Prevention and control of sexually transmitted infections among adolescents: the importance of a socio-ecological perspective--a commentary

Two-Year Trajectories of Sexual Risk Behaviors Among Drug-Using Adolescents and Emerging Adults in an Urban Community

Among 14-24 year-olds who used drugs and were recruited from an emergency department, we examined 2-year trajectories of sexual risk behaviors. We hypothesized that those in higher risk trajectories would have more severe substance use, mental health concerns, and dating violence involvement at baseline. Analyses identified three behavioral trajectories. Individuals in the highest risk trajectory had a more severe profile of baseline alcohol use, marijuana use, dating violence involvement, and mental health problems. Future research will examine longitudinal differences in risk factors across trajectories. Understanding risk factors for sexual risk behavior trajectories can inform the delivery and tailoring of prevention interventions.

HIV/AIDS Communication Inequalities and Associated Cognitive and Affective Outcomes: A Call for a Socioecological Approach to AIDS Communication in Sub-Saharan Africa

Three-and-a-half decades on, no cure or vaccine is yet on the horizon for HIV, making effective behavior change communication (BCC) the key preventive strategy. Despite considerable success, HIV/AIDS BCC efforts have long been criticized for their primary focus on the individual-level field of influence, drawing on the more reductionist view of causation at the individual level. In view of this, we conducted a series of studies that employed a household survey, field experiment, and textual content analysis, and explored the macro-social-level effects of HIV/AIDS-related media and messages on HIV/AIDS cognitive and affective outcomes in Ethiopia. Against a backdrop of epidemiological and socioecological differences, urban versus rural residence has emerged as an important community-level factor that impacts HIV/AIDS-related media and message consumption processes and associated outcomes. The central thread crossing through the six studies included in this paper demonstrates that urban and rural people in high HIV prevalence contexts differ in their concern about and information needs on HIV/AIDS, HIV/AIDS-related media use, and HIV/AIDS-related cognitive and affective outcomes, as well as in their reaction to differently designed/framed HIV prevention messages. This paper proposes that HIV prevention media and message effects in high epidemic situations should be considered from a larger community-level perspective and calls for a socioecological approach to AIDS communication in the hard-hit sub-Saharan Africa. With a number of concrete recommendations to current and future HIV/AIDS BCC efforts in the region, the study joins an emerging body of health communication literature and theorizing that suggests the need to consider media and message effects from a macro-social perspective.

Predictors of Risky Behavior and Offending for Adolescents With Mild Intellectual Disability

Adolescents with intellectual disability (ID) engage in risky behavior and offending. However, little is known on the impact school-related predictors have on engagement in risky behaviors for adolescents with ID. This study analyzed secondary data from the National Longitudinal Transition Study-2 (NLTS2) to determine levels of engagement in risky behaviors and offending for adolescents with mild and moderate/severe ID. School-related predictors of engagement for adolescents with mild ID were also explored. Results indicated adolescents with mild ID engage in risky behaviors and offending at significantly higher rates as compared to adolescents with moderate/severe ID. Participation in a social skills or life skills class was a significant predictor of less engagement in risky behaviors for individuals with mild ID.

Cognitive emotion regulation strategies among Chinese adolescents having unprotected sex: a latent profile analysis

The association between cognitive emotion regulation strategy use and adolescents' risk behavior has long been emphasized. To identify coping profiles of Chinese adolescents having unprotected sex and to examine the characteristics and associations among those subgroups, 541 adolescents (age, 14-19 years) were screened from secondary schools in 10 Chinese cities. By latent profile analysis (LPA), the participants were identified into three latent profiles: the low reaction profile (LRP, N = 70), the medium reaction profile (MRP, N = 369), and the high reaction profile (HRP, N = 102) based on nine subscales of the Cognitive Emotion Regulation Questionnaire (CERQ). By one-way analysis of variance, chi-square tests, and multivariate logistic regression analysis, we found that: the HRP has the highest level of using eight strategies and the lowest unprotected sex, meanwhile the LRP has the lowest level of using nine strategies and the highest unprotected sex among three groups (both p < .05). The low response coping was more prevalent among boys and younger students. It indicates that more active cognitive coping, using both adaptive and maladaptive strategies, may associate with less unprotected sex. The programs of enhancing active copying may be targeted in interventions aiming to reduce adolescent unprotected sex.

The intersection of abandonment, HIV-positive status and residential care for a group of perinatally infected adolescents

Although anti-retroviral treatments have significantly reduced the incidence of mother-to-child transmission of HIV and AIDS, there remains, for the foreseeable future, a group of adolescents who have been perinatally infected. Noting the paucity of information regarding the impact of paediatric AIDS and its intersection with residential care, this paper investigates the lived realities of 20 South African adolescents who were vertically infected with HIV and AIDS, were abandoned, and have been raised in residential care. The exploratory study highlights that for these youth the dimensions of their adolescence, HIV-positive status and associated abandonment as well as life in residential care are mutually reinforcing and interconnected. Issues of race and class also interact with these social dimensions. Ultimately, these dimensions intersect to create a particular form of social exclusion. Intentional, critical intervention is required on the micro level to support these teens develop a coherent identity. On the meso level, the residential facility should actively facilitate community integration, particularly with the adolescents' communities (and where possible, families) of origin. Governments need to strengthen intersectoral, rights-based responses and in particular, address the consequences of cognitive impairment associated with perinatal transmission.

Feasibility and Acceptability of Text Messaging to Assess Daily Substance Use and Sexual Behaviors among Urban Emerging Adults

BACKGROUND

Daily process research can help distinguish causal relationships between substance use and sexual risk behaviors in high-risk groups, such as urban emerging adults. We employed text messaging to assess 18-25 year-olds' daily substance use and sexual risk behaviors over 28 days. We describe the implementation of this method, attitudes regarding the daily surveys, and correlates of survey completion.

METHOD

We recruited 111 emerging adults from an urban Emergency Department in a resource-limited area who reported recent drug use and unprotected sex (M_age=22.0; 53.2% female; 45.1% African American; 43.2% receiving public assistance).

RESULTS

Respondents completed M=18.0 (SD = 8.7) of 28 daily surveys (27 items each). Participants completing a 1-month follow-up found the surveys not at all/only a little annoying (90.3%) and were comfortable with questions about drugs/alcohol (97.9%) and sex (94.6%). Completion was higher on weekdays versus weekends, and earlier in the study. Daily survey completion was unrelated to same-day substance use measured by the Timeline Follow Back at follow-up; polysubstance use and drinks consumed were associated with lower odds of next-day completion. School enrollment, public assistance, unlimited texting plan, lower baseline alcohol use, and depression symptoms at follow-up were associated with higher completion. Technology difficulties were commonly mentioned barriers to completion.

