Arranged cohabitation among Chinese Muslims.

While modern family-related ideas and behaviors have become more widely accepted in contemporary China, Chinese Muslim minorities continue to hold on to traditional religious practices. Surprisingly, data from our survey conducted in Gansu province in China's northwestern borderlands reveal that Muslims of the Hui and Dongxiang ethnicities reported much higher rates of cohabitation experience than the secular majority Han. Based on follow-up qualitative interviews, we found the answer to lie in the interplay between the highly interventionist Chinese state and the robust cultural resilience of local Islamic communities. While the state maintains a high minimum legal age of marriage, the early marriage norm remains strong in Chinese Muslim communities, where religion constitutes an alternative and often more powerful source of legitimacy-at least in the private sphere of life. Using the 2000 census data, we further show that women in almost all 10 Muslim ethnic groups have higher percentages of underage births and premarital births than Han women, both nationally and in the northwest where most Chinese Muslims live. As the once-outlawed behavior of cohabitation became more socially acceptable during the reform and opening-up era, young Muslim Chinese often found themselves in "arranged cohabitations" as de facto marriages formed at younger-than-legal ages. In doing so, Chinese Muslim communities have reinvented the meaning of cohabitation. Rather than liberal intimate relationship based on individual autonomy, cohabitation has served as a coping strategy by which Islamic patriarchs circumvent the Chinese state's aggressive regulations aimed at "modernizing" the Muslim family.

The prevalence and factors of willingness to accept circumcision among MSM in Maanshan City, China.

To investigate the prevalence of male circumcision and the willingness to undergo male circumcision and influencing factors among MSM in Maanshan City, we conducted a cross-sectional study from June 2016 to December 2019. Respondent-driven sampling (RDS) was used to recruit participants. Influential factors of willingness to accept circumcision were identified by a multivariable logistic regression model. The multivariable logistic regression model revealed that five variables were independent influential factors for willingness to participate. The factors include that used condoms during last anal intercourse (OR = 1.87, 95% CI:1.03-3.41, P = 0.04), sex with female sex partners (OR = 0.499, 95% CI:0.298-0.860, P = 0.012, level of education (junior college: OR = 0.413, 95% CI:0.200-0.854, P = 0.017; bachelor's degree or higher: OR = 0.442, 95% CI:0.208-0.938, P = 0.033), condom use during oral sex in the last six months (OR = 4.20, 95% CI:1.47-12.0, P = 0.007) and level of knowledge of PrEP (OR = 5.09, 95% CI:1.39-18.7, P = 0.014). Given the willingness of MSM to accept circumcision was low in China, establishing a proper understanding of circumcision is essential if it is to be used as a strategy to prevent HIV infection among MSM. Therefore, publicity and education on the operation should be strengthened to increase the willingness to undergo male circumcision.

Inclusion of a Parental Component in a Sports-Based HIV Prevention Program for Dominican Youth.

BACKGROUND: Underprivileged youth in the Dominican Republic (DR) are at high risk of acquiring the human immunodeficiency virus (HIV). Protective parenting practices may inhibit sexual risk-taking. OBJECTIVE: We investigated whether parental involvement in a sports-based HIV prevention program increased self-efficacy to prevent HIV and safe sex behavior among Dominican youth. METHOD: The study had a quasi-experimental design with repeated measures. N = 90 participants between 13 and 24 years of age participated in the program through two different trainings, UNICA and A Ganar, both of which had an experimental (i.e., program with parental component) and a control (i.e., program without parental component) condition. RESULTS: Self-efficacy to prevent HIV significantly increased among participants in the experimental condition of UNICA. Self-efficacy for safe sex increased among sexually active participants in the experimental condition of A Ganar. Implications for Impact: These findings are important to meet the United Nations' Sustainable Development Goal of good health and wellbeing, as they suggest that parental involvement in sports-based HIV prevention programs can enhance their positive effects for increasing youth's self-efficacy to practice HIV-preventive behaviors. Randomized control trials and longitudinal studies are needed.

Multilevel stigma and depression among a national sample of Black and Latinx LGBTQ+ adolescents in the United States.

