Adolescents' risky sexual behaviours and practices: Implications for sexuality education implementation in Zambia.

BACKGROUND:  Adolescents' risky sexual behaviours (RSB) are detrimental to their sexual and reproductive health (SRH) well-being and present a serious public health threat, particularly in low- and middle-income countries (LMICs). AIM:  This study aims to assess RSB among Grade 12 school-going adolescents after exposure to comprehensive sexuality education (CSE). SETTING:  This study was conducted in Kitwe district, Zambia. METHODS:  This cross-sectional study included 807 Grade 12 pupils at 13 selected secondary schools. Data were collected using a structured questionnaire. Proportionate probability sampling involving 13 schools was employed. Risky sexual behaviours binary outcome variables were based on transactional sex, sex while drunk, multiple sexual partners, age-disparate sexual relationships, and condomless sex. We conducted univariate and bivariate analyses to summarise sociodemographic factors and fitted binary and multivariable logistic regression models. RESULTS:  The prevalence of RSB was 40.4%. Drinking alcohol (adjusted odds ratio [AOR] = 20.825; 95% CI [6.7-64.489]); ever had sex (AOR = 9.024; 95% CI [1.953-41.704]); school location (AOR = 6.50; 95% CI [1.61-26.24]); living with mother only (AOR = 4.820; 95% CI [1.328-17.493]); sex (male) (AOR = 2.632; 95% CI [1.469-4.713]), watching pornography (AOR = 1.745; 95% CI [1008-3.021]); religion (AOR = 0.472; 95% CI [0.250-0.891]) and attending religious functions (AOR = 0.317; 95% CI [0.118-0.848]) were significantly associated with RSB. Of the sexually active pupils, 221 (67.7%), 64 (19.6%) and 41 (12.5%) were in the low, medium and high-risk categories, respectively. CONCLUSION:  Close to half of the respondents engaged in RSB. This is a significant number that needs intervention. The CSE programme needs to be linked with structural programmes that address the social drivers of RSB among adolescents.Contribution: The study provides a backdrop for evaluating current CSE strategies in LMICs.

HIV pre-exposure prophylaxis use during periods of unprotected sex among female sex workers in Tanga city, Tanzania: a control arm analysis of the pragmatic quasi-experimental trial.

Background: Pre-exposure prophylaxis (PrEP) prevention-effective adherence is of critical importance but challenging particularly among key populations where periods of high HIV risk are frequent. We assessed the use of PrEP with reference to periods of unprotected sex among female sex workers in the city of Tanga. Methods: This was part of the pragmatic quasi-experimental trial for HIV PrEP rollout in Tanzania involving a control cohort of 313 female sex workers aged ≥18 years recruited by respondent-driven sampling and followed for 12 months. PrEP use and periods of condomless or unprotected sex were assessed at the 6th and 12th month of follow-up. Prevention-effective adherence was defined as PrEP use of ≥2 pills/week and ≥6 pills/week for anal and vaginal condomless sex. Multivariable modified Poisson regression was conducted to determine factors influencing PrEP use (≥2 pills/week). Results: Overall, 59.2 and 45.9% of participants had unprotected anal and vaginal sex with a client, respectively. The prevention-effective adherence for anal sex ranged from 8.0% (months 6) to 10.0% (months 12) while that of vaginal sex was from 10.1% (month 6) to 3.8% (month 12). Participants who lived with friends were 25.5 times more likely to use ≥2 PrEP doses per week than those who lived alone (aPR = 25.5; 95%CI: 2.55-255.42, p = 0.006). Compared to self-reporting poor health status, self-reporting good health status significantly increased the use of ≥2 PrEP doses per week (aPR = 17.4; 95%CI: 3.01-101.02, p = 0.001). Refusing condomless sex with a steady partner increased the likelihood of using ≥2 PrEP doses per week than accepting condomless sex with a steady partner (aPR = 11.2; 95%CI: 1.55-80.48, p = 0.017). The prevalence of using ≥2 PrEP doses per week was less among participants accepting condomless sex at high pay than those who refused (aPR = 0.1; 95%CI: 0.03-0.26, p = 0.000). Conclusion: Use of PrEP during periods of unprotected sex was rare among female sex workers. Living with friends, self-reporting good health status, and refusing condomless sex with steady partners were associated with increased use of ≥2 PrEP doses per week. However, accepting condomless sex for increased payment was associated with reduced use of ≥2 PrEP doses per week. This calls for an in-depth study to understand the perspectives and circumstances shaping poor adherence during periods of unprotected sex among female sex workers.

