of annual surveys from March 13, 2007, through July 29, 2010. Study recruitment took place at venues where the population of focus was known to congregate, such as clubs, bars, community centers, and low-income housing. The convenience sample of at-risk youth (persons aged 12-24 years) included 5337 individuals approached about the survey and 3142 (58.9%) who were screened for eligibility. Of the 2607 eligible participants, 2559 (98.2%) ultimately agreed to participate., Interventions: Achievement of locally identified structural changes that targeted public and private entities (eg, federal agencies, homeless shelters, and school systems) with the goal of fostering changes in policy and practice to ultimately facilitate positive behavioral changes aimed at preventing HIV., Main Outcomes and Measures: Number of sexual partners, partner characteristics, condom use, and history of sexually transmitted infections and HIV testing., Results: Exposure to structural changes was not statistically significantly associated with any of the outcome measures, although some results were in the direction of a positive structural change effect (eg, a 10-unit increase in a structural change score had an odds ratio of 0.88 [95% CI, 0.76-1.03; P = .11] for having an older sexual partner and an odds ratio of 0.91 [95% CI, 0.60-1.39; P = .39] for using a condom half the time or less with a casual partner)., Conclusions and Relevance: This study evaluated a broad representation of at-risk individuals and assessed the effect of numerous structural changes related to various HIV risk factors. No structural changes as measured in this study were associated with a statistically significant reduction in risk behaviors. These null findings underscore the need for a long-term approach in evaluating structural interventions and the development of more nuanced methods of quantifying and comparing structural-change initiatives and determining the appropriate strategies for evaluating effect.

Introduction: The patterning of the HIV epidemic within young key populations (YKPs) highlights disproportionate burden by mental disorders in these populations. The mental wellbeing of YKPs is closely associated with biological predispositions and psychosocial factors related to YKPs' sexual and gender identities and socio-economic status. The purpose of this paper is to highlight sources of risk and resilience, as well as identify treatment and supports for mental health disorders (MHDs) among YKPs., Discussion: This paper utilizes Bronfenbrenner's Bioecological Systems Theory and the Social Stress Model to explore the risk and protective factors for MHDs across YKPs' ecological systems, and identify current gaps in treatment and support for MHDs among these youth. We emphasize the fluidity and intersections across these categorizations which reinforce the vulnerability of these populations, the lack of concrete data to inform mental health interventions among YKPs, and the need to ground YKP interventions and programmes with human rights principles stipulated in the convention on the rights of a child., Conclusions: We put forth recommendations for future research and strategies to address the mental wellbeing of YKPs, including the need for integrated interventions that address the multiplicity of risk factors inherent in the multiple group membership, rather than single-focus interventions whilst addressing the unique needs or challenges of YKPs.

Psychological distress among adolescents living with HIV (ALH) has been associated with risky behaviors including non-adherence to anti-retroviral therapy, leading to increased risk for AIDS morbidity and mortality. Efforts to establish the nature, prevalence, and impact of psychological distress among ALH in Uganda are hindered by the lack of culturally relevant assessment tools. The purpose of this study was to develop and test a measure for psychological distress for Ugandan ALH aged 12-19 years (N = 508; 53.1 % female). Using a mixed method approach, we developed and tested a 25-item checklist with six subscales-anhedonia, depressive-anxiety, isolation, suicidal ideation, sleep problems, and somatization. We found adequate reliability for the scale (α = 0.89), and a satisfactory measurement structure in our confirmatory factor analyses (RMSEA <1.0, and CFI and TLI >0.90). We discuss the potential use of this culturally sensitive scale to examine psychological distress among ALH in Uganda.

