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Background: Improving HIV detection and prevention remains a critical public health initiative that requires policy-based solutions. This study sought to compare HIV detection/prevention behaviors before and after healthcare reform in Massachusetts, USA, among heterosexually active persons — the group with the highest reported number of undiagnosed HIV cases. The current study sought to (1) characterize differences in insurance coverage and HIV detection/prevention behaviors between cycles 1 (2006) to 5 (2019); (2) evaluate socio-demographic disparities in insurance coverage accounting for cycle; and (3) evaluate associations between health insurance coverage and HIV detection/prevention behaviors accounting for cycle and socio-demographics. Methods: This is a secondary analysis of the National HIV Behavioral Surveillance (NHBS) project: Boston HET cycle (i.e., made up of heterosexually active persons living in the Boston area) data. Descriptive, bivariate (e.g., chi-square), and multiple logistic and negative binomial loglink regression analyses were conducted. Results: In chi-square analyses with post hoc Bonferroni tests, the proportion of participants with current health insurance significantly increased from cycle 1 (77%) to cycle 2 (95%), p <.001. In the regression models that controlled for NHBS cycle, 1-year change in age (adjusted odds ratio [aOR] = 1.03, 95% confidence interval [CI] = 1.02, 1.05), female gender (aOR = 3.41, 95% CI = 2.48, 4.69), and change in education category (aOR = 1.19, 95% CI = 1.02, 1.39) were associated with a higher likelihood of having health insurance. In regression models that controlled for cycle, age, gender, and education, participants with health insurance were more likely than those without insurance to report seeing a medical provider in the past year (aOR = 3.49, 95% CI = 2.32, 4.66), ever having an HIV test (aOR = 1.52, 95% CI = 0.35, 2.69) and more frequent HIV testing in the past 2 years (incidence rate ratio [IRR] = 1.44, 95% = 1.14, 1.82). Participants with health insurance did not differ from those without insurance in number of vaginal condomless sex partners (IRR = 1.16, 95% CI = 0.95, 1.41) but did report more condomless anal sex partners in the past year (IRR = 1.97, 95% CI = 1.46, 2.65). Conclusions: This study demonstrates how health insurance coverage is positively associated with HIV detection and prevention relevant to both US and international efforts to end the HIV epidemic. [ABSTRACT FROM AUTHOR]

Though feminist theory asserts that women's sexuality influences their general relationship with heterosexual men, the leading psychological measure of women's attitudes towards heterosexual men, the Ambivalence towards Men Inventory (AMI), has not yet accounted for sexual orientation as a meaningful individual difference. In this current United States-based research (N = 318), we revisited the AMI to examine women's attitudes towards heterosexual men as a function of women's sexual orientation (i.e. lesbian, bisexual, or heterosexual). Drawing from feminist and psychological theories of attitudes towards men, we 1) tested competing hypotheses regarding whether lesbian and bisexual women or heterosexual women would be highest in hostility, and 2) hypothesised that heterosexual women would hold more benevolent attitudes than lesbian and bisexual women. When controlling for feminist identity, lesbian women held more hostile attitudes towards heterosexual men, specifically on subscales of Resentment of Paternalism and Heterosexual Hostility. However, there were no differences in benevolence towards heterosexual men between groups. We discuss hostility as a reaction to gendered oppression and the utility of benevolence in modern times. Testing the AMI with a sexually diverse sample reveals nuanced understandings of intergroup relations and demonstrates a need to establish more inclusive measures of gendered attitudes. [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]

Lesbian and bisexual women experience significantly higher rates of sexual assault and rape compared with heterosexual women. Despite this, researchers have yet to distinguish whether sexual orientation itself or some other related social characteristics explain these higher rates. The objective of this study was to analyze women's rates of sexual assault and rape across sexual orientation status while accounting for other social characteristics (e.g., race, education, income, outness). Women (N = 1,366), who identified as lesbian (31%), bisexual (32%), and heterosexual (31%), completed a nationally distributed, cross-sectional online survey in 2016. Victimization and repeat victimization were assessed using a modified version of Sexual Experience Survey–Short Form Victimization. Overall, 63% of bisexual, 49% of lesbian, and 35% of heterosexual women reported experiencing rape in their lifetime. When holding all other social characteristics constant, sexual orientation remained a significant predictor in the model. Compared with the odds of heterosexual women experiencing sexual assault or rape, bisexual women (3.7 odds of victimization; 7.3 odds of repeat victimization) and lesbian women (3.2 odds of repeat victimization) were disproportionately victimized. Sexual orientation clearly plays a role in sexual victimization risk, independent of other measured sociodemographic indicators. Continued research is needed to explore possible mechanisms behind sexual assault and rape prevalence, as well as the influence of contextual factors of victimization risk among sexual minority men. [ABSTRACT FROM AUTHOR]

