Condom use with serious and casual heterosexual partners: findings from a community venue-based survey of young adults

Pubertal Development and Pregnancy Outcomes Among System-Involved Youth

System-involved youth are a vulnerable population at high-risk of experiencing numerous sexual reproductive health (SRH) outcomes. They are likely to have several risk factors for teen pregnancy and parenting including abuse and neglect histories, lack of a supportive consistent adult in their lives, and limited opportunities to experience normal romantic relationships. Issues of pubertal development are rarely addressed in this population. Data is from system-involved adolescents (n = 301) enrolled in a SRH intervention. The final analysis is restricted to those who were sexually active at baseline (n = 229). Most participants were African Americans between 13-21 years of age. More than 70% reported an early mean age of first sex. Approximately a quarter self-reported early pubertal development. Logistic regression was utilized to examine the odds of pregnancy in relation to self-reported pubertal timing. The findings support the need to develop programming for system-involved youth which address their unique needs.

Condom use across casual and committed relationships: The role of relationship characteristics

BACKGROUND

While the existence of a complex variety of casual sexual relationships (CSRs) has been acknowledged, studies rarely describe the prevalence of condom use across these relationships or how their hybrid nature, specifically relationship characteristics, affect condom use. This study aims to describe condom use within committed relationships and various types of casual sexual relationships (CSRs), examining the influence of relationship characteristics on condom use among culturally validated relationship types (committed, friends with benefits, hookups, booty call).

METHODS

Emerging adults (N = 728, 18-29 years, M = 22.56; SD = 3.01) completed a survey with four blocks: sociodemographics; brief sexual history; relationships over the previous year; and current relationship, assessing relationship type, ten relationship characteristics (e.g., commitment, emotional and sexual exclusivity, partner acquaintance, sexual involvement) and condom use (vaginal, oral, and anal), operationalized by three measures (use at last encounter, likert-type scale and percentage of use).

RESULTS

The results showed patterns in condom use by relationship type and illuminated how relationship characteristics-grouped into three factors: commitment, intimacy, and sexuality-mediate condom use. Condom use was more frequent in vaginal than anal and oral sex, and less frequent in committed relationships. No significant differences were found in condom use in vaginal sex between committed relationships and hookups, with condom in these relationships being significantly lower than in booty call. Intimacy mediated between all contrasts tested and condom use in vaginal sex, while sexuality mediated between committed vs. CSRs and condom use in anal and oral sex.

CONCLUSIONS

Findings point to the need of considering the diversity of CSRs for understanding condom use and highlight the role of intimacy as a relevant mechanism associated with condom use in vaginal sex and of sexuality in oral and anal sex, which should be taken into consideration in the tailoring of health promoting efforts.

Correlates of Sexual Behavior Across Fatherhood Status: Finding From the National Longitudinal Study of Adolescent to Adult Health (Add Health), 2016-2018

Amid national trends in postponed parenthood and more diverse family structures, the fatherhood identity may be important to men's sexual behaviors. This study examined factors associated with reports of consistent contraceptive use and multiple sexual partners across fatherhood status. Using public data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), Wave V (2016-2018), two sexual behaviors were examined among 1,163 men aged 32 to 42 years. Outcomes were two binary indicators: consistent contraceptive use with partner and having multiple (≥2) sexual partners in the past year. Fatherhood status was categorized as nonfather, resident father, and nonresident father. Demographic (e.g., race/ethnicity, education, income, and relationship type) and health-related (e.g., drinking, perceived stress, depressive symptoms, and insurance status) factors were considered. Logistic regression analysis produced odds ratios and 95% confidence intervals and were stratified by fatherhood categories. In the sample, 72% of men were resident fathers, 10% were nonresident fathers, and 18% were nonfathers; 28% reported consistent contraceptive use and 16% reported multiple sexual partners. For nonfathers, relationship type and race were associated with reporting multiple sexual partners. For resident fathers, relationship type was the crucial factor associated with consistent contraceptive use and reporting multiple sexual partners. In nonresident fathers, relationship type, education, and income were important factors to consistent contraceptive use and reporting multiple sexual partners. Key findings suggest that relationship type, income, and education are crucial factors to men's sexual behavior. Heterogeneous effects were observed across fatherhood status. This study adds to limited research on fatherhood and sexual behavior among men transitioning from young adulthood to middle age.

The Dynamics of Intimate Relationships and Violent Victimization Among Young Women

Despite the fact that intimate partner violence (IPV) occurs within intimate relationships, we know relatively little about the characteristics of those intimate relationships, and even less about how IPV changes across time within different relationships. We use the Relationship Dynamics and Social Life (RDSL) study, based on a random sample of 1003 18-19-year-old women residing in a Michigan county. Women were interviewed weekly for 2.5 years, resulting in an age range of 18 through 22. We estimate hybrid "within-between" regression models, which allows us to directly compare the same woman's risk of experiencing IPV across her different relationships, varied in terms of resources, balance of power, conflict, childbearing, relationship type, and duration. Our analyses demonstrate that power imbalance in intimate relationships, non-monogamous and unstable relationships, relationships with men who are not the father of a woman's existing children, and serious relationships (especially stayover and cohabiting) place young women in their late teens and early twenties at particularly high risk of multiple dimensions of IPV. Our fixed-effects modeling strategy isolated the increase in IPV risk that is due to these characteristics and experiences within intimate relationships from the risk due to young women being at high risk of IPV for other reasons who might tend to choose these types of relationships. The elevated risk of IPV in relationships with these characteristics and experiences supports a causal link between them. Our research supports the potential efficacy of interventions that reduce conflict, equalize power within relationships, and encourage women-especially young mothers-to delay serious relationships.

Longitudinal Associations Among Adolescents' Sexual Attitudes, Beliefs, and Behaviors

Youth sex and relationship education programs aim to improve adolescent well-being by changing their knowledge, beliefs, and attitudes regarding sex and their health. However, there is a gap in existing research linking these cognitive targets to relevant behaviors, and a particular dearth of data on links with sexual behaviors. The current study tested longitudinal links between cognitive factors related to sex (attitudes about sex, normative beliefs, risk-avoidant intentions, and confidence in refusal skills) and outcomes of sexual behaviors (recent sexual encounters, number of sexual partners, and frequency of condom use). Data were drawn from three waves of data from a panel study of US high-school students and were analyzed using cross-lagged structural equation modeling. We hypothesized direct, reciprocal links between intentions and behaviors, but this hypothesis was not supported. Instead, more conservative attitudes about sex emerged as the most consistent prospective predictor of fewer sexual encounters and sexual partners, though with small effect sizes (βs = - .08 to - .131, ps < .05). Further, bidirectional interrelationships were observed among several of the cognitive and behavioral variables over time. These results highlight attitudes about sex as a potentially useful intervention target, but also suggest that sex and relationship education curricula and evaluations should consider multiple pathways of links between cognition and behavior. Continued research is needed on causal links between adolescents' sexual attitudes, knowledge, intentions, and behavior.

