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: Introduction: South African men face a substantial burden of HIV and are less likely to test for HIV and initiate antiretroviral therapy if tested positive and more likely to die from AIDS‐related causes than women. In addition to condoms and circumcision, guidelines provide for the use of daily oral pre‐exposure prophylaxis (PrEP) as an HIV prevention intervention for any men who recognize their need and request PrEP. However, heterosexual men have not been a focus of PrEP programmes, and since its introduction, there is limited literature on PrEP use among men in South Africa. This study explores the experiences, motivators and barriers to oral PrEP use among heterosexual men accessing primary healthcare services in South Africa. Methods: This study forms part of a mixed‐methods implementation science study aimed at generating evidence for oral PrEP introduction and conducted in primary healthcare clinics in South Africa since 2018. Men aged ≥15 years who initiated oral PrEP and enrolled in a parent cohort study were purposefully invited to participate in an in‐depth interview (IDI). Between March 2020 and May 2022, 30 men participated in IDIs exploring their motivators for PrEP use, and experiences with accessing health services. Interviews were audio recorded, transcribed and analysed thematically. Results: The final analysis included 28 heterosexual men (18–56 years old). Motivations to initiate PrEP included fear of acquiring HIV, self‐perceived vulnerability to HIV and mistrust in relationships; health systems factors which motivated PrEP use included the influence of healthcare providers, educational materials and mobile services. Perceived reduction in HIV vulnerability and changing proximity to partners were reasons for PrEP discontinuation. Side effects, daily‐pill burden and stigma were noted as challenges to PrEP use. Health system barriers to PrEP use included limited PrEP availability, school and work demands, and inconsistent mobile clinic schedules. Conclusions: Our study reports on the experiences of heterosexual men accessing oral PrEP in real‐world settings and contributes to the limited literature among this population. We highlight multiple levels which could be strengthened to improve men's PrEP use, including individual support, education among partners and communities, and addressing health system barriers to access., INTRODUCTION South Africa had an estimated 7.6 million people living with HIV in 2022, of whom 2.6 million (34%) are men aged ≥15 years [1]. Despite the implementation of the [...]

Tourism destinations provide unique social contexts which foster sexual risk-taking. Banff, Alberta, Canada is one such destination with high rates of STI and risk-taking, particularly among tourism workers (TW's).Twenty-five TW's [...]

CONTEXT: Little evidence is available from India concerning young people's use of condoms in premarital relationships. METHODS: Data from a subnationally representative study of Indian youth conducted in 2006-2008 were [...]

CONTEXT: Heterosexual anal sex is not uncommon in the United States, and it poses risk for STDs. However, who engages in it and why are not well understood, particularly among young adults. METHODS: In 2006-2008, data on sexual health-related topics were collected in surveys (483 respondents) and qualitative interviews (70 participants) with black and Puerto Rican 18-25-year-aids in Hartford and Philadelphia. Bivariate and multivariate analyses of survey data assessed predictors of anal sex with the most recent serious heterosexual partner. Interview transcripts were analyzed for anal sex experiences and reasons for and against engaging in this behavior. RESULTS: Some 34% of survey respondents had had anal sex; this behavior was more common with serious partners than with casual partners (22% vs. 8%). Black respondents were less likely than Puerto Ricans to report anal sex (odds ratio, 0.3); women were more likely to do so than were men (2.9). In the qualitative cohort, perceptions of anal sex as painful and unappealing were the predominant reasons for not having anal sex, whereas sexual pleasure and, in serious relationships, intimacy were the main reasons for engaging in it. Condom use during anal sex was rare and was motivated by STD or hygiene concerns. CONCLUSIONS: Heterosexual anal sex is not an infrequent behavior and should be considered in a broad sexual health context, not simply as an indicator of STD risk. Health providers should address it openly and, when appropriate, as a positive sexual and emotional experience. Perspectives on Sexual and Reproductive Health, 2010, 42(4):267-274, doi: 10.1363/4226710

