Factors associated with HPV-associated sexual risk behaviors among sexually active college students.

High-risk sexual behavior is the primary risk factor for the acquisition and persistence of human papillomavirus (HPV) infection and the development of HPV-associated diseases including cancer. Incidence of HPV infection is high among individuals in their late teens and early 20s. Thus, college students represent a historically high-risk group for HPV infection yet are also a group with the ability to independently access HPV vaccination for HPV prevention. To inform future interventions, we examined factors associated with HPV-associated risky sexual behaviors among sexually active college students. Data (N = 741) were from an anonymous online survey distributed to students at a public Midwestern university in 2021. The outcomes were HPV-associated sexual risk behaviors-number of oral or vaginal sexual partners [high (≥ 5) or low (< 5)] and age of oral or vaginal sexual debut [early (< 18 years) or late (≥ 18 years)]. Multivariable logistic regression models estimated the association between HPV-associated risky sexual behaviors and several predictors including age, gender, relationship status, academic level, country of birth, and rural-urban status. Among sexually active students, approximately 47% and 41% had a high number of lifetime vaginal and oral partners, respectively. Among the same group, 60% and 64% had early vaginal and oral sexual debut. Students who were single and dating (aOR = 1.93; 95% CI = 1.21, 3.08) or single and not dating (2.11; 1.28, 3.48) were more likely to have a high number of vaginal lifetime partners compared with married students. Single (vs. married) students were also about twice as likely to have a high number of oral lifetime partners. Relative to graduate students, freshmen/sophomores were more likely to have an early vaginal (2.44; 1.45, 4.11) and oral (2.14; 1.26, 3.63) sexual debut. Interventions tailored to college freshmen/sophomores and unmarried students should encourage students to receive the HPV vaccine for prevention of future HPV-associated diseases.

Risky Sexual Behaviour and Sexual Victimization among Young People with Risky Substance Use in Europe-Perspectives from Belgium, Sweden, the Czech Republic, and Germany.

BACKGROUND: Research indicates that among the risks associated with young people's alcohol and illicit drug use are sexual risks. However, insights into co-occurrence of substance use and sexual risks in adolescent samples and possible differences across countries are limited. METHODS: A sample of 1449 adolescents from Belgium, Sweden, the Czech Republic, and Germany screened positive for risky alcohol/illicit drug use in a web-based intervention against alcohol and illicit drug use. They also reported incidents of sex while being drunk and/or high on drugs, condomless sex on these occasions, and sexualized touching and sexual victimization while being drunk or high on drugs. RESULTS: In the sample, 21.5% of the participants reported sexualized touching, 9.9% being victim to sexual assault, and 49.8% having had sex while being drunk and/or high on drugs; of the latter, 48.3% had condomless sex. Reports on having had sex while being drunk and/or high on drugs were associated with higher levels of past 30-day binge drinking. Being a victim of sexual assault was associated with past 30-day binge drinking only in young men. CONCLUSION: When devising preventive interventions against risky substance use in adolescents, an additional focus should be set on integrating steps against sexual risks.

Investigating pathways for predisposing, enabling and need factors in predicting the use of STI/HIV-testing services among Syrian and Iraqi migrants in Scania, Sweden - a cross-sectional study with directed acyclic graphs for modelling pathways to testing.

BACKGROUND: Some groups of migrants have increased vulnerability to Sexually Transmitted Infections (STI) and Human Immunodeficiency Virus (HIV) transmission partly due to a lower uptake of disease preventive activities targeting the general population in receiving country. Limited access to economic and social resources and poor language skills may exacerbate exposure to sexual risks and utilization of health services. AIM: To explore general and migrant specific predictors for STI/HIV-testing among Syrian and Iraqi migrants in Sweden and to investigate potential pathways that link predisposing, enabling and need- factors to STI/HIV-testing. METHOD: Cross-sectional study design based on a migration specific framework for health care utilization. Directed acyclic graphs (DAGs) were used to model assumptions about factors associated with the uptake of STI/HIV-testing services. Bi-variable and multivariable logistic regression analyses assessed individual predictors while adjusting for covariates. The magnitude of the indirect effect of mediating variables were estimated with bootstrap analyses and a method for decomposing the total effect. RESULT: The pathways between younger age, unmarried, and self-identifying as bi- or homosexual and testing were mainly indirect, mediated by experiences of sexual coercion and other risk behaviours. One third of the indirect mediating effect of the pathway between higher education and testing could be attributed to Swedish language skills. CONCLUSION: Utilization of STI/HIV-testing services among Syrian and Iraqi migrants seemed to be motivated by sexual risk exposure and risk awareness. Interventions should focus on language-adapted information about available screening services and where to go for advice on sexual wellbeing and sexual rights. Such activities should be implemented within an integration promoting framework, addressing structures that increase STI/HIV risk exposure, specifically targeting vulnerable subgroups of migrants.

