Concurrent partnerships, nonmonogamous partners, and substance use among women in the United States

Prevalence and risk factors associated with psychostimulant use among Black individuals: A meta-analysis and systematic review

BACKGROUND

Psychostimulants (e.g., cocaine, amphetamine) are among the most widely used drugs globally with detrimental short and long-term physical, psychological and social consequences. There is limited data on psychostimulant use for various racial and ethnic groups, including Black people, and the challenges they face living as minorities overcoming historical challenges including increased incarceration associated with drug possession.

METHODS

Peer-reviewed articles were identified in five databases (APA PsycInfo, CINAHL, Cochrane CENTRAL, Embase, MEDLINE). Eligible studies were published in French or English, provided empiral data on psychostimulant use in Black individuals living in a minority context. The PRISMA guideline was used for structuring the review. Random-effects meta-analyses were generated to estimate the pooled prevalence of lifetime and periodic psychostimulant use among Black individuals using STATA 16.

RESULTS

Sixty-three studies published from 1991 to 2022 with a sample size of 139,683 Black individuals were included in the current meta-analysis. Results indicate a pooled prevalence estimate of 11.4% for any form of psychostimulant use among Black individuals. The pooled prevalence estimates were 12.4% (95% CI, 8.4% - 16.4%) for cocaine, 8.3% (95% CI, 0% - 19.1%) for amphetamines, and 11.4% (95% CI, 4.6% - 18.1%) for other stimulants. Prediction intervals for all psychostimulant types were highly heterogenous ranging from 0% to as high as 51.2% for amphetamine suggesting prevalence of use in some studies of Black people could be found to be as low as zero. Subgroup analyses were conducted to examine differences between age groups, gender, reference period, and type of assessment.

CONCLUSIONS

High prevalence rates of psychostimulant use among Black people argues for greater access to evidence-based treatments. However, current psychosocial interventions are suboptimal, warranting further study. Consideration needs to be given to the challenges of the large range of prediction intervals, living in urban areas, racial discrimination experiences, race-based stress, and sociodemographic characteristics, including poverty, education level, age, gender.

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.

Vaginal microbiota of American Indian women and associations with measures of psychosocial stress

Molecular-bacterial vaginosis (BV) is characterized by low levels of vaginal Lactobacillus species and is associated with higher risk of sexually transmitted infections (STI). Perceived psychosocial stress is associated with increased severity and persistence of infections, including STIs. American Indians have the highest rates of stress and high rates of STIs. The prevalence of molecular-BV among American Indian women is unknown. We sought to evaluate measures of psychosocial stress, such as historic loss (a multigenerational factor involving slavery, forced removal from one's land, legally ratified race-based segregation, and contemporary discrimination) and their association with the vaginal microbiota and specific metabolites associated with BV, in 70 Northwestern Plains American Indian women. Demographics, perceived psychosocial stressors, sexual practices, and known BV risk factors were assessed using a modified version of the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project survey. Self-collected mid-vaginal swabs were profiled for bacterial composition by 16S rRNA gene amplicon sequencing and metabolites quantified by targeted liquid-chromatography mass spectrometry. Sixty-six percent of the participants were classified as having molecular-BV, with the rest being either dominated by L. crispatus (10%) or L. iners (24%). High levels of lifetime trauma were associated with higher odds of having molecular-BV (adjusted Odds Ratio (aOR): 2.5, 95% Credible Interval (CrI): 1.1-5.3). Measures of psychosocial stress, including historic loss and historic loss associated symptoms, were significantly associated with lifestyle and behavioral practices. Higher scores of lifetime trauma were associated with increased concentrations of spermine (aFC: 3.3, 95% CrI: 1.2-9.2). Historic loss associated symptoms and biogenic amines were the major correlates of molecular-BV. Historical loss associated symptoms and lifetime trauma are potentially important underlying factors associated with BV.

The Role of Alcohol-Related Behavioral Risk in the Design of HIV Prevention Interventions in the Era of Antiretrovirals: Alcohol Challenge Studies and Research Agenda

HIV/AIDS remains a significant health threat and alcohol is a robust contributing factor. After 25 years of alcohol challenge studies investigating alcohol-related behavioral risk (ARBR), much has been learned delineating how drinking influences sexual transmission. We examine this research and consider its relevance for interventions in the era of antiretrovirals. We consider prototypic alcohol challenge methods, illustrative findings, and prevention/intervention implications, noting three perspectives: (a) scale up/extend existing interventions, including identifying under-targeted risk groups and intersecting with PrEP/PEP interventions; (b) modify existing interventions by cultivating psychoeducational content related to alcohol expectancies, alcohol myopia, sexual arousal, risk perception, sexual abdication, and condom use resistance; and (c) innovate new interventions through Science of Behavior Change approaches and repurposing ARBR paradigms. Finally, we suggest research directions concluding that until HIV incidence diminishes significantly, psychosocial interventions addressing the nexus of alcohol use, sexual transmission, and adherence to biomedical protocols will be an important priority.

The Prevalence, Frequency and Social Ecology of Sexual Concurrency Among Young Adult Women

CONTEXT

Sexual concurrency among women is associated with increased risks of STD transmission, unintended pregnancy and sexual health disparities. Understanding the prevalence of concurrency-overlapping sexual partnerships-is imperative to reducing these disparities.

METHODS

Weekly, population-representative panel data from 757 women aged 18-22, collected from 2008 to 2012 in Michigan, were drawn from the Relationship Dynamics and Social Life study. Univariate analyses assessed the prevalence of two forms of sexual concurrency. Multivariate logistic regression models investigated associations between women's social-ecological characteristics and concurrency.

RESULTS

Twenty percent of women had vaginal intercourse with two partners in one week; 14% had intercourse with a second partner during an ongoing relationship. In both cases, the majority of individuals had intercourse with the second partner in one to three weeks in total. The likelihood of both types of concurrency was elevated among women who believed they should have sex with men after seeing them for a while (log-odds, 0.27 and 0.23, respectively) and among those who were Black (0.58 and 1.02, respectively); the likelihood was reduced among women who were more willing to refuse unwanted sex (-0.10 and -0.13, respectively) and who were in exclusive, cohabiting, or married or engaged relationships (-1.82 to -2.64). Having intercourse with multiple partners in one week was also associated with receiving sex education from parents, the degree that parents and friends approved of sex, and having had early intercourse without contraception.

CONCLUSIONS

Sexual concurrency among young women is prevalent but intermittent, and interventions that address individuals' social-ecological contexts are needed to reduce negative health outcomes.

The Effects of Trauma, Violence, and Stress on Sexual Health Outcomes Among Female Clinic Clients in a Small Northeastern U.S. Urban Center

Background: Threats to sexual health can emerge across one's life span and are influenced by individual and interpersonal experiences, as well as certain environmental exposures. Although previous research has recognized the importance of ecological frameworks to understand the complexity of health and behaviors in marginalized communities, there continues to be a dearth of research that truly utilizes this perspective to gain insight into the multifaceted factors that can concurrently influence threats to sexual health among women. Methods: A sample of 279 ethnoracially diverse women were recruited from a U.S. northeastern small urban center health clinic to participate in a parent study on trauma and immunity. A hierarchical block analysis was conducted to investigate associations between women's experiences of trauma, stress and violence (i.e., childhood trauma (CHT), intimate partner violence (IPV), neighborhood stressors), and sexual health outcomes and behaviors (i.e., lifetime sexually transmitted infection [STI] diagnosis, concurrent partnerships, and lifetime sex trading). Results: In the full hierarchical model, IPV and life stress trauma were associated with lifetime sex trading and partner concurrency. Also in the full model, sexual CHT was associated with lifetime STI acquisition and partner concurrency, while emotional CHT was associated with lifetime sex trading. Lastly, as neighborhood disorder increased, so did the number of lifetime sex trading partners. Conclusion: Sexual health assessments in clinical and community settings require a holistic, comprehensive, and meaningful approach to inform person-centered health promotion intervention. Prevention and treatment interventions require a focus on parents and families, and should assist adolescents and young adults to adopt therapies for healing from these experiences of trauma, violence, and stress. Interventions to enhance sexual health promotion must also include the following: advocacy for safe environments, social policy that addresses lifelong impacts of CHT, and fiscal policy that addresses economic vulnerability among women and threatens sexual health. Further recommendations are discussed.

