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We used an Intervention Mapping Approach (IMA) to derive multi-level HIV prevention strategies aiming to develop an HIV prevention intervention program among female sex workers (FSWs). We also aimed at pilot testing the effects of the IMA-based "HIV Prevention and Awareness Program (HIV-PAP)" on safe sex behaviors and its determinants among FSWs in Tabriz, Iran. To develop HIV-PAP, we conducted the six-step process of IMA. At Step 1, in a cross-sectional study, 140 FSWs were face-to-face interviewed. At Step 2, the program matrix was provided based on the importance and variability for identifying priority factors. At Steps 3 and 4, the methods and strategies for behavioral change were selected, and the HIV-PAP program components and materials were developed. At Steps 5 and 6, evaluation (as a pilot testing with Static-Group Comparison design) was conducted applying a pre-experimental study, in which 30 FSWs were assigned to intervention (n = 15) and control (n = 15) groups. The intervention group participated in a two-month long program, and one month later, the initial questionnaires were completed by both groups. The respondents (M age: 33.4 years, SD: 9.7) acquired low score (less than 50%) in negotiating for condom use (49.8%) only, and moderate scores (50–65%) in perceived social support (61.6%) and knowledge (60.5%). Adjusted for other variables, the factors (R2 = 32.0%) associated with safe sex behaviors among FSWs were predisposing factors [self-efficacy (β = 0.331), perceived norms (β = 0.945), and perceived barriers (β = 0.258)], condom use negotiation (β = 1.386), and environmental factors (β = 0.333). Our IM-based framework had an adequate fit index (χ2 = 130.8, CFI = 0.78). Looking for inter-group comparison after intervention, we found significant mean difference (MD) for knowledge (MD: 2.18; 95% Confidence Interval (CI) −.38 to 4.74, p < 0.05), self-efficacy to use condom (MD: 6.71; 95% CI − 1.85 to 9.29, p < 0.05), perceived risk (MD: 2.03; 95% CI 0.58, to 3.49, p < 0.05), perceived social support (MD: 4.64; 95% CI − 5.37 to 11.31, p < 0.01), and safe sexual behaviors (MD: 7.75; 95% CI − 4.19 to 9.71, p < 0.05). The HIV-PAP showed effectiveness in promoting safe sexual behaviors and their determinants among FSWs. Healthcare providers should better understand the determinants of safe sexual behaviors among FSWs in the settings with legal prohibitions for sex work. In such communities, they should try to either develop or adapt such stage-specific interventions, within which promoting the above-mentioned factors is the core priorities of the program. [ABSTRACT FROM AUTHOR]

In the United States, HIV prevalence is increasing in rural areas, specifically among rural adolescent sexual minority males (ASMM). However, it is unclear what HIV sexual risk behaviors rural ASMM engage in and what HIV preventative services they utilize. This study aimed to (1) document the lifetime HIV sexual risk behaviors and service utilization of rural ASMM and (2) compare rural–urban differences in the prevalence of HIV sexual risk behaviors and service utilization. We analyzed data collected from 1615 ASMM who participated in a baseline survey for an online HIV prevention program from April 2018 to June 2020. We compared the prevalence of lifetime HIV sexual risk behaviors and HIV healthcare utilization among rural and urban participants via descriptive statistics, chi-square tests, linear and logistic regressions, and zero-inflated Poisson regressions. These analyses indicated that rural ASMM were more likely than urban ASMM to engage in condomless sex when they had anal sex. Rural ASMM could benefit from offline and online evidence-based HIV prevention interventions, especially interventions that increase condom use. [ABSTRACT FROM AUTHOR]

In the southern USA, where religiosity is higher than in other parts of the country, many researchers have questioned if the religiosity of parents plays a role in emerging adults' risky sexual behavior (RSB). Specifically, research suggests that certain aspects of religiosity (i.e., conservatism) are especially detrimental when examining RSB. In the current study, college students (N = 585, 65.5% women, 69.2% White, 25.0% Black) completed the following self-report measures: the Stearns-McKinney Assessment of Religious Traits – Short Form, the Parental Environment Questionnaire, and the Student Sexual Risks Scale. Results of path analysis (reported statistics have p <.05) indicated that perceived maternal relationship quality had a significant negative association with RSB in emerging adult women, β = −.27, and men, β = −.20; perceived paternal relationship quality also associated negatively with RSB in women, β = −.12, and men, β = −.20. Of all the parental religiosity variables, only perceived maternal conservatism had a significant effect, where it demonstrated a positive association with RSB in women, β =.34, and men, β = −.20. These results suggest that perceived parent–child relationship quality and perceived maternal conservative religiosity influence emerging adult RSB. This study presents novel insight into the specific aspects of perceived parental religiosity that, at least in the current study, are found to influence RSB. [ABSTRACT FROM AUTHOR]

Prioritizing adolescent health is a public health priority to achieve the sustainable development goals, including reducing the risk of unsafe sex. Data on unsafe sex have remained scarce among adolescents in low-and middle-income countries (LMICs). To estimate the prevalence of unsafe sex in LMICs, we conducted secondary data analysis on the Global School-based Student Health Surveys among 244,863 students aged 13–17 years from 68 countries across five World Health Organization regions. The overall prevalence of ever had sex was 16.2%. The highest to lowest regional prevalence estimation of ever had sex was 30.5% (28.9–32.1) in the Americas, 28.6% (26.8–30.4) in Africa, 10.9% (9.2–12.6) in the Eastern Mediterranean, 9.6% (8.8–10.5) in South-East Asia, and 8.0% (6.8–9.1) in the Western Pacific. The highest prevalence of sexual intercourse before age 14 and practicing sexual intercourse without condom use were 36.5% (34.5–38.5) and 32.2% (30.1–34.3) in Africa, respectively. Findings suggest that current interventions are inadequate in promoting the uptake of safe sexual behaviors and an urgent intervention is needed. [ABSTRACT FROM AUTHOR]

Research on hooking up is rife with examinations of risky sexual health practices among LGBTQ+ young adults; yet, little has been written about the personal safety practices for this population. This omission is notable because safety practices can enhance the notable positive outcomes related to hooking up. Drawing on one-on-one interviews with 50 LGBTQ+ young adults (20 cismen, 20 ciswomen, two transmen, and eight others) in British Columbia, California, and Connecticut, we developed the safety spectrum theory, which used a spectral measurement to assess how LGBTQ+ young adults negotiate safety practices and implement safety rules. This spectrum was then applied to a three-step sequence of application (app)-based hookup rituals: online initiation, pre-meeting preparation, and in-person meetup. Results indicated that safety strategies may be dictated by situational factors, where individuals adapt to varying circumstances to be more in control of personal safety when hooking up. We further identified that participants move across the spectrum depending upon contextual factors, such as the gender of the potential hookup partner. This work suggests that LGBTQ+ young adults are mindful of their personal safety and deserve more credit than previously attributed in queer and sexual health research. From these findings, we provide evidence-based recommendations to make dating/hookup apps and public health campaigns more effective at mitigating hookup-related risks. [ABSTRACT FROM AUTHOR]