Stigmatization of Consensual Non-Monogamous Partners: Perceived Endorsement of Conservation or Openness to Change Values Vary According to Personal Attitudes

Studies have shown that romantic partners in consensual non-monogamous (CNM) relationships are targets of stigmatization. However, little is known about the underlying mechanisms and the conditions under which such stigmatization occurs. In two experimental studies (combined N = 772), we asked participants to read the description of two partners in a relationship (monogamous vs. open relationship vs. polyamorous) and make a series of judgments about those partners. Overall results showed that CNM (vs. monogamous) partners were perceived as less trustworthy and as having more sexual health concerns (Studies 1 and 2), and as being less committed and less sexually satisfied (Study 2). Results from a conditional mediation analysis (Study 2) further showed that participants with negative attitudes toward consensual non-monogamy perceived CNM (vs. monogamous) partners as having less conservation and more openness to change values, which was then associated with more stigmatization. In contrast, participants with positive attitudes toward consensual non-monogamy perceived CNM (vs. monogamous) partners as having more openness to change values, which was then associated with less stigmatization. Taken together, these results extended the literature focused on prejudice, discrimination, and stigmatization of minority groups and highlighted key elements that can be used to buffer stigmatization.

A Trend Analysis of Condom use in Spanish Young People over the Two Past Decades, 1999-2020

HIV exposure is one of the greatest sexual risks in young people, and condom use is the best protective measure. Despite the preventive efforts, trend in condom use is still unclear. This study examines the trend of condom use by gender in Spanish young people, in different sexual practices (vaginal, oral and anal), relationships (regular and casual) and having sex after drugs consumption during the two past decades (from 1999 to 2020). For this, 14,472 people who ranged from 17 to 40 years old (63.5% women) filled the AIDS Prevention Questionnaire in each year. In general, low condom use remains stable and even gets worse regardless of the type of sexual practice, relationship and the substance consumption. Regarding gender, this trend is worse in women who have been less likely to report condom use than men have. Moreover, older people have reported a minor frequency of condom use than the youngest people have done, except for anal sex. Therefore, it is necessary to analyze why, despite preventive efforts, condom use seems to decrease over time.

Regulatory Focus and Sexual Health: Motives for Security and Pleasure in Sexuality are Associated with Distinct Protective Behaviors

We examined if motives for security (i.e., prevention focus) or pleasure (i.e., promotion focus) were uniquely associated with intentions to get tested for STIs and behavioral control over condom use, over and above variables already identified in theoretical models. We conducted an online survey with Portuguese adults (N = 836; M_age = 22.27, SD = 5.14). Overall, 99.4% of the participants knew at least one of eight STIs, but only 25.2% got tested in the last six months. Participants more focused on prevention had condomless sex less frequently, whereas participants more focused on promotion knew more STIs and got tested for more STIs. Furthermore, participants had stronger intentions to get tested for STIs if they got tested for more STIs in the past, were more concerned about STIs, perceived greater susceptibility to STI acquisition, and were more focused on promotion (but not prevention). Participants had greater behavioral control over condom use if they had condomless sex less often and were more focused on prevention (but not promotion). These findings suggest that promotion-focused people are more likely to consider the consequences of having condomless sex. In contrast, prevention-focused people are more likely to take control of their sexual health.

Patterns of sexual behaviour associated with repeated chlamydia testing and infection in men and women: a latent class analysis

BACKGROUND

Adolescents and young adults are at higher risk of acquiring Chlamydia trachomatis infection (chlamydia), so testing is promoted in these populations. Studies have shown that re-testing for chlamydia is common amongst them. We investigated how sexual risk behaviour profiles are associated with repeated testing for chlamydia.

METHODS

We used baseline data from a cohort of 2814 individuals recruited at an urban STI -clinic. We applied latent class (LC) analysis using 9 manifest variables on sexual behaviour and substance use self-reported by the study participants. We fitted ordered logistic regression to investigate the association of LC membership with the outcomes repeated testing during the past 12 months and lifetime repeated testing for chlamydia. Models were fit separately for men and women.

RESULTS

We identified four LCs for men and three LCs for women with increasing gradient of risky sexual behaviour. The two classes with the highest risk among men were associated with lifetime repeated testing for chlamydia: adjOR = 2.26 (95%CI: 1.50-3.40) and adjOR = 3.03 (95%CI: 1.93-4.74) as compared with the class with lowest risk. In women, the class with the highest risk was associated with increased odds of repeated lifetime testing (adjOR =1.85 (95%CI: 1.24-2.76)) and repeated testing during past 12 months (adjOR = 1.72 (95%CI: 1.16-2.54)). An association with chlamydia positive test at the time of the study and during the participant's lifetime was only found in the male highest risk classes.

CONCLUSION

Prevention messages with regard to testing for chlamydia after unprotected sexual contact with new/casual partners seem to reach individuals in highest risk behaviour classes who are more likely to test repeatedly. Further prevention efforts should involve potentially more tailored sex-specific interventions taking into consideration risk behaviour patterns.

Predictors of condom use among system-involved youth: The importance of Sex Ed

Sexual health education has been proven effective in improving adolescent sexual reproductive health outcomes. System-involved youth, including those in child welfare or juvenile justice systems, experience disproportionately poor outcomes as compared to youth in the general population, especially concerning STIs and early or unplanned pregnancies. Using logistic regression, this cross-sectional study examined the odds of condom use in a sample (n = 318; 61.3% males; 79.9% African American) of system-involved youth with multiple high-risk sexual behaviors. Specifically, it examined the impact of sexual health education, attitudes and beliefs about condoms, and the moderating effect of gender. The logistic regression models showed that youth were more likely to use a condom when exposed to comprehensive sexual health education (p < .05). Beliefs about condom effectiveness increased the odds of condom use in the second model (p < .01). Gender was not found to have a moderating effect. This study examined whether receiving comprehensive sexual health education and adolescent attitudes and beliefs towards condoms were associated with non-condom use using logistic regression in a sample of system-involved youth. Results suggest that comprehensive sexual health education could improve condom use in this vulnerable population.

Internet Study about Risk Factors Associated with HIV among Heterosexuals in Puerto Rico

OBJECTIVE

Heterosexual intercourse is the main mode of HIV transmission among heterosexual women in Puerto Rico and the third for men. We conducted an Internetbased study of heterosexual young adults in Puerto Rico to explore their sexual practices, beliefs and decision-making skills for HIV prevention. Data presented in this study will help to understand the factors that contribute to the sexual transmission of HIV among heterosexuals within the Puerto Rican context.

METHODS

We administered an online-based survey to a sample of 618 young adult heterosexual men and women. Data were collected using Perseus Survey Solutions software.

RESULTS

Overall, most participants expressed they had the same sexual partner in the previous six months, never or almost never used male condoms with their main partner and did not perceive themselves at-risk of contracting HIV (have a low HIV risk perception). Men reported using male condoms more frequently than women (e.g. male condom on their male partner) during vaginal sex, in particular single and younger men. Women expressed more positive attitudes toward male condoms than men.

CONCLUSION

Results confirm the need to implement interventions that increases the sense of vulnerability among heterosexuals, as well as skills and use of male condoms. This study contributes additional data on sexual practices and attitudes to encourage the identification of new or current changes in HIV protective or risk factors, specifically for an understudied population of Heterosexuals in Puerto Rico.

Taking the Maximum Risks for Satisfaction: Understanding the Process of Condom Discontinuation among National Youth Service Corps' Members in Nigeria

Objectives: To examine the process of condom discontinuation among members of the National Youth Service Corps in Nigeria who had been required to take part in a compulsory one year national service right after tertiary graduation. Methods: We used a qualitative research design to achieve this objective. Results: Findings revealed that the motivations for condom discontinuation among our sample include the need to achieve pleasure, the perception of the withdrawal method skill as an alternative to condom use, intimacy and trust among others. Cultural influence such as the promise of marriage and proof of fertility motivated both men and women to discontinue condom use. For many, intermittent condom discontinuation was normal throughout the course of relationships. Also, while verbal communication was more common among males than females, non-verbal communication strategies were employed by more of the females in their condom discontinuation behaviour. Conclusions: Overall, the findings improve our understanding of how condom discontinuation processes occur among young people and concludes that many young people (respondents) are yet to grapple with the potential consequences of unsafe sex.

