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Accumulating evidence suggests that trauma exposure is positively associated with future engagement in risky behavior, such as substance misuse, aggression, risky sex, and self‐harm. However, the psychological factors driving this association and their relevance across gender groups require further clarification. In a community sample of 375 adults with a high rate of trauma exposure (age range: 18–55 years, M = 32.98 years, SD = 10.64; 76.3% assaultive trauma exposure), we examined whether emotional reactivity linked lifetime assaultive trauma exposure with past–month risky behavior. We also explored whether this model differed for cisgender women (n = 178, 47.6%) and men (n = 197, 52.5%). As hypothesized, assaultive trauma was positively related to emotional reactivity, β =.20, SE = 0.03, t(369) = 3.65, p <.001, which, in turn, partially accounted for the association between assaultive trauma and past‐month risky behavior, indirect effect: β =.03, SE = 0.01, 95% bootstrapped CI [0.01, 0.06]. Gender moderated this association such that assaultive trauma was indirectly associated with risky behavior via emotional reactivity for women but not for men, index moderation: B = ‐0.03, SE = 0.02, 95% bootstrapped CI [‐0.07, ‐0.01]. Cross‐sectional results suggest that emotional reactivity may be a proximal target for clinical intervention to aid in the reduction of risky behavior among women. [ABSTRACT FROM AUTHOR]

Introduction: The COVID‐19 pandemic likely affected adolescent sexual behaviors and alcohol use, although how is not well understood. Method: Youth were sampled from the national, online longitudinal Growing up with Media study. They responded via text messaging to open‐ended questions about how the COVID‐19 pandemic may have impacted the sexual behavior and alcohol use of adolescents. Conventional content analysis summarized open‐ended responses. Results: 416 responses were analyzed from 335 participants (aged 15–30, US residents), 81 of whom provided data for both topics. Participants suggested that the pandemic affected some youths' sexual health precautions (increased and varying) and attitudes about sex (positive and negative). They discussed how adolescents met partners during the pandemic, including increased use of online platforms. Participants also suggested researchers investigate sexual risk in the realm of COVID‐19 transmission and the practice of "safe sex." Many participants believed adolescents were drinking alcohol more as a result of the pandemic, both alone and with friends; however, others perceived adolescents were drinking less. Participants proposed researchers investigate adolescent drinking habits during the pandemic, as well as how this compares to before the pandemic and the type and quantity of alcohol consumed. Conclusions: Young people believe adolescent sexual relationships and drinking behaviors changed due to the pandemic, though how varied. Future research could examine the contexts and individual differences that shape these varying behaviors. Overall, this study highlights the importance of directly asking youth about their pandemic experiences and the diversity of views on how the pandemic has influenced adolescent behavior. [ABSTRACT FROM AUTHOR]

Background and Objectives: According to the acquired preparedness model, personality traits, such as impulsivity, may influence the learning process, contributing to heightened expectations surrounding risky behaviors (i.e., alcohol use, sexual risk‐taking). As bisexual women demonstrate heightened risk for hazardous alcohol‐ and sex‐related behaviors, the present study examined a sequential pathway, whereby the relation between impulsivity and sexual risk‐taking is mediated through sex‐related alcohol expectancies and alcohol use. Methods: Data were collected from 225 self‐identified cisgender, bisexual women between the ages of 18 and 30 years (M = 22.77, SD = 3.45), who participated in an online survey. Participants reported on impulsivity, sex‐related alcohol expectancies, alcohol use, and experiences of sexual risk‐taking. Results: Results revealed that sex‐related alcohol expectancies and alcohol use sequentially mediated the relation between impulsivity and sexual risk‐taking. Thus, greater impulsivity was related to greater sexual risk‐taking through heightened sex‐related alcohol expectancies and elevated alcohol use. Discussion and Conclusions: Findings from this study highlight mechanisms associated with risky drinking and sexual behaviors among this at‐risk population. Such information could aid the development of more efficacious prevention and intervention programs aimed at reducing consequences associated with alcohol use and sexual risk‐taking among bisexual women. Scientific Significance: Bisexual women are at heightened risk for alcohol‐related problems, including sexual risk‐taking. Findings from the current study identify impulsivity and sex‐related alcohol expectancies as independent and integrative predictors of such risky behaviors. Incorporation of these constructs may aid in the development of more efficacious clinical methods aimed at bettering health outcomes among bisexual women. [ABSTRACT FROM AUTHOR]

Objectives: To examine the global disease burden and country‐specific trends of penile cancer incidence by age group and investigate its associations with several factors. Materials and Methods: The Global Cancer Observatory database was interrogated for penile cancer incidence. The 10‐year cancer incidence rates were collected from the Cancer Incidence in Five Continents Plus. The country‐specific data were extracted from the World Health Organization Global Health Observatory and Global Burden of Disease databases for conducting risk factors analysis. The penile cancer incidence was presented using age‐standardised rates. Its associations with various factors were examined by linear regression, while the incidence trend was estimated using joinpoint regression and presented as average annual percentage change with 95% confidence intervals in different age groups. Results: There were an estimated 36 068 new cases of penile cancer in 2020. There was a considerable geographical disparity in the disease burden of penile cancer, with South America reporting the highest incidence. Overall, alcohol drinking, human immunodeficiency virus (HIV) infection, and unsafe sex were positively associated with a higher penile cancer incidence, while circumcision was found to be a protective factor. There has been a mixed trend in penile cancer incidence overall, but an increasing trend was found among younger males. Conclusions: There was a global variation in the penile cancer burden associated with prevalence of alcohol drinking, HIV infection, unsafe sex, and circumcision. The increasing penile cancer incidence in the younger population is worrying and calls for early detection and preventive interventions. [ABSTRACT FROM AUTHOR]

In this paper, we use data from the National Longitudinal Study of Adolescent to Adult Health and latent class analysis to assess the extent to which individuals integrate guns into broader health lifestyles. We also examine how these new health lifestyles differ for men and women. While men integrate guns with a variety of risk‐taking behaviors, including smoking, heavy drinking, risky sexual behavior, and fast‐food consumption, women do not. Our results are consistent with a gendered theory of gun ownership and health lifestyles. On the one hand, some men may use guns and other risky health behaviors to project hegemonic masculinity. On the other hand, some women may avoid guns and other elements of risky lifestyles to signify normative femininity. It is important for sociologists and public health scholars to focus more on how and why men are more likely to integrate guns into generally unhealthy lifestyles. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prevalence of non‐testing for HIV among immigrant men who have sex with men (MSM) residing in Brazil and identify associated factors. Design: An analytical web‐survey study was conducted across all Brazilian states from January 2020 to May 2021. Sample: The study included 804 MSM immigrants from Portuguese‐speaking countries. Measurements: Odds ratio (OR) and adjusted Odds Ratio (AOR) were utilized to determine the strength of the association between non‐HIV testing and associated factors. Results: Among the participants, 63.7% had never undergone HIV testing. Multivariate analysis revealed several factors associated with a higher likelihood of not being tested for HIV: having a steady/monogamus partner (AOR: 1.5; 95%CI: 1.1‐2.3) or both casual and steady partners (AOR: 1.8; 95%CI: 1.2‐3.4), not engaging in bareback sex (AOR: 1.91; 95%CI: 3‐3.5), being an immigrant in the country for less than 12 months (AOR: 3.7; 95%CI: 2.5‐9.7), and having a preference for insertive (AOR: 1.5; 95%CI: 1.1‐2.5) or receptive (AOR: 2.9; 95%CI: 1.4‐5.7) roles. However, practicing chemsex was found to be a protective factor for testing (AOR: 4). Conclusion: To enhance HIV prevention strategies, it is crucial to implement specific measures that ensure accessibility, confidentiality, and a reduction in stigma associated with HIV testing. [ABSTRACT FROM AUTHOR]

Does fear of being single (FOBS) predict risky health behaviors when such behavior could promote pursuit of a romantic connection? Study 1 tested general tendencies toward taking health risks associated with FOBS. Study 2 tested how those with stronger FOBS navigated romantic versus non‐romantic risk behavior during the COVID‐19 pandemic. Study 3 extended the test of risky behavior beyond the pandemic to test whether FOBS was associated with willingness to engage in risky sexual behavior. Despite nonsignificant associations with taking health risks more generally, FOBS was associated with greater willingness to engage in risky behaviors in dating contexts, particularly when considering their willingness to settle for less in relationships. This research provides novel insight into dating choices associated with stronger FOBS and how willingness to settle predicts risky health behavior when it could appeal to romantic prospects. [ABSTRACT FROM AUTHOR]

In March 2020, in response to the COVID‐19 pandemic, Canadian provincial governments instituted a variety of public health measures that included social distancing and isolation, which may have had unintended consequeses. According to the Loneliness and Sexual Risk Model, gay, bisexual, and other men who have sex with men (GBM) often cope with loneliness through risky sexual behaviors. Previous studies have demonstrated that COVID‐19 measures such as social distancing and isolation led to increases in loneliness; thus, these measures may also have led to elevated sexual risk‐taking among some GBM. Participants were recruited from an ongoing cohort study on GBM health and well‐being, and were included in the current analysis if they had completed relevant study questions (n = 1134). GBM who reported lower levels of social support pre‐COVID‐19, were younger, and lived alone each reported greater loneliness during the first year of COVID‐19. Although feelings of loneliness did not predict sexual risk‐taking within the first year of COVID‐19, loneliness did predict greater sexual risk‐taking 6 months later. Additionally, younger GBM and those living alone were more likely to engage in sexual risk‐taking at both COVID‐19 data collection points. These findings offer some support of the Loneliness and Sexual Risk Model; however, it is possible that the unique circumstances of the COVID‐19 pandemic resulted in a temporary suspension of this association, as many GBM took steps to protect themselves and partners in the context of COVID‐19. [ABSTRACT FROM AUTHOR]

