Search

Cross-sectional survey data from 226 heterosexual and 201 gay men in the UK and Germany, analysed using moderation analyses, showed a positive relationship between identity resilience – self-efficacy and engaging in condomless sex and drug use in sexualised settings in gay men only. It is proposed that higher self-efficacy may lead to increased feelings of invincibility in gay men, which in turn is associated with sexual risk-taking. Understanding the relationship between psychological constructs, such as self-efficacy, and sexual risk-taking behaviours is key. This study examines associations between identity resilience – self-efficacy and frequency of both condomless sexual encounters and drug use in sexualised settings in a sample of heterosexual and gay men. Higher identity resilience – self-efficacy was found to be associated with greater sexual risk-taking behaviours in gay men only. [ABSTRACT FROM AUTHOR]

AbstractBisexual women report higher rates of alcohol use and risky sexual behavior than lesbian and heterosexual women. Impulsivity (i.e., action without considering negative consequences) is a risk factor for greater alcohol use and sexual behavior, but few studies have examined the impact of impulsivity on alcohol use and sexual behavior among cisgender bisexual women. Consequently, the purpose of this study was to examine the moderating role of impulsivity on the association between hazardous alcohol use and sexual risk-taking among cisgender bisexual emerging adults. Participants were 225 self-identified cisgender bisexual women (Mage = 22.77, SD = 3.45) who completed an online survey about their hazardous alcohol use using the Alcohol Use Disorder Identification Test (AUDIT), impulsivity, and sexual behaviors over the past 30 days. A moderated regression model examined main effects of impulsivity and alcohol use severity, and their interaction, on sexual risk-taking. The association between alcohol use severity and sexual risk-taking was moderated by impulsivity. Simple slopes analyses revealed that greater alcohol use severity was associated with greater sexual risk-taking, but this only occurred for participants with average or high scores of impulsivity. These results suggest prevention programs that target alcohol use should address the role that impulsivity may have on risky sexual behaviors among young bisexual women. Future research would benefit from looking at various outcomes related to sexual risk to determine which are most predominantly associated with alcohol use severity and impulsivity. [ABSTRACT FROM AUTHOR]

Objective: To examine the associations of dimensions of masculinity—respect/toughness and anti-femininity/hypersexuality—with sexual risk behaviors and protective behavioral intentions and the effects of awareness of anti-Blackness. Participants: 127 Black heterosexual men were recruited from four Historically Black Colleges and Universities and one Minority Serving Institution in the South. Methods: Students completed an online survey as part of a pilot study to assess the sexual health needs of Black college students. Results: Our results indicated that respect/toughness and anti-femininity/hypersexuality were significant correlates of protective behavioral intentions. After accounting for awareness of anti-Blackness and age, anti-femininity/hypersexuality was a significant correlate of sexual risk behaviors. Conclusions: Our study highlights the complex multi-dimensional construct of masculinity and how forms of anti-Blackness continue to influence HIV vulnerability. Therefore, there is a need to include structural factors within research to better understand behaviors among Black college men and incorporate dimensions of masculinity that promote healthy sexual behaviors in interventions and programming. [ABSTRACT FROM AUTHOR]

This study examined how mental health and intimate partner violence (IPV) relate to women's beliefs about their ability to communicate with partners about sexual history and risk (i.e., sex behavior self-efficacy). Participants were composed of 148 women (M age = 34.6; 69% non-Hispanic Black; 74% income <$20,000/year) recruited from community organizations in the US Mid-South. A hierarchical linear regression was used to examine associations among sex behavior self-efficacy and depressive symptoms, resilience (Model 1) and physical IPV, psychological IPV, sexual IPV, negotiation, and IPV perpetration (Model 2). The final model was significant with variability in sex behavior self-efficacy explained by depressive symptoms, partner negotiation frequency, and IPV perpetration. Findings highlight novel areas to consider when assessing barriers and facilitators of partner communication and when developing culturally responsive interventions for women experiencing relationship-based adversity. [ABSTRACT FROM AUTHOR]

Black and African American men who have sex with men (Black MSM) experience the greatest proportion of new HIV infections in the United States. To address this challenge, a better understanding of the HIV environment riskscape including both risk and resilience factors is warranted among Black MSM. Research indicates that stress is associated with increased HIV sexual risk behaviors. Further, behavioral factors such as serosorting and community level factors including social support and community connection are resilience factors that protect against risk behaviors. The present study examines whether everyday stress is associated with HIV sexual risk behavior, as well as the role of risk and resilience factors among 125 Black MSM recruited in the Real Talk study. The Real Talk project examined the relationships between resilience, HIV risk behaviors, and HIV prevention strategy among a sample of Black MSM. Using generalized estimating equations, our results indicate a positive association between everyday stress and engaging in condomless anal intercourse only after adjusting for risk, resilience, and correlate variables. Similarly, having multiple sex partners and using substances during sex also show positive associations with condomless anal intercourse. Resilience factors of engaging in serosorting and being connected to both the Black and gay communities were negatively associated with condomless anal intercourse. Future prevention research and programming should focus on both risk and resilience factors to mitigate new HIV infections among Black MSM. [ABSTRACT FROM AUTHOR]

Background: Mental health and substance use disorders are common among people living with HIV and are associated with high-risk sexual behaviors, such as unprotected sex and multiple sexual partners, but Asia-Pacific data are limited. Methods: Adults living with HIV in care at 5 Asia-Pacific HIV clinics were enrolled at routine clinic visits between July 2019 and June 2020. Depression, substance use, sexual practice, and sociodemographic data were collected using the Patient Health Questionnaire-9, Alcohol, Smoking, and Substance Involvement Screening Test, and a study-specific questionnaire. Clinical data were accessed from medical records. Risk factors for medium-to high-risk sexual practices, defined based on total scores from the sexual practice questionnaire assessing number of sexual partners and condom use, were analyzed using logistic regression. Moderate-to-severe depression was defined as a Patient Health Questionnaire-9 score >9 and moderate- to high-risk substance use as an Alcohol, Smoking, and Substance Involvement Screening Test score ≥11 for alcohol or ≥4 for other substances. Results: Among 723 participants, the median age was 38 years, 89% were men, 99% were on antiretroviral therapy and 37% had medium- to high-risk sexual practices. Medium- to high-risk sexual practices were more common among those ≤30 years old, unemployed, and those with HIV status disclosed and were more likely in participants with moderate-to-severe depression (aOR 2.09, 95% CI: 1.17 to 3.74) compared with none-to-minimal depression, and moderate- to high-risk substance use (aOR 1.73, 95% CI: 1.23 to 2.44) compared with those without. Conclusions: Further integration of comprehensive sexual risk reduction strategies, mental health services, and substance use harm reduction within HIV clinical settings in the region is needed. [ABSTRACT FROM AUTHOR]