Prevalence and Correlates of Active Amphetamine-Type Stimulant Use Among Female Sex Workers in Malaysia.

The use of amphetamine-type stimulants (ATS) has been associated with increased sexual risk behaviors and HIV transmission, among other adverse health outcomes. However, ATS use among female sex workers (FSWs) in Malaysia has not yet been characterized. We examined the prevalence and correlates associated with ATS use among Malaysian FSW. Between February and December 2016, 492 FSWs, including cisgender (n = 299) and transgender (n = 193) women, were recruited using respondent-driven sampling in Greater Kuala Lumpur, Malaysia. A structured questionnaire was used to collect demographic characteristics, sexual behaviors, ATS and other substance use, behavioral health issues, involvement in criminal justice, and experience of physical and sexual trauma. Logistic regression analyses were conducted to determine factors associated with active ATS use, defined as ATS use in the last 30 days. Nearly one-third (32.3%) of participants reported active ATS use. In the multivariable model, ATS use was associated with drug use during sex work (aOR = 17.10; 8.32-35.15), having moderate to severe level of substance use disorder (aOR = 3.38; 1.48-7.70), and engaging in sex work with multiple clients per day (two clients: aOR = 3.39; 1.36-8.46; three clients: aOR = 5.06; 1.81-14.10). A high prevalence of ATS use was documented in our sample. The presence of moderate to severe substance use disorder, the use of drugs during sex work activity, and having multiple sex work clients per day were significantly associated with active ATS use. Given these findings, prevention and harm reduction strategies need to be tailored to address the increasing ATS use and the associated adverse health consequences among FSWs in Malaysia.

Correlates of Engagement Within an Online HIV Prevention Intervention for Single Young Men Who Have Sex With Men: Randomized Controlled Trial.

BACKGROUND: Digital HIV interventions (DHI) have been efficacious in reducing sexual risk behaviors among sexual minority populations, yet challenges in promoting and sustaining users' engagement in DHI persist. Understanding the correlates of DHI engagement and their impact on HIV-related outcomes remains a priority. This study used data from a DHI (myDEx) designed to promote HIV prevention behaviors among single young men who have sex with men (YMSM; ages 18-24 years) seeking partners online. OBJECTIVE: The goal of this study is to conduct a secondary analysis of the myDex project data to examine whether YMSM's online behaviors (eg, online partner-seeking behaviors and motivations) are linked to participants' engagement (ie, the number of log-ins and the number of sessions viewed). METHODS: We recruited 180 YMSM who were randomized into either myDEx arm or attention-control arm using a stratified 2:1 block randomization. In the myDEx arm, we had 120 YMSM who had access to the 6-session intervention content over a 3-month period. We used Poisson regressions to assess the association between YMSM's baseline characteristics on their DHI engagement. We then examined the association between the participants' engagement and their self-reported changes in HIV-related outcomes at the 3-month follow-up. RESULTS: The mean number of log-ins was 5.44 (range 2-14), and the number of sessions viewed was 6.93 (range 0-22) across the 3-month trial period. In multivariable models, the number of log-ins was positively associated with high education attainment (estimated Poisson regression coefficient [ß]=.22; P=.045). The number of sessions viewed was associated with several baseline characteristics, including the greater number of sessions viewed among non-Hispanic YMSM (ß=.27; P=.002), higher education attainment (ß=.22; P=.003), higher perceived usefulness of online dating for hookups (ß=.13; P=.002) and perceived loneliness (ß=.06; P=.004), as well as lower experienced online discrimination (ß=-.01; P=.007) and limerence (ß=-.02; P=.004). The number of sessions viewed was negatively associated with changes in internalized homophobia (ß=-.06; P<.001) and with changes in perceived usefulness of online dating for hookups (ß=-.20; P<.001). There were no significant associations between the number of log-ins and changes in the participants' behaviors at the 90-day follow-up. CONCLUSIONS: DHI engagement is linked to participants' sociodemographic and online behaviors. Given the importance of intervention engagement in the intervention's effectiveness, DHIs with personalized intervention components that consider the individuals' differences could increase the overall engagement and efficacy of DHIs. TRIAL REGISTRATION: ClinicalTrials.gov NCT02842060; https://clinicaltrials.gov/ct2/show/NCT02842060.