Limited research has examined how multiple forms of oppression (e.g., racism, heterosexism, transphobia)-manifesting across multiple levels (e.g., interpersonal, structural)-can place Black and Latinx lesbian, gay, bisexual, transgender, queer, and other sexual/gender minority (LGBTQ+) adolescents at increased risk for internalizing psychopathology, including depression. Utilizing a national sample of 2,561 Black and Latinx LGBTQ+ adolescents (aged 13-17), we examined associations among depressive symptoms and several adolescent-focused manifestations of stigma, including: (a) interpersonal racial/ethnic bullying, (b) interpersonal sexual orientation bullying, (c) nine state-level forms of structural stigma or protection for LGBTQ+ adolescents, and (d) a new adolescent-focused composite index of state-level anti-LGBTQ+ structural stigma. Racial/ethnic bullying and sexual orientation bullying were found to be prevalent among the sample and were associated-both independently and jointly-with increased depressive symptoms. One harmful state-level anti-LGBTQ+ structural stigma indicator (i.e., anti-LGBTQ+ community attitudes) and seven protective state-level anti-LGBTQ+ structural stigma indicators (e.g., conversion therapy bans) were associated with odds of depressive symptoms, in the expected directions. Black and Latinx LGBTQ+ adolescents residing in states with greater overall anti-LGBTQ+ structural stigma reported increased depressive symptoms, even when adjusting for racial/ethnic and sexual orientation bullying. Additionally, Black and Latinx LGBTQ+ adolescents living in the most stigmatizing states demonstrated 32% increased odds of depressive symptoms, as compared to those living in the most LGBTQ+ affirming states. Multilevel, intersectional interventions could have optimal effects on the mental health and resilience of Black and Latinx LGBTQ+ adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Sexuality Among Young Danes Treated for Long-Lasting or Severe Physical Disease: Baseline Findings in a Nationwide Cohort Study.

PURPOSE: Sexual ramifications of physical disease are well-documented in adult populations, but are scarcely investigated among adolescents and young adults (AYA). This study compared measures of sexuality and sexual health among 8,696 15-year-old to 24-year-old Danes with and without a history of treatment for long-lasting or severe physical disease. METHODS: Using baseline data from Project SEXUS, a nationally representative cohort study on sexual health in the Danish population, differences in various domains of sexual behaviors and sexual health between AYA who have and AYA who have not been treated for long-lasting or severe physical disease were investigated. Logistic regression analyses yielded demographically weighted age-adjusted odds ratios (ORs) for associations between physical diseases and sexual outcomes. RESULTS: AYA treated for long-lasting or severe physical disease resembled their healthy peers on fundamental aspects of sexual interest, activity and satisfaction. However, significantly increased odds ratios of various sexual difficulties and dysfunctions, early sexual debut, high sex partner numbers, discontentment with body or genital appearance, gender nonconformity, nonheterosexuality, and exposure to sexual assaults were observed, overall or within specific disease categories. DISCUSSION: The overall similarity in sexual profiles between AYA treated for physical disease and healthy peers indicates that clinicians should routinely address questions related to sexuality and relationships when encountering AYA with chronic health conditions. Moreover, the observed excess of certain adversities, including sexual assaults, among physically ill AYA highlights the need for preventive measures and counseling services specifically targeted at AYA afflicted by physical disease.

Sexual Networks and STI Infection Among Young Black Men Who Have Sex With Women in a Southern U.S. City.

PURPOSE: The configuration of one's sexual network has been shown to influence sexually transmitted infection (STI) acquisition in some populations. Young Black men who have sex with women (MSW) have high rates of STIs, yet little is known about their sexual networks. The purpose of this study is to describe the characteristics of sexual networks and their association with selected STI infections among young Black MSW. METHODS: Black MSW aged 15-26 years who were enrolled in the New Orleans community-based screening program named Check It from March 2018 to March 2020 were tested for C. trachomatis and N. gonorrhoeae infection and asked about the nature of their sexual partnerships. Sexual partnerships with women were defined as dyadic, somewhat dense (either themselves or their partner had multiple partners), and dense (both they and their partner(s) had multiple partners). RESULTS: Men (n = 1,350) reported 2,291 sex partners. The percentage of men who reported their networks were dyadic, somewhat dense, and dense was 48.7%, 27.7%, and 23.3%, respectively; 11.2% were STI-positive and 39.2% thought their partner(s) had other partners. Compared to men in dyadic relationships, those in somewhat dense network did not have increased risk of STI infection, but those in dense networks were more likely to have an STI (adjusted odds ratio = 2.06, 95% confidence interval [1.35-3.13]). DISCUSSION: Young Black MSW, who had multiple partners and who thought their partner(s) had other sex partners were at highest risk for STIs. Providers should probe not only about the youth's personal risk but should probe about perceived sexual partners' risk for more targeted counseling/STI testing.

Serious Mental Illness and Sexual Offending in Forensic Psychiatric Patients.

