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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]

Although adolescents are generally healthy, they are at unique psychosocial, cognitive, and physical development stages that can affect their decision-making ability and overall health. This age group often engages in risky behaviors such as unsafe sex, drug abuse, and unhealthy eating habits. Despite these potential risks, adolescents are less likely to seek prompt medical attention, often due to concerns about parental awareness of their health problems and concerns. Objectives: Organizations recommend providing confidential adolescent health care to reduce the consequences of high-risk health behaviors such as substance use, unhealthy eating patterns, and high-risk sexual behaviors. Family physicians are uniquely positioned to provide confidential counseling and care to this vulnerable population but must be trained to provide such care. This study describes the impact of formal and informal training on the knowledge of and comfort level in providing confidential adolescent healthcare among a sample of US Family Medicine residents. Methods: Electronic surveys were distributed to all Family Medicine residents throughout the United States. We used descriptive statistics and χ2 analysis where appropriate to determine the association between resident-reported receipt of training, confidence, and frequency in providing confidential adolescent health care. Results: A total of 714 Family Medicine residents completed the survey. The majority reported no formal training in residency (50.3%). The receipt of formal and informal training in both medical school and residency was associated with a greater degree of comfort in providing confidential adolescent care and a higher likelihood of providing confidential time alone. Those reporting formal training were more likely to always provide confidential care (P = 0.001). Conclusions: Training focused on confidential adolescent health care in medical school or residency was associated with a greater degree of comfort and a higher likelihood of providing confidential adolescent health care. [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]

Background: Women living with HIV (WLWH) are often coinfected with Trichomonas vaginalis (TV), and annual screening is recommended. Our goal was to assess differences in TV prevalence at study entry and over time in enrollment cohorts of the Women's Interagency HIV Study. Methods: In a multisite study, TV was diagnosed by wet mount microscopy. Prevalence was determined across four enrollment waves: 1994–1995, 2001–2002, 2011–2012, and 2013–2015. Generalized estimating equation multivariable logistic regression models assessed changes in visit prevalence across waves after controlling for HIV disease severity and other risks. Results: At 63,824 person-visits (3,508 WLWH and 1,262 women without HIV), TV was diagnosed by wet mount at 1979 visits (3.1%). After multivariable adjustment, HIV status was not associated with TV detection, which was more common among younger women, women with multiple partners, and irregular condom use. All enrollment waves showed a decline in TV detection over time, although p-value for trend did not reach significance for most recent waves. To explore the potential utility of screening among WLWH, we assessed rates of TV detection among women without appreciable vaginal discharge on examination. Initial TV prevalence among asymptomatic women was 3.5%, and prevalence decreased to 0.5%–1% in the most recent wave (2013–2015) (p-trend <0.0001). Conclusions: In this cohort, TV rates are low among WLWH, and HIV does not increase TV risk. Screening may benefit newly diagnosed WLWH, women with risk factors, or those receiving care sporadically but is unlikely to further reduce the low rate of TV among women in care, especially older women without multiple partners. The clinical trials registration number for WIHS is NCT00000797. [ABSTRACT FROM AUTHOR]

For adolescents who have a father in their lives, father–teen conversations about sex and relationships can protect teens from risky sexual behaviors. However, little is known about the content and process of these conversations. This study explored topics of and approaches to fathers' talk with their teens about sex and relationships in interviews with a diverse sample of 43 fathers of high school-aged adolescents from across the United States. Interview data were analyzed using content analysis. The results showed how fathers talked with their adolescent children about topics of sexual behavior, risks of sex, dating and relationships, as well as less studied areas of diverse sexual and gender identities and consent, and how these conversations differed with male and female teens. Findings also showed that fathers took multiple approaches to talk about sex, including personal talk, talk about friends and family, and use of media and other distal contexts to start conversations. These findings show how fathers contribute to the sexual socialization of their adolescent children and suggest points of access for fathers who are unsure how to approach talk with their teens about sex and relationships. [ABSTRACT FROM AUTHOR]

Black men and people belonging to sexual minority groups are disproportionately impacted by criminal legal involvement and sexually transmitted infections (STIs). Traumatic experiences are often associated with later criminal legal involvement, depression symptoms, sexual risk behavior, and STIs. Research on the joint influence of trauma and incarceration on STI risk among racial and/or sexual minority people is limited. This study tested the association between posttraumatic stress disorder (PTSD) symptoms and incarceration on sexual risk behavior and STI among Black sexual minority men (SMM), a population that may be at higher risk for contracting STIs. Using data from the HIV Prevention Trials Network 061 Study, a longitudinal study of adult Black SMM in six U.S. cities (N = 855), we tested associations between past 6-month incarceration and subsequent sexual risk behavior, STI, and depression symptoms, for those with and without preincarceration PTSD symptoms. PTSD symptoms were elevated among participants who reported Hispanic ethnicity, having sex with both men and women, and previous incarceration. Although there were no significant differences between recent incarceration and sexual risk for those with and without PTSD, incarceration was linked to some sexual risk behaviors regardless of PTSD symptoms. Among people with PTSD symptoms, there was a higher prevalence of sexual risk and depression symptoms, regardless of incarceration. These findings suggest a potentially compounding influence of PTSD symptoms and incarceration on sexual risk and infection among Black SMM. Public Significance Statement: The results of this study show that sexual risk and infection may be amplified for Black sexual minority men with posttraumatic stress disorder symptoms and criminal legal involvement. This study highlights the potential importance of further assessment, intervention, and referrals for newly released racial and sexual minority men with trauma histories, to reduce sexually transmitted infections and promote sexual health. [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]

Men who have sex with men (MSM) and engage in sex work (MSW) frequently meet clients through dating/hookup apps. This provides an opportunity to discuss the parameters of the exchange prior to meeting and to learn things about the prospective client and the risks he might pose. Limited research has examined the specific issues or topics MSWs discuss with clients before agreeing to meet. We analyzed interview data from a sample of 180 MSWs from eight U.S. cities who engaged in exchange sex with clients they had primarily met through dating/hookup apps and websites. Participants typically asked about clients' sexual interests and expectations regarding what will transpire when they meet to make sure they were compatible with their own boundaries and limitations. Most participants inquired about clients' sexual health and often discussed condom use. Assertiveness and communication skills training might help MSWs negotiate encounters with clients that promote health and safety. [ABSTRACT FROM AUTHOR]

