Scope of HIV risk and co-occurring psychosocial health problems among young adults: violence, victimization, and substance use

A longitudinal pathway from ethnic-racial discrimination to sexual risk behaviors among Black women and Latinas: Ethnic-racial identity exploration as a protective factor

BACKGROUND

Black women and Latinas in their thirties continue to be at risk for HIV transmission via heterosexual intercourse.

METHODS

Informed by the Theory of Gender and Power, this study investigated a longitudinal path model linking experiences of ethnic-racial discrimination in late adolescence to sexual risk behaviors in adulthood among 492 Black women and Latinas. We also tested whether ethnic-racial identity exploration served as a resilience asset protecting women against the psychological impact of ethnic-racial discrimination. Survey data from female participants in the Harlem Longitudinal Development Study, which has followed a cohort of New York City Black and Latinx youth since 1990, were analyzed. Data for this analysis were collected at four time points when participants were on average 19, 24, 29, and 32 years of age. Structural equation modeling was used to examine a hypothesized pathway from earlier ethnic-racial discrimination to later sexual risk behaviors and the protective role of ethnic-racial identity exploration.

RESULTS

Results confirmed that ethnic-racial discrimination in late adolescence was linked with sexual risk behaviors in the early thirties via increased levels of affective distress in emerging adulthood, experiences of victimization in young adulthood, and substance use in the early thirties among women low in ethnic-racial identity exploration. We also found that ethnic-racial identity served as a resilience asset, as the association between discrimination in late adolescence and affective distress in emerging adulthood was not significant among women with higher levels of ethnic-racial identity exploration.

CONCLUSIONS

The results provide important preliminary evidence that ethnic-racial identity exploration may serve as a resilience asset among Black women and Latinas confronting racial discrimination. Further, we suggest that ethnic-racial identity exploration may constitute an important facet of critical consciousness.

"I'm an adult now": Health risk behaviors and identifying as an adult

Is identifying as an adult associated with lower rates of participation in risky behaviors? This study focuses on how identity affects health behaviors for young adults. We use an original sample of over 500 18- to 29-year-olds in the United States to explore how self-identification as an adult is associated with three clusters of health risk behaviors: substance use, risky sexual behavior, and risky driving behavior. Consistent with our predictions, we find that viewing oneself as an adult is associated with lower levels of participation in each of the health risk behavior outcomes.

Alcohol use and intimate partner violence in HIV-uninfected pregnant women in Cape Town, South Africa

In settings with a high burden of HIV, pregnant women often experience a cluster of risk factors, including alcohol use and intimate partner violence (IPV). These interrelated risks are poorly understood among pregnant women at risk of HIV in sub-Saharan Africa. We aim to determine cross-sectional associations between pregnant women's alcohol use and victimization due to IPV in the HIV-Unexposed-Uninfected Mother-Infant Cohort Study in Cape Town, South Africa. Women who tested HIV-negative at first antenatal care (ANC) visit were followed to delivery. Trained interviewers collected demographic and psychosocial information, including recent alcohol use and experiences of IPV victimization. We assess the prevalence of alcohol use and associations with IPV using multivariable logistic regression. In 406 HIV-uninfected pregnant women (mean age = 28 years; mean gestational age = 21 weeks), 41 (10%) reported alcohol consumption in the past 12 months; 30/41 (73%) of these at hazardous levels. Any and hazardous alcohol use were associated with greater odds of reporting past year IPV (adjusted odds ratio [aOR] for hazardous use: 3.24, 95% CI = 1.11, 7.56; aOR for any alcohol use: 2.97, 95% CI = 1.19, 7.45). These data suggest the occurrence of overlapping HIV risk factors among pregnant women and may help design improved health interventions in this population.

The relationship between severity of drug problems and perceived interdependence of drug use and sexual intercourse among adult males in drug addiction rehabilitation centers in Japan

BACKGROUND

Consuming drugs in conjunction with sexual intercourse may shape the perceived interdependence of drug use and sexual intercourse (PIDS). Additionally, the severity of drug problems may have a significant impact on PIDS. However, this relationship remains unverified. Therefore, this study investigates whether the severity of drug problems is associated with PIDS among adult males in drug addiction rehabilitation centers (DARC) in Japan.

