Participatory mapping in low-resource settings: Three novel methods used to engage Kenyan youth and other community members in community-based HIV prevention research.

Understanding the link between health and place can strengthen the design of health interventions, particularly in the context of HIV prevention. Individuals who might one day participate in such interventions - including youth - may further improve the design if engaged in a meaningful way in the formative research process. Increasingly, participatory mapping methods are being used to achieve both aims. We describe the development of three innovative mapping methods for engaging youth in formative community-based research: 'dot map' focus groups, geocaching games, and satellite imagery-assisted daily activity logs. We demonstrate that these methods are feasible and acceptable in a low-resource, rural African setting. The discussion outlines the merits of each method and considers possible limitations.

The Impact of Spirituality and Religiosity on Unprotected Sex for Adult Women.

OBJECTIVES: To explore the relationship of spirituality and religiosity with sexual behavioral self-efficacy in predicting recent unprotected sex in a sample of adult women, predominantly comprised of African Americans. METHODS: Data were collected from a sample of 171 adult women via a paper-and-pencil questionnaire. We conducted a path analysis to test the proposed relationships. RESULTS: An increase in both religiosity and spirituality predicted a decrease in number of types of recent unprotected sex, indirectly through sexual behavior self-efficacy. All indirect effects were similar in magnitude. CONCLUSIONS: The results suggest that religiosity and spirituality are both associated with unprotected sex through sexual self-efficacy among African-American women. Faith-based strategies warrant further examination as components of sexual risk reduction efforts for this population.

A Randomized Control Trial for Evaluating Efficacies of Two Online Cognitive Interventions With and Without Fear-Appeal Imagery Approaches in Preventing Unprotected Anal Sex Among Chinese Men Who Have Sex with Men.

Fear appeal approach has been used in health promotion, but its effectiveness has been mixed. It has not been well applied to HIV prevention among men who have sex with men (MSM). The present study developed and evaluated the relative efficacy of three online interventions (SC: STD-related cognitive approach, SCFI: STD-related cognitive plus fear appeal imagery approach, Control: HIV-related information based approach) in reducing prevalence of unprotected anal intercourse (UAI) among 396 MSM using a randomized controlled trial design. Participants' levels of fear-related emotions immediately after watching the assigned intervention materials were also assessed. Participants were evaluated at baseline and 3 months after the intervention. Results showed that participants in the SCFI scored significantly higher in the instrument assessing fear after the watching the intervention materials. However, no statistically significant differences were found across the three groups in terms of UAI at Month 3. Some significant within-group reductions in some measures of UAI were found in three groups. Further studies are warranted to test the role of fear appeal in HIV prevention.

The development and evaluation of stimulant treatment programmes.

PURPOSE OF REVIEW: To summarize the recent literature (1st January 2014-1st February 2015) on stimulant treatment programme evaluations, and highlight key areas for future programme development. RECENT FINDINGS: Advances have been made in addressing both sexual risks and stimulant use among gay and bisexual men in the United States, and in adapting evidence-based resource-intense interventions to real-world settings. Programme outcome measures increasingly include changes in substance use as well as health and wellbeing indicators and measures of risk. SUMMARY: Future programme directions include: expansion of the psychosocial repertoire to include narrative and mindfulness-based therapies; web-based programme delivery; sex-sensitive programming to attract and retain women; comprehensive programming to address coexisting mental and physical illness and polysubstance use (including tobacco smoking); and improving accessibility to promote early intervention. Comparability of evaluation data can be improved by developing standardized tools particularly for measuring change in sexual-risk behavior. The use of new statistical techniques can address the lack of comparison populations.

Invited commentary: broadening the evidence for adolescent sexual and reproductive health and education in the United States.

Scientific research has made major contributions to adolescent health by providing insights into factors that influence it and by defining ways to improve it. However, US adolescent sexual and reproductive health policies-particularly sexuality health education policies and programs-have not benefited from the full scope of scientific understanding. From 1998 to 2009, federal funding for sexuality education focused almost exclusively on ineffective and scientifically inaccurate abstinence-only-until-marriage (AOUM) programs. Since 2010, the largest source of federal funding for sexual health education has been the "tier 1" funding of the Office of Adolescent Health's Teen Pregnancy Prevention Initiative. To be eligible for such funds, public and private entities must choose from a list of 35 programs that have been designated as "evidence-based" interventions (EBIs), determined based on their effectiveness at preventing teen pregnancies, reducing sexually transmitted infections, or reducing rates of sexual risk behaviors (i.e., sexual activity, contraceptive use, or number of partners). Although the transition from primarily AOUM to EBI is important progress, this definition of evidence is narrow and ignores factors known to play key roles in adolescent sexual and reproductive health. Important bodies of evidence are not treated as part of the essential evidence base, including research on lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth; gender; and economic inequalities and health. These bodies of evidence underscore the need for sexual health education to approach adolescent sexuality holistically, to be inclusive of all youth, and to address and mitigate the impact of structural inequities. We provide recommendations to improve US sexual health education and to strengthen the translation of science into programs and policy.