A Brief Clinic-Based Intervention to Reduce Alcohol Misuse and Sexual Risk Behavior in Young Women: Results from an Exploratory Clinical Trial

This exploratory trial determined the feasibility, acceptability, and preliminary efficacy of a brief intervention (BI), supplemented with text messaging and a curated Web site, on alcohol use and sexual risk behavior among young women. Young women seeking care at a reproductive health clinic were screened for alcohol misuse and sexual risk behavior. Those who screened positive and who agreed to participate (N = 48; M = 22.67 years) were randomized to either (a) a brief in-person session during which personalized feedback regarding alcohol use and sexual risk taking was provided and discussed, or (b) a control condition. Feasibility was assessed by recruitment and retention rates. Acceptability was assessed with participant ratings of their intervention. Efficacy was measured using self-reported alcohol use and sexual behavior at baseline and during a 3-month follow-up. We supplemented the quantitative data with qualitative data from semi-structured interviews. Feasibility data indicated that 64% of eligible women agreed to participate, 74% of eligible women were enrolled, and 86% of enrolled women were retained through follow-up. Acceptability data showed that women who received the BI reported strong satisfaction with their intervention (M = 4.65 vs. 3.98 on a five-point scale) and also reported that text messaging was helpful (M = 4.73 on a seven-point scale) and acceptable (M = 5.27 on a seven-point scale). Qualitative data provided additional support for BI feasibility and acceptability. Efficacy data showed that women in both conditions reduced alcohol use and sexual risk behavior over time; women who received the BI reduced their maximum daily alcohol intake more than controls (BI from 7.68 to 4.82 standard drinks vs. control from 6.48 to 5.65; Wald χ² = 4.93, p < .05). Women in the BI reported fewer occasions of condomless sex (median = 2.50) than controls (median = 5.00) at the follow-up, but this difference was not statistically significant (OR = 0.61, 95% CI [0.32, 1.15]). A brief intervention, supplemented with text messaging and a Web site, that targeted alcohol use and sexual behavior was feasible and acceptable to young women and led to lower levels of alcohol misuse and sexual risk behavior.

The Relationship Between Economic Deprivation, Housing Instability and Transactional Sex Among Women in North Carolina (HPTN 064)

Transactional sex is associated with socioeconomic disadvantage and HIV risk but few studies in the United States (US) have examined both individual and area-level predictors of transactional sex or distinguished transactional sex from sex work. We combined data from HIV Prevention Trials Network 064 study and the US Census to estimate prevalence ratios (PR) for the relationship between census-level and individual measures of economic deprivation and housing instability on transactional sex in 417 women in North Carolina. Increased transactional sex was associated with food insecurity (PR 1.86; 95%; CI 1.57, 2.19), housing instability (PR 1.33; 95% CI 1.11, 1.59), substance abuse (PR 1.90; 95% CI 1.64, 2.19) and partner incarceration (PR 1.32; 95% CI 1.09, 1.61). Census-level indicators were not associated with transactional sex, adjusted for individual-level covariates. Interventions should support housing stability and financial opportunities among southern African American women to reduce HIV risk, particularly among women with incarcerated partners.

Adolescent Sexual Initiation: A Cross-Classified Multilevel Analysis of Peer Group-, School-, and Neighborhood-Level Influences

PURPOSE

This study examines the simultaneous roles of neighborhood, school, and peer group contexts on variation in age of U.S. adolescent sexual initiation (coitarche). All three contexts have been shown to be important determinants of adolescent sexual and reproductive health outcomes but are typically examined separately, leaving a large gap in our understanding of their relative and joint importance. Furthermore, little is known about whether these contexts matter differently for boys and girls.

METHODS

Using sociocentric network data from the National Longitudinal Study of Adolescent to Adult Health, we combine gender-stratified analyses, social network community detection (to identify teens' social cliques), and cross-classified multilevel modeling to simultaneously analyze gender, neighborhood, school, and peer group effects. These results are compared against results from traditional multilevel models (MLMs), which analyze the contexts individually.

RESULTS

Evaluated separately in MLM, peer groups accounted for 6.79% of the total variation in coitarche, schools for 3.56%, and neighborhoods for 4.11%. Under simultaneous cross-classified multilevel modeling analysis, a different story emerges: peer groups and schools accounted for 3.66% and 3.19% of the total variation in coitarche, respectively, whereas neighborhood explained only 1.16% of the total variation. Stratified analyses indicate that gender modifies these associations.

CONCLUSIONS

Results demonstrate that omitting any one of these contexts may lead to an overestimation of the importance of contexts included in models. When modeled simultaneously with neighborhoods, our findings suggest that peer groups and schools are meaningful contributing contexts to the variance in sexual initiation, and that these contexts matter differently for boys and girls.

Sexual Concurrency and Contraceptive Use Among Young Adult Women

Leveraging 2.5 years of weekly data from the Relationship Dynamics and Social Life Study, we investigate the relationship between young women's sexual concurrency and their contraceptive behavior. Specifically, we (1) examine whether young women changed their contraceptive use when switching from one to multiple concurrent sexual partners in the same week; (2) explore the uniformity of contraceptive responses to concurrency across relationship context; and (3) compare the contraceptive behaviors of never-concurrent women with those of ever-concurrent women in weeks when they were not concurrent. Nearly one in five sexually active young women had sex with two or more people in the same week. When they were concurrent, these women's odds of using any contraception increased threefold, and their odds of using condoms increased fourfold. This pattern of contraceptive adjustments was the same across relationship characteristics, such as duration and exclusivity. Yet when they were not concurrent, ever-concurrent women were less likely to use any contraception and used condoms less consistently than women who were never concurrent. We discuss these findings in the context of ongoing debates about the role of sexual concurrency in STI transmission dynamics.

Risky Sexual Behaviors, Substance Use, and Perceptions of Risky Behaviors Among Criminal Justice Involved Women Who Trade Sex

This study examined risky sexual behaviors, Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV)-defined alcohol and substance use disorders, and perceptions of risky behaviors among community released, justice-involved women, who are currently trading sex (CTS), formerly traded sex (FTS), or have never traded sex. Data were derived from 266 sexually active women recruited from a Municipal Drug Court System in St. Louis, Missouri. In an adjusted multinomial regression model, being dependent on alcohol and cocaine was the most robust correlate of sex-trading status (adjusted odds ratio [AOR]: CTS = 4.21, FTS = 4.66). Perceptions of sexual risk and HIV were significantly associated with CTS (AOR = 3.39), however, not FTS. Other significant correlates of sex trading status included age, lifetime injection drug use, lower education, child sexual abuse, and unstable housing. Gender-specific interventions tailored toward currently and formerly sex-trading women are needed.