METHODS

This study was a secondary analysis of the "DARC Follow-Up Study in Japan" conducted by the National Center of Neurology and Psychiatry in 2016, in which participants from 46 facilities completed a self-report questionnaire. A total of 440 males with drug dependence were included in the analysis. We analyzed participants' demographic characteristics, history of sexually transmitted disease diagnoses, and responses to questions related to drug use (e.g., primary drug use and PIDS). Additionally, we measured the severity of drug problems using the Japanese version of the Drug Abuse Screening Test-20 (DAST-20).

RESULTS

The median age of the participants was 42 years. The median DAST-20 score was 14.0, the primary drug was methamphetamine (61.4%) and new psychoactive substances (NPS: 13.6%). Multivariate analysis indicated that participants' experiences with unprotected sexual intercourse ("mostly a non-condom user": adjusted odds ratio (AOR) = 4.410), methamphetamine use (AOR = 3.220), new psychoactive substances use (AOR = 2.744), and the DAST-20 score (AOR = 1.093) were associated with PIDS.

CONCLUSIONS

This study indicated that the frequency of unprotected sexual intercourse under the influence of drugs, methamphetamine and NPS use were strongly associated with PIDS. The severity of drug problems was also significantly associated with PIDS. It is necessary to develop culturally appropriate treatment programs adapted to the needs of patients who experience strong PIDS.

Adolescent Predictors of Generalized Health Risk in Young Adulthood: A 10-Year Longitudinal Assessment

We conducted a prospective examination of multiple adolescent predictors of generalized health risk in early adulthood. Data were used from 3,392 members of a longitudinal cohort surveyed at ages 13 and 23. A measure of generalized risk was constructed using confirmatory factor analysis to represent shared variance among substance use, sexual risk, and victimization. Multiple regression analysis indicated several robust sociodemographic, behavioral, and environmental early predictors of generalized adult risk, including gender, age, race, not coming from a nuclear family, engaging in smoking and deviant behavior as an adolescent, having poor grades in high school, alcohol and cigarette use by an adult important to the adolescent, and being offered substances as an adolescent. Results support the existence of an underlying risk construct in early adulthood, the importance of early adolescent deviance and substance use exposure in predicting risk, and the use of early comprehensive interventions that prevent several risks simultaneously.

Sexually Transmitted Infection History among Adolescents Presenting to the Emergency Department

BACKGROUND

Adolescents and young adults account for about half of the annual diagnoses of sexually transmitted infections (STI) in the United States. Screening and treatment for STIs, as well as prevention, are needed in health-care settings to help offset the costs of untreated STIs.

OBJECTIVE

Our aim was to evaluate the prevalence and correlates of self-reported STI history among adolescents presenting to an emergency department (ED).

METHODS

Over two and a half years, 4389 youth (aged 14-20 years) presenting to the ED completed screening measures for a randomized controlled trial. About half (56%) reported lifetime sexual intercourse and were included in analyses examining sexual risk behaviors (e.g., inconsistent condom use), and relationships of STI history with demographics (sex, age, race, school enrollment), reason for ED presentation (i.e., medical or injury), and substance use.

RESULTS

Among sexually active youth, 10% reported that a medical professional had ever told them they had an STI (212 females, 35 males). Using logistic regression, female sex, older age, non-Caucasian race, not being enrolled in school, medically related ED chief complaint, and inconsistent condom use were associated with increased odds of self-reported STI history.

CONCLUSIONS

One in 10 sexually active youth in the ED reported a prior diagnosed STI. Previous STI was significantly higher among females than males. ED providers inquiring about inconsistent condom use and previous STI among male and female adolescents may be one strategy to focus biological testing resources and improve screening for current STI.

