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Evaluating routine HIV testing and treatment and use of services for people who inject drugs (PWID) is critical to curb the ongoing HIV epidemic. We analyzed data from the 2018 National HIV Behavioral Surveillance of PWID aged 18 years or older, recruited using respondent-driven sampling and offered anonymous HIV testing after survey. We performed bivariate and multivariable analyses with log-linked Poisson regression of the generalized linear models to examine the associations between demographics and PWID service use, past-year HIV testing, and current antiretroviral therapy (ART) use. Among 10,311 HIV-negative PWID, 56% reported past-year HIV testing, and of the 553 HIV-positive PWID, 69% reported current ART use. Of the HIV-negative PWID, 64% (2874/4482) in drug treatment and 62% (3386/5440) who used syringe service programs (SSPs) reported past-year HIV testing. Among HIV-positive PWID, 75% (187/248) in drug treatment and 67% (200/298) SSP participants were on ART. In the adjusted multivariable model, past-year HIV testing was associated with drug use treatment (aPR 1.26, 95% CI 1.23–1.31) and SSP participation (aPR 1.19, 95% CI 1.13–1.26) among HIV-negative PWID. Current ART use was associated with drug use treatment (aPR 1.13, 95% CI 1.00–1.28) but the link was not significant probably due to small sample size. Findings support the expansion and improvement of PWID-targeted services, into comprehensive programs, including drug use treatment, SSP, and HIV testing and treatment. [ABSTRACT FROM AUTHOR]

Objective: This study explored the influence of demographic characteristics on attitudes toward the benefits of breast-feeding, approval of public breast-feeding, and the use of infant formula. Additionally, the study examined whether attitudes were related to infant feeding practices among mothers enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Texas. Design: This study used a cross-sectional design. Setting: Participants completed questionnaires at WIC clinic sites across Texas. Participants: Mothers of young children who were receiving WIC benefits. Main Outcome Measure(s): Attitudes toward the benefits of breast-feeding, attitudes toward public breast-feeding, attitudes toward infant formula, and the choice of infant feeding practice. Analysis: Descriptive statistics, multivariate ordinary least squares regression, and multinomial logistic regression. Results: A key finding was that many Hispanic mothers held favorable attitudes toward both breast milk and infant formula. Younger and less educated mothers were least likely to agree with the benefits of breast-feeding. Mothers with positive attitudes toward the benefits of breast-feeding were likely to exclusively breastfeed and use both formula and breast milk. Conclusions and Implications: Attitudes toward breast-feeding, public breast-feeding, and infant formula and their influence on breast-feeding behavior should inform the curriculum of breast-feeding promotion programs. (Contains 4 tables.)

This study examined multiple dimensions of religious involvement and the risk of divorce among a nationwide sample of 2,979 first-time married couples. Multivariate proportional hazards modeling was used to analyze two waves of the National Survey of Families and Households. Results indicated that although each partner's religious attendance bore a modest relationship to marital dissolution, the risk of divorce was lower if husbands had conservative theological beliefs and when both partners belonged to mainline Protestant denominations. Conversely, the risk of divorce was elevated if husbands attended services more frequently than their wives and if wives were more theologically conservative than their husbands. These patterns withstood controls for sociodemographic covariates, marital duration, and marital quality. Directions for future research are discussed.

This study examines the short- and long-term impact of AmeriCorps participation on members' civic engagement, education, employment, and life skills. The analysis compares changes in the attitudes and behaviors of participants over time to those of individuals not enrolled in AmeriCorps, controlling for interest in national and community service, member and family demographics, and prior civic engagement. Results indicate that participation in AmeriCorps led to positive impacts on members, especially in the area of civic engagement, members' connection to community, knowledge about problems facing their community, and participation in community-based activities. AmeriCorps had some positive impacts on its members' employment-related outcomes. Few statistically significant impacts were found for measures of participants' attitude toward education or educational attainment, or for selected life skills measures. Within a subset of community service programs that incorporate a residential component for members, the study also uncovered a short-term negative impact of participation on members' appreciation for ethnic and cultural diversity, which disappeared over time. The implications of these findings for future research on national service are discussed. (Contains 4 tables and 17 footnotes.)

