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Gebru NM, James TG, Ahn S, Cheong J, Berry MS, Cook RL, Leeman RF. A Behavioral Economic Examination of Sexual Behaviors in the Era of Pre-exposure Prophylaxis via Explanatory Sequential Mixed Methods. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1541-1559. [PMID: 38472604 PMCID: PMC11124550 DOI: 10.1007/s10508-024-02822-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 11/28/2023] [Accepted: 01/24/2024] [Indexed: 03/14/2024]
Abstract
Pre-exposure prophylaxis (PrEP) use may be associated with condom use decisions. The current investigation examined sexual decision-making in the context of PrEP among young adult men who have sex with men (MSM) between 18 and 30 years old, using an explanatory sequential mixed methods design. For the quantitative aim, 99 MSM currently taking PrEP (i.e., PrEP-experienced) and 140 MSM not currently taking PrEP (i.e., PrEP-naive) completed an online survey, including the Sexual Delay Discounting Task (SDDT), which captures likelihood of condom use. For the qualitative aim, 15 people from each group were interviewed about their (1) conceptualizations of risky sex and (2) ways they manage their sexual risk. Participants were, on average, 25.69 years old (SD = 3.07) and 64% White. Results from the quantitative aim revealed, controlling for covariates, PrEP-experienced participants exhibited significantly lower likelihood of (1) using an immediately available condom and (2) waiting for a delayed condom (i.e., sexual delay discounting) compared to PrEP-naive participants. Qualitative themes explaining what young adult MSM consider to be risky sex included: (1) any sex as risky sex, (2) risky sex as "sex without a conversation," and (3) risky sex as sex with risk for physical harm. Themes on ways young adult MSM manage sexual risk were classified as proactive, reactive, and passive. Results suggest that PrEP use is related to condom use decisions. Taken together, quantitative differences in sexual delay discounting, but qualitatively similar conceptualizations and management of risky sex, suggest that the SDDT may be a useful tool in sex research to capture processes (i.e., delay discounting) underlying sexual decision-making that may be missed by traditional self-reports. Implications of results, including potentially providing (good quality) condoms with every PrEP prescription, and future research topics are discussed.
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Affiliation(s)
- Nioud Mulugeta Gebru
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main St., Box G-S121-3, Providence, RI, 02912, USA.
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA.
- Southern HIV and Alcohol Research Consortium (SHARC), University of Florida, Gainesville, FL, USA.
| | - Tyler G James
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Seungjun Ahn
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - JeeWon Cheong
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Meredith S Berry
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Robert L Cook
- Southern HIV and Alcohol Research Consortium (SHARC), University of Florida, Gainesville, FL, USA
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Robert F Leeman
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
- Department of Health Sciences, Northeastern University, Boston, MA, USA
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Luehring-Jones P, Fulford D, Palfai TP, Simons JS, Maisto SA. Alcohol, Sexual Arousal, and Partner Familiarity as Predictors of Condom Negotiation: An Experience Sampling Study. AIDS Behav 2024; 28:854-867. [PMID: 37751109 DOI: 10.1007/s10461-023-04189-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
Numerous contextual factors contribute to risky sexual decision-making among men who have sex with men (MSM), with experimental laboratory-based studies suggesting that alcohol consumption, sexual arousal, and partner familiarity have the potential to impact condom negotiations during sexual encounters. The purpose of the current study was to extend this line of inquiry outside of the laboratory and into the everyday lives of MSM. We collected six weeks of daily data on alcohol consumption and sexual behaviors from 257 moderate- and heavy-drinking MSM to examine the within- and between-subjects effects of alcohol consumption, average daily sexual arousal, and partner familiarity on condom negotiation processes during sexual encounters. We hypothesized that alcohol consumption, higher levels of average daily sexual arousal, and greater partner familiarity would all contribute to a reduced likelihood of condom negotiation prior to sexual activity, and that they would also affect the difficulty of negotiations. Contrary to hypotheses, none of these three predictors had significant within-subjects effects on condom negotiation outcomes. However, partner familiarity and average daily sexual arousal did exert significant between-subjects effects on the incidence of negotiation and negotiation difficulty. These findings have important implications for risk-reduction strategies in this population. They also highlight the challenges of reconciling results from experimental laboratory research and experience sampling conducted outside of the laboratory on sexual risk behavior.
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Affiliation(s)
- Peter Luehring-Jones
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, USA.
| | - Daniel Fulford
- Department of Occupational Therapy and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Tibor P Palfai
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, USA
| | - Jeffrey S Simons
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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Cortina AH, Scanlan J, Paneque RJ, Vasquez Osses MA. Cross-Cultural Adaptation and Psychometric Evaluation of Condom Use Self-Efficacy Scale in Chilean College Students. J Nurs Meas 2023; 31:360-369. [PMID: 37558259 DOI: 10.1891/jnm-2021-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Background and Purpose: Limited culturally relevant condom self-efficacy measures have been adapted for use with Chilean college students. This study aims to culturally adapt and measure the psychometric properties of the Condom Use Self-Efficacy Scale (CUSES) by use in college students in Chile. Methods: This cross-sectional study was carried out in six stages: (a) authorization from original authors, (b) translation, (c) back translation, (d) analysis of equivalences, (e) content analysis, and (f) exploratory factor analysis and reliability assessment. Results: Of the 460 college students who completed the Chilean CUSES (Ch-CUSES), 73.9% were women and 99% were single with a mean age of 20.5. Total scale Cronbach's alpha was 0.845, and factor analysis demonstrated six dimensions with 59.1% of the total variance. The factor loading scores of 21 items ranged between 0.515 and 0.921. Conclusions: Ch-CUSES shows good psychometric properties for assessing self-efficacy for condom use in Chilean college students.
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Affiliation(s)
- Abdul Hernández Cortina
- Universidad Autónoma de Chile, Providencia, Región Metropolitana, Chile
- Universidad Finis Terrae, Providencia, Región Metropolitana, Chile
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Brasileiro J, Widman L, Hurst JL. Sexual self-efficacy and sexual communication among adolescent girls: moderated mediation results from a randomized controlled trial. Psychol Health 2023; 38:1273-1287. [PMID: 34905990 PMCID: PMC9210825 DOI: 10.1080/08870446.2021.2012573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/28/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Guided by the Operating Conditions Framework, the goal of this study was to identify how and for whom an online sexual health program called Health Education and Relationship Training (HEART) worked. DESIGN Data come from a randomized controlled trial among 198 U.S. high school girls who completed HEART or an attention-matched control. We conducted mediation and moderated mediation models to determine if sexual self-efficacy was a mediator and if program acceptability and sexual activity status were moderators of HEART efficacy. MAIN OUTCOME MEASURE Sexual communication skills were assessed with a behavioral role-play task. RESULTS HEART significantly improved sexual communication skills. These effects were fully mediated through sexual self-efficacy. Specifically, HEART improved sexual self-efficacy which in turn increased sexual communication skills. Also, when participants liked the program more, the effect of HEART on sexual self-efficacy was stronger. Further, among girls who had engaged in sexual activity, sexual self-efficacy was significantly associated with sexual communication skills. CONCLUSION This study provides insights into the mechanisms of behavior change underlying HEART. Results highlight the need to further 'unpack' the effects of other sexual health programs, as we showed that programs may work better under certain conditions.
