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Diaz JE, Preciado E, Chiasson MA, Hirshfield S. Association Between Age of Anal Sex Debut and Adult Health Behaviors Among Sexual Minoritized Men Living with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3565-3575. [PMID: 37378702 PMCID: PMC11034742 DOI: 10.1007/s10508-023-02642-2] [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: 10/13/2020] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
Earlier age of anal sex debut (ASD) has been linked with contemporary and long-term health outcomes, including vulnerability to HIV acquisition. The goal of this study was to utilize a life course approach to examine associations between earlier ASD and recent health behaviors among sexual minoritized men (SMM) living with HIV. A total of 1156 U.S. SMM living with HIV recruited from social and sexual networking apps and websites completed online surveys as part of a longitudinal eHealth intervention. Data from baseline surveys were analyzed to determine associations between age of ASD and adult health outcomes, including mental health, HIV viral load, and substance use. The median age of ASD among these participants was 17 years old, consistent with other work. Earlier ASD was significantly associated with a greater likelihood of past 2-week anxiety (AOR = 1.45, 95% CI 1.07-1.97) and past 3-month opioid use (AOR = 1.60, 95% CI 1.13-2.26); no significant associations were found for recent depression, HIV viral load, or stimulant use. Earlier ASD may function as an important proxy measure for deleterious health outcomes in adulthood, particularly recent anxiety and opioid use. Expansion of comprehensive and affirming sexual health education is critical to early engagement of individuals with a higher risk of HIV acquisition, with plausible downstream health benefits lasting into adulthood among SMM living with HIV.
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Affiliation(s)
- José E Diaz
- Department of Medicine, STAR Program, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | | | - Mary Ann Chiasson
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Sabina Hirshfield
- Department of Medicine, STAR Program, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA.
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Oliveira CM, Marques LM, de Medeiros DS, Salgado VDJ, Soares F, Magno L, Dourado I, da Silva ÁMB, de Brito HIL, Figueiredo TB, Campos GB. Prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis infections among adolescent men who have sex with men and transgender women in Salvador, Northeast Brazil. Epidemiol Infect 2023; 151:e196. [PMID: 37869965 PMCID: PMC10728983 DOI: 10.1017/s095026882300170x] [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] [Received: 03/24/2023] [Revised: 09/29/2023] [Accepted: 10/08/2023] [Indexed: 10/24/2023] Open
Abstract
Adolescent men who have sex with men (AMSM) and transgender women (ATGW) enrolled as part of the PrEP1519 study between April 2019 and February 2021 in Salvador were tested for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections.We performed real-time polymerase chain reaction using oropharyngeal, anal, and urethral swabs; assessed factors associated with NG and CT infections using multivariable Poisson regression analysis with robust variance; and estimated the prevalence ratios (PRs) and 95% confidence intervals (95% CIs). In total, 246 participants were included in the analyses (median age: 18.8; IQR: 18.2-19.4 years). The overall oropharyngeal, anal, and urethral prevalence rates of NG were 17.9%, 9.4%, 7.6%, and 1.9%, respectively. For CT, the overall, oropharyngeal, anal, and urethral prevalence rates were 5.9%, 1.2%, 2.4%, and 1.9%, respectively. A low level of education, clinical suspicion of STI (and coinfection with Mycoplasma hominis were associated with NG infection. The prevalence of NG and CT, especially extragenital infections, was high in AMSM and ATGW. These findings highlight the need for testing samples from multiple anatomical sites among adolescents at a higher risk of STI acquisition, implementation of school-based strategies, provision of sexual health education, and reduction in barriers to care.