The prevention of human immunodeficiency virus (HIV) infection has recently emphasized the use of pre- and post-exposure prophylaxis (PrEP and PEP), both of which were highly effective in prevention of HIV infection. Since the last published guidance regarding the cotreatment of people with anti-seizure medications (ASM) and antiretroviral treatments (ARTs) in 2012, both fields have numerous new medication options. Historically, cotreatment of HIV and seizures could be challenging with increased risk of virologic failure and barriers in access to health care due to global availability, social determinants of health, and stigma of both HIV and seizures. In this narrative review, we describe the data-driven and expected bidirectional pharmacokinetic (PK) interactions between guideline-based PrEP and PEP treatment and ASM, as well as overlapping side effects. There are many ASMs with no known interaction with PrEP or PEP regimens. The interactions focus on enzyme inducing ASMs, valproate, and lamotrigine. Most prominently, enzyme inducing ASMs lower serum levels of tenofovir-containing PrEP regimens and elements of PEP (dolutegravir, raltegravir, and ritonavir), which increased risk of virologic treatment failure in people with HIV but have unclear clinical significance on the effectiveness of PrEP and PEP. In addition, ritonavir treatment in PEP may significantly lower lamotrigine serum levels even during the 4 weeks of treatment, which may increase risk for breakthrough seizures during PEP and skin reactions after discontinuation of ritonavir. In addition to PK interactions, overlapping side effects are common including osteopenia, hepatic toxicity, and other gastrointestinal effects. This narrative review aims to be a resource for all clinicians prescribing ASMs so that they can create a welcoming environment to enable successful treatment of seizures and reduce the risk of HIV infection in people at risk. In addition, we highlight knowledge gaps and areas of unmet need that can be addressed with future studies. [ABSTRACT FROM AUTHOR]

Adolescents who are unaware of infertility risk factors and the long-term health effects of their lifestyle choices may participate in unsafe sexual and lifestyle behaviors. Their reproductive goals and health may be affected by such behaviors. Adolescents' awareness of male and female infertility risk factors was assessed, along with lifestyle risk variables related to sexual behavior and psychoactive substance use. The causes of inconsistent condom use were also examined. In 2022, a cross-sectional survey was undertaken involving 598 sexually active university students from Nigeria (18.6 years±0.9), the majority of whom were female (57.2 %). Descriptive statistics, bivariate analysis, and binary logistic regression were utilized in the data analysis to determine the influence of lifestyle factors and levels of knowledge on fertility. Most participants had a moderate understanding of male and female infertility risk factors. The results showed that female students were more informed. Multiple sexual partners and psychoactive substance use were common lifestyle variables. Younger female students, those with several partners, and participants who frequently used alcohol and narcotics used condoms inconsistently. The study emphasizes the need for fertility health and lifestyle risk education for Nigerian youth. Despite moderate knowledge, lifestyle implications on fertility are unclear. Fertility health education in schools could help students make informed reproductive choices and lower the risk of infertility and chronic diseases. Research is needed to confirm findings and inform nationwide targeted interventions. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionsTo examine the utility of a novel sexual risk index (SRI) to better use National College Health Assessment (NCHA) sexual health-related questions.The first phase included discussions, testing, and recoding of the initial set of items. In the second phase, a correlation analysis was run; items were systematically removed to achieve a Cronbach’s alpha of .714.All currently enrolled students in Spring 2020 at medium-sized, 4-year public university in Florida were recruited (n = 4,850) for the NCHA. Of the 441 total respondents, 223 students were included in the SRI analyses. Most had very low SRI scores, indicating few sexual risks. Nontraditional students were half as likely to experience academic challenges as compared to traditional students (TS; OR = .487, p = .033), while increasing SRI scores (OR = 1.182, p = .022) and decreasing GPA scores (OR = −1.975, p < .001) were associated with an increased likelihood of self-reporting academic challenges.Results suggest high utility and reliability of the SRI. The use of the SRI provides a better overall picture of sexual risk-taking through a score rather than comparison of individual NCHA items. [ABSTRACT FROM AUTHOR]

This study used a person-centred approach to consider profiles of parent–child sex communication. We sought to determine whether profiles of sex communication were distinguishable from one another based on aspects of both the parent and the child. Participants included 596 US young people (51% female at birth; Mage = 14.55, SD = 1.70, 56% white), and their mother (n = 596; Mage = 41.23, SD = 8.18; 64% white) and father (n = 354; Mage = 43.44, SD = 8.56; 62% white) figures. Analyses suggested three profiles of parent–child sex communication with mothers and four with fathers. Patterns were similar across profiles, with variation being primarily the degree to which parents reported timing, frequency and quality of communication. Parents who more strongly endorsed proactive and reactive parenting, and who reported more frequent and open conversations with their children were warmer and had higher levels of self-efficacy. They also had children who were more sexually active, but who had healthier sexual outcomes. Discussion focuses on the importance of considering multiple aspects of parent–child sex communication and highlights the importance of continuing to empower parents to discuss sex and sexuality with their children. [ABSTRACT FROM AUTHOR]

Background: The human immunodeficiency virus (HIV) epidemic in South Africa is among the worst in the world; in 2017, 38% of new infections were among young people aged 15–24 years. Estimates for HIV infection in 2020 worldwide indicate that there will be 1.5 million new cases, 10.2 million untreated cases (out of 37.7 million), and 680 000 deaths from acquired immunodeficiency syndrome (AIDS). Despite a 46% decline in new HIV infections among adolescents and youth over the previous 10 years, two of the seven new HIV infections in 2019 occurred in people between the ages of 15 and 24. HIV prevalence among young people has remained unchanged since 2008. This consistent pattern among people under 30 years of age indicates a failure in HIV prevention. Aim: The study aimed to explore HIV and sexual risk behaviours by 18–25-year-old youth at Nyandeni Municipality in the Eastern Cape province. Setting: The investigation was conducted Nyandeni Municipality in the Eastern Cape province. Methods: Qualitative approach was used to explore, describe and investigate the knowledge and attitudes about HIV among the 18–25 years old youth Results: The findings are based on three themes namely, knowledge and attitudes about HIV and AIDS in youth, sexual risk behaviour among youth, and HIV prevention strategies. Conclusion: This exploratory investigation confirms that the participants’ knowledge is limited by showing that most of them knew very little about HIV and AIDS infection and prevention. Ongoing educational initiatives are required. Contribution: Youth experience high HIV incidence because of their knowledge gaps.

Economic vulnerability is often reported to underlie involvement in sex work among female sex workers (FSW), but may also create urgency in women's work, limiting women's negotiating power with clients and in turn, increasing their vulnerability for violence and HIV. This study assessed economic vulnerability in relation to violence and sexual risk behaviors for HIV among a sample of FSW in Tijuana, Mexico. FSW at least 18 years of age were recruited through venue-based sampling for a survey (n = 228) and in-depth interviews (n = 50) to investigate HIV risk factors in this region. Using crude and adjusted logistic regression models, we assessed lack of financial support from others as well as reports of financial hardship separately in relation to experiencing sexual violence (e.g. by clients, police, relationship partners, in the past 6 months), physical violence (past 6 months), STI diagnosis, and inconsistent condom use (past 30 days). Qualitative interviews (n = 50), conducted with a subsample of the survey participants, were also examined for related themes. FSW who reported no financial support were more likely to report sexual violence (OR = 2.1; 95% CI:1.1-4.2). FSW who reported financial hardship were more likely to experience sexual violence (OR = 1.9; 95% CI:1.1-3.6) and physical violence (OR = 1.9; 95% CI:1.1-3.6), as well as to report past 30-day inconsistent condom use (OR = 2.4; 95%CI: 1.3-4.6) and to test positive for an STI (OR = 1.9; 95% CI:1.1-3.4). Qualitative data substantiated these findings. Findings suggest that interventions to improve economic well-being may be useful to prevent the intersecting concerns of violence and HIV among FSW.