Analysis of risky sexual behaviors among male college students who were sexually active in Sichuan, China: a cross-sectional survey.

BACKGROUND: Males have accounted for a significant share of new HIV infections among young people in the recent years. This study aimed to identify the factors associated with risky sexual behaviors, including early sexual debut, multiple sexual partnership and condomless sex, among sexually active male college students and provide implications for tailored health interventions. METHODS: The cross-sectional study was conducted from December 2020 to December 2021 in 16 colleges that were located in Sichuan Province, one of the high-risk areas in China. Overall 1640 male college students who reported sexually experienced were analyzed in this study. Multivariable logistic regression analysis was applied to determine factors associated with early sexual debut, multiple sexual partnership and condomless sex. RESULTS: The average age of included male students was 19.95 ± 1.56. Of them, 27.74% initiated sexual behavior early, 48.60% reported multiple sexual partnership, and 16.52% did not use condoms at the latest sexual intercourse. Students who were younger (age ≤ 19, AOR = 7.60, 95%CI: 4.84-11.93; age20-21, AOR = 3.26, 95%CI: 2.04-5.21) and self-identified as sexual minorities (AOR = 2.38, 95%CI: 1.69-3.36) were more likely to have early sexual debut. The odds of having multiple sexual partners were higher among those who were ethnic minorities (AOR = 1.79, 95%CI: 1.33-2.41) and accepted extramarital sex (AOR = 1.33, 95%CI: 1.03-1.71). The likelihood of engaging in condomless sex at the latest sexual intercourse was lower among those who had sufficient knowledgeable about HIV (AOR = 0.63, 95%CI: 0.44-0.89), were very confident in condom use efficacy (AOR = 0.26, 95%CI: 0.16-0.43) and confident (AOR = 0.48, 95%CI: 0.34-0.69). Early sexual debut was positively associated with multiple sexual partnership (AOR = 3.64, 95%CI: 2.82-4.71) and condomless sex at the latest intercourse (AOR = 1.53, 95%CI: 1.07-2.20), respectively. CONCLUSION: Early sexual debut, multiple sexual partnership and condomless sex were of considerable concern among male college students. Comprehensive sex education curricula were advised by developing customized information on HIV prevention, sexuality and empowering students with assertiveness and negotiation skills with regard to condom use during and before college.

HIV Treatment Optimism Moderates the Relationship between Sexual Risk Behavior and HIV Risk Perception among Urban HIV-negative Gay, Bisexual, and Other Men who have Sex With Men.

Using baseline data of the Engage Cohort Study, a Canadian study of sexually active gay, bisexual and other men who have sex with men (GBM), we evaluated the association between sexual behavior and risk perception among HIV-negative participants and whether HIV treatment optimism moderated this relationship. Participants were recruited by respondent-driven-sampling (RDS). We defined high-risk sexual behavior in the past six months as any condomless anal sex with a casual partner (i.e. not the participant's main partner) with either unknown HIV-status where neither used pre-exposure prophylaxis or with a partner living with HIV having detectable/unknown viral load. We assessed HIV treatment optimism-skepticism using a 12-item scale. RDS-II-weighted adjusted logistic regression models examined associations with risk perception measured by the question "How would you assess your current risk of getting HIV?" (response options were on a 6-point Likert-scale ranging from "very unlikely" to "very likely", dichotomized into "No Perceived Risk" (very unlikely/unlikely) and "Perceived Risk" (somewhat likely/likely/very likely/I think I already have HIV). Of 1961 participants, engagement in high-risk sexual behavior was reported by 155 (17.0%), 62 (12.4%), 128 (17.2%) of participants in Montréal, Toronto, and Vancouver, respectively. High-risk sexual behavior increased the odds of perceived HIV risk (pooled adjusted odds ratio = 2.9, 95%CI = 2.2-3.8). HIV treatment optimism-skepticism scores moderated the relationship: for GBM engaging in high-risk sexual behavior, higher HIV treatment optimism-skepticism scores increased perceived HIV risk. Promoting awareness around advances related to HIV prevention and treatment is important for appropriate risk assessment and for increased engagement in prevention interventions.