Introduction: Sex work is a common phenomenon, but socially invisible and stigmatized. Due to exposure to work‐related risks, sex workers (SWs) are vulnerable to developing health problems. However, little attention has been paid to their mental health. The purpose of this systematic review was to synthesize the existing literature on mental health and to explore risk factors related to psychopathology in sex workers. Methods: A systematic review (CRD42021268990) was conducted on the Web of Science, PubMed, Scopus, and PsycInfo for peer reviewer papers published between 2010 and 2022. The Newcastle‐Ottawa Scale (NOS) was used to examine the quality of the studies. Of the 527 studies identified, 30 met the inclusion criteria. Results: Mental health problems were prevalent among sex workers. Depression was the most common mental health problem; however, other psychological problems were also high, including anxiety, substance abuse, and suicidal ideation. Sex workers are exposed to numerous work‐related risks, including violence and high‐risk sexual behaviors. Despite the high prevalence of mental health problems, SWs often encounter significant barriers to accessing healthcare services. Conclusion: These results suggest the need to focus on preventive measures to promote psychological well‐being among sex workers. [ABSTRACT FROM AUTHOR]

Introduction: Despite widespread success in reducing vertical HIV transmission, most antenatal care (ANC) programmes in eastern and southern Africa have not emphasized primary prevention of maternal HIV acquisition during pregnancy and lactation/breastfeeding. We hypothesized that combination HIV prevention interventions initiated alongside ANC could substantially reduce maternal HIV incidence. Methods: We constructed a multi‐state model describing male‐to‐female HIV transmission in steady heterosexual partnerships during pregnancy and lactation/breastfeeding, with initial conditions based on population distribution estimates for Malawi and Zambia in 2020. We modelled individual and joint increases in three HIV prevention strategies at or soon after ANC initiation: (1) HIV testing of male partners, resulting in HIV diagnosis and less condomless sex among those with previously undiagnosed HIV; (2) initiation (or re‐initiation) of suppressive antiretroviral therapy (ART) for male partners with diagnosed but unsuppressed HIV; and (3) adherent pre‐exposure prophylaxis (PrEP) for HIV‐negative female ANC patients with HIV‐diagnosed or unknown‐status male partners. We estimated the percentage of within‐couple, male‐to‐female HIV transmissions that could be averted during pregnancy and lactation/breastfeeding with these strategies, relative to base‐case conditions in which 45% of undiagnosed male partners become newly HIV diagnosed via testing, 75% of male partners with diagnosed but unsuppressed HIV initiate/re‐initiate ART and 0% of female ANC patients start PrEP. Results: Increasing uptake of any single strategy by 20 percentage points above base‐case levels averted 10%−11% of maternal HIV acquisitions during pregnancy and lactation/breastfeeding in the model. Joint uptake increases of 20 percentage points in two interventions averted an estimated 19%−23% of transmissions, and with a 20‐percentage‐point increase in uptake of all three interventions, 29% were averted. Strategies achieving 95% male testing, 90% male ART initiation/re‐initiation and 40% female PrEP use reduced incident infections by 45%. Conclusions: Combination HIV prevention strategies provided alongside ANC and sustained through the post‐partum period could substantially reduce maternal HIV incidence during pregnancy and lactation/breastfeeding in eastern and southern Africa. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this secondary data analysis was to identify potential contributors to high‐risk sexual behaviors among sexually active adolescents who were tested for HIV and STDs compared to those who did not test for HIV and STDs. Method: Data from the 2019 Youth Risk Behavior Survey (YRBS) was used to explore potential predictors of risky behaviors among those tested for HIV/STD. A sample size of 3226 from the YRBS data base was used to explore predictors using Chi‐square and logistic regressions analyses. Results: Most adolescents reported not being tested for HIV (77.4%) and STD (83.9%). There were statistical differences between those tested for HIV and condom use, sexual intercourse before the age of 13 years, sexual intercourse with multiple people, and use of marijuana. Similar findings were found with adolescents tested for STDs. Conclusion: Findings of this study support the recommendations for a better understanding of the associations between drug use, early initiation of sexual activity, and condom use. Development of appropriate public health educational interventions can help decrease risky behaviors among these adolescents. [ABSTRACT FROM AUTHOR]

Introduction: Since many countries in sub‐Saharan Africa are willing to implement HIV oral pre‐exposure prophylaxis (PrEP) for men who have sex with men (MSM), data are needed to assess its feasibility and relevance in real life. The study objectives were to assess drug uptake, adherence, condom use and number of sexual partners, HIV incidence and trends in the prevalence of gonorrhoea and chlamydia. Methods: In this oral PrEP demonstration study conducted prospectively in Benin, a combination of tenofovir disoproxil fumarate‐TDF 300 mg and emtricitabine‐FTC 200 mg (TDF‐FTC) was offered daily or on‐demand to MSM. Participants were recruited from 24 August to 24 November 2020 and followed over 12 months. At enrolment, month‐6 and month‐12, participants answered to a face‐to‐face questionnaire, underwent a physical examination and provided blood samples for HIV, gonorrhoea and chlamydia. Results: Overall, 204 HIV‐negative men initiated PrEP. The majority of them (80%) started with daily PrEP. Retention rates at month‐3, 6, 9 and 12 were 96%, 88%, 86% and 85%, respectively. At month‐6 and month‐12, respectively, 49% and 51% of the men on daily PrEP achieved perfect adherence (self‐reported), that is seven pills taken during the last week. For event‐driven PrEP, the corresponding proportions for perfect adherence (last seven at‐risk sexual episodes covered) were 81% and 80%, respectively. The mean number (standard deviation) of male sexual partners over the last 6 months was 2.1 (1.70) at baseline and 1.5 (1.27) at month‐12 (p‐value for trend <0.001). Consistent condom use during the last 6 months was 34% (enrolment), 37% (month‐6) and 36% (month‐12). Three HIV seroconversions (2‐daily and 1‐event‐driven) were recorded. Crude HIV incidence (95% confidence interval) was 1.53 (0.31−4.50)/100 person‐years. Neisseria gonorrhoeae and/or Chlamydia trachomatis prevalence at the anal and/or pharyngeal and/or urethral sites was 28% at baseline and 18% at month‐12 (p‐value = 0.017). Conclusions: In West Africa, oral PrEP introduction in routine practice as a component of a holistic HIV prevention package is feasible and may not result in a significant increase in condomless sex among MSM. Since HIV incidence was still higher, additional interventions, such as culturally tailored adherence counselling, may be needed to optimize the benefits of PrEP. [ABSTRACT FROM AUTHOR]

The assessment of mood disorders and addiction linked to the practice of chemsex is of interest given the psychoactive substances used. The aim of this study was to assess risky sexual and addictive behavior to chemsex and related anxiety/depression symptoms in individuals receiving HIV pre‐exposure prophylaxis (PrEP). In this cross‐sectional study, all adults presenting for PrEP renewal at French sexual health centers were enrolled from January 2018 to March 2019. Participants completed a questionnaire on chemsex (i.e., the use of psychoactive substances before/during sex), including adapted Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) to chemsex addiction (questions of ASSIST were modified to focus on chemsex). Anxiety/depression was assessed with the Hospital Anxiety and Depression Scale. In the last 3 months before enrollment, 39.8% (94/236) of participants reported chemsex. The main psychoactive substances consumed during chemsex were cathinones (74.6%), gamma‐hydroxybutyrate (66.3%), and other psychostimulants (60%). The median score of the chemsex‐focused ASSIST was 8 [IQR25–75: 3–15]; 72.2% of participants had a score justifying at least a brief intervention (>4). In multivariate analyses, anxiety and cathinones consumption were associated with an ASSIST score >4: OR 13.65 (95%CI 1.68–662.7), P = 0.0062, and OR 8.468 (95%CI 2.066–43.059), P = 0.0014, respectively. The level of addiction to the practice of chemsex can be difficult to estimate for the user, and the ASSIST makes it possible to evaluate this addiction and to direct the subjects toward specialized consultations of addictology, sexual health, or PrEP renewals. The implementation of the modified ASSIST in these consultations can allow early systematic screening and counseling. [ABSTRACT FROM AUTHOR]

There are many reasons why individuals engage in prosocial behavior; communal sexual altruism is based on the notion that some practice safer sex in the interest of promoting the well‐being of their community/in‐group. Given that definitions of what constitutes "safer sex" have changed with advances in human immunodeficiency virus (HIV) prevention, we investigated the importance of communal sexual altruism (herein "altruism") among urban gay, bisexual, and other sexual minority men (GBM) in the contemporary context. Using a sample of 2449 GBM we examined the association of both safer‐sex‐related attitudes (e.g., HIV treatment optimism–skepticism) and behaviors (e.g., condomless anal sex [CAS]) with altruism scores. Higher altruism scores were associated with a lower likelihood of CAS and a greater frequency of discussing HIV status with new partners. These findings demonstrate that many GBM are motivated to engage in several kinds of behaviors that improve the well‐being of their in‐group (i.e., the GBM community). [ABSTRACT FROM AUTHOR]