Black sexually minoritized men (SMM) and transgender women (TW) are subgroups with lower rates of substance use and comparable rates of condom use relative to White SMM and TW yet experience heightened vulnerability to HIV. This study sought to explore associations of substance use, including sex-drug use (i.e., drug or alcohol use during sex to enhance sex), and condomless sex among Black SMM and TW. Data were collected from Black SMM and TW living in Chicago, Illinois, enrolled in the Neighborhoods and Networks (N2) cohort study, from November 2018 to April 2019. We used bivariate analyses followed by a multilevel egocentric network analysis to identify factors associated with condomless sex. We conducted Spearman correlation coefficients to examine correlations between pairs of sex-drugs to enhance sex. We used a bipartite network analysis to identify correlates of sex-drug use and condomless sex. A total of 352 Black SMM and TW (egos) provided information about 933 sexual partners (alters). Of respondents, 45% reported condomless sex and 61% reported sex-drug use. In unadjusted analyses, marijuana (34%) and cocaine/crack (5%) sex-drug use were associated with condomless sex (p < 0.05). Condomless sex was positively associated with sex-polydrug use, or the use of 2+ drugs or 1 drug and alcohol (OR = 1.48; 95% CI: 1.02–2.14; p = 0.039), and negatively associated with sharing an HIV-negative serostatus with a sexual partner (OR = 0.57; 95% CI: 0.33–0.98; p = 0.041), having a different HIV serostatus with a sexual partner (OR = 0.37; 95% CI: 0.21–0.64; p < 0.001) or not knowing the HIV serostatus of a sexual partner (OR = 0.47; 95% CI: 0.26–0.84; p = 0.011). The following pairs of sex-polydrug use had Spearman correlation coefficients higher than 0.3: marijuana and alcohol, ecstasy and alcohol, cocaine/crack and ecstasy, and methamphetamine and poppers (p < 0.05). HIV prevention interventions for Black SMM and TW designed to reduce HIV transmission through egocentric sexual networks could address sex-drug use through sex-positive and pleasure-centered harm reduction strategies and provide and promote biomedical prevention and care options at supraoptimal levels. [ABSTRACT FROM AUTHOR]

Purpose: Perinatal intimate partner violence (IPV) is a prevalent problem in Peru, but no evidence-based interventions have been developed to address the needs of Peruvian pregnant women exposed to IPV. The current qualitative study examined existing resources in Lima, Peru for IPV-exposed pregnant women, barriers to women's access to resources, and how to make a new intervention for these women accessible and responsive to their needs. Method: Using thematic analysis, the study analyzed qualitative focus groups data from healthcare providers (N = 11) and pregnant women (N = 14, 50% of whom had experienced perinatal IPV) in Lima. Results: Women used word of mouth from other women to determine which community resources were trustworthy. Obstacles to resource utilization included IPV-related barriers, emotional barriers, and lack of knowledge about, access to, and trust in community and legal resources. Participants discussed that future interventions for IPV-exposed pregnant women should provide information to bolster women's resilience across the lifespan, such as childhood education about safe sex and gender equality, and education in adulthood about safety planning for IPV, healthy relationships, and maternal health and infant care. To improve resource accessibility, participants described the importance of fostering trust among women and healthcare providers, providing childcare, transportation, and mental and physical health services at little to no cost. Conclusion: Study findings have important implications for mental health supports, women's access to information, and broader social efforts aimed at reducing perinatal IPV in Peru, especially the role of accessible community resources in fostering women's resilience. [ABSTRACT FROM AUTHOR]

Unhealthy alcohol use and sexually transmitted infections (STIs) are significant public health concerns for US college students. Because alcohol use and condomless sex often co-occur in this population, alcohol-associated condomless sex has been identified as a behavioral intervention target. Existing theoretical frameworks have not garnered sufficient empirical support to serve as the foundation for interventions. The primary goal of the current study was to use a mixed-methods approach to develop a model of college student alcohol-associated condomless sex that combines elements from well-established health behavior theories. In Aim 1, multilevel modeling was used to predict condomless vaginal sex in a sample of heterosexual college student drinkers (N = 53). Aim 2 consisted of in-depth interviews (n = 18) to gather perceptions about the role of alcohol in sexual activity and identify supplemental constructs omitted from theories in Aim 1. The multilevel model explained a significant proportion of variance in condomless vaginal sex at the between- and within-person level. Themes derived from the in-depth interviews identified complementary elements of condom use decision-making. Findings from both aims were synthesized to construct a combined model of alcohol-associated condomless sex. This model can be further refined and ultimately serve as the foundation of an alcohol-STI prevention-intervention. [ABSTRACT FROM AUTHOR]

Sexuality and intimate relationships are topics of interest to adolescents and young adults with Autism Spectrum Disorder (ASD). However, their situation sometimes puts them at risk of being abused or developing self-harming behaviors. The purpose of this article is to develop a toolkit to support sexuality, sexual health, and sustainable sexual practices in youth with ASD. A Multimethod study based on a co-creation approach was used. Interviews were conducted with youth with ASD over the age of 18, with practitioners in a specialized setting, and with school-based practitioners in order to gain access to the different needs and expectations that they may have. Both practitioners and youth seem to agree that the lack of knowledge of youth with ASD is what most hinders their sexual development, followed by their social difficulties. They need access to the basics of sexuality in order to prevent the development of inappropriate behaviors at an early age. The kit could be used as early as age 12. The teaching methods chosen for the toolkit seems to be an adequate way to meet the need for access to basic information about sexuality for young people with ASD. The modalities also seem to be appreciated by both youth and specialist, particularly the use of custom-made pictograms. The toolkit created is a good starting point in bridging the knowledge gap for youth with ASD about sexuality. It would also lessen the burden placed on the various practitioners to do this teaching when they may not all be comfortable. [ABSTRACT FROM AUTHOR]

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]

This study aims to investigate whether Girl2Girl, a text messaging-based pregnancy prevention program for cisgender LGB+ girls, had different effects on subgroups based on age, sexual identity, and experience with penile-vaginal sex. A total of 948 girls, 14–18 years old, were recruited nationally via social media and enrolled over the telephone. Once they completed the baseline, they were randomized to either Girl2Girl or an attention-matched control program that discussed "healthy lifestyle" topics (e.g., self-esteem). Both programs were 5 months long: Girls received daily messages for 8 weeks, and then went through a "latent" period of 3 months, and finished with a 1-week review. Outcome measures included condom-protected sex, uptake of other types of birth control, abstinence, and pregnancy. Measures were collected at baseline; 3-month, 6-month, 9-month, and 12-month post-intervention end, which was 17 months after enrollment. Effect modification was examined using longitudinal mixed effects models. Overall, results suggested significant moderating effects of age, (f2 =.12), sexual identity (f2 <.14), and sexual experience (f2 =.11) on rates of condom use and use of other contraception. Although there were no significant moderating effects on pregnancy, abstinence, or intentions to use condoms, use birth control, or be abstinent, (p's >.16), patterns of effects were in the same direction as for significant findings. For example, at 9-month post-intervention, among those who identified as bisexual, the incidence rate of protected sex events was 39% higher for intervention vs. control (IRR = 1.39, 95% CI: 1.06–2.70), adjusting for baseline rate of condom use and sexual experience. Similarly, at 12 months, among bisexual participants, intervention participants had a significantly higher IRR of condom-protected sexual events (IRR = 2.65, 95% CI: 1.31–5.34). There were also higher odds of uptake of birth control use other than condoms for intervention vs. control at 6- (OR = 1.10, 95% CI: 1.01–1.77), 9 m (OR = 1.11, 95% CI: 1.07–1.89), and 12-month (OR = 1.13, 95% CI: 1.07–1.78) follow-up. Girl2Girl appears to be particularly effective for older adolescents, bisexual girls, and those who have already had penile-vaginal sex. No one single approach is going to affect teen pregnancy. Instead, it is more likely that different intervention content and delivery methods will be more accessible and salient to some but not other youth. Understanding for whom the intervention works is just as important as understanding for whom the intervention does not, as this can inform opportunities for future intervention development. Clinical Trial Registration: ClinicalTrials.gov ID# NCT03029962. [ABSTRACT FROM AUTHOR]