Structural characteristics of the online social networks of maltreated youth and offline sexual risk behavior

Maltreated youth are at risk for exposure to online sexual content and high-risk sexual behavior, yet characteristics of their online social networks have not been examined as a potential source of vulnerability. The aims of the current study were: 1) to test indicators of size (number of friends) and fragmentation (number of connections between friends) of maltreated young adults' online networks as predictors of intentional and unintentional exposure to sexual content and offline high-risk sexual behavior and 2) to test maltreatment as a moderator of these associations. Participants were selected from a longitudinal study on the effects of child maltreatment (n = 152; Mean age 21.84 years). Data downloaded from Facebook were used to calculate network variables of size (number of friends), density (connections between friends), average degree (average number of connections for each friend), and percent isolates (those not connected to others in the network). Self-reports of intentional and unintentional exposure to online sexual content and offline high-risk sexual behavior were the outcome variables. Multiple-group path modeling showed that only for the maltreated group having a higher percent of isolates in the network predicted intentional exposure to online sexual content and offline high-risk sexual behavior. An implication of this finding is that the composition of the Facebook network may be used as a risk indicator for individuals with child-welfare documented maltreatment experiences.

HIV Testing, Positivity, and Receipt of Services among Black, White, and Hispanic Women Participating in HIV Prevention Programs Funded by the Centers for Disease Control and Prevention, 2015

BACKGROUND

Black women who are positive for human immunodeficiency virus (HIV) are more likely than other HIV-positive women to experience poor health outcomes. Given these disparities, we compared receipt of HIV testing and other preventive services among Black, White, and Hispanic women participating in HIV prevention programs funded by the Centers for Disease Control and Prevention in 2015.

METHODS

Data came from 61 health department jurisdictions and 123 community-based organizations. Using Wald χ² tests, we assessed racial/ethnic differences in HIV testing by demographic characteristics, risk factors, HIV status, HIV service delivery, and (using unlinked data) participation in evidence-based HIV prevention interventions among women. We also assessed temporal changes in Black women's receipt of preventive services (2012-2015).

RESULTS

In 2015, there were 1,326,589 HIV testing events (single sessions in which one or more HIV tests are performed to determine HIV status) that occurred among Black, White, and Hispanic women, resulting in 4,868 positive diagnoses. Proportionally fewer Black (vs. White and Hispanic) women were linked to HIV medical care within 90 days (64.4% vs. 69.1% and 73.7%), interviewed for partner services (50.4% vs. 54.4% and 63.5%), and referred to risk reduction services (55.5% vs. 57.7% and 59.8%). From 2012 to 2015, HIV testing events among Black women decreased by 15.2%, but linkage to care within 90 days increased by 30.6% and participation in one or more evidence-based intervention increased by 46.8% among HIV-positive Black women.

CONCLUSIONS

Black HIV-positive women were less likely than White and Hispanic women to receive services that prevent HIV-related morbidity and mortality. Additional programmatic efforts are needed to increase the proportion of HIV-positive Black women who are linked to services to reduce HIV disparities among women.

Associations of Drug Use, Violence, and Depressive Symptoms with Sexual Risk Behaviors Among Women with Alcohol Misuse

BACKGROUND

Alcohol misuse is associated with increased human immunodeficiency virus sexual risk behaviors by women. Drug use, intimate partner violence (IPV), and depressive symptoms frequently co-occur, are well-recognized alcohol misuse comorbidities, and may interact to increase risk behaviors. Using a syndemic framework we examined associations between drug use, IPV, and depressive symptoms and sexual risk behaviors by 400 women with alcohol misuse attending an urban sexually transmitted infections clinic.

METHODS

Participants completed computer-assisted interviews querying drug use, IPV, and depressive symptoms and sexual risk behavior outcomes-unprotected sex under the influence of alcohol, sex for drugs/money, and number of lifetime sexual partners. We used multivariable analysis to estimate prevalence ratios (PR) for independent and joint associations between drug use, IPV, and depressive symptoms and our outcomes. To investigate synergy between risk factors we calculated the relative excess prevalence owing to interaction for all variable combinations.

RESULTS

In multivariable analysis, drug use, IPV, and depressive symptoms alone and in combination were associated with higher prevalence/count of risk behaviors compared with women with alcohol misuse alone. The greatest prevalence/count occurred when all three were present (unprotected sex under the influence of alcohol [PR, 2.6; 95% confidence interval, 1.3-4.9]), sex for money or drugs [PR, 2.6; 95% confidence interval, 1.7-4.2], and number of lifetime partners [PR, 3.2; 95% confidence interval, 1.9-5.2]). Drug use, IPV, and depressive symptoms did not interact synergistically to increase sexual risk behavior prevalence.

CONCLUSIONS

A higher prevalence of sexual risk behaviors by women with alcohol misuse combined with drug use, IPV, and depressive symptoms supports the need for alcohol interventions addressing these additional comorbidities.

Implicit attitudes to sexual partner concurrency vary by sexual orientation but not by gender-A cross sectional study of Belgian students

High rates of sexual partner concurrency have been shown to facilitate the spread of various sexually transmitted infections. Assessments of explicit attitudes to concurrency have however found little difference between populations. Implicit attitudes to concurrency may vary between populations and play a role in generating differences in the prevalence of concurrency. We developed a concurrency implicit associations test (C-IAT) to assess if implicit attitudes towards concurrency may vary between individuals and populations and what the correlates of these variations are. A sample of 869 Belgian students (mean age 23, SD 5.1) completed an online version of the C-IAT together with a questionnaire concerning sexual behavior and explicit attitudes to concurrency. The study participants C-IATs demonstrated a strong preference for monogamy (-0.78, SD = 0.41). 93.2% of participants had a pro-monogamy C-IAT. There was no difference in this implicit preference for monogamy between heterosexual men and women. Men who have sex with men and women who have sex with women were more likely to exhibit implicit but not explicit preferences for concurrency compared to heterosexual men and women. Correlates of the C-IAT varied between men and women.

Protective behaviours among young African American women with non-monogamous sexual partners

In the USA, partner non-monogamy is reported to be more common among African American women than White women and may contribute to African American women's increased risk for HIV and other sexually transmitted infections (STIs). Few studies have explicitly and comprehensively described the protective behaviours that African American women employ with non-monogamous partners to reduce their HIV risk. We conducted interviews to examine protective behaviours among 11 African American women aged 18-24 years who perceived that a partner in the preceding 12 months had another sex partner. Participants described three types of partnerships with 29 non-monogamous men; these partnerships clustered into three categories. Narrative analysis revealed an overall paucity of protective behaviours with non-monogamous partners. Protective behaviours (i.e. communication and condom use) were informed by partnership type, rather than perceptions of non-monogamy. There were few instances in which partner non-monogamy motivated women to terminate sex partnerships. Rather, these decisions were often motivated by changes in other relationship dynamics. To address HIV/STI risk related to partner non-monogamy, HIV prevention strategies for young African American women should emphasise the importance of condom use in all non-marital partnership types. Interventions where testing is available may be effective for women who frequently test for HIV/STIs but do not use condoms.

From Theory to Practice: Implementation of a Resource Allocation Model in Health Departments

OBJECTIVE

To develop a resource allocation model to optimize health departments' Centers for Disease Control and Prevention (CDC)-funded HIV prevention budgets to prevent the most new cases of HIV infection and to evaluate the model's implementation in 4 health departments.

DESIGN, SETTINGS, AND PARTICIPANTS

We developed a linear programming model combined with a Bernoulli process model that allocated a fixed budget among HIV prevention interventions and risk subpopulations to maximize the number of new infections prevented. The model, which required epidemiologic, behavioral, budgetary, and programmatic data, was implemented in health departments in Philadelphia, Chicago, Alabama, and Nebraska.