Persons who inject drugs (PWID) and exchange sex face disproportionate HIV rates. We assessed prevalence of exchange sex (receiving money/drugs for sex from ≥ 1 male partner(s) during the past year) among cisgender PWID, separately for women and men with a history of sex with men (MSM). We examined factors associated with exchange sex, including sociodemographic characteristics, sexual and drug use behaviors, and healthcare access/utilization. Over one-third of the 4657 participants reported exchange sex (women: 36.2%; MSM: 34.8%). Women who exchanged sex (WES) were significantly more likely to test HIV-positive than other women. Men who exchanged sex with men (MESM) showed a similar trend. WES and MESM shared many characteristics, including being uninsured, experiencing recent homelessness, condomless sex, polydrug use, and receptive/distributive needle sharing. These findings highlight a need to strengthen prevention interventions and address structural determinants of HIV for WES and MESM, particularly PWID who exchange sex. [ABSTRACT FROM AUTHOR]

HIV rapid testing algorithms (RTAs) using any two orthogonal rapid tests (RTs) allow for on-site confirmation of infection. RTs vary in performance characteristics therefore the selection of RTs in an algorithm may affect identification of infection, particularly if acute. National HIV Behavioral Surveillance (NHBS) assessed RTAs among men who have sex with men recruited using anonymous venue-based sampling. Different algorithms were evaluated among participants who self-reported never having received a positive HIV test result prior to the interview. NHBS project areas performed sequential or parallel RTs using whole blood. Participants with at least one reactive RT were offered anonymous linkage to care and provided a dried blood spot (DBS) for testing at CDC. Discordant results (RT-1 reactive/RT-2 non-reactive) were tested at CDC with lab protocols modified for DBS. DBS were also tested for HIV-1 RNA (VL) and antiretroviral (ARV) drug levels. Of 6500 RTAs, 238 were RT-1 reactive; of those, 97.1% (231/238) had concordant results (RT-1/RT-2 reactive) and 2.9% (7/238) had discordant results. Five DBS associated with discordant results were available for confirmation at CDC. Four had non-reactive confirmatory test results that implied RT-1 false reactivity; one had ambiguous confirmatory test results which was non-reactive in further testing. Regardless of order and type of RT used, RTAs demonstrated high concordant results in the population surveyed. Additional laboratory testing on DBS following discordant results confirmed no infection. Implementing RTAs in the context of anonymous venue-based HIV testing could be an option when laboratory follow-up is not practicable. [ABSTRACT FROM AUTHOR]

The short- and long-term impacts of participation in the AmeriCorps on the civic engagement, education, employment, and life skills of its members are studied. Participation in AmeriCorps led to civic engagement and employment, but impacts on educational attainment and life skills were less statistically significant.

Background: Gay, bisexual, and other men who have sex with men (MSM) are at high risk of acquiring human immunodeficiency virus (HIV). Taking pre-exposure prophylaxis (PrEP) daily reduces the risk of acquiring HIV through sexual contact by up to 99%. This study aimed to assess the prevalence of PrEP awareness and use, and the associated factors among HIV-negative, sexually active MSM in Dallas, Texas. Methods: Data from 406 HIV-negative, sexually active MSM recruited through venue-based sampling in 2017 and obtained from the National HIV Behavioral Surveillance project in Dallas, Texas, were analyzed. We used descriptive and inferential statistics that included bivariate and multivariate regression models to explore the associations between self-reported PrEP awareness and use, and the sociodemographic characteristics and high-risk sexual behaviors. Results: Prevalence of PrEP awareness and use in the past 12 months were 83.7% and 18.2%, respectively. PrEP awareness was significantly (p<0.05) less common among Black and Hispanic/Latino MSM (80.0% and 77.2% respectively) and among those with a high school diploma/General Educational Development (GED) or less (65.3%) or five or less male sexual partners in the past 12 months (80.4%). It was also lower among those with a household income of less than $20,000 (55.4%) and persons experiencing homelessness (57.7%) or incarceration (61.3%). PrEP use was significantly (p<0.05) lower among Black and Hispanic/Latino MSM (11.7% and 13.8% respectively) as well as those without health insurance (12.3%), with a high school diploma/GED or less (9.2%), and with household income lower than $20,000 (7.1%). PrEP awareness was 13% less common among Black MSM (adjusted prevalence ratio [aPR]=0.87, 95% confidence interval [CI]: 0.79-0.97) and 15% less common among Hispanic MSM (aPR=0.85, 95% CI: 0.78-0.93) compared to White MSM. In contrast, PrEP awareness (aPR: 1.12, 95% CI: 1.02-1.22) and use (aPR:2.02, 95% CI: 1.42-2.88) were significantly (p<0.05) associated with participation in HIV behavioral interventions. Conclusion: The positive association of HIV behavioral interventions with both PrEP awareness and use suggests that this approach may enhance PrEP rollout in Dallas and also serve as a model for statewide campaigns in the MSM communities. In addition, efforts to increase PrEP awareness and use should target Black and Hispanic MSM and MSM with lower socioeconomic status (SES). [ABSTRACT FROM AUTHOR]