The role of serious mental illness among those who sexually offend is not well understood. We investigated clinical and risk-related areas of difference between male forensic psychiatric patients with (n = 86) and without (n = 245) a sexual offense history, including the age at which indications of mental disorder and criminal offending first emerged, from a registry of Ontario patients adjudicated Not Criminally Responsible on account of Mental Disorder (NCRMD) from 1999-2012. We further explored motivations for offending among a subset of patients deemed NCRMD for a sexual offense specifically (n = 41). While no differences were found in the age onset of illness or offending across those with and without a sexual offending history, the former group was rated as having higher levels of historical/static risk for violence. Forensic patients with a sexual offense history were also more likely to offend against a stranger, and less likely to offend against a family member. Sexual index offenses were psychotically-motivated in the majority of cases, but with a meaningful proportion appearing to reflect criminogenic motivations, especially substance use and paraphilic interests. Results suggest greater similarity than difference among forensic patients with and without a sexual offense history, but also highlight an important divergence from the literature showing that victims of sexual offenses are frequently known to the individual committing them.

Comportamiento sexual de pacientes con infección por VIH según grupos de edad / Sexual behavior among patients with HIV according to age groups

Nuestro objetivo fue determinar la prevalencia y conductas de riesgo por grupos de edad entre pacientes con infección por VIH. Se realizó un estudio observacional analítico transversal de pacientes que acuden al servicio de Enfermedades Infecciosas a recibir tratamiento antirretroviral. Resultados: De 117 personas que ingresaron al estudio, se observó que el grupo etario de los jóvenes varones con infección por VIH señalaron una orientación homosexual (HSH) en 64,5% y una mayor tasa de haber sufrido abuso sexual (29%) respecto al resto. En adultos el uso de métodos anticonceptivos es 71,4% y superior al resto de grupos de edad, la concurrencia a lugares de riesgo (visita a trabajadoras sexuales de la calle) se encuentra mayoritariamente en el rango de 45 a 90 años. El rol homosexual activo de los hombres con VIH representa 66,7%. Los hallazgos enfatizan la necesidad de realizar más estudios que profundicen el tema del abuso sexual en adolescentes y adultos jóvenes, debido a la alta prevalencia encontrada en este estudio(AU)

Our objective was to determine the prevalence and risk behaviors by age groups in patients with HIV infection. A cross-sectional analytical observational study of patients attending the Infectious Diseases service to receive antiretroviral treatment was carried out.Results: Out of 117 people who entered the study, it was observed that the age group of young men with HIV infection indicated a homosexual orientation (MSM) 64.5%; and a higher rate of having suffered sexual abuse (29%) in comparison to the others. In adults, the use of contraceptive methods is 71.4%, and higher than the rest of the age groups, attendance at places of risk (visits to street sex workers) is mostly in the range of 45 to 90 years. The active homosexual role of men with HIV represents 66.7%. The findings emphasize the need for more studies that delve into the issue of sexual abuse in adolescents and young adults, due to the high prevalence found in this study(AU)

Conocimiento y conductas sexuales de las mujeres gestantes / Knowledge and sexual behaviors of pregnant women / Conhecimento e comportamentos sexuais de mulheres grávidas

Introducción: escasos son los estudios que investigan el conocimiento sexual y las conductas sexuales de las mujeres dentro de un periodo tan importante como lo es el embarazo. En esta etapa se producen una serie de cambios que repercuten en su vida y por lo tanto en su sexualidad, por tal motivo es que surge realizar este trabajo de investigación. Objetivo: evaluar el nivel de conocimiento y conducta sexual durante la gestación, en un grupo de gestantes que acuden al Centro de Atención Periférica Número 8 perteneciente a la Dirección General de Atención Periférica de la Dirección Nacional de Sanidad de la Fuerzas Armadas. Materiales y métodos: se realizó un análisis observacional, descriptivo y prospectivo de cohorte transversal de los datos obtenidos a través de entrevistas realizadas a embarazadas. Se entrevistan gestantes que cursan los tres trimestres de embarazo y concurren a sus controles obstétricos en el periodo comprendido entre el 22 de abril y 22 de julio de 2021 que cumplen con los criterios de inclusión y exclusión. Para alcanzar el objetivo se aplicó un cuestionario con respuestas cerradas que consta de 11 preguntas basadas en conocimientos y conductas sexuales en gestantes. Resultados: el 52% de nuestras pacientes gestantes encuestadas tienen más de 30 años, 52% cursa su primera gestación y 51% un embarazo no deseado, pero si aceptado. El 61% de ellas dicen que el estar embarazadas afectó su actividad sexual, 39% refiere que son más satisfactorias las relaciones sexuales en el segundo trimestre, 78% manifiesta que el mantener relaciones sexuales no adelanta el parto, el 83% expresa que la posición menos recomendada es boca arriba, el 9% no saben dónde se localiza el tapón mucoso y el 100% de las encuestadas no tuvo educación sobre sexualidad en los controles prenatales. Conclusiones: durante el embarazo se producen cambios anatómicos, psicológicos y emocionales que provocan cambios en la actividad sexual. La educación que tienen sobre sexualidad es nula por lo que es recomendable la implementación de programas formativos de educación sexual en gestantes y sus parejas para afrontar una salud sexual plena.