This study aims to describe and understand the relationship between sociodemographic factors and PrEP awareness, and willingness to use a PrEP modality (oral or injectable).Despite the availability of effective prevention tools such as HIV preexposure prophylaxis (PrEP), African immigrants in the United States are disproportionately affected by HIV. Although PrEP can significantly reduce HIV infection in this population, research evidence on PrEP outcomes, such as awareness, knowledge, and willingness to use, is extremely limited. Between April and May 2022, 92 participants completed an online survey assessing their awareness, knowledge, and willingness to use oral or injectable PrEP. The association between sociodemographic characteristics and PrEP-related measures was examined using descriptive and Pearson's chi-squared or Fisher's exact tests. Participants (N = 92) were born between 1990 and 1999 (46.7%), female (70.76%) and highly educated (59.6%). About 52.2% were unaware of PrEP, and 65.6% were willing to use a PrEP modality. Findings indicate that individuals who reported being aware of PrEP demonstrated a high level of knowledge regarding the medication. Having a healthcare provider was associated with PrEP awareness and willingness to use, while educational status was associated with PrEP awareness. 51.1% of participants were willing to use an oral pill for prevention and 47.8% were willing to use injectable PrEP. Our findings highlight the need for PrEP-related research and interventions for African immigrants to increase awareness and provide options for HIV prevention, as African immigrants are currently not well-represented in PrEP delivery systems in the US. [ABSTRACT FROM AUTHOR]

This study aimed to (1) describe male mildly intellectually disabled (MID) adolescents' general romantic and sexual development, education experience with topics on sexuality and relationships, and frequency of undesirable sexual behaviors and experiences; and (2) explore how sexuality related attitudes, self-esteem, sexual knowledge, and resilience to peer pressure link to MID male adolescents' sexual and dating violence (SDV) perpetration, SDV victimization and sexual risk behavior. We used baseline data from a randomized controlled trial on a program for psychosexual health promotion and prevention of undesirable sexual experiences for MID male adolescents (N = 120, Mage = 15.03 years), assessed with self-report questionnaires. We examined cross-sectional associations with correlations and (logistic) regression analyses between sexuality-related attitudes, global self-esteem, sexual knowledge, and resilience to peer pressure with SDV perpetration, SDV victimization and behavioral intentions following sexual rejection. Results indicated that male MID adolescents were romantically and sexually active, and reported unsafe sex, 47.7% experienced SDV perpetration and 33.9% victimization. Positive attitudes towards dating violence were associated with having experienced both SDV perpetration and victimization, and more adherence to heterosexual double standards was related to more negative and fewer positive behavioral intentions upon sexual rejection. Participants who experienced SDV victimization had more sexual knowledge. Self-esteem and resilience to peer pressure were unrelated to SDV. Concluding, male MID adolescents are similarly sexually active to the general population but may need more guidance in the form of timely, tailored prevention and education. We provide concrete suggestions such as focusing on changing attitudes and practicing skills. [ABSTRACT FROM AUTHOR]

Unsafe sex has become a public safety problem that endangers society, and research on deaths and disability-adjusted life years (DALYs) related to unsafe sex is valuable for global policy-making. We aimed to estimate the deaths and DALYs attributable to unsafe sex by country, gender, age group, and sociodemographic status from 1990 to 2019. We extracted data on disease burden from the Global Disease Burden 2019 (GBD 2019) database for unsafe sex, including deaths, DALYs and age-standardized rates (ASRs). Comparative analyses were performed on data about deaths, DALYs and the responding ASRs attributable to unsafe sex in different countries and regions using the Social Demographic Index (SDI). The global age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) attributable to unsafe sex were 11.98 (95% uncertainty intervals (UI): 10.97–13.52) per 100,000 people and 570.78 (95% UI: 510.24–658.10) per 100,000 people, respectively. Both the ASMRs and ASDRs were the highest in southern sub-Saharan Africa and lowest in Australasia and decreased with increasing SDI levels. About unsafe-sex-related disease, HIV/AIDS has the highest ASMR [8.48 (95% UI: 7.62–9.95)/100,000 people] and ASDR [447.44 (95% UI: 394.82–533.10)/100,000 people], followed by Cervical cancer [ASMR: 3.40 (95% UI: 2.90–3.81)/100,000 people and ASDR: 107.2 (95% UI: 90.52–119.43)/100,000 people] and sexually transmitted infections excluding HIV [ASMR: 0.10 (95% UI: 0.08–0.11)/100,000 people and ASDR: 16.14 (95% UI: 10.51–25.83)/100,000 people]. The death and DALY burden caused by these three diseases were more serious in the over 75 years old age group. The 40–44 age group for men and the 35–39 age group for women had the highest population of unsafe sex-related deaths and DALYs, respectively. In addition, the burden of unsafe sex in women was more serious than those in men. Unsafe sex is an important risk factor for global disease burden and a leading cause of substantial health loss. We found that the risk of ASMRs and ASDRs attributable to unsafe sex had negative correlation with SDI levels. These results demonstrate that the need for revised policies that focus on efforts to reduce overall unsafe sex worldwide. [ABSTRACT FROM AUTHOR]

Purpose: Adolescent and young adult (AYA) oncology populations have unique sexual health concerns that deserve more attention. Our study aimed to describe sexual health and related concerns in young adults (YAs) to move toward integrating sexual health into routine care. Methods: A total of 127 YAs (ages 19–39) in active treatment and survivorship from three outpatient oncology clinics provided demographic and clinical information. They completed versions of the NCCN Distress Thermometer and Problem List (AYA-POST; AYA-SPOST) developed specifically for AYAs as part of an ongoing needs assessment study. Results: Over one quarter (27.6%) of the total sample (Mage= 31.96, SD = 5.33) — 31.9% in active treatment (n = 72) and 21.8% in survivorship (n = 55) — reported at least one sexual health concern (i.e., sexual concern, loss of libido (desire for sex), pain with sex, and unprotected sex). Those undergoing active treatment with sexual concerns had significantly higher distress than those without sexual concerns, whereas this pattern was nonsignificant for those in survivorship. Both genders often endorsed general sexual concerns and loss of libido. Conclusion: The current study adds to the important and burgeoning literature on sexual health concerns of YAs oncology populations. The prevalence of sexual concerns, differences between treatment status and between those with and without sexual concerns highlight the utility and need to embed screening that includes sexual health items at point of care. This can facilitate discussion of these sensitive and multifaceted needs throughout the cancer continuum. [ABSTRACT FROM AUTHOR]

The college student population is among the highest risk group for contracting sexually transmitted infections (STIs) such as gonorrhea, chlamydia, and HIV. Safe sex practices, which are intended to mitigate risks associated with sexually transmitted infections, are often negated in the population of heterosexual college students. Historically, research on safe sex practices has shown that the burden of behavior change and the focus on educational efforts historically fall onto the female population. There is little published on how safe sex education for males impacts attitudes and behaviors towards safe sex practices. This community-based participatory research (CBPR) project explored heterosexual college male attitudes and behaviors about safe sex responsibilities with the goal of creating effective health promotion messages to increase safer sex. The research team comprised almost entirely of undergraduate male students, which strengthened the design and translation of results to practice. A mixed methods design was employed utilizing both focus groups and surveys as data collection (n=121). Results showed that young men are still prioritizing pregnancy prevention over disease contraction and/or testing, and relying on female partners to initiate safe sex. Implications for health promotion practice efforts on college campuses include: male-led peer education programming and support and messaging around screening and prevention of STIs. [ABSTRACT FROM AUTHOR]

