Associations in preventive sexual health service utilization and pre-exposure prophylaxis (PrEP) interest among young Black women in the United States, 2018.

Despite declines in HIV prevalence among all U.S. women, HIV remains a serious concern for Black women. PrEP is an effective biomedical intervention and has high acceptability among Black women. Therefore, offering PrEP, in addition to screening and testing for STI/HIV consistently, can reduce HIV risk among this population. We examine the associations of preventive sexual health service utilization (PSHSU) and PrEP interest among young Black women (YBW) (N = 209) in the United States in 2018. YBW, ages 18-25, completed a self-administered questionnaire, assessing sexual risk and prevention behaviors, HIV/STI testing, and PrEP interest. More than half of YBW were aware of PrEP and its benefits. YBW, who received an HIV test within the past three to six months, had higher odds of PrEP interest. The proportion of YBW who reported being interested in PrEP did not differ by PSHSU. Active contraceptive use was associated with PrEP interest. The results suggest YBW engage in preventive sexual health services, including HIV/STI testing, reproductive health, and sexual health behavioral counseling. Additional efforts should be made to normalize PrEP education for heterosexual, cisgender women at student health centers on college and university campuses, and other venues outside of traditional HIV/STI testing facilities.

Associations of Social Network- and Individual-Level Factors with HIV Testing, Condom Use, and Interest in PrEP Among Young Black Women.

To achieve the 2030 goal of ending the HIV epidemic, we must consider social network- along with individual-level factors related to HIV prevention among young Black women (YBW). This cross-sectional study examined egocentric social network- and individual-level data of 180 YBW aged 18-24. Multivariable logistic regression models were used to study social network characteristics and individual sexual behaviors related to HIV prevention behaviors (e.g., HIV testing, condom use, and interest in preexposure prophylaxis, or PrEP). On average, YBW nominated 11 social network members (SNMs; seven friends, two family members, and one sex partner). About 92% of YBW spoke to at least one SNM about condom use and 58% spoke to at least one SNM about HIV testing. Respondents who spoke to a sex partner about condom use had 70% lower odds of being interested in PrEP, but 2.99 times the odds of reporting condom use during last sex. Odds of being tested for HIV in the prior 3 months were significantly increased by 3.97 times for those who spoke to at least one sex partner about HIV testing. However, odds of being interested in PrEP were significantly decreased by 63% for YBW who were tested for HIV in the prior 3 months. Findings underscore that understanding network- and individual-level factors is crucial in increasing HIV testing, condom use, and interest in PrEP among YBW.

Predictors of condom use among system-involved youth: The importance of Sex Ed.

Sexual health education has been proven effective in improving adolescent sexual reproductive health outcomes. System-involved youth, including those in child welfare or juvenile justice systems, experience disproportionately poor outcomes as compared to youth in the general population, especially concerning STIs and early or unplanned pregnancies. Using logistic regression, this cross-sectional study examined the odds of condom use in a sample (n = 318; 61.3% males; 79.9% African American) of system-involved youth with multiple high-risk sexual behaviors. Specifically, it examined the impact of sexual health education, attitudes and beliefs about condoms, and the moderating effect of gender. The logistic regression models showed that youth were more likely to use a condom when exposed to comprehensive sexual health education (p < .05). Beliefs about condom effectiveness increased the odds of condom use in the second model (p < .01). Gender was not found to have a moderating effect. This study examined whether receiving comprehensive sexual health education and adolescent attitudes and beliefs towards condoms were associated with non-condom use using logistic regression in a sample of system-involved youth. Results suggest that comprehensive sexual health education could improve condom use in this vulnerable population.

Individual and Social Network Correlates of Sexual Health Communication Among Youth Experiencing Homelessness.

Despite the potential for sexual health communication to be leveraged for HIV prevention among youth experiencing homelessness (YEH), there has yet to be a rigorous examination of individual and network or relational characteristics associated with sexual health communication in this group of young people. Cross-sectional survey and social network data from 1014 YEH aged 14-25 recruited in Los Angeles, California, were utilized to assess individual and network or relational characteristics associated with communication regarding condom use and HIV testing among YEH. Results suggest that social networks are key to understanding sexual health communication; YEH's engagement in sexual health communication was significantly related to the composition of their networks. To increase testing and decrease new HIV cases, a prudent strategy would be to train existing social network members (e.g., staff members, home-based peers, or partners) as agents of change in naturally occurring social networks of YEH.

