Implementing pathogen reduction technology while discontinuing blood donor deferral criteria for sexual risk behaviors: A simulation study.

BACKGROUND: Combining pathogen reduction technology (PRT) with blood screening may alleviate concerns over the risk of transfusion-transmitted infections (TTI) and support changes in blood donor selection to potentially increase blood availability. This study aimed to estimate the residual risk of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) transfusion-transmission in Canada after implementing PRT, while eliminating deferrals for sexual risk behaviors. STUDY DESIGN AND METHODS: A probabilistic approach that combined Bayesian networks with Monte Carlo simulations was used to estimate the risk of transfusing HIV-, HBV-, or HCV-contaminated blood components. Different scenarios were considered to compare the current residual risk after PRT implementation, with and without donor deferral criteria for sexual risk behaviors. Donor profiles and blood component outcomes were simulated based on a literature review including the prevalence and incidence of HIV, HBV, and HCV in the Canadian blood donor population; the use of current blood screening assays; and HIV, HBV, and HCV blood donor viral loads. RESULTS: In the universal PRT scenario (i.e., with PRT/without deferral criteria), the estimated risks of HIV, HBV, and HCV transmission were significantly lower than those in the currently observed scenario (i.e., without PRT/with deferral criteria). CONCLUSIONS: This risk model suggests that PRT for platelets and plasma (and eventually for RBCs when available) significantly reduces the residual risks of HIV, HBV and HCV transfusion-transmission and could enable the removal of blood donor deferral criteria for sexual risk behaviors.

Low Level of Accurate Knowledge of Undetectable Equals Untransmittable (U = U) Among Men Who Have Sex with Men (MSM) Challenges U = U Achievement in Chengdu, Southwestern China.

The introduction of the undetectable equals untransmittable (U = U) statement significantly reduces HIV stigma and provides an empirical basis for achieving "zero transmission." U = U messaging has gained increasing support and is well-developed in several countries. However, the current status of accurate knowledge of U = U and its associated factors among men who have sex with men (MSM) in China remians unclear. We conducted a cross-sectional survey among MSM recruited in Chengdu, China, from March to May 2022 to investigate the percentage of those who knew U = U accurately and to explore associations between sexual risk behaviors, HIV testing, socio-behavioral measures, and accurate knowledge of U = U. Of 497 MSM included in our study, 23.4% (116/497) had accurate knowledge of U = U. More than half of the participants (63.2%, 314/497) reported multiple sexual partnerships, 15.7% (78/497) used substance during sex, 37.4% (186/497) reported inconsistent condom use, and 76.1% (378/497) took HIV testing in the past six months. Factors associated with accurate knowledge of U = U among MSM included substance use during sex (multivariate odds ratios ORm = 1.96; 95%CI: 1.13-3.41), HIV status tested in the last six months (ORm = 2.07; 95%CI: 1.14-3.77), HIV-related literacy (ORm = 1.41; 95%CI: 1.14-1.74) and perceived higher risk of HIV infection (ORm = 1.11; 95%CI: 1.02-1.21). The findings indicate that great challenges need to be conquered for U = U achievement among the MSM population in Chengdu, China. Intervention strategies should be prioritized in health education on high-risk behaviors such as group sex and substance use, information provision and counseling of U = U in HIV testing services, and encouraging U = U knowledge sharing among MSM with their partners in China.

Longitudinal Associations between Different Types of Sexting, Adolescent Mental Health, and Sexual Risk Behaviors: Moderating Effects of Gender, Ethnicity, Disability Status, and Sexual Minority Status.

The present study investigated the moderating effect of adolescent demographic variables in the longitudinal associations among different types of sexting, mental health (i.e., depression, self-harm, subjective health complaints), and sexual risk behaviors. There were 1113 adolescents (ages 14-17 years; Mage = 16.36; SDage = .81; 50% female) from six high schools located in the United States included in this study. Adolescents completed questionnaires on their sexting behaviors, mental health, and sexual risk behaviors during the ninth grade; in tenth grade, they completed questionnaires on mental health and sexual risk behaviors. Non-consensual sexting and pressured sexting were both related positively to each of the mental health variables and sexual risk behaviors. The relationship between non-consensual sexting and depressive symptoms was stronger for girls, ethnic minorities, those adolescents with disabilities, and sexual minorities. Similar patterns were found for pressured sexting, non-suicidal self-harm, and subjective health complaints. The relationships between pressured sexting and sexual risk behaviors were stronger for girls, ethnic minorities, those adolescents with disabilities, and those who identified as sexual minorities. Research focused on the relationships among different types of sexting, mental health, and sexual risk behaviors is important as such research facilitates the development of evidence-based recommendations for sexting harm prevention and sexual education programs.