Nonconsensual condom removal (NCCR) is a form of sexual violence that a significant minority of men use to obtain unprotected sex. Experiencing NCCR is associated with serious physical and mental health consequences, such as sexually transmitted infections, unplanned pregnancies, anxiety, and depression. Alcohol use is known to be associated with sexual violence in general; however, limited research has been done on the association between alcohol-related factors and NCCR specifically. Thus, the present study examined the associations between event-level drinking, daily drinking, drinking motives, alcohol expectancies, and NCCR. Young, single, heterosexually active men (N = 96) completed cross-sectional measures of their NCCR behavior, event-level drinking, drinking motives, and alcohol expectancies. A total of 19 (19.8%) participants reported successfully engaging in NCCR at least once since age 14. Results showed that consuming more alcohol during the event, having more highly intoxicated partners, drinking to enhance sex, and holding more negative alcohol expectancies were associated with increased likelihood of NCCR. To effectively decrease the rates of NCCR, prevention efforts could aim to decrease event-level alcohol consumption for both men and their partners and to challenge men's beliefs regarding alcohol's role in sexual behavior. Given the current study's limitations, future studies should consider employing an ecological momentary assessment design to avoid recall bias and include more diverse samples to increase the generalizability of findings. [ABSTRACT FROM AUTHOR]

Generally, romantically partnered individuals report better health than romantically unpartnered individuals. Known increasingly as positive "partnership-health" associations, these may be less frequent among minority or marginalized individuals. Full-service sex workers (FSSW) are relatively common in the U.S., report relatively poor health, and engage in professional behavior that may influence their personal romantic relationships. Therefore, we assessed partnership-health associations among U.S. FSSW. Study researchers collaborated with local and national sex worker organizations, both to design an online survey of relationships and health, and to recruit participants. Here, we used t-tests to compare the health of romantically partnered versus unpartnered FSSW. Health domains assessed included mental health, e.g. depression, anxiety; physical health, e.g. sleep, fatigue; and health behaviors, e.g. substance use, sexual behavior. Results indicated that partnered FSSW reported using fewer measured drugs, using these drugs less often, and trended toward using condoms with paying partners more. However, partnered FSSW also reported more fatigue. No other group-level differences in health were reported. Overall, few positive partnership-health associations were reported among FSSW, adding to extant work indicating partnership-health associations may be attenuated within partnerships involving minority or marginalized individuals. Implications for future research, clinical work with FSSW, and health-related policy are discussed. [ABSTRACT FROM AUTHOR]

Background: Sexually transmitted infections (STIs) and food insecurity are public health concerns in the United States (US) due to their growing prevalence and incidence among young people, and particularly in college students. Studies have reported that college students are at higher risk of STIs due to the high rates of risky sexual behavior (RSB). Most studies report a food insecurity prevalence of more than 30% among college students, which was more than twice the overall national food insecurity rate of 10.5% in 2020. This study aims to assess the relationship between food insecurity and RSB among college students during the early-stages of the COVID-19 pandemic. Methods: This was a cross-sectional study from a convenience sample of 320 students enrolled at the University of Nevada, Las Vegas during the 2020 Fall semester. Data was collected using an online survey. Univariate and multivariate logistic regression analyses were conducted. Results: Food insecure students were 2.9 times more likely to report receiving or giving fellatio without using a condom at least once in the past 6 months (P < 0.01) compared to food secure students. There was no significant association between food insecurity and other RSBs evaluated in this study. Conclusions: The current study provides valuable information on food insecurity and RSB among college students during the early stages of the COVID-19 pandemic. Larger and longitudinal studies are needed to assess the trajectory of the association between food insecurity and fellatio with no condom use and other RSB among college students. [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]

Objectives: We examined sociodemographic, clinical, and behavioral factors associated with previous incarceration among people with diagnosed HIV to inform HIV care efforts for this population. Methods: We used 2015-2017 data from a cross-sectional, nationally representative sample of US adults with diagnosed HIV (N = 11 739). We computed weighted percentages and 95% CIs to compare the characteristics of people with HIV incarcerated in the past 12 months (ie, recently) with people with HIV not recently incarcerated. We used adjusted prevalence ratios (aPRs) with predicted marginal means to examine associations between selected factors and incarceration status. Results: Adults with HIV who were recently incarcerated, when compared with those who were not, were more likely to be aged 18-29 years (prevalence ratio [PR] = 2.51), non-Hispanic Black (PR = 1.39), less educated (

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]

The discovery that people with an undetectable HIV viral load are unable to transmit the virus to sex partners (U = U) has ushered in a new era in HIV care. As a result of this discovery, treatment as prevention (TasP) has become a powerful tool toward ending the epidemic. However, despite its sound scientific basis, many communities affected by HIV face barriers toward adopting TasP as a complete HIV prevention strategy. In addition, most research to date has only focused on TasP in the context of committed monogamous partnerships. To identify barriers to TasP adoption among some of those most affected by HIV, we conducted in-depth qualitative interviews with 62 sexual and gender minority individuals of varying serostatuses. Participants were identified from the results of an online survey, where those who indicated at least some awareness of TasP were invited to partake in a follow-up interview. Interviews were thematically coded to identify emergent themes relating to TasP adoption. Seven primary barriers emerged from data analysis pertaining to TasP science, internalized beliefs about HIV safety, and interactional dynamics between partners: (1) unfamiliarity with TasP science, (2) perceived limitations of TasP science, (3) difficulty changing understanding of "safe sex," (4) unwillingness to rely on partners' reports of being undetectable, (5) persistent HIV stigma, (6) less difficulty finding serosimilar partners, and (7) difficulty incorporating TasP into casual encounters. Together, these barriers confirm the existing findings about TasP adoption, and extend the literature by identifying barriers beyond a lack of education and outside of monogamous contexts. [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]

While the sexual health risks among young people of color in foster care have been well-documented, healthy sexual development in this population has been less examined. The current study explored the experiences of Black youth in foster care and the factors that influenced their safer sex practices. Qualitative interviews were conducted with 18 sexually active Black participants (18–22 years old) in foster care from a large, Midwestern city in the United States. Grounded theory methods were used to (a) construct a conceptual framework illustrating the conditions the youth experienced that influenced their safer sex efforts, and (b) describe different types of intimate relationships that reflected their sexual health practices. Using specific strategies, the majority of the youth overcame obstacles and participated in positive sexual health practices. More than half (59%) reported they were in an intimate relationship for at least 6 months and either abstained from sex, used condoms 100% of the time, or employed safer sex methods. The findings suggest Black youth in state care can engage in positive sexual health practices and form healthy intimate relationships. [ABSTRACT FROM AUTHOR]