Introduction: there are few studies that investigate the sexual knowledge and sexual behaviors of women in such an important period as pregnancy. During this stage, a series of changes take place that have repercussions in their lives and therefore in their sexuality, which is the reason why this research work has been carried out. Objective: to evaluate the level of knowledge and sexual behavior during pregnancy in a group of pregnant women attending the Peripheral Care Center Number 8 belonging to the General Directorate of Peripheral Care of the National Health Directorate of the Armed Forces. Materials and methods: an observational, descriptive and prospective cross-sectional cohort analysis of the data obtained through interviews with pregnant women was carried out. Pregnant women in the three trimesters of pregnancy and attending their obstetric check-ups between April 22 and July 22, 2021 who met the inclusion and exclusion criteria were interviewed. To achieve the objective, a questionnaire with closed answers consisting of 11 questions based on knowledge and sexual behaviors in pregnant women was applied. Results: 52% of our pregnant patients surveyed were over 30 years of age, 52% were in their first pregnancy and 51% had an unwanted pregnancy, but accepted it. 61% of them said that the pregnancy was unwanted. Sixty-one percent of them say that being pregnant affected their sexual activity, 39% say that sexual relations are more satisfactory in the second trimester, 78% say that having sexual relations does not advance labor, 83% say that the least recommended position is on the back, 9% do not know where the mucus plug is located and 100% of the respondents had no education on sexuality in prenatal checkups. Conclusions: During pregnancy there are anatomical, psychological and emotional changes that cause changes in sexual activity. The education they have about sexuality is null, so it is advisable to implement sex education programs for pregnant women and their partners in order to achieve full sexual health.

Introdução: há poucos estudos que investiguem o conhecimento sexual e o comportamento sexual das mulheres durante um período tão importante como a gravidez. Nesta fase, ocorre uma série de mudanças que têm repercussões em suas vidas e, portanto, em sua sexualidade, razão pela qual este estudo de pesquisa foi realizado. Objetivo: avaliar o nível de conhecimento e comportamento sexual durante a gravidez em um grupo de mulheres grávidas que freqüentam o Centro de Atenção Periférica Número 8 pertencente à Direção Geral de Atenção Periférica da Direção Nacional de Saúde das Forças Armadas. Materiais e métodos: foi realizada uma análise observacional, descritiva e prospectiva de coorte transversal dos dados obtidos através de entrevistas com mulheres grávidas. Foram entrevistadas mulheres grávidas no terceiro trimestre de gestação e que compareceram aos check-ups obstétricos entre 22 de abril e 22 de julho de 2021, que preenchiam os critérios de inclusão e exclusão. Para alcançar o objetivo, foi aplicado um questionário com respostas fechadas que consiste em 11 perguntas baseadas em conhecimentos e comportamentos sexuais em mulheres grávidas. Resultados: 52% de nossas pacientes grávidas pesquisadas tinham mais de 30 anos de idade, 52% estavam grávidas pela primeira vez e 51% tiveram uma gravidez indesejada, mas aceitaram-na. 61% deles dizem que estar grávida afetou sua atividade sexual, 39% dizem que as relações sexuais são mais satisfatórias no segundo trimestre, 78% dizem que ter relações sexuais não antecipa o trabalho de parto, 83% dizem que a posição menos recomendada é na parte de trás, 9% não sabem onde o plugue de muco está localizado e 100% dos entrevistados não tiveram nenhuma educação sobre sexualidade nos check-ups pré-natais.

Sexualidade de adolescentes na unidade socioeducativa de internação: pulsões e interseções / Sexuality of adolescents in a socio-educational inpatient unit: drives and intersections / Sexualidad de adolescentes en una unidad de internación socioeducativa: impulsos e intersecciones

O artigo integra uma investigação documental em prontuários de adolescentes que cumprem medida socioeducativa de internação. Tem como objetivo explorar dados referentes à sexualidade e práticas sexuais, em interlocução com a interseccionalidade e a teoria das pulsões em Freud. As informações disponíveis nos prontuários indicam que a vida sexual ativa faz parte da realidade de muitos dos adolescentes. No entanto, oportunidades para abordar a sexualidade em sentido ampliado, que levem em conta as relações interseccionais de poder, parecem ser perdidas no cotidiano de uma unidade de internação. Ao restringir o corpo com a privação da liberdade de ir e vir, o sistema socioeducativo impacta o exercício da sexualidade de modo entrelaçado aos marcadores de gênero, classe e raça dos sujeitos adolescentes. (AU)