Objectives: Ethnic discrimination and acculturative stress play an important role in sexual risk behaviors for Latinx emerging adults, who are at disproportionate risk for sexually transmitted infections. Factors such as familism support and ethnic identity may be protective, yet research is limited. This study is guided by a culturally adapted stress and coping framework to examine associations of ethnic discrimination and acculturative stress with sexual risk behaviors (i.e., multiple sex partners, alcohol or drug use before sex, and condomless sex with a primary or casual partner), and examine the moderating roles of familism support and ethnic identity among Latinx emerging adults. Method: Participants were recruited from Arizona and Florida and were primarily female (51.3%) with a mean age of 21.48 years (SD = 2.06). Using cross-sectional data from 158 sexually active Latinx emerging adults, this study employed multiple logistic regression and moderation analyses. Results: Higher levels of ethnic discrimination and pressure to acculturate were associated with fewer sex partners, and higher levels of pressure against acculturation were associated with increased condomless sex with a casual partner. The moderation effect of higher levels of familism support on pressure to acculturate was associated with fewer sex partners, and the moderation effect of higher levels of ethnic identity on pressure against acculturation was associated with decreased condomless sex with casual partners. Conclusions: Examining the results within a culturally informed theoretical framework supports that protective factors may help mitigate sexual risk factors among Latinx emerging adults experiencing acculturative stress. Public Significance Statement: Ethnic discrimination and acculturative stress can be linked with sexual risk behaviors among Latinx emerging adults. This study found that while ethnic discrimination and pressure to acculturate were linked with fewer sex partners, pressure against acculturation was linked to increased condomless sex with a casual partner. Family support and ethnic identity can be protective in the prevention of sexual risk behaviors among Latinx emerging adults who experience acculturative stress. [ABSTRACT FROM AUTHOR]

Young adults experiencing homelessness (YAEH) are at elevated risk for HIV compared to their stably housed peers. Preexposure prophylaxis (PrEP) is highly effective at preventing HIV infection, yet YAEH have been largely overlooked in PrEP efforts to date despite YAEH reporting high overall interest in PrEP. We assessed individual, social, and structural variables associated with PrEP interest and use among a sample of 195 YAEH (ages 18–25) recruited from drop-in centers across Los Angeles County who met criteria for HIV risk. In the current sample, though most had heard of PrEP (81.0%), the majority were not interested in taking PrEP (68.2%) and only a minority had used/were using PrEP (11.8%). YAEH who identified as sexual and/or gender minority, reported knowing someone who had used PrEP, or recently accessed sexual health services were more likely to have used and/or reported interest in using PrEP. Those who reported more episodes of heavy drinking were less likely to report having used PrEP. Suggestions are provided for better integrating PrEP-related services into existing behavioral and health service programs for YAEH, as well as leveraging peers and fostering positive social norms to reduce PrEP-related stigma and increase interest and use of PrEP among YAEH. [ABSTRACT FROM AUTHOR]

Traditional gender role beliefs, or marianismo beliefs, are theorized to be largely protective against health risk behaviors, including sexual risk behaviors among Latina young adults. However, measurement differences across studies and research with heterogeneous samples of abstinent and sexually active Latina young adults have led to unclear findings. Thus, we investigated whether endorsement of certain marianismo beliefs may promote sexual health behaviors or solely promote abstinence. Guided by gender role schema theory, this study investigated the multidimensional construct of marianismo beliefs in relation to past-year abstinence from sexual activity, STI and HIV testing, and condom use among 611 Latina young adults. Results indicated that endorsement of the Virtuous and Chaste belief was associated with decreased odds of sexual activity (i.e., increased odds of being abstinent) in the past year. None of the five marianismo beliefs were significantly linked with condom use. Among sexually active participants, the Virtuous and Chaste belief was associated with decreased likelihood to be tested for both STIs and HIV in the past year. Findings support the notion that certain marianismo beliefs (e.g., the Virtuous and Chaste belief) may promote abstinence, yet pose a risk for sexual health via reduced likelihood for STI and HIV testing. Results may inform culturally-tailored HIV prevention interventions with Latinas to reduce the disproportionate HIV burden in this population. [ABSTRACT FROM AUTHOR]

ObjectivesWe examined sex-specific associations of partner age disparity and relationship concurrency with Neisseria gonorrhoeae and/or Chlamydia trachomatis (NG/CT) infection, higher-risk relationships, and condom use as proxies for HIV risk.MethodsData were collected in 2016 from 2179 adults in 12 communities in Uganda and Kenya. Logistic regression models examined associations of age disparity and relationship concurrency with NG/CT infection, condom use, and higher-risk (commercial sex and other higher-risk) relationships in the past 6 months, controlling for covariates.ResultsPartner age and relationship concurrency were associated with NG/CT infection in women but not men. Relative to women in age-disparate relationships, women in both age-disparate and age-homogeneous relationships had higher odds of NG/CT infection (adjusted odds ratio [aOR]=3.82, 95% confidence interval [CI]: 1.46-9.98). Among men and women, partnership concurrency was associated with higher-risk partnerships. In addition, relative to those with a single age-homogeneous partner, those with concurrent age-homogeneous partners had higher odds of condom use (men: aOR=2.85, 95% CI: 1.89-4.31; women: aOR=2.99, 95% CI: 1.52-5.89). Concurrent age-disparate partnerships were associated with condom use among men only (aOR=4.02, 95% CI: 2.54-6.37).ConclusionFindings underscore the importance of targeted HIV prevention efforts for couples in age-disparate and concurrent relationships.

IntroductionLow-level HIV epidemic settings like Singapore face the challenge of reaching men at-risk who have less contact with programmes. We investigated patterns of meeting platform use by men seeking male sexual partners (MSM) as potential marker of risk to differentiate sub-groups for interventions.MethodsLatent Class Analysis (LCA) was applied to a survey sample of MSM recruited from bars/clubs, saunas and a smartphone application, using purposive sampling. The best-fit LCA model which identified homogeneous sub-groups with similar patterns of meeting platform was factored in multivariable regression to identify associations with risk behaviors on the pathway to HIV infection.ResultsOverall 1,141 MSM were recruited from bars/clubs (n = 426), saunas (n = 531), and online (n = 184). Five patterns emerged, reflecting salient platform use characteristics: Sauna-centric (SC; n = 413), App-centric (AC; n = 276), Multiple-platforms (MP; n = 123), Platform-inactive (PI; n = 257), and “Do not hook up” (DNH; n = 72) classes. Men in the SC and MP classes had high probabilities of using saunas to meet partners; SC were older and less likely to have disclosed their sexual orientation. The MP class had high probabilities of connecting across all platforms in addition to saunas and more likely to have disclosed their sexual orientation, than the PI class. Men in the SC and MP classes had twice the odds of reporting multiple sex partners (aORSC = 2.1; 95%CI: 1.33.2; aORMP = 2.2; 95%CI: 1.14.6). Single/non-partnered MSM and those using alcohol/drugs during sex had 1.7 (95%CI: 1.22.5) and 3.2 (95%CI: 2.05.1) the odds respectively, of reporting multiple sex partners. The SC and MP classes had higher odds of engaging in group sex while MSM using alcohol/drugs during sex had twice the odds of reporting group sex. Alcohol/drugs and group sex were independently associated with condomless sex (as was lower education). Group sex, alcohol/drugs during sex, disclosure of sexual orientation or being Singaporean/permanent resident were associated with recent testing for HIV.DiscussionThe five distinct risk profiles identified can help tailor differentiated HIV interventions—combined with field knowledge and other prevention—to expand HIV self-testing, Pre-Exposure Prophylaxis and other services (e.g., Mpox vaccination) to sub-groups at risk.