CONCLUSIONS

Participants in this urban, resource-constrained sample found the daily text message methodology acceptable for reporting sensitive information. With rapid advancements in technologies and increased accessibility, text messaging remains a promising methodology for the study of daily processes in substance use and HIV risk behaviors. Keywords: text messaging; assessment; emerging adults; substance use; risky sex; mobile technology.

Assessing Spatial Relationships Between Rates of Crime and Rates of Gonorrhea and Chlamydia in Chicago, 2012

Sexually transmitted infections (STIs) remain serious public health problems particularly in urban environments in the USA. Despite accumulating research into the role of aggregate rates of crime in shaping rates of STIs, few studies account for spatial dependence in the structure of geographical data. Using multiple spatial analysis methodologies, the following study investigated spatial patterns in community area rates of violent, drug, and property crimes and rates of infection of gonorrhea and chlamydia in 77 community areas in Chicago. Moran's I analyses confirmed global spatial dependence and statistically significant clusters of STI. Spatial lag regression analyses found that greater rates of drug crimes were associated with higher rates of chlamydia and gonorrhea after adjusting for percent in poverty and racial composition. Finally, a weighted geographic regression identified regions in the urban environment in which local regression coefficient values diverged from their global estimates. Spatial heterogeneity of STIs suggest that public health interventions must be targeted to specific areas of the urban environment with particular attention to substance use.

Impact of telemonitoring approaches on integrated HIV and TB diagnosis and treatment interventions in sub-Saharan Africa: a scoping review

Background: This paper explores telemonitoring/mhealth approaches as a promising real time and contextual strategy in overhauling HIV and TB interventions quality access and uptake, retention,adherence and coverage impact in endemic and prone-epidemic prevention and control in sub-Sahara Africa. Methods: The scoping review method was applied in acknowledged journals indexing platforms including Medline, Embase, Global Health, PubMed, MeSH PsycInfo, Scopus and Google Scholar to identify relevant articles pertaining to telemonitoring as a proxy surrogate method in reinforcing sustainability of HIV/TB prevention/treatment interventions in sub-Saharan Africa. Full papers were assessed and those selected that fosters evidence on telemonitoring/mhealth diagnosis, treatment approaches and strategies in HIV and TB prevention and control were synthesized and analyzed. Results: We found telemonitoring/mhealth approach as a more efficient and sustained proxy in HIV and TB risk reduction strategies for early diagnosis and prompt quality clinical outcomes. It can significantly contribute to decreasing health systems/patients cost, long waiting time in clinics, hospital visits, travels and time off/on from work. Improved integrated HIV and TB telemonitoring systems sustainability hold great promise in health systems strengthening including patient centered early diagnosis and care delivery systems, uptake and retention to medications/services and improving patients' survival and quality of life. Conclusion: Telemonitoring/mhealth (electronic phone text/video/materials messaging)acceptability, access and uptake are crucial in monitoring and improving uptake, retention,adherence and coverage in both local and national integrated HIV and TB programs and interventions. Moreover, telemonitoring is crucial in patient-providers-health professional partnership, real-time quality care and service delivery, antiretroviral and anti-tuberculous drugs improvement, susceptibility monitoring and prescription choice, reinforcing cost effective HIV and TB integrated therapy model and survival rate.

Social Context and Problem Factors among Youth with Juvenile Justice Involvement Histories

Youth with juvenile justice histories often reside in poorly resourced communities and report high rates of depression, gang involved networks, and STI-sexual related risk behaviors, compared to their counterparts. The primary aim of this study was to examine the relationship between social context (ie, a combined index score comprised of living in public housing, being a recipient of free school lunch, and witnessing community violence) and risk factors that are disproportionately worse for juvenile justice youth such as depression, gang involved networks and STI sexual risk behaviors. Data were collected from a sample of detained youth ages 14 to 16 (N = 489). Questions assessed demographics, social context, depression, gang-involved networks, and STI risk behaviors. Multiple logistic regression models, controlling for age, gender, race, school enrollment, and family social support, indicated that participants who reported poorer social context had double the odds of reporting being depressed; three times higher odds of being in a gang; three times higher odds of personally knowing a gang member; and double the odds of having engaged in STI-risk behaviors. These results provide significant information that can help service providers target certain profiles of youth with juvenile justice histories for early intervention initiatives.

Life history factors, personality and the social clustering of sexual experience in adolescents

Adolescent sexual behaviour may show clustering in neighbourhoods, schools and friendship networks. This study aims to assess how experience with sexual intercourse clusters across the social world of adolescents and whether predictors implicated by life history theory or personality traits can account for its between-individual variation and social patterning. Using data on 2877 adolescents from the Avon Longitudinal Study of Parents and Children, we ran logistic multiple classification models to assess the clustering of sexual experience by approximately 17.5 years in schools, neighbourhoods and friendship networks. We examined how much clustering at particular levels could be accounted for by life history predictors and Big Five personality factors. Sexual experience exhibited substantial clustering in friendship networks, while clustering at the level of schools and neighbourhoods was minimal, suggesting a limited role for socio-ecological influences at those levels. While life history predictors did account for some variation in sexual experience, they did not explain clustering in friendship networks. Personality, especially extraversion, explained about a quarter of friends' similarity. After accounting for life history factors and personality, substantial unexplained similarity among friends remained, which may reflect a tendency to associate with similar individuals or the social transmission of behavioural norms.

Correlates of Sexually Transmitted Infections among Adolescents Attending Public High Schools, Panama, 2015

BACKGROUND

Sexually transmitted infections (STIs) are common in adolescents worldwide. Vulnerability to STIs increases with risky sexual practices. This study described the sexual practices, estimated the prevalence of STIs, and identified correlates associated with STIs among participants, enrolled in public high schools, in the District of Panama, Panama.

METHODS

A cross sectional study, using multistage cluster sampling, was conducted among participants, aged 14-18 years, enrolled in public high schools, in the District of Panama, Panama City, Panama, from August to November, 2015. Participants completed a self-administered questionnaire and provided biological samples. The samples of those reporting sexual activity (oral, vaginal, and/or anal intercourse) were tested for STIs. Odds ratios were used to identify correlates of STIs in this population.

RESULTS

A total of 592 participants were included, of whom, 60.8% reported a history of sexual activity, and 24.4% tested positive for least one STI. STIs were more common in female participants, (33.5%). Compared to those without STIs, higher proportions of those with at least one STI reported ≥3 sexual partners in their lifetime (60.0%) and current sexual activity (76.3%). In the multivariable model, correlates of STI included female participants (Adjusted Odds Ratio (AOR) = 5.8, 95% Confidence Interval (CI) 2.3-14.6) and those who engaged in sexual intercourse with casual partners (AOR = 3.0, 95% CI: 1.2-7.5).