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Affiliation(s)
- Julia Brasileiro
- Department of Psychology, North Carolina State University, Raleigh, USA
| | - Laura Widman
- Department of Psychology, North Carolina State University, Raleigh, USA
| | - Jeffrey L Hurst
- Department of Psychology, North Carolina State University, Raleigh, USA
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Moon N, Kang H, Heo SJ, Kim JH. Factors affecting the safe sexual behaviors of Korean young adults by gender: a structural equation model. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2023; 29:115-127. [PMID: 37415480 DOI: 10.4069/kjwhn.2023.06.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/16/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE The aim of this study was to determine the factors that influence safe sexual behaviors of Korean young adults and identify differences by gender. METHODS This study aimed to determine which factors affected safe sexual behaviors based on the Theory of Planned Behavior. Data from 437 Korean young adults (in their 20s and 30s) were collected via online survey between January 3 and January 28, 2022. The questionnaire included items on sexual body image, sexual role perception, sexual attitudes, sexual socialization, sexual communication, and safe sexual behaviors. Structural equation modeling was performed. RESULTS According to the overall model fit of the hypothetical model, the final model was acceptable and explained 49% of safe sexual behaviors. Sexual attitudes (β=-.70, p<.001) and sexual communication (β=.53, p<.001) directly affected safe sexual behaviors, and sexual role perception (β=.42, p<.001) indirectly affected safe sexual behaviors in a combined model. There were gender differences in the path from sexual attitudes (β=-.94, p<.001) and sexual communication (β=.66, p<.001) to safe sexual behaviors and from sexual body image (β=.27, p<.001) to sexual communication. CONCLUSION Sexual attitudes and sexual communication were predictors of safe sexual behaviors, which differed by gender. Strategies that consider sexual attitudes, sexual communication, sexual role perception, and differences between men and women should be developed to improve the safe sexual behaviors of young adults.
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Affiliation(s)
- Nalae Moon
- College of Nursing Science, Kyung Hee University, Seoul, Korea
| | - Hyunjin Kang
- College of Nursing Science, Kyung Hee University, Seoul, Korea
| | - Su Ji Heo
- College of Nursing Science, Kyung Hee University, Seoul, Korea
| | - Ju Hee Kim
- College of Nursing Science, Kyung Hee University, Seoul, Korea
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Malone MA, Gower AL, Reiter PL, Kiss DE, McRee AL. "What does it matter?" Young sexual minority men discuss their conversations with sexual partners about HPV vaccination. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:489-495. [PMID: 33830878 PMCID: PMC9404533 DOI: 10.1080/07448481.2021.1895806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/27/2020] [Accepted: 02/21/2021] [Indexed: 05/14/2023]
Abstract
Objective: Human papillomavirus vaccination coverage is suboptimal, especially among males. Social networks influence young adults' health behaviors and could be leveraged to promote vaccination. We sought to describe how young sexual minority men communicate about human papillomavirus (HPV) vaccination with their sexual partners. Participants: National (U.S.) sample of sexual minority men ages 18-26 (n = 42) from January 2019. Methods: We conducted four online focus groups and identified salient themes using inductive content analysis. Results: Across groups, participants described that HPV vaccination is not a focus of their conversations with sexual partners. Other key themes related to HPV vaccine communication included: varying discissions based on relationship type, and valuing conversations with partners about safer sex. Conclusions: Findings provide novel insight into how young sexual minority men communicate with their sexual partners about HPV vaccination and identify potential areas for interventions to promote communication. Future research is needed to investigate associations between partner communication and HPV vaccine uptake.
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Affiliation(s)
- Molly A. Malone
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Amy L. Gower
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Paul L. Reiter
- Division of Health Behavior and Health Promotion, The Ohio State University, Columbus, OH, USA
| | - Dale E. Kiss
- Division of Health Behavior and Health Promotion, The Ohio State University, Columbus, OH, USA
| | - Annie-Laurie McRee
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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Dunn CE, Hood KB, Hall CJ. Do gendered racial microaggressions influence the relationship between body appreciation and Black emerging adult women's condom use behaviors? JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-9. [PMID: 36595584 DOI: 10.1080/07448481.2022.2155055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 06/19/2022] [Accepted: 09/19/2022] [Indexed: 06/17/2023]
Abstract
Background: Sexual protective behaviors, such as consistent condom use and intention, are important preventative measures against the transmission of HIV/AIDS and sexually transmitted infections. Current sexual health research has yet to explore the interaction between contextual factors, such as gendered racial microaggressions, and the role of personal factors (i.e., body appreciation) on Black women's sexual risk and protective behaviors in the United States. Guided by objectification theory, we hypothesized that sexually objectifying gendered racial microaggressions moderated the body appreciation and condom use behaviors relationship. Participants: The current study consisted of 114 Black emerging adult women in the southern United States. Results: Results showed significant interactions between the frequency of sexually objectifying gendered racial microaggressions and body appreciation on consistent condom use and condom use intention. Conclusion: Overall, these findings suggested the need for sexual health researchers and interventionists to further explore the influence of gendered racial microaggressions and body appreciation on condom use behaviors.
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Affiliation(s)
- Chelsie E Dunn
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kristina B Hood
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Calvin J Hall
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
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Bhushan NL, Musara P, Hartmann M, Stoner MCD, Shah SR, Nabukeera J, Rukundo I, Mutero P, Lewis MA, Piper J, Shapley‐Quinn MK, Etima J, Minnis AM. Making the Case for Joint Decision-Making in Future Multipurpose Prevention Technology (MPT) Choice: Qualitative Findings on MPT Attribute Preferences from the CUPID Study (MTN-045). J Int AIDS Soc 2022; 25:e26024. [PMID: 36254362 PMCID: PMC9577116 DOI: 10.1002/jia2.26024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Young women in sub‐Saharan Africa account for two‐thirds of all new HIV infections and face high rates of unintended pregnancy. Multipurpose prevention technologies (MPTs) are promising products under development that are designed to simultaneously prevent HIV and unintended pregnancy. Since MPTs will be used in the context of sexual relationships, ensuring acceptability and use requires understanding the role of male partners in MPT use decision‐making. Methods This paper draws on qualitative data from 39 couples enrolled in the Microbicide Trials Network (MTN) 045 study, conducted in 2019–2020. Partners completed a discrete choice experiment (DCE), first separately and then jointly, to measure preferences for future MPT attributes and then completed a qualitative interview. We also draw on quantitative data from interviewer observation about who dominated the decision‐making process during the joint DCE. Content analysis was used to examine (1) how couples made decisions on existing non‐MPT HIV and pregnancy prevention products; (2) how couples made decisions on future ideal‐MPT product during the DCE; and (3) how these decision‐making processes varied by decision‐making dominance (10 male, 10 female and 19 equal) and interview type (19 joint and 20 separate). Results Existing non‐MPT product decisions focused on trust between partners and product attributes, while future ideal‐MPT product decisions exclusively focused on product attributes. Across existing and future products, preferences for product attributes varied by gender. Male partners were most concerned with limiting side effects impacting sexual pleasure, female partners were most concerned with limiting side effects causing physical symptoms and both were concerned with the return to fertility. Across all dominance and interview types, couples reported making decisions together and female partners were often able to negotiate with male partners for their preferred product or set of product attributes. Conclusions Research activities in this study provided an opportunity for couples to openly present their product attribute preferences to their partner, learn about their partner's attribute preferences, negotiate for their ideal set of attributes and ultimately choose attributes that benefited the couple without disempowering the female partner. Future research should focus on the utility of couple‐based decision‐making aids or similar tools for facilitating joint MPT decision‐making.
