A Contextualization of Transgender Women and Condom Use Using the HIV Syndemic Framework: Scoping Review

Objective: To contextualize condom use in the transgender women population utilizing the HIV syndemic framework. Methods: Studies reporting condom use frequency and syndemic factors associated with HIV risk in transgender women were systematically searched. We followed the Scoping Reviews (PRISMA-ScR) checklist. Results: Social factors have a proven relationship with using condoms and HIV among transgender women. Syndemic factors, defined as co-occurring adverse factors that interact to contribute to risk behaviors, deserve a specific analysis to develop strategies to face HIV among transgender women. Conclusions: A syndemic perspective allows to generate specific health intervention and prevention policies to protect transgender women.

Nurse-Led Brief Intervention for Enhancing Safe Sex Practice Among Emerging Adults in Hong Kong Using Instant Messaging: Feasibility Study

BACKGROUND

The incidence of sexually transmitted infections has been increasing throughout the world. Additionally, substantial changes in emerging adults' attitudes toward sex and the popularization of premarital sex could further affect the diagnosis and treatment of sexually transmitted infections. With the high acceptability and effectiveness of instant messaging (IM) interventions for health promotion, there is potential for such interventions to improve condom use knowledge and promote safer sex practice.

OBJECTIVE

The study evaluates the feasibility of a nurse-led IM intervention to promote safer sex practices in emerging adults.

METHODS

A 30-minute adaptive IM intervention and a 5-day booster dose of daily messages after 2 weeks through WhatsApp (Meta Platforms, Inc) were conducted with emerging adults in local universities in Hong Kong aged between 18 and 29 years with previous sexual experience. A questionnaire was distributed 1 week after the intervention that measured the consistency in condom use, the change in condom use knowledge and attitudes, and the acceptability of the intervention. The feasibility of the intervention was assessed by Bowen's feasibility framework.

RESULTS

A total of 20 participants completed the intervention and questionnaire. Results showed (1) high satisfaction level (mean satisfaction score: 9.10/10), (2) high demand of the intervention (retention rate: 95%), (3) smooth implementation of the intervention, (4) high practicality (13/20, 65% of the participants viewed IM to be an effective means of intervention), (5) potential integration of the intervention, and (6) significant mean increase in condom use knowledge and attitudes (mean increase 9.05; t19=3.727; 95% CI 3.97-14.13; P=.001).

CONCLUSIONS

The IM intervention was feasible, acceptable, and had potential impacts on improving safer sex practices. These findings will support the future development of IM interventions in the arena of sexual health promotion.

Sharp increase in gonorrhoea notifications among young people, EU/EEA, July 2022 to June 2023

Gonorrhoea cases increased steeply in women aged 20 to 24 years across 15 EU/EEA countries in July to December 2022 and January to June 2023 with, respectively, 73% and 89% more cases reported than expected, based on historical data from 2015 to 2019. Smaller increases among men due to heterosexual transmission were observed in nine EU/EEA countries. Interventions to raise awareness among young people about sexually transmitted infection risks are needed, emphasising the benefit of safe sexual practices and testing.

Consistent condom use among sexually active young adults in Ghana: an analysis of prevalence and associated factors

Consistent and proper condom use offers a safer, economically cheap and practically effective means of preventing HIV infection. Using the 2014 Ghana Demographic and Health Survey with a sample of 2779 sexually active youth (males = 682 and females = 2,097) in the age range 15-24, this study explored the prevalence of, and factors associated with consistent condom use among sexually active young adults in Ghana. Multivariate logistic regression was used to analyse the data. Our results showed that approximately 11% of the respondents reported consistent condom use in their previous sexual activity. Females were more likely than males to have used a condom consistently. The logistic regression results showed that females who had tested for HIV were less likely to use a condom consistently. However, those who have obtained family planning information from print media and those from the northern part of Ghana were more likely to practise consistent condom use. Furthermore, males who professed the Traditional African religion were less likely to use a condom consistently. In contrast, males in the rich wealth category were more likely to use a condom consistently. These findings underscore the need for behavioural change campaigns targeting young adults, particularly those who are sexually active, to encourage consistent condom use. These interventions should target young adults with less family planning knowledge, those who know their HIV status and those who profess the Traditional African religion.

Is there a need to implement sex education?

BACKGROUND

Displacement has been associated with an increased risk of HIV transmission. In light of the lack of data from Libya on sexual behavior and HIV/AIDS knowledge, the effort was undertaken to assess HIV/AIDS knowledge and attitudes towards HIV and condom use in Libyan internally displaced males (IDPs) in Tripoli.

METHODS

Cross-sectional study design using purposive sampling to identify internally displaced Libyan males from five camps in Tripoli. HIV/AIDS knowledge, attitudes towards HIV and condom use, and prevention practices were evaluated through a self-administered, close/ended anonymous questionnaire in Arabic.

RESULTS

The study population consisted of 390 participants, all Muslims, with a mean age of 32.81 years (SD = 8.93). Overall, the average HIV and prevention knowledge score was 6.34 (SD = 1.98). The majority of the respondents thereby had an insufficient or low knowledge' level of HIV and prevention knowledge (58.70%). The mean attitude score indicated overall a negative attitude towards condom use (Mean = 32.60, SD = 7.97).