Background: Adolescent gay/bisexual men exhibit the highest prevalence of undiagnosed HIV infections. Ascertaining antecedents of behaviorally acquired HIV infections among adolescent gay/bisexual men can be challenging; however, these challenges can be overcome through the utilization of secondary data, such as the Youth Risk Behavior Survey. Objective: Syndemics theory suggests that HIV infections are not a singular phenomenon; instead, many infections occur at the intersection of syndemic factors, such as substance use, violence, and mental health. Our objective is to describe and synthesize research methods of secondary data analyses that examine syndemic factors in relation to HIV risk behavior outcomes among subsamples of adolescent gay/bisexual men. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo were systematically searched. Inclusion criteria were (a) peer-reviewed Youth Risk Behavior Survey secondary data analyses conducted in the United States after 1991, (b) subsamples with adolescent gay/bisexual men, (c) one or more syndemic factor(s), and (d) one or more HIV risk behavior outcome(s). We used the National Institutes of Health Quality Assessment Tools for quality appraisal. Results: Of 1,036 citations retrieved, nine studies met inclusion criteria. Results included using logistic regression analysis and data from 2015 to 2017 in six studies and underpinnings with minority stress theory in four studies. Eight studies omitted race/ethnicity in subsamples and six grouped lesbians with adolescent gay/bisexual men. Seven studies examined substance use, six examined violence, and five examined mental health. Condom use and number of partners were the most studied HIV risk behavior outcomes in four studies, whereas intercourse in the last 3 months was an outcome in only one study. Protective factors were not present. Conclusion: Limitations found the need to highlight better inclusion of race/ethnicity and sexual orientation. Adding contemporary survey items is also necessary, such as nonbinary sex and gender identity, access to HIV prevention (condoms, HIV testing, and preexposure prophylaxis), and experiences with stigma, to elucidate risk behaviors among populations disproportionately affected by HIV infections, including Blacks/African Americans and Hispanics/Latinos. [ABSTRACT FROM AUTHOR]

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

The United States has a higher rate of teen pregnancy than any other developed country with 30% of American girls becoming pregnant before the age of 20. Laws regarding the inclusion and content of sexuality education vary across the country, which are associated with differences in pregnancy and sexually transmitted infection (STI) rates between states. This systematic review aims to determine whether comprehensive sexuality education (CSE) is more effective than abstinence-only or no sexuality education at reducing teenage pregnancy. Secondary objectives include analyzing the effect of CSE on STI incidence, sexual activity, safe-sex behaviors, and social discomfort. We searched multiple databases for studies published from 1990 to 2021. Twenty-nine studies met our inclusion criteria. Seven included pregnancy as an outcome, with three fitting our meta-analysis criteria. There was a decrease in pregnancy rates for participants in the CSE intervention compared to the control (n = 3, risk ratio = 0.89, 95%CI 0.79–1.00, I2 = 0%). We found that CSE is likely to reduce pregnancy rates; however, there was limited data available on this outcome. CSE increased safe-sex behaviors but did not have a notable impact on sexual activity or STIs. This review can serve as evidence for the implementation of CSE in the US. [ABSTRACT FROM AUTHOR]

Cisgender sexual minority girls report an earlier average age at first sex than cisgender heterosexual girls, but little is known about these first experiences with sex. As part of a larger study to develop a sexual health intervention for cisgender sexual minority girls, this analysis explored the context of first sexual experiences of 48 cisgender, sexually experienced, sexual minority girls ages 14 to 18 years in four online focus groups. We used qualitative description to explore with whom girls had their first sex, where it took place, and the context surrounding the experience. Our findings documented both thoughtful intended first sex in committed and intimate friend relationships, and casual, unintended experiences influenced by alcohol, in parental homes and outdoor settings, and provide brief glimpses into the first experiences for sexual minority cisgender girls. They can provide a starting point for sexual health education content that is more inclusive of sexual orientation, and support sexual minority girls' knowledge of how to have safe, enjoyable, and positive sexual experiences. [ABSTRACT FROM AUTHOR]

Using six samples of unmarried U.S. residents aged 18–24 who were part of a larger biennial nationally representative survey (2008–2018), the present study examined whether pornography consumption is a risk factor for condomless sex during emerging adulthood. Condomless sex is the norm in popular, commonly consumed, pornography. Further, emerging adulthood is a time of heightened sexual experimentation and risk taking, and many emerging adults view pornography. Consistent with a sexual scripting perspective on media processes and effects, emerging adults who viewed pornography were more likely to have condomless sex than their peers who did not consume pornography. The link between pornography use and condomless sex was similar for men and women, white youth and youth of color, as well as heterosexual and LGB youth. The link was not moderated by age. Further, the link was robust even when indicators of both sexual and nonsexual sensation seeking predilections were included in analyses. These results are consistent with recent suggestions from public health experts that sex education programs need to include modules on pornography literacy. [ABSTRACT FROM AUTHOR]

Affect has been linked to risky sexual decision-making and may be particularly important for college students. Research has overlooked the role of affective arousal, rather focusing exclusively on affective valence. Other decision-making factors that may be impacted by affective states, such as sexual abdication (i.e. yielding sexual decision-making), have also been disregarded. Using a 2 × 2 randomized-factorial design, this experimental study investigated the effects of affective arousal on intentions to engage in condomless sex with heterosexual college students (N = 136; 50% women). Potential indirect effects of sexual abdication were also explored. Results demonstrated no main effect of affective arousal on intentions to engage in condomless sex, yet indicated an indirect effect through sexual abdication. This is the first experimental data about the relationship between affective arousal and sexual decision-making. Findings suggest affective causes of sexual risk warrant further investigation. [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: 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]

Public health professionals have raised concern that increased use of long-acting reversible contraceptives (LARC) could raise women's risk for sexually transmitted infections (STIs), because LARC's superior pregnancy protection may decrease women's motivation to use a barrier method for supplemental pregnancy prevention. This study uses population-based data to examine whether condom use is lower, particularly among young women who are at increased STI risk, after initiating LARC versus moderately effective methods. With the 2011–2019 data files of the National Survey of Family Growth, we examine the percent of sexually active months with condom use in the year after LARC or moderately effective method initiation for a nationally representative sample of 2,018 women aged 15–44 years. Multinomial logistic models regressed condom use on method type and age group, as well as their interaction, while adjusting for key confounders. The unadjusted likelihood of any condom use is substantially lower among women who initiated LARC versus moderately effective methods (12% vs. 37%), and this difference is greater among younger versus older women. After accounting for differences in women's reproductive and sociodemographic profiles, however, a statistically significant difference in condom use by method initiated remains only for those aged 20–34 years. Crude estimates suggest that condom use is lower after initiating LARC versus moderately effective methods, especially among young women. After accounting for the confounding effects of LARC users' distinct profiles—particularly in terms of parity and teenage childbearing—the difference is decreased overall and no longer significant for adolescent women. Overall results indicate a need for new STI prevention strategies and policies that emphasize the importance of dual prevention for LARC users at risk of STIs. [ABSTRACT FROM AUTHOR]

