Structural vulnerabilities and PrEP awareness among Boston heterosexuals and people who inject drugs at risk for HIV: findings from 2018 to 2019 cycles from the Boston, MA site of the NHBS.

Little is known about biopsychosocial factors relating to pre-exposure prophylaxis (PrEP) awareness among people with either heterosexual or injection drug use HIV risk behaviors. Participants engaged in vaginal/anal sex with a person of the opposite sex (N = 515) or were people who injected drugs (PWID; N = 451) in the past 12 months from 2018-2019 in Boston, MA. We examined associations between PrEP awareness and: homelessness; perceived HIV-related stigma; country of birth; bacterial STDs, chlamydia, and/or gonorrhea in the past 12 months, lifetime hepatitis C virus (HCV) infection, sexual orientation, and poverty. More PWID (36.8%) were aware of PrEP than people with heterosexual HIV risk (28%; p = .001). Among people with heterosexual risk, homelessness (aOR = 1.99, p = .003), and among PWID: homelessness (aOR = 2.11, p = .032); bacterial STD (aOR = 2.96, p = .012); chlamydia (aOR = 6.14, p = .008); and HCV (aOR = 2.40, p < .001) were associated with increased likelihood of PrEP awareness. In the combined sample: homelessness (aOR = 2.25, p < .001); HCV (aOR = 2.18, p < .001); identifying as homosexual (aOR = 3.71, p = .036); and bisexual (aOR = 1.55, p = .016) were each associated with PrEP awareness. Although having an STD, HCV, identifying as homosexual or bisexual, and experiencing homelessness were associated with increased PrEP awareness, most participants were unaware of PrEP. Efforts to increase PrEP awareness could engage PWID and heterosexual HIV risk behavior.

Grandparents' visitation rights and custody.

Grandparents have traditionally played a central role in the family kinship system. Today the altered patterns of marriage and parenting have had an impact on family structures, including intergenerational family relationships. Grandparent visitation statutes have been established in all 50 states to permit grandparents to seek court-ordered visitation with their grandchildren. Court-ordered visitation, over the objection of a custodial parent, is a controversial legal development that continues to be litigated. All states also have laws that authorize third-party custody, including grandparent custody, in certain circumstances. Grandparents are increasingly involved in third-party custody disputes with the parents of their grandchildren. These disputes most commonly involve grandparents who have already been raising their grandchildren for several years under an informal arrangement. These disputes may pit the child's and grandparents' interest in continuity and care against the parents' interest in family integrity. In other custody disputes grandparents are challenging the parents' fitness for custody. There are a number of different custodial relationships that can be created between grandparent and grandchild, including informal custody, foster care, guardianship, and adoption. In custody disputes between a grandparent and a parent, there may be a tension between awarding custody according to the parent's natural right and awarding custody according to the child's best interest.