CONCLUSIONS

We report a high STI prevalence among adolescents attending public high schools, in the District of Panama. Reported risky sexual practices were common and correlated with STIs. Female participants and those reporting sexual intercourse with casual partners were more likely test positive for at least one STI. Our study identified a need for effective interventions to curb future infections in this population.

Translating the Social-Ecological Perspective Into Multilevel Interventions for Family Planning

Scholars and practitioners frequently make recommendations to develop family planning interventions that are “multilevel.” Such interventions take explicit account of the role of environments by incorporating multilevel or social-ecological frameworks into their design and implementation. However, research on how interventions have translated these concepts into practice in the field of family planning—and generally in public health—remains scarce. This article seeks to review the current definitions of multilevel interventions and their operationalization in the field of family planning. First, we highlight the divergent definitions of multilevel interventions and show the persistent ambiguity around this term. We argue that interventions involving activities at several levels but lacking targets (i.e., objectives) to create change on more than one level have not incorporated a social-ecological framework and should therefore not be considered as “multilevel.” In a second step, we assess the extent to which family planning interventions have successfully incorporated a social-ecological framework. To this end, the 63 studies featured in Mwaikambo et al.’s systematic review on family planning interventions were reexamined. This assessment indicates that the multilevel or social-ecological perspective has seldom been translated into interventions. Specifically, the majority of interventions involved some form of activity at the community and/or organizational level, yet targeted and measured intrapersonal change as opposed to explicitly targeting/measuring environmental modification.

Association of Situational and Environmental Factors With Last Episode of Unprotected Anal Intercourse Among MSM in Hong Kong: A Case-Crossover Analysis

This study investigates event-specific factors that differentiate the last episodes of unprotected anal intercourse (UAI) from protected anal intercourse (PAI) with regular partner (RP) among 213 men who have sex with men (MSM) who did not use condoms consistently using case-crossover analysis. Factors positively associated with the last episode of UAI with RP included: two situational factors (i.e., participant's suggestion to have UAI, alcohol use) and three environmental/setting factors (i.e., sex took place overseas, during a weekday and not at home). Negative associations with an episode of UAI with RP included: five situational factors (i.e., discussion about condom use prior to sex, RP's suggestion to have PAI, participant's suggestion to have PAI, perception that RP would like to use a condom, participant's planning to use a condom) and two environmental/setting factors (i.e., condoms placed at the venue where sex took place, partner possessed a condom). Thus, these significant event-specific factors explained under which circumstances some MSM would use and would not use condoms during anal sex with RP.

Amphetamine-type stimulant use among men who have sex with men (MSM) in Vietnam: Results from a socio-ecological, community-based study

INTRODUCTION

Amphetamine-type-stimulants (ATS) use is associated with HIV-related sexual risk behaviours and is an emergent problem among men who have sex with men (MSM) in Vietnam. The purpose of this study is to describe ATS use patterns and understand the correlates of recent methamphetamine use from a socio-ecological perspective.

METHODS

From September through December, 2014, 622 MSM were recruited in Hanoi and Ho Chi Minh City, Vietnam. We collected information on demographic characteristics, HIV testing behaviours, use of ATS and other recreational drugs (ever and recently), sexual sensation seeking, depressive mood, experienced and internalized stigma related to homosexuality, social involvement with other MSM, and perceptions of ATS use in MSM networks. We performed descriptive statistics to describe ATS use patterns and multivariate logistic regression to establish independent correlates of recent methamphetamine use.

RESULTS

Nearly one-third (30.4%) had ever used ATS, including 23.6% who had used methamphetamine, 4.3% who had used amphetamine ('speed') and 20.9% who had used ecstasy. 20.1% and 11.9% had ever used methamphetamine and ecstasy, respectively, during sex. Eighteen percent of methamphetamine users were classified as engaged in high-risk use. Recent methamphetamine use (in the last 3 months) was associated with participants perceiving more methamphetamine use in their MSM network, recent sex work, and higher sexual sensation seeking scores.

CONCLUSIONS

ATS use is relatively prevalent among MSM sampled in Vietnam's main cities. Interventions to address methamphetamine are warranted for MSM in Vietnam. Methamphetamine treatments are needed for high-risk users.

Correlates of Cumulative Sexual Risk Behaviors among African American Youth Living in Public Housing

African American youth and especially those who reside in public housing report high rates of sexually transmitted disease (STI) risk behaviors; however, too few studies have examined the correlates of cumulative sexual risk behaviors among this population. This study recruited 298 youth ages 11 to 21 and examined to what degree factors such as age, gender, self-efficacy, substance use, negative peer norms, and delinquency were correlated with cumulative sexual risk behaviors. Major findings indicated that gender, substance use, self-efficacy, and involvement with delinquent peer networks were independent correlates of cumulative sexual risk behaviors, with gender and self-efficacy being the strongest of these factors. Collectively, these findings suggest that gendered approaches to sexual risk reduction among this population are warranted with special content and attention focused on substance abuse risk reduction, improving self-efficacy and managing negative peer influences.

Sexual Behaviors of US Women at Risk of HIV Acquisition: A Longitudinal Analysis of Findings from HPTN 064

We describe the sexual behaviors of women at elevated risk of HIV acquisition who reside in areas of high HIV prevalence and poverty in the US. Participants in HPTN 064, a prospective HIV incidence study, provided information about individual sexual behaviors and male sexual partners in the past 6 months at baseline, 6- and 12-months. Independent predictors of consistent or increased temporal patterns for three high-risk sexual behaviors were assessed separately: exchange sex, unprotected anal intercourse (UAI) and concurrent partnerships. The baseline prevalence of each behavior was >30 % among the 2,099 participants, 88 % reported partner(s) with >1 HIV risk characteristic and both individual and partner risk characteristics decreased over time. Less than high school education and food insecurity predicted consistent/increased engagement in exchange sex and UAI, and partner's concurrency predicted participant concurrency. Our results demonstrate how interpersonal and social factors may influence sustained high-risk behavior by individuals and suggest that further study of the economic issues related to HIV risk could inform future prevention interventions.