Abstinence beliefs in early adolescence and sexual risk behavior two years later.

INTRODUCTION: The United States has the highest teen pregnancy rate and sexually transmitted infection rates among developed countries. One common approach that has been implemented to reduce these rates is abstinence-only-until-marriage programs that advocate for delaying sexual intercourse until marriage. These programs focus on changing adolescents' beliefs toward abstinence until marriage; however, it is unclear whether adolescents' beliefs about abstinence predict their sexual behavior, including sexual risk behavior (SRB). An alternative approach may be encouraging youth to delay their sexual debut until they reach the age of maturity, but not necessarily until marriage. METHODS: To address this question, we compare the longitudinal association between abstinence beliefs (i.e., abstaining completely until marriage) and beliefs about delayed sexual debut with subsequent SRB 24 months later. The harmonized data set included 4620 (58.2% female, Mage = 13.0, SDage = 0.93) participants from three randomized controlled trials attending 44 schools in the southern United States. Negative binomial regressions were employed to examine the association of abstinence until marriage beliefs and beliefs regarding delaying sex with SRB. RESULTS: We identified that beliefs supporting delaying sex until an age of maturity were associated with lower odds of engaging in SRB, such as having multiple sex partners and frequency of condomless sex, for both sexes. However, stronger abstinence beliefs had no significant associations with all SRB outcomes. CONCLUSIONS: Findings suggest prevention programming that focuses on encouraging youth to delay sex until an appropriate age of maturity may be more effective at preventing SRB and consequent negative sexual health outcomes.

Does the Association Between Stimulant use and High Risk Sexual Behavior Vary by Injection Drug Use, Sexual Minority Status, or HIV Infection Status? A Meta-analysis.

There is strong evidence linking stimulant use, namely methamphetamine use, to sexual risk behavior among sexual minority men (SMM); we do not, however, have a good understanding of this relationship among other at-risk populations. In this study, we systematically reviewed associations between stimulant use (i.e., methamphetamine, crack cocaine, cocaine) and sexual risk behaviors among populations facing elevated risk of HIV transmission and acquisition (i.e., SMM, people who inject drugs (PWID), and people living with HIV/AIDS (PLWH)). Random-effects meta-analyses and sensitivity analyses that included crude and adjusted estimates separately were conducted to evaluate the impact of potential confounding variables. The results showed strong relationships between stimulant use and condomless sex, transactional sex, and multiple sexual partners. Results were broadly consistent when analyses were stratified by type of stimulant (methamphetamine, crack cocaine, and other stimulants) and risk group. Sensitivity analyses with confounding variables did not greatly impact results. The results indicate that stimulant use is associated with numerous sexual risk behaviors regardless of risk group, suggesting prevention efforts focused on reducing methamphetamine-related HIV risk should target a range of at-risk populations.

The Impact of Providing Free HIV Self-testing on Sexual Risk Behaviors Among Men who have Sex with Men in Hunan, China: A Randomized Controlled Trial.

HIV self-testing (HIVST) increases testing frequency among men who have sex with men (MSM). However, its impact on sexual risk behaviors is unclear. In a randomized controlled trial conducted in Hunan Province, China, HIV-negative MSM were randomized to receive one of two interventions for one year: (1) facility-based HIV testing, or (2) facility-based HIV testing augmented with free HIVST. From April to June 2018, 230 MSM were enrolled. They self-reported sexual behaviors every 3 months for 12 months. Among 216 MSM with follow-ups (intervention: 110; control: 106), adjusting for potential confounders in Generalized Estimating Equation models, there were no statistically significant differences in consistent condom use with male partners (regular/casual) or female partners, nor on number of male or female sexual partners. Provision of free HIVST kits does not increase risky sex and should be included in comprehensive HIV prevention packages, particularly for sexual minority men in China.

Does Context and Adversity Shape Sexual Behavior in Youth? Findings from Two Representative Samples of Puerto Rican Youth.