MAIN OUTCOME MEASURES

The optimal allocation of funds, the site-specific cost per case of HIV infection prevented rankings by intervention, and the expected number of HIV cases prevented.

RESULTS

The model suggested allocating funds to HIV testing and continuum-of-care interventions in all 4 health departments. The most cost-effective intervention for all sites was HIV testing in nonclinical settings for men who have sex with men, and the least cost-effective interventions were behavioral interventions for HIV-negative persons. The pilot sites required 3 to 4 months of technical assistance to develop data inputs and generate and interpret the results. Although the sites found the model easy to use in providing quantitative evidence for allocating HIV prevention resources, they criticized the exclusion of structural interventions and the use of the model to allocate only CDC funds.

CONCLUSIONS

Resource allocation models have the potential to improve the allocation of limited HIV prevention resources and can be used as a decision-making guide for state and local health departments. Using such models may require substantial staff time and technical assistance. These model results emphasize the allocation of CDC funds toward testing and continuum-of-care interventions and populations at highest risk of HIV transmission.

A comparison of self-reported sexual effects of alcohol, marijuana, and ecstasy in a sample of young adult nightlife attendees

Alcohol, marijuana, and ecstasy (3,4-methylenedioxymethamphetamine [MDMA], 'Molly') are among the most prevalent substances used by young adults; however, few studies have focused on the specific sexual effects associated with use. Examining subjective sexual effects (e.g. increased libido) associated with use can inform prevention efforts. Data were analysed from 679 nightclub and dance festival attendees in New York City (ages 18-25) to examine and compare self-reported sexual effects associated with use of alcohol, marijuana, and ecstasy. Results suggest that compared to marijuana, alcohol and ecstasy were more strongly associated with heightened perceived sexual effects (i.e. perceived sexual attractiveness of self and others, sexual desire, length of intercourse, and sexual outgoingness). Increased body and sex organ sensitivity and increased sexual intensity were most commonly associated with ecstasy use. Sexual dysfunction was most common while using alcohol or ecstasy, especially among males, and females were more likely to report sexual dysfunction after using marijuana. Post-sex regret was most common with alcohol use. Alcohol, marijuana, and ecstasy each have different sexual effects; therefore, each is associated with different risks and benefits for users. Findings can inform prevention and harm reduction as young adults are prone to use these substances.

Reductions in HIV Diagnoses Among African American Women: A Search for Explanations

BACKGROUND

African American women experienced a 46% reduction in the rate of HIV diagnoses from 56.0 in 2008, to 30.0 in 2014 (per 100,000). The reasons for this decrease are unknown; however, we hypothesize that improvements in socioeconomic status, health care access, and risk behaviors may have contributed to this reduction.

METHODS

We analyzed data from 2006, 2010, and 2013 of the National HIV Behavioral Surveillance system. African American women living at or below poverty were surveyed from 19 United States cities using respondent-driven and venue-based sampling, and tested for HIV infection. We used generalized estimating equations to determine differences for selected outcomes regarding health care and risk behaviors over time.

RESULTS

Among 11,065 women, we found increases in the percentage of women who reported having a recent HIV test (P value = 0.0002); having health insurance (P < 0.0001); and recently visiting a health care provider (P < 0.0001). Being unemployed declined significantly (P = 0.0057), as did reporting recent injection drug use (P < 0.0001). Crack use declined among women aged 25-44 years (P < 0.0001). However, reporting condomless vaginal sex at last sex (P = 0.0268), condomless anal sex at last sex (P = 0.6462), or 3 or more sex partners in the past 12 months (P = 0.5449) remained stable.

DISCUSSION

Enhanced health care access and socioeconomic status and reductions in drug use may have contributed to the declines in HIV diagnoses among African American women in the United States.

The Committed Intimate Partnerships of Incarcerated African-American Men: Implications for Sexual HIV Transmission Risk and Prevention Opportunities

Incarceration is thought to influence HIV transmission by disrupting partnerships that provide support and protect against sex risk-taking. Current correctional facility-based family-strengthening programs focus on marital partnerships, a minority of inmates' partnerships. Research on the sex partnerships of incarcerated African-American men and the types of partnerships most likely to protect against HIV-related sex risk is limited. Improved understanding can inform expansion of correctional facility-based family-strengthening programs to a greater proportion of protective partnerships and HIV risk reduction programs to partnerships vulnerable to sex risk. Project DISRUPT is a cohort study of African-American men being released from prison in North Carolina who were in committed heterosexual partnerships at prison entry. Using baseline survey data (N = 189), we conducted latent class analysis (LCA) to identify subgroups of participants with distinct relationship profiles and measured associations between relationship characteristics and multiple partnerships of inmates and their partners in the six months before incarceration. LCA indicated a two-class solution, with relationships distinguished by satisfaction/stability (satisfied/stable class: 58.0%; dissatisfied/unstable class: 42.0%); each class had comparable relationship length and levels of marriage and cohabitation. Dissatisfied/unstable relationships were associated with multiple partnerships among participants (AOR 2.93, 95% CI 1.50, 5.72) and partners (AOR 4.95, 95% CI 1.68, 14.58). Satisfaction indicators-versus length, marriage, or cohabitation-were the strongest independent correlates of inmates' and partners' multiple partnerships. Pre-incarceration economic deprivation, mental disorder symptoms, substance use, and violence in relationships were associated with dissatisfaction/instability. Prison-based programs designed to maintain healthy partnerships, strengthen relationship skills, and reduce HIV risk-taking and violence in relationships are warranted and should be targeted to both marital and nonmarital partnerships. Programming also should address the poverty, mental illness, and substance use factors that threaten relationship satisfaction/stability and increase HIV risk.

Changing Attitudes About Concurrency Among Young African Americans: Results of a Radio Campaign

We created and evaluated an 8-month campaign of provocative radio ads to change attitudes about concurrent (overlapping) sexual partnerships among young African Americans. We created a concurrency attitude scale and compared its score distributions in independent samples of African Americans, ages 18-34 years, interviewed by telephone before (n = 678) and after (n = 479) the campaign. Pre- and post-campaign samples reflected similar response rates (pre: 32.6%; post: 31.8%) and distributions of personal characteristics. Reported exposure to concurrency messages was greater after the campaign (pre: 6.3%, post: 30.9%), and mean scores indicated less acceptance of concurrency (pre: 3.40 [95% CI 3.23, 3.57]; post: 2.62 [2.46, 2.78]). Score differences were not a function of differences in composition of the samples (adjusted means: pre: 3.37 [3.21, 3.53]; post: 2.62 [2.47, 2.76]). Findings demonstrate that a carefully targeted, intensive mass media campaign can change attitudes about concurrency, which should facilitate behavior change.

Sexual Risk and Protective Behaviors Among Reproductive-Aged Women in the United States

BACKGROUND

In 2014, women represented 19% of HIV diagnoses in the United States. Of these, 78% were among black women and Latinas. Sexual risk behaviors-for example concurrent sex partnerships, nonmonogamous sex partners, and inconsistent condom use-are associated with increased HIV transmission and prevalence; these behaviors have been understudied, collectively, in women.

METHODS

To examine HIV-related sexual risk behaviors among sexually active women aged 18-44 years by race/ethnicity and over time, we used data from the 2006-2008, 2008-2010, and 2011-2013 cycles of the National Survey of Family Growth. We estimated weighted percentages and performed logistic regression to measure adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for associations between selected behaviors and sociodemographic covariates.