HIV Testing and Healthcare Utilization Among U.S. African-American Women.

A severe HIV/AIDS disparity exists for U.S. African-American women. Although HIV testing and healthcare engagement are paramount to HIV prevention and community health, many African-American women do not test for HIV or optimize healthcare services. To unpack the relationship between HIV testing and healthcare utilization among African-American women, latent class analysis (LCA) was used among a national, representative sample from the 2014 National Health Interview Survey to assess subgroup profiles of African-American women regarding HIV testing and healthcare utilization behaviors. This study also explored the covariates predicting latent class membership: age, income, cost of living worry, and healthcare service satisfaction. LCA identified three subgroups of U.S. African-American women: (a) Moderate HIV testing/Low healthcare utilization, (b) Moderate HIV testing/High healthcare utilization, and (c) No HIV testing/High healthcare utilization. Future HIV prevention interventions should be tailored to specific subgroups of African- American women based on HIV testing behaviors and healthcare use and experiences.

Are Parental Relationships Always Protective? A Social Network Analysis of Black, Latino, and White Homeless Youth and Sexual Risk-Taking Behaviors.

Black and Latino homeless youth are at high risk of HIV, and yet no HIV prevention interventions have been specifically designed for these groups. Given the success of parent-child intervention programs for housed Black and Latino youth, this study examined parental relationships that could be leveraged for future HIV prevention efforts targeting minority homeless youth, specifically the associations among presence of parents in social networks, parental influence, and parental support. A convenience sample of Black, Latino, and White homeless youth (N = 754) was recruited from three drop-in centers in Los Angeles. Participants completed a computerized, self-administered questionnaire and an interviewer-led personal social network interview. Multivariate logistic regression models assessed the association between parental relationships and sexual risk behaviors. Forty-five percent (n = 338) of youth identified a parent in their network. Having at least one parent in their network was significantly associated with decreased odds of using a condom for Black and White youth. Black youth were almost four times more likely to report being tested for HIV if they spoke to their parents about sex, whereas Latino youth were 91 % less likely to report being tested for HIV if they talked with their parents about sex. Black youth who identified a parent as a positive influence (i.e., promoting condom use or discouraging multiple partners) were almost four times more likely to have used a condom during their last sexual encounter. Parent-child HIV prevention interventions targeting homeless youth would benefit from culturally tailored adaptations.

Pilot Test of an Adapted, Evidence-Based HIV Sexual Risk Reduction Intervention for Homeless Women.

Women experiencing homelessness are at heightened risk for HIV, yet risk reduction interventions specifically designed for this population are lacking. This study reports on a pilot efficacy trial of a brief evidence-based intervention, Sister To Sister (STS), that we specifically adapted for homeless women in the temporary/emergency settings where they typically seek services. Seventy-nine women, recruited from three service sites in Los Angeles County, were assigned to the 40-min adapted STS intervention or an information-only control group. At 30-day follow-up, intervention participants reported significantly greater condom use, intentions to use condoms, and sexual impulse control (as well as marginally higher positive condom beliefs and condom self-efficacy) compared to control participants. Results provide preliminary evidence that HIV risk reduction can be achieved for homeless women through a brief skill-based intervention. A randomized controlled trial employing a longer follow-up period to monitor outcomes will be necessary to determine efficacy of the adapted intervention.

Birth Care Gaps in the Childbirth Options, Information, and Person-Centered Explanation (CHOICEs) Measure.