Effects of a health care provider intervention in reduction of sexual risk and related outcomes in economically marginal communities in Mumbai, India.

BACKGROUND: The present study assessed the effectiveness of a brief narrative intervention implemented by trained biomedical and Ayurveda, Yoga, Unani, Siddha, Homeopathy (AYUSH) providers from three low-income communities in Mumbai, India. METHODS: A quasi-experimental research design compared attitudinal and behavioural changes among a cohort of 554 patients presenting gupt rog ('secret sexual illnesses') to biomedical and AYUSH providers who were trained in the narrative intervention model (NIM; referred to as 'narrative prevention counseling' in the intervention manual) with those providing standard care (untrained in NIM). Data were analysed using multivariate and longitudinal statistical models. RESULTS: Patients who received treatment for gupt rog from trained providers reported receiving a significantly higher number of services than those receiving services from untrained providers (mean 8.9 vs 7.6 services, respectively; P<0.001). In addition, a higher number of patients seeing the trained providers no longer had gupt rog problems than those seeing untrained providers (42% vs 25%, respectively; P<0.001). Patient-reported sex with a partner who was not the wife decreased significantly from baseline to follow-up for the entire sample but was significantly greater among patients receiving treatment from trained AYUSH providers (from 27% at baseline to 2% at follow up) compared with untrained providers (from 18% at baseline to 5% at follow up; P<0.001). CONCLUSIONS: The results support the effectiveness of brief narrative intervention in primary care settings for reducing sexual risk and associated vulnerabilities among married men.

Young Danes' experiences with unsafe sex.

INTRODUCTION: Surveying sexual behaviour of the general population serves to identify key points of preventive interventions, monitor the effect and interpret changes in patterns of disease. Validated questionnaires describing sexual behaviour can be adapted to some extent from other countries, but national adaption, refinement and validation are needed due to cultural differences. The aim of this study was to identify factors influencing sexual risk behaviour among Danish adolescents with a view to designing and -initiating a national sexual behaviour surveillance programme in Denmark. MATERIAL AND METHODS: We conducted four semi-structured focus group interviews with a total of 19 sexually -experienced adolescents aged 18-23 years who attended a Danish Folk High School. Data were transcribed verbatim and analysed using qualitative description. RESULTS: Four main categories of sexual risk behaviour were identified: 1) alcohol consumption which was associated with lack of condom use, 2) one-night stands after a night out partying, at festivals or on vacations, 3) low self-esteem which increased the risk of pushing one's personal boundaries, thus resulting in promiscuous sexual behaviour, 4) increased sexual experience which resulted in lack of condom use. CONCLUSION: This study identified four categories that may lead to unsafe sex. These results should be taken into consideration when planning future preventive programmes aiming to reduce sexually transmitted infections and unwanted pregnancies among adolescents and young adults. FUNDING: Not relevant. TRIAL REGISTRATION: Not relevant.

Consumo de drogas y prácticas sexuales de los adolescentes de la ciudad de Medellin (Colombia) / Drug use and sexual practices of teenagers in the city of Medellin (Colombia)

Se estudia la relación entre consumo de drogas y prácticas sexuales en adolecentes de la ciudad de Medellín (Colombia). Mediante muestreo probabilístico aleatorio y por conglomerados, se obtuvo una muestra representativa de 955 adolescentes entre los 14 y 17 años de edad pertenecientes a colegios públicos y privados de la ciudad de Medellín de los grados 9º, 10º y 11º. Los resultados muestran que la prevalencia general de relaciones sexuales bajo el efecto de alcohol o drogas es del 43,67%. Las drogas más usadas para tener prácticas sexuales son el alcohol, la marihuana, el popper, la cocaína y el éxtasis. Consumir alcohol o drogas y tener prácticas sexuales presenta una asociación estadística significativa (p= 0.001). Las practicas sexuales mas frecuentes bajo el efecto de sustancias psicoactivas son las exploratorias (manoseo, caricias) 71%; la penetrativa vaginal (63.67%), el sexo oral (45.30%) y la masturbación (19.59%). Con respecto a tener prácticas sexuales bajo efecto de alcohol o drogas y usar métodos de protección, el 55,9% de los jóvenes usan siempre el condón, el 37,3% lo usan algunas veces y el 6,8% nunca lo usan. Este estudio prueba lo ya constatado por otras investigaciones donde se muestra la alta asociación estadística que hay entre el consumo de drogas y las prácticas sexuales, pero da cuenta que no existe asociación estadística significativa entre tener practicas sexuales bajo efectos de alcohol o drogas y el uso o no uso de métodos de protección, lo que constituye su hallazgo mas importante(AU)