The present study sought to evaluate the effectiveness of a Sex Education Intervention on sexual knowledge in a group of female adolescents with intellectual disabilities. This research was conducted in a pretest-posttest design with a control group. The sample included 30 female adolescents with intellectual disabilities that were selected through convenience sampling and randomly divided into two groups: an experimental group and a control group (15 participants in each group). The experimental group received 18 sessions of a Sex Education Intervention while the control group did not receive this intervention. Assessment of Sexual Knowledge in Adolescents (ASKA) was used to measure sexual knowledge of the adolescents. The results showed that Sex Education Intervention improved general sexual knowledge and subscales like parts of the body, public and private parts and places, puberty, relationships, social sexual boundaries, safe sex practices, and sex and the law in the experimental group. However, no effect of the intervention was observed in subscales of masturbation and sexuality. The present research emphasizes the importance of Sex Education Intervention in increasing sexual knowledge in female adolescents with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Unsafe sex has become a public safety problem that endangers society, and research on deaths and disability-adjusted life years (DALYs) related to unsafe sex is valuable for global policy-making. We aimed to estimate the deaths and DALYs attributable to unsafe sex by country, gender, age group, and sociodemographic status from 1990 to 2019. We extracted data on disease burden from the Global Disease Burden 2019 (GBD 2019) database for unsafe sex, including deaths, DALYs and age-standardized rates (ASRs). Comparative analyses were performed on data about deaths, DALYs and the responding ASRs attributable to unsafe sex in different countries and regions using the Social Demographic Index (SDI). The global age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) attributable to unsafe sex were 11.98 (95% uncertainty intervals (UI): 10.97–13.52) per 100,000 people and 570.78 (95% UI: 510.24–658.10) per 100,000 people, respectively. Both the ASMRs and ASDRs were the highest in southern sub-Saharan Africa and lowest in Australasia and decreased with increasing SDI levels. About unsafe-sex-related disease, HIV/AIDS has the highest ASMR [8.48 (95% UI: 7.62–9.95)/100,000 people] and ASDR [447.44 (95% UI: 394.82–533.10)/100,000 people], followed by Cervical cancer [ASMR: 3.40 (95% UI: 2.90–3.81)/100,000 people and ASDR: 107.2 (95% UI: 90.52–119.43)/100,000 people] and sexually transmitted infections excluding HIV [ASMR: 0.10 (95% UI: 0.08–0.11)/100,000 people and ASDR: 16.14 (95% UI: 10.51–25.83)/100,000 people]. The death and DALY burden caused by these three diseases were more serious in the over 75 years old age group. The 40–44 age group for men and the 35–39 age group for women had the highest population of unsafe sex-related deaths and DALYs, respectively. In addition, the burden of unsafe sex in women was more serious than those in men. Unsafe sex is an important risk factor for global disease burden and a leading cause of substantial health loss. We found that the risk of ASMRs and ASDRs attributable to unsafe sex had negative correlation with SDI levels. These results demonstrate that the need for revised policies that focus on efforts to reduce overall unsafe sex worldwide. [ABSTRACT FROM AUTHOR]

We establish a mathematical model to analyze what factors cause the epidemics of sexually transmitted diseases (STDs) and how to eliminate or mitigate them. According to the level of prevention awareness, we divide the susceptible population into two groups of individuals, whose behavior, population size, and recruitment rate are affected by the interventions. First, the threshold, R 0 , of STDs model is obtained. If R 0 < 1 , the disease-free equilibrium is globally asymptotically stable. We also obtain the conditions for switching the equilibrium state of the model among disease-free equilibrium, endemic equilibrium, and limit cycle. Second, the threshold and transcritical bifurcation show that interventions for high-risk sexual behaviors of high-risk susceptible individuals can eliminate STDs. Additionally, sex education, influenced by the size of infected individuals and by interventions, can effectively cut down the size of STDs. Third, extending the survival time of the infected individual may prolong the time to end STDs unless they reject high-risk sexual behavior. Fourth, we analyze the existence, stability, and direction of Hopf bifurcation, which may explain the periodic oscillation in the size of infected population. [ABSTRACT FROM AUTHOR]

Condoms provide protection against sexually transmitted diseases; however, condomless sex remains common among college students and intentions to use condoms do not consistently translate into condom use. This study tested which indicator of condom use intentions from a delay discounting paradigm of condom-protected sex best accounted for variance in condom use behavior. The sample consisted of 187 sexually active college students (51.9% female) who completed measures of condom use during vaginal and anal sex over the past three months and a decision-making paradigm regarding condom intentions with hypothetical sexual partners. In separate models, condom behavior was regressed on one of three indicators of condom intentions: initial intentions to use a condom, delay discounting of condom-protected sex, and overall area under the curve across all trials. Results showed that delay discounting of condom-protected sex best accounted for variance in absolute frequency of condomless sex, whereas initial intentions to use a condom best accounted for variance in relative proportion of condomless sex. Future research directions and implications for interventions are discussed. [ABSTRACT FROM AUTHOR]

Risky sexual behaviors (RSBs) incur large societal and personal costs. Despite widespread prevention efforts, RSBs and associated consequences (e.g., sexually transmitted infections) continue to rise. A proliferation of research has emerged on situational (e.g., alcohol use) and individual difference (e.g., impulsivity) factors to explain this rise, but these approaches assume an unrealistically static mechanism underlying RSB. Because this prior research has resulted in few compelling effects, we sought to innovate by examining the interaction of situation and individual differences in explaining RSBs. A large sample (N = 105) completed baseline reports of psychopathology and 30 daily diary reports of RSBs and associated contexts. These data were submitted to multilevel models including cross-level interactions to test a person-by-situation conceptualization of RSBs. Results suggested that RSBs are most strongly predicted from interactions of person- and situation-level factors in both protective and facilitative directions. These interactions outnumbered main effects and commonly included partner commitment as a central mechanism. These results point to theoretical and clinical gaps in preventing RSB and urge a departure from prior ways of conceptualizing sexual risk as a static outcome. [ABSTRACT FROM AUTHOR]

The article explores the question does sex positivity need sexual rights with focus on people living with disabilities (PLWD). Topics discussed include the sexual health and sexual citizenship of vulnerable group specifically PLWD and the vulnerability worries about how many PLWDs can aspire to safe sexual citizenship.

Previous research links risky sexual behavior (RSB) to externalizing problems and to substance use, but little research has been conducted on relationships between internalizing problems (INT) and RSB. The current study addresses that literature gap, using both a twin sample from Colorado (N = 2567) and a second twin sample from Minnesota (N = 1131) in attempt to replicate initial results. We explored the hypothesis that the latent variable INT would be more strongly associated with the latent variable RSB for females than for males, examining relationships between INT and RSB via phenotypic confirmatory factor analysis and multivariate twin analyses. We found a small but significant phenotypic association between the latent variables. However, despite using two large twin samples, limited power restricted our ability to identify the genetic and environmental mechanisms underlying this association. Our sex differences hypothesis was not fully supported in either sample and requires further investigation. Our findings illustrate the complexity of the relationship between internalizing problems and risky sexual behavior. [ABSTRACT FROM AUTHOR]

In recent years, gambling has evolved and grown substantially with new gambling activities and facilities being introduced, making gambling products and opportunities more available than ever before in Uganda. While the growth of gambling industry is considered to have a beneficial impact on the economy, it is increasingly becoming a social and public health issue especially among a minority of young people who experience problem gambling, which can damage personal, family, vocational, and academic pursuits. The present study estimated the prevalence of problem gambling and identified the socio-demographic, school, environmental and health risks of problem gambling among secondary school students in Mbarara Municipality, Uganda. A cross-sectional study was conducted among secondary school students in Mbarara Municipality. A total of 921 students from 12 schools were recruited using cluster sampling. An ordinal logistic regression model was used to explore the relationship between problem gambling and the socio-demographic, academic, environmental and health variables. Of 905 participants, 362 reported having ever gambled (40%), and 160 were classified as problem gamblers (17.7%; 44.2% among those who had ever gambled). Problem gambling was significantly associated with being male, being non-religious, other religion (African traditional religion), having employment (outside of school), distance to nearest gambling venue, parental gambling, peer gambling, substance use, risky sexual behavior, and psychological distress. The present study found a very high prevalence of problem gambling among Ugandan secondary school students. Therefore, there is need to institute public health measures towards raising awareness, prevention and treatment of problem gambling among Ugandan adolescents. [ABSTRACT FROM AUTHOR]

Limited access to sexual health information is a significant problem faced by young adults with intellectual and developmental disabilities. In a survey of family members and school-based professionals, we assessed which sexual health topics are covered by whom, as well as from whom survey respondents believe young adults with intellectual and developmental disabilities should be getting information. Participants report providing some sexual health information but that more information should be provided, especially on topics such as sexual orientation and gender identity. Results demonstrate medical providers are being expected to provide more sexual health information, and that the internet is a non-preferred source of education. These findings should inform recommendations about who should be providing sexual health education for young adults with intellectual and developmental disabilities. [ABSTRACT FROM AUTHOR]