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Affiliation(s)
| | - Lucas Miranda Marques
- Multidisciplinary Institute for Health, Federal University of Bahia, Salvador, Brazil
- State University of de Santa Cruz, Ilhéus, Brazil
| | | | | | - Fabiane Soares
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
| | - Laio Magno
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
- Department of Life Sciences, State University of Bahia, Salvador, Brazil
| | - Inês Dourado
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
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Stout CD, Paredes CD, Nelson KM. "I wish I actually had known what the heck sex was:" What adolescent sexual minority males knew and wish they knew prior to sexual debut with a male partner. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2023; 20:84-93. [PMID: 36873566 PMCID: PMC9977109 DOI: 10.1007/s13178-021-00682-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 05/16/2023]
Abstract
Introduction Understanding the sexual health needs of adolescent sexual minority males (ASMM) at the time of sexual debut will inform programs seeking to decrease sexual health inequities experienced by ASMM. Methods In 2020, sexually active, cisgender ASMM (n=102, age 14-17) in the United States completed the baseline assessment of an online sexual health intervention pilot trial. Participants responded to closed- and open-ended questions about their sexual debut with a male partner, including sexual behavior, skills and knowledge they knew and wish they knew at the time of their debut, and sources of said skills and knowledge. Results On average, participants were 14.5 years old (SD=1.4) at their debut. Participants reported knowing how to say no to sex (80%) and wishing they knew how to talk with partners about what they would (50%) and would not (52%) like to do sexually. Open-ended responses indicated that participants desired sexual communication skills at sexual debut. Personal research (67%) was the most common knowledge source prior to debut, and open-ended responses suggest that Google, pornography, and social media were the most frequently used websites and phone applications to find information about sex. Conclusions Results suggest sexual health programs for ASMM should occur prior to sexual debut, teach sexual communication skills, and teach media literacy skills to help youth deduce credible sexual health resources. Policy Implications Incorporating the sexual health needs and wants of ASMM into sexual health programs will likely improve acceptability and efficacy, and ultimately decrease sexual health inequities experienced by ASMM.
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Affiliation(s)
- Claire D Stout
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Christian D Paredes
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Kimberly M Nelson
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Department of Psychiatry, Boston University Medical School, Boston, MA, USA
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Sexual Behavior Patterns of Black Young Adults in Georgia: Results from a Latent Class Analysis. J Racial Ethn Health Disparities 2023; 10:271-281. [PMID: 35018580 DOI: 10.1007/s40615-021-01217-y] [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: 06/17/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 02/03/2023]
Abstract
The state of Georgia ranks first in the rate of new diagnosis of HIV/AIDS, yet studies focused on understanding the drivers of this epidemic in the most at-risk groups outside the Atlanta Metropolitan Statistical Area (MSA) remain sparse. Among the many consequences of this is the inability to effectively design tailored intervention programs that appropriately address the reduction of HIV/AIDS and other STDS in the state. Reducing disparities in HIV/AIDS remains an important goal in the National HIV/AIDS Strategy. Given the disproportionate burden of the HIV/AIDS epidemic among Blacks in the state of Georgia, there is a significant need to focus research attention on the sexual behavior of young people that predisposes them to increased risk of HIV/AIDS infection. The current study used latent class analysis (LCA) to examine the sexual behavior patterns of Black young adults living in Georgia. LCA results revealed a two-class fit with distinct sexual behavior patterns. Gender and educational attainment emerged as significant predictors of class membership. Our findings contribute to the vast literature showing that sexual behavior patterns of Black young adults are not homogenous, and underscore the significance of socio-demographic and contextual factors in shaping sexual risk behavior.
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Yeboah I, Okyere J, Dey NEY, Mensah RO, Agbadi P, Essiaw MN. Multiple sexual partnership among adolescent boys and young men in Ghana: analysis of the 2003-2014 Ghana Demographic and Health Survey. Trop Med Health 2022; 50:88. [PMID: 36443834 PMCID: PMC9703711 DOI: 10.1186/s41182-022-00484-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Multiple sexual partnership (MSP) is a major cause of HIV/AIDS epidemic and unplanned pregnancies in sub-Saharan Africa. We investigate how individual, household, interpersonal, community and structural factors correlate with multiple sexual partnership of adolescent boys and young men in Ghana. METHODS We pooled secondary data from the 2003, 2008 and 2014 Ghana Demographic and Health Surveys (GDHS). Analytic sample of 1422 males aged 15-24 years who are sexually active and never married were used for the study. The outcome variable for the study was two or more sexual partners in the last 12 months preceding the survey. Five models were fitted using multilevel mixed effects logistic regression to identify predictors of multiple sexual partners. Results were presented using adjusted odds ratios (ORadj) with its corresponding 95% confidence interval. RESULTS The pooled data prevalence of multiple sexual partnership was 28.1%, with 18.7%, 30.0% and 33.3% of adolescent boys and young men involved in multiple sexual partnerships in 2003, 2008 and 2014, respectively. Results of the study showed that young men aged 20-24 years [ORadj = 1.39, 95% CI = 1.01-1.91], being from household with richest wealth index [ORadj = 1.76, 95% CI = 1.01-3.06] and those with secondary/higher education [ORadj = 2.94, 95% CI = 1.44-6.06] were more likely to have multiple sexual partners. On the other hand, those who delayed their first sex [ORadj = 0.45, 95% CI = 0.29-0.70] and those currently using modern contraceptive methods [ORadj = 0.37, 95% CI = 0.28-0.50] were less likely to have multiple sexual partners. CONCLUSION The findings provide support for the social ecological argument that sexual health behaviours are influenced by individual, interpersonal, community and contextual characteristics. Future policies and interventions seeking to address the increasing prevalence of multiple sexual partnerships among adolescent boys and young men should take into consideration family planning programmes and sexual education in affluent communities, secondary and higher institutions.