Lifestyles, sexuality and gender: vulnerability to STIs and unplanned pregnancy among female migrant beer promoters in Lao PDR.

In Southeast Asia, many young rural female migrants supplement their income by working as beer promoters. This study examined how young, female beer promoters working in Vientiane Capital, Lao PDR, navigate intimate relations and sexual encounters and how their experiences create sexual vulnerabilities. A total of 30 female beer promoters aged 18-24 years old were recruited using snowball sampling. Repeated face-to-face in-depth interviews were undertaken and thematic analysis conducted to identify common themes. Most participants had their first coital experience pre-migration but living in the city introduced them to a larger pool of potential partners. Unprotected sexual intercourse was common, with young women usually deferring to their male partners preference for non-condom use. Working as beer promoters, the sexualised environment of the bar room promoted male ideals of femininity and exposed the young women to sexual harassment. While the young women used various strategies to assert their autonomy, and challenge unequal gender norms, the prevailing male hegemony acted to subvert female sexual agency. Leveraging young urban migrants' desire to complete education, live independently and postpone motherhood may provide opportunities to examine and challenge gender norms and harmful practices.

Intersectionality of cultural norms and sexual behaviours: a qualitative study of young Black male students at a university in KwaZulu-Natal, South Africa.

BACKGROUND: Sexual risk behaviours that occur among young men are based on dominant notions and practices that prevail in cultural contexts. As such, understanding the intersection of cultural norms and sexual risk behaviours among young men is very important. METHODS: The study used a qualitative design and conducted four focus group discussions with 36 male students who were purposively selected from different levels of study at the University of KwaZulu-Natal. Data were analysed through line-by-line coding, and grouped into emerging themes and sub-themes facilitated by the use of Atlas.ti. RESULT: The findings emphasize that socialisation agents such as the family, peers and community play an important role in prescribing acceptable and unacceptable sexual behaviour of young men. Some of the young men seemed to adhere to prescribed gender norms of what it means to be a man while some rejected them for alternative versions of being a man. In the context of the university environment, these findings reveal that male students cannot make informed decisions regarding condom use when they are intoxicated, and thus expose themselves to sexually transmitted infections and other risks. CONCLUSION: University sexual risk reduction programs should be developed considering the specific cultural context, using strategies that empower young men to challenge the widely accepted cultural norms that may predispose them to sexual risks. Sexual behaviours and cultural norms are interconnected, it is through culture that people learn how to behave and understand the world around them. In many cultural contexts, young men are taught from a very young age how to behave based on dominant notions of what it means to be a man in that particular context. As such, in some cultural context sexual risk-taking such as having multiple sexual partners and unprotected sex are perceived as normal behaviour for men. Some young men embrace such normalised sexual behaviours which often has negative implications on their future. This study explored the influence of cultural norms on the sexual behaviour of young men. This qualitative study was conducted at the University of KwaZulu-Natal. Four focus group discussions were conducted among first-year students to postgraduate students who were between the ages of 18 to 30 years. Our findings revealed that there other influences on the sexual behaviours of the young men, which included family, community and peers. It also emerged that gender norms regarding what it means to be a man still prevailed which some of the young men in the study adhered to, notably such notions seemed to be rejected by some of them. The university setting appeared to be space where a lot of sexual risk-taking took place, which potentially exposed the young men in the study to many sexual risks. In conclusion, targeted programs for the university setting should aim to challenge gender norms that expose young men to sexual risks.

Young people who inject drugs in India have high HIV incidence and behavioural risk: a cross-sectional study.