MARSSI (Momentary Affect Regulation – Safer Sex Intervention) is a counseling-plus-mobile health (mhealth) intervention to reduce sexual and reproductive health (SRH) risks for women with depression and high-risk sexual behavior. Due to the COVID-19 pandemic limiting in-person care, we sought to develop the counseling and mhealth app onboarding for virtual implementation. A team with SRH, adolescent medicine, motivational interviewing, cognitive behavioral therapy, and technology expertise adapted the counseling through an iterative consensus process. We identified essential aspects of the counseling, specified the content so the counseling could be delivered in person or virtually with fidelity, and considered best practices for telehealth for the focus population. Virtual counseling retained key elements from in-person counseling while including enhancements with engaging visual and audio–video aids. Instructions and programming were developed to support virtual counseling delivery and onboarding for the mhealth app component of MARSSI. After testing the virtual format in mock sessions, we implemented a small-scale feasibility study in an adolescent medicine clinic with women with depressive symptoms and high-risk sexual behavior age 18–24 years (N = 9). Participants experienced minimal technical difficulties and expressed satisfaction with the virtual format, and all were able to complete app onboarding successfully. Expanding delivery options for SRH interventions to include virtual can improve access, particularly for populations with psychological and environmental barriers to care. [ABSTRACT FROM AUTHOR]

The present study sought to identify differences in the rates and predictors of risky sexual behavior among college students with and without attention-deficit hyperactivity disorder (ADHD). Current ADHD diagnosis, medication status among those with ADHD, executive functioning, substance use, comorbid anxiety, comorbid depression, and gender were identified as potential predictors of increased risky sexual behavior. Multiple group latent growth curve modeling was used to estimate trajectories of risky sexual behavior across four years of college among college students with ADHD (nmedicated = 99, nunmedicated = 105) and a comparison group (n = 217) recruited from colleges throughout the eastern United States (M age = 18.23 years, 53% female, 70% White). First-year college students with ADHD reported significantly higher rates of sexual risk behavior than their peers without ADHD, with no significant differences found based on medication status. Students with ADHD who were taking medication for ADHD reported significant decreases in risky sexual behavior over time. Among college students with ADHD, anxiety was related to increased current risky sexual behavior in the medicated group, while depression was predictive of decreased future risky sexual behavior in the unmedicated group. Alcohol and cannabis use were significantly associated with increased mean levels of risky sexual behavior across all three groups, and cannabis use was associated with decreased future risky sexual behavior within the comparison group. Executive functioning deficits and male gender were predictive of risky sexual behavior within the comparison group. The results demonstrate that college students with ADHD, regardless of medication status, are at an increased likelihood of engaging in risky sexual behavior. [ABSTRACT FROM AUTHOR]

Few studies have examined sexual risk behaviors of HIV-positive, heterosexual, injection drug using (IDU) men. We investigated such behaviors and associations with risk among sexually active, HIV-positive IDU men who reported only female sex partners in the 3 months prior to baseline interview. We examined associations separately for four non-exclusive groups of men by crossing partner type (main or casual) and partner serostatus (HIV-positive or HIV-negative/unknown). Of 732 male participants, 469 (64%) were sexually active with only female partners. Of these 469 men, 155 (33%) reported sex with HIV-positive main partners, 127 (27%) with HIV-negative or unknown serostatus main partners, 145 (31%) with HIV-positive casual partners, and 192 (41%) with HIV-negative/unknown serostatus casual partners. Significant multivariate associations for unprotected sex with HIV-negative or unknown serostatus main partners were less self-efficacy to use condoms, weaker partner norms supporting condoms, and more negative condom beliefs. Similar correlates were found for unprotected sex with HIV-positive main and casual partners. In addition, alcohol or drug use during sex was a significant correlate of unprotected sex with HIV-positive main partners, while depression was significant for HIV-positive casual partners. For unprotected sex with HIV-negative/unknown status casual partners, self-efficacy for condom use, sex trade, and education were significant multivariate correlates. A combination of broad and tailored intervention strategies based on the relationship pattern of men's lives may provide the most benefit for reducing unprotected sex with female partners.

This study investigated the relationship between youth violence exposures (i.e., peer and neighborhood) and early sexual initiation. It also explored whether caring relationships with teachers might moderate this relationship and whether results differed for heterosexual versus non-heterosexual African American youth. The study sample (N = 580) comprised 475 heterosexual and 105 non-heterosexual youths, 319 female and 261 male, ages 13 to 24 years (M age = 15.8). Students were assessed for peer and neighborhood violence, relationship with teachers, early sexual initiation, sexual orientation, and socioeconomic status. Major results indicated a positive relationship between exposure to peer and neighborhood violence and early sexual initiation for heterosexual youth but not those who identified as non-heterosexual. Further, identifying as female (vs. male) was significantly associated with later sexual initiation for both heterosexual and non-heterosexual youth. In addition, caring teachers moderated the relationship between exposure to peer violence and age of sexual initiation among non-heterosexual youth. Programs and interventions to curtail violence sequelae would need to consider the unique effects of various types of youth violence exposures and the significance of sexual orientation. [ABSTRACT FROM AUTHOR]

Purpose of Review: Sexual and gender minority (SGM) individuals are diagnosed with HIV at disproportionate rates, and hazardous alcohol use can increase their HIV risk. This review assessed the state of the literature examining interventions for addressing alcohol use and sexual HIV risk behaviors among SGM individuals. Recent Findings: Fourteen manuscripts from 2012 to 2022 tested interventions that address both alcohol use and HIV risk behaviors among SGM populations, with only 7 randomized controlled trials (RCTs). Virtually all the interventions targeted men who have sex with men, with none focused on transgender populations or cisgender women. While they demonstrated some evidence of effectiveness in reducing alcohol use and/or sexual risk, the outcomes varied widely between studies. Summary: More research is needed that tests interventions in this area, particularly for transgender individuals. The use of larger-scale RCTs with diverse populations and standardized outcome measures are needed to strengthen the evidence base. [ABSTRACT FROM AUTHOR]

Transgender women experience disproportionate risk of HIV acquisition and transmission. We piloted 'Sheroes', a peer-led group-level intervention for transgender women of any HIV status emphasizing empowerment and gender affirmation to reduce HIV risk behaviors and increase social support. Participants (N = 77) were randomized to Sheroes (n = 39) or a time- and attention-matched control (n = 38). Sheroes is 5 weekly group sessions; topics include sexuality, communication, gender transition, and coping skills. Control participants attended 5 weekly group movie sessions. At 6-month follow up, HIV-negative and unknown status Sheroes participants reported reductions in condomless intercourse and improved social support compared to control. Among participants living with HIV, both the control and intervention groups reduced their total number of sex partners; this change was sustained at 6-month follow-up for Sheroes participants but not for control participants relative to baseline. Sheroes was deemed highly feasible and acceptable to participants; findings support preliminary efficacy of Sheroes.