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2010.04.039 Byline: Cui Yang (a), Carl Latkin (a), Rongsheng Luan (b), Kenrad Nelson (c) Abstract: Despite their crucial role in HIV infection and transmission, commercial sex male clients (CSMCs) are rarely studied. The purpose of this study was to examine the relationship between peer norms and consistent condom use with female sex workers (FSWs) among CSMCs in Sichuan province, China. Male clients with peers who had paid for sex (n = 562) were recruited by local health workers through snowball sampling. Measures of peer norms included 1) descriptive norms which were evaluated by perceptions of peer's condom attitudes and behaviors with FSWs; 2) injunctive norms which were assessed by the perceived peer approval of using condoms with FSWs; and 3) communication of HIV-related topics with peers. The outcome was consistent condom use with FSWs. Results of multivariate logistic regression models revealed that consistent condom use with FSWs was significantly more likely among male clients who perceived more pro-condom descriptive and injunctive norms among their peer groups. In addition, the pattern of commercial sex visits moderated the relations between peer norms and consistent condom use with FSWs. More peer approval of condom use and more HIV-related communication were significantly associated with consistent condom use among clients who visited FSWs with friends but not among those who visited FSWs alone. The findings suggest that social activities surrounding commercial sex visits may provide an entry point for HIV prevention intervention with men who patronize FSWs and that such efforts should tap into existing dynamics of social interaction to promote pro-condom norms. Author Affiliation: (a) Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States (b) Department of Epidemiology, West China School of Public Health, Sichuan University, PR China (c) Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2009.10.011 Byline: Frances Aboud (a)(b), Nafisa Lira Huq (b), Charles P. Larson (b)(c), Livia Ottisova (a) Abstract: Efforts to prevent HIV from becoming widespread among the youth population 15-24 years in Bangladesh are in the early stages. However, conservative religious and cultural norms may curtail the dissemination of needed information about sexuality and condoms. The community-readiness stages model was adopted as a framework for assessing the level of preparedness of community leaders to facilitate planned HIV prevention efforts. Six focus group discussions with three professional groups (teachers, businessmen, drugshop vendors) in Hobiganj district were conducted in late 2005, and a single multi-professional group made up of teachers, imams, and drugshop vendors was convened in early 2007 to assess changes. The audio recordings in Bangla were coded as were English translations. Everyone had heard of AIDS and regarded it as a potential catastrophe for the health, economy and social fabric of Bangladesh. Remarks concerning Stage 1-Vulnerability indicated that most did not believe their community to be at risk, though Bangladesh was. Remarks at Stage 2-Knowledge of Transmission were mostly vague but accurately identified sex, blood and needles as the main means of spread; however sex with sex workers was also mentioned in each group. Remarks at Stage 3-Prevention showed strong opposition to condoms for unmarried males and a preference for current means of forbidding sex outside of marriage. A few in each group recognized the importance of condoms for wayward youth. Stage 4-Planning discussions centered on raising awareness and fear, and a desire for government and media to take the lead. By 2007 participants articulated more realistic strategies that they themselves could, and had, implemented, but also raised barriers that authorities should help them overcome. The findings provide formative information on the constraints and opportunities of community groups as partners in HIV preventive interventions and strategies to help them move to a higher stage of readiness. Author Affiliation: (a) McGill University, Montreal, QC, Canada (b) International Centre for Diarrhoeal Diseases Research, Bangladesh (c) University of British Columbia, Vancouver, Canada Article Note: (footnote) [star] This investigation was funded through the Global Fund for Aids, Tuberculosis and Malaria: HIV/AIDS Youth Prevention Project, under the stewardship of the Ministry of Health and Family Welfare, Government of Bangladesh and Save the Children USA-Bangladesh. The project was administered by the Centre for Diarrhoeal Diseases Research, Bangladesh, which provided scientific and ethical approval, and which acknowledges with gratitude the commitment of all donors to the Centre's research effort. Thanks go to the moderators of group discussions Ruby, Deenha, and Raquib; to the translators of transcripts, namely Ibtesam Nazim Ahmed, Asif Yusuf, and Sazzad Nasir; and to Elizabeth Oliveras and Fariha Haseen who helped develop the coding framework.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2009.08.014 Byline: Nuriye Nalan Sahin-Hodoglugil (a), Ariane van der Straten (b)(c), Helen Cheng (b), Elizabeth T. Montgomery (b)(h), Deborah Kacanek (d), Sibongile Mtetwa (e), Neetha Morar (f), Jane Munyoro (g), Nancy Padian (b) Abstract: In sub-Saharan Africa more women are infected with HIV/AIDS than men and new prevention methods are urgently needed. One major attribute of female-initiated HIV prevention methods is that they can be used covertly, without a male partner's knowledge. Using mixed methods, we explored the predictors and dimensions of covert use of the diaphragm in a randomized controlled trial that tested its effectiveness for HIV prevention. The Methods for Improving Reproductive Health in Africa (MIRA) trial was conducted in Zimbabwe and South Africa, and data collection took place between September 2003 and January 2007. This study is a secondary analysis of quantitative and qualitative data from participants randomized to the intervention group, and their male partners. It includes survey data from 2316 women (mean age=28.3), 14 focus group discussions (FGD) conducted with 104 women, and 7 FGD and 10 in-depth interviews with 37 male partners. The median follow-up for trial participation was 21 months (range: 12-24). At their final visit, approximately 9% of women had never disclosed to their primary partners that they were using the diaphragm (covert use). In multivariate analysis, predictors of covert use included being older, not co-habiting with the partner, having a partner who did not use condoms, and being from South Africa. Qualitative analysis revealed that covert use was not dichotomous, but ranged along a continuum, which we categorized into five levels (i.e. full disclosure; mostly open use; occasional covert use; mostly covert use; and completely covert use). We discuss the critical role of the option of covert use for many women in the context of an HIV prevention trial, as well as gender power dynamics which may influence women's decisions about disclosure. Author Affiliation: (a) Touro University California, COHS Public Health Program, 1310 Johnson Lane, Mare Island, Vallejo, CA 94592, USA (b) RTI International San Francisco Project Office, San Francisco, CA, USA (c) Center for AIDS Prevention Studies, University of California San Francisco, CA, USA (d) Ibis Reproductive Health, Cambridge, USA (e) UZ-UCSF Research Collaborative Programme in Women's Health, Harare, Zimbabwe (f) Medical Research Council, Kwazulu-Natal, South Africa (g) Perinatal HIV Research Unit, Johannesburg, South Africa (h) London School of Hygiene and Tropical Medicine, Infectious Diseases Epidemiology Unit, Department of Epidemiology, London, UK Article Note: (footnote) [star] We would like to thank the women who participated in this study. For H. Cheng, E. Montgomery, N. Padian, N. Sahin-Hodoglugil, and A. van der Straten, a significant part of the work for this paper was conducted while at the University of California San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences. We also thank Norm Constantine, Sylvia Guendelman, Malcolm Potts, and Charis Thompson for their review of the earlier versions of this paper. The MIRA trial was funded through a grant from the Bill and Melinda Gates Foundation (#21082).