Young black gay/bisexual and other men who have sex with men (YB-GBMSM) living with HIV are at risk for poor engagement in HIV care. Relatively little is known about factors that impact engagement outcomes at various stages along the HIV care continuum in this specific population. The purpose of this analysis was to examine associations between various psychosocial factors and likelihood of engagement at each stage of the care continuum, among a geographically diverse sample of 132 YB-GBMSM living with HIV. Negative self-image, a component of HIV stigma, had an inverse association with early care seeking after HIV diagnosis (OR=1.05; 95% CI 1.01-1.10). Negative self-image was also inversely associated with adherence to medical appointments (OR=0.95; 95% CI 0.91-0.99), while employment (OR=0.30; 95% CI 0.12-0.75) and ethnic identity affirmation (OR=0.28; 95% CI 0.12-0.68) were both positively associated with appointment adherence. HIV-positive identity salience was associated with a higher likelihood of being on antiretroviral therapy (OR=1.06; 95% CI 1.02, 1.09). These findings highlight the importance of processes related to identity development, as both barriers and facilitators of engagement in care for HIV-positive YB-GBMSM.

Social support helps youth manage psychosocial stress. Though many studies have investigated the role of social support in helping youth in developed countries cope with their HIV status, such research is lacking among youth living in sub-Saharan African countries, including Kenya. The importance of research on youth living with HIV in Kenya is enhanced given young people's unique developmental stages and the HIV prevalence rate of 8.8% among Kenyans aged 25 to 29 years. To gain further insight, qualitative focus group interviews were conducted with 53 youth aged 18 to 27 years who lived in the informal urban settlement of Kibera in Nairobi, Kenya. A phenomenological approach was used to analyse the data from which four major types of social support were identified: 1) emotional; 2) informational; 3) appraisal; and 4) instrumental. Within each of these overarching themes more specific sub-themes were identified. The youth also reported receiving social support from eight main sources: 1) family; 2) friends; 3) clinicians and clinical services; 4) counsellors; 5) support groups; 6) religious sources; 7) partners; and 8) other. These findings suggest that various forms of social support, provided by diverse sources, which may fall outside of those commonly involved in interventions, can help youth living with HIV cope with their diagnosis and promote healthy lifestyles. Future research should investigate the roles and interactions of different types and sources of support, specifically as they relate to interventions aiming to ameliorate the experiences of youth newly diagnosed with HIV.

Given the increasing numbers of young gay/bisexual men (YGBM) diagnosed with HIV, it is important to understand the resilience processes enacted by this population in order to develop interventions that support their healthy development. Qualitative interviews were conducted with 54 YGBM (ages 17 to 24; 57% African American, 22% Latino) living with HIV from four geographically diverse clinics in the United States. Resilience processes clustered into four primary thematic areas: (1) engaging in health-promoting cognitive processes; (2) enacting healthy behavioral practices; (3) enlisting social support from others; and (4) empowering other young gay/bisexual men. These data suggest that YGBM living with HIV demonstrate resilience across multiple dimensions, including intrapersonal-level resilience related to individual cognitions and behaviors, as well as interpersonal-level resilience related to seeking support and providing support to others. Implications for the development of culturally-appropriate and strengths-based secondary prevention and other psychosocial interventions for YGBM living with HIV are discussed.

This article describes the influence of a group-based behavioral intervention for adolescents and young adults newly diagnosed with HIV (Project ACCEPT) on four dimensions of HIV-related stigma-personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes about people with HIV-as measured by the Berger HIV Stigma Scale. Stigma was addressed in a holistic manner during the intervention by providing HIV/AIDS-related information, facilitating the acquisition of coping skills, and providing contact with other youth living with HIV in order to improve social support. Fifty youth (28 male, 22 female; mean age=19.24 years) newly diagnosed with HIV from four geographically diverse clinics participated in a one-group pretest-posttest design study whereby they received the intervention over a 12-week period, and completed assessments at baseline, post-intervention, and 3-month follow-up. Results from the combined sample (males and females) revealed overall reductions in stigma in three dimensions: personalized stigma, disclosure concerns, and negative self-image, although only the combined-sample effects for negative self-image were maintained at 3-month follow-up. Gender-specific analyses revealed that the intervention reduced stigma for males across all four dimensions of stigma, with all effects being maintained to some degree at the 3-month follow-up. Only personalized stigma demonstrated a decrease for females, although this effect was not maintained at the 3-month follow-up; while the other three types of stigma increased at post-intervention and 3-month follow-up. Findings are discussed in terms of gender specific outcomes and the need for a different type of intervention to reduce stigma for young women.