Objectives: To compare women with men presenting with HIV to a public health HIV clinic, to identify the special characteristics and health care needs of women living with HIV in the Barwon South West region in Victoria. Methods: A retrospective cohort study of 35 women and 135 men living with HIV who attended the clinic between 2009 and 2020. Gender differences were assessed using nonparametric analyses. Results: The women were diagnosed with HIV younger than the men (mean 29.5 years vs. 36.7 years) and more were born in Africa (28.6% vs. 5.2%). More men than women presented with sexually transmittable infections (38.5% vs. 14.3%) at the time of diagnosis, and were diagnosed through a sexual health screen (37% vs. 17%). The proportions of men and women who used alcohol and other drugs (recent to their diagnosis) were similar (68.1% vs. 48.6%), and there was no difference in proportions presenting with AIDS-defining illnesses (p?=?0.425), or CD4 cell count (advanced: ?200 cells, relatively well: ?201 cells, p?=?0.241), but the women had a lower viral load (p?0.001). Conclusions: In this study of 170 people living with HIV, nearly one-half of the men with known HIV history were diagnosed through sexual health screens, but women's HIV was mostly detected through targeted screening. Results highlight gender disparity in access to sexual health screening and assessment, including low awareness of sexual health risks for women, and endorse the view that HIV is a heterosexual sexually transmittable infection in women.

Background: Sexual autonomy is an influential component of sexual health risk reduction frameworks, but a universal assessment of sexual autonomy is currently lacking. Objectives: This study develops and validates the Women's Sexual Autonomy scale (WSA), a comprehensive measure that captures women's perception of their sexual autonomy. Design: Forty-one items were initially created based on current research and in consultation with sexual health experts. In Phase I, a cross-sectional study with 127 women was conducted to finalize the scale. In Phase II, a cross-sectional study with 218 women was conducted to test the stability and validity of the scale. A confirmatory factor analysis was conducted with an independent sample of 218 participants. Methods: In Phase I, principal component analysis with promax rotation was conducted to examine the factor structure for the sexual autonomy scale. Cronbach's alphas were conducted to assess the internal consistency of the sexual autonomy scale. In Phase II, confirmatory factor analyses were conducted to confirm the factor structure of the scale. Logistic and linear regressions were used to assess validity of the scale. Unwanted condomless sex and coercive sexual risk were used to test construct validity. Intimate partner violence was used to test predictive validity. Results: Exploratory factor analysis identified four factors across 17 items: 4 items on sexual cultural scripting (Factor 1), 5 items on sexual communication (Factor 2), 4 items on sexual empowerment (Factor 3), and 4 items on sexual assertiveness (Factor 4). Internal consistency for the total scale and subscales were adequate. The WSA scale showed construct validity by negatively relating to unwanted condomless sex and coercive sexual risk, and predictive validity by negatively relating to partner violence. Conclusion: The results of this study suggest the WSA scale provides a valid, reliable assessment of sexual autonomy for women. This measure can be incorporated into future studies investigating sexual health. [ABSTRACT FROM AUTHOR]

BACKGROUND: Early sexual reproductive health (SRH) education is linked to a reduction in risky sexual behaviors. Sexually transmitted infections (STIs) are rising at alarming rates. Risky sexual behaviors, including initiation of sex before age 13, having more than four sexual partners, and lack of use of condoms, increase the chance of infection and cancer. Informing students about the link between risky behaviors and cancer is vital to reduce morbidity and mortality. METHODS: A trend analysis of the Youth Risk Behavior Surveillance System (YRBSS) data between 2001 and 2019 was conducted. Results from four survey responses related to sexual risk behaviors among 9th to 12th grade in Mississippi students are compared with their US peers. RESULTS: Between 2001 and 2019, favorable declines in 3 out of 4 sexual risk behaviors were observed. Declining prevalence was reported for "ever had sexual intercourse," "age of sexual initiation at age 13 or younger," and "having 4 or more sexual partners in their lifetime" are promising. However, fewer students report using condoms. The adjusted prevalence rates for Mississippi students in all 4 measures were higher than the national responses. CONCLUSIONS: Our analysis supports the need for early skill‐based sex education to promote health. States with increased behavioral risk among students should consider trends in data to improve education and policy. [ABSTRACT FROM AUTHOR]

Objective: The internet and social media enhance communication, education, and social connection among users; however, some adverse effects on health are notable, particularly sexual risk engagement and mood problems. Mobile dating applications (apps)/websites facilitate high sexual-risk access, particularly among lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals. Recognition of the characteristics of using these platforms and identifying factors related to high sexual risk among LGBTQ youths will facilitate both targeting of those at risk and subsequent intervention. Materials and Methods: Adolescents and youths were invited to voluntarily join this study, scan the QR code, and anonymously complete the questionnaires. These validated questionnaires were launched online via a popular platform among LGBTQs during 2017-2018. Multiple logistic regression was employed to identify factors independently associated with high sexual risk among study subjects. Results: Of 360 participants (mean age: 21±2.8 years, range: 11-25), 60.8% self-reported as homosexual, and the rest were bisexual. Median dating app/website usage was 2 (range 1-10). Two-thirds (62.8%) met partners from those e-platforms, and most (79.6%) developed a sexual relationship. Over half (52.2%) did not use a condom, and one-third (30.6%) abused substances during sex. Poor condom compliance, multiple partners, and substance use were strongly associated with individuals who used >2 apps for longer than 3 years. Depression susceptibility was 32.2%, and was related to condom-use failure (p=0.01). Conclusion: Among LGBTQs, the greater the number and longer time exposed to dating apps/websites, the higher the number of sexual risk behaviors. Moreover, unsafe sex increased among individuals at risk for depression.

The greatest proportion of new HIV infections among men who have sex with men (MSM) is occurring among young Black MSM (YBMSM) ages 13-24. Consequently, research is needed to understand the psychosocial pathways that influence HIV risk and resilience in YBMSM. Minority Stress Theory proposes that the stigma, prejudice, and discrimination facing sexual and racial minorities are chronic stressors that lead to increased engagement in risk behaviors. The present study examined whether minority stress is associated with stimulant use and sexual risk behaviors by depleting psychosocial resilience. We recruited 1817 YBMSM, ages 18-29, from multiple venues in two major cities in Texas for participation in a brief survey. Results from structural equation modeling indicated that decreased resilience partially mediated the association of minority stress with sexual risk behavior. Resilience was also negatively associated with stimulant use. Interventions focused on cultivating psychosocial resilience could mitigate the deleterious consequences of minority stress and reduce stimulant use in YBMSM.

This study examines substance use, emotional/behavioral symptoms and sexual risk among first-time offending, court-involved, non-incarcerated (FTO-CINI) youth. Youth and caregivers (N=423) completed tablet-based assessments. By time of first justice contact (average 14.5 years old), 49% used substances, 40% were sexually active and 33% reported both. Youth with co-occurring substance use and sexual risk had more emotional/behavioral symptoms; youth with delinquent offenses and females had greater co-occurring risk. Time of first offense is a critical period to intervene upon high rates of mental health need for those with co-occurring substance use and sexual risk to prevent poor health and legal outcomes.