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2009.07.035 Byline: Dallas Swendeman (a), Ishika Basu (b), Sankari Das (b), Smarajit Jana (b), Mary Jane Rotheram-Borus (a) Abstract: The Sonagachi Project was initiated in Kolkata, India in 1992 as a STD/HIV intervention for sex workers. The project evolved to adopt strategies common to women's empowerment programs globally (i.e., community mobilization, rights-based framing, advocacy, micro-finance) to address common factors that support effective, evidence-based HIV/STD prevention. The Sonagachi model is now a broadly diffused evidence-based empowerment program. We previously demonstrated significant condom use increases among female sex workers in a 16 month replication trial of the Sonagachi empowerment intervention (n =110) compared to a control community (n =106) receiving standard care of STD clinic, condom promotion, and peer education in two randomly assigned rural towns in West Bengal, India (). This article examines the intervention's impacts on 21 measured variables reflecting five common factors of effective HIV/STD prevention programs to estimate the impact of empowerment strategies on HIV/STD prevention program goals. The intervention which was conducted in 2000-2001 significantly: 1) improved knowledge of STDs and condom protection from STD and HIV, and maintained STD/HIV risk perceptions despite treatment; 2) provided a frame to motivate change based on reframing sex work as valid work, increasing disclosure of profession, and instilling a hopeful future orientation reflected in desire for more education or training; 3) improved skills in sexual and workplace negotiations reflected in increased refusal, condom decision-making, and ability to change work contract, but not ability to take leave; 4) built social support by increasing social interactions outside work, social function participation, and helping other sex workers; and 5) addressed environmental barriers of economic vulnerabilities by increasing savings and alternative income, but not working in other locations, nor reduced loan taking, and did not increase voting to build social capital. This study's results demonstrate that, compared to narrowcast clinical and prevention services alone, empowerment strategies can significantly impact a broader range of factors to reduce vulnerability to HIV/STDs. Author Affiliation: (a) Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, United States (b) Durbar Mahila Samanwaya Committee, Kolkata, India Article Note: (footnote) [star] World AIDS Foundation Grant No. 202 (99-028) supported this research. The American Institute of Indian Studies (AIIS) and the Center for HIV Identification, Prevention, and Treatment Services (CHIPTS) funded subsequent research by the first author that supported development and interpretation of this study's results. The authors are also grateful for the participation of sex workers in this study.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2009.04.018 Byline: Jenny Trinitapoli Abstract: This study examines the relationship between religion and HIV risk behaviors in rural Malawi, giving special attention to the role of religious congregations, the organizations with which rural Africans have most immediate contact. It draws on 2004 data from a household survey in 3 districts (N =3386), and quantitative and qualitative data collected in 2005 from 187 leaders of religious congregations previously identified in the survey. The first aim is descriptive - to identify overall patterns and variations in what religious leaders in rural Malawi teach about HIV and about sexual behavior in light of the epidemic. The second aim is to assess how religious organizations impact the behavior of individual members. I examine three outcomes that correspond with the ABCs of HIV prevention: abstinence (for never married persons), fidelity (for married persons), and condom use (among sexually active persons). Multi-level models reveal that religious affiliation and involvement are not correlated with the sexual behavior of congregation members, but that beliefs about appropriate sexual behavior and particular congregational characteristics are associated with adherence to A, B, and C. Individuals belonging to congregations led by clergy who 1) frequently deliver formal messages about HIV, 2) monitor the sexual behavior of members, and 3) privately encourage condom use report greater adherence to the ABCs of HIV prevention, suggesting that religious congregations are relevant for the sexual behavior of members and for better understanding the forces shaping individual behavior in the context of the African AIDS epidemic. Author Affiliation: Arizona State University, School of Social and Family Dynamics, PO Box 873701, Tempe, AZ 85287-3701, USA Article Note: (footnote) [star] I am grateful to Mark Regnerus, Susan Watkins, Bob Hummer, jimi adams, Steven Haas, and to the anonymous reviewers at Social Science and Medicine for their helpful feedback on earlier drafts. This research was supported by an NICHD training grant (T32 HD07081-27) to the Population Research Center, The University of Texas at Austin. Data from the Malawi Diffusion and Ideational Change Project were supported by grants from the Rockefeller Foundation, NICHD (R01-HD41713, R01-HD373-276); NIA (AG1236-S3); and the Center for AIDS Research and the Center on the Demography of Aging, both at the University of Pennsylvania. Data from the Malawi Religion Project were supported by a grant from NICHD (R01-HD050142-01).