BACKGROUND: Lesbian, gay, bisexual, and questioning (LGBQ) adolescents are at increased risk of poor mental health due to minority stress, a chronic stress associated discrimination, social rejection, and victimization brought on by prejudicial attitudes towards LGBQ individuals. To improve understanding of the differential impact of various kinds of victimization on mental health outcomes for LGBQ adolescents, we analyzed data from the 2015 Youth Risk Behavior Survey (YRBS) for victimization and mental health symptom clusters and associations high school youth and compared by sexual orientation and gender. METHODS: Separate Latent Class Analysis (LCA) was conducted to identify profiles of both victimization and mental health symptoms for participants (N = 15,624). Subsequently, stratified weighted logistic regression models were used on an eligible analytic sample of 11,458 to assess differences in the association of victimization and mental health between LGBQ and heterosexual high school students. RESULTS: In each LCA, participants were assigned to one of 3 classes for victimization (minimal, 81.3%; bullying, 12.5%; or physical/sexual violence, 6.2%) and 1 of 2 classes for mental health symptoms (minimal, 81.2%; severe, 18.8%). LGBQ participants were overrepresented in physical/sexual violence and bullying victimization profiles. Both bullying and physical/sexual violence profiles were associated with almost 5 times the odds of endorsing severe mental health symptoms. Conclusions: This study expands our understanding of the relationship between types and effect of peer victimization for LGBQ and heterosexual youth with implications for school health and prevention efforts through increased positive school climate for LGBQ students. [ABSTRACT FROM AUTHOR]

Relatively little is known about how gender and sexual orientation intersect to predict young adults' responses to unwanted romantic and sexual overtures from men and women suitors. To better understand these potential differences, and explore possible mechanisms that explain them, this pre-registered study used an online questionnaire to assess reactions to both hypothetical and recalled suitors among a sample of 855 cisgender heterosexual and gay young adults (18-35) from the United States. Results revealed that gay women and heterosexual men reported the most negative hypothetical reactions to men (versus women) suitors, while gay women, heterosexual men, and heterosexual women all recalled more negative reactions to men than women suitors. Gay men recalled relatively benign reactions to suitors of both genders. A desire to be seen as one's true orientation was a mediating factor for both gay women's and heterosexual men's negative reactions to men suitors. These findings and their potential explanations highlight the complexity of how gender and sexual orientation intersect to shape responses to romantic and sexual overtures from men and women suitors.

Anal intercourse is reported by many heterosexuals, and evidence suggests that its practice may be increasing. We estimated the proportion of the HIV burden attributable to anal sex in 2015 among heterosexual women and men in the United States. The HIV Optimization and Prevention Economics model was developed using parameter inputs from the literature for the sexually active U.S. population aged 13-64. The model uses differential equations to represent the progression of the population between compartments defined by HIV disease status and continuum-of-care stages from 2007 to 2015. For heterosexual women of all ages (who do not inject drugs), almost 28% of infections were associated with anal sex, whereas for women aged 18-34, nearly 40% of HIV infections were associated with anal sex. For heterosexual men, 20% of HIV infections were associated with insertive anal sex with women. Sensitivity analyses showed that varying any of 63 inputs by ±20% resulted in no more than a 13% change in the projected number of heterosexual infections in 2015, including those attributed to anal sex. Despite uncertainties in model inputs, a substantial portion of the HIV burden among heterosexuals appears to be attributable to anal sex. Providing information about the relative risk of anal sex compared with vaginal sex may help reduce HIV incidence in heterosexuals. [ABSTRACT FROM AUTHOR]