Objectives: This study examined associations between young adults' psychological characteristics and psychosocial consequences of sex, and whether risky sexual encounters mediated these associations. Methods: College students (N = 265; Mage = 19.49) completed questionnaires concerning risky sexual relationships, behaviors, situations, and psychosocial consequences during their most recent encounter and over the last year. Results: Sexual restraint indirectly predicted positive consequences of the most recent encounter via risky sexual behaviors. Sexual restraint and permissiveness predicted positive and negative consequences over the past year via risky relationships. Conclusions: Psychological characteristics may influence the likelihood of risky sexual encounters, thereby influencing consequences. [ABSTRACT FROM AUTHOR]

Early life adversity (ELA) is associated with sexual risk, but ELA dimensions—and potential mechanisms—have been less examined. We evaluated associations between threat and deprivation—two key ELA dimensions—and sexual behaviors in adolescents. Secondary analyses investigated age at menarche as a mechanism linking ELA with sexual outcomes in girls. We predicted associations between threat and sexual behaviors, with younger age at menarche as a pathway. Data were from the National Comorbidity Survey, Adolescent Supplement. Adolescents and caregivers reported on youths' ELA experiences, which were categorized as threat- or deprivation-related. Adolescents reported if they engaged in sex (N = 9,937) and on specific sexual risk indicators, including age at first sex, number of past-year sexual partners, and condom use consistency ("always" vs. "not always" used). Girls reported age at menarche. Threat (odds ratio [OR] = 1.76 [95% confidence interval [CI], 1.62–1.92]) and deprivation (OR = 1.51 [95% CI, 1.24–1.83]) were each linked with engagement in sex, p s<.05. Threat-related experiences were associated with multiple sexual risk markers, even when accounting for deprivation: earlier age at first sex (b = −0.20 [95% CI, −0.27 to 0.13]), greater number of partners (b = 0.17 [95% CI, 0.10–0.25]), and inconsistent condom use (OR = 0.72 [95% CI, 0.64–0.80]), p s <.001. Deprivation was not associated with sexual risk when adjusting for threat. We observed no significant indirect effects through age at menarche. Although threat and deprivation were related to engagement in sexual activity, threat-related experiences were uniquely associated with sexual risk. Screening for threat-related ELA may identify adolescents at-risk for poor sexual health. [ABSTRACT FROM AUTHOR]

According to the epidemiological paradox, less acculturated Latina/o youth display fewer sexual risk behaviors. A systematic review was performed on psychosocial and cultural mechanisms potentially underlying the epidemiological paradox in sexual risk behaviors of U.S. Latina/o youth across acculturation measures (between January 2000 to October 2022). Thirty-five publications (n = 35) with forty-eight analyses of underlying mechanisms met the inclusion criteria. Thirty-one results from twenty-three publications found supporting evidence that one of the five factors was an underlying mechanism in the epidemiological paradox (n = 13 parenting practices, n = 4 peer influences, n = 4 familismo values, n = 4 religiosity, n = 6 traditional gender norms) as, generally protective, mediators or moderators in the link between acculturation and sexual risk behaviors. Studies varied in the sexual risk behavior examined and measurement of acculturation, but primarily employed cross-sectional designs and recruited samples through schools. Mechanisms that enhance close ties and unity of the family, such as those of familismo values and positive parenting, reduce the likelihood of sexual risk behaviors as Latina/o youth become more acculturated. Future directions are discussed which may provide guidance for risk prevention and intervention. [ABSTRACT FROM AUTHOR]

Amidst a global pandemic, survival needs become salient and the ability of individuals to regulate feelings and actions might be particularly relevant to protecting themselves from harm. Drawing from Regulatory Focus Theory individuals who are more focused on prevention are also more likely to enact health-protective behaviours, including sexual health behaviours, because they are more aware of threats. Extending this reasoning to the COVID-19 pandemic, we conducted a pre-registered longitudinal study with 174 individuals from 23 countries (Mage = 30.66, SD = 11.81; 77.6% women), to examine the role of regulatory focus in predicting the sexual activity of single individuals. We assessed demographic information, regulatory focus, and personality traits at baseline (T1), perceived threats two weeks later (T2), and sexual activity indicators two weeks later (T3). As hypothesised, results showed that single individuals who reported a greater focus on prevention at the onset of the pandemic perceived more pandemic-related threats and, in turn, reported less frequent sexual activity. These effects were consistent even when controlling for promotion (i.e. pleasure motives), personality, geographic location, local social distancing policies, gender, and sexual orientation. Findings are discussed considering their implications for the sexual functioning and sexual health of single individuals. [ABSTRACT FROM AUTHOR]

ABSTRACT: Objectives: We examined sex-specific associations of partner age disparity and relationship concurrency with Neisseria gonorrhoeae and/or Chlamydia trachomatis (NG/CT) infection, higher-risk relationships, and condom use as proxies for HIV risk. Methods: Data were collected in 2016 from 2179 adults in 12 communities in Uganda and Kenya. Logistic regression models examined associations of age disparity and relationship concurrency with NG/CT infection, condom use, and higher-risk (commercial sex and other higher-risk) relationships in the past 6 months, controlling for covariates. Results: Partner age and relationship concurrency were associated with NG/CT infection in women but not men. Relative to women in age-disparate relationships, women in both age-disparate and age-homogeneous relationships had higher odds of NG/CT infection (adjusted odds ratio [aOR]=3.82, 95% confidence interval [CI]: 1.46–9.98). Among men and women, partnership concurrency was associated with higher-risk partnerships. In addition, relative to those with a single age-homogeneous partner, those with concurrent age-homogeneous partners had higher odds of condom use (men: aOR=2.85, 95% CI: 1.89–4.31; women: aOR=2.99, 95% CI: 1.52–5.89). Concurrent age-disparate partnerships were associated with condom use among men only (aOR=4.02, 95% CI: 2.54–6.37). Conclusion: Findings underscore the importance of targeted HIV prevention efforts for couples in age-disparate and concurrent relationships.

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

Abstract Background HIV prevention, diagnosis, treatment and care services might be hampered by inaccurate risk assessment. This study aimed to investigate the extent of and factors associated with the discordance between perceived risk and actual risky sexual behaviors among undergraduates in mainland China, guided by the Anderson's behavioral model. Methods This study involved a secondary analysis of cross-sectional data collected during the fall semester of 2018–2019 academic year. The present analysis was restricted to 8808 undergraduates with low risk perception. Those who had low perceived risk but actually engaged in risky sexual behaviors were categorized as risk discordance (RD). Univariate and multivariate Logistic regression analyses were conducted to identify factors associated with RD. Results Overall, the discordance rate between perceived and actual risk was 8.5% (95% CI: 7.9%-9.1%). Multivariate Logistic regression analysis indicated that non-heterosexual women (AOR = 0.41, 95% CI:0.27–0.60), heterosexual men (AOR = 0.45, 95% CI:0.33–0.61) and women (AOR = 0.26, 95% CI:0.19–0.35) were less likely to exhibit RD, when compared with non- heterosexual men. Furthermore, non-freshmen (AOR = 1.57, 95% CI:1.30–1.90), early initiators of sexual intercourse (AOR = 5.82, 95% CI:4.10–8.26), and those who had lower levels of HIV knowledge (AOR = 1.28, 95% CI:1.08–1.51), displayed higher levels of stigma against PLHIV (AOR = 1.50, 95% CI:1.26–1.77) and had ever been tested for HIV (AOR = 1.36, 95% CI:1.04–1.77) were more prone to reporting RD. Those with more enabling resources [i.e., displaying high levels of condom use self-efficacy (AOR = 0.70, 95% CI:0.59–0.84) and being knowledge of local testing center (AOR = 0.71, 95% CI:0.60–0.83)] were less likely to report RD. However, spending more than 2000 Yuan a month on basic needs (AOR = 2.55, 95% CI:2.07–3.14), residing in urban areas (AOR = 1.35, 95% CI:1.15–1.59) and being knowledgeable of the national AIDS policy (AOR = 1.40,95% CI:1.18–1.66) increased the chance of exhibiting RD. Conclusions Comprehensive interventions, including targeting students with high-risk characteristics, improving the acceptability of PrEP and PEP, conducting health education, enhancing self-efficacy for using condoms and making opt-out HIV testing routine in college campus, should be taken to reduce the discordance between perceived and actual HIV risk and finally to reach the goal of Zero AIDS.