Black men who have sex with men (BMSM) are disproportionately incarcerated in the United States. Incarceration is a barrier to health equity and may be a risk factor for experiences of interpersonal violence. However, the effect of incarceration on experienced violence among BMSM is understudied. We examined associations between recent incarceration on subsequent experiences of race- or sexuality-based violence, intimate partner violence, or community violence. We analyzed data from the HPTN 061 study. Analysis includes data on 1,169 BMSM recruited from 6 U.S. cities who were present at baseline as well as 6- and 12-month followup interview. We tested if self-reported incarceration between baseline and 6 months was associated with self-reported outcomes between 6 and 12 months using logistic regression with inverse probability of treatment weighting and multiple imputation methods. Experienced outcomes included violence due to race or sexuality, intimate partner violence and aggression, and community violence (i.e., gang violence, robbery, shooting). Approximately 14% reported incarceration between baseline and 6 months and 90% reported experiencing violence between 6 and 12 months. In adjusted analyses, incarceration was associated with subsequent race- or sexuality-based violence [aOR (adjusted odds ratio) range: 1.25-1.41, 95% CI (confidence interval) range: 1.00-1.74], experiences of physical abuse and aggression from intimate partners (aOR: 2.35; 95% CI: 1.50, 3.70) and community violence (OR 1.82; 95% CI: 1.23, 2.72). Recent incarceration experience increased risk of exposure to future violence in this population. Mixed methods research examining mediating paths between and downstream effects of incarceration and violence on the wellbeing and health of BMSM is needed. We implore researchers to study violence and incarceration among BMSM. Practitione should implement strategies such as trauma-informed interventions, and policies strengthening the social and economic support needs of Black populations. [ABSTRACT FROM AUTHOR]

Background: Anal intercourse (AI) is not uncommon among U.S. women and, when condomless, confers a far greater likelihood of HIV transmission than condomless vaginal intercourse. We aim to identify determinants preceding AI, among women with, and women without HIV.Methods: 3708 women living with (73%), and without HIV (27%) participating in the Women's Interagency HIV Study provided sexual behavior and other data at 6-monthly visits over a median of 9 years (1994-2014). We used generalized estimating equation models to examine sociodemographic, structural and behavioral determinants reported in the visit preceding (1) AI, and (2) condomless AI.Results: AI was reported at least once over follow-up by 31% of women without, and 21% with HIV. AI was commonly condomless; reported at 76% and 51% of visits among women living without HIV, and with HIV, respectively. Women reporting AI were more likely to be younger (continuous variable, adjusted odds ratio (aOR) = 0.97, 95% confidence interval (CI):0.96-0.98), Hispanic (aOR = 1.88, CI:1.47-2.41) or White (aOR = 1.62, CI:1.15-2.30) compared to Black, and have at least high school education (aOR = 1.33, CI:1.08-1.65). AI was more likely following the reporting of either (aOR = 1.35, CI:1.10-1.62), or both (aOR = 1.77, CI:1.13-2.82) physical and sexual violence, excessive drinking (aOR = 1.27, CI:1.05-1.66) or any drug use (aOR = 1.34, CI:1.09-1.66), multiple male partners (aOR = 2.64, CI:2.23-3.11), exchange sex (aOR = 3.45, CI:2.53-4.71), one or more female sex partners (aOR = 1.32, CI:1.01-1.75), condomless vaginal intercourse (aOR = 1.80, CI:1.53-2.09), and high depressive symptoms (aOR = 1.23, CI:1.08-1.39).Conclusion: AI disproportionally follows periods of violence victimization, substance use, multiple sex partners and depression. Better prevention messaging and biomedical interventions that reduce acquisition or transmission risk are needed, but when AI occurs in the context of violence against women, as our findings indicate, focusing on gender-based violence reduction and immediate treatment to reduce HIV transmission risk is important. [ABSTRACT FROM AUTHOR]

The study's aim was to determine the association between school-based violence and being under the influence of drugs/alcohol during the last sexual intercourse among US high-school adolescents. A total of 3136 students from the 2019 Youth Risk Behavior survey were included. Multivariate logistic regression models were conducted to examine associations of exposure to school-based violence and being under the influence of drugs/alcohol during the last sexual intercourse, adjusting for demographics, early initiation of risky behaviors, mental health indicators, and good school performance. Adolescents who had been threatened/injured with a weapon on school property showed higher odds of engagement in being under the influence of drugs/alcohol during their last sexual intercourse (aOR = 1.49(1.05, 2.11)). Study findings highlight the substantial need for addressing associated factors for RSBs. Future research should explore the longitudinal association between school-based violence and risky sexual behaviors. [ABSTRACT FROM AUTHOR]

Background: HIV infections disproportionately impact Latino gay and bisexual men (GBM) in the United States. Pre-Exposure Prophylaxis (PrEP) is a proven prevention strategy that can help reduce new HIV infections in this population. Unfortunately, PrEP adoption and persistence among Latino GBM remain low. The added benefits of using PrEP experienced by Latino GBM can provide important insights to inform the development of PrEP messaging to motivate this population to explore and consider PrEP as an appropriate and acceptable HIV prevention tool. Methods: We conducted in-depth interviews with Latino GBM PrEP users to explore positive feelings and emotions, and additional benefits gained from using PrEP. Data were analyzed using thematic analysis. Results: A total of 29 Latino GBM completed the study interview. The average age of participants was 30 years, and the mean length of time using PrEP was 17.1 months. Five themes were constructed from the data representing the additional benefits gained by Latino GBM PrEP users, and included: (1) reduced fear, anxiety, and stress about HIV, HIV testing, and sex; (2) feeling empowered and in control of their HIV risk; (3) greater awareness of sexual risk behaviors and sexual health; (4) greater sexual exploration and pleasure, and comfort having condomless sex; and (5) a greater connection to community and a feeling of contributing to the elimination of HIV. Conclusions: The added benefits identified in this study represent a range of social, emotional, and psychological benefits that Latino GBM experience while using PrEP. They speak to the complementary benefits that PrEP can bring to Latino GBM who decide to use the medication, that go beyond HIV prevention. These findings can inform the development of future PrEP messaging to help improve motivation for PrEP uptake and persistent use among Latino GBM. [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]

