The scarlet V: how women with dyspareunia negotiate postfeminist discourses of sexual agency.

Young women must often contend with cultural scripts dictating neoliberal/postfeminist ideals of female sexual agency, including the ability to act in accord with one's personal sexual self-interest. The aim of this study was to explore how young women (n = 26) living with dyspareunia (pain experienced during penetrative sexual activity) negotiate these ideals. We found that in addition to discussing traditional discourses that assign value to women in accordance with their perceived sexual virtue, women judged themselves according to the degree to which their behaviour reflected sexual agency. Women perceived to be sexually agentic were, for the most part, lauded, while those perceived to lack sexual agency were either denigrated (in the case of high sexual activity) or seen as deficient (in the case of low sexual activity). The inability to be penetrated without pain significantly limited women's sexual repertoires. Contrasting their sexual agency with that of other women and of their past selves, women expressed feelings of disempowerment. Conceptualising agency as a spectrum rather than something that one has or lacks, as well as actively cultivating the potentialities of sexual 'transgression', may allow young women to resist heteronormative sexual hierarchies - including those rooted in a a postfeminist ethos.

An Integrated Conceptual Framework of Behavioral Intervention Technologies to Promote Healthcare Utilization Among Socially-Marginalized Populations in the United States.

In the U.S., socially marginalized groups disproportionately shoulder the burden of health outcomes. The evolving development of behavioral intervention technologies provides opportunities to support users in changing behaviors and improving health. No conceptual model is available to guide technology-based behavioral interventions among vulnerable groups in the new era of digitalization. Our conceptual framework combines the Behavioral Model of Healthcare Utilization (HCU) for Vulnerable Populations and the Integrated Model of Behavioral Prediction (IMBP). With the Socioecological Model leading the vertical direction, the overarching HCU-IBMP model is incorporated by the Behavioral Intervention Technology-Technological Instantiation Framework (BIT-Tech). The HCU model explains how vulnerable populations influence healthcare access and utilization behaviors by personal and contextual factors. Through the lens of the IMBP, healthcare utilization intention is highly predictable and maybe even causally correlated with the corresponding behavior. To assist the healthcare utilization intention translates into the corresponding behaviors, we employ a medium using the technological implementation in a system that can assist the end-users in adopting the desired behavior. With the integrated model that combines a technological framework with the behavioral components, the BIT-Tech guides the procedure intervention development. Our integrated conceptual framework indicated that theoretical and technical components should be considered during a technological tool development to support the research community. A real-world intervention design has been demonstrated using the framework to guide behavioral intervention technologies to promote PrEP care and utilization among racial/ethnic minority women in the U.S.

Perceived access to PrEP as a critical step in engagement: A qualitative analysis and discrete choice experiment among young men who have sex with men.

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

HIV-serodifferent couples' perspectives and practices regarding HIV prevention strategies: A mixed methods study.

A substantial proportion of heterosexually acquired HIV infections in the U.S. occur between partners in primary relationships characterized by mixed HIV status. The U.S. Centers for Disease Control and Prevention have issued guidelines prioritizing HIV-serodifferent couples for primary HIV prevention, including treatment-as-prevention and pre-exposure prophylaxis (PrEP). Yet, very little research has been conducted to understand the perspectives and practices of HIV-serodifferent couples regarding HIV prevention strategies in the U.S. To help fill this gap, we conducted a mixed methods study with 27 mostly Black/African American and Latinx HIV-serodifferent heterosexual couples residing in New York City to explore their knowledge, attitudes, practices, and perspectives regarding combination HIV prevention, including condoms, PrEP and viral control. All couples expressed the desire to maintain viral suppression in the HIV-positive partner, which was not always achieved. There was considerable heterogeneity in the use of HIV prevention methods by couples; and several patterns emerged that were largely driven by gender and relationship dynamics. Female partners, in particular, expressed high levels of anxiety around transmission of HIV and thus desired multiple methods of protection. Healthcare providers should consider couples' psychosocial well-being, relationship quality, and other motivational factors when helping to tailor HIV preventative care for mixed-status couples.

'It's just a matter of playing the odds': Navigating risks associated with sexual behaviour in the COVID-19 era.