Our understanding of sexual prejudice, or prejudice against gay men, lesbian women, bisexual people, and other sexual minorities, has improved substantially over the last few decades. Less is known about the factors that predict trans prejudice, or prejudice against trans people. Using the framework of social identity theory, we examined the relationship between gender self-esteem, sexual prejudice toward gay men and lesbian women, and trans prejudice in a sample of 391 self-identified cisgender heterosexual students from a Midwestern university in the United States. Compared to women, men reported more sexual prejudice, trans prejudice, more prejudice toward gay men than lesbian women, and more violence toward, teasing of, and discomfort around trans women than trans men. Whereas both men and women reported more teasing of trans women than of trans men, men reported more discomfort around trans women and women reported more discomfort around trans men. Gender self-esteem significantly predicted sexual prejudice and trans prejudice in men but not women. Consistent with other research, our results indicate that men's sexual prejudice and trans prejudice may be motivated by similar factors, whereas the predictors of women's prejudice may be more specific to the type of prejudice. [ABSTRACT FROM PUBLISHER]

Research on Black sexual health often fails to represent the heterogeneity of Black ethnic groups. For people of Caribbean descent in the USA, ethnicity is a salient cultural factor that influences definitions and experiences of sexual health. Most research on people of Caribbean descent focuses on the relatively high rate of STIs, but sexual health is defined more broadly than STI prevalence. Psychological and emotional indicators and the voice of participants are important to consider when exploring the sexual health of a minority culture. The purpose of this study was to qualitatively explore how heterosexual Black men of Caribbean descent define and understand sexual health for themselves. Eleven men who self-identified as Black, Caribbean and heterosexual participated in three focus groups and were asked to define sexual health, critique behaviours expertly identified as healthy and address what encourages and discourages sexual health in their lives. Findings point to six dimensions of sexual health for heterosexual Black men of Caribbean descent. These include: heterosexually privileged, protective, contextual, interpersonal, cultural and pleasurable dimensions. There were some notable departures from current expert definitions of sexual health. Recommendations for further theory development are provided. [ABSTRACT FROM PUBLISHER]

The present research explores benefits and barriers of friendships for transgender individuals. Participants included 536 individuals who self-identified as transgender or gender variant. Participants completed an online survey asking about friendship experiences with transgender, cisgender, sexual minority, and heterosexual friends. Using a feminist intersectional theoretical framework, content analysis attended to the benefits and barriers to friendship and highlighted patterns of responses by allowing for comparisons across friends' gender identity and sexual orientation. Unique friendship barriers and benefits were found across normative (cisgender/heterosexual) and non-normative (transgender/sexual minority) dimensions of identities. In addition, friendship experiences with transgender and sexual minority friends displayed unique similarities and differences. In our analyses we emphasize the usefulness of a feminist intersectional approach in investigating transgender friendship experience. [ABSTRACT FROM PUBLISHER]

Prior research has explored perceptions of intimate partner violence (IPV), and how these perceptions differ based on gender of the participant, victim, and perpetrator. In the current study, 178 undergraduate students ( n = 88 males; n = 90 females) attending a university in the Southwestern United States read a hypothetical IPV scenario, experimentally crossed by victim gender and perpetrator gender, and completed measures exploring gender (i.e., participant gender, victim gender, and perpetrator gender) and situational perceptions on participants' intended responses to an IPV scenario. Results indicated that perceptions of the IPV situation and responses varied by genders of the participant, victim, and perpetrator. Specifically, males were more likely than females to hold the victim responsible for the violence, and ignore the situation; females were more likely than males to encourage the victim to seek professional help and seek help from another person regarding the IPV scenario as presented in the vignette. When the victim was a male, participants viewed the situation as less serious, the victim as more responsible, and were more likely to ignore the situation, than when the victim was female. Overall, results indicated that gender factors (especially participant gender) had a stronger and more consistent influence on responses to the IPV scenario than perceptions of the situation. The findings of the current study are discussed in light of implications for future research to expand an understanding of the role of gender and perceptions influencing anticipated helping behavior for victims of IPV, which will inform intervention. [ABSTRACT FROM AUTHOR]