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Affiliation(s)
| | - Petina Musara
- Clinical Trials Research CentreUniversity of ZimbabweHarareZimbabwe
| | | | | | - Shweta R. Shah
- RTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Josephine Nabukeera
- Makerere University ‐ Johns Hopkins University Research Collaboration (MU‐JHU)KampalaUganda
| | - Ivan Rukundo
- Makerere University ‐ Johns Hopkins University Research Collaboration (MU‐JHU)KampalaUganda
| | - Prisca Mutero
- Clinical Trials Research CentreUniversity of ZimbabweHarareZimbabwe
| | - Megan A. Lewis
- RTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Jeanna Piper
- National Institute of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaMarylandUSA
| | | | - Juliane Etima
- Makerere University ‐ Johns Hopkins University Research Collaboration (MU‐JHU)KampalaUganda
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Widman L, Maheux AJ, Craig E, Evans-Paulson R, Choukas-Bradley S. Sexual Communication between Adolescent Partners: A Scoping Review and Directions for Future Research. JOURNAL OF SEX RESEARCH 2022; 59:984-999. [PMID: 35917190 DOI: 10.1080/00224499.2022.2099787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sexual communication between adolescent partners is an important component of sexual health and wellbeing. Over 40 years of research on adolescent sexual communication has yielded rich information, yet there remain gaps in our understanding of the communication process. The purpose of this scoping review was to synthesize the body of research on adolescent sexual communication to identify how communication has been conceptualized, how researchers have measured communication, and what theoretical frameworks have been applied across the literature. We identified 198 assessments of sexual communication across 119 quantitative studies. This work included 127,489 adolescents (Mage = 15.97) from 15 countries (81.5% U.S.-based). Most studies relied on self-reports (93.4%) and surveyed only one member of a couple (97.5%). The definition of sexual communication was highly varied across the literature: in half of assessments (52.0%) sexual communication was operationalized as a behavior-the verbal or nonverbal exchange of messages about sex-whereas the remaining half of assessments captured social-cognitive aspects of communication (e.g., communication self-efficacy, fear/anxiety). There was also a tendency for investigators to create their own idiosyncratic instruments: half of studies (48.9%) used instruments created by the research team with limited or no discussion of reliability/validity. Regarding the topic of communication, a third of assessments (33.8%) focused exclusively on condom communication and another quarter (24.0%) focused on other safer-sex issues (e.g., STDs, abstinence). Notably absent were studies focused on communication surrounding consent or sexual pleasure. Also absent was a guiding conceptual model or theory that could unify this body of work. Overall, results highlight gaps and inconsistencies in how partner sexual communication has been conceptualized, measured, and theorized about in previous work. We provide several recommendations for future theory-building efforts as well as rigorous, multimethod empirical investigations of adolescent sexual communication that would further our understanding of this important aspect of adolescent sexual wellbeing.
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Affiliation(s)
- Laura Widman
- Department of Psychology, North Carolina State University
| | - Anne J Maheux
- Department of Psychological and Brain Sciences, University of Delaware
| | - Elizabeth Craig
- Department of Communication, North Carolina State University
| | | | - Sophia Choukas-Bradley
- Department of Psychological and Brain Sciences, University of Delaware
- Department of Psychology, University of Pittsburgh
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Gesselman AN, Ryan R, Yarber WL, Vanterpool KB, Beavers KA, Francis H, Grant BT, Wood K, Graham CA, Milhausen R, Sanders SA, Crosby RA. An exploratory test of a couples-based condom-use intervention designed to promote pleasurable and safer penile-vaginal sex among university students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1665-1672. [PMID: 33151840 DOI: 10.1080/07448481.2020.1818753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/29/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
Objective: Dual use of male condoms and female contraceptives is widely advocated for unplanned pregnancy prevention, yet college students often neglect condoms. This feasibility and acceptability study assessed the efficacy of a self-guided home-based condom-promotion intervention among college students in heterosexual relationships. Participants: Fifty-nine couples who had been together at least 30 days and had penile-vaginal sex at least twice weekly. Methods: Assessments were done at baseline and 6 months later. Outcomes were frequency of condom-unprotected penile-vaginal sex and four psychosocial mediators of condom use. Results: Frequency of unprotected penile-vaginal sex decreased over time. Several corresponding psychosocial mediators showed change, particularly among women. Using actor-partner interdependence modeling, men's increase in condom use was associated with an increase in women's sexual pleasure. Conclusion: Findings support implementation of a brief, self-guided, home-based condom-use intervention that could lower incidence of unplanned pregnancy and STIs among heterosexually active college students.
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Affiliation(s)
- Amanda N Gesselman
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
| | - Rebecca Ryan
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - William L Yarber
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
- Department of Gender Studies, Indiana University, Bloomington, Indiana, USA
| | - Karen B Vanterpool
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Karly A Beavers
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Heather Francis
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Brandon T Grant
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Katherine Wood
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Cynthia A Graham
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- Department of Psychology, University of Southampton, Southampton, UK
| | - Robin Milhausen
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Canada
| | - Stephanie A Sanders
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- Department of Gender Studies, Indiana University, Bloomington, Indiana, USA
| | - Richard A Crosby
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
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Kahn J, Washington C, Ding L, Wyllie T, Rosen B, Gorbach P. Partner-Level and Sexual Networking Factors Are Associated With Vaccine-Type and Nonvaccine-Type Human Papillomavirus Infection After Vaccine Introduction in Young Women. Sex Transm Dis 2022; 49:429-436. [PMID: 35093984 PMCID: PMC9133057 DOI: 10.1097/olq.0000000000001608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study was to determine individual-level, partner-level, and sexual networking factors associated with vaccine- and non-vaccine-type human papillomavirus (HPV) in young women, by vaccination status. METHODS Sexually experienced women 13 to 26 years old (n = 784) completed a survey and were tested for 36 HPV genotypes. We determined factors associated with 4-valent vaccine-type HPV (HPV-6, HPV-11, HPV-16, HPV-18) and non-vaccine-type HPV among vaccinated and unvaccinated women, using univariable and multivariable logistic regression models. RESULTS Participants' mean age was 19.2 years, 77.7% had received ≥1 vaccine dose, and 7.7% were positive for vaccine-type HPV (HPV-6, HPV-11, HPV-16, and/or HPV-18). Factors associated with vaccine-type HPV in vaccinated women included gonorrhea history (adjusted odds ratio [AOR], 2.71), new female sex partner(s) (AOR, 4.79), age at vaccination (≥15 vs. <15 years; AOR, 2.47), and age discordance with most recent partner (don't know vs. discordant; AOR, 9.17). Factors associated with non-vaccine-type HPV in vaccinated women included history of sexually transmitted infection (AOR, 2.69), male most recent partner (AOR, 2.85), age of first sex (AOR, 1.15), and partner concurrency (don't know vs. 1 other partner; AOR, 2.03). Factors associated with vaccine-type HPV in unvaccinated women included new female sex partner(s) (AOR, 7.45) and partner concurrency (don't know vs. no; AOR, 2.95). Factors associated with non-vaccine-type HPV in unvaccinated women included race (White vs. multiracial; AOR, 4.10) and partner concurrency (don't know vs. 0; AOR, 4.65). CONCLUSIONS Novel findings of this study, including associations between female sex partners and HPV, and between not knowing about partner concurrency and HPV, have implications for sexual education, clinical counseling, and public health interventions.