The article is part of a documentary investigation in medical records of adolescents who are serving a socio-educational measure of detention. It aims to explore data related to sexuality and sexual practices, in dialogue with intersectionality and the theory of drives in Freud. The information available in the medical records indicates that an active sexual life is part of the reality of many adolescents. However, opportunities to approach sexuality in a broader sense, which take into account intersectional power relations, seem to be lost in the daily life of a detention unit. By restricting the body by depriving the freedom to come and go, the socio-educational systemimpacts the exercise of sexuality in an intertwined way with the adolescent subjects' gender, class and race markers.(AU)

El artículo es parte de una investigacióndocumental en historias clínicas de adolescentes que se encuentran cumpliendo una medida socioeducativa de detención. Tiene como objetivo explorar datos relacionados con la sexualidad y las prácticas sexuales, en diálogo con la interseccionalidad y la teoría de los impulsos en Freud. La información disponible en las historias clínicas indica que una vida sexual activa es parte de la realidad de muchos adolescentes. Sin embargo, las oportunidades para abordar la sexualidad en un sentido más amplio, que toman en cuenta las relaciones de poder interseccionales, parecen perderse en la vida diaria de una unidad de detención. Al restringir el cuerpo al privar de la libertad de ir y venir, el sistema socioeducativo impacta el ejercicio de la sexualidad de manera entrelazada con los marcadores de género, clase y raza de los sujetos adolescentes. (AU)

COVID-19 Vaccination Coverage and Vaccine Confidence by Sexual Orientation and Gender Identity - United States, August 29-October 30, 2021.

Lesbian, gay, bisexual, and transgender (LGBT) populations have higher prevalences of health conditions associated with severe COVID-19 illness compared with non-LGBT populations (1). The potential for low vaccine confidence and coverage among LGBT populations is of concern because these persons historically experience challenges accessing, trusting, and receiving health care services (2). Data on COVID-19 vaccination among LGBT persons are limited, in part because of the lack of routine data collection on sexual orientation and gender identity at the national and state levels. During August 29-October 30, 2021, data from the National Immunization Survey Adult COVID Module (NIS-ACM) were analyzed to assess COVID-19 vaccination coverage and confidence in COVID-19 vaccines among LGBT adults aged ≥18 years. By sexual orientation, gay or lesbian adults reported higher vaccination coverage overall (85.4%) than did heterosexual adults (76.3%). By race/ethnicity, adult gay or lesbian non-Hispanic White men (94.1%) and women (88.5%), and Hispanic men (82.5%) reported higher vaccination coverage than that reported by non-Hispanic White heterosexual men (74.2%) and women (78. 6%). Among non-Hispanic Black adults, vaccination coverage was lower among gay or lesbian women (57.9%) and bisexual women (62.1%) than among heterosexual women (75.6%). Vaccination coverage was lowest among non-Hispanic Black LGBT persons across all categories of sexual orientation and gender identity. Among gay or lesbian adults and bisexual adults, vaccination coverage was lower among women (80.5% and 74.2%, respectively) than among men (88.9% and 81.7%, respectively). By gender identity, similar percentages of adults who identified as transgender or nonbinary and those who did not identify as transgender or nonbinary were vaccinated. Gay or lesbian adults and bisexual adults were more confident than were heterosexual adults in COVID-19 vaccine safety and protection; transgender or nonbinary adults were more confident in COVID-19 vaccine protection, but not safety, than were adults who did not identify as transgender or nonbinary. To prevent serious illness and death, it is important that all persons in the United States, including those in the LGBT community, stay up to date with recommended COVID-19 vaccinations.

Predictors of HIV testing among youth aged 15-24 years in The Gambia.