RESULTS

Among 13,588 women, 1.1% reported concurrent sex partnerships, 10.3% reported male partners whom they perceived were nonmonogamous, and 21.1% reported using a condom at either last vaginal or anal sex. Black women (aPR = 1.52; CI = 1.36-1.71) and Latinas (aPR = 1.29; CI = 1.14-1.47) were more likely to report condom use at either last vaginal or anal sex compared with white women. However, black women were also more likely to report concurrent opposite-sex partnerships (aPR = 2.44; CI = 1.57-3.78) and perceived nonmonogamous sex partners (aPR = 1.33; CI = 1.14-1.56) compared with white women.

CONCLUSIONS

Improved HIV behavioral risk-reduction strategies are needed for women. Black women could benefit from interventions that address partnership concurrency. For black women and Latinas, who are more likely to use condoms, further examination of broader social and structural factors as contributors to racial/ethnic gaps are warranted and vital for understanding and decreasing HIV-related disparities.

Age of First Arrest, Sex, and Drug Use as Correlates of Adult Risk Behaviors Among Rural Women in Jails

Incarcerated women frequently report initiation of substance use and sexual encounters at an early age, and often engage in high-risk drug use and sexual behaviors as adults. This study examined the timing of first sex, drug use, and arrest, as well as their unique influences on specific risky behaviors in adulthood, among a high-risk population of rural women recruited from jails. Ages of initiation were all positively and significantly correlated, and each independently increased the likelihood of several risky behaviors in adulthood. Implications are discussed for screening, intervention, and treatment targeting high-risk women and girls in rural areas, particularly within criminal justice settings.

Correlates of concurrency among young people in Carletonville, South Africa

There is still a considerable debate about whether socioeconomic or cultural factors underpin the high prevalence of sexual partner concurrency in parts of Southern and Eastern Africa. We analyzed the patterning and correlates of concurrency in a population-based sample of 1182 sexually active 14-24 year olds in Carletonville, South Africa. Potential demographic, socioeconomic and attitudinal risk factors were assessed via a questionnaire. The association between risk factors and respondent reported concurrency were assessed using multivariate logistic regression. Separate models were run for men and women. Point-concurrency rates at the time of the survey and 6 months prior to the survey were similarly high--19.3 (95% confidence interval, CI 14.2-18.5%) and 16.2% (CI 14.1-18.4%), respectively. Multivariate logistic regression revealed that for men and women, concurrency was not associated with socioeconomic deprivation but was associated with a number of sexual partners, being married and having a partner who was thought to have an additional partner. Female concurrents were more likely to use alcohol, have an older partner and have difficulties negotiating condom usage and refusing sex with their partners. Male concurrents were less likely to use a condom regularly and less likely to wear a condom when their partner asked them to. The strong relationship between respondent and partner concurrency appears to depend on contemporary concurrency, as opposed to the behavior of previous partners. If high concurrency rates are in part driven by positive feedback loops of partner and respondent concurrency, then norm change involving the rejection of concurrents could be self-amplifying leading to a rapid decline of concurrency.

Characteristics of African American Women and Their Partners With Perceived Concurrent Partnerships in 4 Rural Counties in the Southeastern U.S

BACKGROUND

To the individual with concurrent partners, it is thought that having concurrent partnerships confers no greater risk of acquiring HIV than having multiple consecutive partnerships. However, an individual whose partner has concurrent partnerships (partner's concurrency) is at increased risk for incident HIV infection. We sought to better understand relationships characterized by partner's concurrency among African American women.

METHODS

A total of 1013 African American women participated in a cross-sectional survey from 4 rural Southeastern counties.

RESULTS

Older age at first sex was associated with lower prevalence of partner's concurrency (prevalence ratio, 0.70; 95% confidence interval, 0.57-0.87), but the participant's age was not associated with partner's concurrency. After adjusting for covariates, ever having experienced intimate partner violence (IPV) and forced sex were most strongly associated with partner's concurrency (prevalence ratios, 1.61 [95% confidence intervals, 1.23-2.11] and 1.65 [1.20-2.26], respectively). Women in mutually monogamous partnerships were the most likely to receive economic support from their partners; women whose partners had concurrent partnerships did not report more economic benefit than did those whose partners were monogamous.

CONCLUSIONS

Associations between history of IPV and forced sex with partner's concurrency suggest that women with these experiences may particularly benefit from interventions to reduce partner's concurrency in addition to support for reducing IPV and other sexual risks. To inform these interventions, further research to understand partnerships characterized by partner's concurrency is warranted.

Prevalence of High-Risk Sexual Behaviors Among Monoracial and Multiracial Groups from a National Sample: Are Multiracial Young Adults at Greater Risk?

The present study compared the prevalence and variation in high-risk sexual behaviors among four monoracial (i.e., White, African American, Asian, Native American) and four multiracial (i.e., White/African American, White/Asian, White/Native American, African American/Native American) young adults using Wave IV data (2008-2009) from the National Longitudinal Study of Adolescent to Adult Health (N = 9724). Findings indicated differences in the sexual behavior of monoracial and multiracial young adults, but directions of differences varied depending on the monoracial group used as the referent and gender. Among males, White/African Americans had higher risk than Whites; White/Native Americans had higher risk than Native Americans. Otherwise, multiracial groups had lower risk or did not differ from the single-race groups. Among females, White/Native Americans had higher risk than Whites; White/African Americans had higher risk than African Americans. Other comparisons showed no differences or had lower risk among multiracial groups. Variations in high-risk sexual behaviors underscore the need for health research to disaggregate multiracial groups to better understand health behaviors and outcomes in the context of experiences associated with a multiracial background, and to improve prevention strategies.

Racial-ethnic differences in sexual risk behaviors: The role of substance use

This research investigates the impact adolescent substance use has on adult sexual risk behaviors within racial-ethnic groups. Previous research has found support for this relationship, but often relies on concurrent measures of substance use and sexual risk behavior meaning that the causal direction of this relationship may be unclear. The data for this study come from the National Longitudinal Survey of Adolescent to Adult Health (Add Health), a nationally representative survey that followed respondents from adolescence in 1994 to adulthood in 2008. Results show that substance use correlates with sexual risk behavior, but the impact varies by race-ethnicity.

Association of perceived partner non-monogamy with prevalent and incident sexual concurrency

OBJECTIVES

Concurrency is suggested as an important factor in sexually transmitted infection transmission and acquisition, though little is known regarding factors that may predict concurrency initiation. We examined the association between perception of a partner's non-monogamy (PPNM) and simultaneous or subsequent concurrency among at-risk heterosexual young adults in the Los Angeles area.

METHODS

We used Poisson regression models to estimate the relationship between PPNM and incident concurrency among 536 participants participating in a cohort study, interviewed at 4-month periods during 1 year. Concurrency was defined as an overlap in reported sexual partnership dates; PPNM was defined as believing a partner was also having sex with someone else.

RESULTS

Participants (51% female; 30% non-Hispanic white, 28% non-Hispanic black, 27% Hispanic/Latino) had a mean age of 23 years and lifetime median of nine sex partners. At each interview (baseline, 4-month, 8-month and 12-month), 4-month concurrency prevalence was, respectively, 38.8%, 27.4%, 23.1% and 24.5%. Four-month concurrency incidence at 4, 8 and 12 months was 8.5%, 10.6% and 17.8%, respectively. Participants with recent PPNM were more likely to initiate concurrency (crude 4-month RR=4.6; 95% CI 3.0, 7.0; adjusted 4-month RR=4.0, 95% CI 2.6 to 6.1).

CONCLUSIONS

Recent PPNM was associated with incident concurrency. Among young adults, onset of concurrency may be stimulated, relatively quickly, by the PPNM. Programmes which promote relationship communication skills and explicit monogamy expectations may help reduce concurrency.