INTRODUCTION: There are limited data on young people who inject drugs (PWID) from low- and middle-income countries where injection drug use remains a key driver of new HIV infections. India has a diverse injection drug use epidemic and estimates suggest that at least half of PWID are ≤30 years of age. We compared injection and sexual risk behaviours and HIV incidence between younger and older PWID and characterized uptake of HIV testing and harm reduction services to inform targeted HIV prevention efforts. METHODS: We analysed cross-sectional data from 14,381 PWID recruited from cities in the Northeast and North/Central regions of India in 2013 using respondent driven sampling (RDS). We compared "emerging-adult" (18 to 24 years, 26% of sample) and "young-adult" PWID (25 to 30 years, 30% of sample) to older PWID (>30 years, 44% of sample) using logistic regression to evaluate factors associated with three recent risk behaviours: needle-sharing, multiple sexual partners and unprotected sex. We estimated age-stratified cross-sectional HIV incidence using a validated multi-assay algorithm. RESULTS: Compared to older adults, emerging-adults in the Northeastern states were significantly more likely to share needles (males adjusted odds ratio [aOR] 1.82; females aOR 2.29, p < 0.01), have multiple sexual partners (males aOR 1.56; females aOR 3.75, p < 0.01), and engage in unprotected sex (males aOR 2.29, p < 0.01). In the North/Central states, young-adult males were significantly more likely to needle-share (aOR 1.23, p < 0.05) while emerging-adult males were significantly more likely to have multiple sexual partners (aOR 1.74, p < 0.05). In both regions, emerging-adults had the lowest HIV testing. Participation in harm reduction services was low across all age groups. Annual HIV incidence was higher in emerging- and young-adult PWID in the North/Central region: emerging-adults: 4.3% (95% confidence interval [CI] 3.0, 5.6); young-adults: 4.9% (95% CI 3.7, 6.2); older adults: 2.1% (95% CI 1.4, 2.8). CONCLUSIONS: Higher HIV incidence and engagement in risky behaviours among younger PWID compared to older PWID, coupled with low utilization of harm reduction services highlight the importance of targeting this population in HIV programming. Age-specific interventions focused on addressing the needs of young PWID are urgently needed to curb the HIV epidemic in this vulnerable population.

Exploring the Determinants of Risky Sexual Behavior Among Ethnically Diverse University Students: the Student Behavioral Health Survey-Web.

Universities create policies and develop programs to prevent HIV and other sexually transmitted infections. Unfortunately, most historically Black colleges and Hispanic-serving institutions have limited information about student practices and program effectiveness. This study examined the prevalence and determinants of risky sex among students attending a Hispanic-serving university. A cross-sectional online survey was conducted to obtain sensitive data from a random sample of students. Nearly two-thirds (65.2%) of 632 respondents reported engaging in risky sex. Sexual risk was significantly associated with older age (AOR = 2.16, 95% CI 1.09-4.30), lower self-control (AOR = 0.58, 95% CI 0.34-0.97), and higher alcohol (AOR = 2.10, 95% CI 1.20-3.67) and drug use (AOR = 2.59, 95% CI 1.48-4.50). Most respondents were unaware of university policies and programs. Programs to improve sexual health must influence risk-taking students. Perceptions of self-control and use of alcohol and drugs affected sexual decision-making. These factors should be ascertained and addressed by behavioral interventions aimed at minimizing risky behaviors and limiting the transmission of sexually transmitted infections.

Pathways From Peer Victimization to Sexually Transmitted Infections Among African American Adolescents.

African American youths, especially those in low resource communities, are vulnerable to peer victimization, which can increase risk of sexually transmitted infections. However, few studies explored the relationship between these two health concerns and the pathways that may link them. The present study aimed to address this gap. We used descriptive statistics, correlation coefficients, and structural equation modeling to analyze data collected from 277 adolescents ages 13 to 24 years in Chicago. Primary results indicated that peer victimization was not directly related to acquisition of sexually transmitted infections. However, peer victimization was negatively associated with condom use, and condom use was negatively associated with sexually transmitted infections. Furthermore, affiliation with sexually active peers was positively associated with substance use. These findings have implications for bullying and sexual risk prevention and intervention of low-income youths. Attention to treatment approaches and interventions that are holistic and culturally feasible is recommended for practitioners working with urban youth.

Feasibility and Outcomes of an HIV Testing Intervention in African American Churches.

The updated National HIV/AIDS Strategy recommends widespread HIV education and testing and calls the faith community to assist in these efforts. Yet, limited information exist on church-based HIV testing interventions. This study examined feasibility and assessed HIV testing outcomes of Taking It to the Pews (TIPS), a multilevel HIV education and testing intervention. Four African American churches were matched and randomized to TIPS or a standard-information control arm. Intervention churches delivered the religiously-tailored TIPS Tool Kit, which included educational materials to individuals and ministry groups; pastoral activities (e.g., sermons preached, receipt of HIV testing role-modeled), responsive readings, and church bulletin inserts in church services; and HIV testing during church services and church outreach events. All churches delivered 2-3 tools/month and coordinated 3 HIV testing events. At 12 months, significant increases in receipt of HIV testing (59% vs. 42%, p = 0.008), and particularly church-based testing (54% vs. 15%, p < 0.001), relative to controls were found. TIPS has great potential to increase reach, feasibility, and impact of HIV testing in African American churches.