BACKGROUND: Worldwide, an estimated 38.0 million people lived with the human immunodeficiency virus in 2019, and 3.4 million young people aged 15~24 years were living with HIV. Sub-Saharan Africa carries a significant HIV burden with West and Central Africa most affected with HIV. Among the young people living with HIV in West and Central Africa, an estimated 810,000 were aged 15~24 years. This study aimed to assess predictors that influence the uptake of HIV testing among youth aged 15~24 years in The Gambia. METHODS: The 2013 Gambia Demographic and Health Survey data for youth aged 15~24 years was used. The Andersen behavioral model of health service use guided this study. A cross-sectional study design was used on 6194 subjects, among which 4730 were female. The analysis employed Chi-squared tests and hierarchical logistic regression. RESULTS: Less than one-quarter of the youth 1404 (22.6%) had ever been tested for HIV. Young people aged 20~24 years (adjusted odds ratio (aOR): 1.98), who were females (aOR: 1.13), married youth (aOR: 3.89), with a primary (aOR: 1.23), secondary or higher education (aOR: 1.46), and who were from the Jola/Karoninka ethnic group (aOR: 1.81), had higher odds of having been tested for HIV. Those with adequate HIV knowledge and those who were sexually active and had aged at first sex ≥15 years (aOR: 3.99) and those <15 years (aOR: 3.96) were more likely to have been tested for HIV compared to those who never had sex. CONCLUSION: This study underscores the low level of model testing on HIV testing among youth (15~24 years) in The Gambia. Using Anderson's Model of Health Service Utilization, the predisposing factors (socio-demographic and HIV knowledge) and the need-for-care factors (sexual risk behaviors) predict healthcare utilization services (HIV testing) in our study; however, only socio-demographic model explained most of the variance in HIV testing. The low effect of model testing could be related to the limited number of major variables selected for HIV knowledge and sexual risk behavior models. Thus, consideration for more variables is required for future studies.

The Prevalence of Sexual Grooming Behaviors in a Large Sample of Clergy.

Following the exposure of child sexual abuse (CSA) within the U.S. Catholic Church, it was postulated that many of these cases went unreported because sexual grooming was involved. The present study examined the prevalence of sexual grooming behaviors of clergy through the lens of the content-validated Sexual Grooming Model (SGM). The study used archival data from a victim survey of 10,667 cases of alleged CSA within the U.S. Catholic Church. Results revealed the accused clergy frequently used tactics in the gaining access and isolation, trust development, and desensitization stages of the SGM. From the limited data available for the victim selection and post-abuse maintenance stages, the findings showed these tactics were relatively less common. Overall, clergy who were alleged to have committed CSA used tactics consistent with sexual grooming in general, although there were unique aspects of sexual grooming given their institutional role and position.

Cross-sectional study of mental health and sexual behaviours for Ebola Survivors in Beni, Butembo and Katwa health zones of the Democratic Republic of Congo.

OBJECTIVES: To understand the prevalence of mental health disorders in Ebola-affected communities and their association with condom use. DESIGN: Cross-sectional study. SETTING: Beni, Butembo and Katwa health zones, Democratic Republic of Congo (DRC). PARTICIPANTS: 223 adult Ebola survivors, 102 sexual partners and 74 comparison respondents. PRIMARY AND SECONDARY OUTCOME MEASURES: Post-traumatic stress disorder (PTSD), depression, anxiety, substance use, suicidal ideation and attempts, stigma, condom use and sexual behaviour. RESULTS: Most respondents reported to be married, Christian, from the Nande ethnic group, and farmers/herders. Survivors met symptom criteria for depression at higher rates than partners (23.5% (95% CI 18.0 to 29.1) vs 5.7 (1.2 to 10.1); p<0.001). PTSD symptom criteria for survivors (24.1%, 95% CI 18.5% to 29.7%) and partners (16.7%, 95% CI 9.4% to 23.9%) were four times greater than the comparison participants (6.0%, 95% CI 0.6% to 11.4%). Two times as many survivors as partners reported that sexual activity precautions were discussed at discharge (71.5% (95% CI 65.6 to 77.5) vs 36.2% (95% CI 26.9 to 45.5); p<0.001). The majority of survivors (95.0 (95% CI 85.1% to 98.5%) and partners 98.5% (95% CI 89.6% to 99.8%; p=0.26) participated in risky sexual behaviour after the survivor left the Ebola treatment centre. The ability to refuse sex or insist on condom use before Ebola had a threefold increase in the odds of condom use (adjusted OR 3.3, 95% CI 1.7 to 6.1, p<0.001). Up to 36% of the comparison group held discriminatory views of survivors. CONCLUSIONS: The new outbreaks in both Guinea and DRC show Ebola remains in semen longer than previously known. Understanding and addressing condom non-use and updating condom use guidelines are necessary to protect against future Ebola outbreaks, especially among sexual partners who did not have similar access to health information regarding sexual transmission of Ebola. Mental health treatment and decreasing stigma in Ebola areas is a priority.

"They are Assuming That We are Going to Accuse Them of Rape, and We are Assuming That They are Going to Rape us": A Developmental Perspective on Emerging Adults' Consent Conversations Post #MeToo.