How black heterosexual men's narratives about sexual partner type and condom use disrupt the main and casual partner dichotomy: 'we still get down, but we not together'

Sexual partner types and partnership dynamics have important implications for condom use. Yet most HIV prevention research conceptualises condom use as individual-level rather than dyadic-level behaviour. Evidence of a generalised HIV epidemic in urban predominantly low-income US Black heterosexual communities highlights the need for a culturally and contextually-grounded understanding of partner types, partnership dynamics and condom use from the perspective of Black heterosexual men. We conducted individual interviews with 30 self-identified men between the ages of 18 and 44, 18 (60%) of whom reported at least two partner types in the last 6 months. Key findings include: (1) 'main and casual' partner types per the HIV prevention literature; (2) three casual-partner subtypes: primary, recurrent, and one-time casuals; (3) overlapping partnership dynamics between main partners, primary-casual partners and recurrent-casual partners, but not one-time casual partners; and (4) consistent condom use reported for one-time casual partners only. The study underscores the critical need for more condom promotion messages and interventions that reflect the dyadic and culturally-grounded realities of US Black heterosexual men's sexual partner types and partnership dynamics.

The Dynamics of Intimate Relationships and Contraceptive Use During Early Emerging Adulthood

We investigate the immediate social context of contraceptive behaviors: specifically, the intimate relationship. We use the Relationship Dynamics and Social Life (RDSL) study (2008-2012), based on a random sample of 1,003 women ages 18-19 residing in a Michigan county. Women were interviewed weekly for 2.5 years, resulting in an age range of 18-22. We test three sets of hypotheses about change over time within a relationship, using relationship-level within-between models, which compare a couple's contraceptive behaviors across different times in the relationship. First, we find that a couple is less likely to use contraception when the relationship is more intimate and/or committed and that a couple becomes less likely to use contraception over time, regardless of intimacy and commitment. Second, we find that a couple using contraception becomes increasingly likely to choose hormonal over coital methods, but this change occurs as a relationship endures and is unrelated to intimacy and/or commitment. Third, we find that a condom-using couple's consistency does not decline when there is conflict; rather, consistency of condom use declines over time regardless of the relationship's characteristics. We also demonstrate that conflict and power imbalance increase reliance on hormonal methods among those using contraception; conflict decreases consistency among withdrawal (but not condom) users; and nonmonogamy increases reliance on condoms and decreases withdrawal consistency. The strong and consistent link between duration and contraceptive behaviors-regardless of intimacy, commitment, conflict, or power imbalance-suggests that the continual vigilance required for long-term contraceptive use is difficult during early emerging adulthood.

The impact of semen testing for Ebola virus RNA on sexual behavior of male Ebola survivors in Liberia

Sexual transmission of Ebola virus (EBOV) is well established and has been implicated in multiple resurgences during the West African Ebola epidemic. Given the persistence of viral RNA in semen, guidelines from the World Health Organization (WHO) recommend abstinence or condom use for at least 1 year or until two semen PCR tests are negative. To better understand the impact of semen testing on sexual behavior, male EVD survivors were surveyed regarding their sexual behavior before and after semen testing. Of the 171 men who enrolled, 148 reported being sexually active following discharge from an ETU with 59% reporting episodes of condomless sex. At least one semen sample for testing was provided by 149 men and 13 of these men had EBOV RNA detected in their semen. When comparing sexual behaviors before and after semen testing, a positive semen test result had limited impact on behavior. Of those with seminal EBOV RNA detected, 61% reported no change in behavior pre- and post-semen testing with 46% engaging in condomless sex before and after testing and only 1 adopted safer sex behaviors following receipt of a positive result. Similarly, among men with undetectable EBOV in their semen, 66% reported no change in sexual behaviors with semen testing, with 55% forgoing condoms during sex. In only 11% was a negative semen result followed by abandoning condoms. There were no known sexual transmission events of Ebola virus in this cohort despite viral presence in semen during periods of condomless sex. This highlights the need to better understand the infectious potential of viral RNA persistence and determine what constitutes effective counseling for survivors and their partners.

Ebola virus (EBOV) is established as a sexually transmitted infection, however there is limited information on the sexual behaviors of Ebola survivors. We surveyed a cohort of male Ebola survivors regarding sexual activity and condom use and offered semen testing to assess EBOV persistence in semen. We found that a large majority of men who were sexually active prior to contracting Ebola Virus Disease remained sexually active after their recovery with most reporting only intermittent condom use. Semen testing for the presence of Ebola virus had limited impact on sexual behaviors, with most continuing to report engaging in condomless sex whether EBOV was detected or not. This finding has implications for use of semen testing for outbreak control as well as counseling for Ebola survivors and their partners.

Sexually Transmitted Infection Risk Reduction Strategies Among US Adolescents and Adults With Multiple Opposite-Sex Sex Partners or Perceived Partner Nonmonogamy, 2011-2017

BACKGROUND

This study examined condom use and sexually transmitted infection (STI) testing among unmarried, non-cohabiting women and men who had multiple past-year partnerships or perceived their partner's involvement in another sexual relationship.

METHODS

We identified 5868 and 5330 unmarried, non-cohabiting sexually active women and men aged 15 to 44 years using National Survey of Family Growth data for 2011 to 2017. To measure multiple partnerships, we created 4 dichotomous variables that included both past-year number of opposite-sex sex partners (1, 2 or more) and perceived partner nonmonogamy (PPNM) (yes, no). Results were stratified by relationship type at last sex ("steady" vs "casual").

RESULTS

Overall, 39.4% of women and 48.3% of men reported multiple partnerships and 23.4% and 24.0% reported PPNM. Lower condom use was seen for women and men who had 2 or more partners in the past year and PPNM than those with only 1 partner and no PPNM (women, 28.5%; 95% confidence interval [CI], 24.1-32.9 vs 39.3%; 95% CI, 36.6-41.9) (men, 37.7%; 33.5-41.8 vs 54.9%; 51.9-57.9). STI testing was higher for groups with PPNM. Men with a steady sex partner had higher prevalence of past-year STI testing if they reported PPNM than not (adjusted prevalence ratio, 2.00; 95% CI, 1.63-2.45).

CONCLUSIONS

Screening practices that include a standardized sexual risk assessment could identify those with multiple sex partners or PPNM and improve linkage to STI services. Availability of point-of-care tests and expedited partner therapy could provide targeted strategies that prioritize rapid diagnosis and effective partner treatment which may prevent further STI spread.

Intimate relationship dynamics and women's expected control over sex and contraception

OBJECTIVE

We examined whether women's experiences across and within their intimate relationships affect their expected level of control over sex and contraceptive use.

STUDY DESIGN

We used data from 648 women ages 18-20 in the Relationship Dynamics and Social Life (RDSL) study, which interviewed a random, population-based sample in a Michigan county. We used ordered logistic regression with fixed-effects to control for individual- and relationship-level characteristics.