Most new HIV infections in Kenya occur among young people. The purpose of this study was to understand ecological factors that influence HIV-related sexual risk and resilience among young people in rural Kenya and to elicit their ideas for HIV prevention interventions. Nine focus groups (N = 199) were conducted with both female (55%) and male (45%) participants (ages 14-24 years) living in rural communities in Kenya. Findings were organized into thematic areas related to the following systems of influence: (i) intrapersonal (substance use, HIV knowledge), (ii) interpersonal (peer pressure, lack of parent-child communication, interpersonal sexual violence), (iii) institutional/community (pornography, transactional sex, 'idleness', lack of role models) and (iv) socio-cultural/policy (Kikuyu culture, Western influence, religious beliefs, HIV-related stigma and gendered sexual scripts). Results regarding the types of HIV prevention programs that participants believed should be developed for young people in rural Kenya revealed seven primary themes, including (i) HIV prevention community/group workshops, (ii) condom distribution, (iii) job skills trainings, (iv) athletic and social clubs, (v) HIV-related stigma reduction campaigns, (vi) community-wide demonstrations and (vii) other HIV/AIDS activities led by young people. Implications for the development of culturally and developmentally appropriate HIV prevention interventions for young people in rural Kenya are discussed.

Unlabelled: In the United States, youth of 13-24 years account for nearly a quarter of all new HIV infections, with almost 1000 young men and women being infected per month. Young women account for 20% of those new infections.This article describes the design, feasibility, and acceptability of a secondary prevention empowerment intervention for young women living with HIV entitled, Evolution: Young Women Taking Charge and Growing Stronger. The nine session intervention aimed to reduce secondary transmission by enhancing social and behavioral skills and knowledge pertaining to young women's physical, social, emotional, and sexual well-being,while addressing the moderating factors such as sexual inequality and power imbalances. Process evaluation data suggest that EVOLUTION is a highly acceptable and feasible intervention for young women living with HIV. Participants reported enjoying both the structure and comprehensive nature of the intervention. Both participants and interventionists reported that the intervention was highly relevant to the lives of young women living with HIV since it not only provided opportunities for them to broaden their knowledge and risk reduction skills in HIV, but it also addressed important areas that impact their daily lives such as stressors, relationships,and their emotional and social well-being. Thus, this study demonstrates that providing a gender-specific,comprehensive group-based empowerment intervention for young women living with HIV appears to be both feasible and acceptable.

Objective: Untreated psychiatric illness is detrimental to the health and well-being of HIV-infected youth. This study examines the relationships between social and demographic variables and the rates of psychiatric treatment among HIV-infected youth., Methods: Analyses are from a cross-sectional survey of 1706 HIV-infected youth (13-26 years) in care at treatment sites or affiliates of the Adolescent Medicine Trials Network for HIV/AIDS Interventions from 2010 to 2011. Among the youth who reported recent significant mental health symptoms, comparisons on demographic variables (including race, ethnicity, language spoken, level of education, sexual orientation, and household income) were made., Results: Psychiatrically symptomatic black youth were significantly less likely than symptomatic nonblack peers to receive mental health care (37.4% versus 48.6%) and psychiatric medications (19.3% versus 26.9%)., Conclusion: Care providers should be alerted to the potential disparities in mental health care treatment that exist for black youth living with HIV.