Posttraumatic stress disorder (PTSD) symptoms may interfere with gay, bisexual and other men who have sex with men's (MSM) ability to engage in safe sex practices. An indirect relationship with dissociation may help to elucidate the relationship between PTSD symptom severity and condomless sex among MSM with childhood sexual abuse (CSA) histories. These relationships have not previously been examined in this group, which has a unique vulnerability for HIV acquisition. A cross-sectional sample of MSM with histories of CSA (N=290) was recruited at study sites in Boston, MA, and Miami, FL. Participants had a mean age of 37.95 years (SD=11.68), 22% were African American and 29.4% identified as Latino. The sample reported a mean of 10.47 (SD=4.38) lifetime PTSD symptoms and 26.4% met the clinical threshold for dissociation. Logistic regression models (adjusted for age, education, and substance use disorder) were used to assess indirect effects of dissociation on the relationship between lifetime PTSD symptoms and condomless anal/vaginal sex episodes with serodiscordant or unknown status partners in the past 3 months. Dissociation accounted for the association between lifetime PTSD symptom severity and condomless sex episodes. The Sobel test (Sobel = 2.04, p=.042; CI 95% bias-corrected bootstrap) suggested significant indirect effects for dissociation. Dissociation among MSM with CSA histories may compromise accurate appraisals of sexual risk and safety and increase vulnerability for HIV acquisition. Further research is warranted to address HIV prevention in the context of PTSD symptom severity to improve the mental health of MSM and increase the effectiveness of HIV prevention interventions. [ABSTRACT FROM AUTHOR]

Objective:Explore how perceptions of the sex ratio in Black communities' impact heterosexual Black women's confidence in negotiating condom use with sex partners and condom use at last sex. Methods: Using log-binomial regression models, we estimated the association between perception of the sex ratio and condom negotiation self-efficacy and condom use at last sex. Results: Perception of the sex ratio among Black women surveyed was not significantly associated with condom negotiation self-efficacy and condom use at last sex. Conclusion: Overall, the results do not demonstrate an association between perception of the sex ratio and condom negotiation self-efficacy and condom use at last sex. [ABSTRACT FROM AUTHOR]

Abstract: Aims: Emerging adulthood, spanning adolescence into early adulthood, is marked by heightened substance use and sexual risk-taking, and emerging adults living in disadvantaged urban areas experience disproportionately more negative outcomes. Research on the social psychology of time perspective and the behavioral economics of substance use suggests that such impoverished environments contribute to development of a decision-making style characterized by devaluation of delayed rewards and outcomes that support adaptive functioning in favor of persistent preference for short-term rewards associated with longer term costs. This cross-sectional observational study investigated the hypothesis that substance use and sexual risk-taking among young African American women living in such communities were related to present-dominated time perspectives and higher delay discounting, which reflect relative preference for sooner typically smaller than later larger rewards. Methodology: Young African American women ages 15 – 25 (N = 223, M age = 20.4 years) from disadvantaged urban neighborhoods in the Southern United States were recruited using Respondent Driven Sampling, a peer-driven sampling method suitable for recruiting community-dwelling participants that compensates for biases of snowball sampling. In-person structured field interviews assessed substance use, sexual practices, and risk/protective factors, including time perspectives (Zimbardo Time Perspective Inventory [ZTPI]) and behavioral impulsivity (delay discounting task). Multiple regression analyses were conducted to examine whether substance use and sexual risk-taking were associated with delay discounting and ZTPI present hedonistic and future time perspective subscales, controlling for several demographic characteristics. Results: As hypothesized, regression models showed that higher ZTPI present hedonism scores were significantly associated with both greater substance involvement and sexual risk-taking, whereas greater discounting was associated only with greater sexual risk-taking (ps <.05). Future time perspectives were not associated with either risk behavior. Conclusions: Risk behaviors among young women living in disadvantaged urban areas appear to be associated with hedonistic rewards available in the present without considering future outcomes. Future research should investigate experimentally whether lengthening time perspectives and promoting enriched views of possible futures may prevent and reduce substance involvement and sexual risk-taking among disadvantaged young adults. Those living in disadvantaged communities likely have great need for such interventions because they tend to have limited rewarding economic and social opportunities that can compete with present choices to use substances and engage in risky sex. [ABSTRACT FROM AUTHOR]

Young Men who have Sex with Men (MSM) continue to face disproportionate HIV risk. Despite its well accepted role in HIV prevention, pre-exposure prophylaxis (PrEP) uptake remains below desired goals. Systemic barriers to PrEP access, including insurance complexity, cost, and wait times to start PrEP may contribute to low PrEP engagement. We conducted in-depth interviews and designed a discrete choice experiment (DCE) to assess preferences for and barriers to PrEP access in the United States. Methods: We conducted in-depth interviews with 18 MSM aged 18–30 years old who were not on PrEP and created a DCE based on the results. For the DCE, a convenience sample of young MSM in the United States who reported recent condomless anal sex was recruited through social media applications. Consenting participants provided sociodemographic information and responded to a series of 10 choice tasks about PrEP access. Preferences were analyzed utilizing marginal willingness-to-pay (mWTP) methods. Results: In-depth interviews revealed preferences for highly effective PrEP and concerns about barriers to access due to insurance coverage and privacy. The online DCE was completed by 236 eligible MSM aged 18–30. The most-preferred PrEP package—with all elements significantly preferred over other options—was insurance covered, could be maintained confidential from parents and employers, was available immediately, and had an online option. Need to take out new insurance or add a supplemental insurance in order to cover PrEP significantly detracted from willingness to pay for a PrEP program. Attributes most associated with willingness to pay for PrEP were PrEP being covered by an insurance the client already has and insurance coverage that was private. Conclusions: Young MSM at high risk for HIV in the United States who are not currently on PrEP showed strong preferences for PrEP options that were covered by insurance and could be kept confidential from parents and employers. Lack of these options may present major barriers to PrEP access among young MSM who are at particularly high risk. Rapid access to PrEP, as well as the option of receiving some care online, may also enhance PrEP uptake. [ABSTRACT FROM AUTHOR]