RESUMEN: Evaluamos la asociación entre el comportamiento sexual y la percepción de riesgo entre los participantes VIH negativos y si el optimismo sobre el tratamiento del VIH moderó esta asociación. Definimos comportamiento sexual de alto riesgo en los últimos seis meses como cualquier sexo anal sin condón con una pareja casual con un estado de VIH desconocido donde ninguno utilizó profilaxis previa a la exposición o con una pareja que vive con el VIH y que tiene una carga viral detectable/desconocida. Se evaluó el optimismo sobre el tratamiento del VIH mediante una escala de 12 ítems. Los modelos de regresión logística ajustados examinaron las asociaciones con la percepción del riesgo ("Riesgo no percibido" vs. "Riesgo percibido"). De 1961 participantes, 155 (17,0%), 62 (12,4%), 128 (17,2%) de los participantes en Montreal, Toronto y Vancouver, informaron comportamiento sexual de alto riesgo. El comportamiento sexual de alto riesgo se mostró asociado con riesgo percibido. El optimismo sobre el tratamiento modero la asociación. Promover la conciencia sobre los avances relacionados con la prevención y el tratamiento del VIH es importante para una evaluación adecuada de los riesgos y una mayor participación en las intervenciones de prevención.

Prevalence of substance and hazardous alcohol use and their association with risky sexual behaviour among youth: findings from a population-based survey in Zimbabwe.

OBJECTIVES: Hazardous drinking (HD) and substance use (SU) can lead to disinhibited behaviour and are both growing public health problems among Southern African youths. We investigated the prevalence of SU and HD and their association with risky sexual behaviour among youth in Zimbabwe. DESIGN: Data analysis from a population-based survey conducted between October 2021 and June 2022 to ascertain the outcomes of a cluster randomised trial (CHIEDZA: Trial registration number:NCT03719521). Trial Stage: Post-results. SETTING: 24 communities in three provinces in Zimbabwe. PARTICIPANTS: Youth aged 18-24 years living in randomly selected households. OUTCOME MEASURES: HD was defined as an Alcohol Use Disorders Identification Test score ≥8, SU was defined as ever use of ≥1 commonly used substances in the local setting. RESULTS: Of 17 585 participants eligible for this analysis, 61% were women and the median age was 20 (IQR: 19-22) years. Overall, 4.5% and 7.0% of participants reported HD and SU, respectively. Men had a substantially higher prevalence than women of HD (8.2% vs 1.9%) and SU (15.1% vs 1.5%). Among men, after adjusting for socio-demographic factors, we found increased odds of having >1 sexual partner in those who engaged in SU (adjusted OR (aOR)=2.67, 95% CI: 2.21 to 3.22), HD (aOR=3.40, 95% CI: 2.71 to 4.26) and concurrent HD and SU (aOR=4.57,95% CI: 3.59 to 5.81) compared with those who did not engage in HD or SU. Similarly, there were increased odds of receiving/providing transactional sex among men who engaged in SU (aOR=2.51, 95% CI: 1.68 to 3.74), HD (aOR=3.60, 95% CI: 2.24 to 5.79), and concurrent HD and SU (aOR=7.74, 95% CI: 5.44 to 11.0). SU was associated with 22% increased odds of inconsistent condom use in men (aOR=1.22, 95% CI: 1.03 to 1.47). In women, the odds of having >1 sexual partner and having transactional sex were also increased among those who engaged in SU and HD. CONCLUSION: SU and HD are associated with sexual behaviours that increase the risk of HIV acquisition in youth. Sexual and reproductive health interventions must consider HD and SU as potential drivers of risky sexual behaviour in youths.