Addressing the problem of suicidal thoughts in adolescents requires understanding the associated risk factors. Multiple studies have shown that risky sexual behavior affected the adolescents' psychological health that leads to their suicidal thoughts, behaviors and attempts. This study aimed to identify the association between various risky sexual behaviours and suicidal thoughts among unmarried adolescents in India. We used data collected from 4221 unmarried adolescent boys and 5987 unmarried adolescent girls aged 10–19 years, from the two rounds of the Understanding the Lives of Adolescents and Young Adults (UDAYA) survey. Descriptive analysis was done to observe changes in the selected variables from wave-1 to wave-2. Random effect regression analysis was used to estimate the association of suicidal thoughts among unmarried adolescents with their risky sexual behaviours. The percentage of adolescent boys having suicidal thoughts increased from 1.35% in wave 1 to 2.19% in wave 2. Among adolescent girls, the percentage increased from 2.92% in wave 1 to 5.05% in wave 2. A proportion of 3.26% adolescent boys had more than one sexual partner during wave 1 whereas in wave 2, it rose to 8.71%, while in case of adolescent girls, the estimates only increased from 0.26% at wave 1 to 0.78% at wave 2. Nearly 4.55% boys and 1.37% girls had early sexual debut. Almost five percentage boys were sexually active at wave 1 whereas in wave 2, it rose to 13.56%, while among adolescent girls, the estimates decreased from 1.54% at wave 1 to 1.51% at wave 2. Contraceptive use increased over time among both adolescent boy and girls. Also, a large proportion of adolescent boys reported watching pornography (27.08% at waive 1 and 49.39% at wave 2) compared to adolescent girls (4.46% at wave 1 and 13.10% at wave 2). Adolescents who had more than one sexual partner [Coef: 0.04; p < 0.001], exposed to early sexual debut [Coef; 0.019; p < 0.01], sexually active [Coef: 0.058; p < 0.001] and reported watching pornography [Coef: 0.017; p < 0.001] were more likely to have suicidal thoughts. Adolescent boys and girls with risky sexual behaviors are likely to be at a higher risk of suicidal ideation, and thus, they should be treated with special care and attention by local healthcare practitioners. [ABSTRACT FROM AUTHOR]

Women's ability to negotiate for safer sex has been found to be dependent on their household decision making power. However, there is paucity of studies investigating the association between women's household decision making power and safer sex negotiation in Ghana. Thus, we examined the association between women's household decision making autonomy and safer sex negotiation among Ghanaian women in sexual unions using the 2014 Ghana's Demographic and Health Survey. Descriptive statistics, Chi-square test, and multivariable logistic regression models were performed. Statistical significance was set at p <.05 at 95% confidence interval. The results showed high prevalence of safer sex negotiation among women with high household decision-making capacity (91.6%). Compared to women with low household decision making autonomy, those with high autonomy in household decision making were more likely to negotiate for safer sex (aOR = 2.06; CI = 1.32–3.21). Women aged 25–34 were more likely to negotiate for safer sex compared to those aged 15–24 (aOR = 1.50; CI = 1.07–2.11). Higher odds of safer sex negotiation were found among women with comprehensive HIV and AIDS knowledge (aOR = 1.49; CI = 1.09–2.05), women who had tested for HIV (aOR = 1.57; CI = 1.27–1.95) and those exposed to newspaper (aOR = 1.80; CI = 1.17–2.78) compared to those who had no comprehensive knowledge on HIV and AIDS, those who had never tested for HIV and those who were not exposed to newspaper, respectively. However, women who belonged to other ethnic groups and the Islamic religion had lower odds of safer sex negotiation compared to Akans (aOR = 0.68; CI = 0.48–0.96) and Christian women (aOR = 0.63; CI = 0.46–0.85). Women empowerment programmes need to be intensified to enable Ghanaian women with low household decision making autonomy to negotiate for safer sex with their partners. Ghana could achieve the Sustainable Development Goals (SDGs), particularly, SDG 3.7 (universal access to sexual and reproductive health services), and SDG 5 (achieve gender equality and empower all women and girls) when household decision-making capacity among women is further strengthened. [ABSTRACT FROM AUTHOR]

Self-objectification is associated with a number of negative mental and behavioral outcomes. Though previous research has established associations between self-objectification and risky sex, no study to date has examined whether self-objectification affects propensity to engage in risky sex. The current research employed an experimental design to examine the effect of heightened self-objectification on a laboratory analog of risky sex (n = 181). We observed that when college-attending women experienced a heightened state of self-objectification, they were more likely to engage in sex without a condom and less likely to wait to use a condom with a highly desirable partner. Given the frequency of intended and unintended objectifying messages that young women face, this increase in willingness to engage in risky sex behavior represents a consequential health concern. [ABSTRACT FROM AUTHOR]

Alcohol and sexual arousal are contextual determinants of condomless sex. Dual-process theory postulates that two types of cognitive processing contribute to the regulation of behavior: one that is fast, intuitive and automatic, and another that is slower and deliberative. This study applied a dual-process model to investigate condomless sexual behavior, highlighting the potential importance of implicit attitudes in condomless sex. We investigated whether the impact of alcohol and sexual arousal on condom use-related attitudes and intentions was explained by diminished working memory capacity, as dual-process models suggest. We also investigated whether this effect could be explained by implicit and explicit attitudes toward condom use. Male participants (N = 30) were randomized using a 2 × 2 within-subjects design that manipulated alcohol intoxication (placebo vs. alcohol beverages) and sexual arousal (neutral vs. erotic movie clips). We measured participants' working memory capacity, intentions to use a condom, and explicit and implicit attitudes toward condom use. Significant main effects of alcohol intoxication and sexual arousal on working memory capacity were found. No significant interaction was found for the combined effect of alcohol intoxication and sexual arousal on intentions to use a condom. There was no significant effect of implicit attitudes on intentions to use a condom, although a trend toward significance (p = 0.06) was found for the effect of implicit attitudes on intentions to use a condom when participants were in a state of alcohol intoxication. Theoretical and practical implications of this study are discussed. [ABSTRACT FROM AUTHOR]

Background and aims: In the current global scenario, the monkeypox virus has infected over 3000 individuals from endemic countries like Nigeria, along with non-endemic countries like the UK, Canada, the USA, etc. Based on the current information, it has been observed that monkeypox cases have primarily, though not exclusively, been found among men who have sex with men (MSM) in countries such as the UK. This article discusses the recent outbreak of monkeypox, its causes, and the various approaches to combat monkeypox infections. Methods: We evaluated the trends of recent outbreaks of monkeypox in different countries and compared them to how the COVID-19 pandemic started. Results: At present, monkeypox has been reported to spread to over 58 countries via skin-to-skin contact, body fluids, contaminated bed sheets, clothing, or respiratory routes. Smallpox vaccines have been proven to have 85% efficacy against monkeypox. To mitigate this current outbreak, WHO urges people to practice good hygiene and safe sex. The documentation of more cases and further onward spread in the countries in member states are most likely to reoccur, and if not contained, we might experience another global pandemic. Therefore, more research is required to avert this problem. Conclusion: Monkeypox virus is testing if we have complied with COVID-19 pandemic lessons and elucidates the urgency of research required to understand the monkeypox disease. [ABSTRACT FROM AUTHOR]

With the world's migratory flow, the risk of infection by the human immunodeficiency virus (HIV) among migrants is increasing. The prevalence of intercourse without condoms with a casual or commercial sex partner, a high-risk sexual behavior for HIV infection, is unknown among migrants. The purpose of this study was to determine the prevalence of intercourse without condoms among migrants and the risk factors associated with not using condoms. In Oujda, we conducted a cross-sectional survey of 416 sexually active migrants. We used a multistage sampling method. Face-to-face interviews were conducted with participants to collect socio-demographic information, disease perception, behavioral habits, sexual behavioral habits, and para-clinical parameters. A multivariate logistical regression analysis identified the risk factors associated with high-risk HIV sexual behaviors. The prevalence of intercourse without condoms with a casual or commercial sex partner was 72.8%, with a median age of 25.0 years, and 212 (69.9%) were males. The prevalence of HIV was 0.2%. Being homeless, having difficulty obtaining condoms, and only having a basic education were all risk factors for these sexual behaviors. Migrants with precarious living conditions are at increased risk of having intercourse without condoms. This group must be prioritized by strengthening public health programs targeting the health of migrants as well as the intervention of thematic non-governmental organizations. Vigilant monitoring of the HIV epidemic, with a focus on vulnerable populations, should be a high priority in Morocco. [ABSTRACT FROM AUTHOR]