CONCLUSIONS

This is the first biobehavioral survey among IDPs in Libya demonstrating a low level of HIV and prevention knowledge as well as a prevailing negative attitude level of HIV/AIDS and condom use.

Outcomes of substance use and sexual power among adolescent girls and young women in Cape Town: Implications for structural and cultural differences

Adolescent girls and young women (AGYW) in South Africa experience contextual barriers to HIV risk reduction including incomplete schooling, unintended pregnancy, substance use, and gender-based violence. A cluster randomised trial in Cape Town allocated 24 Black and Coloured communities to a gender-focused HIV risk-reduction intervention or HIV testing, with 500 AGYW total enrolled. We evaluated intervention efficacy by comparing mean differences overall, by community population group (Black and Coloured) and among those with structural barriers based on neighbourhood, education, and employment (n = 406). Both arms reported reductions in alcohol, cannabis, and condomless sex, with no intervention efficacy overall. Among AGYW with barriers, intervention participants reported fewer days of methamphetamine use at 6 months (t(210) = 2·08, p = ·04). In population group analysis, we found intervention effects on alcohol and sexual communication. Intervention participants in Black communities had fewer days of alcohol use at 12 months (t(136) = 2·10, p = ·04). Sexual discussion (t(147) = -2·47, p = ·02) and condom negotiation (t(146) = -2·51, p = ·01) increased for intervention participants at 12 months in Coloured communities. Gender-focused interventions must address population group differences and intersecting barriers to decrease substance use and increase education, skills, and sexual health protection.

Testing the effectiveness of two psychosocial interventions - ACCENT and Didactic - to prevent HIV/AIDS behavioral risk factors in Mozambican women: a randomized controlled study

In Mozambique, women are the most affected by HIV/AIDS and heterosexual encounters remain the main route for HIV/AIDS. Condom use is the most effective method of HIV/AIDS prevention, and the intention to use and buy/get condoms has a significant role in safe sex behavior. This study aimed to evaluate the efficacy of two psychosocial interventions - the Didactic and ACCENT Interventions - to prevent HIV/AIDS among Mozambican Women. Participants were Mozambican women (n = 150), users of the gynecology clinic of the Central Hospital of Beira. The study design was a randomized controlled trial (RCT) with assignment to three groups: Didactic intervention, ACCENT intervention, and Control group. Measures were from an adaption of the Women's Health Questionnaire, which includes questions about sociodemographic, clinical, and behavioral variables related to HIV prevention/risk. There was a significant group effect on condom use and safer sex preparatory behaviors, F(2, 146) = 6.45, p = .002, with Bonferroni post-hoc tests showing differences between the ACCENT vs. Control groups and ACCENT vs. Didactic groups (all p = .022). There were no statistically significant time effects on both condom use and safer sex preparatory behaviors. Results are promising for HIV/AIDS prevention in Mozambican women at sexual risk, but replication is needed for generalizability of findings.

Sexual Behaviors and Aggression in Gay Pornography

Previous studies have suggested a substantial number of men who have sex with men (MSM) have consumed and used pornography to learn about same-sex sexual behaviors. Yet, past research has focused almost exclusively on condom-use in the category of Gay pornography and ignored the types of sexual behaviors and aggression depicted within the content. This study examined aggression and sexual behaviors depicted in Gay online pornography (N = 415). We found fellatio and anal sex were the most common behaviors, occurring in roughly two-thirds of scenes, while kissing occurred in less than a third of scenes. Additionally, sexual aggression occurred in 31% of scenes, with spanking being the most common, occurring in 20% of scenes. Anal sex and forced fellatio were found to be predictors of physical aggression. These findings point to normalization of aggression and narrow sexual behaviors in Gay pornography, which may have implications for MSM's norm perceptions related to sexuality.

Risky Sexual Behaviour and Sexual Victimization among Young People with Risky Substance Use in Europe-Perspectives from Belgium, Sweden, the Czech Republic, and Germany

BACKGROUND

Research indicates that among the risks associated with young people's alcohol and illicit drug use are sexual risks. However, insights into co-occurrence of substance use and sexual risks in adolescent samples and possible differences across countries are limited.

METHODS

A sample of 1449 adolescents from Belgium, Sweden, the Czech Republic, and Germany screened positive for risky alcohol/illicit drug use in a web-based intervention against alcohol and illicit drug use. They also reported incidents of sex while being drunk and/or high on drugs, condomless sex on these occasions, and sexualized touching and sexual victimization while being drunk or high on drugs.

RESULTS

In the sample, 21.5% of the participants reported sexualized touching, 9.9% being victim to sexual assault, and 49.8% having had sex while being drunk and/or high on drugs; of the latter, 48.3% had condomless sex. Reports on having had sex while being drunk and/or high on drugs were associated with higher levels of past 30-day binge drinking. Being a victim of sexual assault was associated with past 30-day binge drinking only in young men.