Since the outbreak of the COVID-19 pandemic, scholars and popular media outlets have been speculating on the pandemic's effects on sexual relationships. While research differs as to whether COVID-19 is associated with sexual behaviour changes, none has focused on how sexual risk-taking during the pandemic is perceived and accomplished. Drawing on semi-structured interview data collected from 30 sexual minority men in the US, this study explores how men make sense of and manage risk during sexual activity taking place outside the bounds of lockdown. Four themes arose from these interviews: (a) the commonality of sexual activity despite COVID-19 risk; (b) sexual motivations rooted in emotions such as desire, longing for connection, and the wish to live fully in the face of the pandemic; (c) varied perceptions regarding the possibility of preventing COVID-19 infection; and (d) risk assessment and management strategies that were similar to those used for HIV prevention. Assuming or calling for abstinence neglects questions of risk navigation and omits the experiences of large swaths of the population. Addressing these issues might minimize COVID-19 transmission associated with sexual risk-taking among sexual minority men.

'It's history in the making all around us': examining COVID-19 through the lenses of HIV and epidemic history.

Research increasingly considers how collective narratives/experiences of HIV influence understandings of and responses to COVID-19 among men who have sex with men and how these discussions articulate with the larger literature on the social significance of epidemics. Drawing on interviews with 30 men who have sex with men, as well as discussion of epidemics as dramaturgical events, this study aimed to determine how men living in the USA make sense of COVID-19 in the light of their collective knowledge and/or memories of the HIV pandemic. Participants experienced progressive revelations regarding COVID-19's seriousness and constructed frameworks with which to manage the unpredictability of infection. Participants also believed that the initial public response to COVID-19 on the part of the US federal government, health officials and the scientific community, although inadequate, was stronger and more extensive than the response had been to HIV. As communities and the USA negotiated their pandemic responses, participants negotiated their own personal responses with incomplete, uncertain, dynamic and conflicting information. This study provides evidence regarding the social organisation of a contemporary pandemic and how individuals perceive and guard against risk, assign responsibility for virus transmission and acquisition, and navigate the threat of a potentially deadly infection.

The Magnetic Couples Study: protocol for a mixed methods prospective cohort study of HIV-serodifferent heterosexual couples' perspectives and use of pre-exposure prophylaxis (PrEP).

INTRODUCTION: HIV transmission within serodifferent heterosexual couples plays a key role in sustaining the global HIV pandemic. In the USA, transmission within established mixed-status couples accounts for up to half of all new HIV infections among heterosexuals. Oral HIV pre-exposure prophylaxis (PrEP) is a highly effective prevention method, although underutilised among serodifferent couples. Moreover, there is a dearth of research on US HIV-serodifferent couples' perspectives and use of PrEP, alone or in combination with other prevention methods. In this paper, we describe the study protocol for the Magnetic Couples Study, designed to fill critical knowledge gaps regarding HIV-serodifferent heterosexual couples' perspectives, experiences and utilisation of PrEP. METHODS AND ANALYSIS: The Magnetic Couples Study is a mixed methods prospective cohort study designed to describe temporal patterns and identify determinants at multiple levels (individual, couple, HCF) of PrEP outcomes along the care continuum (PrEP awareness, linkage, uptake, retention and medication adherence) among HIV-serodifferent heterosexual couples residing in New York City. The study will also examine clinical management of PrEP, side effects and changes in sexual-related and substance use-related behaviour. A prospective cohort of 230 mixed-status couples already on oral PrEP was recruited, with quarterly assessments over 18 months; in addition, a cross-sectional sample of 150 mixed-status couples not currently on PrEP was recruited. In-depth semistructured qualitative interviews were conducted with a subsample of 25 couples. Actor-partner interdependence modelling using multilevel analysis will be employed for the analysis of longitudinal dyadic data. Framework analysis will be used to analyse qualitative data. A parallel convergent design will be used for mixed methods integration. ETHICS AND DISSEMINATION: The study was approved by the University of Rochester Institutional Review Board (RSRB00052766). Study findings will be disseminated to community members and providers and to researchers and policy makers.