RESULTS

We found a u-shaped relationship between intimacy/commitment and expected control, with the lowest expected control in the least intimate/committed and the most intimate/committed relationships, and the highest expected control in the intermediate relationships. Women expected more control in their long-term compared to short-term relationships, and expected control increases over time in a specific relationship. Women also expected less control in their conflictual and/or asymmetric relationships - those with older and/or violent partners, and expected control decreases after experiencing violence or a partner's non-monogamy.

CONCLUSIONS

Our results are consistent with cross-sectional research suggesting that women in violent relationships experience more reproductive coercion than women in non-violent relationships, but we also found that other aspects of intimate relationships are important determinants of expected control over sex and contraception.

IMPLICATIONS

Intervention strategies should consider a wider range of intimate relationship characteristics - beyond violence - to improve women's control of their reproductive behaviors.

Intimate Relationship Dynamics and Changing Desire for Pregnancy Among Young Women

CONTEXT

Although substantial research has focused on unintended pregnancy among young women, less is known about the circumstances under which pregnancy is desired. Whether a young woman's pregnancy desire changes across her different relationships, or over time within a relationship, has not been directly assessed.

METHODS

Data on intimate relationships and pregnancy desire were assessed weekly for 895 women aged 18-22 who participated in the Relationship Dynamics and Social Life study in a county in Michigan (2008-2012). Within-between logistic regression models were used to examine within-cluster and between-cluster differences-comparisons of a woman's pregnancy desire within a relationship over time as well as across a woman's different relationships.

RESULTS

Young women were more likely to desire pregnancy if they were in any relationship more intimate and committed than a casual relationship (odds ratios, 1.6-9.2); the odds of desiring pregnancy were also higher in long-term relationships rather than in short-term ones (2.1). In general, pregnancy desire increased over time as a relationship endured and became more serious. The odds of desiring pregnancy were lower among women with less educated, rather than equally educated, partners (0.7), while the odds were higher in nonmonogamous or violent relationships than in monogamous or nonviolent relationships (1.6 and 1.9, respectively).

CONCLUSIONS

Young women's pregnancy desire changes depending on their intimate relationship context, across the range of relationships they experience during the transition to adulthood.

Towards an Information Motivation and Behavioral Skills Model for New Sex Partners: Results of a Study of Condom Use as an HIV Prevention Method for Emerging Adults Who Met Partners on Dating and Sex-Seeking Platforms or Offline

The information, motivation, behavioral Skills (IMB) model was used to identify factors that affect condom use with new sex partners that were met offline or online. Mixed methods data were collected from adults between the ages of 18 and 29 years who reported a new sex partner. A model was composed of participants' IMB scale scores to determine the effect of these variables on condom use. A subset of 20 survey participants completed interviews exploring how IMB model elements may have influenced their condom use. Mixed methods results showed condom use skills were influential for condom use during the first sexual encounter between new partners. Qualitative findings suggest the information and motivation may also influence condom use with new sex partners. The IMB model for new partners may be relevant model for the development of interventions that encourage emerging adults to use condoms at first sex with new sex partners.

Sexual risk among African American girls seeking psychiatric care: A social-personal framework

OBJECTIVE

This study examined individual and social factors associated with sexual risk behavior among African American girls seeking outpatient mental health services across 2 years and key developmental transitions.

METHOD

African American females 12-16 years old (M = 14.5; SD = 1.15; n = 266) were recruited from eight outpatient mental health clinics and completed interviewer-administered and computer-assisted measures at baseline, 12, and 24 months. Analyses tested individual attributes (externalizing and internalizing problems) and family context (maternal acceptance-rejection, mother-daughter communication about sex) at baseline, peer influences (peer support of substance use, girlfriend dating behavior) and partner relationship characteristics (rejection sensitivity, partner risk communication frequency and openness) at 12 months, and girls' sexual behavior at 24 months.

RESULTS

At baseline, 32% of girls reported having had vaginal/anal sex compared with 60% at 24 months. Data analyses revealed robust associations between externalizing problems and maternal acceptance-rejection and mother-daughter risk communication during early adolescence, peer support of substance use and girlfriend dating behavior 1 year later, and girls' sexual risk taking 2 years later.

CONCLUSION

Findings support a social-personal framework (SPF) of sexual risk for African American girls seeking mental health care, underscoring the potential benefits of early intervention to reduce externalizing problems while strengthening mother-daughter communication and relationships to prevent subsequent sexual risk and associated negative outcomes. (PsycINFO Database Record

Is Online Partner-Seeking Associated with Increased Risk of Condomless Sex and Sexually Transmitted Infections Among Individuals Who Engage in Heterosexual Sex? A Systematic Narrative Review

Use of Internet websites and mobile applications to meet potential romantic and sexual partners is becoming increasingly popular. While the Internet might foster better communication and sexual negotiation between partners, it can also be a deceptive environment that instigates and accelerates sexual risk-taking. Given the complexities of the Internet, it is critical to examine the association between risky sexual behaviors (RSBs) and online partner-seeking. Five databases (i.e., Google Scholar, PubMed, PsycINFO, Web of Science, and Ovid Medline) were searched for articles published before September 10, 2017, that examined the association between online partner solicitation (either for romantic and/or sexual reasons) and RSBs. Studies were eligible for inclusion if they were empirical papers published in English-language peer-reviewed journals looking at samples of online partner seekers who practice heterosexual sex (with a comparison group) and reporting either condom use or sexually transmitted infections (STIs) status, which were the two primary outcomes. A total of 25 studies met the criteria to be included in our review. Results from this literature search do not indicate a clear association between online partner-seeking and condom use or STI status. Potential moderators (i.e., age, gender, reasons for online partner solicitation, duration of Internet correspondence, and Internet modalities) that should be included in future research were identified. Sexual health prevention efforts should address methods to negotiate safe practices between sexual partners and to encourage healthy non-virtual relationships, particularly among vulnerable populations.

High Prevalence of Inconsistent Condom Use With Regular Female Sex Partners Among Heterosexual Male Sexually Transmitted Disease Patients in Southern China

This study was to investigate the prevalence of and factors associated with inconsistent condom use with regular female sex partners (RPs) among heterosexual male STD patients (MSTDPs) in China. We interviewed 413 MSTDPs who had had sex with at least one RP and had received a diagnosis within the past week to six months. The prevalence of inconsistent condom use with RPs was 42.9% since STD diagnosis. Associated factors included perceptions related to condom use, regret about the decision of having unprotected sex with RP, and perceived personal partners' responsibility of using condoms.

A Qualitative Assessment to Understand the Barriers and Enablers Affecting Contraceptive Use Among Adolescent Male Emergency Department Patients

Early fatherhood is common in the United States (U.S.). The emergency department (ED) plays a disproportionate role in serving patients with unmet reproductive and sexual health needs. With 8 million adolescent males visiting U.S. EDs annually, the ED is a potential site to implement interventions to minimize early fatherhood and unintended teenage pregnancy. Little is known about how adolescent male ED patients perceive and behave in sexual relationships and how they influence contraceptive decision making. The objective of this study was to identify the barriers and enablers affecting contraceptive and condom use among adolescent male ED patients. Semistructured interviews were conducted with males aged 14-19 in one urban ED. Enrollment continued until saturation of key themes. Interviews were recorded, transcribed, and coded based on thematic analysis using NVivo 10. The Social Ecological Model was used to organize and understand themes. Participants ( n = 24) were predominantly 18-19 years (63%) and Hispanic (92%). Most (71%) had sex ≤3 months prior but infrequently used a condom at last intercourse (42%). The primary barrier influencing contraceptive use was lack of knowledge of effective contraceptives. Other barriers consisted of perceived gender roles, poor partner communication, and little relationship with a primary provider. Enablers included intention not to get a partner pregnant, school-based sexual health education, normalcy to use condoms, and a trustworthy confidante. The identified barriers and enablers influencing adolescent males' perspectives toward contraceptives should be addressed if designing future ED-based pregnancy prevention interventions targeting teen males.