Sexual risk behaviors often co-occur. Understanding the heterogeneity in patterns of sexual behavior among youth and how context of majority and minoritized status may be related to these behaviors can inform targeted STIs/HIV interventions. Data are from the Boricua Youth Study, a longitudinal study of two probability samples of Puerto Rican youth recruited in the South Bronx (SBx) and the metropolitan area in Puerto Rico (PR). We identified patterns of sexual behaviors among young adults (ages 15-24) with sexual experience (N = 1,203) using latent class analysis. Analyses examined context differences and the prospective relationship between adverse childhood experiences (ACEs) (childhood maltreatment/violence, family/parental dysfunction) and patterns of sexual behaviors (age at first sex, number of sex partners, sex with a high-risk partner, condom use, sex while intoxicated, oral sex, anal sex). We identified five classes of sexual behaviors: (1) currently inactive (16.51%); (2) single partner, low activity (13.49%); (3) single partner, inconsistent condom use (32.19%); (4) single partner, sex without a condom (27.65%); and (5) multirisk (10.16%). Young adults from the SBx (minoritized context), those who identified as male, and those with higher child maltreatment/violence ACEs were more likely to be in the multi-risk class relative to the single partner, inconsistent condom use class. Those from the SBx were also more likely to be in the single partner, sex without condom class, relative to the single partner, inconsistent condom use class. Differences in young adults' patterns of sexual behaviors between the two contexts, one representing the minoritized context (SBx) contrasted to the majority context (PR), were not explained by ACEs. Findings highlight the heterogeneity in the patterns of sexual behaviors among Puerto Rican young adults as well as how such patterns vary based on sociocultural contexts. Exposure to child maltreatment/violence ACEs was related to the riskier patterns; however, they did not explain why riskier patterns of sexual behaviors were found in the SBx compared to PR. Results underscore the need for tailored interventions and more in-depth examination of differences across contexts.

How Does Migration Affect HIV Sexual Risk Behaviors Among Involuntary Bachelors? The Mediating Roles of Neighborhoods and Social Networks.

The sex ratio imbalance in China since the 1980s has resulted in a large number of involuntary bachelors in rural China. Previous studies have found an association between migration and HIV sexual risk behaviors among involuntary bachelors, but how migration affects these bachelors' HIV sexual risk behaviors remain poorly understood. Using data from a cross-sectional survey in 2017 (a sample of 740 male respondents who had rural household registration, had never been married, and were aged 28-49 years), we investigated the relationship between migration and HIV sexual risk behaviors. Logistic regressions show that migration, neighborhood characteristics, and social networks were significantly associated with commercial sex and multiple sex partners, whereas only neighborhood characteristics and social networks were positively correlated with sexual partnership concurrency. Neighborhood characteristics and social networks mediated the relationships of migration with commercial sex and migration with multiple sex partners. Social networks mediated the association between neighborhood characteristics and concurrency. Multiple-step mediation analysis showed that the indirect effect of migration on commercial sex and multiple sexual partners through neighborhood characteristics and social networks was significant. Our findings suggest that further interventions should address neighborhood characteristics and social networks together.

The Impact of Parent-Adolescent Communication on Reduction of Sexual Risk Possibility Among Adolescents: Findings from the Suubi-Maka Study.

Sexual risky behaviors among adolescents and young people remain a major public health problem worldwide. This study examined the impact of parent-adolescent communication on adolescents' possibility to engage in risky behaviors. The study used baseline data from the Suubi-Maka Study (2008-2012) implemented in 10 primary schools in Southern Uganda. Binary logistic regression models were conducted to determine the association between parent-adolescent communication and sexual risk possibility. Results indicate that gender [OR 0.220, 95% CI 0.107, 0.455], age [OR 1.891, 95% CI 1.030, 3.471], household size [OR 0.661, 95% CI 0.479, 0.913], and comfort level of family communication [OR 0.944, 95% CI 0.899, 0.990] were significantly associated with lower levels of sexual risk possibility among adolescents. There is a need to build interventions that make it easy and comfortable for adolescents to have open discussion and communication with parents on sexual risk possibility, risky behaviors, and risky situations.

Socialization processes within adolescents' relationships with parents and peers predicting couples' intimate partner violence in adulthood: A social learning perspective.