A Syndemic Model of Exchange Sex Among HIV-Positive Men Who Have Sex With Men.

Exchange sex is a behavior associated with HIV transmission risk among men who have sex with men (MSM). Few studies have examined exchange sex among HIV-positive MSM. We utilize a syndemic framework to account for co-occurring psychosocial problems that suggest the presence of intertwining epidemics (i.e., syndemics), which have not been examined within the context of exchange sex among HIV-positive MSM. In 2015, MSM were recruited via online sexual networking Web site and app advertisements for Sex Positive![+], a video-based online intervention that aimed to improve health outcomes for men living with HIV. Participants completed surveys every three months for a year. Surveys covered demographics, drug use, exchange sex, intimate partner violence (IPV), and past 2-week depressive symptoms. We conducted three logistic regression models to assess syndemic factors associated with exchange sex in the past 3 months. Of the 722 HIV-positive MSM included in the sample, 59 (8%) reported exchange sex in the past 3 months at 12-month follow-up. HIV-positive MSM who had more syndemic factors had greater odds of exchange sex. Exchange sex was associated with being African-American/Black, age 18-29 years, past and present experiences with IPV, stimulant use, polysubstance use, and depressive symptoms. Exchange sex was associated with multiple psychosocial factors, indicating exchange sex may be part of a syndemic involving substance use, depression, HIV, and IPV. Interventions should address the social and behavioral circumstances that perpetuate environments that can foster multiple negative health outcomes.

Pre-exposure Prophylaxis Use Among Men Who Have Sex with Men Experiencing Partner Violence.

Intimate partner violence (IPV) significantly increases HIV risk among MSM. Pre-exposure prophylaxis (PrEP) may provide MSM experiencing IPV an option for self-protection from HIV without requiring condom negotiation or compromising safety. This study examined relationships among various forms of IPV (physical, emotional, monitoring, controlling, and forced sex) and PrEP use among 863 MSM participating in a cross-sectional, internet-based survey. Participants reported IPV rates during the prior 6 months that were consistent with prior research (physical violence, 23.3%; emotional violence, 36.3%; monitoring, 45.1%; controlling, 25.3%; forced sex, 20.0%). Forced sex and emotional IPV were negatively associated with PrEP use in our sample; in contrast, controlling was positively associated with PrEP use. We suggest clinical IPV screenings among MSM seeking PrEP, as well as PrEP-focused interventions that explicitly address IPV.

Associations Between Relationship Power and Pre-Exposure Prophylaxis (PrEP) Use Among Men Who Have Sex With Men.

Few studies have attempted to understand relationship-level factors impacting PrEP utilization among men who have sex with men (MSM). This study examined associations between relationship power and PrEP use among 826 MSM participating in a cross-sectional, Internet-based survey. The results of our analysis indicate that decision-making dominance was positively associated with PrEP use among MSM, but the association between relationship control/overall relationship power and PrEP use was inconclusive. Furthermore, when examining specific types of decision-making dominance, equal and greater dominance compared to one's partner regarding types of sexual activity engaged in, as well as dominance more generally, were positively associated with PrEP use. However, the relationships between decision-making dominance related to condom use/sexual initiation and PrEP use were inconclusive. This study suggests that the promotion of egalitarian relationships-as well as other relationship-level determinants-should be an essential component of biobehavioral interventions targeting this population.

Association of Medical Mistrust and Poor Communication with HIV-Related Health Outcomes and Psychosocial Wellbeing Among Heterosexual Men Living with HIV.

Studies have suggested that effective patient-provider relationships may reduce health disparities and foster engagement across the HIV care continuum among people living with HIV/AIDS. However, no studies have explored specific mechanisms between medical mistrust/poor communication and HIV-related/psychosocial health outcomes among HIV-positive men of color who have sex with women (MCSW) in the United States. From 2011 to 2012, the research team recruited 317 eligible participants in New York City. Using validated explanatory and predictive modeling strategies, we explored the associations between mistrust/poor communication and HIV-related/psychosocial health outcomes among this group. Subgroup analyses were further conducted to assess the different effects of non-Hispanic black and Hispanic men. A total of 313 males (204 black, 93 Hispanic, and 16 others) reported that valid responses were included in the current analysis. In the explanatory models, both mistrust and poor communication were negatively associated with various HIV-related and psychosocial outcomes among this group of HIV-positive MCSW. In the predictive models, predictors of mistrust for the overall sample and the black subsample were nearly the same. On the contrary, predictors of poor communication were substantially different when comparing black and Hispanic HIV-positive MCSW. Our findings confirm that patient-provider relationship quality is associated with poor HIV-related and psychosocial outcomes in black and Hispanic MCSW. A different set of multi-level predictors are associated with mistrust and poor communication comparing black and Hispanic MCSW. We call for interventions addressing patient-provider relationship quality that are tailored differently for black and Hispanic men.