Building our youth for the future

Adolescents and young adults are at increased risk for HIV due to the many developmental, psychological, social, and structural transitions that converge in this period of the lifespan. In addition, adolescent deaths resulting from HIV continue to rise despite declines in other age groups. There are also young key populations (YKPs) that bear disproportionate burdens of HIV and are the most vulnerable, including young men who have sex with men (MSM), transgender youth, young people who inject drugs, and adolescent and young adult sex workers. As a society, we must do more to stop new HIV infections and untimely HIV-related deaths through both primary and secondary prevention and better management approaches. Using an interwoven prevention and treatment cascade approach, the starting point for all interventions must be HIV counselling and testing. Subsequent interventions for both HIV-negative and HIV-positive youth must be "adolescent-centred," occur within the socio-ecological context of young people and take advantage of the innovations and technologies that youth have easily incorporated into their daily lives. In order to achieve the global goals of zero infections, zero discrimination and zero deaths, a sustained focus on HIV research, policy and advocacy for YKPs must occur.

A faith-based community partnership to address HIV/AIDS in the southern United States: implementation, challenges, and lessons learned

Though race and region are not by themselves risk factors for HIV infection, regional and racial disparities exist in the burden of HIV/AIDS in the US. Specifically, African Americans in the southern US appear to bear the brunt of this burden due to a complex set of upstream factors like structural and cultural influences that do not facilitate HIV/AIDS awareness, HIV testing, or sexual risk-reduction techniques while perpetuating HIV/AIDS-related stigma. Strategies proposed to mitigate the burden among this population have included establishing partnerships and collaborations with non-traditional entities like African American churches and other faith-based organizations. Though efforts to partner with the African American church are not necessarily novel, most of these efforts do not present a model that focuses on building the capacity of the African American church to address these upstream factors and sustain these interventions. This article will describe Project Fostering AIDS Initiatives That Heal (F.A.I.T.H), a faith-based model for successfully developing, implementing, and sustaining locally developed HIV/AIDS prevention interventions in African American churches in South Carolina. This was achieved by engaging the faith community and the provision of technical assistance, grant funding and training for project personnel. Elements of success, challenges, and lessons learned during this process will also be discussed.

Injection and sexual HIV/HCV risk behaviors associated with nonmedical use of prescription opioids among young adults in New York City

Prevalence of nonmedical prescription opioid (PO) use has increased markedly in the U.S. This qualitative study explores the drug-use and sexual experiences of nonmedical PO users as they relate to risk for HIV and HCV transmission. Forty-six New York City young adult nonmedical PO users (ages 18-32) completed in-depth, semi-structured interviews. Despite initial perceptions of POs as less addictive and safer than illegal drugs, PO misuse often led to long-term opioid dependence and transition to heroin use and drug injection. Injectors in the sample reported sporadic syringe-sharing, frequent sharing of non-syringe injection paraphernalia and selective sharing with fellow injectors who are presumed "clean" (uninfected). Participants reported little knowledge of HCV injection-related risks and safer injection practices. They also reported engaging in unprotected sex with casual partners, exchange sex and group sex, and that PO misuse increases the risk of sexual violence. Prevention efforts addressing HIV/HCV risk should be targeted to young nonmedical PO users.

Who's asking the important questions? Sexual topics discussed among young pregnant couples

The aim was to examine gender differences in sexual risk communication among young couples and factors influencing communication. Sample consisted of 296 young pregnant couples. We assessed individual, interpersonal, and community factors on sexual risk communication. The Actor-Partner Independence Model was used to assess actor and partner effects on sexual risk communication. For actor effects, being female, older, not being Hispanic, and higher condom use self-efficacy was associated with sexual risk communication. The significant partner effect was avoidant romantic attachment. Gender interactions were significant for high risk behaviors and family functioning. High risk behaviors and family functioning were associated with sexual risk communication for females but not for males. The study emphasizes the need to promote sexual risk communication among young high risk couples, particularly for males. Family support could serve as a catalyst for sexual risk communication and other sexual protective behaviors among young couples.

High parental monitoring prevents adolescents from engaging in risky sexual practices in Harar, Ethiopia

BACKGROUND

Emerging findings have shown that high parental monitoring of adolescents' sexual and reproductive health (SRH) communications between parents and adolescents and good parenting styles prevent adolescents from engaging in risky sexual practices.

OBJECTIVE

The aim of this study was to examine the associations of parental monitoring, parent-adolescent SRH communications, and parenting styles with risky sexual practices among adolescents in Harar, Ethiopia.

DESIGNS

This was a cross-sectional study conducted on adolescents aged 13-18 who had sexual initiations. Adolescents who failed to use any contraceptive method and/or condom during last sexual intercourse and who experienced multiple sexual partners in the 12 months prior to the study were taken as 'at risk'. In view of these, the adolescents risk count ranged from zero to three--greater number indicates higher count of risky sexual practices. Poisson regression model was used to examine the associations and p<0.05 indicated a statistical significance.

RESULTS

It was found out that 301 of 633 (47.55%; 95% CI=43.62%, 51.45%) adolescents experienced one or more risky sexual practices. High parental monitoring compared to low decreases the Incidence Rate of engaging in risky sexual practices by 28% (adjusted incidence rate ratio, or IRR=0.72; 95% CI=0.520, 0.986). Those who had a satisfactory level of SRH communications with their parents compared to poor communicators experianced less incidence rate of risky sexual practices which was marginal (adjusted IRR=0.82; 95% CI=0.637, 1.051).

CONCLUSIONS

A significant proportion of the adolescents engaged in one or more risky sexual practices. Importantly, high parental monitoring decreases the likelihood of these risky practices. Therefore, parents need to be encouraged to keep an eye on their young children.

Change in Age-Specific, Psychosocial Correlates of Risky Sexual Behaviors Among Youth: Longitudinal Findings From a Deep South, High-Risk Sample

The current study examined psychosocial predictors of change in intercourse frequency and number of sexual partners among youth within a socio-ecological framework and assessed whether these determinants vary by stage of adolescent development. Longitudinal data were derived from a large, community study of adolescent risky behavior among predominantly high-risk, African American youth. Significant predictors of intercourse frequency for early adolescents included age, gender, self-worth, and familial factors; for older youth, age, gender, self-worth, curfews, and sense of community exerted significant effects. Among early adolescents, age, gender, self-worth, familial factors, and sense of community predicted change in the number of sexual partners in the previous year, while age, gender, self-worth, parental knowledge, curfews, and sense of community were predictive of change in the number of sexual partners in the previous year among older youth. Study implications and future directions are discussed.