An Evaluation of TransLife Care: A Locally Developed Structural HIV Prevention Intervention for Transgender Women in Chicago, Illinois.

Transgender women are disproportionately impacted by HIV infection. We report herein the findings of a pre-post evaluation of the TransLife Care (TLC) project in Chicago, Illinois, on behaviors associated with HIV transmission among transgender women. Participants who received any TLC component versus those who did not were compared using mixed-effects logistic regression with random intercepts across follow-up time points. Ninety-seven participants aged 18 to 59 (median age 24) enrolled; 76.3% were transgender women of color. There was a decrease in condomless sex without consistent PrEP use at 8 months, which was not significantly different between those who did and did not receive the TLC intervention, controlling for calendar time. Evidence does not indicate that the TLC reduces condomless sex without PrEP protection among urban transgender women. However, given the preponderance of evidence of the influence of structural barriers on condomless sex, future research should continue to test the efficacy of structural interventions.

Risky sexual behavior and associated factors among university students in Ethiopia: a cross-sectional national survey.

BACKGROUND: Risky sexual behavior (RSB) is one of the major youth sexual and reproductive health problems globally, including in Ethiopia. RSB among youth increases the risk of HIV infection, other sexually transmitted infections (STIs), unintended pregnancy, and unsafe abortion. Therefore, the aim of this study was to examine RSB and its associated factors among university students in Ethiopia. METHODS: A cross-sectional study was employed in six randomly selected public universities in Ethiopia from August 2021 to February 2022. A stratified two-stage sampling technique was applied to reach the required number of study participants, and a structured self-administered questionnaire was used. RSB was defined as having had sexual relationships with more than one partner and using condoms with a new sexual partner irregularly or not at all in the last 12 months. Bivariable and multivariable logistic regression analyses were used to identify factors associated with RSB among those participants who were sexually active. RESULTS: The prevalence of RSB among those who had had sexual intercourse in the last 12 months (n = 523) was 19.5% (n = 102). One hundred forty-four (29.9%) students had multiple sexual partners, and 325 (69.3%) students did not always use condoms with a new sexual partner. Adjusted odds ratios (AOR) showed that those students aged 21-24 years had lower odds of RSB than those aged above 25 years AOR 0.18 (95% CI 0.03-0.98). The adjusted odds of RSB were 6.7 times higher (95% CI 1.26-35.30) among students who started sex at the age of 10-17 years than those who started sex at 21 years and above and 3.9 times higher (95% CI 1.33-11.39) among students who had experienced emotional violence. CONCLUSION: RSB continues to be a problem among university students in Ethiopia. Those students who started sex at an early age and those who experienced emotional violence were more likely to engage in RSB. Therefore, universities in Ethiopia should implement strategies such as RSB targeted health education programs that consider early sexual debut, experiences of emotional violence, and safe sexual practices.

Drug use and condomless sex among sexual minority men in relationships: Whether relationship quality is a risk or protective factor depends upon what they believe their partners do.