Background: Prospects for a gonococcal vaccine have advanced. Vaccine acceptability is crucial to maximizing population-level protection among key groups, such as men who have sex with men (MSM). We assessed the prevalence of gonococcal vaccine acceptability among sexually active MSM in the United States.Methods: We used data from the American Men's Internet Study conducted from August 2019 to December 2019. We calculated frequencies of sociodemographic characteristics, vaccine acceptability, and preferred location for vaccine receipt. Using log-binomial regression analyses, we calculated unadjusted prevalence rates (PRs) and 95% confidence intervals (CIs) to evaluate factors associated with vaccine acceptability.Results: Of 4951 MSM, 83.5% were willing to accept a vaccine and 16.5% were unwilling. Preferred vaccination locations were primary care provider's clinics (83.5%) and sexually transmitted disease (STD) clinics (64.6%). Vaccine acceptability was greater among young MSM (15-24 years [PR, 1.09; 95% CI, 1.05-1.12], 25-29 years [PR, 1.13; 95% CI, 1.09-1.17], and 30-39 years [PR, 1.10; 95% CI, 1.05-1.14] compared with MSM ≥40 years), MSM living with HIV (PR, 1.05; 95% CI, 1.02-1.09), and MSM who reported (in the past 12 months) condomless anal sex (PR, 1.09; 95% CI, 1.06-1.12), a bacterial STD test (PR, 1.18; 95% CI, 1.15-1.21), HIV preexposure prophylaxis use (PR, 1.17; 95% CI, 1.14-1.19), a bacterial STD diagnosis (PR, 1.04; 95% CI, 1.02-1.07), or a health care provider visit (PR, 1.11; 95% CI, 1.06-1.16). Men who have sex with men who reported ≤high school education (PR, 0.93; 95% CI, 0.91-0.97) were less willing to accept a vaccine compared with those with >high school education.Conclusions: Most respondents were willing to accept a gonococcal vaccine. These findings can inform the planning and implementation of a future gonococcal vaccination program that focuses on MSM. [ABSTRACT FROM AUTHOR]

Background: We examined condom use patterns and potential population-level effects of a hypothetical condom intervention on human immunodeficiency virus (HIV) transmission among adolescent sexual minority males (ASMM).Methods: Using 3 data sets: national Youth Risk Behavior Survey 2015 to 2017 (YRBS-National), local YRBS data from 8 jurisdictions with sex of partner questions from 2011 to 2017 (YRBS-Trends), and American Men's Internet Survey (AMIS) 2014 to 2017, we assessed associations of condom use with year, age, and race/ethnicity among sexually active ASMM. Using a stochastic agent-based network epidemic model, structured and parameterized based on the above analyses, we calculated the percent of HIV infections averted over 10 years among ASMM ages 13 to 18 years by an intervention that increased condom use by 37% for 5 years and was delivered to 62% of ASMM at age 14 years.Results: In YRBS, 51.8% (95% confidence interval [CI], 41.3-62.3%) and 37.9% (95% CI, 32.7-42.3%) reported condom use at last sexual intercourse in national and trend data sets, respectively. In AMIS, 47.3% (95% CI, 44.6-49.9%) reported condom use at last anal sex with a male partner. Temporal trends were not observed in any data set (P > 0.1). Condom use varied significantly by age in YRBS-National (P < 0.0001) and YRBS-Trends (P = 0.032) with 13- to 15-year-olds reporting the lowest use in both; age differences were not significant in AMIS (P = 0.919). Our hypothetical intervention averted a mean of 9.0% (95% simulation interval, -5.4% to 21.2%) of infections among ASMM.Conclusions: Condom use among ASMM is low and appears to have remained stable during 2011 to 2017. Modeling suggests that condom use increases, consistent with previous interventions, have potential to avert 1 in 11 new HIV infections among ASMM. [ABSTRACT FROM AUTHOR]

Background: Zika virus (ZIKV) can be transmitted sexually but the risk of sexual transmission remains unknown. Most evidence of sexual transmission is from partners of infected travelers returning from areas with ZIKV circulation.Methods: We used data from the US national arboviral disease surveillance system on travel- and sexually acquired ZIKV disease cases during 2016-2017 to develop individual-level simulations for estimating risk of male-to-female, male-to-male, and female-to-male sexual transmission of ZIKV via vaginal and/or anal intercourse. We specified parametric distributions to characterize individual-level variability of parameters for ZIKV persistence and sexual behaviors.Results: Using ZIKV RNA persistence in semen/vaginal fluids to approximate infectiousness duration, male-to-male transmission had the highest estimated probability (1.3% [95% confidence interval, CI, .4%-6.0%] per anal sex act), followed by male-to-female and female-to-male transmission (0.4% [95% CI, .3%-.6%] per vaginal/anal sex act and 0.1% [95% CI, 0%-.8%] per vaginal sex act, respectively). Models using viral isolation in semen vs RNA detection to approximate infectiousness duration predicted greater risk of sexual transmission.Conclusions: While likely insufficient to maintain sustained transmission, the estimated risk of ZIKV transmission through unprotected sex is not trivial and is especially important for pregnant women, as ZIKV infection can cause severe congenital disorders. [ABSTRACT FROM AUTHOR]

"Stealthing" is a form of sexual violence wherein a sexual partner purposefully removes a condom during penetration without the receptive partner's knowledge. Given the role of substance use in sexual violence broadly, we examined demographic and substance use correlates of stealthing perpetration (SP) and victimization (SV) among emerging adults. Participants comprised 2,550 18- to 25-year-olds (M age = 20.8, SD = 2.3), recruited via social media (48% female; 53.9% non-Hispanic White; 46.0% had another racial/ethnic identity; 67.4% heterosexual; 85.3% had some college education). Unadjusted analyses (t tests, χ2 analysis) and adjusted logistic regression analyses examined associations between demographics (age, education, race/ethnicity, sexual orientation) and substance use (binge drinking, marijuana use, other illegal drug use, and prescription drug misuse) with male SP and male and female SV. Five percent of males and 18.9% of females reported SV; 6.1% of males reported SP. In adjusted analyses, significant correlates of SP were: non-Hispanic White race/ethnicity (odds ratio [OR] = 0.39), binge drinking (OR = 1.39), cannabis use (OR = 1.37), and other drug use (OR = 1.43). Significant correlates of male SV were: non-Hispanic White race/ethnicity (OR = 0.28), non-heterosexual orientation (OR = 0.24), binge drinking (OR = 1.49), and other illegal drug use (OR = 1.79). Significant correlates of female SV were: older age (OR = 1.13), non-Hispanic White race/ethnicity (OR = 0.57), binge drinking (OR = 1.28), cannabis use (OR = 1.29), and other drug use (OR = 1.22). Consistent with literature linking alcohol to sexual violence, binge drinking correlated with both SV and SP, with other substance use also playing a role. Data are needed to explore these relationships using longitudinal, event-level assessments to investigate the influence of acute intoxication. Interventions to reduce sexually transmitted infections, unintended pregnancy, and sexual assault should include content on stealthing and substance use. [ABSTRACT FROM AUTHOR]