HIV Pre-Exposure Prophylaxis Implementation Cascade Among Health Care Professionals in the United States: Implications from a Systematic Review and Meta-Analysis.

Although pre-exposure prophylaxis (PrEP) has been approved for primary HIV prevention for individuals aged 18 years or older since 2012, PrEP utilization has been suboptimal. To understand trends in PrEP provision from the health care providers' perspective, we systematically assessed each specific stage along the PrEP implementation cascade (i.e., awareness, willingness, consultation, and prescription) among health care professionals (HCPs) in the United States. Between June and December 2018, we conducted a systematic review of published studies on this topic. A total of 36 eligible studies were identified and included in the analyses. Random-effect models were employed to examine the pooled prevalence of each key stage along the cascade. Time trend and subgroup analyses were conducted. A thematic analysis was used to identify barriers and facilitators along the PrEP cascade. In this study, a total of 18,265 HCPs representing diverse demographics were included. The pooled prevalence of PrEP awareness was 68% [95% confidence interval (CI) = 55-80%], willingness to prescribe PrEP was 66% (95% CI = 54-77%), PrEP consultation was 37% (95% CI = 25-51%), and prescription provision was 24% (95% CI = 17-32%). Subgroup analyses revealed that PrEP provision among HCPs was lowest in the south, but has been improving annually nationwide. Infectious disease specialists [odds ratio (OR) = 4.06, 95% CI = 3.12-5.28; compared with primary care providers] and advanced practice registered nurses/physician assistants (OR = 1.51, 95% CI = 1.09-2.09; compared with physicians) had higher odds of prescribing PrEP. Barriers and facilitators regarding optimal PrEP implementation were embedded within individual, dyadic, social, and structural levels. This meta-analysis has comprehensively examined the trend and pattern of PrEP implementation among HCPs. To achieve optimal implementation of the PrEP cascade in the United States, tailored training and programs need to be provided to HCPs.

Syndemic factors associated with adherence to antiretroviral therapy among HIV-positive adult heterosexual men.

BACKGROUND: Suboptimal adherence to HIV antiretroviral therapy (ART) and concomitant lack of viral control can have severe consequences for health and onward transmission among persons living with HIV. Little is known about the barriers and facilitators of optimal ART adherence among heterosexual HIV-positive men. METHODS: Structural equation modeling (SEM) was performed to test a theory-derived model of ART adherence using data from a cross-sectional sample of 317 HIV-positive self-identified heterosexual men residing in New York City. We assessed a conceptual model in which mental health (depression, anxiety) and substance use dependence mediated the effects of socio-structural factors (HIV-related stigma, social support) on ART adherence, and subsequently, undetectable viral load. RESULTS: Structural equation modeling analyses indicated that men who reported higher levels of HIV-related stigma tended to experience higher levels of general anxiety, which in turn was associated with reduced probability of optimal ART adherence. Moreover, men who reported higher levels of social support tended to exhibit less dependence on illicit substance use, which in turn was associated with increased probability of optimal ART adherence. African-American men reported lower ART adherence compared to other racial/ethnic groups. CONCLUSIONS: Our findings support the hypothesis that substance use dependence and mental health problems, particularly anxiety, may be primary drivers of suboptimal ART adherence among heterosexual men, and that socio-structural factors such as HIV-related stigma and social support are potential modifiable antecedents of these drivers.

Advancing the case for nurse practitioner-based models to accelerate scale-up of HIV pre-exposure prophylaxis.