Background: Sexual and reproductive health services promote the ability of people to have safe, satisfying, non‐coercive sexual experiences and make informed decisions about pregnancy. Stakeholder input is needed to understand barriers or facilitators to service access for autistic people, who report unmet needs. Methods: We recruited 18 autistic people, 15 parents, and 15 service providers in the United States to participate in an interview and two surveys. Using their input, we created a conceptual model of sexual and reproductive health service needs, access barriers, and facilitators. Results: Stakeholders rated a variety of sexual and reproductive health services as important for autistic people, including those with intellectual disability or minimal verbal language. Stakeholders identified barriers to sexual and reproductive health service utilization including lack of service availability, lack of service providers with autism or neurodiversity training, lack of accurate information about autism and sexuality, verbal and communication differences that are not accommodated by service providers, and socio‐cultural attitudes about sexuality. Stakeholders identified facilitators to service access including person‐centered, trauma‐informed care, service accommodations such as clear and detailed expectations, and long‐enough appointments. We created a conceptual model based on the social ecological model of health to organize these utilization factors and support future research, provider, and policy action. Stakeholders provided feedback and responded favorably on the model's accuracy, utility for spurring research, practice, and policy improvements, and application to diverse groups of autistic people. Conclusions: The model shows the many feasible ways to support equitable access to services for autistic people. [ABSTRACT FROM AUTHOR]

Objectives: This cross‐sectional survey aimed to explore associations between age of menarche, early sexual debut and high‐risk sexual behaviour among urban Tanzanian schoolgirls. Methods: Secondary schoolgirls aged 17–18 years from Mwanza, Tanzania, participated in structured face‐to‐face questionnaire‐based interviews, conducted by nurses and clinicians. Age of menarche was evaluated in categories of 11–12, 13–14, 15–16 or ≥17 years. Primary outcome measures were self‐reported early sexual debut (first vaginal sex at <16 years) and high‐risk sexual behaviour, including non‐use of condoms, having sex for gifts/money, having older sexual partners and/or other risky behaviours. Results: Of 401 girls enrolled, 174 (43.4%) reported prior vaginal sex. Prevalence of early sexual debut was 14.2% but pressured/forced sex and risky sexual behaviours were common. Adjusted for potential confounding, younger age at menarche was associated with early sexual debut (adjusted odds ratio for linear trend: 1.88 per category, 95% confidence interval: 1.21–2.92, p = 0.005). This association remained after excluding girls with first sex at <8 years or experiencing pressure or force at first sex. Further, adjusted for potential confounding (including ever experiencing forced sex), early sexual debut was associated with high‐risk sexual behaviour (adjusted odds ratio: 2.85, 95% confidence interval: 1.38–5.88, p = 0.004). Conclusions: Among urban Tanzanian school girls, younger age of menarche was associated with early sexual debut, and early sexual debut was associated with high‐risk sexual behaviour. Researchers and public health professionals developing and delivering interventions aimed at preventing adverse sexual health outcomes should consider the impact of these early biological and sexual exposures. [ABSTRACT FROM AUTHOR]

A new outbreak of monkeypox virus (MPXV) infection, a zoonotic infection endemic in Central and West Africa, is spreading throughout the world with new epidemiology and clinical features. Our aim was to characterize patients presenting to Dermatology emergency room with a MPXV infection between 15 May and 30 June 2022 in a tertiary hospital in Madrid, Spain. We collected 53 patients and describe their clinical, demographic and epidemiological characteristics and followed their evolution. Most of the patients were men who had sex with men with high‐risk sexual practices and no recent travels abroad. Most of them (91%) had had a sexually transmitted infection before. All patients had typical skin lesions consisting of vesicular‐pustular rash with central umbilication which was localized or disseminated. The most frequent extracutaneous symptoms were fever, painful regional lymphadenopathy and asthenia. Proctitis was present in more than one third of patients. All patients were diagnosed by real time polymerase chain reaction of samples obtained from skin lesions. Pharyngeal and/or rectal exudates demonstrated MPXV in 74% of patients. The current worldwide outbreak of MPXV infections shows epidemiological and clinical differences from previous ones. Clinicians should be aware of these characteristics to correctly diagnose this emerging disease. [ABSTRACT FROM AUTHOR]

Introduction: Sexualized drug use (SDU), the use of psychoactive drugs in the context of sexual intercourse, has been identified as a risk factor for HIV among men who have sex with men (MSM) in Asia. Given the distinct social and cultural context of same‐sex relationships and drug‐using practice in Asia, we aimed to describe the prevalence of SDU in East and South Asian countries and its associations with condomless anal sex (CAI) and HIV status. Synthesizing SDU research in this region, including SDU definitions, prevalence and outcomes, provides insights to inform future research and improved programme planning, resourcing and advocacy. Methods: We systematically searched OVID Medline, OVID EMBASE, OVID Global Health, CINAHL, PsycINFO and SCOPUS publication databases for scientific articles published from 1990 to 2022 measuring SDU among MSM in East and South Asian countries. A narrative synthesis was utilized to describe key study attributes and findings, and meta‐analyses using random pooled effect models were used to estimate SDU prevalence and its associations with CAI and HIV status. Subgroup meta‐analyses, sensitivity analysis and assessment of publication bias examined potential sources of heterogeneity for the pooled SDU prevalence estimates. Results and discussion: Of the 1788 publications screened, 49 publications met the selection criteria and 18 were suitable for meta‐analyses. Findings highlight SDU definitions distinct from other regions but inconsistencies in the definition of SDU between studies that have been highlighted in research elsewhere. The pooled prevalence of recent SDU (past 12 months) was 13% (95% CI = 10–16%; I2 = 97.6) but higher when studies utilized self‐administered surveys (15%; 95% CI = 12–19%; p<0.05). SDU was associated with greater odds of CAI (pooled odds ratio [OR] = 3.21; 95% CI = 1.82–5.66) and living with diagnosed HIV (OR = 4.73; 95% CI = 2.27–8.21). Conclusions: SDU is common among MSM in East and South Asian countries, but varying SDU definitions limit between‐study comparisons. Responses to SDU‐related harms should consider local contexts, including specific drug types used and their relative risks. [ABSTRACT FROM AUTHOR]

Few donor eligibility policy areas have generated as much societal debate as deferral of donors with higher-risk sexual behaviors, for many years focused on gay, bisexual, and other men who have sex with men (gbMSM). Although these donor numbers are inadequate to assess TD marker rates, the program marked an important policy change, since for the first time in over 35 years, some sexually active gbMSM were eligible to donate a blood component in Canada. Data from Italy and Spain, using alternative behavior-based approaches, showed high HIV rates and NAT only positive donors. [Extracted from the article]

Sexual violence against women is highly prevalent on college campuses. Survivors of sexual violence often engage in coping strategies such as risky sexual behavior. The present study used a behavioral task to measure sexual risk‐taking following experiences of positive or negative affect and an emotion suppression experimental manipulation. Sexually active adult female undergraduates (N = 175) completed measures of sexual traumatization and affective experiences as well as an autobiographical recall task and a delay discounting task for hypothetical sexual outcomes. Half of the participants (n = 87) were asked to suppress their emotional response to the autobiographical recall task. The findings indicate that sexual traumatization had a significant effect on risky sexual decision‐making, F(1, 167) = 23.27, p <.001, ηp2 =.12, but affective condition, F(1, 167) =.57, p =.451, and emotion suppression, F(1, 167) =.69, p =.412, exhibited no significant associations with sexual risk‐taking. These findings suggest other factors may underlie the association between sexual trauma and risky sexual behavior, but further research is warranted. [ABSTRACT FROM AUTHOR]

Background: Identifying young people exposed to sexual risk‐taking or violence is fundamental, when seeking to strengthen their health. However, young people seldom share sexual health concerns or experiences of violence with healthcare professionals (HCPs). Studies evaluating how use of a risk assessment tool influences the dialogue about sexual health and violence are sparse. Aims: The aim of this study was to explore HCPs' experiences of using the SEXual health Identification Tool (SEXIT) in encounters with young people at Swedish youth clinics. Method: Three focus group interviews were conducted with 21 HCPs from nine youth clinics, where SEXIT had been introduced. Data were analysed using thematic content analysis. Results: Three themes were identified. The theme, Facilitates dialogue about sexuality and vulnerability, describes how the questionnaire pertaining to SEXIT helped to normalise and help both HCPs and young people to take part in the dialogue about sensitive issues. Need for a trustful encounter presents HCPs' ethical concerns regarding how the questionnaire affects the integrity of young people and trust‐making. Sensitive topics entail challenges describes HCPs' challenges when dealing with sensitive issues. Additionally, it describes needs for knowledge and collaboration when targeting vulnerable young people. Conclusions: The HCPs stated that using SEXIT developed their ability to address sensitive issues and helped both them and young people to take part in the dialogue about sexuality and exposure to violence. SEXIT involves experiences of ethical concerns regarding integrity and trust‐making. It also entails challenges in having dialogues about sensitive issues, how to deal with risk assessment outcomes and in improvements regarding inter‐professional collaborations. [ABSTRACT FROM AUTHOR]