CONCLUSION

When devising preventive interventions against risky substance use in adolescents, an additional focus should be set on integrating steps against sexual risks.

Effects of Online Friendships on Safer Sex Communication and Behavior among Black Sexual Minority Men: A Study of Network Exposure

This study draws on social normative and social learning theories to examine the masspersonal safer sex communication (i.e., Facebook posts about safer sex) and safer sex behavior (i.e., condom use) in a cohort of Black sexual minority men (BSMM) (N = 340), with an eye toward understanding their relationship with the safer sex communication and behaviors of their BSMM Facebook friends. Using linear network autocorrelation regression models, results showed that BSMM's safer sex communication and condom use behavior were each associated with the communication and behavior of their online peers. Specifically, BSMM's condom use was positively associated with their friends' condom use and friends' safer sex communication, and BSMMs' safer sex communication was positively associated with friends' safer sex communication. Moreover, contrary to prior research, BSSM's safer sex communication and condom use were not related to one another, suggesting that talking about safer sex on social media should not be interpreted to be an indication of engageDment in safer sex behavior. These findings underscore an opportunity to leverage peer influence in social media networks, particularly in the form of masspersonal communication, to encourage cascades of safer sex messaging among peers and adoption of safer sex behavior.

U.S. College Students' Sexual Risk Behaviors Before and During the Early COVID-19 Pandemic

The present study describes changes in young adults' sexual behaviors during the early COVID-19 pandemic. Latent class growth analyses (LCGAs) conducted with four waves of data collected between July 2019 to May 2020 in N = 775 college students (Mage = 18.61, SD = 0.33; 50.3% female, 90.2% White) revealed the presence of high- and low-risk classes in separate models for oral, vaginal, and anal sexual risk taking. As anticipated, vaginal and oral risk taking declined in spring 2020. Membership in high-risk trajectories was attributable to high COVID-19-related financial problems, early sexual debut, low self-control, and being in a romantic relationship. Other COVID-19 factors and demographic control variables were not linked to trajectory membership. Thus, while many young adults' sexual risk taking changed during the early pandemic, their perceptions of and experiences with COVID-19 were not predictive of sexual risk trajectory membership.

Intimate Partner Violence and the Sexual Health of Sexual Minority Men

Purpose: This qualitative study explores the pathways by which various forms of intimate partner violence (IPV) impact the sexual health behaviors of cisgender identified sexual minority men (SMM). Methods: Semi-structured interviews were conducted with 23 racially and ethnically diverse SMM who recently experienced IPV and 10 clinical and social service providers focused on how experiences of IPV directly or indirectly influences sexual risk as well as engagement in HIV prevention behaviors (e.g., pre-exposure prophylaxis [PrEP] use). Applied thematic analysis, including cycles of analytic memo writing and coding, aided the identification of patterns across the data. Results: Analyses yielded three overarching themes: use of condoms, use of PrEP, and HIV and sexually transmitted infections (STIs). Participants described different ways condom use or nonuse was a mechanism by which power and/or control might be asserted by one partner over the other partner. A range of responses to questions about PrEP were identified, including partners encouraging PrEP use, as well as avoidance of conversations about PrEP or actual PrEP use, to prevent experiencing aggression or IPV from partners. Responses regarding HIV/STIs included those ranging from a new diagnosis being a potential trigger for violence to the exploitation of status to control partners. Conclusion: These findings suggest that in relationships with IPV, HIV prevention strategies can be sources of relationship control and trigger abuse. Addressing IPV may help to prevent HIV/STI transmission and promote the health of SMM. In addition, long-acting formulations of PrEP may be a promising strategy for SMM experiencing IPV when oral PrEP medications may be a risk factor for violence.

Psychometric Evaluation of the Korean Version of the Perceived Costs and Benefits Scale for Sexual Intercourse

This study aimed to evaluate the psychometric properties of the Korean version of the perceived costs and benefits scale (K-PCBS) for sexual intercourse to deepen our understanding of the complex psychosocial and interpersonal elements influencing young people's sexual decision-making. The study participants were 227 college students in South Korea aged 18-25 years. Two factors were extracted through factor analysis, accounting for 61.05% and 58.18% of the variance for perceived costs and perceived benefits, respectively, and showed a good model fit in the K-PCBS. Reliability was high, as indicated by Cronbach's alphas of 0.87 and 0.84 for the perceived costs and perceived benefits subscales, respectively. The results indicate that the K-PCBS may serve as an appropriate instrument for measuring South Korean youth's cost and benefit analysis regarding their sexual decision-making. Our study makes a significant contribution to the literature and field because it identifies the underlying feelings and attitudes of young adults toward engaging in sexual activities using the K-PCBS for sexual intercourse, which has good reliability, validity, and internal consistency.