Sexual minority male (SMM) couples tend toward behavioral similarity around cannabis use, illicit drug use, and sex with casual partners. Similarity in these behaviors may contextualize associations with relationship quality. This study tested the hypotheses that perceptions of partner (cannabis and illicit) drug use and sexual behavior would predict personal drug use and sexual behavior as well as moderate the association between relationship quality and these health outcomes. Recruitment via social networking applications yielded a sample of 5511 cisgender SMM aged 18-85 (M = 38.21, SD = 12.16) who were in a relationship with an adult cisgender male main partner. Respondents completed an online survey assessing their own cannabis use, illicit drug use, and condomless anal sex (CAS) with casual partners during the past 30 days as well as their belief about their partner's engagement in these behaviors. Three subscales of the Perceived Relationship Quality Components (PRQC) scale assessed relationship quality. Across the observed range of PRQC scores participants who reported their partner used cannabis, used other illicit drugs, and had recent CAS with a casual partner were more likely to report engaging in these activities themselves. Among participants who indicated their partner did not engage in these activities, relationship quality was negatively associated with personal cannabis use (OR = 0.985, p < 0.001), illicit drug use (OR = 0.973, p < 0.001), and CAS with casual partners (OR = 0.979, p < 0.001); meanwhile, among those who reported their partner engaged in these behaviors - relationship quality was positively associated with the odds of these behaviors (OR = 1.018, p < 0.001; OR = 1.015, p < 0.001; OR = 1.019, p = 0.015 for cannabis, illicit drug use and CAS with casual partners respectively). These findings suggest that perceptions of a partner's behavior contextualize associations between relationship quality and personal behavioral risk. Results emphasize the importance of integrating components that support relationship quality into behavioral health interventions for SMM couples and SMM in relationships.

Prevalence of sexually risky behaviors among Mexican medical students.

University students are at high risk of sexually transmitted infections due to the lack of adequate sexual education, as well as multiple associated factors, which lead to risky sexual practices. It is important to update data about sexual behaviors to identify the main factors associated with sexually risky behaviors. The present study aimed to evaluate the current prevalence of sexually risky practices in medical students. A cross-sectional study was conducted among medical students through an anonymous self-administered online questionnaire including demographic characteristics and sexual behaviors. We used descriptive statistics and multivariable regression to analyze the data collected. A total of 1520 undergraduate medical students aged between 18 and 28 years old were included in the study. Sixty percent of the students were sexually active with a higher proportion in men (70%), likewise, they had an earlier sexual debut (16.5 vs 16.9 years old), and a greater number of lifetime sexual partners than women (3.8 vs 2.2). The main sexual activity in both groups was vaginal sex with high use of condoms (75%), however, most of them (67%) reported having unprotected oral sex. Logistic regression analysis showed that condomless sex was associated with having oral sex, anal sex, and being female. The findings of this study showed that medical university students are involved in risky sexual behaviors, the major risk factor was unprotected oral sex. Based on these results, we recommended designing interventions to improve sexual education and preventive approaches from early stages such as in middle school students to mitigate sexually transmitted infections among medical university students.

Outcomes of substance use and sexual power among adolescent girls and young women in Cape Town: Implications for structural and cultural differences.

Adolescent girls and young women (AGYW) in South Africa experience contextual barriers to HIV risk reduction including incomplete schooling, unintended pregnancy, substance use, and gender-based violence. A cluster randomised trial in Cape Town allocated 24 Black and Coloured communities to a gender-focused HIV risk-reduction intervention or HIV testing, with 500 AGYW total enrolled. We evaluated intervention efficacy by comparing mean differences overall, by community population group (Black and Coloured) and among those with structural barriers based on neighbourhood, education, and employment (n = 406). Both arms reported reductions in alcohol, cannabis, and condomless sex, with no intervention efficacy overall. Among AGYW with barriers, intervention participants reported fewer days of methamphetamine use at 6 months (t(210) = 2·08, p = ·04). In population group analysis, we found intervention effects on alcohol and sexual communication. Intervention participants in Black communities had fewer days of alcohol use at 12 months (t(136) = 2·10, p = ·04). Sexual discussion (t(147) = -2·47, p = ·02) and condom negotiation (t(146) = -2·51, p = ·01) increased for intervention participants at 12 months in Coloured communities. Gender-focused interventions must address population group differences and intersecting barriers to decrease substance use and increase education, skills, and sexual health protection.

Regional and Country Prevalence Estimates of Unsafe Sex Among Adolescents in 68 Low-Income and Middle-Income Countries.

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

Dyadic Moderators of the Minority Stress-HIV Risk Association in Male Couples.