Chronic infection with high-risk human papillomavirus is a necessary cause for cervical carcinogenesis. This study examined prevalence of nonavalent vaccine preventable HPV types over four months among sexually active women in the United States. This sub-study obtained meta-data for 80 of the 1,365 women (18–25 years), enrolled in the BRAVO study, a randomized, open-label trial of home screening and treatment of asymptomatic bacterial vaginosis at high-risk for sexually transmitted infections conducted between 2008 and 2013. Participants were randomized to treatment or standard-of-care, and followed every 2-months for 12 months. Stored vaginal swabs from the first three visits were tested for the nine vaccine preventable HPV types using quantitative PCR. Prevalence and associated 95% confidence intervals for the HPV types were assessed using R (version 3.6.1). The average age of the participants was 21.5 (SD ± 2.11) years, with 60% having ever been pregnant and all were African-American. Majority (71%) reported ≥ two sex partners in the prior year with 89% having unprotected vaginal sex and 45% having a new sex partner in the prior year. About 30% had ≥ one of the nine nonavalent vaccine HPV types at all three time points over a period of four months, 15% at two of any three visits, 19% at one of the three visits and 36% were negative for all nine vaccine HPV types at all time points. The most frequently detected HPV vaccine types were 52, 58, 16, and 18. The prevalence of any vaccine HPV types, and high-risk HPV types was 63.8% and 58.8%, respectively. Our findings suggest that HPV vaccination which is currently recommended for all unvaccinated persons through age 26 years, is likely to be more beneficial than previously thought as nonavalent HPV vaccine was not available during the time these data were collected. [ABSTRACT FROM AUTHOR]

In the United States, Hispanic/Latino men who have sex with men (HLMSM) are disproportionally affected by HIV. We conducted a rapid review of national surveillance data to examine disparities in HIV prevention and care outcomes among HLMSM. Thirteen reports provided relevant data from 2011 to 2018. Compared to White MSM, a higher percentage of HIV-negative HLMSM reported not taking PrEP and engaging in condomless sex; a lower percentage of HIV-negative HLMSM at risk for HIV reported PrEP awareness and use; and a lower percentage of HIV-positive HLMSM were aware of their status, linked to HIV care, and virally suppressed. Viral suppression rates in HLMSM were better among Ryan White clients than the national rates, suggesting that access to comprehensive care/services reduces disparities. Findings also call for identifying individual, social, and structural factors contributing to condomless sex without PrEP use and HIV status unawareness and identifying best approaches for scaling up comprehensive care/services. [ABSTRACT FROM AUTHOR]

HIV/STDs and unintended pregnancy persist among adolescents in the United States; thus, effective sexual health interventions that can be broadly disseminated are necessary. Digital health interventions are highly promising because they allow for customization and widespread reach. The current project involved redeveloping and expanding HEART (Health Education and Relationship Training)—a brief, digital sexual health intervention efficacious at improving safer sex knowledge, self-efficacy, and behavior—onto an open-source platform to allow for greater interactivity and accessibility while reducing long-term program costs. The authors describe the process of adapting, reprogramming, and evaluating the new program, which may serve as a guide for investigators seeking to adapt behavioral interventions onto digital platforms. The final product is an open-source intervention that can be easily adapted for new populations. Among 233 adolescents (Mage = 15.06; 64% girls), HEART was highly acceptable and generally feasible to administer, with no differences in acceptability by gender or sexual identity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although lesbian, gay, bisexual and other sexual minority (LGB1) girls are more likely than heterosexual girls to be pregnant during adolescence, relevant pregnancy prevention programming is lacking. METHODS: A national randomized controlled trial was conducted with 948 14- to 18-year-old cisgender LGB1 girls assigned to either Girl2Girl or an attention-matched control group. Participants were recruited on social media between January 2017 and January 2018 and enrolled over the telephone. Between 5 and 10 text messages were sent daily for 7 weeks. Both experimental arms ended with a 1-week booster delivered 12 weeks subsequently. RESULTS: A total of 799 (84%) participants completed the intervention end survey. Participants were, on average, 16.1 years of age (SD: 1.2 years). Forty-three percent were minority race; 24% were Hispanic ethnicity. Fifteen percent lived in a rural area and 29% came from a lowincome household. Girl2Girl was associated with significantly higher rates of condomprotected sex (adjusted odds ratio [aOR] = 1.48, P, .001), current use of birth control other than condoms (aOR = 1.60, P = .02), and intentions to use birth control among those not currently on birth control (aOR = 1.93, P = .001). Differences in pregnancy were clinically but not statistically significant (aOR = 0.43, P = .23). Abstinence (aOR = 0.82, P = .34), intentions to be abstinent (aOR = 0.95, P = .77), and intentions to use condoms (aOR = 1.09, P = .59) were similar by study arm. CONCLUSIONS: Girl2Girl appears to be associated with increases in pregnancy preventive behaviors for LGB1 girls, at least in the short-term. Comprehensive text messaging--based interventions could be used more widely to promote adolescent sexual health behaviors across the United States. [ABSTRACT FROM AUTHOR]

We investigated the prevalence of vaping among college students in South-central Appalachia in the United States and explored factors which were associated with and could predict vaping among the college students. A sample of 498 enrolled students voluntarily completed a self-report REDCap health survey questionnaire in 2018. Outcome variable was use of electronic cigarettes categorized as yes/no. Independent variables included risky behaviors such as texting or emailing while driving, riding in a car with someone who had been drinking, history of protected and unprotected sexual intercourse, age at first intercourse, and type of contraceptive used. Covariates were age, gender, ethnicity/race and high school location. The first category was used as reference. Binary logistic regression was used to identify factors associated with and predicting vaping. Mean age of participants was 20.93(± 8.26), 62.9% were female, a majority (76.5%) were non-Hispanic White, and 43.2% reported vaping at some point in their lives. Initial univariate analysis showed gender (p < 0.0001), seat belt usage (p = 0.002), texting or emailing while driving (p = 0.002), riding in a car with someone who had been drinking (p = 0.001), history of sexual intercourse (p < 0.001), coitarche (p = 0.026), use of birth control pills and withdrawal method were associated with vaping. Adjusting for co-variates, gender (p < 0.002), county of high school (p < 0.009) and texting and e-mailing while driving (0.05), seat belt usage (0.04) remained significant. Vaping was highly prevalent (43.2%) among our participants. Gender, location of high school, texting/emailing while driving and seat belt usage are predictors of vaping among these students. [ABSTRACT FROM AUTHOR]