Sexual Arousal-Delay Discounting: When Condoms Delay Arousal

Sexual arousal plays an important role in condom use decisions. However, combined effects of reduced sexual arousal and delay to achieving arousal on condom use decisions remain understudied. This study used a novel sexual arousal-delay discounting (SADD) task to measure individuals' willingness to use a condom in situations where condom use would (1) delay time to arousal and (2) reduce the level of arousal one could achieve even after the delay (e.g., 5 minutes to reach 50% arousal). In Study 1, U.S. college students (N = 115; Mage = 18.6) reported their willingness to have sex with a condom in hypothetical scenarios where the condom delayed and reduced their partner's sexual arousal. In Study 2, U.S. college students (N = 208; Mage = 19.6; 99% ≤ 24 years old) completed the same task for two partners-partner perceived as most desirable and partner perceived as least likely to have an STI. In this study, a condom would affect either participants' own or partner's arousal. Study 3 replicated Study 2 using a non-college sample in the U.S. (N = 227; Mage = 30.5; 84% ≥ 25 years old). Across studies, willingness to use a condom decreased as the delay to reduced arousal increased. This effect of SADD was stronger when condoms reduced participants' own (vs. partner's) arousal, whereas comparisons between most desirable and least likely-to-have-STI partners provided mixed findings. Men had higher discounting rates than women across conditions. Greater SADD was associated with lower condom use self-efficacy, providing initial evidence for the task's validity. The role of delayed arousal in condom use and implications are discussed.

Condom use increased after a peer group intervention implemented by community volunteers in Malawi

Background

HIV prevention remains a global priority, especially in sub-Saharan Africa. Our research team previously developed an evidence-based peer group program for HIV prevention called Mzake ndi Mzake (Friend to Friend). A community-engaged collaboration adapted the program for community ownership and implementation. Here we report whether this HIV prevention program, implemented by community volunteers, increased condom use among sexually active individuals in rural Malawi.

Methods

Three communities sequentially rolled out the program. Effectiveness was evaluated using repeated surveys. At Time 1, no community had offered the intervention. At Time 2, the first community had offered the intervention and two had not (control group). At Time 3, two communities had offered the intervention and one had not (control group). We used two condom use indicators; condom use frequency in the last 2 months (N = 776) and condom use at last sex (N = 880). For each indicator, the sample included all sexually active persons answering that question at one or more time points. Regression analyses were used to model the two condom indicators over time, controlling for demographic factors, UNAIDS HIV knowledge, safer sex self-efficacy and partner communication.

Results

This peer group intervention implemented by trained community volunteers increased both condom use indicators at Times 2 and 3. In the final regression models. Other predictors of greater condom use for at least one condom use indicator included younger age group (13-19), male gender, not married/cohabiting, high involvement in religiously affiliated activities, higher safer sex self-efficacy, and greater partner communication. Although the intervention increased UNAIDS HIV knowledge, knowledge did not predict condom use.

Conclusions

This community engaged implementation study found that an evidence-based peer group program for HIV prevention increased condom use when delivered by trained community volunteers. Leveraging community strengths and human capital resources facilitated implementation of this effective HIV prevention program in rural Malawi. Community ownership and program delivery by trained local volunteers offers an innovative and cost-effective strategy to address ongoing HIV prevention needs without overburdening heathcare systems in sub.

Trial registration

Clinical Trials.gov NCT02765659 Registered May 6, 2016.

Sexual behavioral factors of the subjects visiting the clinic of sexually transmitted infections in Northern Finland: A cross-sectional study among 775 subjects

Background and Aims

Sexually transmitted infections (STI) are among the most common infections globally. However, the sexual behavioral factors and sexual history of people visiting STI clinics have only been surveyed in a few studies. We aimed to evaluate the characteristics of the patients visiting the open STI clinic.

Methods

This is a prospective observational study performed in the STI clinic in the premises of Department of Dermatology, Oulu University Hospital. All individuals (n = 775) attending the STI clinic between February and August 2022 were included to the study and the profile of the patients was evaluated.

Results

We found that the majority of the STI clinic attendees (58.5%) were female. Mean age of the study population was 28.9 years, with females being significantly younger than males (p < 0.001). Only one-third (30.6%) of the patients reported having symptoms at the time of attending. Most commonly, patients had had one sex partner in the last 6 months. However, one-fifth (21.7%) reported several sex partners (over four). Almost half of the patients (47.6%) reported using a condom only randomly. Those with heterosexual orientation had fewer multiple-sex partners (p < 0.001) than those with homo- or bisexual orientation (p < 0.05).

Conclusion

It is important to increase knowledge about the profile of STI clinic visitors to effectively target STI prevention on the groups at the highest risk of STIs.

Predictors of Condom Use Among Youth of the Rural Tigray, Northern Ethiopia: Community-Based Cross-Sectional Study

Background

Condom is one of the most commonly used and cost-effective HIV preventive measures, particularly in low-income countries. Despite the proven effect of condoms for STI/HIV prevention, there are limited data on its utilization. Hence, this community-based study aimed to assess the level and determinant factors of condom utilization among the youth of the rural Tigray.