This article examines the widespread resistance to condom use in sub-Saharan Africa by describing the major semiotic axes that organize how people talk about condoms and condom use. These axes include the 'sweetness '' of sex, trust and love between sexual partners, and assessments of risk and danger Using data from rural Malawi, we show that framing the meaning of condoms as a simple choice between risky behavior and rational attempts to protect one's health ignores the complex semiotic space that Malawians navigate. Based on data from more than 600 diaries that record rural Malawians' everyday conversations, our analysis charts the semiotic axes related to condom use. Semiotic constraints operate most powerfully at the level of relationships. Condom use signifies a risky, less serious, and less intimate partner. Even when people believe that condom use is appropriate, wise, or even a matter of life and death, the statement that condom use makes about a relationship usually trumps all other meanings. We call for a more nuanced analysis of culture, one that is attentive to the ways agents navigate multiple, contested meanings, and that demonstrates how specific semiotic axes are brought to bear in particular interactional contexts.

A meta-analysis involving 134 estimates of the relationship of self-efficacy (belief in one's ability to perform a behavior) and response-efficacy (belief that a response will be effective) to reduce risk for HIV infection was conducted. Witte's Extended Parallel Processing Model (EPPM) for fear appeals suggests that both of these elements would be requirements for successful educational efforts. The overall averages indicate that self-efficacy (average r = .244) is more predictive than response-efficacy (average r = .093)for reduction of risk, intended or actual. Moderators of type of risk outcome (condom-use intention, self-report of condom use, number of sexual partners, and overall risk measures), sexual orientation (homosexual and heterosexual), HIV serostatus (positive or negative), sample type (college student, high school student, adult, STD clinic attendee, or intravenous drug user), and sex are examined. The results indicate the importance of a prevention message focusing on raising self-efficacy to increase condom use.