There is extensive qualitative evidence of violence and enforcement impacting sex workers who are ethnically or racially minoritized, and gender or sexual minority sex workers, but there is little quantitative evidence. Baseline and follow-up data were collected among 288 sex workers of diverse genders (cis/transgender women and men and non-binary people) in London (2018–2019). Interviewer-administered and self-completed questionnaires included reports of rape, emotional violence, and (un)lawful police encounters. We used generalized estimating equation models (Stata vs 16.1) to measure associations between (i) ethnic/racial identity (Black, Asian, mixed or multiple vs White) and recent (6 months) or past police enforcement and (ii) ethnic/racial and sexual identity (lesbian, gay or bisexual (LGB) vs. heterosexual) with recent rape and emotional violence (there was insufficient data to examine the association with transgender/non-binary identities). Ethnically/racially minoritized sex workers (26.4%) reported more police encounters partly due to increased representation in street settings (51.4% vs 30.7% off-street, p = 0.002). After accounting for street setting, ethnically/racially minoritized sex workers had higher odds of recent arrest (adjusted odds ratio 2.8, 95% CI 1.3–5.8), past imprisonment (aOR 2.3, 95% CI 1.1–5.0), police extortion (aOR 3.3, 95% CI 1.4–7.8), and rape (aOR 3.6, 95% CI 1.1–11.5). LGB-identifying sex workers (55.4%) were more vulnerable to rape (aOR 2.4, 95% CI 1.1–5.2) and emotional violence. Sex workers identifying as ethnically/racially minoritized (aOR 2.1, 95% CI 1.0–4.5), LGB (aOR 2.0, 95% CI 1.0–4.0), or who use drugs (aOR 2.0, 95% CI 1.1–3.8) were more likely to have experienced emotional violence than white-identifying, heterosexual or those who did not use drugs. Experience of any recent police enforcement was associated with increased odds of rape (aOR 3.6, 95% CI 1.3–8.4) and emotional violence (aOR 4.9, 95% CI 1.8–13.0). Findings show how police enforcement disproportionately targets ethnically/racially minoritized sex workers and contributes to increased risk of rape and emotional violence, which is elevated among sexual and ethnically/racially minoritized workers. [ABSTRACT FROM AUTHOR]

Often viewed as right of passage in emerging adulthood on college campuses, most undergraduate students participate in casual sex during their undergraduate career. Sexual exploration typically continues during study abroad programs; however, these programs have previously been associated with an increase in risky sexual behavior due to a lack of familiar social norms and community. The current study examined the casual sexual relationships of 302 undergraduates participating in Semester at Sea, an eleven country, 106-day voyage which incorporates aspects of a traditional college campus combined with the novel experience of studying abroad. The purpose of this research was to explore students' casual sexual relationship perceptions and behaviors in the context of a structured and community-oriented study abroad environment. Over half (52%) of the student population completed a series of open-ended questions regarding their uncommitted sexual activity during the Semester at Sea voyage. Results indicated that 16.9% of students engaged in at least one casual sexual relationship over the course of the trip. Casual sex relationships on-board the Semester at Sea voyage were less prevalent than those on traditional college campuses, but casual sex relationships at sea appeared to focus more on the importance of communication and boundaries during the sexual relationship and concluded on a more positive note. It is likely that these decisions were influenced by the established communal culture on-board the ship, which encouraged students to maintain harmonious social relationships and a high level of awareness of others. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the sex education needs of people with spina bifida through their responses to a questionnaire. The questionnaire was disseminated to people with spina bifida between the ages of 18 and 40 years. Of the 436 questionnaires distributed, we received 48 valid responses (11.0%). The questionnaire included items related to demographic characteristics and preferences regarding the content of sex education. Twenty-two options were created to ascertain the desired content of sex education. These items were classified into the eight key concepts (KCs) specified by the International Technical Guidelines for Sexuality Education. T-tests were conducted for the eight KCs and gender, age, diagnosis, presence of hydrocephalus, physical function, and dating experience. Overall, most participants wanted to be educated on "KC1 Relationships" and "KC4 Violence and Staying Safe." Participants under 30 years of age wanted to be educated on "KC6 The Human Body and Development." Participants diagnosed with spina bifida aperta and those who used diapers/pads preferred to be educated on "KC2 Values, Rights, Culture, and Sexuality" and "KC3 Understanding Gender." Those who had been in a relationship preferred education in "KC3 Understanding Gender," "KC5 Skills for Health and Well-being," and "KC8 Sexual and Reproductive Health." Considering these results, we should enhance sex education for people with spina bifida. [ABSTRACT FROM AUTHOR]

Research on delay discounting and sex suggests that discounting measures correlate to risky sexual behavior. Dating applications are a growing trend in sexual partner seeking and dating culture, but the relationship between dating applications, delay discounting, and risky sexual behavior is relatively unknown. The present study sought to examine the relationship among reported dating application use, delay discounting, and risky sexual behavior. Participants completed a demographic questionnaire that included sexual history and dating-app status, a sexual risk survey, and a delay discounting task involving minutes of hypothetical sexual activity. Sexual discounting was significantly correlated with measures of sexual risk. The strength in correlation was higher for those using dating applications and nonexistent in those not using dating applications. No significant differences existed between dating application users and abstainers for sexual risk or sexual discounting. The implications regarding safe sex practices are discussed. [ABSTRACT FROM AUTHOR]

This study evaluates the impact of an intervention targeting high-risk behaviors among diverse, alcohol-using adults living with HIV (N = 267) from 2009 to 2013 in Miami, FL. The intervention took place in a group setting for eight sessions over 4 weeks and was compared to a didactic health promotion group. Assessments were conducted pre-intervention, post-intervention, and at 3, 6, and 12 months follow-up. Intervention participants (48% of sample) evidenced greater knowledge about HIV, more condom self-efficacy, and greater intentions to use condoms after participation. This was particularly noteworthy because associations among knowledge about HIV, more condom self-efficacy, and greater intentions to use condoms were negatively associated with intervention status at baseline. Participants also reported fewer heavy drinking days after participating in the intervention than those in the control group. Greater HIV knowledge, more condom self-efficacy and intentions to use condoms predicted more condom assertiveness; greater intentions to use condoms predicted fewer unprotected sexual behaviors. These findings underscore the importance of taking a comprehensive, multi-systemic approach to address risky behaviors in high-risk, diverse populations. [ABSTRACT FROM AUTHOR]

This pre-registered study examined the prevalence and correlates of sexual aggression in a sample of 530 Iranians (322 women, 208 men) with a behaviorally specific questionnaire distinguishing between different coercive strategies, victim-perpetrator relationships, and sexual acts. Significantly more women (63.0%) than men (51.0%) experienced at least one incident of sexual aggression victimization since the age of 15 years, and significantly more men (37.0%) than women (13.4%) reported at least one incident of sexual aggression perpetration. In women and men, the experience of child sexual abuse predicted sexual victimization and sexual aggression perpetration after the age of 15 years, both directly and indirectly through higher engagement in risky sexual behavior. Greater endorsement of hostile masculinity among men explained additional variance in the prediction of sexual aggression perpetration. This research is a first step towards documenting and explaining high rates of sexual aggression victimization and perpetration among Iranian women and men, providing important information for sex education as well for the prevention of sexual aggression. However, to achieve these goals, we highlight the need for systematic actions in all educational, social, and legal sectors of Iranian society. [ABSTRACT FROM AUTHOR]