SOCIO-ECOLOGICAL PREDICTORS OF INTERCOURSE FREQUENCY AND NUMBER OF SEXUAL PARTNERS AMONG MALE AND FEMALE AFRICAN AMERICAN ADOLESCENTS

The current study examined 14 waves of data derived from a large, community-based study of the sexual behavior of impoverished youth between 12 and 17 years of age residing in the Deep South. We used multilevel linear modeling to identify ecological predictors of intercourse frequency and number of sexual partners among gender-specific subsamples. Results indicated that predictors of adolescent sexual behavior differed by both type of sexual behavior and gender. For males, age, maternal warmth, parental knowledge, curfew, self-worth, and sense of community predicted intercourse frequency, while age, parental knowledge, curfew, self-worth, friend support, and sense of community were significantly associated with having multiple sexual partners. Among females, age, curfew, and self-worth exerted significant effects on intercourse frequency, while age, parental knowledge, curfew, and self-worth exerted significant effects on having multiple sexual partners. Implications and future directions are discussed.

Socioecological factors in sexual decision making among urban girls and young women

OBJECTIVES

To examine how girls and young women living in disadvantaged urban neighborhoods make decisions relating to sexual debut and HIV prevention.

DESIGN

Thirty semistructured in-depth interviews. We used a socioecological approach to investigate the role of neighborhood and social context on sexual decision making.

SETTING

Community-based organizations and on-campus interview sites.

PARTICIPANTS

African American and Latina girls and young women age 13 to 24 living in disadvantaged neighborhoods.

METHODS

We examine their attitudes and beliefs about sex, first opportunities for sexual intercourse, prevention behaviors, and neighborhood environments.

RESULTS

Lack of neighborhood safety and safe socialization places led youth to spend significant amounts of time indoors, often without adult supervision.

CONCLUSION

The findings provide insight into the socioecological context in which girls are situated as they navigate sexual decision making. Unsupervised, cloistered time coupled with peer norms to engage in sexual behavior may contribute to increased risky sexual behavior among some youth. Prevention efforts should consider neighborhood context and incorporate structural and community-level interventions to create social environments that support healthy sexual decision making.

Women Living with HIV in Rural Areas. Implementing a Response using the HIV and AIDS Risk Assessment and Reduction Model

The global fight against HIV is progressing; however, women living in rural areas particularly in sub-Saharan Africa (SSA) continue to face the devastating consequences of HIV and AIDS. Lack of knowledge and geographical barriers to HIV services are compounded by gender norms often limiting the negotiation of safe sexual practices among women living in rural areas. This paper discusses findings from a qualitative study conducted in rural areas of Mozambique examining factors that influenced women to engage in HIV risk-reduction practices. The findings from this study led to the emergence of an HIV and AIDS risk assessment and reduction (HARAR) model, which is described in detail. The model helps in understanding gender-related factors influencing men and women to engage in risk-reduction practices, which can be used as a framework in other settings to design more nuanced and contextual policies and programs.

Sexual health is dead in my body: participatory assessment of sexual health determinants by refugees, asylum seekers and undocumented migrants in Belgium and The Netherlands

Background

Although migrants constitute an important proportion of the European population, little is known about migrant sexual health. Existing research mainly focuses on migrants’ sexual health risks and accessibility issues while recommendations on adequate sexual health promotion are rarely provided. Hence, this paper explores how refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands define sexual health, search for sexual health information and perceive sexual health determinants.

Methods

Applying Community-based Participatory Research as the overarching research approach, we conducted 223 in-depth interviews with refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. The Framework Analysis Technique was used to analyse qualitative data. We checked the extensiveness of the qualitative data and analysed the quantitative socio-demographic data with SPSS.

Results

Our results indicate that gender and age do not appear to be decisive determinants. However, incorporated cultural norms and education attainment are important to consider in desirable sexual health promotion in refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. Furthermore, our results demonstrate that these migrants have a predominant internal health locus of control. Yet, most of them feel that this personal attitude is hugely challenged by the Belgian and Dutch asylum system and migration laws which force them into a structural dependent situation inducing sexual ill-health.

Conclusion

Refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands are at risk of sexual ill-health. Incorporated cultural norms and attained education are important determinants to address in desirable sexual health promotion. Yet, as their legal status demonstrates to be the key determinant, the prime concern is to alter organizational and societal factors linked to the Belgian and Dutch asylum system. Refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands should be granted the same opportunity as Belgian and Dutch citizens have, to become equally in control of their sexual health and sexuality.

A qualitative analysis of barriers to accessing HIV/AIDS-related services among newly diagnosed HIV-positive men who have sex with men in China

Summary

In China, specific HIV/AIDS-related services have been in place since 2004. However, utilisation of these services remains limited among people living with HIV. We explored barriers to accessing HIV/AIDS-related services from the perspective of newly diagnosed HIV-positive men who have sex with men. We conducted repeated in-depth interviews with 31 newly diagnosed HIV-positive men who have sex with men, using the socio-ecological framework and thematic content analysis. Multiple barriers for utilisation of HIV/AIDS-related services were identified, including perceptions of subjective health and poor quality of services, mental and emotional health problems, lack of trust and understanding of the services on offer, low economic status, lack of insurance, and high medical fees, being refused access to services, and restrictive attendance policies. The findings provide information on potential multi-level obstacles preventing newly diagnosed HIV-positive men who have sex with men to use services that they need. It is recommended that policy makers should create a trustful and non-discriminating environment and services integrating physical and mental healthcare.

A partner-related risk behavior index to identify people at elevated risk for sexually transmitted infections

The purpose of this study was to develop and test a sexual-partner-related risk behavior index to identify high-risk individuals most likely to have a sexually transmitted infection (STI). Patients from five STI and adolescent medical clinics in three US cities were recruited (N = 928; M age = 29.2 years). Data were collected using audio-computer-assisted self-interviewing. Of seven sexual-partner-related variables, those that were significantly associated with the outcomes were combined into a partner-related risk behavior index. The dependent variables were laboratory-confirmed infection with Chlamydia trachomatis, Neisseria gonorrhoeae, and/or Trichomonas vaginalis. Nearly one-fifth of the sample (169/928; 18.4%) tested positive for an STI. Three of the seven items were significantly associated with having one or more STIs: sex with a newly released prisoner, sex with a person known or suspected of having an STI, and sexual concurrency. In combined form, this three-item index was significantly associated with STI prevalence (p < .001). In the presence of three covariates (gender, race, and age), those classified as being at-risk by the index were 1.8 times more likely than those not classified as such to test positive for an STI (p < .001). Among individuals at risk for STIs, a three-item index predicted testing positive for one or more of three STIs. This index could be used to prioritize and guide intensified clinic-based counseling for high-risk patients of STI and other clinics.