HIV prevention has become a new priority for HIV clinicians, as their patients live longer and more sexually active lives. Prevention interventions can be effective in clinical settings, but first patients must be screened and inconsistent condom use must be disclosed. Audio computer-assisted self-interviews (ACASI) are an effective way to elicit this sensitive information. We assessed condom use by ACASI among 198 English- or Spanish-speaking HIV patients at 2 community hospital-based HIV clinics in Queens and the Bronx, New York. Among 120 patients reporting sex with a regular partner in the past 4 weeks, 41 (34%) reported not using a condom every time and 22 (18%) reported never using a condom. Among 81 reporting sex with a casual partner in the past 4 weeks, 21 (26%) reported not using a condom every time and 12 (15%) reported never using a condom. Overall, 24 of 129 sexually active patients (19%) reported never using a condom. In a multivariable model controlling for age, race/ethnicity, gender, and HIV exposure category, depression symptoms (Center for Epidemiological Studies Depression Scale [CES-D] score [greater than or equal to] 16; p = 0.03) and self-reported antiretroviral medication non-adherence ([less than or equal to] 95% doses in past 3 days; p = 0.03) were significantly associated with never using a condom with a regular or casual partner. ACASI interviews may be an effective way of identifying patients in clinical settings who require prevention counseling as well as other psychosocial services.

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1559-1816.2008.00298.x Byline: Blair Beadnell (a), Sharon A. Baker (a), Mary Rogers Gillmore (b), Diane M. Morrison (a), Bu Huang (a), Sorrel Stielstra (a) Abstract: Although the majority of prevention efforts have focused on women, reduction of heterosexual transmission of STDs also requires interventions for men, necessitating understanding of men's safer sex decision making. In a random sample of 486 heterosexually active men, the theory of reasoned action (TRA) was used to predict intentions to use condoms with casual partners, as well as 2 steady-partner safer sex behaviors: mutual monogamy and condom use. The basic TRA model fit the data well. Expanded models identified the mediated (via attitudes, social norms, and self-efficacy) and, for some, direct effects on intentions and behavior of selected intrapersonal, interpersonal, and sociocultural variables. Results suggest that the role of external variables might vary depending on the behaviors in question. Author Affiliation: (a)School of Social WorkUniversity of Washington (b)School of Social Work, College of Public ProgramsArizona State University Article note: (2) Correspondence concerning this article should be addressed to Blair Beadnell, School of Social Work, University of Washington, 4101 15th Avenue, NE, Seattle, WA 98105-6299. E-mail: blairb@u.washington.edu

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2006.05.008 Byline: Joanne E. Mantell (a), Shari L. Dworkin (a), Theresa M. Exner (a), Susie Hoffman (a)(b), Jenni A. Smit (c), Ida Susser (d) Keywords: Female-initiated barrier methods; Gender relations and roles; Female condom; Microbicides; Diaphragm; HIV/STI prevention Abstract: New methods are now available, and others are being developed, that could enable women to take the initiative in preventing sexually transmitted infections. However, attempts to capitalize on 'female-controlled' preventive methods thus far have met with limited success. Female-initiated methods were introduced to intervene in the state of gender relations and assist women who are disempowered vis-a-vis their male partners. Paradoxically, however, we underscore that it is the very structure of regional and local gender relations that shapes the acceptability (or lack of acceptability) of these methods. This paper specifically addresses how the structure of gender relations -- for better and for worse -- shapes the promises and limitations of widespread use and acceptance of female-initiated methods. We draw on examples from around the world to underscore how the regional specificities of gender (in)equality shape the acceptance, negotiation, and use of these methods. Simultaneously, we demonstrate how the introduction and sustained use of methods are shaped by gender relations and offer possibilities for reinforcing or challenging their current state. Based on our analyses, we offer key policy and programmatic recommendations to increase promotion and effective use of women-initiated HIV/STI protection methods for both women and men. Author Affiliation: (a) HIV Center for Clinical and Behavioral Studies, NYS Psychiatric Institute and Department of Psychiatry, Columbia University NY, NY, USA (b) Mailman School of Public Health, Columbia University NY, NY, USA (c) Reproductive Health and HIV Research Unit, University of the Witwatersrand, South Africa (d) City University of New York, USA