Risky Sexual Behavior and Substance Use among Adolescents: A Meta-analysis

This study presents the results of a meta-analysis of the association between substance use and risky sexual behavior among adolescents. 87 studies fit the inclusion criteria, containing a total of 104 independent effect sizes that incorporated more than 120,000 participants. The overall effect size for the relationship between substance use and risky sexual behavior was in the small to moderate range (r = .22, CI = .18, .26). Further analyses indicated that the effect sizes did not substantially vary across the type of substance use, but did substantially vary across the type of risky sexual behavior being assessed. Specifically, mean effect sizes were smallest for studies examining unprotected sex (r = .15, CI = .10, .20), followed by studies examining number of sexual partners (r = .25, CI = .21, .30), those examining composite measures of risky sexual behavior (r = .38, CI = .27, .48), and those examining sex with an intravenous drug user (r = .53, CI = .45, .60). Furthermore, our results revealed that the relationship between drug use and risky sexual behavior is moderated by several variables, including sex, ethnicity, sexuality, age, sample type, and level of measurement. Implications and future directions are discussed.

Identification and risk assessment of Swedish youth at risk of chlamydia

AIMS

The aim of the study was to identify youth at high risk of chlamydia including variables related to sexual health and negative experiences of sexuality.

METHODS

In late 2009, a questionnaire on sexuality was answered by Swedish youth. The study sample was self-selected from different Internet communities. Data from 6544 sexually active participants, aged 15-24 years, were analyzed in a multivariable logistic regression model. Discriminative power was measured by the area under the receiver operating characteristic curve.

RESULTS

In the univariate analysis, self-reported chlamydia was associated with most risk behavior variables, experience of coerced sex, and reimbursement for sex, with slight gender variation. The factors that best predicted self-reported chlamydia among females were number of partners, age, and having been reimbursed for sex. Among males, the number of partners and alcohol consumption were the strongest predictors. Increasing number of partners up to 10 during the past 12 months was the most important predictor for both genders. A skewed distribution of chlamydia was demonstrated, in that 37.6% of cases in females and 38.6% in males were estimated to occur among a tenth of the population.

CONCLUSIONS

Testing, prevention, and care for chlamydia should be directed toward those most at risk, as they account for a large proportion of the total number of chlamydia cases. The special needs of the high-risk group need to be acknowledged and chlamydia regarded as a possible marker for risk behavior and negative sexuality experiences.

Response inhibition moderates the association between drug use and risky sexual behavior

BACKGROUND

HIV infection is problematic among all drug users, not only injection drug users. Drug users are at risk for contracting HIV by engaging in risky sexual behaviors.

OBJECTIVE

The present study sought to determine whether inhibitory processes moderate the relationship between problematic drug use and HIV-risk behaviors (unprotected sex and multiple sex partners).

METHODS

One hundred ninety-six drug offenders enrolled in drug education programs were administered a battery of computer-based assessments. Measures included a cued go/no-go assessment of inhibitory processes, the Drug Abuse Screening Test (DAST) assessment of problematic drug use, and self-report assessment of condom use and multiple sex partners.

RESULTS

Findings revealed that response inhibition assessed by the proportion of false alarms on the cued go/no-go moderated the relationship between problematic drug use and an important measure of HIV risk (condom nonuse) among drug offenders. However, response inhibition did not moderate the relationship between problematic drug use and another measure of HIV risk: multiple sex partners.

CONCLUSIONS

Among this sample of drug offenders, we have found a relationship between problematic drug use and condom nonuse, which is exacerbated by poor control of inhibition. These findings have implications for the development of HIV intervention components among high-risk populations.

Gendered discourses of youth sexualities--an exploration of PubMed articles on prevention of sexually transmissible infections

OBJECTIVE

To explore how gender is addressed in medical articles on the prevention of sexually transmissible infections (STI) among adolescents.

METHODS

Sixtyone articles were retrieved from a PubMed search and scrutinized by qualitative content analysis.