Factors Associated with Sexual Risks and Risk of STIs, HIV and Other Blood-Borne Viruses Among Women Using Heroin and Other Drugs: A Systematic Literature Review.

This systematic literature review identified factors associated with sexual risks related to sexually transmitted infections (STI), HIV and other blood-borne viruses (BBV) among women using heroin and other drugs. The search strategy included five databases (PubMed, EMBASE, PsycNET, Web of Science, Scopus), and PsycEXTRA for grey literature. Out of the 12,135 publications screened, 30 peer-reviewed articles were included. Most publications were cross-sectional (n = 25), quantitative (n = 23) and included 11,305 women. Factors identified were: (1) socio-demographics; (2) gender roles and violence against women; (3) substance use; (4) transactional sex; (5) partner characteristics, partner's drug use, and context of sex; (6) preferences, negotiation and availability of condoms; (7) HIV status and STIs; (8) number of sexual partners; (9) love and trust; (10) reproductive health and motherhood; and (11) risk awareness and perception of control. Overall, this review highlights important implications for future research and practice, and provides evidence for developing STI/BBV preventive strategies.

Intimate relationships and patterns of drug and sexual risk behaviors among people who inject drugs in Kazakhstan: A latent class analysis.

BACKGROUND: Multiple drug and sexual risk behaviors among people who inject drugs (PWID) in intimate relationships increase the risk of HIV and HCV transmission. Using data on PWID in intimate partnerships in Almaty, Kazakhstan, this study performed latent class analysis (LCA) on drug and sexual risk behaviors and estimated associations between dyadic relationship factors and membership in latent classes. METHODS: LCA was performed on a sample of 510 PWID (181-females/FWID, 321-males/MWID) to identify levels of drug and sexual risk behaviors. Generalized structural equation modeling with multinomial regressions estimated associations between relationship factors (length risk reduction communication, risk reduction self-efficacy) and class membership after adjusting for substance use severity, overdose, depression, binge drinking, intimate partner violence, structural factors, and sociodemographic characteristics. Models were sex-stratified to include FWID and PWID. RESULTS: A 3-class model best fit the data and consisted of low, medium, and high-risk classes. GSEM found that greater injection self-efficacy was associated with a lower likelihood of membership in the high-risk class for PWID and FWID. For MWID, greater length of the relationship was associated with a lower likelihood of membership in the medium-risk class. Greater relationship communication was associated with increased risk of membership in the high-risk latent class for MWID. CONCLUSIONS: Future research must investigate if increasing risk reduction and safe sex self-efficacy could reduce drug and sexual risk behaviors and HIV transmission among PWID and their intimate partners. Interventions are needed that reduce power inequities within relationships as a method of increasing self-efficacy, particularly among women.

Prevalence of poppers use and its sexual risks among men who have sex with men in southwestern China: a cross-sectional study.

BACKGROUND: To investigate the prevalence of poppers use and its relationship with sexual risk behaviors among men who have sex with men (MSM) in southwestern China. METHODS: This cross-sectional study was conducted in three cities of southwestern China between July and September 2016. Anonymous questionnaire survey was administered to collect data on demographics, drug use, sexual behaviors, history of STIs and HIV infection. Logistic regression analysis was performed to explore factors correlated with sexual risk behaviors including group sex and unprotected anal intercourse (UAI). RESULTS: Of the 1122 participants included in the study, 24.1% reported a history of poppers use. 11.6% MSM reported ever engaging in group sex and 36.2% participants reported UAI with non-regular male partners in the past 12 months. Multivariate logistic analysis showed that age > 25 (OR = 2.96, 95% CI 1.87-4.68), seeking sex partners through the internet (OR = 3.16, 95% CI 1.59-6.29), preferring receptive anal intercourse (OR = 1.91, 95% CI 1.12-3.26) and ever using poppers (OR = 1.88, 95% CI 1.25-2.83) were positively associated with engaging in group sex. Lower levels of education (OR = 1.93, 95% CI 1.33-2.80) and ever using poppers (OR = 1.44, 95% CI 1.01-2.05) were significantly correlated with UAI with non-regular partners. CONCLUSIONS: The study suggested poppers was prevalent among MSM and its use was significantly associated with sexual risk behaviors. Given high prevalence of HIV among this subpopulation, comprehensive measures are needed to decrease poppers use and its potential risk for HIV transmission in southwestern China.