It is complicated: sexual partner characteristic profiles and sexually transmitted infection rates within a predominantly African American population in Mississippi

BACKGROUND

Mississippi has among the highest prevalence of sexually transmitted infections (STIs) in the United States. Understanding sexual networks can provide insight into risk factors for transmission and guide prevention interventions.

METHODS

Participants included 1437 primarily African American (95%) adults presenting for care at an STI clinic in Jackson, Mississippi. Latent class analysis identified underlying population subgroups with unique patterns of response on a comprehensive set of 14 sexual partner variables, such as living with or having a child with a partner, partner dependence and trust, 1-time sexual encounters, multiple main partners, substance use, sexual concurrency, and incarceration. Classes were compared on participant age, sex, sexual orientation, public assistance, lifetime partners, relationship status, and self-reported past-year STI.

RESULTS

Three classes emerged. Class 1 (n = 746) participants were less dependent on partners and less likely to live with or have a child with a partner. Class 2 participants (n = 427) endorsed multiple STI risk factors, including partner incarceration, 6 or more lifetime partners, sexual concurrency, 1-time sexual encounters, and substance use at last sex. Class 3 participants (n = 226) were more likely to be in dependent, committed relationships with children. Class 2 had a higher proportion of self-report past-year STIs (36.7%) compared with classes 1 (26.6%) and 3 (26.1%).

CONCLUSIONS

Certain partner factors such as incarceration, substance use, and concurrency may contribute to increased STI risk. Partner factors may be useful proxies for STI risks and could be useful questions to include in screening questionnaires in clinical settings.

The complexities of adolescent dating and sexual relationships: fluidity, meaning(s), and implications for young adults' well-being

The complexity of adolescents' dating and sexual lives is not easily operationalized with simple indicators of dating or sexual activity. While building on prior work that emphasizes the "risky" nature of adolescents' intimate relationships, we assess whether a variety of indicators reflecting the complexity of adolescents' relationships influence early adult well-being (i.e., depressive symptoms, self-esteem, gainful activity, intimate partner violence, and relationship quality). Our analysis of longitudinal data from the Toledo Adolescent Relationships Study showed that the number of adolescent dating and sexual partners does not uniformly influence indicators of young adult well-being, which is at odds with a risk framework. The number of dating partners with whom the individual was sexually active, and not the number of "casual" sex partners, increased the odds of intimate partner violence during young adulthood. Relationship churning and sexual nonexclusivity during adolescence were associated with lower relationship quality during young adulthood. Sexual nonexclusivity during adolescence influenced self-reports of depressive symptoms and lower self-esteem among young adults. Future research should develop more nuanced conceptualizations of adolescent dating and sexual relationships and integrate adolescent dating and sexual experiences into research on early adult well-being.

The Epidemiology of Human Immunodeficiency Virus Infection and Care among Adult and Adolescent Females in the United States, 2008-2012

OBJECTIVE

We sought to determine epidemiological patterns in diagnoses of human immunodeficiency virus (HIV) infection and prevalence among females by age, race/ethnicity and transmission category, and essential steps in the continuum of HIV care.

METHODS

Using data from the National HIV Surveillance System, we estimated the number of females aged 13 years or older diagnosed with HIV infection in 2008 through 2012 and living with HIV at the end of 2011 in the United States. We determined percentages of females linked to care, retained in care, and virally suppressed in 18 jurisdictions with complete reporting of CD4 and viral load test results.

RESULTS

From 2008 to 2012, the estimated rate of HIV diagnoses among females decreased from 9.3 to 6.9 per 100,000 (-7.1% per year; 95% confidence interval [CI], -7.9, -6.3). In 2012, the diagnosis rate was highest among Blacks/African Americans (35.7), followed by Hispanics or Latinos (6.4), and Native Hawaiian Other Pacific Islander (5.1), and lowest among Whites (1.8). Most females diagnosed in 2012 were linked to care within 3 months of diagnosis (82.5%). About one-half (52.4%) of females living with HIV in 2011 received ongoing care in 2011 and 44.3% had a suppressed viral load. Viral suppression was lower among American Indian/Alaska Native (29.7%) and Black/African American (41.6%) compared with White females (46.5%). The percentage in care and with viral suppression was lower among younger compared with older females.

CONCLUSION

HIV diagnoses continue to decrease among females; however, disparities exist in HIV burden and viral suppression. Improvements in care and treatment outcomes are needed for all women with particular emphasis on younger women.

Social place as a location of potential core transmitters-implications for the targeted control of sexually transmitted disease transmission in urban areas

PURPOSE

Places are an important determinant of risk for sexually transmitted infection (STI) acquisition and transmission. We sought to identify social places that are critical for targeted STI control activities. The objective of this study was to determine whether sex partner meeting places characterized by drug markets, sex markets, and separately, drug and/or sex markets were more likely to have potential core transmitters as compared with other sex partner meeting places in one urban setting.

METHODS

In 2008-2009, heterosexual sex partner places or venues were identified in Baltimore, MD using a venue-based study approach.

RESULTS

A total of 1334 participants aged 18 to 35 years were enrolled at 85 venues. In those participants, 39 potential core transmitters were identified and 31% of venues had at least one potential core transmitter. In final age-adjusted and gender-adjusted models, core transmitters were significantly more likely to be identified at drug markets (OR = 1.37; 95% CI = 1.23-1.53), sex markets (OR = 1.27; 95% CI = 1.14-1.41), and drug and/or sex markets (OR = 1.49; 95% CI = 1.32-1.68).

CONCLUSIONS

This study identified key characteristics of venues, such as drug and sex market activity, that may be important in identifying places for the targeted control of STI transmission.

Attitudes and stereotypes regarding older women and HIV risk

Persons aged 50 years and over will soon disproportionately represent the future of the HIV/AIDS epidemic. It is estimated that by 2015 older adults will represent 50% of persons living with HIV in the United States. Despite the HIV/AIDS growing population among older adults, attitudes, beliefs, and stereotypes toward older adults that exist in general society have affected HIV prevention, education, and care. Specifically, ageist attitudes about the sexuality of older adults in general and older women in particular, low clinical HIV suspicion among healthcare providers, lack of knowledge about risk among older women, and differentials in power related to negotiating sexual practices all lead to heightened concerns for the prevention, identification, and treatment of HIV disease in mature women. This article examines common attitudes, beliefs, and stereotypes that exist within general society as well as health and social service providers that place older women at a disadvantage when it comes to HIV prevention, education, and treatment.

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

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

Changes in Exposure to Neighborhood Characteristics are Associated with Sexual Network Characteristics in a Cohort of Adults Relocating from Public Housing

Ecologic and cross-sectional multilevel analyses suggest that characteristics of the places where people live influence their vulnerability to HIV and other sexually-transmitted infections (STIs). Using data from a predominately substance-misusing cohort of African-American adults relocating from US public housing complexes, this multilevel longitudinal study tested the hypothesis that participants who experienced greater post-relocation improvements in economic disadvantage, violent crime, and male:female sex ratios would experience greater reductions in perceived partner risk and in the odds of having a partner who had another partner (i.e., indirect concurrency). Baseline data were collected from 172 public housing residents before relocations occurred; three waves of post-relocation data were collected every 9 months. Participants who experienced greater improvements in community violence and in economic conditions experienced greater reductions in partner risk. Reduced community violence was associated with reduced indirect concurrency. Structural interventions that decrease exposure to violence and economic disadvantage may reduce vulnerability to HIV/STIs.