Introduction: Transgender women (TW) experience an increased risk of human immunodeficiency virus (HIV) acquisition. This study identified patterns of HIV awareness and prevention strategies used by TW who were not living with HIV. Methods: Data were drawn from a baseline survey of the LITE Study, a multi‐site cohort of TW in Eastern and Southern United States (March 2018–August 2020). We conducted a latent class analysis to identify classes of HIV awareness and prevention strategies among TW who reported past 12‐month sexual activity (N = 958) using 10 variables spanning HIV knowledge, receipt and use of HIV prevention strategies, and sexual practices. Due to differences across the cohort arms, classes were estimated separately for TW enrolled in site‐based versus online study arms. We identified demographic characteristics, gender‐affirming indicators and HIV vulnerabilities associated with class membership. Results: Four parallel classes emerged: class 1 "limited strategies—less sexually active" (15% and 9%, site‐based and online, respectively), class 2 "limited strategies—insertive sex" (16%/36%), class 3 "limited strategies—receptive sex" (33%/37%) and class 4 "multiple strategies—insertive and receptive sex" (36%/18%). Across all classes, condomless sex, pre‐exposure prophylaxis (PrEP)/post‐exposure prophylaxis (PEP) prevention knowledge and awareness were high but reported PrEP/PEP use was low. Compared with class 1, membership in class 4 was associated with being a person of colour (site‐based OR = 2.15, 95% CI = 1.15–4.00, online OR = 4.54, 95% CI = 1.09–18.81) increased odds of self‐perceived medium‐to‐high HIV risk (site‐based OR = 4.12, 95% CI = 2.17–7.80, online OR = 11.73, 95% CI = 2.98–46.13), sexually transmitted infections (STI) diagnosis (site‐based OR = 6.69, 95% CI = 3.42–13.10, online OR = 8.46, 95% CI = 1.71–41.78), current sex work (site‐based OR = 6.49, 95% CI = 2.61–16.11, online OR = 10.25, 95% CI = 1.16–90.60) and 2–4 sexual partners in the last 3 months (site‐based OR = 2.61, 95% CI = 1.33–5.13). Class 3, compared with class 1, had increased odds of current sex work partners (site‐based OR = 3.09, 95% CI = 1.19–8.07) and of having 2–4 sexual partners in the last 3 months (site‐based OR = 3.69, 95% CI = 1.85–7.39). Conclusions: TW have varied HIV awareness and prevention strategy utilization, with clear gaps in the uptake of prevention strategies. Algorithms derived from latent class membership may be used to tailor HIV prevention interventions for different subgroups and those reached through facility‐based or digital methods. [ABSTRACT FROM AUTHOR]

Introduction: Internationally, trans women are disproportionately impacted by HIV, encounter specific barriers navigating safer sex and face inequities accessing HIV prevention, including pre‐exposure prophylaxis (PrEP). Aotearoa/New Zealand (hereafter Aotearoa) was one of the first countries internationally to publicly fund PrEP in 2018, including for trans people. However, few data exist on PrEP awareness or sexual negotiation among trans populations to guide implementation. We present the first Aotearoa data on trans people's ability to negotiate barrier protection and awareness of PrEP efficacy and availability. Methods: We used data from a large, diverse community‐based nationwide survey of trans (including non‐binary) people in Aotearoa: Counting Ourselves (N = 1178) conducted from 21 June to 30 September 2018. Generalized regression analyses were carried out among participants who have had sex (n = 704; Mage = 32.5) to identify associations between demographic factors (age, gender and sexual attraction, ethnicity, income, education qualification and current sex work involvement) and the Trans‐Specific Barrier Negotiation Self‐Efficacy (T‐Barrier) Scale and PrEP awareness. Results: The mean value of a 40‐point T‐Barrier Scale was 33.45 (SD: 6.89), suggesting a relatively high perceived ability among our participants to negotiate protective barrier usages in different situations. Asian participants scored 3.46 points lower compared to Pākehā (White) participants, and trans women attracted to men (cisgender and/or trans men) scored 2.40 points higher than trans women not attracted to men. Three‐fifths (59.7%) were aware that PrEP reduced HIV risks and did not prevent sexually transmitted infections (STI) transmission, and only two‐fifths (40.2%) knew PrEP was publicly funded for trans people. In multivariate models, we found participants who were older, trans women or those with lower education qualifications were less likely to have increased levels of PrEP awareness. Conclusions: Participants attracted to men have a higher potential need for PrEP and were more likely to report PrEP awareness and that they could negotiate protective barrier usage. However, trans women and those with lower educational qualifications reported lower levels of PrEP awareness. More trans‐competent sexual health education, drawing on the newly released PrEP guidelines, is needed to promote the benefits of PrEP in the Aotearoa HIV epidemic context, particularly for trans women. [ABSTRACT FROM AUTHOR]

Introduction: The HIV epidemic continues to disproportionately impact Latin‐American transgender women (TGW). We assessed factors associated with long‐term pre‐exposure prophylaxis (PrEP) engagement and adherence among TGW enrolled in the Implementation of PrEP (ImPrEP) study, the largest PrEP demonstration study in Latin America. Methods: HIV‐negative TGW aged ≥18 years reporting 1+eligibility criteria in the 6 months prior to enrolment (e.g. sex partner known to be living with HIV, condomless anal sex [CAS], transactional sex or having a sexually transmitted infection [STI]) who could safely take PrEP were enrolled. Follow‐up visits were conducted at 4 weeks and then quarterly. We conducted logistic regression to identify factors associated with long‐term PrEP engagement (3+ follow‐up visits in 52 weeks) and complete self‐reported adherence (no missed pills in the past 30 days) during follow‐up. For both outcomes, we constructed multivariable models controlling for country, socio‐demographics, sexual behaviour, substance use, STIs and self‐reported adherence at 4 weeks (long‐term engagement outcome only). Results: From March 2018 to June 2021, ImPrEP screened 519 TGW, enrolled 494 (Brazil: 190, Mexico: 66 and Peru: 238) and followed them for 52 weeks. At baseline, 27.5% of TGW were aged 18–24 years, 67.8% were mixed‐race and 31.6% had >secondary education. Most, 89.9% reported CAS, 61.9% had >10 sex partners and 71.9% reported transactional sex. HIV incidence was 1.82 cases per 100 person‐years (95% confidence interval [CI]: 0.76–4.38). Almost half of TGW (48.6%) had long‐term PrEP engagement, which was positively associated with reporting complete adherence at week 4 (aOR:2.94 [95%CI:1.88–4.63]) and was inversely associated with reporting CAS with unknown‐HIV partner (aOR:0.52 [95%CI:0.34–0.81]), migration (aOR:0.54 [95%CI:0.34–0.84]), and being from Mexico (aOR:0.28 [95%CI:0.14–0.53]). Self‐reported adherence was associated with TGW aged >34 (aOR:1.61 [95%CI:1.10–2.34]) compared to those aged 25–34 and those with >secondary education (aOR:1.55 [95%CI:1.10–2.19]) and was lower among TGW from Peru (aOR:0.29 [95%CI:0.21–0.41]) or reporting PrEP‐related adverse effects (aOR:0.63 [95%CI:0.42–0.92]). Conclusions: Although TGW were willing to enrol in ImPrEP, long‐term PrEP engagement and complete self‐reported adherence were limited, and HIV incidence remained relatively high. A successful HIV prevention agenda should include trans‐specific interventions supporting oral PrEP and exploring long‐acting PrEP strategies for TGW. [ABSTRACT FROM AUTHOR]

Introduction: Transgender women (TW) experience an increased risk of human immunodeficiency virus (HIV) acquisition. This study identified patterns of HIV awareness and prevention strategies used by TW who were not living with HIV. Methods: Data were drawn from a baseline survey of the LITE Study, a multi‐site cohort of TW in Eastern and Southern United States (March 2018–August 2020). We conducted a latent class analysis to identify classes of HIV awareness and prevention strategies among TW who reported past 12‐month sexual activity (N = 958) using 10 variables spanning HIV knowledge, receipt and use of HIV prevention strategies, and sexual practices. Due to differences across the cohort arms, classes were estimated separately for TW enrolled in site‐based versus online study arms. We identified demographic characteristics, gender‐affirming indicators and HIV vulnerabilities associated with class membership. Results: Four parallel classes emerged: class 1 "limited strategies—less sexually active" (15% and 9%, site‐based and online, respectively), class 2 "limited strategies—insertive sex" (16%/36%), class 3 "limited strategies—receptive sex" (33%/37%) and class 4 "multiple strategies—insertive and receptive sex" (36%/18%). Across all classes, condomless sex, pre‐exposure prophylaxis (PrEP)/post‐exposure prophylaxis (PEP) prevention knowledge and awareness were high but reported PrEP/PEP use was low. Compared with class 1, membership in class 4 was associated with being a person of colour (site‐based OR = 2.15, 95% CI = 1.15–4.00, online OR = 4.54, 95% CI = 1.09–18.81) increased odds of self‐perceived medium‐to‐high HIV risk (site‐based OR = 4.12, 95% CI = 2.17–7.80, online OR = 11.73, 95% CI = 2.98–46.13), sexually transmitted infections (STI) diagnosis (site‐based OR = 6.69, 95% CI = 3.42–13.10, online OR = 8.46, 95% CI = 1.71–41.78), current sex work (site‐based OR = 6.49, 95% CI = 2.61–16.11, online OR = 10.25, 95% CI = 1.16–90.60) and 2–4 sexual partners in the last 3 months (site‐based OR = 2.61, 95% CI = 1.33–5.13). Class 3, compared with class 1, had increased odds of current sex work partners (site‐based OR = 3.09, 95% CI = 1.19–8.07) and of having 2–4 sexual partners in the last 3 months (site‐based OR = 3.69, 95% CI = 1.85–7.39). Conclusions: TW have varied HIV awareness and prevention strategy utilization, with clear gaps in the uptake of prevention strategies. Algorithms derived from latent class membership may be used to tailor HIV prevention interventions for different subgroups and those reached through facility‐based or digital methods. [ABSTRACT FROM AUTHOR]