BackgroundIn the United States, problematic stimulant use is a prevalent and difficult to treat problem among men who have sex with men (MSM), as well as a major driver of HIV transmission through the large number of sexual partners and concomitant condomless anal sex (CAS). Evidence-based behavioral studies that address problematic stimulant use in MSM at risk for HIV infection are also lacking. In this paper, we describe the design of a behavioral intervention trial to reduce sexual risk behavior and stimulant use in HIV-uninfected MSM.MethodsThis study, funded by the National Institute on Drug Abuse (NIDA), is a randomized controlled trial (RCT) testing an integrated HIV risk reduction and behavioral activation counseling intervention (IMPACT) for HIV-uninfected, stimulant using MSM in Boston, MA, and Miami, FL. Participants are randomized (2:2:1) to either (1) the IMPACT intervention; (2) a relaxation condition, an active therapy time- and intensity-matched control; or (3) a standard of care risk reduction counseling comparison. At enrollment, all participants receive an HIV test and pre- and post-test counseling. The primary outcome is the difference in the rate of change in the number of self-reported condomless anal sex acts without the protection of consistent Pre-Exposure Prophylaxis (PrEP) use, as well as reductions in stimulant use during the prior 4-months. Major assessments are conducted at baseline, 4-, 8-, and 12-month follow-up visits.DiscussionEffective and sustainable behavioral interventions are sorely needed to reduce HIV acquisition in stimulant using MSM at risk for HIV infection. In this study, we will evaluate the evidence of efficacy of the IMPACT intervention to reduce HIV acquisition in HIV-uninfected, stimulant-using MSM. If found effective, the intervention tested here holds promise for being readily integrated into real-world clinical settings.Trial registrationClinicalTrials.gov number NCT03175159 , registered June 5, 2017.

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

This study assessed the role of mental health symptoms and motives for sex in the association between childhood sexual abuse (CSA) and sexual risk-taking among men who have sex with women (MSW). The sample consisted of young adult (ages 21 to 30), non-monogamous MSW (N = 532) who reported having condomless sex at least once in the past year. Due to alcohol-related aims from two larger studies from which the data were analyzed, participation was excluded to men who regularly consumed alcohol (3 to 35 weekly drinks) and reported no symptoms of alcohol use disorder. Participants answered background questionnaires in lab and then completed a six-week, follow-up survey assessing the number of sex partners and condom use during the prior six weeks. CSA survivors reported greater mental health symptoms and sex motives related to coping, self-affirmation, and partner approval relative to non-survivors. CSA, sex for partner approval, and sex to enhance motives were positively associated with the number of sex partners. Participants endorsing self-affirmation sex motives reported higher condom use than those who did not. CSA contributes to long-term mental and sexual health outcomes among MSW. Identifying and treating depressive and anxiety symptoms and motives for sex may improve sexual health among CSA survivors. [ABSTRACT FROM AUTHOR]

Background: Sexting refers to the exchange of sexually explicit digital content in the form of texts, photos, or videos. In recent years, sexting has become a public health concern. Surveys in Malaysia show a high prevalence of young adults engaged in sexting. Given that sexting is associated with sexual risk behavior, cyberbullying, and mental health issues, this behavior needs intervention to alleviate the resulting public health burden. However, there is a scarcity of theory-based intervention programs on the prevention of intention and willingness to sext among young adults. Objective: This study aimed to develop and implement a sexting intervention module guided by the prototype willingness model (PWM), delivered using web-based animated video, and evaluate its effectiveness among diploma students from a public higher educational institution. The primary outcomes were intention and willingness to sext, while the secondary outcomes were knowledge, attitude, perceived norms, and prototype perceptions of sexting. Methods: This 2-armed, parallel, single-blinded cluster randomized controlled trial was conducted in a public higher educational institution in the state of Melaka, Malaysia. Diploma students from 12 programs were randomly allocated into intervention and control groups. Both groups answered a self-administered web-based questionnaire assessing the outcomes at the baseline. The intervention group received a newly developed intervention module based on the PWM in the form of 5 animated videos posted on a private YouTube platform, while the control group was put on the waitlist. The intervention group was encouraged to discuss any issues raised with the researchers via WhatsApp private chat after viewing the videos. All participants were observed immediately and 3 months postintervention. Data analysis was performed with SPSS (version 26; IBM Corp). A generalized linear mixed model was used to determine the effectiveness of the intervention. Results: There were a total of 300 participants with an attrition rate of 8.3% (n=25). After adjusting for age, sex, relationship status, and the amount of time spent on the web, there were significant differences in the intention to sext (β=–.12; P =.002; Cohen d =0.23), willingness to sext (β=–.16; P <.001; Cohen d =0.40), knowledge (β=.12; P <.001; Cohen d =0.39), attitude (β=–.11; P =.001; Cohen d =0.31), perceived norms (β=–.06; P =.04; Cohen d =0.18), and prototype perceptions (β=–.11; P <.001; Cohen d =0.35) between the intervention and control groups over 3 months. Conclusions: In this study, the sexting intervention module using the PWM that was delivered via web-based animated videos was effective in reducing intention and willingness to sext as well as in improving knowledge of sexting, attitudes, perceived norms, and prototype perceptions. Therefore, relevant agencies involved in the promotion of sexual and reproductive health among young adults in Malaysia can consider the implementation of this module. Trial Registration: Thai Clinical Trial Registry TCTR20201010002; https://www.thaiclinicaltrials.org/show/TCTR20201002001 [ABSTRACT FROM AUTHOR]

In the digital neighborhood, Black and Hispanic youth communicate about issues they face, including sex and substance use. This population of young people is also disproportionately burdened by negative consequences associated with sex and substance use behaviors even when their behavior is less risky. Given the increased likelihood of negative outcomes, we investigated how young people communicate about these behaviors in their digital social networks. This mixed-methods study integrates a behavioral survey with a machine learning-supported, qualitative content analysis of one year of Facebook and Twitter posts from 50 Black and Hispanic youth, with feedback from a youth advisory board. Participants who had previously had sex or drank alcohol were more likely to post about sex or alcohol, respectively. Moreover, compared to male youth , female youth posted significantly more about sex in general and about STIs, HIV, and pregnancy. Posts about sexual behavior often discussed trust in sexual partners and gendered views of sex. Posts linked alcohol and marijuana with stress relief and coping withgrief, community violence, and distress. Understanding how youth think and communicate about sexual risk and substance use can inform the design of effective prevention efforts. Prior State of Knowledge: Social media offers an excellent window into youth perspectives and the ways they broadcast and communicate about their lives, beliefs, and health behaviors to their networked peers. Novel Contributions: In this community-engaged study, we center the experiences of Black and Hispanic youth in their digital neighborhoods to understand how youth talk about sex, drugs and alcohol in their own words. We examined the interplay between posts, social identities and health behaviors. Practical Implications: For practitioners using social media in prevention efforts, integrating youth voices and expertise in the development of online prevention efforts may be more effective in identifying drivers of risk taking and supporting risk reduction behavior. [ABSTRACT FROM AUTHOR]