PURPOSE: The objective of this study was to revise and improve the intrapartum items of the shared decision-making (SDM) measure, CH ildbirth O ptions, I nformation and person- C entered E xplanation (CHOICEs). STUDY DESIGN AND METHODS: Methodological sequential triangulation was used to select a purposive sample of 29 people who gave birth in the United States between August 2019 and June 2021. A qualitative descriptive approach was used to analyze and interpret the data. We used an interview guide with questions related to the nine intrapartum items in CHOICEs to address the question: How did decision-making occur during your most recent birth? RESULTS: Four major themes were identified: provider told me what to do ; communication about interventions during labor and birth ; preferences overlooked ; multiple team members . Under the theme of provider told me what to do , there was one sub-theme of induction of labor . CLINICAL IMPLICATIONS: Participants noted lack of shared decision-making, poor communication, and obstetric violence. We found the need for perinatal providers to improve communication with birthing people on topics such as fetal monitoring, induction of labor, and multiple team members who may participate in their care. Revisions of CHOICEs will include seven new items to further address birth preferences, feeling heard, and multiple team members.

The Associations of HIV Pre-Exposure Prophylaxis Interest and Sexual Risk Behaviors Among Young Black Women.

The uptake of pre-exposure prophylaxis (PrEP) is low among young Black cisgender heterosexual women, although this subgroup faces a higher burden of new HIV diagnoses. This study explored the association between sexual risk and prevention behaviors, and oral PrEP and vaginal PrEP ring interest among young Black women (YBW). A sample of YBW (N = 208) 18-25 years of age completed a self-administered questionnaire assessing sexual risk and prevention behaviors, HIV and sexually transmitted infection (STI) testing, and PrEP interest from June to December 2018. Results revealed that 103 YBW were interested in taking oral or vaginal PrEP, with 43% interested in oral PrEP use only, 28% interested in vaginal PrEP use only, and 29% interested in both oral and vaginal PrEP use. Logistic regressions revealed that YBW who had sex in the last 1-4 weeks or 3-6 months had lower odds of being interested in oral PrEP and YBW who had sex in the last 1-4 weeks had lower odds of being interested in vaginal PrEP compared with those whose last sexual encounter occurred in the last week. A large percentage of our sample was unaware of PrEP at the time of survey administration, but after learning about PrEP became more interested in potential PrEP use. This indicates that more education about the benefits of PrEP coupled with harm reduction counseling to lower their risk of STI and HIV infections is necessary to increase PrEP interest among YBW.

Sexual Health Communication Among Young Black Women and Their Social Network Members.

Objective: Young Black women (YBW) are at high risk of HIV infection. Although sexual health communication in social networks has been shown to help prevent HIV among high-risk populations, sexual health communication between YBW and their social network members (SNMs) has been insufficiently studied. Method: Egocentric social-network-level and individual-level data were collected from 78 YBW ages 18-25 to examine their sexual health communication. Multilevel multivariable logistic regression models assessed the association among individual sexual risk behaviors, SNM characteristics, and sexual health communication. Results: Participants nominated an average of 14 SNMs (N = 1,068). Friends were most frequently nominated (55%). YBW communicated to 55% of their SNMs about sex, to 32% regarding condom use, and to 21% regarding HIV testing. If SNMs provided emotional support, YBW were 4 times more likely to talk with them about sex and HIV testing and 2 times more likely to talk about condom use. Conclusions: These results indicate that before developing or adopting HIV interventions geared toward YBW, we need to assess how and with whom YBW are communicating about sexual health to better inform those interventions.

HIV Testing and Health Care Utilization Behaviors Among Men in the United States: A Latent Class Analysis.

Emphasis has been placed on HIV testing and health care engagement, but little is known about how testing and engagement intersect, especially for men. We used latent class analysis to explore underlying profiles of U.S. men regarding HIV testing and health care utilization using data from the 2014 National Health Interview Survey. Multinomial regression was used to predict class membership in four classes: (a) Low HIV Testing/No Health Care Utilization, (b) Some HIV Testing/Low Health Care Utilization, (c) No HIV Testing/Some Health Care Utilization, and (d) High HIV Testing/High Health Care Utilization. Most men were in the No HIV Testing/Some Health Care Utilization class (46%), with a 0% chance of ever having had an HIV test but an 89% chance of seeing a general practitioner in the previous year. Research should include qualitative measures to capture information on facilitators and barriers to HIV testing for men who see general practitioners.