Introduction: Internationally, trans women are disproportionately impacted by HIV, encounter specific barriers navigating safer sex and face inequities accessing HIV prevention, including pre‐exposure prophylaxis (PrEP). Aotearoa/New Zealand (hereafter Aotearoa) was one of the first countries internationally to publicly fund PrEP in 2018, including for trans people. However, few data exist on PrEP awareness or sexual negotiation among trans populations to guide implementation. We present the first Aotearoa data on trans people's ability to negotiate barrier protection and awareness of PrEP efficacy and availability. Methods: We used data from a large, diverse community‐based nationwide survey of trans (including non‐binary) people in Aotearoa: Counting Ourselves (N = 1178) conducted from 21 June to 30 September 2018. Generalized regression analyses were carried out among participants who have had sex (n = 704; Mage = 32.5) to identify associations between demographic factors (age, gender and sexual attraction, ethnicity, income, education qualification and current sex work involvement) and the Trans‐Specific Barrier Negotiation Self‐Efficacy (T‐Barrier) Scale and PrEP awareness. Results: The mean value of a 40‐point T‐Barrier Scale was 33.45 (SD: 6.89), suggesting a relatively high perceived ability among our participants to negotiate protective barrier usages in different situations. Asian participants scored 3.46 points lower compared to Pākehā (White) participants, and trans women attracted to men (cisgender and/or trans men) scored 2.40 points higher than trans women not attracted to men. Three‐fifths (59.7%) were aware that PrEP reduced HIV risks and did not prevent sexually transmitted infections (STI) transmission, and only two‐fifths (40.2%) knew PrEP was publicly funded for trans people. In multivariate models, we found participants who were older, trans women or those with lower education qualifications were less likely to have increased levels of PrEP awareness. Conclusions: Participants attracted to men have a higher potential need for PrEP and were more likely to report PrEP awareness and that they could negotiate protective barrier usage. However, trans women and those with lower educational qualifications reported lower levels of PrEP awareness. More trans‐competent sexual health education, drawing on the newly released PrEP guidelines, is needed to promote the benefits of PrEP in the Aotearoa HIV epidemic context, particularly for trans women. [ABSTRACT FROM AUTHOR]

Introduction: The HIV epidemic continues to disproportionately impact Latin‐American transgender women (TGW). We assessed factors associated with long‐term pre‐exposure prophylaxis (PrEP) engagement and adherence among TGW enrolled in the Implementation of PrEP (ImPrEP) study, the largest PrEP demonstration study in Latin America. Methods: HIV‐negative TGW aged ≥18 years reporting 1+eligibility criteria in the 6 months prior to enrolment (e.g. sex partner known to be living with HIV, condomless anal sex [CAS], transactional sex or having a sexually transmitted infection [STI]) who could safely take PrEP were enrolled. Follow‐up visits were conducted at 4 weeks and then quarterly. We conducted logistic regression to identify factors associated with long‐term PrEP engagement (3+ follow‐up visits in 52 weeks) and complete self‐reported adherence (no missed pills in the past 30 days) during follow‐up. For both outcomes, we constructed multivariable models controlling for country, socio‐demographics, sexual behaviour, substance use, STIs and self‐reported adherence at 4 weeks (long‐term engagement outcome only). Results: From March 2018 to June 2021, ImPrEP screened 519 TGW, enrolled 494 (Brazil: 190, Mexico: 66 and Peru: 238) and followed them for 52 weeks. At baseline, 27.5% of TGW were aged 18–24 years, 67.8% were mixed‐race and 31.6% had >secondary education. Most, 89.9% reported CAS, 61.9% had >10 sex partners and 71.9% reported transactional sex. HIV incidence was 1.82 cases per 100 person‐years (95% confidence interval [CI]: 0.76–4.38). Almost half of TGW (48.6%) had long‐term PrEP engagement, which was positively associated with reporting complete adherence at week 4 (aOR:2.94 [95%CI:1.88–4.63]) and was inversely associated with reporting CAS with unknown‐HIV partner (aOR:0.52 [95%CI:0.34–0.81]), migration (aOR:0.54 [95%CI:0.34–0.84]), and being from Mexico (aOR:0.28 [95%CI:0.14–0.53]). Self‐reported adherence was associated with TGW aged >34 (aOR:1.61 [95%CI:1.10–2.34]) compared to those aged 25–34 and those with >secondary education (aOR:1.55 [95%CI:1.10–2.19]) and was lower among TGW from Peru (aOR:0.29 [95%CI:0.21–0.41]) or reporting PrEP‐related adverse effects (aOR:0.63 [95%CI:0.42–0.92]). Conclusions: Although TGW were willing to enrol in ImPrEP, long‐term PrEP engagement and complete self‐reported adherence were limited, and HIV incidence remained relatively high. A successful HIV prevention agenda should include trans‐specific interventions supporting oral PrEP and exploring long‐acting PrEP strategies for TGW. [ABSTRACT FROM AUTHOR]

Introduction: Risky sexual behaviors. Adequate awareness of reproductive health in young people is important because they are in the early years of fertility, and engaging in risky sexual behaviors is more probable. This study aimed to evaluate the sexual attitude and associated factors of risky sexual behaviors among girls and boys and the difference in sexual norms by gender among university students. Methods: A university‐based study with a cross‐sectional survey was conducted for 9 months in 2019. A total of 800 university students were studied by a random sampling technique using a self‐administered structured questionnaire derived from the World Health Organization illustrative questionnaire to assess sexual attitudes among adolescents and young adults. Results: Most of the respondents were female and single. Girls were more religious, more frequently visited the cinemas and were more likely to discuss sex matters with family members than boys. There was no significant difference in the total score of sexual attitudes in girls and boys, and both genders had negative attitudes toward risky sexual behavior (42/72). Those who go to parties, bars, or movies are more likely to have risky sexual behavior. Being a religious person is an essential predictor of having less risky behavior (RR = 2.02, 95% CI = [0.96, 3.41]). Conclusion: Being religious was a protective factor for engaging in risky sexual behavior. More interventions in schools and universities need to educate students to enhance awareness about the consequences of risky sexual behavior and reduce its rate. [ABSTRACT FROM AUTHOR]

Background: Little is known about how to evaluate relationships and sex education (RSE) delivered to students with intellectual disability and what stakeholders perceive are important outcomes. The present study aimed to systematically review existing studies on outcomes of RSE, as the first step in the development of a core outcome set (COS) for students with intellectual disability. Method: A systematic literature process included two stages: (1) searching for studies reporting on RSE outcomes for students with intellectual disability and (2) studies reporting on measurement properties (e.g. validity, reliability and responsiveness) of standardised instruments identified in stage 1. Results: A total of 135 RSE outcomes were extracted from 42 studies: 43 outcomes for students in secondary education and 92 outcomes for students in further education. No RSE outcomes were reported for primary education. Outcomes referred to the human body, hygiene, relationships, sexuality, sex and its consequences, inappropriate and appropriate social and sexual behaviour, keeping safe, emotional vocabulary and positive self‐esteem. Outcomes were predominantly knowledge‐based, rather than relating to skills and attitudes development. Students with intellectual disability, parents and teachers perceive different RSE outcomes meaningful. Five instruments were used to measure the outcomes, but none have established psychometric properties with this population. Conclusions: The comprehensive list of RSE outcomes for students with intellectual disability will be used to inform the next steps of a Core Outcome Set needed for RSE evaluations in research and education settings. There is an urgent need to develop standardised instruments validated for students with intellectual disability. [ABSTRACT FROM AUTHOR]

Background: Individuals with intellectual and developmental disabilities demonstrate disparities in sexual and reproductive health (SRH) compared to individuals without disabilities (e.g., lack of sexual education and knowledge, increased rates of abuse, unplanned pregnancies and sexually transmitted infections). Therefore, the purpose of this study was to identify topics healthcare providers address and perceived barriers and supports to SRH education. Methods: We conducted semi‐structured interviews with healthcare providers (N = 12). Results: Providers address relationships, safety, protection and appropriate sexual behaviours with clients with intellectual and developmental disabilities. Parent education and client‐centred care were identified as supports, while the patient's level of understanding, the provider's lack of knowledge or access to resources and to appropriate referrals were identified as barriers to SRH education. Conclusion: Future studies are needed to link providers to resources they can use to provide comprehensive, accessible SRH education for clients with intellectual and developmental disabilities. [ABSTRACT FROM AUTHOR]