Sexual risk behavior in young adulthood: broadening the scope beyond early sexual initiation

A robust link between early sexual initiation and sexual risk-taking behavior is reported in previous studies. The relationship may not be causal, however, as the effect of common risk factors is often not considered. The current study examined whether early initiation was a key predictor of risky sexual behavior in the 20s and 30s, over and above co-occurring individual and environmental factors. Data were drawn from the Seattle Social Development Project, a longitudinal panel of 808 youth. Early predictors (ages 10 to 15) and sexual risk taking (ages 21 to 24 and 30 to 33) were assessed prospectively. Early sexual initiation (before age 15) was entered into a series of probit regressions that also included family, neighborhood, peer, and individual risk factors. Although a positive bivariate relation between early sexual initiation and sexual risk taking was observed at both ages, the link did not persist when co-occurring risk factors were included. Behavioral disinhibition and antisocial peer influences emerged as the strongest predictors of sexual risk over and above early sexual initiation. These results suggest that early sexual initiation must be considered in the context of common antecedents; public health policy aimed at delaying sexual intercourse alone is unlikely to substantially reduce sexual risk behavior in young adulthood.

Influence of sexual sensation-seeking on factors associated with risky sexual behaviour among African-American female adolescents

Background The identification of antecedents to sexual risk among youth is critical to the development and dissemination of multilevel interventions. Therefore, the aim of the present study was to examine the effect of sexual sensation-seeking on partner age, partner communication, and the sexual attitudes and behaviours of African-American female youth.

METHODS

This study examined survey data collected by audio computer-assisted self-interviews from 701 young African-American females between 14 and 20 years of age. The survey consisted of items designed to measure adolescents' sexual risk and preventive behaviours.

RESULTS

The results of this study suggest that sexual sensation-seeking is associated with condom use among adolescent African-American females. For adolescents who reported greater sexual sensation-seeking, lower levels of sexual happiness were associated with a decreased likelihood of condom use at last intercourse (β=1.01, P≤0.05). For those reporting lower levels of sexual sensation-seeking, greater sexual enjoyment was associated with a greater likelihood of condom use at last intercourse (β=0.93, P≤0.01). Adolescents with younger sexual partners and lower levels of sexual sensation-seeking reported a higher proportion of condom use in the past 6 months (β=0.70, P=0.01). Higher partner communication self-efficacy and decreasing levels of sexual sensation-seeking were associated with fewer lifetime sexual partners (β=-0.54, P≤0.05).

CONCLUSIONS

Future research should address the impact of these variables on adolescent relationship dynamics and sexual decision-making.

Testing pathways linking exposure to community violence and sexual behaviors among African American youth

Exposure to community violence and HIV sexual risks are two major public health concerns among youth. This study tests various pathways linking exposure to community violence and sexual behaviors among African American adolescents. Using a sample of 563 (61% females) African American youth attending high school we examined whether problematic psychological symptoms, low school engagement, and/or negative perceptions of peer norms about safer sex functioned as pathways linking exposure to community violence and sexual behaviors. Major findings indicated that, for boys, the relationship between exposure to community violence and sexual début and sexual risk behaviors were linked by aggression. In addition, the relationship between exposure to community violence and sexual risk behaviors were linked by negative perceptions of peer attitudes about safer sex. For girls, the relationship between exposure to community violence and sexual début was linked by aggression and negative perceptions of peer attitudes about safer sex. These findings provide support for pathways linking exposure to community violence to sexual behaviors.

Having "The Talk": Individual, Family, and Partner Factors on Unprotected Sex among Female Adolescent Offenders

This study assessed the influence of individual age and substance use, family support and communication, and partner support and communication on the frequency of unprotected sex among incarcerated adolescent females. Subjects (n = 273) completed a survey on psychosocial correlates and risk behaviors for sexually transmitted infections (STI). Communication with male partners and sex while under the influence have a significant impact on condom use. Findings highlight the necessity of providing assertive communication skills training and increasing self-efficacy as STI/HIV prevention components for adolescent females thus empowering their decision-making processes.

Demographic, psychosocial, and contextual factors associated with sexual risk behaviors among young sexual minority women

Young sexual minority women are at risk for negative sexual health outcomes, including sexually transmitted infections and unintended pregnancies, yet little is known about these risks. We examined factors that may influence sexual risk from a psychosocial and contextual perspective. Analyses were conducted to examine within group relationships between sexual behaviors, negative outcomes, and related factors in a sample of young sexual minority women. Participants (N = 131) were young (mean = 19.8) and diverse in terms of race/ethnicity (57% non-White). Sex under the influence, having multiple partners, and having unprotected sex were common behaviors, and pregnancy (20%) and sexually transmitted infection (12%) were common outcomes. Risk behaviors were associated with age, alcohol abuse, and older partners. Results support the need for further research to understand how these factors contribute to risk in order to target risk reduction programs for this population.

Risky sexual behaviors in emerging adults: longitudinal changes and within-person variations

This study examined longitudinal changes in condom use inconsistency and sexual encounters involving alcohol use and the within-person associations of these two risky sexual behaviors with other personal and contextual factors. Data were drawn from a sample of college students who completed surveys on four occasions across 3 years and included 317 participants (48 % male; 32 % African American, 28 % Latino American, and 40 % European American) who reported recent penetrative sexual activities on at least one of the occasions. Multilevel models revealed that, although condom use inconsistency increased and then leveled off over time, sexual encounters involving alcohol use showed a linear increase. Moreover, at times when students held more negative attitudes toward condoms than usual, they used condoms less consistently than usual; at times when students felt more anxious about HIV/AIDS than usual, they had more sexual encounters involving alcohol use than usual; and at times when students were involved in a serious relationship, they used condoms less consistently and had fewer sexual encounters involving alcohol use than usual. Findings demonstrate the utility of a developmental perspective in understanding sexual behaviors, the importance of examining the unique correlates of different risky sexual behaviors, and the distinctiveness between within-person versus between-person associations.

HIV prevention interventions for adolescents and young adults: what about the needs of gay and bisexual males?

While rates of HIV infection among gay/bisexual male adolescents have been increasing in the U.S., there has not been a commensurate increase in the development of HIV prevention interventions targeted specifically for this population. This editorial review examines primary HIV prevention interventions published in peer-reviewed journals between 1991 and 2010 in order to explore the differential focus on heterosexual versus gay/bisexual male adolescents/young adults. Of the 92 articles reviewed, only 5 (5.44 %) included interventions that addressed gay/bisexual sexual orientation or same-gender sexual activity. HIV prevention interventions developed for adolescents/young adults in the U.S. are not targeting those at highest risk of infection. Recommendations for addressing this gap are discussed.