Pre-exposure prophylaxis (PrEP) has the potential to help reduce new HIV infections among young men who have sex with men (YMSM). Using a cross-sectional survey of YMSM (N=1,507; ages 18-24), we gauged YMSM's PrEP awareness and PrEP-related beliefs regarding side effects, accessibility, and affordability. Overall, 27% of the sample had heard about PrEP; 1% reported ever using PrEP prior to sex. In a multivariate logistic regression, we found that YMSM were more likely to have heard about PrEP if they were older, more educated, were residentially unstable in the prior 30 days, had insurance, or reported having at least one sexually transmitted infection in their lifetime. We found no differences by race/ethnicity, history of incarceration, or recent sexual risk behavior. In multivariate linear regression models, Black and Latino YMSM were more likely than Whites to state they would not use PrEP because of side effect concerns. YMSM were more likely to indicate that they would not be able to afford PrEP if they did not have insurance or if they had a prior sexually transmitted infection, PrEP rollout may be hindered due to lack of awareness, as well as perceived barriers regarding its use. We propose strategies to maximize equity in PrEP awareness and access if it is to be scaled up among YMSM.

With young men who have sex with men (YMSM) continuing to be disproportionately affected by the HIV/AIDS epidemic in the U.S., secondary prevention efforts with this population take on increasing significance. We surveyed 200 HIV-positive YMSM (ages 16-24, 66% Black, 18% Latino, 7% White, 7% Multiracial/Other) recruited from 14 HIV primary care sites to examine associations of unprotected anal intercourse (UAI) and partner HIV status with endorsement of serosorting, sexual positioning, and viral load beliefs. Proportions of participants engaging in UAI one or more times during the past three months were consistent across type of UAI (insertive or receptive) and partner status. Belief that an undetectable viral load reduces infectiousness was significantly associated with insertive UAI (p < .05) and receptive UAI (p < .05) with HIV-negative or unknown status partners and receptive UAI with HIV-positive partners (p < .01). Endorsement of belief in serosorting was significantly associated with receptive UAI (p < .01) and insertive UAI (p < .05) with HIV-positive male partners. Implications for sexual behavior and risk reduction beliefs in this population are discussed.

While rates of HIV infection among gay/bisexual male adolescents have been increasing in the U.S., there has not been a commensurate increase in the development of HIV prevention interventions targeted specifically for this population. This editorial review examines primary HIV prevention interventions published in peer-reviewed journals between 1991 and 2010 in order to explore the differential focus on heterosexual versus gay/bisexual male adolescents/young adults. Of the 92 articles reviewed, only 5 (5.44 %) included interventions that addressed gay/bisexual sexual orientation or same-gender sexual activity. HIV prevention interventions developed for adolescents/young adults in the U.S. are not targeting those at highest risk of infection. Recommendations for addressing this gap are discussed.

Using a probability-based neighborhood sample of urban African American youth and a sample of their close friends (N = 202), we conducted a one-year longitudinal study to examine key questions regarding sexual and drug using norms. The results provide validation of social norms governing sexual behavior, condom use, and substance use among friendship groups. These norms had strong to moderate homogeneity; and both normative strength and homogeneity were relatively stable over a one-year period independent of changes in group membership. The data further suggest that sex and substance using norms may operate as a normative set. Similar to studies of adults, we identified three distinct "norm-based" social strata in our sample. Together, our findings suggest that the norms investigated are valid targets for health promotion efforts, and such efforts may benefit from tailoring programs to the normative sets that make up the different social strata in a given adolescent community., (Copyright © 2012 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

Although the relationship between substance use and heightened sexual risk behaviors have been documented in samples of young men who have sex with men (YMSM) and HIV-positive adult men who have sex with men (MSM), there is a dearth of research on the role of substance use in the sexual risk behaviors of HIV-positive YMSM. We examined associations between alcohol and other drug use with sexual risk behaviors among a sample of HIV-positive YMSM (N=200). There were no significant predictors of either receptive or insertive unprotected anal intercourse (UAI) with HIV-positive partners among the substance use variables. Failure to use a condom after drinking alcohol (β=2.00, p<0.01) was significantly associated with insertive UAI with HIV-negative partners or partners of unknown status. Failure to use a condom after drinking alcohol (β=1.36, p<0.05) and age (β=0.35, p<0.05) were significantly associated with receptive UAI with HIV-negative partners or partners of unknown status. Findings from this article underscore the role of alcohol in facilitating UAI among HIV-positive YMSM and their HIV-negative and status-unknown partners.