Methods

This study was part of a large community-based cross-sectional study conducted to assess the utilization of adolescent and youth-friendly health services among randomly selected 631 youth aged 15-24 years from May 23 to June 30, 2018. We used 273 youth who reported having a history of sexual activity during the study period. The data were collected using an interviewer-administered structured questionnaire. Logistic regression analysis was used to determine the independent predictors of the outcome variable and the level of significance was declared at a P-value of <0.05.

Results

A total of 273 participants were included in the study. The mean age (+SD) of the respondents was 19.14 (±2.74) years. Only one-third (35.2%) of the respondents used a condom during their last sexual encounter and 51 (53.1%) of them used it consistently. Being married (AOR = 0.17; 95% CI: 0.04, 0.60), respondent's partner attained primary education (AOR = 0.14; 95% CI: 0.04, 0.50), and having multiple sexual partners (AOR = 6.97; 95% CI: 2.09, 23.20) were found to be the determinants of condom utilization.

Conclusion

The study participants had a low level of condom utilization. Social and sexual related factors were the major predictors of condom use among the youth. Therefore, focused interventions need to be designed specifically to strengthen condom promotion campaigns.

Prevalence and Trends of Sexual Behaviors Among Young Adolescents Aged 12 Years to 15 Years in Low and Middle-Income Countries: Population-Based Study

BACKGROUND

Risky sexual behaviors remain significant public health challenges among adolescents. Nearly 90% of adolescents live in low and middle-income countries (LMICs), but few studies have used standardized methodology to monitor the prevalence and trends of sexual behaviors among adolescents in LMICs.

OBJECTIVE

This study aimed to assess the prevalence of sexual behaviors (ever had sexual intercourse, multiple sexual partners, and condom use) among adolescents aged 12 years to 15 years as well as the trends in prevalence between 2003 and 2017.

METHODS

For this population-based study, we used recent data from the Global School-based Student Health Survey conducted in 69 LMICs from 2003 to 2017 to assess the recent prevalence of sexual behaviors by using complex analysis and a random effects meta-analyses method. Using the chi-square trend test, we also assessed the trends in the prevalence of sexual behaviors in 17 countries that had conducted ≥1 round of surveys from 2003 to 2017.

RESULTS

We included 145,277 adolescents aged 12 years to 15 years (64,719/145,277, 44.5% boys) from the 69 LMICs that had conducted ≥1 survey and 80,646 adolescents aged 12 years to 15 years (34,725/80,646, 43.1% boys) from the 17 LMICs that had conducted ≥1 round of surveys. The recent global prevalence of ever had sexual intercourse was 6.9% (95% CI 6.2%-7.6%) and was higher among boys (10.0%, 95% CI 9.1%-11.1%) than girls (4.2%, 95% CI 3.7%-4.7%) and among those aged 14 years to 15 years (8.5%, 95% CI 7.7%-9.3%) than those aged 12 years to 13 years (4%, 95% CI 3.4%-4.7%). Among adolescents who had ever had sex, the recent global prevalence of having multiple sexual partners was 52% (95% CI 50.4%-53.6%) and was higher among boys (58%, 95% CI 56.1%-59.9%) than girls (41.4%, 95% CI 38.9%-43.9%) and among those aged 14 years to 15 years (53.5%, 95% CI 51.6%-55.4%) than those aged 12 years to 13 years (49.7%, 95% CI 45.9%-53.5%). Among adolescents who had ever had sex, the recent global prevalence of condom use was 58.1% (95% CI 56.2%-59.9%) and was higher among girls (59.2%, 95% CI 56.4%-61.9%) than boys (57.7%, 95% CI 55.7%-59.7%) and among those aged 14 years to 15 years (59.9%, 95% CI 58.0%-61.8%) than those aged 12 years to 13 years (51.6%, 95% CI 47.5%-55.7%). Between the earliest and latest surveys, the overall prevalence of ever had sexual intercourse (3.1% decrease) and condom use (2.0% decrease) showed downward trends. The overall prevalence of having multiple sexual partners increased by 2.6%.

CONCLUSIONS

We provide evidence and important implication for policymakers to develop targeted policy support systems to prevent and reduce risky sexual behaviors among young adolescents in LMICs with a high prevalence of risky sexual behaviors.

Assessing Condom Use and Views on HIV Counselling and Testing among TVET College Students in Limpopo Province, South Africa

South Africa's population is predominantly young, presenting a powerful resource for the country. Despite this, adolescents and young people remain at the epicentre of the HIV epidemic, particularly adolescent girls and young women (AGYW). There are limited studies that investigate the views on HIV Counselling and Testing (HCT) and condom use among adolescents and young people, and college students in particular, in South Africa. This cross-sectional study assessed condom use among college students and their views and opinions on HCT. Utilising an adapted questionnaire from the Australian Secondary students and the South African Sexual Health survey, the data from 396 students were analysed using univariate and multiple logistic regression performed using Stata IC version 16. The majority of the students (n = 339, 85.8%) had a sexual partner at the time of the study. Our findings reveal a relatively high occurrence of condom use in the last sexual encounter (n = 225, 60%) and high HCT uptake (n = 50, 88.4%). Females were generally more comfortable regarding HIV services compared to their male counterparts. More than half, 54.6% vs. 36.0% were comfortable about testing, 34.0% vs. 48.3% felt very scared about testing for HIV, 3.6% vs. 10.1% reported that they were not ready to take an HIV test, 7.6% vs. 5.6% intended getting tested soon (p = 0.0002). Condom use was significantly associated with the use of a condom during the first sexual encounter (aOR = 4.71, 95% CI: 2.14, 10.37) and knowing their partner's HIV status (aOR = 2.08, 95% CI: 1.19-3.65). The HCT and condom promotion strategies implemented by Higher Health in TVET colleges is showing success and colleges in other parts of the region could emulate these best practices. Program developers should consider tailor-made combinations of prevention interventions that would appeal to both female and male college students to improve condom use and uptake of HIV testing services.