Background: This systematic review was aimed to estimate hepatitis C virus (HCV) seroprevalence and burden in disease in WHO South East Asia Region (SEAR). Methods: Electronic databases (PubMed, Scopus, Embase, and Google Scholar) and websites of non‐indexed national medical journals, government and international health agencies were searched to identify English language literature published between 1991 and June 2020. We selected the studies reporting HCV seroprevalence in asymptomatic general (low‐risk) and high‐risk adult populations, that is, persons living with HIV (PLHIV), persons who inject drugs (PWID), sex workers, persons on maintenance hemodialysis (MHD), people in prison, and men sex with men (MSM). Seroprevalence data were combined to estimate weighted pooled prevalence (95% confidence interval) in each group and in each country, using the random‐effects model. Estimated pooled seroprevalences were multiplied with estimated populations at risk to estimate the overall HCV burden. Results: The analysis included 538 studies (35 Bangladesh, 6 Bhutan, 2 DPR Korea, 323 India, 43 Indonesia, 2 Maldives, 18 Myanmar, 29 Nepal, 11 Sri Lanka, 67 Thailand, and 2 Timor‐Leste). In SEAR, the weighted pooled anti‐HCV seroprevalence was estimated as 0.84% (0.56–1.12) in low‐risk population and 13.67% (10.95–16.40) in PLHIV, 51.44% (43.67–59.20) in PWID, 25.80% (20.34–32.09) in MHD, 8.39% (5.84–11.51) in prison inmates, 2.69% (1.43–4.13) in people with high‐risk sex behavior, and 11.43% (8.61–14.74) in MSM. The total HCV burden in low‐risk and high‐risk populations in SEAR countries was estimated as 12.45 million and 1.65 million, respectively. Conclusion: Our estimates of HCV seroprevalence and burden should help the respective countries in planning their HCV elimination strategies. [ABSTRACT FROM AUTHOR]

Most research to date has focused on negative health outcomes associated with adverse childhood experience (ACE) exposure. The goal of the present study was to examine the relationship between ACE exposure and health information seeking, health promoting behaviours and health screening among US college students. Supplemental ACE items were added to the cross‐sectional National College Health Assessment survey administered between 2017 and 2018 with young adult (ages 18–29) college students in California (n = 3862) and Texas (n = 451). Approximately 41.9 per cent of participants reported ACE. ACE‐exposed participants were consistently and significantly less likely to receive health information from their university (p < 0.01). Using multivariable logistic regression models, reporting four or more ACE was associated with significantly lower odds of past year seatbelt use (AOR = 0.62, 95% CI = 0.44–0.89) and past 30‐day condom use during oral sex (AOR = 0.51, 95% CI = 0.27–0.97). Increases in ACE exposure were significantly associated with an increase in the odds of ever testing for HIV (AORs:1.26–2.49). Longitudinal research is needed to uncover the complex interplay between ACE, mental health, negative health behaviours and health promotion activities among young adults. Interventions to improve health promotion activities in ACE‐exposed populations could improve health and quality of life for this vulnerable population. Key Practitioner Messages: ACE exposure has a potentially harmful impact on health education efforts and health promotion outcomes including healthy behaviours and obtaining regular health screenings.Young adults with a history of ACE exposure are more likely to report HIV screenings and more work is needed to uncover the reason for this association.College campus health education and promotion programs should target ACE affected young adults. [ABSTRACT FROM AUTHOR]

Objective: Some interventions have been developed and tested to reduce high risk sexual behaviors among Hispanic/Latino gay, bisexual, and men who have sex with men (MSM). The purpose of this paper is to critically appraise published interventions designed to reduce high risk sexual behaviors among Hispanic/Latino gay, bisexual, and MSM. Design/sample/measurement: A critical appraisal of published interventions designed to reduce high risk sexual behaviors among Hispanic/Latino gay, bisexual, and MSM was conducted. Using guidelines established by the Johns Hopkins Nursing Evidence‐Based Practice Rating Scale published research articles were categorized and evaluated using these guidelines. Results: The critical appraisal identified nine intervention studies that met all inclusion criteria. The critical appraisal of these interventions highlighted strengths and weaknesses of these interventions which should be considered when developing future interventions to decrease high risk sexual practices among Hispanic/Latino gay, bisexual, and MSM. Conclusion: While several interventions have been created to specifically address HIV infection among Hispanic/Latino gay, bisexual, and MSM, these interventions were varied. Suggestions for future intervention development to decrease high risk sexual behaviors among Hispanic/Latino gay, bisexual, and MSM based on the findings of the critical appraisal of the literature are included. [ABSTRACT FROM AUTHOR]

Aims: Integrated reproductive health promoting behaviors, including safe sexual intercourse, preventing sexually transmitted diseases, sexual responsibility, and genital health management, are essential for adolescents in developing countries. The Philippines is currently facing several reproductive health threats. The aim of this study was to identify factors affecting reproductive health promoting behaviors based on a theoretical model using structural equation modeling. Methods: In this cross‐sectional study and a structural equation modeling, a total of 227 female adolescents in the Philippines participated in a self‐reported questionnaire survey. Results: The results indicated that reproductive health knowledge (β =.14, p =.033), attitudes regarding reproductive health behaviors (β =.31, p =.027), and reproductive health self‐efficacy (β =.31, p =.002) influenced participants' reproductive health promoting behaviors. Social norms (β =.31, p =.021) influenced reproductive health self‐efficacy and indirectly influenced reproductive health promoting behaviors. Attitude toward gender roles (β =.20, p =.020) was associated with reproductive health knowledge. Conclusions: This study confirmed the direct effect of reproductive health knowledge, attitudes regarding reproductive behaviors, and reproductive health self‐efficacy, as well as the indirect effect of social norms, on reproductive health promoting behaviors using structural equation modeling. [ABSTRACT FROM AUTHOR]

Introduction: Being aware of one's HIV‐positive status can help reduce unprotected sex and promote early treatment seeking. Therefore, HIV self‐test (HIVST) programs may help control the HIV epidemic by case finding. The aims of this study were to determine the effect of HIVST programs on HIV case finding, time to confirmatory diagnosis and factors associated with linkage to confirmatory diagnosis in Taiwan. Methods: The Centers for Disease Control in Taiwan initiated HIVST programs and imported 78,000 self‐test kits in 2017 and 2019. Clients paid 7 US dollars for a self‐test kit at facilities, vending machines or online. The programs set up an HIVST logistics management system; each kit had a unique barcode for monitoring the programs because purchases were anonymous. When clients provided their test results with photo barcodes online or at HIV/AIDS‐designated hospitals, they received full monetary reimbursement. We conducted a quasi‐experimental interrupted time‐series (ITS) analysis that covered a period of 60 months from 2015 to 2019. We enrolled a retrospective cohort of reported HIV cases with initial positive results from HIVST programs between March 2017 and July 2020. Results: The ITS analysis included data from 10,976 reported HIV cases from 2015 to 2019. The HIVST‐positive cohort included 386 reported HIV cases, of whom 99.7% were males and 97% were men who have sex with men (MSM); the median age was 28 years. The ITS analysis showed a positive slope change in the number of reported HIV cases immediately in the beginning implementation month (coefficient: 51.09 in 2017 and 3.62 in 2019), but there was a significant decrease over time. It was a negative slope change by 9.52 cases per month in 2017 and 5.56 cases per month in 2019. In the HIVST‐positive cohort, three of five individuals linked to HIV confirmatory diagnosis within 1 month after a positive self‐test result, and an early linkage to confirmatory diagnosis was associated with HIVST disclosure (adjusted OR = 6.5; 95% CI: 3.9–10.6). Conclusions: HIVST programs were associated with an increase in HIV case finding. Our findings suggest that countries with a high incidence of HIV among MSM populations should offer multichannel HIVST services. [ABSTRACT FROM AUTHOR]

Aims: To test whether recreational drug use (RDU) and sexualized drug use (SDU) changed in the Amsterdam area between 2008 and 2018 and quantify associations of SDU with condomless anal sex (CAS), recent human immunodeficiency virus (HIV) or sexually transmitted infections (STI) among human immunodeficiency virus (HIV)-negative men who have sex with men (MSM). Design: Open prospective cohort study. Setting: Public Health Service of Amsterdam, the Netherlands. Participants: A total of 976 HIV-negative MSM, aged = 18 years. Measurements: Self-reported RDU and sexual behaviour in the past 6 months. Laboratory-confirmed HIV and STI (chlamydia, gonorrhoea and syphilis). We studied: any RDU; any SDU (i.e. any RDU during sex); specific SDU (i.e. use of mephedrone, methamphetamine, gamma-hydroxybutyric acid/gamma-butyrolactone, ketamine, amphetamine, cocaine and/or ecstasy during sex); use of individual drugs; and use of individual drugs during sex. We evaluated changes over calendar years in the proportion of individuals with these end-points [using logistic regression with generalized estimating equations (GEE)] and number of drugs (using negative binomial regression with GEE), adjusted for current age, country of birth and education level. Findings: Median age of participants in 2008 was 33.2 years (interquartile range = 27.8-40.1); 83.1% were born in the Netherlands. The proportion of any RDU increased from 67.2% in 2008 to 69.5% in 2018 [adjusted odds ratio (aOR) = 1.25; 95% confidence interval (CI) = 1.03-1.51]. Any SDU increased from 53.8% in 2008 to 59.8% in 2013 (aOR = 1.23; 95% CI = 1.07-1.42) and remained stable afterwards. Specific SDU increased from 25.0% in 2008 to 36.1% in 2018 (aOR = 2.10; 95% CI = 1.71-2.58). The average number of drugs used increased for those reporting any RDU, any SDU and specific SDU (all P < 0.05. Among those engaging in sex, any SDU was associated with CAS (aOR = 1.36; 95% CI = 1.19-1.55), HIV (aOR = 5.86; 95% CI = 2.39-14.4) and STI (aOR = 2.31; 95% CI = 1.95-2.73). Specific SDU was associated with CAS (aOR = 1.58; 95% CI = 1.37-1.81), HIV (aOR = 6.30; 95% CI = 3.28-12.1) and STI (aOR = 2.15; 95% CI = 1.81-2.55). Conclusions: Among human immunodeficiency virus (HIV)-negative men who have sex with men in Amsterdam, recreational drug use, including sexualized drug use, increased between 2008 and 2018. Sexualized drug use was strongly associated with condomless anal sex, HIV and sexually transmitted infections. [ABSTRACT FROM AUTHOR]