Adolescents living with HIV require engagement with care providers in order to access the critical medical and psychosocial services they need. The current study sought to explore developmental determinants of adherence to medical appointments as one aspect of engagement in care among a geographically diverse sample of 200 gay/bisexual male adolescents (16-24 years) living with HIV, with a specific focus on ethnic identity, sexual orientation identity, and identity as a young man living with HIV. Ethnic identity affirmation (OR = 0.6; 95% CI: 0.3, 0.9), morality of homosexuality (OR = 1.7; 95% CI: 1.2, 2.5), and HIV-positive identity salience (OR = 1.5; 95% CI: 0.9, 2.4) were associated with significantly higher risk for missed appointments in the past 3 months. These findings highlight the importance of attending to developmental factors, such as the development of multiple identities, when attempting to increase engagement in care for gay/bisexual male adolescents living with HIV.

This article describes psychosocial outcomes of a group randomized controlled trial of a friendship-based HIV/STI prevention intervention grounded in the AIDS Risk Reduction Model (ARRM). A total of 264 African American adolescent females 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 < .01), knowledge of living with HIV/STI (p < .01), perceived HIV risk (p < .05), perceived STI risk (p < .01), and intentions to use condoms for vaginal sex (p < .05). Findings suggest that a brief friendship-based HIV/STI prevention intervention for youth can impact ARRM factors that increase the ability to recognize and label risky sexual behaviors as problematic and promote commitment to changing high-risk behaviors.

This article explores gay and bisexual male adolescents' positive perceptions of their sexual orientation identity. In-depth qualitative interviews were conducted with an ethnically diverse sample of 63 gay/bisexual male adolescents in Chicago (N=42) and Miami (N=21). Data revealed two major conceptual categories: 1) positive personal conceptualizations of being gay/bisexual, and 2) resiliency in the face of gay-related oppression. Additional primary themes and sub-themes were identified within each category that further illustrate how gay/bisexual youth were able to develop positive conceptualizations of their sexual orientation despite experiencing negative societal messages about being gay/bisexual. Implications for the development of interventions to promote the health and well-being of gay/bisexual male youth are discussed.

In this study we explore associations between child and adult victimization and sexual risk behavior in 118 young, HIV positive women. Prior research has demonstrated associations between victimization and engagement in sexual risk behavior. Victimization sequelae can include disrupted assertiveness and communication, as well as increased association with risky partners, both of which are also linked with engagement in sexual risk behavior. Thus, we propose a model wherein victimization is linked to sexual risk behavior through two mediating pathways, sexual communication and affiliation with risky partners. We also examine the moderating effects of the presence of an anxiety or depressive disorder on the path from child to adult victimization. Results suggested that adult victimization was associated with unprotected sex with a main partner; however, this association was mediated by less sexual communication and having a risky partner. Trends toward significance were found for depression and anxiety as a moderator of the relationship between child and adult victimization. Child victimization did not have direct effects on unprotected sex. Implications for secondary prevention of HIV and healthy intimate relationships are discussed.

There is evidence that risks for HIV and sexually transmitted infections among adolescent females are higher for those with older male sexual partners. Yet, little empirical research has been conducted with male adolescents who engage in sexual activity with older men. In this article, we summarize in a number of ways the range of sexual activity reported by an ethnically diverse sample of 200 gay and bisexual male youth (15-22 years old) in Chicago and Miami. A general pattern of progression from oral sex with men to both receptive and insertive anal sex with men appeared to characterize the sample during their adolescence. Further, there appeared to be a high degree of "versatile" positioning among the sexually active gay and bisexual young men, in both age-discrepant and age-concordant dyads. Risk analysis revealed having primarily age-concordant partners to be a significant predictor of sexual risk behavior. HIV risk among young gay and bisexual men engaging in sexual activity with older men may occur not only within a distinct biological context from their heterosexual counterparts, but also in a social context that may not as rigidly bound to traditional assumptions about age, gender, and power. The significant associations among participants with partners who were the same age and the risk behavior measures in this analysis have implications for HIV prevention efforts.