RESULTS

Most articles were affiliated with North American research institutions, but there were also reports from Europe, Africa, South America, and Asia. Gender turned up in the following four recurrent discourses: Gendered Receptiveness for Information, Stereotyped Heterosexual Expectations, Power Imbalance in Sexual Relations, and Gendered Prevention Approaches. Young women were described as knowledgeable, communicative, and responsible, but at risk because of feminine ideals and a lack of negotiating power. Men were described as less informed, more reluctant to discuss, and more risk taking due to masculine ideals and power dominance. Prevention approaches concerned how to postpone sex and/or tailor gender-sensitive programs for specific groups of young women and men.

CONCLUSION

Researchers' own gender expectations might have a substantial impact on how sex and sexual health is considered in prevention research. To avoid reconstruction of current inequalities and stereotypes regarding sexual practices of young women and men, the impact of gender, the power structures in intimate relations, and the cultural context should be considered. Medical research on STI prevention could benefit from including a wider array of gender perspectives.

Prescription drug misuse and sexual risk behaviors among adolescents and emerging adults

OBJECTIVE

The purpose of this study was to evaluate associations between prescription drug misuse (PDM) and sexual risk behaviors (SRBs) among adolescents and emerging adults.

METHOD

In a hospital emergency department, 2,127 sexually active 14- to 20-year-olds (61% female) reported on past-year alcohol use severity (using the Alcohol Use Disorders Identification Test-consumption [AUDIT-C]), cannabis use, PDM (n = 422), and SRBs (inconsistent condom use, multiple partners, intercourse following alcohol/other drug use).

RESULTS

Bivariately, AUDIT-C score, cannabis use, and PDM of stimulants, opioids, and sedatives were positively associated with each SRB. Because many participants reported PDM for multiple drug classes (i.e., sedatives, stimulants, opioids), participants were categorized as (a) no PDM (n = 1,705), (b) PDM of one class (n = 251), (c) PDM of two classes (n = 90), or (d) PDM of three classes (n = 81). Three hierarchical logistic regression models evaluated the associations of number of classes of PDM with SRBs separately, after accounting for demographics (age, gender, race), AUDIT-C score, and cannabis use. Adding PDM statistically improved each model beyond what was accounted for by demographics, alcohol, and cannabis use. For inconsistent condom use and substance use before sex, PDM of one, two, or three classes was significantly associated with increased odds of these SRBs. PDM of two or three classes was associated with increased odds of reporting multiple partners.

CONCLUSIONS

Findings suggest that PDM, especially poly-PDM, may be a pertinent risk factor for SRBs among youth. Event-based research could further evaluate how PDM, as well as other substance use, is related to SRBs at the event level in order to inform interventions.

Parental rearing behavior prospectively predicts adolescents' risky decision-making and feedback-related electrical brain activity

The present study examined the role of parental rearing behavior in adolescents' risky decision-making and the brain's feedback processing mechanisms. Healthy adolescent participants (n = 110) completed the EMBU-C, a self-report questionnaire on perceived parental rearing behaviors between 2006 and 2008 (T1). Subsequently, after an average of 3.5 years, we assessed (a) risky decision-making during performance of the Balloon Analogue Risk Task (BART); (b) event-related brain potentials (ERPs) elicited by positive (gain) and negative feedback (loss) during the BART; and (c) self-reported substance use behavior (T2). Age-corrected regression analyses showed that parental rejection at T1 accounted for a unique and significant proportion of the variance in risk-taking during the BART; the more adolescents perceived their parents as rejecting, the more risky decisions were made. Higher levels of perceived emotional warmth predicted increased P300 amplitudes in response to positive feedback at T2. Moreover, these larger P300 amplitudes (gain) significantly predicted risky decision-making during the BART. Parental rearing behaviors during childhood thus seem to be significant predictors of both behavioral and electrophysiological indices of risky decision-making in adolescence several years later. This is in keeping with the notion that environmental factors such as parental rearing are important in explaining adolescents' risk-taking propensities.