Determinants of HIV/AIDS-related information needs and media use: beyond individual-level factors

Despite the centrality of information and communication in the fight against HIV/AIDS, little research has investigated the factors associated with HIV/AIDS-related information needs and media use in hard-hit Sub-Saharan Africa. This study explored individual-level and socioecological determinants among urban and rural residents in northwest Ethiopia. Urbanity versus rurality, education, direct experience with HIV/AIDS, perceived salience of HIV/AIDS-related information, and personal health concern were tested as predictors. Regression analyses showed that urbanity versus rurality and education are the major determinants of HIV/AIDS-related information needs and media use. Being urbanite and educated were associated with high concern about and information needs on HIV/AIDS and HIV/AIDS-related mass media use. Moreover, urbanity versus rurality and education significantly predicted preferences for specific types of HIV/AIDS-related information. While rurality and low education were associated with a preference for basic HIV transmission and prevention information, urbanity was associated with a preference for information on HIV/AIDS-related care and support. In most cases, urbanity versus rurality emerged as a substantial predictor and also significantly moderated the effects of other variables. Given the evolving nature of the pandemic and its expansion to rural areas, ruralites' low information needs and media use deserve due attention. Equally, communication interventions targeting urban contexts need to move beyond providing only the ABCs of HIV transmission and prevention and should attend to urbanites' progressive information needs, which seem to have now become more on care and support so as to live and deal with the pandemic.

The role of the healthcare sector in the prevention of sexual violence against sub-Saharan transmigrants in Morocco: a study of knowledge, attitudes and practices of healthcare workers

BACKGROUND

Sub-Saharan transmigrants in Morocco are extremely vulnerable to sexual violence. From a public health perspective, the healthcare system is globally considered an important partner in the prevention of sexual violence. The aim of this study is twofold. In a first phase, we aimed to identify the current role and position of the Moroccan healthcare sector in the prevention of sexual violence against sub-Saharan transmigrants. In a second phase, we wanted these results and available guidelines to be the topic of a participatory process with local stakeholders in order to formulate recommendations for a more desirable prevention of sexual violence against sub-Saharan transmigrants by the Moroccan healthcare sector.

METHODS

Knowledge, attitudes and practices of healthcare workers in Morocco concerning sexual violence against sub-Saharan transmigrants and its prevention were firstly explored in semi-structured interviews after which they were discussed in a participatory process resulting in the formulation of recommendations.

RESULTS

All participants (n=24) acknowledged the need for desirable prevention of sexual violence against transmigrants. Furthermore, important barriers in tertiary prevention practices, i.e. psychosocial and judicial referral and long-term follow-up, and in secondary prevention attitudes, i.e. active identification of victims were identified. Moreover, existing services for Moroccan victims of sexual violence currently do not address the sub-Saharan population. Thus, transmigrants are bound to rely on the aid of civil society.

CONCLUSIONS

This research demonstrates the low accessibility of existing Moroccan services for sub-Saharan migrants. In particular, there is an absence of prevention initiatives addressing sexual violence against the sub-Saharan transmigrant population. Although healthcare workers do wish to develop prevention initiatives, they are dealing with structural difficulties and a lack of expertise. Recommendations adapted to the context of sub-Saharan transmigrants in Morocco are suggested.

Sexual concurrency among young African American women

Young African-American women are disproportionately affected by human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) sexually transmitted infections (STI), and engage in greater sexual concurrency than other race/ethnicities. It is important to evaluate behaviors and characteristics associated with the risk of sexual concurrency, so that interventions can target factors most likely to affect positive change. An emphasis on correlates of concurrency beyond individual-level factors has been suggested. The purpose of this study, therefore, was to identify individual- and partner-level characteristics associated with sexual concurrency among high-risk, young African-American women. Data were collected from 570 African-American adolescent women (aged 15-21) recruited from a STI clinic, a family planning clinic, and a teen clinic located in Atlanta, GA from March 2002 through August 2004. Logistic regression analysis was conducted in 2012 to evaluate correlates of sexual concurrency. Results show that almost one-quarter of participants reported sexually concurrent partnerships and 28.4% suspected male partner concurrency. Logistic regression results indicated the number of lifetime sexual partners and relationship factors were the primary contributors to engaging in concurrency in this sample. These findings suggest relationship factors may be important contributors to the prevalence of sexual concurrency among young African-American women. Interventions targeted toward sexual health among young African-American women may need to specifically address partner/relationship factors. Through these findings, we hope to better understand sexual risk taking and develop strategies that would overcome barriers to existing interventions aimed at improving the sexual health outcomes of young African-American women.

Social environment and sexual risk-taking among gay and transgender African American youth

More prevention effort is required as the HIV epidemic increases among gay and transgender African American youth. Using ecological systems theory and an integrative model of behaviour change, this study examines the sexual behaviour of gay and transgender African American young people as embedded within the unique social and structural environments affecting this population. Also examined is the important role played by mobile technology in the social and sexual lives of individuals. Seven focus groups were conducted with 54 African American young adults in a northeastern US city. The findings provide a rich examination of the social and sexual lives of gay and transgender African American youth, focusing on the social environment and the impact of the environment on sexual-risk behaviour.

A call for parental monitoring to improve condom use among secondary school students in Dar es Salaam, Tanzania

BACKGROUND

The number of people newly infected with human immunodeficiency virus (HIV) has been decreasing in sub-Saharan Africa, but prevalence of the infection remains unacceptably high among young people. Despite the alarming pervasiveness of the virus, young people in this region continue to engage in risky sexual behaviors including unprotected sexual intercourse. In developed countries, parents can play important roles in protecting young people from such behaviors, but evidence regarding the impact of parental involvement is still limited in sub-Saharan Africa. Therefore, we conducted this study to examine the magnitude of risky sexual behaviors and the association of parental monitoring and parental communication with condom use at last sexual intercourse among secondary school students in Dar es Salaam, Tanzania.

METHODS

We conducted this cross-sectional study among 2,217 male and female students aged 15 to 24 years from 12 secondary schools in Dar es Salaam. From October to November 2011, we collected data using a self-administered questionnaire. Multiple logistic regression analyses were conducted to examine the association of parental monitoring and parental communication with condom use at last sexual intercourse, adjusting for potential confounders.

RESULTS

A total of 665 (30.3%) secondary school students reported being sexually active within the year prior to data collection. Among them, 41.7% had multiple sexual partners, 10.5% had concurrent sexual partners, and 41.1% did not use a condom at last sexual intercourse. A higher level of parental monitoring was associated with increased likelihood of condom use at last sexual intercourse among male students (AOR: 1.56, 95% CI: 1.05-2.32; p = 0.03) but not among female students (AOR: 1.54, 95% CI: 0.71-3.37; p = 0.28). The association between parental communication and condom use at last sexual intercourse among both male and female students was not statistically significant.