Sexual discordance and sexual partnering among heterosexual women

This study examined characteristics of self-identified heterosexual women who were concordant or discordant in their sexual behavior and the association of discordance and sexual partnering among those aged 15-44 years from the 2006-2010 National Survey of Family Growth (n = 7,353). Sexual concordance was defined as reporting a heterosexual identity and no female partners in the past year; discordance was reporting a heterosexual identity and having at least one female partner in the past year. Sexual partnering was defined as being concurrent, serially monogamous or monogamous with a male partner in the previous year. Polytomous logistic regression models evaluated the association between sexual discordance and sexual partnering. Among self-identified heterosexual, sexually active women, 11.2 % reported ever having had a same sex partner. Heterosexually discordant women who had both male and female partners in the previous year were 5.5 times as likely to report having a concurrent relationship (95 % CI 2.77-11.09) and 2.4 times as likely to report engaging in serially monogamous relationships (95 % CI 1.19-4.97) with male partners. Discordance between heterosexual identity and same sex behavior is a factor in risky behaviors. Women who have sex with women and men may act as bridges for the transmission of STDs, particularly to their female partners. Sexual education should include information inclusive of non-heteronormative behaviors and identities to provide sexual minorities with the tools and information they need. Clinical guidelines should ensure that all women are offered counseling and screening for reproductive and sexual health.

Associations between early first sexual intercourse and later sexual and reproductive outcomes: a systematic review of population-based data

The assumption that early sexual debut leads to adverse outcomes has been used as justification for sexual health interventions and policies aimed at delaying sexual initiation, yet research in the area has been limited. This review identified and synthesized published literature on the association between early first sexual intercourse and later sexual/reproductive outcomes. Literature searches were conducted in Medline, Embase, PsycINFO, and Current Contents. In all, 65 citations met the selection criteria (industrialized, population-based studies). By far the most common sexual behavior to have been investigated has been sexual partners. Studies consistently reported early first intercourse to be associated with more recent, lifetime, and concurrent sexual partners. Early initiators were also more likely to participate in a wider range of sexual practices and report increased sexual satisfaction (among men). Furthermore, early first intercourse, in some studies, was shown to increase the risk of teen pregnancies, teen births, and having an abortion, while findings on STIs and contraceptive use have been mixed. These findings, however, must be interpreted with caution due to methodological problems and limitations present in the research, including a lack of consensus on what constitutes early sexual intercourse and inconsistencies and problems with analyses.

Age at first intercourse and subsequent sexual partnering among adult women in the United States, a cross-sectional study

BACKGROUND

Concurrency and serial monogamy may increase risk for STIs when gaps fall within the infectious period. This study examined the association between early sexual debut and concurrent or serial sexual partnering among heterosexual adult women.

METHODS

We identified 6,791 heterosexually active women, ages 21-44, from the 2006-2010 National Survey of Family Growth, a multi-stage probability sample of women in the United States. Self-reported age at first intercourse was categorized as <15, 15-17 and ≥18 years (referent). Sexual partnering was defined as concurrency (within the same month), serial monogamy with either a 1-3 month, or ≥4 month gap between partners, or monogamy (referent) in the year prior to interview. Polytomous logistic models provided adjusted odds ratios (aOR) and 95% confidence intervals (CI).

RESULTS

Concurrent partnerships in the year prior to interview were reported by 5.2% of women. Serial monogamy with a 1-3 month gap was reported by 2.5% of women. Compared with women whose sexual debut was ≥18 years, those <15 years at sexual initiation had 3.7 times the odds of reporting concurrent partnerships (aOR: 3.72; 95% CI: 2.46-5.62). Women <15 years of age at sexual debut had twice the odds of serial monogamy with gap lengths of 1-3 months between partners (aOR1-3 months: 2.13; 95% CI 1.15-3.94) as compared to women ≥18 years at sexual debut.

CONCLUSIONS

Sexual debut at <15 years is associated with both concurrency and serial monogamy with 1-3 month gaps between partners in U.S. women aged 21-44.

Women, drugs and HIV

BACKGROUND

Women who use drugs, irrespective of whether these are injected or not, are faced with multiple issues which enhance their vulnerability to HIV.

METHODS

In this commentary, we explore the HIV risks and vulnerabilities of women who use drugs as well as the interventions that have been shown to reduce their susceptibility to HIV infection.

RESULTS

Women who inject drugs are among the most vulnerable to HIV through both unsafe injections and unprotected sex. They are also among the most hidden affected populations, as they are more stigmatized than their male counterparts. Many sell sex to finance their own and their partner's drug habit and often their partner exerts a significant amount of control over their sex work, condom use and injection practices. Women who use drugs all over the world face many different barriers to HIV service access including police harassment, judgmental health personnel and a fear of losing their children.

CONCLUSION

In order to enable these women to access life-saving services including needle-syringe and condom programs, opioid substitution therapy and HIV testing and treatment, it is essential to create a conducive environment and provide tailor-made services that are adapted to their specific needs.

A comparison of self-reported sexual risk behaviours between US civilian and active duty military women

Women in the US military report a high prevalence of sexual risk behaviours, such as binge drinking and new or multiple sexual partnerships. However, demographical differences pose challenges to making comparisons with civilians. Two public-use datasets were used to compare prevalence of sexual risk behaviours between sexually active military and civilian women, after adjusting for demographic factors. It was found that women in the military reported a higher prevalence of binge drinking and new/multiple sexual partners as compared with civilians, which suggests that military women are a high-risk group and the military environment may at least partially facilitate these risk behaviours.

Prevalence and predictors of concurrent sexual partnerships in a predominantly African American population in Jackson, Mississippi

Concurrent sexual partnerships, or sexual partnerships that overlap in time, have been associated with HIV and sexually transmitted infections (STI). How best to measure concurrency and the personal characteristics and predictors of concurrency are not yet well understood. We compared two frequently used concurrency definitions, including a self-reported measure based on participant response regarding overlapping sex with partners, and the UNAIDS measure based on overlapping dates of last sex and intention to have sex again. We performed multivariable logistic regression analyses to identify socio-demographic, behavioral, and structural predictors of concurrency among 1,542 patients at an urban STI clinic in Jackson, Mississippi. Nearly half (44 %) reported concurrency based on self-reported sex with other partners, and 26 % reported concurrency according to the UNAIDS concurrency measure. Using the self-reported concurrency measure, the strongest predictors of concurrency were perceived partner concurrency, drug use at last sex, having more than 10 lifetime partners, and being recently incarcerated. Strongest predictors of concurrency using the UNAIDS measure were lifetime number of partners and perceived partner concurrency. Concurrency is highly prevalent in this population in the Deep South and social, structural and behavioral factors were important predictors of concurrency for both measures. Future research should use time anchored data collection methods and biomarkers to assess whether both definitions of concurrency are associated with HIV outcomes.

Migration patterns among Floridians with AIDS, 1993-2007: implications for HIV prevention and care

OBJECTIVES

To characterize migration patterns among people diagnosed as having and who died of acquired immunodeficiency syndrome (AIDS) from 1993 to 2007 because migrating to a new community can disrupt human immunodeficiency virus/AIDS care delivery and patients' adherence to care and affect migrants' social services and healthcare needs.

METHODS

Florida AIDS surveillance data were used to describe patterns of migration among people diagnosed as having and who died of AIDS from 1993 to 2007. Individual and community characteristics were compared between residence at the time of AIDS diagnosis and residence at the time of death by type of migration.