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Affiliation(s)
- Jessica Kahn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S
| | | | - Lili Ding
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S
| | - Tornia Wyllie
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S
| | - Brittany Rosen
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S
| | - Pamina Gorbach
- Department of Epidemiology, Fielding School of Public Health & Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, U.S
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Rowell-Cunsolo TL, Mkuu RS, Bellerose M, Haile R, Wechsberg W. "I Said Maybe We Should Use a Condom, and Then that Just Went South": Exploring Condomless Sex among Formerly Incarcerated Black Men in New York City, USA. JOURNAL OF SEX RESEARCH 2022; 59:662-670. [PMID: 34854792 PMCID: PMC9118125 DOI: 10.1080/00224499.2021.2004083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
More than 600,000 incarcerated individuals are released annually in the United States; a large proportion are Black men incarcerated for drug-related offenses, including drug use and possession. Formerly incarcerated Black men report elevated rates of condomless sex and sexually transmitted infections, including human immunodeficiency virus (HIV). The purpose of this study was to explore condom usage among Black men who were formerly incarcerated for drug-related offenses and living in New York City (NYC). Using a semi-structured interview guide, in-depth interviews were conducted with 26 formerly incarcerated Black men. Interviews were audio-recorded, transcribed, and entered into NVivo, then manually coded utilizing thematic analysis methods. The following four themes were identified: partner type and length of the relationship affected condom use; diminished pleasure was a barrier for condom use; challenges with ill-fitting and poor-quality condoms; and the withdrawal method was used as an HIV prevention technique. Our findings suggest that formerly incarcerated Black men are engaging in condomless sex post-incarceration. Greater exposure to prevention messages and targeted interventions with content that includes interpersonal and condom use skill-building, methods to increase pleasurable condom use, information on HIV and STI transmission modes, and access to pre-exposure prophylaxis (PrEP) may be beneficial for this population.
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Affiliation(s)
| | | | | | - Rahwa Haile
- Health & Society, State University of New York - College at Old Westbury
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13
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Algarin AB, Shrader CH, Hackworth BT, Ibanez GE. Condom use likelihood within the context of PrEP and TasP among men who have sex with men in Florida: a short report. AIDS Care 2022; 34:294-300. [PMID: 33565330 PMCID: PMC8353001 DOI: 10.1080/09540121.2021.1883515] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Despite the development of targeted interventions for men who have sex with men, this population continues to comprise the majority of new HIV diagnoses. Though condoms are highly efficacious, some sexually active MSM use sero-sorting as a method of HIV prevention. This study aimed to characterize: (1) differences between partner sero-status and condom use likelihood, and (2) demographic, behavioral, and knowledge-related factors influencing condom use likelihood with varying sero-status partners. Using convenience sampling, 150 sexual and gender minority men completed a survey on PrEP and sexual behaviors. The majority of participants identified as racial/ethnic minorities (51.7%), having 4 years of college or more (52.0%), and being HIV-negative (not on PrEP) (68.8%). Our sample reported the lowest average condom use likelihood with a partner on PrEP (2.93 ± 1.39) and the highest average likelihood with an HIV-positive partner (unknown VL) (4.57 ± 0.98). Age, race/ethnicity, education, HIV-status, and HIV and PrEP knowledge were significantly associated with differences in condom use likelihood. Our findings elucidate the complexity of sero-sorting scenarios and decision-making processes in the context of biomedical HIV prevention. These results may provide insight for future condom use and sero-sorting interventions in the context of biomedical HIV prevention.
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Affiliation(s)
- Angel B. Algarin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0507, USA
| | - Cho Hee Shrader
- Department of Public Health Sciences, University of Miami, 1120 NW 14th Street, CRB 1006, Miami, FL 33136, USA
| | | | - Gladys E. Ibanez
- Department of Epidemiology, Florida International University, 11200 SW 8th St. AHC5-505, Miami, FL 33199, USA
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14
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Chimoyi L, Chikovore J, Musenge E, Mabuto T, Chetty-Makkan CM, Munyai R, Nchachi T, Charalambous S, Setswe G. Understanding factors influencing utilization of HIV prevention and treatment services among patients and providers in a heterogeneous setting: A qualitative study from South Africa. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000132. [PMID: 36962320 PMCID: PMC10021737 DOI: 10.1371/journal.pgph.0000132] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 11/29/2021] [Indexed: 12/16/2022]
Abstract
Despite advances made in HIV prevention and treatment interventions in South Africa, barriers to their utilization continue to exist. Understanding perspectives from patients and providers of healthcare can shed light on the necessary strategies to enhance uptake of HIV services. A cross-sectional qualitative study was conducted in July 2020 in Ekurhuleni District. Based on HIV prevalence estimates from a national survey, male condom use coverage and antiretroviral treatment (ART) initiation rates from routinely collected clinical data for 2012, we selected facilities from geographical areas with varying HIV prevalence and uptake of HIV services. In-depth interviews were conducted with adult (≥18 years) patients and healthcare workers in selected primary healthcare facilities. Thematic analysis was performed following a framework built around the social cognitive theory to describe behavioural, personal, and social/environmental factors influencing utilization of HIV services. Behavioural factors facilitating uptake of HIV services included awareness of the protective value of condoms, and the benefits of ART in suppressing viral load and preventing mother-to-child HIV transmission which was evident across geographical areas. Barriers in high prevalence areas included suboptimal condom use, fears of a positive HIV result, and anticipated HIV-related stigma while seeking healthcare services. Across the geographical areas, personal factors included ability to correctly use available services enhanced by knowledge acquired during counselling sessions and community-based health promotion activities. Further, social support from family reinforced engagement in care. Compared to low uptake areas, clinics in high uptake areas used care-facilitators, outreach teams and decanting programs to address the environmental barriers including staff shortages and long queues. Barriers at multiple levels prevent optimal utilization of HIV services, calling for strategies that target and address the different levels and tailored to needs of specific settings. Overall, improved delivery of HIV prevention or treatment interventions can be achieved through strengthening training of healthcare providers in facilities and communities and addressing negative sequelae from utilising services in low uptake areas.