Previous studies have established that individual characteristics such as violent behavior, substance use, and high-risk sexual behavior, as well as negative relationships with parents and friends, are all risk factors for intimate partner violence (IPV). In this longitudinal prospective study, we investigated whether violent behavior, substance use, and high-risk sexual behavior in early adulthood (ages 22-23 years) mediated the link between family conflict and coercive relationship talk with friends in adolescence (ages 16-17 years) and dyadic IPV in adulthood (ages 28-30 years). A total of 998 individuals participated in multimethod assessments, including observations of interactions with parents and friends. Data from multiple reporters were used for variables of interest including court records, parental and self-reports of violence, self-reports of high-sexual-risk behaviors and substance use, and self- and romantic partner-reports of IPV. Longitudinal mediation analyses showed that violent behavior during early adulthood mediated the link between coercive relationship talk with friends in adolescence and dyadic IPV in adulthood. No other mediation paths were found and there was no evidence of gender differences. Results are discussed with attention to the interpersonal socialization processes by which IPV emerges relative to individual risk factors.

Screening for Adolescent Risk Behaviors: Preliminary Evidence for a Family Functioning Tool.

BACKGROUND: Family functioning is associated with adolescent drug use, alcohol use, cigarette use, and sexual risk behaviors. Assessing adolescents for family functioning, commonly associated with multiple risk behaviors, may help identify adolescents at risk for adverse health outcomes. This study examined whether a latent family functioning construct, encompassing multiple dimensions of family functioning, was associated with adolescents' substance use and sexual risk behaviors. METHOD: This study used data harmonization with three intervention trials, including data from 1451 adolescents (M = 13.6, SD = 1.0), to perform a full-information item bifactor analysis on 46 family functioning items from five pre-existing family functioning measures. Regression analysis was used to examine the association between the identified subset of items and the following outcomes: cigarette use, alcohol use, drug use, and condom use. RESULTS: Bifactor analysis identified a 26-item latent family functioning construct. Regression analysis indicated that a 26-item latent family functioning construct was associated negatively with lifetime and past 90-day cigarette use, alcohol use, and drug use. CONCLUSION: In sum, the multi-dimensional latent family functioning construct may target specific barriers to risk screening in adolescent populations, including time constraint, hesitancy in discussing sensitive health topics, and use culturally appropriate and age-appropriate assessments.

Migration, Social Networks, and HIV Sexual Risk Behaviors Among Involuntary Bachelors in Rural China.

In rural China there is an abnormally high male-biased sex ratio. The result is a large number of involuntary bachelors. This study examines how migration and social networks relate to bachelors' sexual risk behaviors. Data are from a cross-sectional questionnaire survey in which 740 male respondents who had rural household registration, had never married, and were aged 28 or older were interviewed in 2017. Logistic regression reveals that both migration and social networks place the bachelors at an especially high risk of HIV transmission by increasing the chance that they engage in commercial sex, whereas only social networks are significantly associated with sexual partnership concurrency. Additionally, social networks mediate the association between migration and commercial sex. This suggests that social networks play an important role in bachelors' risk of HIV transmission and that further intervention should address their social networks.

Pre- and Post-immigration HIV Testing Behaviors among Young Adult Recent Latino Immigrants in Miami-Dade County, Florida.

HIV testing early in the immigration process can facilitate timely linkage to HIV prevention and treatment services for immigrants. This study aims to determine the prevalence of self-report HIV testing pre- and post-immigration and the associations between pre-immigration HIV sexual risk behaviors, access to healthcare post-immigration, and HIV testing post-immigration among young adult recent Latino immigrants. Cross-sectional data from 504 recent Latino immigrants aged 18 to 34 who immigrated to Miami-Dade County, Florida during the 12 months before assessment were analyzed using robust Poisson regression models. We found that 23.8% of participants reported HIV testing post-immigration and 56.7% reported HIV testing pre-immigration. The prevalence ratio for post-immigration HIV testing was higher for participants that had health insurance (adjusted prevalence ratio [aPR]: 1.70, 95% confidence interval [CI]: 1.21-2.38) and a regular doctor or healthcare provider after immigration (aPR: 1.43, 95% CI 1.03-2.00), and post-immigration HIV testing was higher for participants that had ever been tested for HIV before immigration (aPR: 2.41, 95% CI 1.68-3.45). Also, the prevalence ratio was lower for those who engaged in condomless sex in the three months prior to immigration (aPR: 0.65, 95% 0.47-0.90). These findings suggest that addressing barriers to healthcare and prevention services for young adult recent Latino immigrants is needed to scale-up HIV testing in this population early in the immigration process.