There is a dearth of research regarding the influence of family members on adolescent dating. This study explored messages that African American adolescents received from family members regarding dating attitudes, norms and behaviors. Qualitative interviews were conducted with sexually experienced urban African American heterosexual adolescents (N = 51) between the ages of 15-17. Analyses revealed that participants received a diversity of messages from a range of both nuclear and extended family members, and that these messages were organized around three temporal phases of dating: initiation, maintenance, and termination. Types and sources of messages are discussed, as well as implications for intervention development.

This study explored organizational and contextual factors impacting coalition functioning across 15 community-researcher coalitions that were formed to lower rates of HIV among youth. Mixed-methods (qualitative and quantitative) longitudinal data were collected from both community partners and researchers across three time points, and were analyzed to assess factors associated with initial coalition development and functioning. Specific facilitators of coalition functioning over time included developing group trust and cohesion, creating diverse coalition membership, developing a shared vision, and ensuring clarity of coalition purpose and goals. Specific barriers to coalition functioning over time included experiencing a lack of clarity over member roles and responsibilities, balancing power/resource dynamics between researchers and community partners, balancing coalition building and coalition pace, and experiencing HIV/AIDS-related stigma. Recommendations are offered for how to develop and sustain successful community-researcher coalitions over time in order to address relevant social issues.

Sexual debut represents a developmental transition that holds possibility for growth and for risk. Family and neighborhood may impact timing of debut. This qualitative study examined family strategies (e.g., moving, parental monitoring), perceptions of neighborhood, and attitudes about sex and sexual debut among sexually experienced and inexperienced African American adolescent females living in disadvantaged urban neighborhoods. Findings show that more familial strategies were reported by sexually inexperienced females, suggesting that strategies may delay sexual debut. Furthermore, experiences with neighborhood violence related to attitudes about sex and sexual debut, suggesting a linkage between death anxiety and sexual debut among female youth.

Scholars have identified the presence of natural mentoring relationships (NMRs) as one of a set of protective factors that promote and protect the health and well-being of "at-risk" and marginalized youth. While this work has informed our understanding of the importance of NMRs for supporting youth and promoting positive development, it has only just begun to extend its inquiry focus onto the lives of same-sex attracted (SSA) youth (e.g., gay and bisexual youth). Thirty-nine in-depth interviews with self-identified gay, bisexual, and questioning (GBQ) male youth (ages 15 - 22) were qualitatively analyzed for the presence, form, and function of NMRs. Results from this inquiry revealed that participants identified a diverse range of "natural mentors" and that the provision of social support was of thematic prominence in these relationships. Results from this effort are here presented. Clinical and programming implications, as well as directions for future work are discussed.

Coalitions provide the potential for merging the power, influence, and resources of fragmented individuals and institutions into one collective group that can more effectively focus its efforts on a specific community health issue. Connect to Protect® coalitions devote resources to address the HIV epidemic at a structural level. This study examines differential challenges in coalition processes that may hinder coalition building to achieve HIV prevention through structural change. Qualitative interviews conducted with community partners participating across 10 coalitions were analyzed to compare responses of those individuals working on HIV prevention coalitions targeting adolescent and young adult gay and bisexual men versus those targeting adolescent and young adult heterosexual women. Community partner responses revealed differences across several key areas including: (a) acceptability and goals in discussing sexual issues with adolescents, (b) goals of sexual health promotion activities, and (c) competition among collaborating agencies. Themes highlighted in this study can complement existing community intervention literature by helping community mobilizers, interventionists, and researchers understand how cultural norms affect youth-specific coalition work.

Adolescents often engage in concurrent sexual partnerships as part of a developmental process of gaining experience with sexuality. The authors qualitatively examined patterns of concurrency and variation in normative and motivational influences on this pattern of sexual partnering among African American adolescents (31 males; 20 females), ages 15 to 17 years. Using content analysis, gender and contextual differences in social norms and motivations for concurrency were explored. Findings describe the normative influences on adolescent males and females with regard to sexual concurrency and the transfer of these norms from one generation to the next.