AIMS: To explore the factors that position nurse practitioners (NPs) to lead the implementation of HIV pre-exposure prophylaxis. BACKGROUND: The HIV epidemic represents a global health crisis. Reducing new HIV infections is a public health priority, especially for Black and Latino men who have sex with men (MSM). When taken as directed, co-formulated emtricitabine and tenofovir have over 95% efficacy in preventing HIV; however, substantial gaps remain between those who would benefit from pre-exposure prophylaxis (PrEP) and current PrEP prescribing practices. DESIGN: This is a position paper that draws on concurrent assessments of research literature and advanced practice nursing frameworks. METHOD: The arguments in this paper are grounded in the current literature on HIV PrEP implementation and evidence of the added value of nurse-based models in promoting health outcomes. The American Association of Colleges of Nursing's advanced nursing practice competencies were also included as a source of data for identifying and cross-referencing NP assets that align with HIV PrEP care continuum outcomes. CONCLUSIONS: There are four main evidence-based arguments that can be used to advance policy-level and practice-level changes that harness the assets of nurse practitioners in accelerating the scale-up of HIV PrEP. RELEVANCE TO CLINICAL PRACTICE: Global public health goals for HIV prevention cannot be achieved without the broader adoption of PrEP as a prevention practice among healthcare providers. NPs are the best hope for closing this gap in access for the populations that are most vulnerable to HIV infection.

Feasibility and acceptability of pre-exposure prophylaxis use among women in violent relationships.

Intimate partner violence (IPV) is associated with a high risk of HIV acquisition. Pre-exposure prophylaxis (PrEP), which does not require partner knowledge or consent, is a promising HIV risk reduction option for women experiencing IPV. Drawing on semi-structured interviews with 26 women experiencing IPV within the last six months, this study explored the feasibility and acceptability of PrEP use in this population. Slightly more than half of the women in this study expressed interest in taking PrEP when in a relationship with an abusive partner. Potential barriers to PrEP, discussed regardless of women's expressed interest in PrEP, included fear of side effects and long-term health concerns, low risk perceptions, potential partner interference, and prioritizing coping with the relationship over HIV prevention. When offering PrEP counseling, providers should inquire about IPV, as women in violent relationships may require tailored counseling to address barriers and concerns specific to their situation.

Effects of Discrimination on HIV-Related Symptoms in Heterosexual Men of Color.

HIV-related symptoms have a deleterious effect on quality of life. One determinant of HIV symptom burden among individuals of color may be discrimination. The aim of this study was to explore whether multiple lifetime discrimination events are associated with a greater number of HIV-related symptoms among heterosexual HIV-positive men of color and to examine the influence of anxiety and social support on this relationship. Data for this study were drawn from a cross-sectional survey of 307 heterosexual HIV-positive men recruited from health and social service agencies in New York City (NYC). This study indicated that the number of discrimination events experienced in one's lifetime was positively associated with the number of HIV-related symptoms experienced in the past month. Moreover, the direct effect of discrimination on HIV symptoms remained significant after anxiety was included as a mediator in the model, and there was a significant indirect effect of discrimination on HIV symptoms through anxiety. Evidence supported a potential moderated mediation effect involving social support: As social support increased, the indirect effect of discrimination on HIV symptoms through anxiety decreased. The results of this study suggest an association between discrimination and HIV-related symptom burden. Furthermore, the relationship between number of major discrimination experiences and HIV symptom burden was partially mediated by anxiety. Future research should consider how lifetime discrimination might be associated with negative health outcomes among HIV-positive individuals of color.

Willingness to Take PrEP for HIV Prevention: The Combined Effects of Race/Ethnicity and Provider Trust.

Blacks and Hispanics/Latinos are disproportionately burdened by HIV compared to non-Hispanic Whites, as evidenced by higher HIV incidence, prevalence, and deaths attributable to AIDS. Increasing the use of novel prevention techniques such as Truvada for pre-exposure prophylaxis (PrEP) could greatly help in reducing these disparities by lowering HIV incidence among these higher risk groups. Trust in providers, which may differ by race and ethnicity, may influence willingness to take PrEP. This study explores the moderating effect of race/ethnicity on trust in one's primary care provider (PCP) on PrEP willingness. This study found a significant association between PCP trust and PrEP willingness, with those with greater trust having 3.24 times the adjusted odds of being willing to try PrEP. Results regarding the effects of race and ethnicity on these outcomes, however, were inconclusive. Results indicate the importance of fostering trust between PrEP-prescribing PCPs and their patients.