RESULTS

Of 31,816 people in the cohort, 2510 (7.9%) migrated to another county in Florida and 1306 (4.1%) migrated to another state. Interstate migrants were more likely to be men, 20 to 39 years old, non-Hispanic white, and born in the United States, to have had a transmission mode of injection drug use (IDU) or men who have sex with men with IDU (MSM&IDU), and to have been diagnosed before 1999. Intercounty migrants were more likely to be non-Hispanic white, younger than 60 years, have had a transmission mode of MSM, IDU, or MSM&IDU, have higher CD4 counts/percentages, and to have lived in areas with low levels of poverty or low physician density. There was a small net movement from urban to rural areas within the state.

CONCLUSIONS

A sizable percentage of people, particularly younger people and people with a transmission mode of IDU and IDU&MSM, migrated at least once between the time of their AIDS diagnosis and death. This has important implications for care and treatment, as well as efforts to prevent the disease. Further research is needed to explore barriers and facilitators to access to care upon migration and to assess the need for programs to help people transfer their human immunodeficiency virus/AIDS care, ensuring continuity of care and adherence.

Change in sexual behavior with provision of no-cost contraception

OBJECTIVE

To estimate whether providing no-cost contraception is associated with the number of sexual partners and frequency of intercourse over time.

METHODS

This was an analysis of the Contraceptive CHOICE Project, a prospective cohort study of 9,256 adolescents and women at risk for unintended pregnancy. Participants were provided reversible contraception of their choice at no cost and were followed-up with telephone interviews at 6 and 12 months. We examined the number of male sexual partners and coital frequency reported during the previous 30 days at baseline compared with 6-month and 12-month time points.

RESULTS

From our total cohort, 7,751 (84%) women and adolescents completed both 6-month and 12-month surveys and were included in this analysis. We observed a statistically significant decrease in the fraction of women and adolescents who reported more than one sexual partner during the past 30 days from baseline to 12 months (5.2% to 3.3%; P<.01). Most participants (70-71%) reported no change in their number of sexual partners at 6 and 12 months, whereas 13% reported a decrease and 16% reported an increase (P<.01). More than 80% of participants who reported an increase in the number of partners experienced an increase from zero to one partner. Frequency of intercourse increased during the past 30 days from baseline (median, 4) to 6 and 12 months (median, 6; P<.01). However, greater coital frequency did not result in greater sexually transmitted infection incidence at 12 months.

CONCLUSION

We found little evidence to support concerns of increased sexual risk-taking behavior subsequent to greater access to no-cost contraception.

Substance use patterns and factors associated with changes over time in a cohort of heterosexual women at risk for HIV acquisition in the United States

BACKGROUND

Substance use is associated with HIV sexual risk behaviors, yet few studies have examined substance use patterns longitudinally. We evaluated the types and frequency of substances used over a six-month period among U.S. women at risk for HIV acquisition.

METHODS

Women reporting unprotected sex with a man in the previous six months and at least one other personal or partner HIV risk characteristic enrolled in a multisite cohort study and completed interviews about substance use at study visits. Prevalence and frequency of substance use at the baseline and six-month visits were compared and correlates of decreased substance use at the six-month visit were assessed.

RESULTS

Of 2099 women enrolled, 1882 had substance use data at baseline and six-months. Of these, 76.1% reported using at least one drug or binge drinking in the previous six months; 37.5% were frequent and 38.6% non-frequent substance users. Binge drinking was most frequently reported (63.3%), followed by cocaine (25.0%) and opioids (16.5%). Fifty-five percent of opiate users and 30% of cocaine users reported daily/almost daily use. At the six-month visit, 40.5% reported a decrease in frequency of use. Adjusting for income and type of drug used, poly-substance users were less likely to decrease frequency of use compared to those who only used one substance.

CONCLUSION

A substantial decrease in frequency of substance use over time was observed in this cohort. Poly-substance users were less likely to reduce frequency of use over time, suggesting that specific substance use interventions targeting these users are warranted.

Sexual victimization, alcohol intoxication, sexual-emotional responding, and sexual risk in heavy episodic drinking women

This study used an experimental paradigm to investigate the roles of sexual victimization history and alcohol intoxication in young women's sexual-emotional responding and sexual risk taking. A nonclinical community sample of 436 young women, with both an instance of heavy episodic drinking and some HIV/STI risk exposure in the past year, completed childhood sexual abuse (CSA) and adolescent/adult sexual assault (ASA) measures. A majority of them reported CSA and/or ASA, including rape and attempted rape. After random assignment to a high alcohol dose (.10 %) or control condition, participants read and projected themselves into an eroticized scenario of a sexual encounter involving a new partner. As the story protagonist, each participant rated her positive mood and her sexual arousal, sensation, and desire, and then indicated her likelihood of engaging in unprotected sex. Structural equation modeling analyses revealed that ASA and alcohol were directly associated with heightened risk taking, and alcohol's effects were partially mediated by positive mood and sexual desire. ASA was associated with attenuated sexual-emotional responding and resulted in diminished risk taking via this suppression. These are the first findings indicating that, compared to non-victimized counterparts, sexually victimized women respond differently in alcohol-involved sexual encounters in terms of sexual-emotional responding and risk-taking intentions. Implications include assessing victimization history and drinking among women seeking treatment for either concern, particularly women at risk for HIV, and alerting them to ways their histories and behavior may combine to exacerbate their sexual risks.

"Do you think your main partner has other sex partners?" A simple question provides insight into sexual risk in Jamaica

To estimate the association between a simple measure of sexual partner concurrency and sexually transmitted infection (STI) we conducted a cross-sectional population-based household survey (n = 1795) and targeted surveys of people at venues where people meet sexual partners (n = 1580) to ask about sexual behaviour. Persons interviewed at venues were tested for HIV, gonorrhoea, chlamydia, and trichomoniasis. We compared the association between STI and reporting a partner had other partners. More women than men reported their main partner had other partners. Thirteen percent of all women in the population-based survey and 14.4% in the targeted survey reported having one partner in the past 12 months and that partner had additional partners. STI prevalence was significantly associated with reporting a partner had other partners (36.8% vs. 30.2%; prevalence ratio [PR] 1.2; 95% confidence interval [CI] 1.1, 1.4). Construction of complete sexual networks is costly and not routinely feasible. We recommend adding a question to cross-sectional surveys used to monitor sexual behaviour about whether the respondent believes his or her partner has other sexual partners. Although subject to bias, the question was useful in Jamaica to identify a group of women with only one sexual partner at increased risk of infection.

Utilization of HIV prevention services across racial/ethnic groups among men who have sex with men in San Francisco, California, 2008

Human Immunodeficiency Virus (HIV) infection in the US is disproportionally higher among Black and Latino men who have sex with men (MSM), compared to other racial/ethnic groups. The 2008 US National HIV Behavioral Surveillance (NHBS) survey of MSM was analyzed to compare utilization of HIV testing, receiving condoms, and individual and group HIV prevention programs among racial/ethnic groups in San Francisco, CA. Using a weighted analysis of the time-location sampling method, racial/ethnic subpopulation estimates were obtained for utilization of these services in the prior 12 months. There was no significant difference in utilization of HIV prevention services among Black (N=37), Latino (N=128), and White (N=275) MSM in San Francisco, CA. Overall 60-70 % of MSM reported their last HIV test within the past 12 months and more than 75 % reported receiving condoms in the last 12 months. However, less than 15 % of MSM reported utilizing individual or group HIV prevention counseling sessions. The NHBS survey demonstrate that the majority of MSM in San Francisco, CA have utilized one or more HIV prevention service in the past 12 months and that there were no racial/ethnic disparities in utilization of these services. However, the utilization of individual or group HIV prevention programs is low and HIV testing is below current recommendations for MSM.