Minority stressors have been linked to HIV risk behaviors among gay, bisexual, queer, and other men who have sex with men (MSM). Committed partnerships are a key context for new HIV infections and coping with minority stress among MSM, but very little work has tested the minority stress-HIV risk link among male couples, and little is known about how processes within one's relationship may exacerbate or buffer this association. The present study examined links between minority stress (i.e., internalized stigma, microaggressions) and HIV transmission risk behaviors (i.e., condomless anal sex with outside partners, breaks in relationship agreements) among male couples, as well as relationship-based moderators (i.e., social support, dyadic coping) of these associations. An analytic sample of male couples from a large cohort study (analytic N = 410 individuals, 205 dyads) completed self-report measures of minority stress, relationship-based moderators, and HIV transmission risk behaviors which were submitted to moderated actor-partner interdependence models (APIMs). In many cases, coping with stress with one's partner buffered the minority stress-HIV transmission link risk. However, findings also suggested situations in which partners may overburden one another with coping, thus exacerbating HIV-related risk behaviors.

Rural-Urban Differences in HIV Sexual Risk Behaviors and HIV Service Utilization Among Adolescent Sexual Minority Males in the United States.

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

Development of a risk estimation model for condomless sex among college students in Zhuhai, China: a cross-sectional study.

BACKGROUND: Condom use at last intercourse is an effective indicator for human immunodeficiency virus (HIV) prevention. To identify at-risk individuals and improve prevention strategies, this study explored factors associated with condomless sex at last intercourse in the last year and developed a risk estimation model to calculate the individual possibility of condomless sex among college students in Zhuhai, China. METHODS: A cross-sectional study was conducted among 1430 college students who had sex in the last year from six universities in Zhuhai. The least absolute shrinkage and selection operator (LASSO) and logistic regression were performed to explore the predictors of condomless sex. The nomogram was constructed to calculate the individual possibility of condomless sex. Discrimination and calibration of the nomogram were evaluated using the area under the receiver-operator characteristic curve (AUROC) and the calibration curve. RESULTS: The proportion of students who had condomless sex at last intercourse was 18.2% (260/1430). Students who had experienced more types of intimate partner violence (aOR, 1.58; 95% CI, 1.31 ~ 1.92) and had anal sex (aOR, 1.75; 95% CI, 1.06 ~ 2.84) were more likely to have condomless sex. Students who had heterosexual intercourse (aOR, 0.37; 95% CI, 0.21 ~ 0.70), used condoms at first sex (aOR, 0.20; 95% CI, 0.14 ~ 0.27), had high attitudes towards condom use (aOR, 0.87; 95% CI, 0.80 ~ 0.95) and self-efficacy for condom use (aOR, 0.84; 95% CI, 0.78 ~ 0.90) were less likely to have condomless sex. The nomogram had high accuracy with an AUROC of 0.83 and good discrimination. CONCLUSIONS: Intimate partner violence, anal sex, condom use at first sex, attitude towards condom use, and self-efficacy for condom use were associated with condomless sex among college students. The nomogram was an effective and convenient tool for calculating the individualized possibility of condomless sex among college students. It could help to identify individuals at risk and help universities and colleges to formulate appropriate individualized interventions and sexual health education programs.

A Mixed-Methods Approach to Develop a Combined Model of U.S. College Student Alcohol-Associated Condomless Sex.

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.

Validation of the Sexual Discounting Task for Use in Adolescents.