What's age got to do with it? Partner age difference, power, intimate partner violence, and sexual risk in urban adolescents

Adolescent girls with older male main partners are at greater risk for adverse sexual health outcomes than other adolescent girls. One explanation for this finding is that low relationship power occurs with partner age difference. Using a cross-sectional, descriptive design, we investigated the effect of partner age difference between an adolescent girl and her male partner on sexual risk behavior through the mediators of sexual relationship power, and physical intimate partner violence (IPV), and psychological IPV severity. We chose Blanc's framework to guide this study as it depicts the links among demographic, social, economic, relationship, family and community characteristics, and reproductive health outcomes with gender-based relationship power and violence. Urban adolescent girls (N = 155) completed an anonymous computer-assisted self-interview survey to examine partner and relationship factors' effect on consistent condom use. Our sample had an average age of 16.1 years with a mean partner age of 17.8 years. Partners were predominantly African American (75%), non-Hispanic (74%), and low-income (81%); 24% of participants reported consistent condom use in the last 3 months. Descriptive, correlation, and multiple mediation analyses were conducted. Partner age difference was negatively associated with consistent condom use (-.4292, p < .01); however, the indirect effects through three proposed mediators (relationship power, physical IPV, or psychological IPV severity) were not statistically significant. Further studies are needed to explore alternative rationale explaining the relationship between partner age differences and sexual risk factors within adolescent sexual relationships. Nonetheless, for clinicians and researchers, these findings underscore the heightened risk associated with partner age differences and impact of relationship dynamics on sexual risk behavior.

Forced intercourse, individual and family context, and risky sexual behavior among adolescent girls

PURPOSE

This study tested the hypothesis that individual and family factors associated with adolescent risky sexual behavior (RSB) operate differently in their relationship to RSB among girls who have experienced forced sexual intercourse (FSI), as compared to those girls who have not.

METHODS

Data were collected from 3,863 eighth-grade girls from a larger statewide sample. Different subgroups of participants received different sets of questions, so 655-2,548 students were included in each analysis. Multilevel modeling was used to examine relationships of individual (social negotiation skills, personal safety, depression, and sensation-seeking personality) and family factors (sibling deviance, parental monitoring, and quality of family relationships) to RSB. FSI was examined as a predictor of RSB and as a moderator of the relationship between individual and family variables and sexual risk.

RESULTS

In the case of individual predictors, social negotiation skills were associated with lower RSB for all girls, but these skills had a stronger relationship to RSB among girls who had experienced FSI. Depression and sensation-seeking tendencies had small positive relationships to RSB for all girls. In the case of family predictors, for girls without a history of FSI, parental monitoring was associated with lower RSB. However, among girls who had experienced FSI, parental monitoring was not significantly related to RSB, but sibling deviance was associated with lower RSB.

CONCLUSIONS

Results suggest that social negotiation skills and parental monitoring may warrant further attention in research and intervention.

Effects of Timing of Adversity on Adolescent and Young Adult Adjustment

Effects of Timing of Adversity on Adolescent and Young Adult Adjustment Abstract Exposure to adversity during childhood and adolescence predicts adjustment across development. Further, adolescent adjustment problems persist into young adulthood. This study examined relations of contextual adversity with concurrent adolescent adjustment and prospective mental health and health outcomes in young adulthood. A longitudinal sample (N = 808) was followed from age 10 through 27. Perceptions of neighborhood in childhood predicted depression, alcohol use disorders, and HIV risk in young adulthood. Further, the timing of adversity was important in determining the type of problem experienced in adulthood. Youth adjustment predicted adult outcomes, and in some cases, mediated the relation between adversity and outcomes. These findings support the importance of adversity in predicting adjustment and elucidate factors that affect outcomes into young adulthood.

An evaluation of immediate outcomes and fidelity of a drug abuse prevention program in continuation high schools: project towards no drug abuse (TND)

The present study provides an implementation fidelity, process, and immediate outcomes evaluation of Project Towards No Drug Abuse (TND), a drug prevention program targeting continuation high school youth (n=1426) at risk for drug abuse. A total of 24 schools participated in three randomized conditions: TND Only, TND and motivational interviewing follow-up, and no treatment control. Fidelity was high: across program schools the curriculum was implemented as intended and was received favorably by students. Relative to controls, intervention conditions produced effects on hypothesized mediators, including greater gains in program related knowledge, greater reductions in drug use intentions, and positive changes in motivation. However, few generalizations to attitudes and intentions regarding risky sexual behavior were found. The pattern of results suggests that the experimental manipulations worked as intended.