The Information-Motivation-Behavioral skills (IMB) model has been a useful tool for understanding sexual risk behavior. However, its utility in predicting sexual risk behaviors among bar patrons, for whom the bar setting poses a higher risk of alcohol-related sexual risk behavior, has been underexplored. We assessed (1) the extent to which the IMB predicted number of episodes of unprotected sex in the past six months and (2) whether incorporating sex under the influence of alcohol and alcohol use improved the predictability of the model among bar patrons. Hierarchical regression models were conducted on data from 406 men and women from bars in rural areas of North-West province, South Africa. Behavioral skills were the sole IMB variable to predict unprotected sex with main partners (β = - 0.40; p < .001), explaining 18% of the variance. Variance explained increased to 21% with addition of sex under the influence of alcohol (β = 0.13; p = .019) and further increased to 26% with the addition of alcohol use (β = 0.24; p < .001). Motivation (β = - 0.21; p = .006) and behavioral skills (β = - 0.21; p = .006) were the significant IMB predictors of unprotected sex with casual partners (explaining 15% of the variance). Variance explained increased to 22% with the addition of sex under the influence of alcohol (β = 0.26; p = .001), but alcohol consumption was not an independent predictor of episodes of unprotected sex with casual partners. Interventions for improving HIV prevention behaviors among bar patrons should focus on enhancing individuals' behavioral skills and motivation and reducing their alcohol consumption. [ABSTRACT FROM AUTHOR]

People differ in their predispositions to value safety maintenance (i.e., disease prevention regulatory focus) or pleasure pursuit (i.e., pleasure promotion regulatory focus). Extending recent research, results of a cross-sectional study with participants living in Portugal and Spain (N = 770) showed that these individual differences resulted in a trade-off between potential health risks and pleasure rewards in sexual practices and experiences with casual partners. Specifically, people who were more focused on promotion (vs. prevention) reported riskier and more unrestricted sexual activities (more frequent condomless sex activities; more casual partners) and experienced more positive sexual outcomes (more sexual satisfaction; more positive and less negative affect related to condomless sex). This pattern of results remained the same after controlling for country differences, suggesting the robustness of our findings across different cultural contexts. Our study shows the complexity of sexual decisions and align with our reasoning that prevention-focused people tend to prioritize health safety, whereas promotion-focused people tend to prioritize sexual pleasure. Theoretical and applied implications are discussed. [ABSTRACT FROM AUTHOR]

In summary, our study documents contemporary patterns in HPV-associated cancer incidence among young men and highlights growing racial disparities that could be potentially minimized by improving HPV vaccination coverage. Human papillomavirus (HPV)-associated oropharyngeal and anal cancer incidence has increased markedly among men over the last several decades in the United States (US).[1] Recent studies reported decreased cervical cancer incidence among young women, attributable to HPV vaccination.[2] However, contemporary patterns in cancer incidence among young men during the HPV vaccination era remain unclear. Abbreviations HPV Human papillomavirus RR Rate ratio APC Age-period-cohort IRR Incidence rate ratio SEER Surveillance, Epidemiology, and End Results Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. [Extracted from the article]

Introduction: A small but growing body of evidence suggests individualized support services and improved access to contraception can promote healthy birth spacing among adolescent mothers. This study examines the effectiveness of Steps to Success, a 2-year home visiting program in San Angelo, Texas, enhanced with content designed to reduce rapid repeat pregnancy among young mothers, increase fathers' involvement, and support mothers' education and career aspirations. Methods: The study used a randomized controlled trial, with 594 young mothers ages 14–20 randomly assigned to either a program group that received Steps to Success or a control group that received an existing home visiting program focused only on parenting and child development. Women in both research groups completed a baseline survey upon enrolling in the study and 1- and 2-year follow-up surveys. Results: After 2 years, participants in the Steps to Success and existing home visiting groups had similar rates of repeat pregnancy. However, women in the Steps to Success group were more likely to use long-acting reversible contraceptives (effect size = 0.18, p = 0.066), particularly younger adolescent mothers ages 14–18 (effect size = 0.34, p = 0.010). Steps to Success also decreased the incidence of unprotected sex for younger adolescent mothers (effect size = -0.25, p = 0.035). Steps to Success did not improve outcomes in other domains. Discussion: Steps to Success improved some outcomes related to healthy birth spacing among younger adolescent mothers. Communities interested in similar programming may want to consider focusing their services on this age group. [ABSTRACT FROM AUTHOR]

An examination of the sexual attitudes, knowledge, and behaviors post-incarceration was conducted in the current study. Further, factors linked to sexual health (i.e., age, race, education, length imprisoned), as well as pornography consumption, and infidelity, were examined. Data were collected from 100 heterosexual men released from incarceration in the last 36 months. The prevalence of risky sexual behaviors and correlations among all sexual behavior, attitude, and knowledge items were analyzed. A series of multivariate regression models examined the moderating effect of certain demographic factors between condom use and STI/HIV testing. The most notable results revealed that a vast majority of participants engaged in inconsistent condom use during vaginal (77%), oral (92%), and anal (71%) sex. Most participants (70%) tested for STIs infrequently after engaging in unprotected sex. Consistent with this, most participants lacked knowledge about STIs, as demonstrated by the fact that, on average, they answered 37% of questions assessing knowledge on STIs correctly. Research about individuals' sexual health risks post-incarceration commonly focuses on those diagnosed with HIV/AIDS despite most men being HIV-seronegative post-incarceration. Empirical research that directly assesses men's sexual attitudes, knowledge and behaviors post-incarceration more generally is warranted and, therefore, the current study's primary objective. Further, little but existing literature contends that a lack of sexual health knowledge and education are closely linked to safe sex practices post-incarceration. The current study examined these relationships further. [ABSTRACT FROM AUTHOR]

Given the potential for unintended pregnancy and exposure to sexually transmitted infections, both of which can have long-term deleterious health consequences, the identification of predictors of adolescent risky sexual behavior remains an important line of inquiry. Although prior research has identified a variety of family and individual factors that are associated with risky sexual behavior, few studies have examined the role of family economic stress. The current study utilized three waves of data from a community sample of African American families with adolescents (N = 778, 54% girls, average age = 10.4 years old at Wave 1, 12.3 years old at Wave 2, 15.6 years old at Wave 3) to test the family stress model as an explanation of adolescent risky sexual behavior. Multi-group analyses examined gender differences in the family processes expected to link economic stress and risky sexual behavior. Unlike most studies utilizing this theoretical perspective, family structure was also taken into account. The results supported the propositions of the family stress model for boys and girls for both two-caregiver and single-mother households. Further, in single-mother households, maternal psychological distress continued to have a positive effect on adolescent risky sex even after taking into account the impact of parenting behaviors. Overall, the results suggest that economic stress ripples through the family system, increasing adolescent risky sexual behavior through its negative impact on family processes, highlighting the need for systemic policy changes rather than individual-level intervention/prevention efforts. [ABSTRACT FROM AUTHOR]

Studies suggest men who have sex with men (MSM) practising receptive anal sex are more likely to present with secondary syphilis, implying primary anorectal lesions are likely to be missed. If men could detect anorectal lesions in the primary stage by regular anal self-examination (ASE), transmission could be reduced by early diagnosis and treatment. We aimed to explore the attitudes of MSM on performing ASE to detect primary anorectal syphilis. An online anonymous cross-sectional survey among MSM over 18 years of age living in Australia, was conducted between July and November 2020 and recruitment was from a sexual health clinic and social media. A total of 568 MSM completed the survey (median age: 34 [IQR 27–45]): 32% (183) had previously performed ASE. Among 66% (374) who had never performed ASE, 68% (250) would consider performing ASE in the future with a preferred median frequency of 2 times per 4 weeks (IQR 1–4), whilst men who were already performing ASE were performing it at median 1 per 4 weeks (IQR 0.2–3). Almost two-thirds of MSM who had never performed ASE were willing to adopt ASE practice in the future. Studies are required to determine the effectiveness of ASE for syphilis detection. [ABSTRACT FROM AUTHOR]