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Affiliation(s)
- Lucy Chimoyi
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeremiah Chikovore
- Human and Social Capabilities Research Division, Human Sciences Research Council, Durban, South Africa
| | - Eustasius Musenge
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Tonderai Mabuto
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Candice. M. Chetty-Makkan
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
- Faculty of Health Sciences, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Reuben Munyai
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Tshegang Nchachi
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Salome Charalambous
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Geoffrey Setswe
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- Department of Health Studies, University of South Africa, Pretoria, South Africa
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15
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Torregosa M, Patricio O. The Mediating Role of Sexual Self-Efficacy on Protected Sex. J Prim Care Community Health 2022; 13:21501319221129934. [PMID: 36345219 PMCID: PMC9647276 DOI: 10.1177/21501319221129934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Ascribed traditional gender role has rarely been examined in the topical area of protected sex. OBJECTIVE The purpose of this study was to examine the relationship between HIV knowledge, ascribed cultural gender roles of machismo and marianismo, acculturation, attitudes toward risky sexual behaviors and sexual self-efficacy on protected sex, and the mediating effect of sexual self-efficacy between these predictors and protected sex. METHODS Part of a larger study, Hispanic college students from a Hispanic-serving institution in a U.S. southern border city were recruited. RESULTS AND CONCLUSION Sexual self-efficacy was found a significant mitigating factor against sexual risks associated with machismo as well as a positive reinforcing element on attitudes toward protected sex. Study findings have implications toward the development of culturally sensitive evidence-based interventions that promote sexual self-efficacy skills among Hispanic males who strongly identify with culturally ascribed gender roles.
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16
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Jeremiah RD, Patel DR, Chirwa E, Kapito E, Mei X, McCreary LL, Norr KF, Liu L, Patil CL. A randomized group antenatal care pilot showed increased partner communication and partner HIV testing during pregnancy in Malawi and Tanzania. BMC Pregnancy Childbirth 2021; 21:790. [PMID: 34819018 PMCID: PMC8611988 DOI: 10.1186/s12884-021-04267-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV testing at antenatal care (ANC) is critical to achieving zero new infections in sub-Saharan Africa. Although most women are tested at ANC, they remain at risk for HIV exposure and transmission to their infant when their partners are not tested. This study evaluates how an HIV-enhanced and Centering-based group ANC model-Group ANC+ that uses interactive learning to practice partner communication is associated with improvements in partner HIV testing during pregnancy. METHODS A randomized pilot study conducted in Malawi and Tanzania found multiple positive outcomes for pregnant women (n = 218) assigned to Group ANC+ versus individual ANC. This analysis adds previously unpublished results for two late pregnancy outcomes: communication with partner about three reproductive health topics (safer sex, HIV testing, and family planning) and partner HIV testing since the first antenatal care visit. Multivariate logistic regression models were used to assess the effect of type of ANC on partner communication and partner testing. We also conducted a mediation analysis to assess whether partner communication mediated the effect of type of care on partner HIV testing. RESULTS Nearly 70% of women in Group ANC+ reported communicating about reproductive health with their partner, compared to 45% of women in individual ANC. After controlling for significant covariates, women in group ANC were twice as likely as those in individual ANC to report that their partner got an HIV test (OR 1.99; 95% CI: 1.08, 3.66). The positive effect of the Group ANC + model on partner HIV testing was fully mediated by increased partner communication. CONCLUSIONS HIV prevention was included in group ANC health promotion without compromising services and coverage of standard ANC topics, demonstrating that local high-priority health promotion needs can be integrated into ANC using a Group ANC+. These findings provide evidence that greater partner communication can promote healthy reproductive behaviors, including HIV prevention. Additional research is needed to understand the processes by which group ANC allowed women to discuss sensitive topics with partners and how these communications led to partner HIV testing.
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Affiliation(s)
- Rohan D Jeremiah
- College of Nursing, University of Illinois Chicago, Chicago, USA.
| | - Dhruvi R Patel
- College of Nursing, University of Illinois Chicago, Chicago, USA
| | - Ellen Chirwa
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Esnath Kapito
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Xiaohan Mei
- School of Public Health, University of Illinois Chicago, Chicago, USA
| | - Linda L McCreary
- College of Nursing, University of Illinois Chicago, Chicago, USA
| | - Kathleen F Norr
- College of Nursing, University of Illinois Chicago, Chicago, USA
| | - Li Liu
- School of Public Health, University of Illinois Chicago, Chicago, USA
| | - Crystal L Patil
- College of Nursing, University of Illinois Chicago, Chicago, USA
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17
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Evans-Paulson R, Widman L, Brasileiro J, Maheux AJ, Choukas-Bradley S. Examining the Link Between Sexual Self-Concept and Sexual Communication among Adolescents. COMMUNICATION QUARTERLY 2021; 69:525-543. [PMID: 34707323 PMCID: PMC8545267 DOI: 10.1080/01463373.2021.1969585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The purpose of this study was to move beyond a sexual risk framework to investigate the possible associations among three sex-positive constructs for adolescents: their sexual self-concept (i.e., their positive/negative feelings about themselves as sexual beings), their sexual communication with romantic/sexual partners, and their sexual communication self-efficacy. We also examined differences in these constructs by sexual intercourse experience and gender. Participants were 171 adolescents who had been in a dating or sexual relationship in the past year (M age=16.32 years; 64.3% girls). Compared to girls, boys had more positive sexual self-concepts but less self-efficacy to communicate with their partners about sex. Adolescents who reported having had sexual intercourse had more positive sexual self-concepts as well as more frequent partner sexual communication compared to adolescents without sexual intercourse experience. Adolescents with a more positive sexual self-concept had higher sexual communication self-efficacy and reported more frequent sexual communication. In addition, sexual communication self-efficacy partially mediated the relationship between sexual self-concept and sexual communication. Results highlight the connection between sexual self-concept and sexual communication and contribute to a growing body of work on the positive aspects of adolescent sexuality.
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Affiliation(s)
- Reina Evans-Paulson
- Innovation Research & Training, 5316 Highgate Drive, Suite 125, Durham, NC 27713
| | - Laura Widman
- North Carolina State University, Department of Psychology, Campus Box 7650, Raleigh, NC, USA 27695-7650
| | - Julia Brasileiro
- North Carolina State University, Department of Psychology, Campus Box 7650, Raleigh, NC, USA 27695-7650
| | - Anne J. Maheux
- University of Delaware, Department of Psychological and Brain Sciences, 105 The Green, Newark, DE, USA 197716
| | - Sophia Choukas-Bradley
- University of Delaware, Department of Psychological and Brain Sciences, 105 The Green, Newark, DE, USA 197716
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18
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Frederick D, Gillespie BJ, Lever J, Berardi V, Garcia JR. Sexual Practices and Satisfaction among Gay and Heterosexual Men in Romantic Relationships: A Comparison Using Coarsened Exact Matching in a U.S. National Sample. JOURNAL OF SEX RESEARCH 2021; 58:545-559. [PMID: 33428466 DOI: 10.1080/00224499.2020.1861424] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Gay men are underrepresented in research on sexual satisfaction. We examined sexual satisfaction and over 50 sexual practices in an online U.S. national survey of men in relationships. Coarsened exact matching created comparable samples of heterosexual (n = 3527) and gay (n = 452) men on six demographic factors, including relationship length. Results identified many similarities between the groups, including sexual frequency, orgasm frequency, duration of sex, and sexual satisfaction. The majority of heterosexual and gay men expressed physical or emotional affection during their last sexual encounter, reporting that they or their partner said "I love you" (66%; 57%) and engaged in deep kissing (69%; 75%) or gentle kissing (82%; 72%). Heterosexual men were less likely than gay men to usually-always receive (27%; 61%) or give (37%; 68%) oral sex when intimate in the past month; were less likely to view pornography with their partner (35%; 61%); but were more likely to give their partner massages in the past year to improve their sex lives (71%; 58%). Number of sexual communication behaviors was a strong predictor of sexual satisfaction, particularly for gay men (β =.36). These findings enhance our understanding of heterosexual and gay men's sexual lives.