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Affiliation(s)
- Isaac Yeboah
- Institute of Work, Employment and Society, University of Professional Studies, Accra, Ghana.
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | | | - Ronald Osei Mensah
- Centre for Languages and Liberal Studies, Takoradi Technical University, Takoradi, Ghana
| | - Pascal Agbadi
- Department of Sociology and Social Policy, Lingnan University, SAR, Hong Kong, China
| | - Mary Naana Essiaw
- Institute of Work, Employment and Society, University of Professional Studies, Accra, Ghana
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Kaltiala R. Aspects of Gender and Sexuality in Relation to Experiences of Subjection to Sexual Harassment among Adolescents in General Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9811. [PMID: 36011437 PMCID: PMC9408105 DOI: 10.3390/ijerph19169811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
Subjection to sexual harassment (SH) has been reported more commonly by girls than by boys, by sexual and gender minority youth more than by mainstream youth, and by sexually active youth more than by those not yet experienced in romantic and erotic encounters. However, the research so far has not addressed these correlates simultaneously. This study aimed to explore independent associations between experiencing SH and these aspects of sex, gender and sexuality-considering all of them concurrently. A cross sectional survey with data from Finland was used, with an analyzable sample of 71,964 adolescents aged 14 to 16-years- of age, collected in 2017. The data were analysed using cross-tabulations with chi-square statistics and logistic regression analyses. The types of SH studied were gender harassment, unwelcome sexual attention, and sexual coercion. Girls, sexual and gender minority youth, and youth engaging in romantic and erotic encounters had experienced all three types of SH more commonly than boys, mainstream youth and those not sexually active. Associations between minority status and experiences of sexual harassment were stronger among boys, and being sexually active had stronger associations with subjection to sexual harassment in girls. The findings appear to support the assumption that sexual harassment serves both as a means of perpetuating heteronormativity and the sexual double standard.
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Affiliation(s)
- Riittakerttu Kaltiala
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland;
- Department of Adolescent Psychiatry, Tampere University Hospital, 33520 Tampere, Finland
- Vanha Vaasa Hospital, 65380 Vaasa, Finland
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Kutner BA, Perry NS, Stout C, Norcini Pala A, Paredes CD, Nelson KM. The Inventory of Anal Sex Knowledge (iASK): A New Measure of Sexual Health Knowledge Among Adolescent Sexual Minority Males. J Sex Med 2022; 19:521-528. [PMID: 35090838 PMCID: PMC9115869 DOI: 10.1016/j.jsxm.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/16/2021] [Accepted: 12/16/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Knowledge about sexual health is a key determinant of sexual behavior among adolescent sexual minority males (ASMM). No measures exist to assess anal sex knowledge, even though anal sex is the primary route by which ASMM acquire sexually transmitted infections (STIs), including a disproportionate burden of human immunodeficiency virus (HIV). AIM We developed a new measure as a first step toward assessing the prevalence and correlates of anal sex knowledge and potential effects of interventions to improve knowledge. METHODS Two coders independently outlined domains of knowledge within 2 sex education videos designed to address anal sex knowledge among ASMM. An initial set of 56 items, some duplicative, encompassed all domains. A larger team, including a psychometrician, then iteratively revised and reduced the set of items, and assessed construct validity via cognitive testing among ASMM (N = 4, aged 16-17 years old, 75% identifying as racial/ethnic minorities). For the final set of 10 items, factor structure and convergent and divergent validity were assessed using baseline responses to an online survey within a randomized controlled pilot trial among 154 ASMM. Open-ended questions assessed their comprehension and the acceptability of items. OUTCOMES We examined correlates that we anticipated would be theoretically related (ie, the HIV Knowledge Questionnaire [HIV-KQ-18] and the STD-Knowledge Questionnaire [STD-KQ]) and theoretically distinct (ie, the Patient Health Questionnaire [PHQ-2], Generalized Anxiety Disorder scale [GAD-2], and employment status). RESULTS The one-factor model explained 42% of the items' common variance and demonstrated acceptable internal reliability (Cronbach's alpha = 0.72). The measure withstood tests of convergent and divergent validity when compared to current