Sexual health in the French military: a multidimensional and gendered perspective.

BACKGROUND: Sexual health in the military comprises a range of concerns including sexually transmitted infections (STI), unintended pregnancy, sexual violence and sexual dysfunction. This study aims to estimate the prevalence of sexual health concerns by gender in the French military and compare these prevalences to estimates in the general population. METHODS: COSEMIL, the first sexual health survey in the French military comprises a probability sample of 1500 military personnel. Chi-square tests were used to compare lifetime abortion, STIs and sexual assault, and recent sexual dysfunction and sexual satisfaction by gender and explore the association between these indicators and current sexual risk (condom use at last intercourse). RESULTS: Women were more likely than men to declare negative sexual health outcomes, with the greatest difference related to sexual assault (24.3% versus 5.1% of males, p < 0.001) and sexual dysfunction hindering sexuality (15.2% of females versus 5.3% of males, p < 0.001). Women were also twice as likely to report ever having an STI (6.7% versus 3.4%, p = 0.03). Comparison with the French general population indicates lower percentages of STIs among military men (2.9% versus 4.9%) and higher percentages of abortion (17.6% versus 14.3%) forced sex (10.6% versus 7.4%) and sexual dysfunction (14.2% versus 9.3%) among military women. CONCLUSION: These results highlight gendered pattern of sexual health in the French military with women suffering greater sexual risks than men. Military health services should include women's health services to address the sexual and reproductive health gender gap.

Associations between Sociodemographic Characteristics and Sexual Risk Behaviors among Methamphetamine-using Men who Have Sex with Men.

BACKGROUND: Methamphetamine-using men who have sex with men (MSM) exhibit elevated rates of HIV and STI prevalence, indicating increased engagement in sexual risk behaviors. OBJECTIVES: This analysis elucidates associations between participant sociodemographics (i.e., age, racial/ethnic identity, sexual identity, educational attainment, and HIV status) and sexual risk behaviors, particularly substance use before/during sex, and engagement in condomless anal intercourse (CAI) with casual, anonymous, and/or exchange male partners. METHODS: From March 2014 through January 2016, 286 methamphetamine-using MSM enrolled in a technology-based study to reduce methamphetamine use and HIV sexual risk behaviors. A robustly estimated generalized structural equation model employing the negative binomial family and log link function (n = 282) tested the simultaneous associations between participant sociodemographics and engagement in HIV sexual risk behaviors. RESULTS: Participants' racial/ethnic identity (χ2(6) = 43.5; p < 0.0001), HIV status (χ2(6) = 22.0; p = 0.0012), educational attainment level (χ2(6) = 13.8; p = 0.0322), and years of age (χ2(6) = 32.4; p < 0.0001) all influenced participants' engagement in substance use before/during sex and engagement in CAI. Methamphetamine (χ2(2) = 7.0; p = 0.0309) and marijuana (χ2(2) = 9.7; p = 0.0079) use before/during sex influenced participants' engagement in CAI with casual, anonymous, and exchange male partners. CONCLUSION: Results indicate the importance of intervention efforts focused on younger racial/ethnic minority MSM with fewer years of educational attainment, and provides evidence of the specific subpopulations of MSM at greatest risk of detrimental effects of illicit substance use.

Sexual Networking and Partner Characteristics Among Single, African, Caribbean, and Black Youth in Windsor, Ontario.