The purpose of this research project was to study the relationship between drug consumption and sexual practices in teenagers in the city of Medellin, Colombia. A transversal studied was designed in order to identify the variables related to having had sexual intercourse under the effects of drugs or alcohol. The sample was made up of 955 teenagers between 14 and 17, who were in 9th, 10th and 11th grades in public and private schools in the city of Medellin. The results show that the prevalence of drug and alcohol influence in sexual intercourse is 43,67%. The most common drugs used for sexual practices are alcohol, marihuana, popper, cocaine and ecstasy. Consuming alcohol or drugs and having sexual practices shows an associated meaningful statistic (p= 0.001). The more common sexual practices under psychoactive substances are the exploratory ones (caresses and touching) (71%), vaginal penetration (63.67%), oral sex (45.30%) and masturbation (19.59%). Regarding the protection methods during sexual intercourse under drug or alcohol influence 55,9% always use a condom, 37,3% sometimes use it, and 6,8% never do it. This study proves what had been previously established by other research projects that show a high statistic association between drug consumption and sexual practices, but realizes that there is no statistically significant association between sexual practices under the influence of alcohol or drugs and the use or non-use of protective methods, which is the most important finding (AU)

Multilevel modeling in psychosomatic medicine research.

The primary purpose of this study is to provide an overview of multilevel modeling for Psychosomatic Medicine readers and contributors. The article begins with a general introduction to multilevel modeling. Multilevel regression modeling at two levels is emphasized because of its prevalence in psychosomatic medicine research. Simulated data sets based on some core ideas from the Familias Unidas effectiveness study are used to illustrate key concepts including communication of model specification, parameter interpretation, sample size and power, and missing data. Input and key output files from Mplus and SAS are provided. A cluster randomized trial with repeated measures (i.e., three-level regression model) is then briefly presented with simulated data based on some core ideas from a cognitive-behavioral stress management intervention in prostate cancer.

'Eat coffee candy and die': sex, death and Huli funerals.

BACKGROUND: Sex and death have traditionally been linked in Huli culture in the Southern Highlands in Papua New Guinea. Huli regarded that close contact with women could result in men becoming sick or dying. However, there has been rapid social and economic development in the area and Huli traditions are changing. At the same time, HIV prevalence is rising. METHODS: Twenty-five semistructured in-depth interviews were carried out with key informants during a study on HIV risk in the Southern Highlands. Interviews were conducted mostly in Tok Pisin. Interviews were transcribed and the data were analysed though thematic coding. RESULTS: Huli people use 'eating coffee candy' as a metaphor for engaging in sex at funerals. This is very new and against traditional values, where women attended funerals and men only built the coffins and buried the body. Nowadays, sex occurs at funerals. This change has disturbed older people because it has not only changed the customary meaning of the funeral space, but it has also encouraged the spread of HIV. Huli use the fatalistic expression 'Eat coffee candy and die,' to refer to funerals as a space of HIV risk. CONCLUSION: Huli community and church leaders, and health workers are attempting to deal with the situation by not allowing men to stay at the funeral site overnight, burying the dead on the same day they die and using customary village law to charge men caught having sex at a funeral. However, traditional beliefs and rapid social change in the context of an HIV epidemic need to be taken into account.

Double jeopardy--drug and sex risks among Russian women who inject drugs: initial feasibility and efficacy results of a small randomized controlled trial.