RESUMEN: Obtener una prueba del VIH al inicio del proceso de inmigración puede facilitar una conexión inmediata con los servicios de prevención y tratamiento del VIH. Este estudio tiene como propósito determinar la prevalencia auto informada de las pruebas de VIH antes y después de la inmigración, y las asociaciones entre las conductas sexuales de riesgo antes de la inmigración, el acceso a los servicios médicos después de la inmigración y las pruebas de VIH realizadas después de la inmigración en Latinos jóvenes adultos recién llegados a los Estados Unidos. Los datos transversales de 504 inmigrantes Latinos recién llegados entre los 18 y 34 años, que inmigraron al condado de Miami-Dade, Florida, durante los 12 meses anteriores a la evaluación, se analizaron utilizando modelos de regresión de Poisson robustos. Encontramos que 23.8% de los participantes informaron haberse realizado la prueba del VIH después de la inmigración y 56.7% informaron haberse realizado la prueba del VIH antes de la inmigración. El índice de prevalencia para las pruebas del VIH después de la inmigración fue mayor para los participantes que tenían seguro médico [índice de prevalencia ajustado (IPa): 1.70, intervalo de confianza (IC) del 95%: 1.21-2.38] y un médico o proveedor regular de atención médica después de la inmigración [IPa: 1.43, IC del 95%: 1.03-2.00], y para los participantes que se habían hecho la prueba del VIH antes de la inmigración [IPa: 2.41, IC de 95%: 1.68-3.45]. Además, el índice de prevalencia fue menor para aquellos participantes que tuvieron relaciones sexuales sin condón en los tres meses previos a la inmigración [IPa: 0.65, IC del 95%: 0.47-0.90]. Estos resultados sugieren que es necesario abordar las barreras a los servicios médicos y de prevención en los inmigrantes Latinos jóvenes adultos recién llegados a los Estados Unidos para ampliar las pruebas del VIH en esta población al inicio del proceso de inmigración.

A Systematic Review of Randomized Controlled Trials of School Based Interventions on Sexual Risk Behaviors and Sexually Transmitted Infections Among Young Adolescents in Sub-Saharan Africa.

Young adolescents in Sub-Saharan Africa (SSA) are at high risk of involvement in sexual risk behaviors; and curable sexually transmitted infections (STI), herpes simplex virus type 2 (HSV-2), human immunodeficiency virus (HIV) and unintended pregnancies remain persistently high in this population. Evidence based strategies are urgently needed to improve these outcomes. The aim of this systematic review was to synthesize the evidence from randomized controlled trials (RCT) to determine whether school-based interventions promote safe sex behaviors, reduce sexual risk behaviors and risk of curable STIs, HSV-2, HIV and unintended pregnancies among young adolescents aged 9-19 years in SSA. Electronic databases were searched for published studies and manual searches were conducted through reviewing of references of cited literature in the English language up to December 2019. Two independent reviewers screened and abstracted the data. We identified 428 articles and data from nine RCTs (N = 14,426 secondary school students) that fulfilled the selection criteria were analysed. Two studies measured pregnancy as an outcome and showed significant declines in unintended pregnancies. Of the five studies that measured HIV/AIDS related-knowledge, condom-use outcomes (normative beliefs, knowledge, and self-efficacy) and attitudes to HIV testing, four showed significant improvements. Of the six studies that measured sexual debut, four reported moderate but non-significant declines and in two studies sexual debut information was either incomplete or unreliable. One study measured curable STIs and found no significant declines; whilst the second study that measured HSV-2 and HIV, no significant declines were observed. This review highlights the need to undertake well-designed research studies to provide evidence on the impact of interventions on curable STIs, HSV-2 and HIV, critical to improving the health of young adolescents.

The Disaggregated Repeated Measures Design: A Novel Approach to Assess Sexual Risk Behaviors.