This study aimed to determine the prevalence and the correlation between early sexual intercourse and its consequences among men who inject drugs (MWID) in Iran. In this cross-sectional survey, 2399 subjects who inject drugs were recruited using facility-based sampling from ten cities in 2014. A structured questionnaire was used to collect data regarding the participants' sexual and drug-related practices. Early sexual intercourse was defined as having sex before the age of 18 years old. Among the study samples, 2333 subjects were men and 2027 of them reported a lifetime history of their sexual intercourse. Totally, 1978 (97.6%) MWID reported their age at the time of their first sexual intercourse. The prevalence of early sexual intercourse was estimated as 32.9%. Using the multivariable logistic regression, it was shown that early sexual contact is significantly associated with age < 30 years old (adjusted Odds Ratio [aOR]: 1.52; p-value < 0.001), and drug abuse debut < 16 years old (aOR: 3.49; p-value < 0.001). As well, those with a history of early sexual intercourse had more condomless sex during the last 12 months (aOR: 1.46; p-value < 0.001). Moreover, they had more access to a free condom within 12 months (aOR: 1.31; p-value = 0.04). One in three MWID experienced early sexual intercourse. MWID who had early sexual intercourse were younger. They had higher risk profiles such as drug abuse at a younger age, as well as more outcomes like condomless sex in the last 12 months. So, age at the time of the first sexual intercourse should be considered in sexual health and HIV prevention programs among MWID. [ABSTRACT FROM AUTHOR]

Risky sexual behavior (RSB) during adolescence increases risk for sexually transmitted diseases, HIV/AIDs, and teenage pregnancy. Youth with externalizing disorders are more likely to engage in RSB, and antisocial traits in adolescence may be particularly relevant to RSB. It is still not clear which specific antisocial traits are most relevant to RSB and RSB attitudes, or how biological sex influences RSB and RSB attitudes in adolescence. The present study examined RSB and RSB attitudes, and their relationship with sex among inpatient adolescents with antisocial traits. 128 female and 52 male (N = 180) inpatient adolescents ranging from 12 to 17 years of age (M = 15.28, SD = 1.41) completed self-report measures of antisocial features, RSB, and RSB attitudes. Correlations, followed up with multiple linear regressions, were used to examine relations between antisocial features, adolescent age, RSB, and RSB attitudes. Results indicated no sex differences in RSB; however, significant sex differences in RSB attitudes were found. All antisocial facets, apart from stimulus seeking, were not related to RSB. Most antisocial facets were found to be related to RSB attitudes, most significantly antisocial behavior. Age at admission was the variable most significantly related to RSB and RSB attitudes. Results suggest that, for inpatient adolescents, antisocial features may not be related to engagement in RSB; however, the presence of riskier attitudes may affect future engagement in RSB among adolescent males with antisocial traits later in life and therefore present important preventative targets. [ABSTRACT FROM AUTHOR]

Despite growing evidence and support for co-locating behavioral services in primary care to prevent risky health behaviors, implementation of these services has been limited due to a lack of reimbursement for services and negative perceptions among providers. We investigated potential to overcome these barriers based on new developments in healthcare funding and screening and referral to prevention (SRP) in primary care based on the Consolidated Framework for Implementation Research (CFIR), which could guide future SRP implementation strategies. To investigate the economic need for healthcare-based SRP, we quantified hospital charges to healthcare payors for services arising from adolescent risky behaviors (e.g., substance use, risky sex). Annual North Carolina (NC) hospital charges for these services exceeded $327 M (2019 dollars), suggesting high potential for cost savings if SRP can curb hospital services associated with risky behaviors. To investigate provider barriers and facilitators, we surveyed 151 NC pediatricians and 230 NC family therapists about their attitudes regarding a recently developed well-child visit SRP with family-based prevention. Both sets of professionals reported widespread need for and interest in the SRP but cited barriers of lack of reimbursement, training, and referrals to/from each other. Physicians, but not family therapists, reported concerns with poor patient or parent compliance. Many barriers could be resolved by co-locating family therapists in pediatric clinics to conduct well-child SRP. Our results support further research to develop business models for payor-funded SRP and CFIR-guided research to develop implementation strategies for primary care SRP to prevent adolescent risky health behaviors. [ABSTRACT FROM AUTHOR]

This article explores a critical moment of going bareback in the career of arguably the biggest gay porn performer of the 2010s, Johnny Rapid. The analysis reveals a decidedly negative reception of Rapid, the promotion of bareback as event, and the quality of the bareback performance itself, all of which I read in accordance with what these narratives have to tell us about bareback at the time. Yet I also take the opportunity—writing several years after this critical moment in Rapid's career—to reflect on the success of the campaign. I read the case study in line with the concept of time, which has particular resonance with bareback. Through this reflection, I arrive at the conclusion that the time was right for an aging twink performer to be freshened-up by a transition to bareback—similar transitions of which have become widespread across the gay porn landscape in the intervening years between the 2015 Johnny Rapid Goes Bareback event and the present day, thanks in no small part to advancements in HIV prevention technologies. [ABSTRACT FROM AUTHOR]

Chinese people's pornography use is increasing and condomless sex is prevalent in pornography. However, both the relationship between pornography and condom use among Chinese adults and the mechanisms underlying this relationship are underexplored. This study examined how perceptions of pornography were associated with attitudes toward condom use through the mediating effect of gratification of sexual pleasure and safer sex communication apprehension, and how shared pornography use with a partner during sex moderated these relationships. A total of 658 participants (391 women and 267 men) aged 18–65 years and involved in a romantic relationship completed an online survey assessing pornography consumption, condom use, gratification of sexual pleasure, and safer sex communication apprehension. Results showed that expressive/erotic perceptions of pornography were associated with higher levels of gratification of sexual pleasure, which were, in turn, associated with more negative attitudes toward condom use. Expressive/erotic perceptions of pornography were also associated with lower levels of safer sex communication apprehension and lower levels of negative attitudes toward condom use. Higher levels of shared pornography use with a partner during sex strengthened the direct positive relationship between expressive/erotic perceptions of pornography and negative attitudes toward condom use. Higher levels of shared pornography use during sex also strengthened the positive relationship between expressive/erotic perceptions of pornography and gratification of sexual pleasure, and the negative relationship between expressive/erotic perceptions of pornography and safer sex communication apprehension, which in turn, were significantly associated with attitudes toward condom use. Implications for sexual health education and limitations are discussed. [ABSTRACT FROM AUTHOR]

Despite the availability of efficacious and effective family-based interventions, such interventions are scarce for sexual minority adolescents, particularly among ethnic/racial minorities. Prior to creating an entirely new intervention, a prudent first step may be to determine if existing interventions are efficacious in reducing risk behaviors in sexual minority adolescents. This study assesses the relative efficacy of a general, family-based intervention (Familias Unidas) on improving substance and condom use outcomes among Hispanic adolescents with same gender sexual behaviors (HASGB). Data across five distinct trials of Familias Unidas were synthesized. HASGB were randomized either to an intervention (n = 94) or control condition (n = 100). Mediation analyses tested for intervention efficacy on past 90-day substance (cigarette/alcohol/illicit drug) use and condomless sex at last intercourse in HASGB participants and whether family functioning indicators—parent–adolescent communication, positive parenting, and parental monitoring of peers—mediated the effects. Post hoc analyses explored the moderating role of study target population based on prior risk. Familias Unidas did not impact substance use but significantly reduced condomless sex postintervention relative to the control condition. Hypothesized mediators did not explain this effect. Post hoc analyses indicated that the effect was significant in studies that recruited based on prior risk but not studies that recruited universal samples. Our results suggest that a general, family-based intervention may have positive effects on condom use in HASGB, particularly those with prior indicated risk. Identifying intervention components that drive this effect in addition to developing tailored content for HASGB is needed. [ABSTRACT FROM AUTHOR]