Physical Intimate Partner Violence and Contraceptive Behaviors Among Young Women

BACKGROUND

Understanding the link between physical intimate partner violence (IPV) and contraception is key to preventing unintended pregnancy and sexually transmitted infections.

MATERIALS AND METHODS

Data from the Relationship Dynamics and Social Life study, a longitudinal study of a racially and socioeconomically diverse population-representative random sample of 18- to 19-year-old women residing in a Michigan county in 2008-2009 and followed weekly through 2011-2012, were used. Logistic regression models of contraceptive behaviors on temporally specific measures of physical violence victimization: recent, history in the current relationship, and history in prior relationships were conducted among 711 women.

RESULTS

Women who experienced physical IPV in their current relationship had lower odds of using contraception (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.28, 0.76 for recent; OR, 0.53; 95% CI, 0.33, 0.83 for past). Condom use was lower among women who experienced past physical IPV in their current relationship (OR, 0.44; 95% CI, 0.26, 0.73), while withdrawal use was higher (OR, 1.99; 95% CI, 1.24, 3.19). Women who experienced physical IPV used condoms less consistently (OR, 0.34; 95% CI, 0.13, 0.85 for recent; OR, 0.27; 95% CI, 0.14, 0.52 for prior relationships).

CONCLUSIONS

Physical IPV victimization is a dynamic and strong predictor of contraceptive use, method type, and consistency of condom use.

Contraceptive Method Use and Chlamydia Positivity Among California Family Planning Clients: The Case for New Multipurpose Prevention Technologies

BACKGROUND

Adolescent girls and young women experience high rates of sexually transmitted infection (STI) with currently available contraceptive methods, yet few studies examine the burden of chlamydial infection by contraceptive method used.

MATERIALS AND METHODS

In this cross-sectional analysis, we linked July 2012-June 2013 claims from a publicly-funded family planning program in California to chlamydia laboratory test results. Female clients were classified by the most effective contraceptive method reported by providers during the year: tier 1 (high-efficacy permanent or long-acting reversible methods), tier 2 (shorter-acting hormonal methods), or tier 3 (barrier methods, emergency contraception, or natural family planning). In addition, we identified clients who received condoms from providers. We used log-binomial models to estimate adjusted prevalence ratios comparing chlamydia positivity by contraceptive method(s).

RESULTS

Of 74,636 female clients of ages 15-29 years with chlamydia test results, 5.1% had at least one positive test during the year. Chlamydia positivity was highest among tier 2 users (5.3%) compared with 4.5% and 4.9% among tiers 1 and 3 users, respectively (p < 0.001). Positivity was higher among clients who received condoms from providers than those who did not (6.3% vs. 4.3%, p < 0.001). In adjusted analyses, there were no significant differences in positivity by contraceptive tier. However, clients who received condoms had 1.32 (95% confidence interval: 1.24-1.40) times the positivity of those who did not.

CONCLUSIONS

We found high chlamydia positivity among young female family planning clients regardless of contraceptive method. The development and provision of additional Multipurpose Prevention Technologies that confer protection against both pregnancy and STIs may help to address unmet need for STI prevention.

Norms and stigma around unintended pregnancy in Alabama: Associations with recent contraceptive use and dual method use among young women

The role of unintended pregnancy norms and stigma in contraceptive use among young women is understudied. This study investigated relationships between anticipated reactions from others, perceived stigma, and endorsed stigma concerning unintended pregnancy, with any and dual contraceptive use in this population. From November 2014 to October 2015, young women aged 18-24 years (n = 390) and at risk for unintended pregnancy and sexually transmitted infections participated in a survey at a university and public health clinics in Alabama. Multivariable regression models examined associations of unintended pregnancy norms and stigma with contraceptive use, adjusted for demographic and psychosocial characteristics. Compared to nonusers, more any and dual method users, were White, nulliparous, and from the university and had higher income. In adjusted models, anticipated disapproval of unintended pregnancy by close others was associated with greater contraceptive use (adjusted Odds Ratio [aOR] = 1.54, 95 percent confidence interval [CI] = 1.03-2.30), and endorsement of stigma concerning unintended pregnancy was associated with lower odds of dual method use (aOR = 0.71, 95 percent CI = 0.51-1.00). Unintended pregnancy norms and stigma were associated with contraceptive behavior among young women in Alabama. Findings suggest the potential to promote effective contraceptive use in this population by leveraging close relationships and addressing endorsed stigma.

Do Associations Between Pleasure Ratings and Condom Use During Penile-Vaginal Intercourse Vary by Relationship Type?: A Study of Canadian University Students

Research suggests the relationship between pleasure and condom use during penile-vaginal intercourse (PVI) is associated with relationship status. This online study examined pleasure ratings and condom use at last PVI, stratifying by partner type, among a national sample of Canadian university students. Participants were 715 undergraduates (60.7% women, 39.3% men) who reported on their most recent sexual experience. Condom use decreased with level of relationship commitment, whereas ratings of pleasure increased. Overall, participants were more likely to rate their most recent PVI as Very pleasurable when condoms were not used compared to when condoms were used. However, when stratified by partner type, these differences largely disappeared. For women, with one exception, there were no differences in pleasure between PVI with and without condoms across most partner-type categories. Women in committed dating relationships were more likely to report their last PVI as very pleasurable if condoms were not used than women in these same relationships who had used condoms. Across relationship categories, men who did and did not use condoms did not differ in terms of their pleasure ratings. The results of this study suggest relationship context should be taken into account when assessing condom use experiences.

Measurement of Social Norms Affecting Modern Contraceptive Use: A Literature Review

As a critical building block to developing social norms interventions to support healthy family planning and other reproductive health behaviors, we conducted a literature review to identify and evaluate social norm measures related to modern contraceptive use. Of 174 articles reviewed in full, only 17 studies met our criteria for inclusion. Across these articles, no single measure of norms was used in more than one study; failure to specify the boundaries of who was engaging in and influencing the behaviors of interest contributed to the variation. Most of the studies relied on cross-sectional data, only included condom use as their contraceptive use outcome, used individual- or interpersonal-level behavior change theories rather than social-level theories, and assumed a reference group, all of which limit the quality of the norm measures. We make several recommendations to bring greater consistency and comparability to social norm measures.

Motivating factors for dual-method contraceptive use among adolescents and young women: a qualitative investigation

OBJECTIVE

This qualitative study explores how adolescents and young women perceive the need for and describe the use of dual method contraception.

STUDY DESIGN

We interviewed 20 sexually active women aged 16-24 who attended an adolescent-focused Title X family-planning clinic and were using a non-barrier contraceptive method. We used a semi-structured interview guide that included domains related to sexual activity, knowledge of and use of contraceptives and condoms, and relationship factors. We coded transcripts using grounded theory techniques and used an iterative process to develop overarching themes.