Prevalence and correlates of condom use at last sexual intercourse pre- and post-COVID-19 lockdown among adolescent girls and young women in central and western Kenya

We investigated condom use at last sexual intercourse among adolescent girls and young women (AGYW) to determine the prevalence and correlates of condom use pre- and post-COVID-19 lockdown. Condom use was compared pre- and post-COVID-19 lockdown using a single group interrupted time series analysis. Multivariable Poisson regression was used to determine the correlates of condom use at last sexual intercourse. We found a statistically significant decrease in prevalence of condom use at last sexual intercourse post-COVID-19 lockdown. Condom use at last sexual intercourse was associated with younger age, current contraceptive use, and higher education. AGYW in concurrent relationships were less likely to use condoms, as were owners of mobile phones. These findings suggest a disconnect between youth knowledge of HIV prevention and their actual condom use, particularly in concurrent sexual partnerships. Future research should explore how dynamic fertility intentions, mobile phone access, concurrent sexual partnerships and empowerment influence condom use among sub-Saharan AGYW.

Impact of the COVID-19 pandemic on access to HIV testing and condom use among two-spirit, gay, bisexual, and queer (2SGBQ+) men in Manitoba

This cross-sectional online survey (n = 347) examined the impact of the COVID-19 pandemic on access to HIV testing and condom use among Two-Spirit, gay, bisexual, and queer (2SGBQ+) men in Manitoba. Logistic regression assessed the relationship between socio-demographics and the impact of COVID-19 on access to HIV testing and condom use. Among those who answered a question on testing (n = 282), 27.7% reported reduced access to HIV testing. Among those who answered questions on condom use (n = 327), 54.4% reported decreased use of condoms. Compared to living in Winnipeg, living in a medium-sized city (Brandon) and in rural and remote areas were both associated with higher odds of reporting reduced access to HIV testing due to COVID-19. Participants who were dating (vs. married or partnered) were significantly more likely to report reduced access to HIV testing, but less likely to report decreased use of condoms, while younger age was associated with decreased use of condoms. Service providers must be prepared to respond to the impact of COVID-19 on HIV testing and condom use among younger, sexually active 2SGBQ + men, as well as those who live in small, rural, and remote areas in Manitoba.

Factors associated with buying sex and the knowledge that condoms prevent HIV among long-distance truck drivers at Kazungula weighbridge terminal, Chobe District, Botswana

Background: Long-distance truck drivers (LDTDs) have a higher rate of HIV infection compared to the general population. This is due to their living and working conditions which predispose them to riskier sexual behaviours. Inadequate knowledge of HIV and AIDS, coupled with risky sexual behaviours such as unprotected sex with commercial sex workers (CSWs), predisposes LDTDs to contract and propagate HIV. This study aims to determine the factors associated with buying sex and the knowledge that condoms prevent HIV transmission among long-distance truck drivers at Kazungula weighbridge terminal in the Chobe District of Botswana.Methods: A cross-sectional descriptive survey was employed and 399 LDTDs participated. A questionnaire was used to collect sociodemographic data and information on knowledge of HIV and AIDS and the sexual behaviours of the LDTDs.Results: The results reveal that more than half of the LDTDs (56.9%; n = 227) had paid for sex with CSWs at some point in their travels, and 27.1% (n = 108) reported having had unprotected sex with CSWs. The LDTDs who preferred to have sex with CSWs without a condom had about five times the odds of buying sex with CSWs than those who preferred to use a condom (AOR 4.9; 95% CI 2.85-8.46). Disliking condom use was a factor contributing to less knowledge of condom use preventing HIV among the LDTDs (AOR 0.4; CI 0.17-0.97).Conclusion: It can be concluded from the results of this study that the LDTDs engage in considerable risky sexual behaviours, and associated factors were found to be multidimensional. This population remains of concern in HIV acquisition and transmission. Therefore, there is a need for a robust public health response to deal with the problem of both new infection and re-infection with HIV in this population.

Factors affecting risk-taking behaviors among sexually active adolescents tested for HIV/STD

OBJECTIVE

The purpose of this secondary data analysis was to identify potential contributors to high-risk sexual behaviors among sexually active adolescents who were tested for HIV and STDs compared to those who did not test for HIV and STDs.