Correlates of forced sex among populations of men who have sex with men in Thailand

Although forced sex is a correlate of HIV infection, its prevalence and associated risks are not well described among men who have sex with men (MSM) in developing-country settings. Between March and October 2005, we assessed the prevalence of forced sex and correlates among populations of MSM (this includes general MSM, male sex workers, and male-to-female transgender persons) in Thailand using a community-based sample. Participants were enrolled from venues around Bangkok, Chiangmai, and Phuket using venue day-time sampling. Handheld computer-assisted self-interviewing was used to collect demographic and behavioral data and logistic regression evaluated factors associated with forced sex, defined as ever being forced to have sexual intercourse against one's will. Of the 2,049 participants (M age, 24.8 years), a history of forced sex was reported by 376 (18.4%) men and, of these, most were forced by someone they knew (83.8%), forced more than once (67.3%), and had first occurrence during adolescence (55.1%). In multivariate analysis, having a history of forced sex was significantly associated with being recruited in Phuket, classification as general MSM or transgender (versus classification as male sex worker), drug use, increased number of male sexual partners, and buying sex. The findings in our assessment were consistent with assessments from Western countries. Longitudinal studies are needed to understand the mechanisms of the relationships between forced sex correlates found in our assessment and HIV acquisition and transmission risks.

Substance use among adolescents of parents living with HIV in New York City

We examined the relationship of community, interpersonal, and personal risk and protective factors to substance use among adolescents of parents with HIV (PWH). Families with HIV (n = 269 PWH and 409 adolescents) from New York City were recruited, and multivariate models were used to examine the associations. Adjusting for age, gender, and ethnicity, substance use was positively associated in univariate analyses with parental substance use, family conflict, adolescent emotional distress, and adverse life events; having academically oriented friends and religiosity were protective. In the multivariate model, multiple problem behaviors (e.g., delinquency) and substance-using peers were significantly associated with substance use. The patterns of associations between the risk factors and substance use are similar to those of adolescents in families not impacted by HIV. Interventions aimed at improving parental care, reducing maladaptive peer networks, and decreasing problem behaviors are important strategies to explore in future prevention studies.

A longitudinal study of sexual risk behavior among the adolescent children of HIV-positive and HIV-negative drug-abusing fathers

PURPOSE

This is a longitudinal study of the precursors of sexual risk behavior among a cohort of adolescent children of HIV-positive and HIV-negative drug-abusing or drug-dependent fathers.

METHODS

Individual structured interviews were administered to 296 drug-abusing or drug-dependent fathers, 43% of whom were HIV positive, and an adolescent child of each father (mean age = 16.3 years; SD = 2.8). Adolescents were reinterviewed approximately 1 year later, at Time 2.

RESULTS

Structural equation modeling showed multiple direct and indirect pathways from psychosocial factors to adolescent sexual risk behavior (sexually active, number of sexual partners, and frequency of condom use). Greater paternal drug addiction and infection with HIV/AIDS, and the youth's perception of environmental hostility (discrimination and victimization), were both related to increased adolescent maladjustment and substance use. Greater paternal drug addiction and infection with HIV/AIDS also were associated with a weaker father-child mutual attachment, which was linked with increased adolescent maladjustment and substance use. Greater perceived environmental hostility (discrimination and victimization), a weak father-child relationship, and greater adolescent maladjustment and substance use had direct pathways to adolescent sexual risk behavior.

CONCLUSIONS

Findings suggest complex interrelationships among paternal, environmental, social, personal, and substance use factors as longitudinal predictors of sexual risk behavior in children whose fathers abuse or are dependent upon drugs. The importance of perceived environmental hostility, the father-child relationship, and adolescent maladjustment and substance use may have implications for public policy as well as prevention and treatment programs.