RESULTS

Dual method contraceptive users primarily discussed pregnancy prevention as their motivating factor. Many expressed anxieties over an unplanned pregnancy and reported condom use as "back-up" contraception. Risk perception for pregnancy or STI acquisition did not necessarily change as relationship trust increased, but rather, their anxiety regarding the negativity of such outcomes decreased. Dual-method contraception use decreased when participants reported that condoms were not readily available, or when they self-described immaturity. Less frequently, participants reported dual method use for sexually transmitted infection (STI) prevention, and many substituted STI testing for condom use. Contraceptive type (short-acting vs. long-acting) did not influence reported attitudes towards dual method use.

CONCLUSION

Health educators and clinicians encourage condom use in young women due to the significant morbidity associated with STI acquisition. Most participants in our study view condoms as a way to improve pregnancy prevention. Acknowledging and addressing this divergence in motivation will allow caregivers to improve strategies for communicating the importance of dual method use.

IMPLICATIONS

Young women primarily describe pregnancy prevention as the reason for dual method use, STI protection is less salient. Consideration of this viewpoint by health educators and clinicians will allow us to communicate more effectively to prevent STI morbidity.

Racial/Ethnic Differences in Young Women's Health-Promoting Strategies to Reduce Vulnerability to Sexually Transmitted Infections

PURPOSE

Young women of color in the United States are disproportionately affected by sexually transmitted infections (STIs). We characterize the protective behaviors used by young women to reduce their vulnerability to STI acquisition and examine how STI prevention strategies differ by race/ethnicity.

METHODS

From 2015 to 2016, women aged 13-24 years presenting to five Northern California family planning clinics were surveyed about their STI prevention strategies. The chi-squared tests and multivariable logistic regression identified associations between race/ethnicity and use of sexual health-promoting strategies.

RESULTS

Among 790 women, the most common strategies included condom use (67%), asking partners about STIs (47%), limiting sexual partners (35%), frequent STI screening (35%), and asking partners about other sexual partners (33%). Black, Hispanic, and Asian women had decreased odds of utilizing strategies before intercourse compared with white women (adjusted odds ratio [aOR]black: .25, confidence interval [.14-.47]; aORHispanic: .36, CI [.20-.65]; aORAsian: .44, CI [.23-.84]). Black women had decreased odds of using strategies requiring partner involvement (aORblack: .35, CI [.13-.92]). White women were more likely to report that providers discussed condoms (aOR: 2.53, CI [1.04-6.15]) and talked to partners about STIs (aOR: 2.56, CI [1.52-4.32]) compared with nonwhite women. Black and Hispanic women were more likely to feel very uncomfortable discussing lifetime sexual partners (aORblack: 4.26, CI [1.36-13.30] and aORHispanic: 5.35, CI [1.79-15.99]) and condom use (aORblack: 3.05, CI [1.14-8.15] and aORHispanic: 2.86, CI [1.11-7.35]) with providers.

CONCLUSIONS

Young women use diverse strategies to prevent STIs that vary by race/ethnicity. Providers can use these findings to improve sexual health counseling and promote equitable education and services.

How Condom Discontinuation Occurs: Interviews With Emerging Adult Women

We have almost no data on how and when couples stop using condoms. This qualitative study investigated the process of condom discontinuation. From November 2013 to April 2014, a total of 25 women living in a college town in the Midwest, ages 18 to 25, participated in semistructured interviews centered around three domains: partner interactions, contraceptive use, and sexually transmitted infection (STI) prevention. Analysis followed a critical qualitative research orientation. Participants described actively seeking the best options to prevent pregnancy, perceiving condom discontinuation in favor of hormonal methods as a smart decision, and reported wanting to discontinue using condoms due to physical discomfort. Oftentimes, nonverbal communication around contextual instances of condom unavailability paved the way for discontinuation. Participants indicated the decision to stop using condoms was neither deliberate nor planned. Condom discontinuation rarely occurred at one point in time; instead, it was preceded by a period of occasional use. Even after participants described themselves as not using condoms, sporadic condom use was normal (typically related to fertility cycles). This study provides a more detailed understanding of how and why emerging adults negotiate condom discontinuation, thereby enhancing our ability to design effective condom continuation messages. Attention should be paid to helping emerging adults think more concretely about condom discontinuation.

Prevalence and correlates of condom use among single midlife Canadian women and men aged 40 to 59

Reported rates of sexually transmitted infections (STIs) among midlife Canadians have increased. However, there is little data on the STI behavioural risk of this age group. The current study investigated the prevalence and correlates of condom use at last penile vaginal intercourse (PVI) among sexually active single (never married, separated/divorced) Canadians aged 40 to 59 (n=830). Men were more likely than women to report using a condom at last PVI (35.3% vs. 27.6%). Number of partners, dating status, partner type at last sex, and concern about STI were significant bivariate predictors of condom use among men and women. Age, marital status, and erectile difficulties were additional bivariate predictors for men. In multivariate analysis, marital status, number of partners, and partner type predicted condom among men. Divorced and separated men were 53% less likely to use a condom than single, never married men. Men who reported 2 or more partners over the past year were almost 2 times more likely to use a condom than men who had one partner over the past year. As partner type at last sex moved from casual to more committed, men were 26% less likely to report condom use at last PVI. Among women, partner type at last sex was the only significant multivariate predictor of condom use, as partner type moved from casual to more committed, condom use was 33% less likely. Condom use was not associated with decreased pleasure during PVI. Educational STI prevention interventions targeting single midlife Canadians are needed.

The Strategies of Heterosexuals from Large Metropolitan Areas for Assessing the Risks of Exposure to HIV or Other Sexually Transmitted Infections from Partners Met Online

Heterosexuals' use of the Internet for meeting romantic or sexual partners is rapidly increasing, raising concerns about the Internet's potential to facilitate encounters that place individuals at risk for acquiring HIV or other sexually transmitted infections (STIs). For example, online sharing of personal information and self-revelations can foster virtual intimacy, promoting a false sense of familiarity that might accelerate progression to unprotected sex. Therefore, it is critical to understand how those who meet sexual partners online attempt to assess the possible risk of acquiring HIV or STIs posed by having unprotected sex with a new partner and decide whether to use a condom. To investigate this issue, in-depth interviews were conducted with a diverse sample of heterosexual male and female participants from large metropolitan cities who had had unprotected vaginal or anal sex with at least two partners met online in the past 3 months. With few exceptions, participants relied on faulty strategies and heuristics to estimate these risks; yet, most engaged in unprotected sex at their first meeting or very soon afterward. While some seemed to try to make a genuine effort to arrive at a reliable assessment of the HIV risk posed, most appeared to be looking for a way to justify their desire and intention to have unprotected sex. The findings suggest the need for more HIV and sexual health education targeted at heterosexuals, especially for those who go online to meet partners.

Condom-Insistence Conflict in Women's Alcohol-Involved Sexual Encounters with a New Male Partner

First-time sexual intercourse with a new male partner, relative to other sexual encounters, is associated with heightened risk to women for contracting sexually transmitted infections. Little is known, however, about women's condom-related decision-making processes during these first-time sexual encounters. In the present study, we surveyed a community sample of 179 women aged 18-30 about their alcohol consumption, desire to use a condom, perception of their partner's desire to use a condom, condom-insistence conflict, and condom-decision abdication and use during their most recent alcohol-involved first-time sexual encounter with a new partner. With structural equation modeling we tested a cognitive mediation model with various configurations of alcohol effects on abdication and condom use (direct, indirect, moderator). A moderated mediation model fit the data best. Women experienced elevated condom-insistence conflict when they wanted to use a condom and perceived their partner did not; conflict, in turn, was associated with higher likelihood of abdication and lower likelihood of condom use. Higher alcohol intoxication attenuated the associations of desire to use a condom, and perceived partner's desire to use a condom, with conflict. Results support an alcohol myopia-conflict inhibition-reduction model and emphasize the importance of sex education programs that teach young women not only about condom-related assertiveness and the effects of alcohol, but also prepare them to respond to experiences of conflict that arise during sexual encounters.