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Affiliation(s)
- David Frederick
- Crean College of Health and Behavioral Sciences, Chapman University
| | | | - Janet Lever
- Department of Sociology, California State University
| | - Vincent Berardi
- Crean College of Health and Behavioral Sciences, Chapman University
| | - Justin R Garcia
- The Kinsey Institute for Research in Sex, Gender, and Reproduction and Department of Gender Studies, Indiana University
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19
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Catelan RF, Saadeh A, Lobato MIR, Gagliotti DAM, Costa AB. Condom-Protected Sex and Minority Stress: Associations with Condom Negotiation Self-Efficacy, "Passing" Concerns, and Experiences with Misgendering among Transgender Men and Women in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4850. [PMID: 34062814 PMCID: PMC8125181 DOI: 10.3390/ijerph18094850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/16/2022]
Abstract
This cross-sectional exploratory study aims to verify associations between condom-protected sex, condom negotiation self-efficacy, self-esteem, and four minority stressors (experiences with misgendering, "passing" concerns, anticipated prejudice, and perceived prejudice) among transgender men (TM) and transgender women (TW). 260 individuals (192 TW and 68 TM) residing in two Brazilian states participated in the study. Data was collected online and in two hospital programs for transgender people and included sociodemographic data, condom-protected sex, the Trans-Specific Condom/Barrier Negotiation Self-Efficacy (T-Barrier) Scale, the Rosenberg Self-Esteem Scale, and four minority stressors. Measures that were significantly associated with condom-protected sex were tested as independent variables in a linear regression model. The main results suggest that lower condom negotiation self-efficacy, higher "passing" concerns, and higher experiences with misgendering were predictors of lower frequency of condom-protected sex. These negative outcomes were found among both TM and TW, which justifies their inclusion in public health policies. Structural strategies and clinical interventions are suggested to address condom negotiation self-efficacy and "passing" concerns in transgender populations.
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Affiliation(s)
- Ramiro Figueiredo Catelan
- Psychology Graduate Program, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre 90619-900, Brazil;
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
| | - Alexandre Saadeh
- Department of Psychology, Pontifical Catholic University of São Paulo, São Paulo 05014-901, Brazil;
- Faculty of Medicine Clinics Hospital, University of São Paulo, São Paulo 05403-000, Brazil;
| | | | | | - Angelo Brandelli Costa
- Psychology Graduate Program, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre 90619-900, Brazil;
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20
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Jin H, Biello K, Garofalo R, Lurie M, Sullivan PS, Stephenson R, Mimiaga MJ. Better Communication Regarding Sexual Agreements Within Serodiscordant Male Couples Leads to Improved Antiretroviral Therapy Adherence Among the HIV-Positive Partner. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1771-1779. [PMID: 34021459 DOI: 10.1007/s10508-021-01954-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
Abstract
Sexual agreements (SAs)-guidelines that outline what type of sexual behaviors are permissible with sexual partners outside of their primary relationship-are often negotiated within same-sex male relationships to reduce their risk for HIV infection. However, HIV risk is not only a function of sexual behavior, but is also affected by factors such as antiretroviral therapy (ART) adherence. We examined whether HIV-positive partners in serodiscordant male couples who have better communication about SAs and report concordant SAs with their partners have greater odds of being adherent to ART to not only improve their health, but to also reduce the risk of transmitting HIV to partners. We analyzed longitudinal data from 135 HIV-positive partners in serodiscordant male couples recruited from Atlanta, GA, Boston, MA, and Chicago, IL to examine the relationship between optimal ART adherence and two independent variables: communication about SAs and if the couples have discrepant SAs. HIV-positive male partners who reported high levels of communication regarding SAs had nearly three times the odds of optimal adherence to ART compared to those who reported lower levels. The HIV-positive partners with discrepant SAs with their male partner had approximately half the odds of optimal adherence to ART compared to those with concordant SAs. Our findings suggest that integrating communication skills training into dyad-level HIV interventions to improve communication regarding HIV may provide more opportunities for couples to discuss ways of reducing the risk of HIV transmission. Couples may benefit from interventions that assist them in composing SAs.
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Affiliation(s)
- Harry Jin
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
- Johns Hopkins Bloomberg School of Public Health, 615 S Wolfe St., Baltimore, 21205, USA.
| | - Katie Biello
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Robert Garofalo
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mark Lurie
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rob Stephenson
- Department of Systems, Population and Leadership and The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Matthew J Mimiaga
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
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21
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Duby Z, Jonas K, McClinton Appollis T, Maruping K, Dietrich J, Mathews C. "Condoms Are Boring": Navigating Relationship Dynamics, Gendered Power, and Motivations for Condomless Sex Amongst Adolescents and Young People in South Africa. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 33:40-57. [PMID: 38596471 PMCID: PMC10807805 DOI: 10.1080/19317611.2020.1851334] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 04/11/2024]
Abstract
Condoms remain an important method for preventing HIV prevention and unintentional pregnancies, however their use in South Africa is sub-optimal. We analyzed survey data on reported condom use among 3009 sexually active adolescent girls and young women (AGYW) aged 15-24 years, and qualitative data from interviews and focus group discussions with 237 AGYW and 38 male peers. Our findings describe the current condom use landscape among adolescents and young people in South Africa, illustrating relationship dynamics, gendered power and notions of masculinity which influence condom negotiation and use in young heterosexual South Africans' sexual encounters.
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Affiliation(s)
- Zoe Duby
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Child and Adolescent Psychiatry, Adolescent Health Research Unit (AHRU), University of Cape Town, Cape Town, South Africa
| | - Tracy McClinton Appollis
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Child and Adolescent Psychiatry, Adolescent Health Research Unit (AHRU), University of Cape Town, Cape Town, South Africa
| | - Kealeboga Maruping
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Janan Dietrich
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Child and Adolescent Psychiatry, Adolescent Health Research Unit (AHRU), University of Cape Town, Cape Town, South Africa
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22
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Haas SM, Perazzo JD, Ruffner AH, Lyons MS. Exploring Current Stereotypes and Norms Impacting Sexual Partner HIV-Status Communication. HEALTH COMMUNICATION 2020; 35:1376-1385. [PMID: 31257927 DOI: 10.1080/10410236.2019.1636340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study sought to explore HIV-related stereotypes and norms that impact HIV-status communication with potential sexual partners. A series of focus groups and in-depth interviews were conducted (N = 59) with HIV-positive and HIV-negative MSM (75%) and Heterosexuals (25%). Findings indicate that HIV stereotypes and stigma remain as barriers to HIV-status discussion. Differences also emerged across groups: 1) HIV-negative MSM were more likely to report engaging in HIV-status communication, 2) HIV-positive MSM described inconsistent HIV-status communication and reported concealing their status at times, and 3) Heterosexuals reported being least likely to engage in HIV-status communication; often using the blanket question "Are you clean?" to encompass all STIs and avoiding direct HIV-status discussion. Overall, findings indicate that many HIV stereotypes and stigma-related communication norms persist that discourage discussion of sexual partners' HIV-status prior to sexual activity.