METHOD

Data from the 2019 Youth Risk Behavior Survey (YRBS) was used to explore potential predictors of risky behaviors among those tested for HIV/STD. A sample size of 3226 from the YRBS data base was used to explore predictors using Chi-square and logistic regressions analyses.

RESULTS

Most adolescents reported not being tested for HIV (77.4%) and STD (83.9%). There were statistical differences between those tested for HIV and condom use, sexual intercourse before the age of 13 years, sexual intercourse with multiple people, and use of marijuana. Similar findings were found with adolescents tested for STDs.

CONCLUSION

Findings of this study support the recommendations for a better understanding of the associations between drug use, early initiation of sexual activity, and condom use. Development of appropriate public health educational interventions can help decrease risky behaviors among these adolescents.

Drought, HIV Testing, and HIV Transmission Risk Behaviors: A Population-Based Study in 10 High HIV Prevalence Countries in Sub-Saharan Africa

Droughts are associated with poor health outcomes and disruption of public health programming. Data on the association between drought and HIV testing and transmission risk behaviors are limited. We combined data from Demographic and Health Surveys from 10 high HIV prevalence sub-Saharan African countries with a high-resolution measure of drought. We estimated the association between drought and recent HIV testing, report of condomless sex, and number of sexual partners in the last year. Respondents exposed to drought were less likely to have an HIV test and more likely to have condomless sex, although effect sizes were small. We found evidence for effect modification by sex and age for the association between drought and HIV testing, such that the negative association between drought and HIV testing was strongest among men (marginal risk ratio [mRR] 0.92, 95% CI 0.89-0.95) and adolescents (mRR 0.90, 95% CI 0.86-0.93). Drought may hinder HIV testing programs in countries with high HIV prevalence.

Multiple Casual Sex Scripts: Shared Beliefs about Behavior among Portuguese Emerging Adults

Objective

Empirical research to differentiate casual sex scripts is still limited. We aimed to ascertain the sexual scripts for three main types of casual sexual relationships: hookup, friends with benefits and one-night stands.

Methods

Through a mixed-method approach, we performed a study consisting in two sequential tasks to (1) complete three lists of script actions, and (2) identify the most agreed-upon actions for each casual sexual relationship.

Results

An important number of actions and events were identified for the three casual sexual scripts, reflecting a high level of elaboration and structure. Following a cognitive-script methodology, the actions retained for the content of the script for each casual sexual relationship were those obtaining at least 60% in respect to the mean of their centrality to the encounter. Only 16.5% of actions were shared among the three scripts, demonstrating their distinctiveness.

Conclusion

Knowledge about the different casual sex scripts can be used to develop relational and personal skills within CSRs and decrease unwanted experiences such as condomless sex.

Disparities in HIV Testing, Condom Use, and HIV Education Between Transgender and Not Transgender High School-Aged Youth: Findings From the 2019 Youth Risk Behavior Survey

Transgender individuals are disproportionately affected by HIV in the United States. Given increased risk of HIV among youth, there is a need to understand HIV risk and protective factors among transgender individuals who are 18 years and younger. Patterns of HIV testing, HIV education, and condom use have known associations with HIV outcomes among youth in general, but are understudied among transgender youth. This study assessed these outcomes by developing a series of sex-stratified multivariable logistic regression models using pooled Youth Risk Behavior Survey data. Results indicate female and male transgender youth as well as males who were not sure they were transgender were more likely have tested for HIV compared with their not transgender peers. Male transgender youth were significantly less likely to have received HIV education compared with not transgender males. Females not sure if they were transgender and male transgender youth were significantly less likely to have used condoms compared with, respectively, not transgender female and not transgender male counterparts. In sum, condom use and HIV education both remain lower among transgender individuals relative to their not-transgender peers. This highlights the need for the promotion of culturally appropriate HIV education and HIV prevention supports among transgender youth.

Pilot-testing a Multiplayer HIV and Sexually Transmitted Infection Prevention Video Game Intervention for Black Adolescent Girls: Protocol for a Randomized Controlled Trial

BACKGROUND

Black adolescent girls aged between 14 and 19 years are more likely than White girls to be diagnosed with a sexually transmitted infection (STI). As STI diagnosis is associated with an increase in the risk for HIV acquisition, an early intervention specifically tailored to Black adolescent girls is warranted. A web-based video game intervention has the potential to reach this demographic. Because studies of social and behavioral determinants of disease demonstrate the protective role of peer group structures on individual outcomes, a multiplayer game can facilitate opportunities to exchange and evaluate information, learn social norms, develop behavioral skills, and allow peers to influence attitudes and behavior. No prior research has examined the feasibility of a web-based multiplayer game intervention for this population.

OBJECTIVE

This study describes the protocol for a randomized controlled trial (RCT) pilot-testing the feasibility, acceptability, and limited efficacy of a multiplayer game-based intervention for increasing HIV and STI testing and condom use in Black adolescent girls.