Struggles for medical legitimacy among women experiencing sexual pain: A qualitative study.

Given the prominent role of medical institutions in defining what is "healthy" and "normal," many women turn to medicine when experiencing pain during intercourse (dyspareunia). The medical encounter can become a contest between patients and providers when physicians do not grant legitimacy to patients' claims of illness. Drawing on interviews conducted from 2007 to 2008 and 2011 to 2012 with 32 women experiencing dyspareunia (ages 18-60 years) and living in New York City and its surrounding areas, this study examined women's and their physicians' claims regarding bodily expertise, particularly women's perceptions of physician invalidation, their understanding of this invalidation as gendered, and the consequences for women's pursuit of medicalization. Women overwhelmingly sought a medical diagnosis for their dyspareunia, in which they believed that providers would relieve uncertainty about its origin, give treatment alternatives, and permit them to avoid sexual activity. When providers did not give diagnoses, women reported feeling that their bodily self-knowledge was dismissed and their symptoms were attributed to psychosomatic causes. Furthermore, some women linked their perceptions of invalidation to both historical and contemporary forms of gender bias. Exploration of women's struggles for medical legitimacy may lead to a better understanding of the processes by which medicalization of female sexuality takes place.

Development and Refinement of a Targeted Sexual Risk Reduction Intervention for Women With a History of Childhood Sexual Abuse.

Childhood sexual abuse (CSA) is associated with sexual risk behavior in adulthood. Traditional sexual risk reduction interventions do not meet the unique needs of women who have been sexually abused. In the current paper, we describe the four-stage process we followed to develop and refine a targeted sexual risk reduction intervention for this population. First, initial quantitative work revealed that the intervention should address how maladaptive thoughts related to traumatic sexualization, trust, powerlessness, and guilt/shame (traumagenic dynamics constructs) influence current sexual behavior. Second, qualitative interviews with 10 women who reported a history of CSA (M age = 34 years; 90% African American) as well as current sexual risk behavior provided support for targeting maladaptive thoughts associated with these traumagenic dynamics constructs. Third, based on the qualitative and quantitative results, we developed a 5-session, group-delivered intervention to address the maladaptive thoughts that occurred as a result of CSA, as well as the cognitive-behavioral determinants of sexual risk behavior. This intervention drew heavily on cognitive behavioral techniques to address cognitions associated with CSA and the links between these cognitions and current sexual risk behavior. Techniques from trauma-based therapies, as well as motivational techniques, were also incorporated into the intervention. Finally, we refined the intervention with 24 women (M age = 33 years; 79% African American), and assessed feasibility and acceptability. These women reported high levels of satisfaction with the intervention. The resultant intervention is currently being evaluated in a small, randomized controlled trial.

Pilot Test of an Integrated Sexual Risk Reduction Intervention for Women with a History of Childhood Sexual Abuse.

HIV and childhood sexual abuse (CSA) are intersecting public health problems for women. We pilot tested an integrated sexual risk reduction intervention for women with a history of CSA that addressed both the consequences of CSA [based on the Traumagenic Dynamics (TD) framework] and the antecedents of sexual risk behavior (based on the Information-Motivation-Behavioral Skills [IMB] model). Women with a history of CSA who were attending a public STI clinic (n = 84) were randomly assigned to a five-session integrated TD/IMB (experimental) group intervention or to a time-matched IMB-guided sexual risk reduction (control) group intervention. Preliminary findings indicated that women in the integrated TD/IMB intervention reduced their average number of episodes of unprotected sex with a primary partner, their alcohol use, and their likelihood of being in a violent relationship, relative to women in the IMB-only group. Our findings suggest that sexual risk reduction interventions that address both the consequences of CSA and the antecedents of sexual risk behavior may be efficacious in reducing sexual risk behavior among women who were sexually abused.