The role men who have sex with men and women (MSMW) play in heterosexual HIV transmission is not well understood. We analyzed baseline data from Project MIX, a behavioral intervention study of substance-using men who have sex with men (MSM), and identified correlates of unprotected vaginal intercourse, anal intercourse, or both with women (UVAI). Approximately 10 % ( n = 194) of the men reported vaginal sex, anal sex, or both with a woman; of these substance-using MSMW, 66 % (129) reported UVAI. Among substance-using MSMW, multivariate analyses found unemployment relative to full/part-time employment (OR = 2.28; 95 % CI 1.01, 5.17), having a primary female partner relative to no primary female partner (OR = 3.44; CI 1.4, 8.46), and higher levels of treatment optimism (OR = 1.73; 95 % CI 1.18, 2.54) increased odds of UVAI. Strong feelings of connection to a same-race gay community (OR = 0.71; 95 % CI 0.56, 0.91) and Viagra use (OR = 0.31; 95 % CI 0.10, 0.95) decreased odds of UVAI. This work suggests that although the proportion of substance-using MSM who also have sex with women is low, these men engage in unprotected sex with women, particularly with primary female partners. This work highlights the need for further research with the substance using MSMW population to inform HIV prevention interventions specifically for MSMW. [ABSTRACT FROM AUTHOR]

This research presents two studies examining scripts for the actual initial romantic encounters of young heterosexual Hispanic adults in the Southeastern U.S. In Study 1, 242 Hispanic undergraduates were asked to describe their most recent first romantic encounter using a cognitive script methodology, and then to classify the encounter as being a date, hangout, hookup, one-night stand, or other type of encounter. Encounters were most frequently classified as a date, followed by hangouts; very few individuals indicated that their most recent encounter was a hookup or one-night stand. Dates were described as highly gender stereotypic, with men performing significantly more actions overall than women. The date script also included more gender-typed actions, was more structured, and was considered more ideal than a hangout. In Study 2, a checklist of 60 actions derived from Study 1 was used to assess the most recent initial romantic encounters of 217 Hispanic undergraduates. Dates were reported most frequently, followed by hangouts. Dates continued to be highly gender stereotyped with men being responsible for more actions than women, and the date script continued to include more gender-typed actions than the hangout. A date was also more structured and rated as more ideal and satisfying than a hangout. The predominance of and preference for dates, the most gender-typed way for young adults to get together romantically, was consistent with Hispanic cultural norms that support traditional gender roles. [ABSTRACT FROM AUTHOR]

This study funded by Centers for Disease Control compares HIV prevalence and risk behavior among heterosexual methamphetamine ( n == 428) and nonmethamphetamine ( n == 878) injectors in California, USA, during 2001--2003. While HIV was not highly prevalent among methamphetamine injectors (3%%), sexual and injection risk behaviors were highly prevalent (ranging from 21%% to 72%%). In multivariate analyses, methamphetamine injectors had higher odds than nonmethamphetamine injectors of unprotected vaginal intercourse and sex with five or more sexual partners in the past 6 months and of distributive and receptive syringe sharing in the past 30 days. There was no significant difference in HIV sero-status by methamphetamine use. Suggestions are made for designing HIV prevention programs. The study's limitations are noted. [ABSTRACT FROM AUTHOR]

Heterosexual partnerships involving the trade of money or goods for sex are a well-described HIV risk factor in Africa and Southeast Asia, but less research has been conducted on exchange partnerships and their impact on HIV infection in the United States. In our study, men and women were recruited from high-risk risk neighborhoods in New York City through respondent-driven sampling in 2006-2007. We examined the factors associated with having an exchange partner in the past year, the relationship between exchange partnerships and HIV infection, and the risk characteristics of those with exchange partners by the directionality of payment. Overall, 28% of men and 41% of women had a past-year exchange partner. For men, factors independently associated with exchange partnerships were older age, more total sexual partners, male partners, and frequent non-injection drug use. For women, factors were homelessness, more total sexual partners, more unprotected sex partners, and frequent non-injection drug use. Exchange partnerships were associated with HIV infection for both men and women, although the relationships were substantially confounded by other behavioral risks. Those who both bought and sold sex exhibited the highest levels of risk with their exchange and non-exchange partners. Exchange partnerships may be an HIV risk both directly and indirectly, given the overlap of this phenomenon with other risk factors that occur with both exchange and non-exchange partners. [ABSTRACT FROM AUTHOR]