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23
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Evans R, Widman L, Stokes MN, Javidi H, Hope EC, Brasileiro J. Association of Sexual Health Interventions With Sexual Health Outcomes in Black Adolescents: A Systematic Review and Meta-analysis. JAMA Pediatr 2020; 174:676-689. [PMID: 32310261 PMCID: PMC7171582 DOI: 10.1001/jamapediatrics.2020.0382] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Black adolescents are at increased risk of contracting HIV and other sexually transmitted infections (STIs) and experiencing unplanned pregnancy. Although sexual health interventions aimed at decreasing these risks exist, evidence of the association between sexual health interventions and the sexual behavior of black adolescents has not been synthesized to our knowledge. OBJECTIVE To examine the associations between sexual health interventions and behavioral, biological, and psychological outcomes. DATA SOURCES For this systematic review and meta-analysis, a systematic search was conducted of studies published through January 31, 2019, using the PubMed, PsycINFO, and CINAHL databases and relevant review articles. The following key words were used: youth, adolesc* or teen*; sexual health or safe* sex or sexually transmitted disease or sexually transmitted infection or STD or STI or HIV or AIDS or pregnancy or reproductive health or condom* or contracept* or unprotected sex or abstinence; intervention or program or education or prevention or promotion or trial; latino* or latina* or latinx* or minorit* or ethnic* or hispanic or african american* or black* or race or racial or biracial. STUDY SELECTION Studies were included if they included a US-based sample of black adolescents, evaluated a sexual health intervention using experimental or quasi-experimental designs, included a behavioral outcome, and were published in English. DATA EXTRACTION AND SYNTHESIS Standardized mean differences and 95% CIs were extracted and meta-analyzed using random-effects models. MAIN OUTCOMES AND MEASURES Behavioral outcomes were abstinence, condom use, and number of sex partners. Biological outcomes were pregnancy and STI contraction. Psychological outcomes were sexual health intentions, knowledge, and self-efficacy. RESULTS Across 29 studies including 11 918 black adolescents (weighted mean age, 12.43 years), there was a significant weighted mean association of sexual health interventions with improvements in abstinence (Cohen d = 0.14; 95% CI, 0.05-0.24) and condom use (Cohen d = 0.25; 95% CI, 0.11-0.39). No significant mean association of these interventions with number of sex partners, pregnancy, or STI contraction was found. Sexual health interventions were significantly associated with improvements in psychological outcomes: sexual health intentions (Cohen d = 0.17; 95% CI, 0.05-0.30), knowledge (Cohen d = 0.46; 95% CI, 0.30-0.63), and self-efficacy (Cohen d = 0.19; 95% CI, 0.09-0.28). Intervention effect sizes were consistent across factors, such as participant sex and age and intervention dose. CONCLUSIONS AND RELEVANCE The findings suggest that sexual health interventions are associated with improvements in sexual well-being among black adolescents. There appears to be a need for wide-scale dissemination of these programs to address racial disparities in sexual health across the US.
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Affiliation(s)
- Reina Evans
- Department of Psychology, North Carolina State University, Raleigh
| | - Laura Widman
- Department of Psychology, North Carolina State University, Raleigh
| | | | - Hannah Javidi
- Department of Psychology, North Carolina State University, Raleigh
| | - Elan C. Hope
- Department of Psychology, North Carolina State University, Raleigh
| | - Julia Brasileiro
- Department of Psychology, North Carolina State University, Raleigh
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Wray TB, Monti PM. Characteristics of Sex Events, Partners, and Motivations and Their Associations with HIV-Risk Behavior in a Daily Diary Study of High-Risk Men Who Have Sex with Men (MSM). AIDS Behav 2020; 24:1851-1864. [PMID: 31832855 PMCID: PMC7228849 DOI: 10.1007/s10461-019-02760-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In the United States, men who have sex with men (MSM) continue to be at high-risk for HIV and other STIs, and condoms represent the most popular, affordable, and accessible method of prevention. Although a vast body of research has explored various factors associated with condom use in MSM, fewer studies have explored situation-level characteristics that affect their decisions about sex partners and condom use. Daily diary studies are well-suited to help improve our understanding of these event-level factors in detail, including the sex events themselves, partner characteristics, and motivations. As part of a larger study using ecological momentary assessment methods, high-risk MSM completed daily diary surveys about their sexual behavior on their smartphones each day for 30 days. This study explored detailed descriptive characteristics of sex events, partner characteristics, and motivations for sex and condom use, and examined whether specific aspects of these characteristics were associated with having condomless anal sex (CAS) with high-risk partners. High-risk CAS was common among MSM, with the majority of participants having met their partners online and many reporting sex the same day they met. Results showed that the odds of CAS were not higher with partners met online versus those met in other ways, but MSM were more likely to have asked online partners about their HIV status and testing history before sex. The odds of engaging in high-risk CAS was higher when MSM reported intimacy or self-assurance motives. Not having condoms readily available was a CAS motivation reported more commonly when MSM had sex with high-risk partners. Findings suggest that interventions should incorporate strategies that help MSM be safer specifically when meeting partners online and when having sex for intimacy or re-assurance. Interventions that remind MSM to carry condoms at opportune moments may also help reduce some HIV risk.
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Affiliation(s)
- Tyler B Wray
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, RI, 02906, USA.
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA.
| | - Peter M Monti
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, RI, 02906, USA
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Wang H, Chang R, Shen Q, Tsamlag L, Zhang S, Shi Y, Ma T, Wang Z, She R, Lau JTF, Wang Y, Cai Y. Information-Motivation-Behavioral Skills model of consistent condom use among transgender women in Shenyang, China. BMC Public Health 2020; 20:394. [PMID: 32216775 PMCID: PMC7098100 DOI: 10.1186/s12889-020-08494-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 03/09/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The Information-Motivation-Behavioral Skills (IMB) model has received consistent empirical support in the context of HIV prevention among various key populations, but not yet among transgender women (TGW). None effective interventions has been carried out among TGW so far to control their high prevalence of unprotected anal intercourse. The intent of the current study is to examine the application of the IMB model to clarifying the association between condom use correlates and condom use frequency among TGW in China. METHODS Using snowball sampling, we recruited 198 self-identified TGW in Shenyang, China from April 2017 to July 2017. Participants were required to complete a questionnaire assessing their background characteristics and IMB model constructs. Structural equation modeling (SEM) was conducted to demonstrate the utility of the IMB model. RESULTS The consistent condom use (CCU) rate was 47.0%. Results of SEM indicated that HIV-preventive motivation (comprising condom use attitude and subjective norms; β = 0.823, P < 0.001) and behavioral skills (including condom use skills and self-efficacy; β = 0.979, P = 0.004) were related to more frequent condom use, whereas HIV knowledge was unrelated to condom use (β = 0.052, P = 0.540). CONCLUSIONS The low CCU rate suggested that TGW in China were at high risk of HIV infection and transmission and a key intervention population. HIV-preventive interventions for this population should focus on enhancing motivation and strengthening behavioral skills to increase condom use frequency and reduce HIV infection.