Prevalence of sexual assault remains high on American college campuses, and sexual consent education is lacking within school-based sexual health education programming. Much empirical research has aimed to reduce sexual violence through a deeper understanding of college students' perceptions of sexual consent. However, researchers have not yet examined the impact of broader social discourse, such as that initiated by the #MeToo movement, on emerging adults' conceptualizations of sexual consent. Gendered focus groups were conducted with 34 college students at a large midwestern university in spring of 2019. Qualitative analyses using a phenomenological framework revealed a developmental process of consent education shaped by socialized sexual scripts and public discourse of the #MeToo movement. Four distinct themes emerged: (1) Introductions to Consent in Childhood, (2) Lack of Sexual Consent Education in Adolescence, (3) The Nuanced College Context, and (4) Consent in the Era of #MeToo. Findings reveal that consent is introduced in childhood, outside the context of sexuality, but is generally not revisited within the context of sexual consent by parents or educators during adolescence, leaving media messaging and socialized sexual scripts to serve as guides for sexual consent. This lack of sexual consent education in adolescence then leaves emerging adults unprepared for nuanced sexual experiences in the college context and unable to critically engage with public discourse surrounding consent such as the #MeToo movement, which has caused both fearful and positive outcomes. Findings support the need for earlier and more comprehensive education about sexual consent in childhood and adolescence and the need for college sexual assault prevention programs to include further instruction on navigating ambiguous sexual consent experiences.

Refusal Rates to Sexual Orientation and Gender Identity Items in the Behavioral Risk Factor Surveillance System, 2014-2019.

Objectives. To explore trends in sexual orientation and gender identity (SOGI) item refusal in the Behavioral Risk Factor Surveillance System (BRFSS). Methods. We used annual data from 7 US states that implemented the SOGI module of the BRFSS from 2014 to 2019 to examine prevalence of sexual orientation (n = 373 332) and gender identity (n = 373 336) item refusal. Analyses included the weighted Wald χ2 test of association between refusal and year and logistic regressions predicting refusal by year. We weighted analyses to account for complex sampling design. Results. We found low SOGI item refusal rates, significant declines in these refusal rates over time, and differences in refusal rates by age, sex, race, education, and language. We also found that Hispanic group membership did not explain SOGI item refusal when accounting for interview language; interview language was strongly associated with both sexual orientation and gender identity item refusal. Conclusions. Our results indicate acceptance of SOGI measurement and empirically support continuation of SOGI in health surveillance surveys. Findings indicate a need to further investigate the association between survey translation and item refusal.

Sexual Victimization, Self-Efficacy to Refuse Sex While Drinking, and Regretting Alcohol-Involved Sex among Underserved Youth in Kampala, Uganda.

The purposes of this study were to determine whether youth who have experienced sexual victimization (SV) have lower self-efficacy to refuse sex and to identify intervention strategies for rape survivors to mitigate further health-risks and harm. Cross-sectional data from the 2014 Kampala Youth Survey (n = 1134) of youth aged 12 to 18 years recruited from Uganda Youth Development Link drop-in centers were used to conduct the analyses. Multivariable statistics were computed to determine the correlates (i.e., sex, education, homelessness, problem drinking, and SV) for (1) self-efficacy to refuse sex, (2) self-efficacy to refuse sex while drinking, and (3) regretting sex due to alcohol use. Among participants, 16.9% reported SV (79% were female and 21% were male). In the final adjusted model, self-efficacy to refuse sex while drinking was only associated with homelessness (OR: 0.52; 95% CI: 0.36, 0.74). Previous SV was not associated with lower self-reports of self-efficacy to refuse sex compared to those who had not experienced SV. Additionally, SV was not associated with increased reports of regrets for sex attributed to alcohol use. Alcohol prevention strategies for the most at-risk youth, including homeless youth, are warranted to improve self-efficacy to refuse sex among youth living in the slums of Kampala.

Development and validation of a data quality index for forensic documentation of sexual and gender-based violence in Kenya.

INTRODUCTION: High-quality forensic documentation can improve justice outcomes for survivors of sexual and gender-based violence, but there are limited tools to assess documentation data quality. This study aimed to develop and validate a data quality assessment index to objectively assess clinician documentation across the 26 key elements of the standardized forensic evidence forms used in Kenya. METHODS: Informed by prior quality assessment tools, an initial draft of the index was developed. Feedback from Kenya- and U.S.-based clinicians and human rights experts was solicited and incorporated into the draft index in an iterative fashion. Two raters independently employed the finalized Physicians for Human Rights Data Quality Index to assess and score the quality of documentation across 31 clinician-completed forms. Inter-rater reliability was determined using Cohen kappa (к) coefficients. RESULTS: The Index was found to have substantial overall reliability. Of the 26 documentation items, the Index had a perfect (к = 1.0) and almost perfect (к = 0.81-0.99) level of inter-rater agreement across 17 (65.4%) and 5 (19.2%) items, respectively. On a low-to-high documentation quality scale of 0 to 2, the majority of items (n = 19, 73.1%) had a mean documentation quality score >1.5-2. CONCLUSION: Quality assurance of forensic documentation is an essential component of post-sexual assault care. To our knowledge, this is the first validated quality-assessment tool in the peer-reviewed literature for sexual assault documentation and may be a promising strategy to enhance the quality of sexual assault documentation in other settings, locally, regionally, and internationally.