measures (HIV knowledge, r = 0.35 and STI knowledge, r = 0.24, both P < .05; internalizing mental health symptoms, r = -0.07 and employment status, r = 0.13, both P > .05). Few respondents found words unfamiliar or uncomfortable. CLINICAL IMPLICATIONS A method for assessing anal sex knowledge may offer opportunities to intervene to lessen harmful sequelae of a lack of knowledge. STRENGTH & LIMITATIONS We developed a brief, psychometrically valid measure of anal sex knowledge. The measure may neither generalize to all anal health knowledge nor to more sexually experienced, older SMM. CONCLUSION The resulting 10-item, single-factor measure, the Inventory of Anal Sex Knowledge (iASK), is psychometrically sound and addresses the lack of anal sex knowledge measures among ASMM. The iASK can function to assess the prevalence and sequelae of anal sex knowledge among ASMM as well as the impact of interventions targeting anal sex knowledge. Kutner BA, Perry N, Stout C, et al. The Inventory of Anal Sex Knowledge (iASK): A New Measure of Sexual Health Knowledge Among Adolescent Sexual Minority Males. J Sex Med 2022;19:521-528.
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Affiliation(s)
- Bryan A Kutner
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA.
| | | | - Claire Stout
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Andrea Norcini Pala
- Social Intervention Group (SIG), Columbia School of Social Work, New York, NY, USA
| | - Christian D Paredes
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Kimberly M Nelson
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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Baiden P, Panisch LS, Kim YJ, LaBrenz CA, Kim Y, Onyeaka HK. Association between First Sexual Intercourse and Sexual Violence Victimization, Symptoms of Depression, and Suicidal Behaviors among Adolescents in the United States: Findings from 2017 and 2019 National Youth Risk Behavior Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157922. [PMID: 34360215 PMCID: PMC8345499 DOI: 10.3390/ijerph18157922] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022]
Abstract
The objective of this study was to investigate the association between first sexual intercourse and sexual violence victimization, symptoms of depression, and suicidal ideation among sexually active adolescents in the United States. Data for this study came from the U.S. 2017 and 2019 iterations of the National Youth Risk Behavior Survey. An analytic sample of 6252 adolescents aged 14–18 years old (49.5% female) who reported ever having sexual intercourse was analyzed using Poisson regression. The outcome variables investigated in this study were sexual violence victimization, symptoms of depression, suicidal ideation, a suicide plan, and suicide attempts, and the main explanatory variables were age at first sexual intercourse and forced sexual intercourse. We also analyzed differences by gender and race. Of the 6252 adolescents who reported ever having sexual intercourse, 7.1% had their first sexual intercourse before age 13, and 14.8% experienced forced sexual intercourse. About 16% of adolescents experienced sexual violence during the past year, 42.6% reported symptoms of depression, 23.9% experienced suicidal ideation, 19.3% made a suicide plan, and 11.1% attempted suicide during the past year. In the regression analysis, early sexual intercourse was significantly and positively associated with suicidal ideation (relative risk (RR) = 1.15, 95% Confidence Interval (CI) = 1.02–1.30), suicide plan (RR = 1.18, 95% CI = 1.00–1.38), and suicide attempts (RR = 1.36, 95% CI = 1.15–1.61). Controlling for the effects of covariates, history of forced sexual intercourse was positively associated with the five outcomes examined with the relative risk ranging between 1.59 and 6.01. Findings of this study suggest that history of early or forced sexual intercourse is associated with poor mental health outcomes among adolescents and underscores the importance of developing interventions that offer psychological support in reducing the adverse impact of early sexual intercourse and forced sexual intercourse on adolescent health.
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Affiliation(s)
- Philip Baiden
- School of Social Work, University of Texas at Arlington, Arlington, TX 76019, USA;
- Correspondence:
| | - Lisa S. Panisch
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA;
| | - Yi Jin Kim
- Department of Social Work, University of Mississippi, University, MS 38677, USA;
| | - Catherine A. LaBrenz
- School of Social Work, University of Texas at Arlington, Arlington, TX 76019, USA;
| | - Yeonwoo Kim
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX 76019, USA;
| | - Henry K. Onyeaka
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA;
- Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA
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