The Structured Assessment of PROtective Factors against Sexual Offending (SAPROF-SO) is a new assessment tool designed to capture protective factors for individuals with a history of sexual offenses and aligns with a strengths-based approach to treatment. The SAPROF-SO, Version 1 consists of 14 items across three subscales: Resilience, Adaptive Sexuality, and Prosocial Connection & Reward. The optional fourth subscale, Professional Risk Management, consists of six items. The current paper seeks to provide guidance in the applied clinical use of the SAPROF-SO by addressing three advantages of the use of this instrument: (1) Facilitating engagement: establishing collaborative treatment goals and a therapeutic alliance, especially with clients who remain ambivalent about treatment; (2) Using the SAPROF-SO for risk management decision: determining the readiness for decreased supervision / increased level of privileges and the development of a risk management plan; and (3) Release planning for individuals with special needs. Case examples are provided. The current paper provides an overview of a new assessment tool, Structured Assessment of PROtective Factors against Sexual Offending (SAPROF-SO), Version 1. The SAPROF-SO is designed to offer clinicians an assessment tool that aligns with a strengths-based approach to treatment, provides a structured assessment of protective factors, and brings balance to risk assessments. The current paper provides clinical guidance in using the SAPROF-SO to increase treatment engagement, assist with risk management decisions, and better assess individuals with special needs. [ABSTRACT FROM AUTHOR]

Social capital, namely civic engagement, adult support, and community support, shapes behaviors in meaningful ways, yet the literature examining the relationship between social capital and sexual risk behaviors and HIV testing among youth remains limited. This study examined the influence of social capital on sexual risk behaviors (i.e., unprotected sex, multiple sex partners, and being drunk or high prior to sex) and HIV testing among youth. A total of 200 primarily ethnic minority youth (mean age of 17.4 years) in Denver, Colorado were included in the study. Structural equation modeling findings indicate that higher levels of social capital were associated with unprotected sex and less HIV testing. Additionally, the association between social capital and sex with multiple partners was mediated by sex refusal self-efficacy. Youth may benefit from social capital, but it may not have the same protective or health-promotive value for youth as for adults.

Background: The ongoing volatile opioid epidemic remains a significant public health concern, alongside continued outbreaks of HIV and hepatitis C virus among people who inject drugs. The limited access to and scale-up of medications for opioid use disorder (MOUD) among people who inject drugs, coupled with multilevel barriers to pre-exposure prophylaxis (PrEP) uptake, makes it imperative to integrate evidence-based risk reduction and HIV prevention strategies in innovative ways. To address this need, we developed an integrated rapid access to HIV prevention program for people who inject drugs (iRaPID) that incorporates same-day PrEP and MOUD for this population. Objective: The primary objective of this pilot study is to assess the feasibility and acceptability of the program and evaluate its preliminary efficacy on PrEP and MOUD uptake for a future randomized controlled trial (RCT). We also aim to explore information on the implementation of the program in a real-world setting using a type I hybrid implementation trial design. Methods: Using a type I hybrid implementation trial design, we are pilot testing the nurse practitioner-led iRaPID program while exploring information on its implementation in a real-world setting. Specifically, we will assess the feasibility and acceptability of the iRaPID program and evaluate its preliminary efficacy on PrEP and MOUD uptake in a pilot RCT. The enrolled 50 people who inject drugs will be randomized (1:1) to either iRaPID or treatment as usual (TAU). Behavioral assessments will occur at baseline, and at 1, 3, and 6 months. Additionally, we will conduct a process evaluation of the delivery and implementation of the iRaPID program to collect information for future implementation. Results: Recruitment began in July 2021 and was completed in August 2022. Data collection is planned through February 2023. The Institutional Review Boards at Yale University and the University of Connecticut approved this study (2000028740). Conclusions: This prospective pilot study will test a nurse practitioner-led, integrated HIV prevention program that incorporates same-day PrEP and MOUD for people who inject drugs. This low-threshold protocol delivers integrated prevention via one-stop shopping under the direction of nurse practitioners. iRaPID seeks to overcome barriers to delayed PrEP and MOUD initiation, which is crucial for people who inject drugs who have had minimal access to evidence-based prevention. [ABSTRACT FROM AUTHOR]

Justice-involved youth may experience unique sexual and mental health risks related to both their gender and sexual orientation. Although previous research has revealed important gender and sexual orientation differences in the sexual and mental health of justice-involved youth, no study has yet examined gender and sexual orientation differences simultaneously within the same sample. The present study addressed this gap in a sample of 347 probation-involved youth, 13–17 years old, recruited as part of a randomized controlled trial of PHAT Life, an HIV/STI, mental health, and substance use prevention program. On the one hand, female and non-heterosexual youth were less likely than male and heterosexual youth to report having ever had sex and to be considered high sexual risk. On the other hand, female youth were more likely than male youth to test positive for STIs and to report certain mental health problems, but non-heterosexual youth showed no difference from heterosexual youth. Finally, female non-heterosexual youth were more likely to report externalizing problems than youth of other gender and sexual orientation combinations. Findings highlight the need for prevention and intervention efforts that specifically target justice-involved youth who identify as female, non-heterosexual, or both. [ABSTRACT FROM AUTHOR]

This study describes sex trafficking and associations with violence and health among female migrants in the sex industry in Mae Sot, Thailand. The mixed-methods study included a qualitative interview phase (n = 10), followed by a cross-sectional survey phase (n = 128). Entry via trafficking (force, fraud, or coercion [FFC], or as minors) was prevalent (76.6%), primarily FFC (73.4%). FFC was associated with inconsistent condom use, inability to refuse clients, poor health, and anxiety. Past-year violence was normative including client sexual violence (66.4%), client coercion for condom nonuse (> 95%), and police extortion (56%). Working conditions enabled violence irrespective of mode of entry. Profound unmet needs exist for safety and access to justice irrespective of trafficking history. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic and resulting public health response has disrupted the lives of adolescents and their families worldwide. We evaluated the impact of the pandemic on attitudes, beliefs, and sexual risk behavior among adolescents in Botswana. Participants were recruited using household-based sampling across residential districts (blocks) in and around Gaborone, Botswana, and completed surveys on laptop computers at a private, central location. We compared baseline survey data from 380 adolescents who completed the survey pre-pandemic (n = 139) to those who completed the survey intra-pandemic (n = 241). Participants had a mean age of 15.2 years; 58.6% were girls and 41.4% were boys. Intra-pandemic, participants reported greater engagement in transactional sex (38.1% compared to 13.6% pre-pandemic, p <. 05), more favorable attitudes toward transactional sex with sugar daddies and sugar mommies (p <. 05), greater intentions to remain sexually active in the future (29.2% vs.13.6%, respectively, p <.05), and lower self-efficacy in handling risky sexual situations (p <.01). Public health interventions that lessen these concerning shifts in attitudes and behaviors will be key to protecting the sexual health of adolescents and to supporting their safe transition to adulthood. [ABSTRACT FROM AUTHOR]

The exchange of money and gifts for sexual services between older male patrons and younger female actors is a prevalent social practice which has its concomitant challenges and tales of woes. This article explores the discourse of regret in sugar or transactional relationships from the nuanced narratives and experiences of female youth in Calabar metropolis, Cross River State, South-eastern Nigeria. The study gains insights from the psychological theory of regret which describes regret as an aspect of social emotion that expresses dissatisfaction as a proof of one's conviction of a past mistake. Drawing on ethnographic qualitative data sourced from semi-structured interviews and informal conversations with twenty female and ten male participants who have respectively been practitioners and patrons of transactional sex in the past five years, the study identifies failed promises, concurrent sexual partnership, sexual exploitation, dominance, and health challenges as predominant themes that emerge in female participants' discourses of regret in sugar relationships. Based on our sampled population, we conclude that sugar relationships are exploitative engagements, and recommend intervention priorities like sexuality education and employment creation for young women to empower them economically and reduce their dependence on men. [ABSTRACT FROM AUTHOR]