This qualitative study examined sexual health information networks among urban African American youth living in low-income communities. The authors identified sources, message content, and utility of messages about sex and sexual health in a sample of 15-17-year olds (N = 81). Youth received sexual health information from a variety of sources. Messages from parents and sex education had high utility, whereas messages from the Internet and religion had low utility. Four information network patterns were identified, suggesting considerable variation in how youth are socialized regarding sex. Findings suggest that sexual information networks have the potential to affect sexual health and development.

The study investigated local determinants of substance use in rural Kenya. Over the years, there has been a growing concern over increased use of substances across ages, gender, religious persuasions, and social class in Kenya. It is still unclear what psychosocial individual and/or community factors might be that offer some explanation for the high levels of alcohol and drug use. The study investigated community members' social status in areas of gender, education, employment, self-esteem, and availability of substances. The sample was comprised of Kenyan rural participants, and included 153 men and 64 women with a mean age of 34.2 years. The participants completed a survey measuring possible psychosocial determinants of alcohol, khat and bhang (i.e., marijuana) use patterns. The sample evidenced high levels of substance use particularly involving the locally available substances (i.e., bottled beer, local brews, chewing khat, smoking bhang). Males in comparison to females were more likely to drink alcohol, chew khat, and smoke bhang. Women compared to men reported higher education and employment status, which were associated with less substance use. Females had higher self-esteem when they did not use bottled beer whereas males had higher self-esteem when they use bottled beer. The implications of these findings are discussed.

Health disparities among gay men (HIV, substance use, depression) have been described as a mutually occurring "syndemic" that is socially produced through two overarching dynamics: marginalization and migration. Although the syndemic theory proposes a developmental trajectory, it has been largely based on epidemiological studies of adult gay men and has not been examined using qualitative data from gay male adolescents and emerging adults describing their developmental experience. We conducted interviews with 54 HIV-positive gay and bisexual male adolescents and emerging adults at four sites in the United States. This study provides examples of developmental trajectories that help explain the early onset of socially produced health disparities among some gay male adolescents and emerging adults, but also the development of risk factors that may follow some gay men into adulthood.

Given the potential for negative psychosocial and medical outcomes following an HIV diagnosis, Project ACCEPT, a 12-session behavioral intervention, was developed and pilot-tested for youth (aged 16-24) newly diagnosed with HIV. Fifty participants recently diagnosed with HIV were enrolled from 4 sites selected through the Adolescent Medicine Trials Network (ATN). The majority of participants identified as African American (78%). Feasibility and acceptability data demonstrated high rates of participation and high levels of satisfaction with the intervention program from both participants and staff. Exploratory outcome data demonstrated improved levels of HIV knowledge that were sustained over time (Cohen's effect [d] d = .52) and improvements in peer (d = .35) and formal (d = .20) social support immediately postintervention. Gender differences emerged over time in the areas of depressive symptoms, family social support, self-efficacy for sexual discussion, and personalized stigma. Project ACCEPT appears to be an acceptable and feasible intervention to implement in clinical settings for youth newly diagnosed with HIV.

Objective: To test predictors of medication adherence in high-risk racial or ethnic minority youth living with HIV (YLH) using a conceptual model of social cognitive predictors including a continuous measure of motivational readiness., Methods: Youth were participants in a multi-site clinical trial examining the efficacy of a motivational intervention. Racial-minority YLH (primarily African American) who were prescribed antiretroviral medication were included (N = 104). Data were collected using computer-assisted personal interviewing method via an Internet-based application and questionnaires., Results: Using path analysis with bootstrapping, most youth reported suboptimal adherence, which predicted higher viral load. Higher motivational readiness predicted optimal adherence, and higher social support predicted readiness. Decisional balance was indirectly related to adherence., Conclusions: The model provided a plausible framework for understanding adherence in this population. Culturally competent interventions focused on readiness and social support may be helpful for improving adherence in YLH.