Introduction: Human Immunodeficiency virus (HIV) is a virus that causes several diseases by attacking the human immune system. It is transmitted by contact with certain bodily fluids of an infected person, most commonly during unprotected sex, through sharing needles, or from mother to baby during pregnancy, birth or breastfeeding. The central nervous system is not spared from this virus, as HIV has been shown to induce several neurological disorders. However most neurological pathologies (such as dementia, infections, meningitis, and neuropathy) rarely show until late stages, in this case, after the patients develop acquired immunodeficiency syndrome (AIDS). This article aims to review the neurological disorders in the HIV population and the attempts initiated to limit the disease. Methodology: Data were collected from medical journals published on PubMed, Ovid MEDLINE, Science Direct and Embase bibliographical databases with a predefined search strategy. All articles considering neurological disorders associated with HIV were considered. Results: To date, the pathogenesis of HIV‐associated neurological complications remains poorly elucidated; thus, imposing a hindrance and limitations on the treatment options. Nevertheless, some studies have reported alterations in dendritic spine as the causative agent for developing brain damage. Conclusion: HIV remains one of the most serious global health challenges, with neurological manifestations imposing a major concern among patients with HIV. Despite the availability and efficacy of antiretroviral therapies, yet, the risk of developing neurological complications remains relatively high among patients with HIV. Thus, the 2030 HIV vision must focus on further preventive measures to protect HIV patients from developing such neurological complications. [ABSTRACT FROM AUTHOR]

Introduction: Transgender (trans) men in sub‐Saharan Africa are a hidden and vulnerable population who may engage in sex work due to socio‐economic exclusion and lack of alternative employment opportunities. Little is known about HIV and sexually transmitted infection (STI) risk among trans men in this setting. We conducted a multi‐method study to characterize HIV/STI risk among trans men in Uganda. Methods: Between January and October 2020, we enrolled 50 trans men into a cross‐sectional study through snowball sampling. Data were collected on socio‐demographic characteristics, sexual practices and depression. We conducted 20 qualitative interviews to explore: (1) descriptions of sexual practices that could increase HIV/STI exposure; (2) experiences of accessing public healthcare facilities; (3) perceptions of HIV or STI testing; (4) HIV and STI service delivery; and (5) drug and alcohol use. We used an inductive content analytic approach centring on descriptive category development to analyse the data. Results: The median age was 25 years (interquartile range 23–28). The prevalence of HIV, syphilis and hepatitis B was 4%, 6% and 8%, respectively. We observed multiple levels of intersecting individual, interpersonal and structural stigmas. (1) Trans men reported transphobic rape motivated by interpersonal stigma that was psychologically traumatizing to the survivor. The resultant stigma and shame hindered healthcare access. (2) Structural stigma and economic vulnerability led to sex work, which increased the risk of HIV and other STIs. Sex work stigma further compounded vulnerability. (3) Individualized stigma led to fear of disclosure of gender identity and HIV status. Concealment was used as a form of stigma management. (4) Multiple levels of stigma hampered access to healthcare services. Preference for trans‐friendly care was motivated by stigma avoidance in public facilities. Overall, the lived experiences of trans men highlight the intertwined relationship between stigma and sexual health. Conclusions: In this sample from Uganda, trans men experienced stigma at multiple levels, highlighting the need for gender‐sensitive healthcare delivery. Stigma reduction interventions, including provider training, non‐discrimination policies, support groups and stigma counselling, could strengthen uptake and utilization of prevention services by this marginalized population. [ABSTRACT FROM AUTHOR]

Research shows that gender norms play a notable role in pregnancy prevention, often placing responsibility on females and allowing some males to pursue sexual encounters without considering the consequences of unprotected sex. This paper examines gender differences in attitudes and behaviors related to condom use and birth control among adolescents using survey, focus group, and interview data gathered from the evaluation of Chicago Healthy Adolescents and Teens (CHAT), a comprehensive sexual health education program implemented with adolescents in Chicago Public High Schools. Results indicate that safe sex attitudes and behaviors differ between male and female adolescents, specifically those related to condoms and birth control. Our findings suggest that (i) females have higher knowledge and presumed responsibility for pregnancy prevention, (ii) infrequent condom use among adolescents prioritizes male pleasure over female health needs, and (iii) social norms discourage females, but not males, from accessing and using birth control. We use the Theory of Gender and Power to show how our findings reflect gender dynamics within the United States and explain the potential health implications for adolescent sexual health. [ABSTRACT FROM AUTHOR]

Risky behaviors, such as substance use and unprotected sex, are associated with various physical and mental health problems. Recent genome-wide association studies indicated that variation in the cell adhesion molecule 2 (CADM2) gene plays a role in risky behaviors and self-control. In this phenome-wide scan for risky behavior, it was tested if underlying common vulnerability could be (partly) explained by pleiotropic effects of this gene and how large the effects were. Single nucleotide polymorphism (SNP)-level and gene-level association tests within four samples (25 and Up, Spit for Science, Netherlands Twin Register, and UK Biobank and meta-analyses over all samples (combined sample of 362,018 participants) were conducted to test associations between CADM2, substance- and sex-related risk behaviors, and various measures related to self-control. We found significant associations between the CADM2 gene, various risky behaviors, and different measures of self-control. The largest effect sizes were found for cannabis use, sensation seeking, and disinhibition. Effect sizes ranged from 0.01% to 0.26% for single top SNPs and from 0.07% to 3.02% for independent top SNPs together, with sufficient power observed only in the larger samples and meta-analyses. In the largest cohort, we found indications that risk-taking proneness mediated the association between CADM2 and latent factors for lifetime smoking and regular alcohol use. This study extends earlier findings that CADM2 plays a role in risky behaviors and self-control. It also provides insight into gene-level effect sizes and demonstrates the feasibility of testing mediation. These findings present a good starting point for investigating biological etiological pathways underlying risky behaviors. [ABSTRACT FROM AUTHOR]

The global COVID‐19 pandemic poses new challenges for communities built around certain sexual practices, and some of which have responded by using their previous experiences of HIV. In this article, we undertake an online ethnography of a popular Anglo‐American barebackers' forum to understand how HIV and COVID‐19 converge and how these men negotiate COVID‐19 risk by adapting previous sexual and disease prevention strategies. Barebackers, aka gay men who eroticise condomless anal intercourse, provide a relevant group to consider given their longstanding negotiation of HIV. We explore processes of responsibility, risk management and pleasure during the COVID‐19 pandemic. We suggest that their experiences of both the AIDS crisis and the current context of HIV frame their decisions around COVID‐19. We focus on how responsibility and desire shape discussions of bathhouses and the survival of barebackers' sexual practices during and after COVID‐19. [ABSTRACT FROM AUTHOR]

Northeastern Uganda has suffered from protracted armed conflict and HIV/AIDS and has some of the highest rates of intimate partner violence (IPV) globally. Little is known about how exposure to conflict and HIV influence individuals' syndemic risk markers or those of their partners. We conducted a population‐based study using multistage sampling across three districts in Northeastern Uganda. We randomly surveyed 605 women aged 13–49 years and estimated syndemic problems for currently partnered women (N = 561) who reported for their male partners. Syndemic problems were lower in the low‐conflict district than the high‐conflict district, p =.009. Conflict exposure was associated with couples' syndemic scores, respondent: β = 0.182, p <.001; partner: β =.181, p <.001. Problem scores were significantly higher among women whose partner was either HIV positive, p =.031, or had an unknown HIV status, p =.016, compared with those whose partner was HIV negative. The total effects of women's, β =.15, p =.034, and men's, β =.137, p =.038, armed conflict exposure on male‐to‐female IPV were significant. For male partners, there were significant total effects of having an unknown, β =.669, p <.001, or positive, β = 1.143, p <.001, HIV status on experiencing female‐to‐male IPV. These results suggest that syndemic problems and corresponding treatments should consider couple influences. Addressing mediating problems of mental distress and alcohol misuse may reduce the risk of male‐to‐female IPV. Providing couple‐based HIV psychosocial interventions could reduce men's exposure to IPV. [ABSTRACT FROM AUTHOR]