Although numerous studies have examined sexual and substance use behaviors that put people at risk for sexually transmitted infections including HIV, most focus on an overall measure of aggregate risk or a few simple and particular subtypes of sexual acts assessed in separate analyses. In this article, we introduce a more sensitive approach to assess how the relative characteristics of sex acts may determine the level of risk in which an individual chooses to engage. Project AWARE, a randomized clinical trial conducted among 5012 patients in nine STD clinics across the U.S., is used to illustrate the approach. Our study was guided by two aims: (1) describe a new approach to examine the count of sexual acts using a disaggregated repeated measures design and (2) show how this new approach can be used to evaluate interactions among different categories of sexual risk behaviors and other predictors of interest (such as gender/sexual orientation). Profiles of different subtypes of sexual acts in the past 6 months were assessed. Potential interactions of the characteristics associated with each subtype which resulted in up to 48 distinct subtypes of sexual risk behaviors-sex with a primary/non-primary partner; partner's HIV status; vaginal/anal sex; condom use; and substance use before or during sex act-can be examined. Specifically, we chose condom use and primary and non-primary status of partner as an application in this paper to illustrate our method. There were significantly more condomless sex acts (M = 23, SE = 0.9) and sex acts with primary partners (M = 27.1, SE = 0.9) compared to sex acts with condoms (M = 10.9, SE = 0.4, IRR = 2.10, 95% CI 1.91-2.32, p < .001) and sex acts with non-primary partner (M = 10.9, SE = 0.5, IRR = 2.5, 95% CI 2.33-2.78, p < .001). In addition, there were significant differences for the count of sexual risk behaviors among women who have sex with men (WSM), men who have sex with women (MSW) and men who have sex with men (MSM) for sex acts with and without condom use, primary and non-primary partner, and their interaction (ps = .03, < .0001, and .001, respectively). This approach extends our understanding of how people make choices among sexual behaviors and may be useful in future research on disaggregated characteristics of sex acts.

A Family-Based Healthy Lifestyle Intervention: Crossover Effects on Substance Use and Sexual Risk Behaviors.

This study examined the efficacy of a healthy lifestyle family-based intervention in reducing substance use and sexual risk behaviors compared with prevention as usual over 24 months in Hispanic adolescents. Participants were overweight/obese Hispanic adolescents (N = 280; M age 13.01; SD = .82) in the 7th/8th grade and their primary caregivers. Participants were randomized to either the healthy lifestyle family-based intervention or to the control condition (i.e., referral to community services offered for overweight and/or obese adolescents and their families). Outcomes included adolescent substance use and sexual risk behaviors among adolescents. Intervention effects were found for adolescent alcohol (b = - 0.37, 95% CI = [- 0.49, - 0.26]), marijuana (b = - 1.00, CI = [- 1.22, - 0.78]), and non-prescription drug use (b = - 3.77, CI = [- 6.49, - 1.05]) over 24 months. No significant intervention effects were found for adolescent sexual risk behaviors. Findings suggest that Familias Unidas for Health and Wellness reduces adolescent alcohol, marijuana, and non-prescription drug use across time. ClinicalTrials.gov Identifier: NCT03943628.

Sexual enhancement expectancy, non-medical use of prescription drugs, and sexual risk behaviors in college students.

Background: American young adults have a high risk of sexually transmitted infections. Sexual risk behaviors may be influenced by psycho-behavioral factors, including substance use and sexual enhancement expectancy. Existing research suggested that substance use may mediate the relationship between sexual enhancement expectancy and sexual risk behaviors. The substance use literature also suggested that non-medical use of prescription drugs (NMUPD) was highly prevalent in college students and was associated with sexual risk. However, limited studies have examined NMUPD-related sexual enhancement expectancy. The current study examined the relationship among sexual enhancement expectancy, NMUPD, and sexual risk behaviors in college students. Methods: Online data were collected in 2016 from 453 US college students with lifetime NMUPD. All participants reported their (1) past-three-month NMUPD, (2) NMUPD sexual enhancement expectancy, and (3) sexual risk behaviors. Structural equation modeling was employed for data analysis. Results: Findings suggested significant associations of NMUPD with sexual enhancement expectancy and sexual risk behaviors. Sexual enhancement expectancy was indirectly associated with sexual risk behaviors through NMUPD. Conclusions: College students' sexual risk behaviors appear to be indirectly influenced by sexual enhancement expectancy through NMUPD. Future sexual risk reduction interventions should attend to sexual enhancement expectancy and NMUPD.

Microenterprise Intervention to Reduce Sexual Risk Behaviors and Increase Employment and HIV Preventive Practices Among Economically-Vulnerable African-American Young Adults (EMERGE): A Feasibility Randomized Clinical Trial.