Abstract: Background: Almost half (49%) of the people diagnosed with HIV/AIDS in the United States (US) are African-Americans. Although African-Americans represent only about 13% of the overall population, they continue to account for a higher proportion of cases at all stages of HIV/AIDS. Most documented interventions targeting the African-American population have focused on women, children, men who have sex with men or drug addicts. Methods: Six focus group sessions with African-American men (39) and women (15) were conducted in a heterogeneously populated American city. We used a pre-focus group questionnaire to collect data about the socio-economic background of the participants. In our focus group sessions we examined the feasibility of instituting a health promotion program for African-American men. Results: The men who participated in the sessions showed great interest in attending the health promotion program. They had no prior knowledge of positive behavioral practices that could promote their individual health and well-being. HIV infection rates in the African-American population remain the highest in the US. Conclusion: The results of our focus group sessions showed that the heterosexual African-American men were eager to learn how to protect themselves against communicable and non-communicable diseases in health promotion programs. [Copyright &y& Elsevier]

Ethnic differences in measures of substance use, sexual risk behaviors, and psychosocial factors (depression, stigma, self-esteem) were examined in a sample of 402 heterosexual methamphetamine users (55.0% Caucasian, 29.9% African American, 15.1% Latino) who participated in a sexual risk reduction intervention between June 2001 and March 2005 in San Diego, California. Participants were primarily male (67%) and noncollege graduates (72%) and belonged to the low-income group (66%). African Americans were older when they first used methamphetamine and had used fewer grams in the past 30 days; Caucasians were more likely to inject. A larger percentage of African Americans reported anonymous sex partners in the past 2 months. African Americans reported lower levels of social stigma, and Caucasians reported lower self-esteem. Limitations and potential applications of these findings to prevention and treatment programs for ethnic minority populations are discussed. [ABSTRACT FROM AUTHOR]

Varying measures of sexual orientation are used in women's health research. As they incorporate different dimensions, definitions, and categorical groupings, the comparability of results obtained across studies using different measures remains unknown. We examined the comparability of results using data from the U.S. 2002 National Survey of Family Growth (n = 6,356). Women were classified according to sexual orientation identity, sex of sex partners in the past year, and sex of sex partners over the lifetime. Associations with six health outcomes were compared across sexual orientation schemes. Associations differed in magnitude and statistical significance, even producing conflicting results. Our analyses resulted in series of methodological recommendations for research on sexual minority women. Data on both behavioral and identity measures should be gathered in health research; identity groups should not be combined for analysis; and researchers should carefully consider which classification scheme(s) to use based on the theoretical basis for the study and the implications for informing interventions. [ABSTRACT FROM AUTHOR]

HIV and AIDS cases in the United States are affecting lower income persons and minority females and adolescents largely when compared with other groups. Individuals infected with HIV often survive for lengthy periods without knowledge of their own infection prior to developing AIDS. Since the beginning of the U.S. epidemic in 1981 an estimated 1.5 million persons have been infected and over 500,000 have died from AIDS. Although new HIV infections appear to have slowed, data from several states with at-risk populations are still not included in the national surveillance reports. These states, which include Alaska, California, Connecticut, Delaware, the District of Columbia, Illinois, Kentucky, Maine, Maryland, Massachusetts, Montana, New Hampshire, New York, Oregon, Pennsylvania, Rhode Island, Vermont and Washington are excluded based on the objection to the name based HIV reporting criteria required by the Centers for Disease Control and Prevention (CDC). HIV/AIDS cases in the US are growing at a phenomenal rate for certain groups while other groups seem to have stabilized. This paper examines the reporting system for new HIV infections in the U.S. Analyses of the reporting system indicates that certain groups known to be at disproportionate risk are underreported, while others are reported more specifically and consistently from the local to the national level. The obvious question arising from this inconsistent reporting system is the accuracy and utility of semi-accurate and incomplete HIV national and state data. Moreover, why are these data inaccurate and incomplete given the devastating effects of the infection? This paper will utilize data on the Latino community to focus on the problem of the national underreporting of HIV infection. [ABSTRACT FROM AUTHOR]