BACKGROUND: With HIV prevalence estimated at 20% among female injecting drug users (IDUs) in St. Petersburg, Russia, there is a critical need to address the HIV risks of this at-risk population. This study characterized HIV risks associated with injecting drug use and sex behaviors and assessed the initial feasibility and efficacy of an adapted Woman-Focused intervention, the Women's CoOp, relative to a Nutrition control to reduce HIV risk behaviors among female IDUs in an inpatient detoxification drug treatment setting. METHOD: Women (N = 100) were randomized into one of two one-hour long intervention conditions--the Woman-Focused intervention (n = 51) or a time and attention-matched Nutrition control condition (n = 49). RESULTS: The results showed that 57% of the participants had been told that they were HIV-positive. At 3-month follow-up, both groups showed reduced levels of injecting frequency. However, participants in the Woman-Focused intervention reported, on average, a lower frequency of partner impairment at last sex act and a lower average number of unprotected vaginal sex acts with their main sex partner than the Nutrition condition. CONCLUSION: The findings suggest that improvements in sexual risk reduction are possible for these at-risk women and that more comprehensive treatment is needed to address HIV and drug risks in this vulnerable population.

AIDS conspiracy beliefs and unsafe sex in Cape Town.

This paper uses multivariate logistic regressions to explore: (1) potential socio-economic, cultural, psychological and political determinants of AIDS conspiracy beliefs among young adults in Cape Town; and (2) whether these beliefs matter for unsafe sex. Membership of a religious organisation reduced the odds of believing AIDS origin conspiracy theories by more than a third, whereas serious psychological distress more than doubled it and belief in witchcraft tripled the odds among Africans. Political factors mattered, but in ways that differed by gender. Tertiary education and relatively high household income reduced the odds of believing AIDS conspiracies for African women (but not men) and trust in President Mbeki's health minister (relative to her successor) increased the odds sevenfold for African men (but not women). Never having heard of the Treatment Action Campaign (TAC), the pro-science activist group that opposed Mbeki on AIDS, tripled the odds of believing AIDS conspiracies for African women (but not men). Controlling for demographic, attitudinal and relationship variables, the odds of using a condom were halved amongst female African AIDS conspiracy believers, whereas for African men, never having heard of TAC and holding AIDS denialist beliefs were the key determinants of unsafe sex.

HPV high risk and protective behaviors: the effects of religious affiliation.

The majority of Americans identify themselves as belonging to some religious group. There is a mixed body of literature on whether or not religious affiliation has an influence on engaging in risky behaviors among young adults attending college. This study examined associations between religious affiliation, risky sexual practices, substance use, and family structure among a sample of predominantly white college females attending a southeastern university. Given the high risk of acquiring genital human papillomavirus infection as a result of high risk sexual practices, gaining a better understanding of how religious affiliation can be used to promote healthy sexual behaviors is warranted.

Hip hopping the gap--performing arts approaches to sexual health disadvantage in young people in remote settings.

OBJECTIVE: Closing the gap in Indigenous health and wellbeing in remote settings in the Torres Strait and Northern Peninsula Area of Far North Queensland (FNQ) includes addressing a well-documented sexual health disadvantage among young people. Community mobilization around the underlying risk factors influencing sexual health is required. METHOD: Performing-arts-based workshops were conducted in schools and after-school venues in four remote Aboriginal and Torres Strait islander locations in FNQ in early 2010, to initiate consciousness-raising around the real dimensions of youth sexual health risk. Specific objectives included strengthening operational partnerships at school-level and developing ongoing consultative processes in each location for sexual health reference group development. RESULTS: Results include a significantly strengthened productive partnership with primary and high schools in each location and sixteen production-ready hip hop songs exploring a range of physical, emotional and sexual health themes authored by the students and recorded on site. Additional outcomes included the willingness of community councils and civil society organizations to support local sexual health reference group activity. CONCLUSIONS: This initiative, the Indigenous Hip Hop Project, although accompanied by opportunity costs including alternative, more core business uses of staff time and program budget, has demonstrated the power of tapping the creative energy of young people at risk and the potential for mobilizing communities to activism around sexual health disadvantage.

Aspects of sexuality education in Europe - definitions, differences and developments.

OBJECTIVE: Sexuality education in Europe has been influenced by political, social and ethical movements. This paper considers some of these influences and the implementation of sexuality education in different parts of Europe. CONTENT: The aim of sexuality education is to enable young people to acquire knowledge, attitudes, skills and values to make appropriate choices in their sexual behaviour and thus experience a healthy sex life that is age-appropriate. This should prevent them from acquiring or passing on sexually transmitted infections, including human immunodeficiency virus, from causing or suffering unwanted pregnancies, and from being the perpetrator or victim of violence. It should enhance understanding and respect diversity, thus contributing to a better society. Sexuality education as such has been widely recognised as essential for sexual health, but the content and principles that form the basis of this education have changed over time and differ widely among the countries of Europe. CONCLUSION: Agreeing on common standards of sexuality education across Europe is a challenge for the 21st century.