Economic vulnerability, such as homelessness and unemployment, contributes to HIV risk among U.S. racial minorities. Yet, few economic-strengthening interventions have been adapted for HIV prevention in this population. This study assessed the feasibility of conducting a randomized clinical trial of a 20-week microenterprise intervention for economically-vulnerable African-American young adults. Engaging MicroenterprisE for Resource Generation and Health Empowerment (EMERGE) aimed to reduce sexual risk behaviors and increase employment and uptake of HIV preventive behaviors. The experimental group received text messages on job openings plus educational sessions, mentoring, a start-up grant, and business and HIV prevention text messages. The comparison group received text messages on job openings only. Primary feasibility objectives assessed recruitment, randomization, participation, and retention. Secondary objectives examined employment, sexual risk behaviors, and HIV preventive behaviors. Outcome assessments used an in-person pre- and post-intervention interview and a weekly text message survey. Several progression criteria for a definitive trial were met. Thirty-eight participants were randomized to experimental (n = 19) or comparison group (n = 19) of which 95% were retained. The comparison intervention enhanced willingness to be randomized and reduced non-participation. Mean age of participants was 21.0 years; 35% were male; 81% were unemployed. Fifty-eight percent (58%) of experimental participants completed ≥ 70% of intervention activities, and 74% completed ≥ 50% of intervention activities. Participation in intervention activities and outcome assessments was highest in the first half (~ 10 weeks) of the study. Seventy-one percent (71%) of weekly text message surveys received a response through week 14, but responsiveness declined to 37% of participants responding to ≥ 70% of weekly text message surveys at the end of the study. The experimental group reported higher employment (from 32% at baseline to 83% at week 26) and lower unprotected sex (79% to 58%) over time compared to reported changes in employment (37% to 47%) and unprotected sex (63% to 53%) over time in the comparison group. Conducting this feasibility trial was a critical step in the process of designing and testing a behavioral intervention. Development of a fully-powered effectiveness trial should take into account lessons learned regarding intervention duration, screening, and measurement.Trial Registration ClinicalTrials.gov. NCT03766165. Registered 04 December 2018. https://clinicaltrials.gov/ct2/show/NCT03766165.

Sexual risk behaviors in the internet age: the case of Chinese men who have sex with men.

This cross-sectional study examined a sample of sexually active Chinese MSM recruited online (N = 403) to determine the associations of MSM social life (both online and in-person) and sexual identity stigma with three types of sexual risk behaviors in the past 12 months, including condom use %, number of anal intercourse partners, and number of partners engaged in condomless anal intercourse (CAI). Hierarchical regression analyses were conducted. More frequent use of social media was associated with higher numbers of anal intercourse partners as well as more condom use in past 12 months, but not number of CAI partners. More active in-person MSM social life was associated with higher numbers of partners in anal intercourse as well as CAI. Both perceived and enacted sexual identity stigma associated with higher numbers of CAI partners; perceived stigma was also linked to less condom use. In conclusion, social life and minority stress are relevant factors of sexual risk among MSM in China in the uptrend of internet use. The internet may be an important and promising platform for HIV prevention, and intervention efforts should consider online-based designs to promote safe sex and reduce sexual minority stigma.

Gender differences in the association between childhood sexual abuse and risk behaviors among people living with HIV in Haiti.

Research shows that in the Caribbean one-third of people living with HIV continue to engage in unprotected sexual practices. Childhood sexual abuse (CSA) and HIV-related risk behaviors have been found to play a contributory role in HIV transmission. We aimed to analyze gender differences in the association between CSA and substance use and sexual risk behaviors among Haitians living with HIV. A total of 276 HIV-positive individuals participated in this study with 56% experiencing sexual abuse during childhood. Results showed that participants who experienced CSA had increased odds of hazardous drinking compared to those who did not experience CSA; men (OR 2.9, 95% CI 1.2-7.3) and women (OR 2.5, 95% CI 1.2-5.6). While, marijuana use was only significantly associated in women (OR 5.2, 95% CI 2.1-13.5). For sexual risk behaviors, unprotected sex was significantly associated in both men (OR 3.0, 95% CI 1.3-7.1) and women (OR 2.0, 95% CI 1.5-7.7) who experienced CSA. Results of this study underscore the need for further research to better understand the role of gender in the relationship between CSA and risky behaviors among PLWH.