Assessment of US Preventive Services Task Force Guideline-Concordant Cervical Cancer Screening Rates and Reasons for Underscreening by Age, Race and Ethnicity, Sexual Orientation, Rurality, and Insurance, 2005 to 2019.

Importance: Cervical cancer screening rates are suboptimal in the US. Population-based assessment of reasons for not receiving screening is needed, particularly among women from historically underserved demographic groups. Objective: To estimate changes in US Preventive Service Task Force guideline-concordant cervical cancer screening over time and assess the reasons women do not receive up-to-date screening by sociodemographic factors. Design, Setting, and Participants: This pooled population-based cross-sectional study used data from the US National Health Interview Survey from 2005 and 2019. A total of 20 557 women (weighted, 113.1 million women) aged 21 to 65 years without previous hysterectomy were included. Analyses were conducted from March 30 to August 19, 2021. Exposures: Sociodemographic factors, including age, race and ethnicity, sexual orientation, rurality of residence, and health insurance type. Main Outcomes and Measures: Primary outcomes were US Preventive Services Task Force guideline-concordant cervical cancer screening rates and self-reported primary reasons for not receiving up-to-date screening. For 2005, up-to-date screening was defined as screening every 3 years for women aged 21 to 65 years. For 2019, up-to-date screening was defined as screening every 3 years with a Papanicolaou test alone for women aged 21 to 29 years and screening every 3 years with a Papanicolaou test alone or every 5 years with high-risk human papillomavirus testing or cotesting for women aged 30 to 65 years. Population estimation included sampling weights. Results: Among 20 557 women (weighted, 113.1 million women) included in the study, most were aged 30 to 65 years (16 219 women; weighted, 86.3 million women [76.3%]) and had private insurance (13 571 women; weighted, 75.8 million women [67.0%]). With regard to race and ethnicity, 997 women (weighted, 6.9 million women [6.1%]) were Asian, 3821 women (weighted, 19.5 million women [17.2%]) were Hispanic, 2862 women (weighted, 14.8 million women [13.1%]) were non-Hispanic Black, 12 423 women (weighted, 69.0 million women [61.0%]) were non-Hispanic White, and 453 women (weighted, 3.0 million women [2.7%]) were of other races and/or ethnicities (including Alaska Native and American Indian [weighted, 955 000 women (0.8%)] and other single and multiple races or ethnicities [weighted, 2.0 million women (1.8%)]). In 2019, women aged 21 to 29 years had a significantly higher rate of overdue screening (29.1%) vs women aged 30 to 65 years (21.1%; P < .001). In both age groups, the proportion of women without up-to-date screening increased significantly from 2005 to 2019 (from 14.4% to 23.0%; P < .001). Significantly higher rates of overdue screening were found among those of Asian vs non-Hispanic White race and ethnicity (31.4% vs 20.1%; P = .01), those identifying as LGBQ+ (gender identity was not assessed because of a small sample) vs heterosexual (32.0% vs 22.2%; P < .001), those living in rural vs urban areas (26.2% vs 22.6%; P = .04), and those without insurance vs those with private insurance (41.7% vs 18.1%; P < .001). The most common reason for not receiving timely screening across all groups was lack of knowledge, ranging from 47.2% of women identifying as LGBQ+ to 64.4% of women with Hispanic ethnicity. Previous receipt of a human papillomavirus vaccine was not a primary reason for not having up-to-date screening (<1% of responses). From 2005 to 2019, among women aged 30 to 65 years, lack of access decreased significantly as a primary reason for not receiving screening (from 21.8% to 9.7%), whereas lack of knowledge (from 45.2% to 54.8%) and not receiving recommendations from health care professionals (from 5.9% to 12.0%) increased significantly. Conclusions and Relevance: This cross-sectional study found that cervical cancer screening that was concordant with US Preventive Services Task Force guidelines decreased in the US between 2005 and 2019, with lack of knowledge reported as the biggest barrier to receiving timely screening. Campaigns addressing patient knowledge and provider communication may help to improve screening rates, and cultural adaptation of interventions is needed to reduce existing disparities.