Examining the content and outcomes of young adults' satisfying and unsatisfying conversations about sex

In this study, we examined young adults' conversational descriptions of satisfying and unsatisfying sexual conversations with a romantic partner and the relational and sexual outcomes. We coded participants' responses for content, when and where conversations occurred, and the results of conversations. Most often, conversations occurred in residences at the beginning of relationships and addressed sexual pleasure, relationship issues, sexual health, past sexual experience, attitudes/values, and sexual decision making. The results of conversations included relational consequences such as distrust, anger, understanding, and being afraid to talk to a partner, as well as sexual outcomes such as better sex, condom use, and better sex talk. The findings suggest that the costs and rewards of young adults' sexual disclosure have implications for the effectiveness of sexual communication.

Long-term effects of drug prevention on risky sexual behavior among young adults

OBJECTIVE

This study assesses the impact of a school-based drug prevention program, called Project ALERT, on risky sexual behavior among 1901 nonmarried, sexually active young adults who participated in one of two program variations as adolescents. It also tests for differences in program effect depending on program duration (middle school only vs. a combined middle school and high school program) and participants' gender.

METHODS

Using survey data from a randomized controlled experiment conducted in 45 midwestern communities (55 schools), we assessed program effects on risky sexual behavior at age 21 with three measures-having unprotected sex because of drug use plus engaging in inconsistent condom use and having sex with multiple partners.

RESULTS

Compared to control, Project ALERT reduced the likelihood of all risky sex outcomes except inconsistent condom use among these sexually active young adults, effects that occurred 5 and 7 years after program exposure. Program effects were partially mediated by reductions in alcohol and drug abuse. There were no significant differences in program effects by gender or by program duration compared to control. Implications for future prevention programs and research are discussed.

Prior victimization and sexual and contraceptive self-efficacy among adolescent females under Child Protective Services care

Adolescent females under Child Protective Services care in Quebec, Canada (n = 328) completed a questionnaire designed to explore associations between prior victimization (childhood sexual abuse and four forms of dating violence) and four dimensions of sexual and contraceptive self-efficacy. Five MANCOVAs were performed. In each model, a victimization index served as the independent variable, four Contraceptive Self-Efficacy subscales as dependant variables, and age, age at first sexual intercourse, and lifetime number of sexual partners as covariates. Childhood sexual abuse was negatively associated with adolescent's perceived ability to communicate about her sexuality and contraceptive practices. Sexual coercion in dating relationships was negatively associated with the adolescent's perceived ability to communicate about her sexuality and contraception, her perceived control over her sexual activity, and her perceived control over her use of contraceptives in passionate situations. Sexual victimization was found to impair important aspects of adolescent females' sexual and contraceptive self-efficacy.

Ethnic differences in substance use, sexual risk behaviors, and psychosocial factors in a sample of heterosexual methamphetamine users

Ethnic differences in measures of substance use, sexual risk behaviors, and psychosocial factors (depression, stigma, self-esteem) were examined in a sample of 402 heterosexual methamphetamine users (55.0% Caucasian, 29.9% African American, 15.1% Latino) who participated in a sexual risk reduction intervention between June 2001 and March 2005 in San Diego, California. Participants were primarily male (67%) and noncollege graduates (72%) and belonged to the low-income group (66%). African Americans were older when they first used methamphetamine and had used fewer grams in the past 30 days; Caucasians were more likely to inject. A larger percentage of African Americans reported anonymous sex partners in the past 2 months. African Americans reported lower levels of social stigma, and Caucasians reported lower self-esteem. Limitations and potential applications of these findings to prevention and treatment programs for ethnic minority populations are discussed.