The disproportionate HIV burden shared by African, Caribbean, and Black (ACB) populations in Canada has not been explained by unique sexual behaviors in this population. This study investigates partner selection and sexual networking as potential contributors to HIV vulnerability. The study examines variations in the characteristics of sexual partners and sexual networking across groups based on differences in ethno-religious identity, gender, and length of Canadian residency among single, 16- to 27-year old, heterosexual-identified, ACB individuals living in Windsor, Ontario, Canada. Respondent-driven sampling maximized the representativeness of the sample of 250 (45 % male; 55 % female) youth with penile-vaginal intercourse experience who completed surveys. Logistic regression and analysis of variance compared groups with respect to number of lifetime partners, concurrency of sexual relationships, non-relational and age disparate partnering, and intra-ethnic sexual networking. For vulnerability associated with number of partners, concurrency and non-relational sex, women, newcomers to Canada, and African-Muslim participants were at lower vulnerability for HIV infection than their comparator groups. For vulnerability associated with sexual networking within a group with higher HIV prevalence, women and newcomers to Canada were at higher vulnerability to HIV infection than their comparator groups. There were insufficient data on age disparate partnering to support analysis. These results point to the importance of considering characteristics of partners and sexual networking both in further research and in developing policies and programs to curtail the spread of HIV and other sexually transmitted infections.

The relationship between life stressors and drug and sexual behaviors among a population-based sample of young Black men who have sex with men in Chicago.

Younger Black men who have sex with men (YBMSM) have the highest rates of HIV incidence in the U.S. and are also exposed to high life stressors (e.g., unemployment, incarceration, and exposure to communality). This study assessed whether life stressors were related to drug use and sexual risk behaviors among a representative sample of YBMSM. The South Side of Chicago and selected adjacent suburbs represents the most populous contiguous Black community in the U.S. Over 10% of the estimated YBMSM population in this geographic region were sampled. Major findings indicated that higher life stress was significantly associated with greater odds of transactional sex (aOR = 2.19; 95% CI 1.09-4.39), substance use with sex with male and transgender partners (aOR = 1.62; 95% CI 1.09-2.39), marijuana (aOR = 2.65; 95% CI 1.43-4.90), crack/cocaine (aOR = 3.21; 95% CI 1.16-8.88), and prescription opioid use (aOR = 3.12; 95% CI 1.37-7.13). HIV approaches which focus on environmental stressors and employ a stress and coping framework may support the reduction of drug and sexual risk behaviors among YBMSM. Cognitive and social support approaches might be especially useful in this regard.

Exploring First Sexual Intercourse, Sexual Orientation, and Sexual Health in Men.

In this study the characteristics of the sexual debut of men who have sex with men (MSM) and men who have sex with women (MSW) age 35 or younger (N = 1,201) were compared with one another. We investigated whether these characteristics were associated with sexual health and behavior, and to what extent. Compared to MSW, MSM tended to be older when they had their first sexual intercourse; their first sex partner was older, they felt less ready, and they experienced more pain. We also found that they reported a higher number of lifetime sexual partners and less condom use compared to MSW. Similarities were also ascertained, such as the fact that individuals from both groups do not differ significantly regarding how they experienced their first sexual intercourse emotionally. Many differences between these groups should not always be seen as problematic, whereas others still indicate a need for targeted interventions.

Sexual Behaviors and Transmission Risks Among People Living with HIV: Beliefs, Perceptions, and Challenges to Using Treatments as Prevention.

Antiretroviral therapy (ART) improves the health of people living with HIV and can reduce infectiousness, preventing HIV transmission. The potential preventive benefits of ART are undermined by beliefs that it is safe to have condomless sex when viral load is below levels of detection (infectiousness beliefs and risk perceptions). In this study, we hypothesized that infectiousness beliefs and HIV transmission risk perceptions would prospectively predict people living with HIV engaging in more condomless sex with HIV-negative and unknown HIV status sex partners. Sexually active HIV-positive men (n = 538, 76 %) and women (n = 166, 24 %) completed computerized interviews of sexually transmitted infection (STI) symptoms and diagnoses, unannounced pill counts for medication adherence, medical chart-abstracted HIV viral load, and 28 daily cell-phone-delivered prospective sexual behavior assessments. Results showed that a total of 313 (44 %) participants had engaged in condomless sex with HIV-negative/unknown status sex partners, and these individuals demonstrated higher rates of STI symptoms and diagnoses. Two-thirds of participants who had condomless sex with HIV-negative/unknown status partners had not disclosed their HIV status. Multivariable logistic regression models showed that beliefs regarding viral load and HIV infectiousness and perceptions of lower risk of HIV transmission resulting from HIV viral suppression predicted condomless sex with potentially uninfected partners over and above sex behaviors with HIV-positive partners and STI symptoms/diagnoses. Interventions that address HIV status disclosure and aggressively treat STI in sexually active people living with HIV should routinely accompany the use of HIV treatments as prevention.