Background: Previous studies examining the role of partnership on HIV care outcomes have primarily focused on the men who have sex with men population in the United States, leaving a gap in the literature on this phenomenon among the heterosexual persons with HIV (PWH). This study examined association between partnership around diagnosis (married, unmarried-partnered, and un-partnered) with time to viral suppression (TVS) and sustained viral suppression (SVS) in newly diagnosed heterosexual PWH from a HIV clinic in Birmingham, Alabama., Methods: TVS [time to first viral load (VL) <200 copies/ml] was measured using VLs from 12 months following diagnosis using Kaplan-Meier and proportional hazard model for interval censoring ( n =153) to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). SVS was measured using VLs for 12 months after first VS using logistic regression model ( n =137) to calculate odds ratios (ORs) and 95% CIs. Models were adjusted for confounding demographics and clinical characteristics., Results: The study population comprised of 77% Black, 57% male, and 46% aged 31-49 years; 24% were married, 35% unmarried-partnered, and 41% un-partnered. The median TVS (days) was 57 for married, 73 for unmarried-partnered, and 75 for un-partnered. Compared to un-partnered individuals, unmarried-partnered had similar, whereas married had 69% higher [HR (95% CI): 1.69 (1.02, 2.78)] hazard of TVS. Compared to un-partnered, unmarried-partnered and married individuals had similar odds of achieving SVS., Conclusion: Married, newly diagnosed, heterosexual PWH had faster TVS than un-partnered individuals suggesting that intimate partners may help achieve HIV care goals.

Objective: Condom use behaviours are proximal to recent STI increases in the USA, yet it remains unclear whether the use of condoms has changed over time among unmarried, non-cohabiting young men who have sex with women (MSW) and how this variability is influenced by STI risk factors., Methods: To examine condom use over time among MSW aged 15-29, we used three cross-sectional surveys from the 2002, 2006-2010 and 2011-2017 National Survey of Family Growth. We estimated weighted percentages, adjusted prevalence ratios (APRs) and 95% confidence intervals (CI) to assess changes in condom use, stratified by whether MSW reported any STI risk factors in the past 12 months (ie, perceived partner non-monogamy, male-to-male sex, sex in exchange for money or drugs, sex partner who injects illicit drugs, or an HIV-positive sex partner)., Results: We observed a divergence in trends in condom use at last sex between men aged 15 -29 with STI risk factors in the past 12 months and those without such history. We saw significant declines in condom use from 2002 to 2011-2017 among men with STI risk factors (APR=0.80, 95% CI 0.68 to 0.95), specifically among those aged 15-19 (APR=0.73, 95% CI 0.57 to 0.94) or non-Hispanic white (APR=0.71, 95% CI 0.54 to 0.93). In contrast, trends in condom use among men with no STI factors remained stable or increased. Across all time periods, the most prevalent STI risk factor reported was perception of a non-monogamous female partner (23.0%-26.9%). Post-hoc analyses examined whether condom use trends changed once this variable was removed from analyses, but no different patterns were observed., Conclusions: While STIs have been increasing, men aged 15-29 with STI risk factors reported a decline in condom use. Rising STI rates may be sensitive to behavioural shifts in condom use among young MSW with STI risk factors., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Problem: Receptive anal intercourse (RAI) is more efficient than receptive vaginal intercourse (RVI) at transmitting HIV, but its contribution to heterosexually acquired HIV infections among at-risk women in the USA is unclear., Method of Study: We analysed sexual behaviour data from surveys of 9152 low-income heterosexual women living in 20 cities with high rates of HIV conducted in 2010 and 2013 as part of US National HIV Behavioral Surveillance. We estimated RAI prevalence (past-year RAI) and RAI fraction (fraction of all sex acts (RVI and RAI) at the last sexual episode that were RAI among those reporting past-year RAI) overall and by key demographic characteristics. These results and HIV incidence were used to calibrate a risk equation model to estimate the population attributable fraction of new HIV infections due to RAI (PAF RAI ) accounting for uncertainty in parameter assumptions., Results: Receptive anal intercourse prevalence (overall: 32%, city range: 19%-60%) and RAI fraction (overall: 27%, city range: 18%-34%) were high overall and across cities, and positively associated with exchange sex. RAI accounted for an estimated 41% (uncertainty range: 18%-55%) of new infections overall (city range: 21%-57%). Variability in PAF RAI estimates was most influenced by uncertainty in the estimate of the per-act increased risk of RAI relative to RVI and the number of sex acts., Conclusion: Receptive anal intercourse may contribute disproportionately to new heterosexually acquired HIV infections among at-risk low-income women in the USA, meaning that tools to prevent HIV transmission during RAI are warranted. The number of RVI and RAI acts should also be collected to monitor heterosexually acquired HIV infections., (© 2020 The Authors. American Journal of Reproductive Immunology published by John Wiley & Sons Ltd.)