The Sexual Discounting Task (SDT) was developed to evaluate the effects of delay on decision making as it relates to sexual risk-taking behaviors. Though previously validated with other populations, including urban emerging adults, the current study sought to validate the SDT with adolescents. A sample of adolescents (N = 155; 61% female) between ages 14 and 21 (Mage = 19.5 years) was recruited to complete the SDT (involving choices between immediate unprotected sex and delayed sex with a condom with hypothetical sexual partners) and the Delay Discounting Task (a delay discounting task for money outcomes). Additionally, they completed several self-report measures assessing demographics, sexual behavior, and sexual history. If the condom was readily available, respondents were more likely to use a condom for partners who were judged "most likely to have an STI" and for those that participants were "least likely to have sex with." Moreover, when a condom was not immediately available, greater self-reported sexual risk-taking was related to greater sexual discounting (i.e., greater effects of delay on decreasing condom use). Furthermore, sexual discounting was greater among partners deemed more desirable and those judged "least likely to have an STI." Differences in sexual discounting were significant after controlling for immediately available condom use. Findings from the current study suggest that the SDT is clinically meaningful for adolescents and is sensitive to factors that influence real-world decisions to use condoms. Future treatment and prevention should consider delay discounting as an important variable affecting sexual risk behavior.

Pornography usage during adolescence: Does it lead to risky sexual behavior?

Are youths who consume pornography more likely to engage in risky sexual behaviors? Using longitudinal data from the National Study of Youth and Religion and an individual fixed effects strategy, this paper investigates the relationship between pornography use among 13- to 23-year-olds and a range of subsequent risky sexual behaviors. It also estimates a lagged dependent variable model where risky sexual behavior of the previous wave is included as a control. The findings suggest that moderate and frequent pornography use increases the likelihood of engaging in acts such as unprotected sex and having multiple sexual partners. Finally, a heterogeneity analysis by gender reveals that males and females behave differently in response to exposure to pornography, but that is true for only a few indicators of risky sex. The paper's findings provide critical information on determinants of risky sexual behavior and meaningful evidence for the policy debate on government censoring and monitoring online behavior.

Validity of Partner Reports of Recent Condomless Sex.

BACKGROUND: Prostate-specific antigen (PSA), a biomarker of vaginal semen exposure, is less susceptible to bias than self-reported condom use behaviors. We examined the agreement of self-reported recent condomless sex (RCS) within couples and how these reports related to PSA detection. METHODS: We analyzed data from a study conducted in Vietnam, 2017 to 2020, of 500 different-sex couples using condoms and no other contraceptive method to prevent pregnancy for 6 months. We assessed enrollment and 6-month data from vaginal swabs and questionnaires from both partners. We calculated Prevalence-Adjusted Bias-Adjusted Kappa (PABAK) to evaluate agreement of men's and women's reports. Among couples with detected PSA, we assessed partner concordance of RCS reporting. RESULTS: At enrollment (n = 499), 79.8% of couples reported no RCS, 16.4% reported RCS, and 3.8% had partner-discordant reports (PABAK, 0.93; 95% confidence interval, 0.91-0.97). At 6 months (n = 472), 91.7% reported no RCS, 5.7% reported RCS, and 2.5% had partner-discordant reports (PABAK, 0.98; 95% confidence interval, 0.96-1.0). Among couples with detected PSA at baseline (11%, n = 55), 36% reported no RCS, 55% reported RCS, and 6% had discordant reports; at 6 months (6.6%, n = 31), 58% reported no RCS, 35% reported RCS, and 3% had discordant reports. CONCLUSIONS: We observed high agreement regarding condomless sex within couples in a population using condoms as contraception in Vietnam; however, a high proportion of couples with detected PSA had both partners reporting no RCS, indicating that concordant reporting of no RCS does not indicate lack of semen exposure.

Frequency of same-day contraceptive initiation, recent unprotected intercourse, and pregnancy risk: a prospective cohort study of multiple contraceptive methods.