Preconception care is an essential component of health, particularly among women and men living with HIV and can optimize medical and psychosocial outcomes. However, there is a paucity of data on this topic, especially when evaluating provider communication with male patients. We conducted a multi-site qualitative study in 7 cities in the United States (US) with 92 providers to assess their attitudes and practices regarding preconceptual counseling, safer conception, and preconception care with their patients living with HIV. Providers were contacted to schedule a phone interview. Recorded interviews were transcribed and coded for a priori and emergent themes. Providers reported infrequent communication with male patients with HIV about their reproductive plans and the use of safer conception, acknowledging they were more likely to initiate such communication with female patients. A small percentage of providers reported talking to all of their patients about reproductive options, including men having sex with men (MSM). Currently, there is no consensus or evidence-based guideline for the delivery of preconception care specific to men. Based on our results, we recommend that providers offer preconception care to all men as part of optimizing family planning and pregnancy outcomes; enhancing reproductive health; preparing men for fatherhood; and in the setting of HIV infection, preventing transmission to an uninfected partner. [ABSTRACT FROM AUTHOR]

Risk behaviors associated with sexually transmitted infections (STIs) among people living with HIV (PLWH) have not been well characterized in the US military. We identified risk behaviors associated with a new STI in this population after the repeal of "Don't Ask, Don't Tell." US Military HIV Natural History Study participants who completed the risk behavior questionnaire (RBQ) between 2014 and 2017 and had at least 1 year of follow-up were included (n = 1589). Logistic regression identified behaviors associated with incident STI in the year following RBQ completion. Overall, 18.9% acquired an STI and 52.7% reported condom use at last sexual encounter. Compared with those with no new sex partners, participants with between one and four or five or more new partners were 1.71 [1.25–2.35] and 6.12 [3.47–10.79] times more likely to get an STI, respectively. Individuals reporting low or medium/high perceived risk of STI were 1.83 [1.23–2.72] and 2.65 [1.70–4.15] times more likely to acquire a new STI than those reporting no perceived risk, respectively. Participants who preferred not to answer about sexual preference, number of new partners, or perceived STI risk were also more likely to acquire a new STI. Our study illustrates that despite regular access to health care and accurate perceptions of risk, rates of STI among PLWH remain high in the US military setting, as in others. Given the potential individual and public health consequences of STI coinfection after HIV, more work is needed to assess interventions aimed at sexual behavior change for PLWH. [ABSTRACT FROM AUTHOR]

Men who have sex with men (MSM) continue to account for a large number of new HIV infections across the United States. While numerous studies have focused on MSM sexual risk behavior and substance use, some research has also examined how public and private environments, such as a bathhouse setting, may play an important role. This cross-sectional study analyzed data surrounding HIV/AIDS complacency, substance use, and sexual risk behavior among a sample of 168 MSM in a bathhouse located within a major urban city. Of the sample, 73.2% had completed at least college, 67.9% were single, 56.5% were identified as Caucasian (both Hispanic and Non-Hispanic), 76.2% identified as gay, and 77.4% were HIV negative. Results demonstrated an association between complacency and sexual risk behavior among participants. Being Black (both Hispanic and Non-Hispanic), HIV-positive, or those reporting drug and/or alcohol usage influenced their safe sex practices and was found to be associated with sexual risk behavior. Implications are examined related to HIV education and prevention efforts among MSM as well as affirming practice and service delivery efforts. [ABSTRACT FROM AUTHOR]

Background: Asians living in the United States face unique HIV risk. From 2010 to 2017, the number of diagnosed HIV cases increased by almost 40% among Asians, while on average, the US has seen a 11% decrease in new HIV diagnoses (Centers for Disease Control and Prevention. HIV and Asians. 2019. Available from: ). Culture-sensitive beliefs, which are often neglected in health communication, might play a role in safe sex practice in this particular population. Method: Utilizing the Integrative Model of Behavioral Prediction as a theoretical framework, this study looks into how acculturation to Chinese home culture contributes to Chinese immigrant women's behavioral intention towards safer sex with a casual partner (N = 125). This relationship is proposed to be mediated by perceived social norms, attitude toward condom use, self-efficacy, and familism. Results: Findings indicate that self-efficacy and favorable attitudes toward condom use were predictive of intent, and that the significant predictive role of home culture on behavioral intent was fully mediated by familism. Conclusions: Future interventions should include strategies for enhancing Asian women's self-efficacy for safe sex practices, cultivating a favorable attitude toward condom use, and emphasizing the home cultural values, specifically familism, that might increase their intent to practice safe sex. [ABSTRACT FROM AUTHOR]

Black men who have sex with men (MSM) account for 26% of all new HIV infections in the United States. Biomedical HIV interventions have proven to reduce HIV infections however the use of these interventions by Black MSM is inconsistent. Research suggests that internalized racism may contribute to inconsistent biomedical HIV interventions (condom use and PrEP use) among Black MSM. Using a national sample of 432 Black MSM, we examined the relationship between condom and PrEP use and internalized racism. The results suggest there is some evidence for an association between internalized racism and PrEP use. In addition, internalized racism was not associated with condom use for both insertive and receptive anal sex among Black MSM. These finding suggest the relationship between internalized racism and HIV prevention strategies is not facile and more attention is needed to understand the true impact of racism, both internal and societal, on HIV prevention strategies among Black MSM. These findings underscore the nature of racism in the daily lives of Black MSM and how it impacts HIV prevention strategies adopted by these men. [ABSTRACT FROM AUTHOR]

It is estimated that 23% of the adults and adolescents living with HIV in the United States are female. The Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention (CDC) funds evidence-based interventions (EBIs) to reduce HIV risk behaviors, including HIV prevention programs for people living with HIV and their partners. While EBIs have been shown to be effective in controlled research environments, there are limited data on intervention implementation in real-world settings. Women Involved in Life Learning from Other Women (WILLOW) is a four-session small-group intervention that targets heterosexual women aged 18–50 who are living with HIV. This evaluation assessed changes in participants' HIV knowledge, attitudes, beliefs and risk behaviors. A repeated measures design was used to collect participant risk behaviors at baseline, and again at three and six months post-intervention. Changes in attitudes, beliefs, and risk behaviors were assessed using generalized estimating equations. After participation in WILLOW, participants reported increased HIV knowledge, attitudes and beliefs, being more supportive of condom use, and reduced prevalence of HIV risk behaviors. Findings suggest that the WILLOW intervention can be successfully delivered by community-based organizations to reduce HIV risk behaviors among members of this high-risk population. [ABSTRACT FROM AUTHOR]