Gender-based violence and HIV: relevance for HIV prevention in hyperendemic countries of southern Africa

Gender-based violence (GBV) is common in southern Africa. Here we use GBV to include sexual and non-sexual physical violence, emotional abuse, and forms of child sexual abuse. A sizeable literature now links GBV and HIV infection.Sexual violence can lead to HIV infection directly, as trauma increases the risk of transmission. More importantly, GBV increases HIV risk indirectly. Victims of childhood sexual abuse are more likely to be HIV positive, and to have high risk behaviours.GBV perpetrators are at risk of HIV infection, as their victims have often been victimised before and have a high risk of infection. Including perpetrators and victims, perhaps one third of the southern African population is involved in the GBV-HIV dynamic.A randomised controlled trial of income enhancement and gender training reduced GBV and HIV risk behaviours, and a trial of a learning programme reported a non-significant reduction in HIV incidence and reduction of male risk behaviours (primary prevention). Interventions among survivors of GBV can reduce their HIV risk (secondary prevention). Various strategies can reduce spread of HIV from infected GBV survivors (tertiary prevention). Dealing with GBV could have an important effect on the HIV epidemic.A policy shift is necessary. HIV prevention policy should recognise the direct and indirect implications of GBV for HIV prevention, the importance of perpetrator dynamics, and that reduction of GBV should be part of HIV prevention programmes. Effective interventions are likely to include a structural component, and a GBV awareness component.

Club drug use in los angeles among young men who have sex with men

Little is known about young men who have sex with men's use of club drugs and the risk factors associated with such use. A structured survey was administered in 2005 to 496 young men who were 18-22 years old (40% were 18-19 years old); self-identified as with a same-sex sexuality (83%), bisexual (16%), and/or had had sex with a man (97%); Caucasian (35%), African American (24%), and Latino of Mexican descent (40%). Subjects were recruited from gay-identified venues in Los Angeles, California, using a venue-based probability sampling design. Descriptive statistics revealed a high prevalence of drug and club drug use. Regression analyses revealed risk factors associated with recent club drug use, including place of residence, religiosity, disclosure of sexuality to family, frequency of attendance at bars/clubs, and involvement in sexual exchange and street economy. Limitations and implications of this research are discussed.

Reproductive health, criminal activity, and abuse among 10- to 15-year-old females enrolled in medicaid

OBJECTIVE

To quantify the degree of abuse or criminal behavior among young females presenting for reproductive health care services.

METHODS

An evaluation was conducted among Alaskan females age 10 through 15 years enrolled in Medicaid. Subjects were identified who had experienced reproductive health outcomes. The Medicaid file was linked to a Child Protective Services database and a Juvenile Justice database to identify episodes of abuse by a caretaker and criminal behavior.

RESULTS

Of 21,350 Alaskan females aged 10-15 years enrolled in Medicaid during 1999-2003, 841 (3.9%) presented for reproductive health care, 2,930 (14%) were referred to Child Protective Services and 1,858 (8.7%) were referred to Juvenile Justice for criminal activity. Among the subjects with a reproductive health-related claim, 39% were referred to Child Protective Services while 31% were referred to Juvenile Justice at some point during the study period. Reproductive health care was strongly associated with referral to Child Protective Services (adjusted odds ratio [aOR] 2.9, 95% confidence interval [CI] 2.5-3.4), substantiated sexual abuse (aOR 2.3, 95% CI 1.7-3.2), and referral to Juvenile Justice (aOR 2.9, 95% CI 2.5-3.4). These associations remained regardless of the type of reproductive health care, including contraceptive management.

CONCLUSION

Females aged 10-15 years enrolled in Medicaid who present for any type of reproductive health care are at increased risk of abuse by a caretaker and criminal behavior. Clinicians caring for low-income females should consider routine screening for sexual activity and the experience of violence.

LEVEL OF EVIDENCE

II-2.

HIV in adolescents

Adolescence is a time of dramatic physical, emotional, cognitive, and social change that brings new vulnerabilities. Youth represent half of all new HIV infections in the United States and the rest of the world. The number of newly infected adolescents who acquire the disease behaviorally and the number of perinatally infected children surviving into adolescence have both contributed to this growth. This article reviews the most recent epidemiology of HIV/AIDS in adolescents, gives guidance on clinical practice, including medical and psychosocial care, and examines prevention issues, including counseling and testing, which are needed to make programs effective for youth.