BACKGROUND: Same-day start removes barriers to contraceptive initiation and may reduce the risk of unintended pregnancy. It may be appropriate for all contraceptive methods, but we lack data comparing methods. OBJECTIVE: This study aimed to assess the frequency of same-day start with 6 contraceptive methods among new contraceptive users and describe the efficacy of same-day start in terms of first-cycle pregnancy risk overall and by each method. STUDY DESIGN: Using prospective data from the HER Salt Lake Contraceptive Initiative, we identified and assessed outcomes for participants initiating a new method of contraception beyond the first 7 days of their menstrual cycle (same-day start). Enrolled participants at 4 family planning clinics in Salt Lake County, Utah between September 2015 and March 2017 received their method of choice regardless of their cycle day or recent unprotected intercourse. All participants self-reported last menstrual period data and unprotected intercourse events in the previous 2 weeks. We excluded participants who received care immediately after or within 2 weeks of abortion care. Clinical electronic health records provided information on contraceptive method initiation and use of oral emergency contraception. Participants reported pregnancy outcomes in 1-, 3-, and 6-month follow-up surveys with clinic verification to identify any pregnancy resulting from same-day initiation. The primary outcomes report the frequency of same-day start use and first-cycle pregnancy risk among same-day start users of all contraceptive methods. The secondary outcomes include frequency of and pregnancy risk in the first cycle of use among same-day start contraception users by method. We also report the frequency of unprotected intercourse within 5 days and 6 to 14 days of contraception initiation, frequency of concomitant receipt of oral emergency contraception with initiation of ongoing contraception, and pregnancy risk with these exposures. We analyzed pregnancy risk for each contraceptive method initiated on the same day and assessed the simultaneous use of oral emergency contraception. RESULTS: Of the 3568 individuals enrolled, we identified most as same-day start users (n=2575/3568; 72.2%), with 1 in 8 of those reporting unprotected intercourse in the previous 5 days (n=322/2575; 12.5%) and 1 in 10 reporting unprotected intercourse 6 to 14 days before contraceptive method initiation (n=254/2575; 9.9%). We identified 11 pregnancies among same-day start users (0.4%; 95% confidence interval, 0.2-0.7), as opposed to 1 (0.1%; 95% confidence interval, 0.002-0.6) among those who initiated contraception within 7 days from the last menstrual period. Users of oral hormonal contraception and vaginal hormonal methods reported the highest first-cycle pregnancy rates (1.0-1.2). Among same-day start users, 174 (6.8%) received oral emergency contraception at enrollment in conjunction with another method. Among the same-day start users who received emergency contraception at initiation, 4 (2.3%) pregnancies were reported. CONCLUSION: Same-day start is common and associated with a low pregnancy risk. Using the "any method, any-time" approach better meets contraceptive clients' needs and maintains a low risk of pregnancy.

Behavior Change Among HIV-Negative Men Who Have Sex with Men Not Using PrEP in the United States.

This study measures changes in condomless anal sex (CAS) among HIV-negative men who have sex with men (MSM) who are not taking pre-exposure prophylaxis (PrEP). It considers the 2014-2019 cycles of the American Men's Internet Survey, a serial, cross-sectional web-based survey of US cisgender MSM aged ≥ 15 years, in which ~ 10% of each year's sample is drawn from the previous year. Among those surveyed for 2 years who remained HIV-negative and off PrEP, reports of having any CAS and of CAS partner number were compared across years. We disaggregated by partner HIV status, and considered demographic predictors. The overall population saw a significant 2.2 percentage-point (pp) increase in reports of any CAS year-over-year. Sub-populations with the largest year-on-year increases were 15-24-year-olds (5.0-pp) and Hispanic respondents (5.1-pp), with interaction (young Hispanic respondents = 12.8-pp). On the relative scale, these numbers correspond to 3.2%, 7.2%, 7.3% and 18.7%, respectively. Absolute increases were concentrated among partners reported as HIV-negative. Multivariable analyses for CAS initiation found effects concentrated among Hispanic and White youth and residents of fringe counties of large metropolitan areas. CAS partner number increases were similarly predicted by Hispanic identity and young age. Although condom use remains more common than PrEP use, increasing CAS among MSM not on PrEP suggests potential new HIV transmission pathways. Concentration of increases among 18-24-year-old MSM portends future increases in the proportion of newly diagnosed HIV that occur among youth. Concentration among young Hispanic MSM will likely expand existing disparities. Although reducing barriers to PrEP remains vital, condom promotion for MSM remains a key public health practice and appears to be missing key audiences. LGBTQ+-inclusive sex education is one avenue for enhancing these efforts.