Since 2015 in the United States (US), the US Neisseria meningitidis urethritis clade (US&#95;NmUC) has caused a large multistate outbreak of urethritis among heterosexual males. Its 'parent' strain caused numerous outbreaks of invasive meningococcal disease among men who have sex with men in Europe and North America. We highlight the arrival and dissemination of US&#95;NmUC in the United Kingdom and the emergence of multiple antibiotic resistance. Surveillance systems should be developed that include anogenital meningococci.

Background: Annual HIV testing is recommended for populations at-risk for HIV in the United States, including heterosexuals geographically connected to urban high-risk areas (HRA) with elevated rates of HIV prevalence and poverty, who are primarily African American/Black or Hispanic. Yet this subpopulation of "individuals residing in HRA" (IR-HRA) evidence low rates of regular HIV testing. HIV stigma is a recognized primary barrier to testing, in part due to its interaction with other stigmatized social identities. Guided by social-cognitive and intersectionality theories, this qualitative descriptive study explored stigma as a barrier to HIV testing and identified ways IR-HRA manage stigma., Methods: In 2012-2014, we conducted in-depth qualitative interviews with 31 adult IR-HRA (74% male, 84% African American/Black) with unknown or negative HIV status, purposively sampled from a larger study for maximum variation on HIV testing experiences. Interviews were audio-recorded and professionally transcribed verbatim. Data were analyzed using a systematic content analysis approach that was both theory-driven and inductive., Results: Stigma was a primary barrier to HIV testing among IR-HRA. In the context of an under-resourced community, HIV stigma was experienced as emerging from, and being perpetuated by, health care organizations and educational institutions, as well as community members. Participants noted it was "better not to know" one's HIV status, to avoid experiencing HIV-related stigma, which could interact with other stigmatized social identities and threaten vital social relationships, life chances, and resources. Yet most had tested for HIV previously. Factors facilitating testing included health education to boost knowledge of effective treatments for HIV; understanding HIV does not necessitate ending social relationships; and tapping into altruism., Conclusions: In the context of economic and social inequality, HIV stigma operates on multiple, intersecting layers. IR-HRA struggle with an aversion to HIV testing, because adopting another stigmatized status is dangerous. They also find ways to manage stigma to engage in testing, even if not at recommended levels. Findings highlight strategies to reduce HIV stigma at the levels of communities, institutions, and individuals to improve rates of annual HIV testing necessary to eliminate HIV transmission and reduce HIV-related racial and ethnic health disparities among IR-HRA.

Adverse childhood experiences (ACEs) have been linked to early sexual debut, which has been found to be associated with multiple adverse health outcomes. Sexual minorities and men tend to have earlier sexual debut compared to heterosexual populations and women, respectively. However, studies examining the association between ACEs and early sexual debut among men and sexual minorities are lacking. The aim of this study was to examine the sex and sexual orientation disparities in the association between ACEs and age at sexual debut. Data were obtained from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic and linear regression models were used to obtain crude and adjusted estimates and 95% confidence intervals adjusting for age, race/ethnicity, income, education, insurance and marital status for the association between ACEs (neglect, physical/psychological abuse, sexual abuse, parental violence, and parental incarceration and psychopathology) and early sexual debut. Analyses were stratified by sex and sexual orientation. Larger effect estimates depicting the association between ACEs and sexual debut were seen for women compared to men, and among sexual minorities, particularly among men who have sex with men (MSM) and women who have sex with women (WSW), compared to heterosexuals. Sexual health education programs with a focus on delaying sexual debut among children and adolescents should also consider addressing ACEs, such as neglect, physical, psychological and sexual abuse, witnessing parental violence, and parental incarceration and psychopathology. Public health practitioners, researchers and sexual health education curriculum coordinators should consider these differences by sex and sexual orientation when designing these programs., (Copyright © 2015 Elsevier Ltd. All rights reserved.)