CONCLUSIONS

A high level of parental monitoring is associated with more consistent condom use among male students in Dar es Salaam, Tanzania -- many of whom have engaged in high-risk sexual behaviors such as multiple sexual partnerships, concurrent sexual partnerships, and unprotected sexual intercourse in the past one year. Interventions should thus be strengthened to reduce multiple sexual partnerships, concurrent sexual partnerships, and to improve parental monitoring among such students toward increasing condom use.

The relationship between ethnic identity and Chlamydia and Gonorrhea infections among low-income detained African American adolescent females

This study explored the relationship between ethnic identity and Chlamydia and Gonorrhea infections among detained African American female adolescents. A cross-sectional survey was conducted among 123 African American female adolescents within eight detention facilities in Georgia. Using audio-computer assisted self-interviewing technology, data were collected on demographics, ethnic identity, laboratory-confirmed Chlamydia and Gonorrhea, and other known correlates for sexually transmitted infections (STIs), such as socioeconomic status, parental monitoring, and risky sexual behaviors. Rates of Chlamydia and Gonorrhea testing yielded incidence rates of 22.6% and 4.3%, respectively. Findings indicated that, controlling for STI correlates, participants who indicated high ethnic identity were 4.3 times more likely to test positive for an STI compared to those scoring low on the measure of ethnic identity.

Contextual and Intrapersonal Predictors of Adolescent Risky Sexual Behavior and Outcomes

The present study was designed to test a model of contextual and intrapersonal predictors of adolescent risky sexual behaviors and of sexually transmitted infection diagnoses. Using Waves I and II from the National Longitudinal Study of Adolescent Health, the authors estimated a structural model in which intrapersonal factors such as adolescents’ attitudes about sex, perceived parental norms, knowledge about sexual health, and birth-control self-efficacy partially mediated the effects of contextual factors such as parent–adolescent relationship quality, school connectedness, and exposure to AIDS and pregnancy education on a number of risky sexual behaviors and outcomes: early sex initiation, sex under the influence of substances, condom use at last intercourse, and having been diagnosed with a sexually transmitted infection. Different patterns of direct and mediated effects emerged for each sexual outcome. Results are discussed in terms of the complex interplay between environment and individual and in terms of how, when, and with whom to intervene in order to improve adolescent sexual health outcomes.

Community-based approaches for prevention of mother to child transmission in resource-poor settings: a social ecological review

INTRODUCTION

Numerous barriers to optimal uptake of prevention of mother to child transmission (PMTCT) services occur at community level (i.e., outside the healthcare setting). To achieve elimination of paediatric HIV, therefore, interventions must also work within communities to address these barriers and increase service use and need to be informed by evidence. This paper reviews community-based approaches that have been used in resource-limited settings to increase rates of PMTCT enrolment, retention in care and successful treatment outcomes. It aims to identify which interventions work, why they may do so and what knowledge gaps remain.

METHODS

First, we identified barriers to PMTCT that originate outside the health system. These were used to construct a social ecological framework categorizing barriers to PMTCT into the following levels of influence: individual, peer and family, community and sociocultural. We then used this conceptual framework to guide a review of the literature on community-based approaches, defined as interventions delivered outside of formal health settings, with the goal of increasing uptake, retention, adherence and positive psychosocial outcomes in PMTCT programmes in resource-poor countries.

RESULTS

Our review found evidence of effectiveness of strategies targeting individuals and peer/family levels (e.g., providing household HIV testing and training peer counsellors to support exclusive breastfeeding) and at community level (e.g., participatory women's groups and home-based care to support adherence and retention). Evidence is more limited for complex interventions combining multiple strategies across different ecological levels. There is often little information describing implementation; and approaches such as "community mobilization" remain poorly defined.

CONCLUSIONS

Evidence from existing community approaches can be adapted for use in planning PMTCT. However, for successful replication of evidence-based interventions to occur, comprehensive process evaluations are needed to elucidate the pathways through which specific interventions achieve desired PMTCT outcomes. A social ecological framework can help analyze the complex interplay of facilitators and barriers to PMTCT service uptake in each context, thus helping to inform selection of locally relevant community-based interventions.

Characteristics of African American adolescent females who perceive their current boyfriends have concurrent sexual partners

PURPOSE

Perceived partner concurrency, reporting that a current sexual partner has other sexual partners, may pose sexual health risks to adolescents. We examined the contextual characteristics of African American female adolescents who reported their current boyfriend was having concurrent sexual relationships.

METHODS

Participants were African American adolescent females (N = 511; mean age = 17.6) recruited from sexual health clinics. Before participating in an STD/HIV prevention trial, the participants completed audio computer-assisted self-interviews with measures of perceived partner concurrency and individual- (e.g., depression, substance use), interpersonal- (e.g., social support, interpersonal stress), and community-level factors (i.e., neighborhood quality).

RESULTS

Twenty-seven percent of participants reported their belief that their current boyfriend had concurrent sexual partners during their relationship. In a logistic regression analysis, participants endorsing perceived partner concurrency reported less relational power (adjusted odds ratio [AOR] = .94, 95% confidence interval [CI] = .89-.98, p < .01), decreased relationship commitment (AOR = .88, 95% CI = .80-.96, p < .01), elevated perceived interpersonal stress (AOR = 1.02, 95% CI = 1.003-1.04, p < .05), and previous STD diagnoses (AOR = 2.07, 95% CI = 1.31-3.28, p < .01; overall model: χ(2) = 67.25; p < .001).

CONCLUSIONS

Results suggest that the efficacy of sexual risk reduction interventions may be improved by emphasizing the increased HIV/STD risks associated with having a boyfriend with concurrent sex partners. In addition, interventions may benefit from incorporating stress management training and addressing key relationship dynamics, particularly among adolescents with a history of STDs.

Preliminary findings exploring the social determinants of Black males' lay health perspectives

The unequal discussion of Black males' health is a pressing social problem. This study addressed Black males' lay perspectives regarding their health, illness, and mortality, with attention to the determinants of men's health, prevention, lifestyle, and opportunities for health promotion using an exploratory/qualitative research methodology. Participants were 68 Black males aged 15 to 68 years, with an average age of 44 years (SD = 14.5). The narratives represented a complex interplay of biopsychosocial factors, ranging from intrapersonal attitudes, interpersonal experiences to discussions about community and public policy injustices. Five prominent themes emerged: (a) lack of chronic disease awareness, (b) fatalism, (c) fear and anxiety of academic-medical settings, (d) hyperactive masculinity fatigue, and (e) the gay-straight divide. The term Tired Black Male Health syndrome was coined in the forum. Implications of these findings are discussed in the context of culturally relevant strategies for improving Black male community health engagement.