Sex Partner Type, Drug Use and Condom Use Self-Efficacy Among African Americans from Disadvantaged Neighborhoods: Are Associations with Consistent Condom Use Moderated by Gender?

Gender inequalities in sexual behavior are explored from the perspective of the theory of gender and power. This study focused on the effect of sex partner type (steady versus casual), drug use, and condom use self-efficacy regarding consistent condom use (CCU) among a community-based sample of adults. The sample included 1,357 African American men and women (M age 37.0, SD 13.1 years; 44% women, 66% men) from 61 disadvantaged census block groups in Atlanta, GA as part of a study of individual and neighborhood characteristics and HIV risk-taking. Having a steady partner decreased the odds of CCU, while higher condom use self-efficacy increased the odds of CCU. Among non-drug users, having a drug-using partner was associated with decreased odds of condom use for women only. Women with drug-using partners, especially a steady partner, were least likely to report CCU. Therefore, interventions intended to empower CCU among women need to expand beyond acknowledging the reduced control that women who use drugs demonstrate to also consider those who have drug-using sexual partners.

Sex, love and money along the Namibian-Angolan border

In sub-Saharan Africa, young women engaged in relationships with multiple partners in order to gain material benefits play a key role in local HIV dynamics. This paper is based upon field observations and interviews with 38 young women who live along the Angolan-Namibian border. In the last 10 years, rapid urbanisation has attracted migrants in search of opportunities to do business in the region. Our findings show that sexual-affective economic networks reflect these socioeconomic changes. Women, particularly those from particular ethnic groups and/or from Namibia, with low levels of formal education and social support are often excluded from the labour market and turn to emotional-sexual male-centred networks for material and financial benefits. Men in these networks tend to be older, have higher socioeconomic status and greater geographic mobility. This 'capitalisation' of intimate relationships is material and symbolic; it enables women to acquire goods and access to services identified with an urban and globalised lifestyle. It is also emotional because relationships include affection and pleasure. Engaging in these relationships involves some social risks (bad reputation, family rejection, discrimination and violence), but maintaining ties often takes priority over safer sex and social sanctions.

Establishment of safety paradigms and trust in emerging adult relationships

There is a critical need to understand the interplay between relationship trust and public health outcomes. The purpose of this study was to develop an understanding of emerging adult women's processes of establishing trust in sexual relationships. Twenty-five women aged 18-24 years participated in semi-structured interviews. Throughout the interviews, women compared and contrasted experiences in which they felt comfortable engaging in sexual intercourse with a partner versus times in which they did not feel comfortable. Analysis was based on a critical qualitative research orientation. When asked to speak to instances when they felt comfortable having sex, most women spoke about relationship trust. Many participants conceptualised trust based on past experiences with bad relationships or sexual violence. Based on their previous experiences of feeling unsafe or undervalued, emotional and physical security became prioritised in relationship development. Trust was developed through friendship, communication over time, and through shared life experiences. This research is among the first to qualitatively investigate trust formation and other impersonal dynamics related to sexual health decision-making. Insights from this study should be translated into future action by public health practitioners to promote healthy sexual relationships and communication about sexual health topics as a form of trust building.

Exploring Factors Associated with Recent HIV Testing among Heterosexuals at High Risk for HIV Infection Recruited with Venue-based Sampling

Annual HIV testing is recommended for high-risk populations in the United States, to identify HIV infections early and provide timely linkage to treatment. However, heterosexuals at high risk for HIV, due to their residence in urban areas of high poverty and elevated HIV prevalence, test for HIV less frequently than other risk groups, and late diagnosis of HIV is common. Yet the factors impeding HIV testing in this group, which is predominantly African American/Black and Latino/Hispanic, are poorly understood. The present study addresses this gap. Using a systematic community-based sampling method, venue-based sampling (VBS), we estimate rates of lifetime and recent (past year) HIV testing among high-risk heterosexuals (HRH), and explore a set of putative multi-level barriers to and facilitators of recent testing, by gender. Participants were 338 HRH African American/Black and Latino/Hispanic adults recruited using VBS, who completed a computerized structured assessment battery guided by the Theory of Triadic Influence, comprised of reliable/valid measures on socio-demographic characteristics, HIV testing history, and multi-level barriers to HIV testing. Logistic regression analysis was used to identify factors associated with HIV testing within the past year. Most HRH had tested at least once (94%), and more than half had tested within the past year (58%), but only 37% tested annually. In both men and women, the odds of recent testing were similar and associated with structural factors (better access to testing) and sexually transmitted infection (STI) testing and diagnosis. Thus VBS identified serious gaps in rates of annual HIV testing among HRH. Improvements in access to high-quality HIV testing and leveraging of STI testing are needed to increase the proportion of HRH testing annually for HIV. Such improvements could increase early detection of HIV, improve the long-term health of individuals, and reduce HIV transmission by increasing rates of viral suppression.

Black Women with Multiple Sex Partners: The Role of Sexual Agency

Motivations of low-income substance using heterosexual Black women in New York City for having multiple sexual partners are explored in this paper. Analysis of in-depth interviews with 50 study participants demonstrates that their relationships consisted of those who had: (1) a main sex partner and a secondary sex partner; or (2) two or more "casual" partners. Individual-level motivations for extra relational sex fell into four dominant themes: sexual pleasure, partner infidelity, sex exchange and past main partners. Using a Black feminist framework, we describe how participants displayed considerable autonomy by actively forming and withdrawing from sexual relationships with men. However, women described low rates of condom use with main partners and inconsistent use of condoms with more casual sexual partners. This contradiction becomes an important area for sexual health interventions. Women who had sexual relations with only one current mate in the past two years were recruited as a monogamous comparison group.

A Question of Love and Trust? The Role of Relationship Factors in Adolescent Sexual Decision Making

OBJECTIVE

While representing only 25% of the sexually active population, 50% of all new sexually transmitted infections occur among young people mostly because of inconsistent condom use. Critically, the majority of adolescent sexual activity takes place in the context of romantic relationships; thus, it is important to understand how relationship factors may influence decision making about the use of protection.

METHODS

We used a mixed-method approach to investigate the extent to which relationship length, degree of trust or love in the relationship, and frequency of intercourse influence both perceptions of the probability of condom use and self-reported condom use in the context of relationships among a diverse sample of high-risk adolescents (age 12-19 yr).

RESULTS

Participants were least likely to use condoms if they were in relationships with high trust or love and high frequency of intercourse. Importantly, sexual experience status was a strong moderator of primary effects.

CONCLUSION

The perspective of motivated cognition provides a useful theoretical framework to better understand adolescent decision making about condom use, particularly for sexually experienced youth.