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Affiliation(s)
- Huwen Wang
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China
| | - Ruijie Chang
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China
| | - Qiuming Shen
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China
| | - Lhakpa Tsamlag
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China
| | - Shuxian Zhang
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China
| | - Yue Shi
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China
| | - Tiecheng Ma
- China Love Aid, Shenyang, 110000, People's Republic of China
| | - Zixin Wang
- Centre for Health Behaviors Research, JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Rui She
- Centre for Health Behaviors Research, JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Joseph T F Lau
- Centre for Health Behaviors Research, JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Ying Wang
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China.
| | - Yong Cai
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, No.227, South Chongqing Road, Shanghai, 200025, People's Republic of China.
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Fonner VA, Mbwambo J, Kennedy CE, Kerrigan D, Sweat MD. Do Sexual Partners Talk to Each Other About HIV? Exploring Factors Associated with HIV-Related Partner Communication Among Men and Women in Tanzania. AIDS Behav 2020; 24:891-902. [PMID: 31165394 DOI: 10.1007/s10461-019-02550-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Communication between sexual partners is an important component of HIV prevention and occurs within a broader context of socio-culturally defined gender norms and dynamics. We analyzed cross-sectional data from a community-based random sample of men and women living in Kisarawe, Tanzania to understand factors related to partner communication about HIV. Bivariate and multivariate logistic regression analyses, disaggregated by gender, included variables at the individual-, relational-, and community-levels. Individuals who knew their HIV-positive status prior to the study were excluded as the focus was on risk communication, not HIV status disclosure. Of 524 participants, 129 women (43.3%) and 96 men (42.5%) reported HIV-related communication with their most recent sexual partner. For women but not men, individual-level socioeconomic factors-including education, possession of a household radio, and employment-and relational-level factors-including partner age and type-were significantly associated with partner communication. At the community level, being socially engaged was positively correlated with partner communication across genders (aOR = 2.02, 95% CI 1.05-3.89, p = 0.03 for men and aOR = 1.74, 95% CI 1.03-2.95, p = 0.04 for women). For women, having less discriminatory attitudes toward people living with HIV and favorable perceived norms of HIV-related communication were significantly associated with partner communication. For men, agreeing that women should be allowed to work outside the home was significantly correlated with partner communication (aOR = 6.02, 95% CI 2.23-16.24, p < 0.001). Findings suggest a link between gender dynamics and partner communication, with individual and relational factors being associated with communication for women and community-level factors being associated with communication for both genders.
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Bovbjerg ML, Pillai S. Current Resources for Evidence-Based Practice, September 2019. J Obstet Gynecol Neonatal Nurs 2019; 48:568-582. [PMID: 31442383 DOI: 10.1016/j.jogn.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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28
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Luft H, Ke W, Trifol L, Halpern M, Larson E. Sexual Relationship Power and Safe Sex Communication Among Partnered Women in the Dominican Republic. J Transcult Nurs 2019; 31:28-37. [PMID: 30943865 DOI: 10.1177/1043659619840413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Research is needed to identify influences on safe sex communication among specific culture groups. This study aimed to (1) describe sexual behaviors and indicators of sexual power among partnered Dominican women and (2) identify which of these indicators are significantly associated with safe sex communication. Methodology: Cross-sectional surveys, grounded in the theory of gender and power, were conducted with 100 partnered women at a clinic in southeastern Dominican Republic. Linear regression modeling was used to identify significant associations. Results: Self-efficacy (β = 0.48), total personal monthly income (β = 0.21), and history of sexually transmitted infection (β = 0.19) were significantly associated with higher level of partner safe sex communication. Discussion: Nurse clinicians, educators, and researchers should consider self-efficacy, personal income, and history of sexually transmitted infection when addressing communication in HIV prevention efforts among Dominican women.
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Affiliation(s)
- Heidi Luft
- Columbia University School of Nursing, New York, NY, USA.,University of Wisconsin-Milwaukee College of Nursing, Milwaukee, WI, USA
| | - Weiming Ke
- Milwaukee College of Nursing, University of Wisconsin, New York, NY, USA
| | - Lara Trifol
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Elaine Larson
- Columbia University School of Nursing, New York, NY, USA.,Columbia University Mailman School of Public Health, New York, NY, USA
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Abstract
Progress in reducing HIV infections has been suboptimal despite availability of effective prevention and treatment interventions and national strategies to bring them to scale. As part of a community-driven process, we expanded previous epidemiologic models using updated surveillance data from the Centers for Disease Control and Prevention to estimate quantitative parameters for ambitious but attainable national HIV prevention goals. We estimated new HIV infections could be reduced by up to 67% and prevalence could begin to decline by 2030 if 95% targets for diagnosis, care retention, and viral suppression are met by 2025 and an additional 20% of transmissions are averted through targeted interventions such as pre-exposure prophylaxis. Notably, this would require the percentage of diagnosed persons retained in HIV care to increase by more than 35 percentage points, which would necessitate innovative models and a substantial expansion of supportive services. Although the HIV incidence reduction goal of 90% as unveiled in the 2019 State of the Union Address is likely unachievable with the current intervention toolkit, it is possible to begin to substantially reduce HIV prevalence in the next decade with sufficient investments and innovation.
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Affiliation(s)
- Heather Bradley
- Department of Population Health Sciences, Georgia State University School of Public Heath, Urban Life Building, 140 Decatur Street, Ste. 463, Atlanta, GA, 30303, USA.
| | - Eli S Rosenberg
- School of Public Health, University at Albany-SUNY, New York, USA
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Logie CH, Okumu M, Ryan S, Yehdego M. Pathways from Resilient Coping to Safer Sex Communication Among African, Caribbean, and Black Women in Toronto, Canada: Results from a Cross-sectional Survey. Int J Behav Med 2019; 25:479-485. [PMID: 29790075 DOI: 10.1007/s12529-018-9728-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE African, Caribbean, and Black (ACB) women in Canada are disproportionately impacted by HIV and other sexually transmitted infections. Although there is reported suboptimal consistent condom use with ACB women, limited research has explored safer sex communication among this population. Coping frameworks highlight the role that resilient coping and condom use self-efficacy may play in facilitating safer sex communication. Structural perspectives stress the need to explore associations between HIV vulnerabilities and food insecurity. We examined pathways from resilient coping to safer sex communication through the mediator of condom use self-efficacy among ACB women in Toronto. METHOD We conducted a cross-sectional survey with a purposive sample of ACB women aged 16 and older across Toronto, Canada. We conducted path analysis to test the direct effects of resilient coping on safer sex communication, and indirect pathways through the mediator (condom use self-efficacy) while controlling for food insecurity. RESULTS Participant (n = 80; mean age 27, SD 7.93) ethnicities included African (58.8%, n = 47), Caribbean (30%, n = 24), and others (11.3%, n = 9). Participants with food security reported significantly higher safer sex communication. We found no direct effect of resilient coping on safer sex communication. Findings support the hypothesized mediation process; resilient coping was associated with condom use self-efficacy, which in turn was associated with safer sex communication. CONCLUSION Findings that condom use self-efficacy mediated the association between resilient coping and safer sex communication align with theoretical assertions of the protective role of adaptive coping strategies. Findings can inform tailored HIV and STI preventive interventions with ACB women.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada. .,Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Canada.
| | - Moses Okumu
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Shannon Ryan
- Black Coalition for AIDS Prevention (BlackCAP), Toronto, Canada
| | - Mary Yehdego
- Black Coalition for AIDS Prevention (BlackCAP), Toronto, Canada
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