Introduction: HIV self‐testing (HIVST) and oral pre‐exposure prophylaxis (PrEP) are complementary, evidence‐based, self‐controlled HIV prevention tools that may be particularly appealing to sex workers. Understanding how HIVST and PrEP are perceived and used by sex workers and their intimate partners could inform prevention delivery for this population. We conducted qualitative interviews to examine ways in which HIVST and PrEP use influence prevention choices among sex workers in Uganda. Methods: Within a randomized trial of HIVST and PrEP among 110 HIV‐negative cisgender women, cisgender men and transgender women sex workers (NCT03426670), we conducted 40 qualitative interviews with 30 sex workers and 10 intimate partners (June 2018 to January 2020). Sex worker interviews explored (a) experiences of using HIVST kits; (b) how HIVST was performed with sexual partners; (c) impact of HIVST on PrEP pill taking; and (d) sexual risk behaviours after HIVST. Partner interviews covered (i) introduction of HIVST; (ii) experiences of using HIVST; (iii) HIV status disclosure; and (iv) HIVST's effect on sexual behaviours. Data were analysed using an inductive content analytic approach centering on descriptive category development. Together, these categories detail the meaning of HIVST and PrEP for these qualitative participants. Results: Using HIVST and PrEP was empowering for this group of sex workers and their partners. Three types of empowerment were observed: (a) economic; (b) relational; and (c) sexual health. (i) Using HIVST and PrEP made sex without condoms safer. Sex workers could charge more for condomless sex, which was empowering economically. (ii) Self‐testing restored trust in partners' fidelity upon being reunited after a separation. This trust, in combination with condomless sex made possible by PrEP use, restored intimacy, empowering partnered relationships. (iii) HIVST and PrEP enabled sex workers to take control of their HIV prevention efforts and avoid the stigma of public clinic visits. In this way they were empowered to protect their sexual health. Conclusions: In this sample, sex workers' use of HIVST and PrEP benefitted not only prevention efforts, but also economic and relational empowerment. Understanding these larger benefits and communicating them to stakeholders could strengthen uptake and use of combination prevention interventions in this marginalized population. [ABSTRACT FROM AUTHOR]

Condom use substantially reduces unwanted pregnancies and sexually transmitted infections. While condom availability is a significant public health priority, effects of condom availability constraints remain relatively under‐researched. The limited research on condom availability suggests two major barriers to use: (1) effort/costs and (2) delay to access. To date, we are aware of no study that explores both demand for and discounting of condom availability; the focus of this study was to account for condom decisions using a reinforcement pathology framework. This study used a condom purchase task and the Sexual Delay Discounting Task to quantify behavioral economics of condom use. Low sexual discounting was associated with higher willingness to engage unprotected sex. Demand metrics suggest participants indicating abstinence at condom breakpoint were willing to pay nearly double for condoms relative to individuals indicating unprotected sex at breakpoint. Finally, we grouped participants into reinforcement pathology risk groups based on their discounting and demand indices; these groups significantly differed in self‐reported number of sexual partners, unprotected sexual partners, and Sexual Desire scores. This study demonstrates the value of behavioral economic approaches to public health concerns, and further underscores the translational benefits of quantitative metrics to shed novel light on risky health decisions. [ABSTRACT FROM AUTHOR]

B Methods: b This was a five-year retrospective cohort analysis of all ART-experienced HIV/TB co-infected patients who completed TB treatment in a specialist HIV clinic between 2009 and 2014. SP 2 sp Ministry of Public Health Thailand, Department of Disease Control, Nonthaburi, Thailand B Background: b The Thai Ministry of Public Health (MoPH) considers HIV self-testing (HIVST) a complementary approach to increase access to and uptake of HIV testing especially among men who have sex with men (MSM) and transgender women (TGW), who historically have low access to HIV testing. Using a real-world claims database, we evaluated the utilization of PrEP in the United States (US) from December 2019 to June 2020. B Results: b The total study sample included 177,572 people (66.0% women, mean age 29 ± 10 years), among whom 86.6% (95%-CI 86.4 to 86.7) had never heard of HIVST, 11.7% (95%-CI 11.6 to 11.9) had heard of HIVST but never tested and 1.7% (95%-CI 1.6 to 1.8) had tested with HIVST. SP 5 sp University of Alabama Birmingham, Nursing, Birmingham, United States B Background: b Pre-exposure prophylaxis (PrEP) is a potent biomedical tool for HIV prevention; however, PrEP is underutilized among African American (AA) women in the Deep South of the United States, despite an inequitable HIV burden. [Extracted from the article]

Pre‐Exposure Prophylaxis (PrEP) is a novel HIV prevention tool. PrEP stigma is a frequently reported barrier, while social disclosure of PrEP use may be an important facilitator. We explored how PrEP users managed PrEP use disclosure using a symbolic interactionist approach. We interviewed 32 participants from two PrEP demonstration projects (Be‐PrEP‐ared, Antwerp; AMPrEP, Amsterdam). We validated qualitative findings through Be‐PrEP‐ared questionnaire data. A minority of participants had received negative reactions on PrEP. The way PrEP use was disclosed was highly dependent on the social situation. In a sexual context among MSM, PrEP use was associated with condomless sex. Friends endorsed PrEP use as a healthy choice, but also related it to carelessness and promiscuity. It was seldom disclosed to colleagues and family, which is mostly related to social norms dictating when it is acceptable to talk about sex. The study findings reveal that PrEP stigma experiences were not frequent in this population, and that PrEP users actively manage disclosure of their PrEP user status. Frequent disclosure and increased use may have helped PrEP becoming normalised in these MSM communities. To increase uptake, peer communication, community activism and framing PrEP as health promotion rather than a risk‐reduction intervention may be crucial. [ABSTRACT FROM AUTHOR]

Neighborhood disorder has been linked to perceptions of shorter life expectancies, and shorter life expectancies have been associated with greater risk‐taking. Yet, no studies have combined these two pathways. Using data from the longitudinal Crossroads study, the present study assessed whether life expectancy mediates the association between neighborhood disorder and risk‐taking—substance use, crime, and risky sex—among 1,093 justice‐involved adolescents. Results indicate that neighborhood disorder was linked to lower estimated life expectancy which in turn related to higher rates of cigarette use, binge drinking, illicit drug use, offending, and casual sex. However, life expectancy did not explain the association between neighborhood disorder and marijuana use or inconsistent condom use. [ABSTRACT FROM AUTHOR]

Introduction: Event‐driven pre‐exposure prophylaxis (edPrEP) with oral tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) is highly effective for preventing HIV acquisition in men who have sex with men (MSM) and is preferred over daily PrEP by some MSM. However, it is largely unknown how well MSM adhere to edPrEP. We then aimed to assess PrEP protection during CAS among MSM using edPrEP and participating in the Amsterdam PrEP demonstration project (AMPrEP). Methods: We analysed data from participants enrolled in AMPrEP who were taking edPrEP. We measured adherence through (1) a mobile application in which sexual behaviour and PrEP‐use were recorded daily, (2) three‐monthly self‐completed questionnaires and (3) dried blood spot (DBS) samples collected around six, twelve and twenty‐four months after PrEP initiation. We assessed the proportion of days with condomless anal sex (CAS) acts that were protected by PrEP, per partner type (i.e. steady partners, known casual partners, unknown casual partners), and the proportion of three‐month periods during which PrEP was correctly used. Intracellular TFV‐diphosphate (TFV‐DP) concentrations were determined from DBS. Good adherence was defined as at least one tablet before and one tablet within 48 hours after a CAS act. Results: Between 11 September 2015 and 6 October 2019, 182 of 376 MSM (48.4%) used edPrEP for at least one three‐month period. Of the 8224 CAS days that were reported in the app during edPrEP‐use, we observed good protection for most CAS days involving steady partners (n = 1625/2455, 66.9%), known casual partners (n = 3216/3472, 92.6%) and unknown casual partners (n = 2074/2297, 90.3%). Men reported consistently correct PrEP‐use in 851 (81.4%) of the 1046 three‐month periods of edPrEP‐use. The median TFV‐DP concentration was 591 fmol/sample (interquartile range = 270 to 896). Conclusions: Adherence to edPrEP was high as determined from the online app and questionnaire. DBS measurements were consistent with two to three tablets per week on average. [ABSTRACT FROM AUTHOR]

Sexual aggression (SA) is a serious public‐health problem on college campuses, and there is a pressing need for basic research fostering the development of novel prevention strategies. The current study (a) developed measures of protective behavioral strategies (PBS) for sexual aggression (SA) and risky sex (RS); (b) characterized college men's PBS use; and (c) evaluated whether those who reported engaging in SA and RS showed lower PBS use. Undergraduate men from two universities (n = 567) who endorsed sexual attraction toward women completed measures of PBS, SA, RS, rape‐supportive and sociosexual attitudes, and alcohol consumption. On average, participants reported using PBS for SA and RS fairly often, but a sizeable number indicated that they seldom or never used the strategies. Men who reported SA engagement in the last year, relative to their peers, endorsed sharply lower reliance on SA PBS and RS PBS. Men who reported at least one RS behavior in the last year used RS PBS far less often than their peers. The PBS measures converged as expected with other attitudinal and behavioral measures. The new PBS measures reference cognitive‐behavioral approaches that a large percentage of college men use on a regular basis, making them potentially acceptable prevention targets. Further, men at greater risk of exhibiting SA are much less likely to take steps to reduce the risks associated with sexual behavior, in comparison with their peers. Thus, future work could evaluate the potential usefulness of incorporating PBS for SA and RS into primary prevention programming in both domains. [ABSTRACT FROM AUTHOR]