Objective: Identify factors associated with appointment-keeping among HIV-infected adolescents and young adults., Methods: HIV-infected adolescent and young adult females in five U.S. cities were followed for a period of 18 months to examine adherence to scheduled clinic visits with their HIV care provider. Psychosocial and behavioral factors that have been shown in other populations to influence appointment adherence were measured at baseline and follow-up visits using an audio computer-assisted self-interview questionnaire. These factors included mood disorder, depressive symptoms, social network support, healthcare satisfaction, disease acceptance, HIV stigma, alcohol use, and marijuana use. CD4 count and prescription of antiretroviral therapy medication were also monitored to understand the influence of health status on appointment- keeping., Results: Participants included 178 youth with a mean age of 20.6 years. Forty-two percent had clinically significant depressive symptoms, 10% had a diagnosable mood disorder, 37% reported marijuana use in the last 90 days, and 47% reported alcohol use. Overall, participants attended 67.3% of their scheduled visits. Controlling for age and health status, marijuana use was the only variable that was associated with appointment-keeping behavior., Conclusions: Considering the importance of appointment-keeping for maintaining personal health and preventing further transmission, screening HIV-infected adolescents for marijuana use could help alert providers of this specific barrier to visit compliance.

In the context of a U.S. dominant masculinity ideology, which devalues men who are not heterosexually identified, many gay, bisexual and questioning (GBQ) adolescent males must develop their own affirming and health-promoting sense of masculinity. In order to promote the well-being of GBQ young men, exploration of their reactions and responses to dominant images of masculinity is needed. We qualitatively analyzed interviews with 39 GBQ African American, Latino, and European American male adolescents (15-23 years old). Participants reported a range of responses to traditional masculinity ideologies, most of which centered on balancing presentations of masculine and feminine characteristics. Negotiation strategies served a variety of functions, including avoiding anti-gay violence, living up to expected images of masculinity, and creating unique images of personhood free of gender role expectations. These data suggest a complex picture of GBQ male adolescents' management of masculinity expectations and serve as a basis for culturally and developmentally specific HIV prevention programs.

Fifteen research sites within the Adolescent Medicine Trials Network for HIV/AIDS Interventions launched Connect to Protect community coalitions in urban areas across the United States and in Puerto Rico. Each coalition has the same overarching goal: Reducing local youth HIV rates by changing community structural elements such as programs, policies, and practices. These types of transformations can take significant amounts of time to achieve; thus, ongoing successful collaboration among coalition members is critical for success. As a first step toward building their coalitions, staff from each research site invited an initial group of community partners to take part in Connect to Protect activities. In this paper, we focus on these researcher-community partnerships and assess change in collaboration factors over the first year. Respondents completed the Wilder Collaboration Factors Inventory at five time points, approximately once every two to three months. Results across all fifteen coalitions show significant and positive shifts in ratings of process/structure (p<.05). This suggests that during the first year they worked together, Connect to Protect researcher-community partners strengthened their group infrastructures and operating procedures. The findings shed light on how collaboration factors evolve during coalition formation and highlight the need for future research to examine change throughout subsequent coalition phases.

Identity development is a critical task of adolescence and occurs across multiple areas of self-identification. Although research on the identity development process among individuals who are ethnic and sexual minorities has been conducted for individuals who have 1 minority status or the other, few studies have examined these processes in people who are both ethnic and sexual minorities. In this qualitative study, the authors examined the dual identity development processes related to ethnic and sexual identity among gay-bisexual-questioning (GBQ) Latino and African American male adolescents. Results indicated that the processes associated with the development of sexual orientation and ethnic identity occur concurrently. However, the actual processes involved with the development of each identity not only differed, but seemed to be independent of each other because neither process was referenced in the development of the other. Overall, the process of ethnic identity development involved the process of becoming aware of one's ethnic and cultural heritage, whereas sexual identity development involved finding one's own personally relevant sexual orientation label and connecting to that community. The implications of these findings for the development of interventions to assist in the healthy development of GBQ adolescents are discussed.