The Role of Sexual Health Professionals in Developing a Shared Concept of Risky Sexual Behavior as it Relates to HIV Transmission

"Risky sexual behavior" accounts for the majority of new HIV infections regardless of gender, age, geographic location, or ethnicity. The phrase, however, refers to a relatively nebulous concept that hampers development of effective sexual health communication strategies. The purpose of this paper was to propose development of a shared conceptual understanding of "risky sexual behavior." We reviewed multidisciplinary HIV/AIDS literature to identify definitions of risky sexual behavior. Both the linguistic components and the social mechanisms that contribute to the concept of risky sexual behaviors were noted. Risky sexual behavior was often defined in a subjective manner in the literature, even in the scientific research. We urge a paradigm shift to focus on explicit behaviors and the social context of those behaviors in determining HIV risk. We also propose a new definition that reduces individual biases and promotes a broader discussion of the degree of sexual risk across a diversity of behavioral contexts. Sexual health professionals can strengthen practice and research initiatives by operating from a concise working definition of risky sexual behavior that is broadly transferable and expands beyond a traditional focus on identity-based groups.

Strategies to uncover undiagnosed HIV infection among heterosexuals at high risk and link them to HIV care with high retention: a "seek, test, treat, and retain" study

Background

Over 50,000 individuals become infected with HIV annually in the U.S., and over a quarter of HIV infected individuals are heterosexuals. Undiagnosed HIV infection, as well as a lack of retention in care among those diagnosed, are both primary factors contributing to ongoing HIV incidence. Further, there are racial/ethnic disparities in undiagnosed HIV and engagement in care, with African Americans/Blacks and Latinos remaining undiagnosed longer and less engaged in care than Whites, signaling the need for culturally targeted intervention approaches to seek and test those with undiagnosed HIV infection, and link them to care with high retention.

Methods/Design

The study has two components: one to seek out and test heterosexuals at high risk for HIV infection, and another to link those found infected to HIV care with high retention. We will recruit sexually active African American/Black and Latino adults who have opposite sex partners, negative or unknown HIV status, and reside in locations with high poverty and HIV prevalence. The “Seek and Test” component will compare the efficacy and cost effectiveness of two strategies to uncover undiagnosed HIV infection: venue-based sampling and respondent-driven sampling (RDS). Among those recruited by RDS and found to have HIV infection, a “Treat and Retain” component will assess the efficacy of a peer-driven intervention compared to a control arm with respect to time to an HIV care appointment and health indicators using a cluster randomized controlled trial design to minimize contamination. RDS initial seeds will be randomly assigned to the intervention or control arm at a 1:1 ratio and all recruits will be assigned to the same arm as the recruiter. Participants will be followed for 12 months with outcomes assessed using medical records and biomarkers, such as HIV viral load.

Discussion

Heterosexuals do not test for HIV as frequently as and are diagnosed later than other risk groups. The study has the potential to contribute an efficient, innovative, and sustainable multi-level recruitment approach and intervention to the HIV prevention portfolio. Because the majority of heterosexuals at high risk are African American/Black or Latino, the study has great potential to reduce racial/ethnic disparities in HIV/AIDS.

Trial registration

ClinicalTrials.gov, NCT01607541, Registered May 23, 2012.

Cultural measures associated with sexual risk behaviors among Latino youth in Southern California: a longitudinal study

CONTEXT

Cultural variables have been associated with sexual risk behaviors among Latino youth, but findings across studies are inconsistent.

METHODS

A longitudinal study of acculturation patterns followed Latino youth in Southern California from 2005 to 2012. Data from 995 participants were used in logistic and ordered regression analyses to test whether cultural variables measured in high school were associated with sexual risk behaviors in emerging adulthood, and whether gender moderated these associations.

RESULTS

The cultural value of respect for parents was negatively associated with participants' odds of reporting an earlier age at sexual debut (odds ratio, 0.8) and condom nonuse at most recent sexual intercourse (0.8). A measure of acculturation reflecting U.S. cultural practices was positively associated with the likelihood of being sexually experienced (1.2), having concurrent sexual partners (1.5) and, among males only, having a greater number of sexual partners (1.3). Second- and later-generation immigrant youth had lower odds of not using a condom at most recent sexual intercourse than first-generation youth (0.6 and 0.5, respectively). Strength of endorsement of Latino cultural practices was negatively associated with females' lifetime number of partners (0.8), but positively associated with males' (1.4).

CONCLUSIONS

The cultural measures associated with Latino youths' sexual behaviors differed across outcomes and by gender. Further understanding of these associations and their underlying mechanisms may help inform the development of culturally sensitive sexual health interventions.

Condom use: The discrepancy between practice and behavioral expectations

Aim: The overall aim of this paper is to examine sexually active young people’s behavioral expectations of condom use. Methods: We collected data at nine youth clinics and one sexually transmitted infections (STI) clinic in Sweden. We included participants whom had been sexually active during the past 12 months: A total of 1022 participants between the ages of 15 and 31 were included. We analyzed the data separately, for different types of sexual practices and types of sexual partners. Multinomial logistic regression was used to analyze age and gender differences for discrepancies. Results: The behavioral expectation of condom use differed, depending on the type of sexual practice and the type of partner. For all types of sex, the overall pattern showed that the participants were most likely to use a condom with a casual unknown partner, followed by a casual known partner, regular partner and lastly, a main partner. Our results also demonstrated that there is a discrepancy between the behavioral expectation of condom use and the self-reported condom use. The lowest discrepancy was for oral sex, especially with a main partner, and the largest discrepancy was for anal sex and vaginal sex with a casual partner. Conclusions: Our results imply that the participants had a greater expectation of condom use than actually occurs, especially for casual unknown partners. There is a lack of knowledge about the risks associated with oral sex, which is evident in the results of the participants’ behavioral expectations of condom use under those conditions.

Maternal drinking and risky sexual behavior in offspring

Teenage mothers are more likely to use drugs, and their children are more likely to use substances and become pregnant during adolescence. Teenage mothers' substance use may play a role in the intergenerational risk for adolescent pregnancy. Pregnant adolescents (12-18 years) were seen during pregnancy and postnatal years 6, 10, 14, and 16 (n = 332). Teenage mothers reported on substance use and family characteristics. The offspring reported substance use (starting at age 10) and sexual behavior (ages 14 and 16). Prenatal alcohol exposure was associated with offspring (a) having a risky first sex partner and (b) multiple sex partners in the past year. Heavy maternal drinking during childhood was associated with offspring reports of a risky first sex partner and early teenage pregnancy. Findings from this unique birth cohort have implications for alcohol prevention efforts with girls during and after a teenage pregnancy and interventions to prevent risky sex in high-risk youth.

Cross-cultural differences and sexual risk behavior of emerging adults

PURPOSE

The authors examined population-specific risk factors that increase emerging adults' risk of acquiring sexually transmitted infections (STIs), including the human papillomavirus (HPV).

DESIGN AND METHOD

A cross-sectional sample of 335 diverse, emerging adults ages 18 to 24 years was recruited from a health center at a large university in the Southeastern United States. The mean age was 20.6 ± 1.9 years, majority were females (74.0%), and 61.0% were Hispanic.

RESULTS

Findings revealed inconsistent condom use, reasons for not using condoms, and a need for more culturally specific intervention strategies.

DISCUSSION AND CONCLUSIONS

Healthcare providers should identify culturally specific reasons for inconsistent condom use, examine cultural and geographic differences in sexual risk behaviors among groups and communities, and modify communication, educational programs, and interventions accordingly.

IMPLICATIONS FOR PRACTICE

By adopting a multicultural approach to the control of STIs, nurses can address specific cultural attitudes and behaviors that may influence exposure to STIs, including HPV.