METHODS

We enrolled 79 Black adolescent girls aged 14 to 19 years residing in the United States into a 2-arm parallel RCT. The intervention is a theory-based, community-informed, multiplayer game that can be played with peers on the web using videoconferencing software. The goal of the game is to empower Black adolescent girls to make healthy decisions regarding dating, relationships, and sex, thus reducing HIV and STI infection. Control condition participants received a list of resources after playing a time and attention control game. All study procedures were conducted via the internet. We conveniently sampled Black adolescent girls using web-based advertisements. Study assessments occurred at enrollment, 1 week, 1 month, and 4 months after enrollment. The primary outcome of this study is increased HIV and STI testing by Black adolescent girls. Secondary outcomes include increased condom use, self-efficacy to use condoms, positive attitudes toward condom use, intentions, harm perceptions, HIV and STI and pre-exposure prophylaxis knowledge, positive sexual norms, sexual communication with partners, and reduced incidence of sexual risk behaviors associated with HIV and STI transmission. Secondary outcomes also included assessment of intervention feasibility and acceptability.

RESULTS

From February to April 2022, a total of 79 Black adolescent girls were enrolled, with 40 (51%) having been randomized into the intervention condition and 39 (49%) into the control condition. At baseline, participant ages ranged from 14 to 19 (mean 16.4, SD 1.23) years.

CONCLUSIONS

Web-accessible game interventions overcome common impediments of face-to-face interventions presenting a unique opportunity to reach Black adolescent girls and improve their sexual health and self-efficacy. Trial data will provide information about the limited efficacy of the intervention and inform future web-based studies and a larger RCT aimed at improving the sexual health of Black adolescent girls.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04108988; https://clinicaltrials.gov/ct2/show/NCT04108988.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/43666.

Do gendered racial microaggressions influence the relationship between body appreciation and Black emerging adult women's condom use behaviors?

Background: Sexual protective behaviors, such as consistent condom use and intention, are important preventative measures against the transmission of HIV/AIDS and sexually transmitted infections. Current sexual health research has yet to explore the interaction between contextual factors, such as gendered racial microaggressions, and the role of personal factors (i.e., body appreciation) on Black women's sexual risk and protective behaviors in the United States. Guided by objectification theory, we hypothesized that sexually objectifying gendered racial microaggressions moderated the body appreciation and condom use behaviors relationship. Participants: The current study consisted of 114 Black emerging adult women in the southern United States. Results: Results showed significant interactions between the frequency of sexually objectifying gendered racial microaggressions and body appreciation on consistent condom use and condom use intention. Conclusion: Overall, these findings suggested the need for sexual health researchers and interventionists to further explore the influence of gendered racial microaggressions and body appreciation on condom use behaviors.

Pre-Exposure Prophylaxis Users' Attitudes About Sexually Transmitted Infections and Its Influence on Condom Use: A Mixed-Method Study in Belgium

Incidence rates of sexually transmitted infections (STIs) are rising among men who have sex with men (MSM). Since the rollout of HIV pre-exposure prophylaxis (PrEP), promoting condom use to prevent the spread of STIs has become more challenging. Using a mixed-method design, we explored MSM PrEP users' attitudes toward STIs, condoms, and condom use with nonsteady partners to prevent STIs. We triangulated data from 22 in-depth interviews conducted at a large HIV/STI clinic between August 2021 and January 2022 and an online survey among 326 PrEP users between September 2020 and January 2022. Interviews were analyzed iteratively using a thematic analysis approach. We used bivariate and multi-variate ordered logistic regression to analyze the online survey data. Themes identified in the qualitative data influencing condom use decisions to prevent STIs were as follows: (1) awareness (i.e., perceived severity of and susceptibility to STIs, condom counseling), (2) motivation (i.e., concerns about STIs, sexual pleasure and protection of own health), and (3) perceived social norms and practices (e.g., reduced condom use at community level). Overall, 10.7% of survey respondents consistently used condoms with nonsteady partners. Survey respondents who reported high or moderate levels of willingness to use condoms to prevent acquiring STIs were significantly more likely to use condoms for anal sex with nonsteady partners; those who initiated PrEP 6-12 months ago were less likely to use condoms. We found a wide variation in attitudes toward condom use for the prevention of STIs among MSM using PrEP. We recommend client-centered approaches, taking into account PrEP users' values and priorities toward STI prevention to help reduce the spread of STIs.

Exploring Self-efficacy for Condom Use in Spanish People: A Trend Analyses by Gender from 2004 to 2020

Self-efficacy seems to be one of the most important resources for the different stages underlying condom use and STI prevention. For this reason, this study evaluates trends in self-efficacy by gender, from 2004 to 2008, 2013 and 2020 in Spain. Throughout these years, 6,698 people ranging from 17 to 40 years old, participated filling the Brief scale of condom use self-efficacy. According to our findings, despite the slight improvement in the recent years, self-efficacy still maintains a risky profile for safe sex, especially among the youngest people. Moreover, most of the traditional gender differences continue over the years with women reporting lower scores for condom purchase and men for putting them. However, these differences are not relevant in other dimensions such as using condoms despite drug consumption where women reveal worse results over the years. Therefore, our findings reaffirm the need of intensifying gendered preventive efforts aimed at Spanish people and, particularly, among the youngest.

Relationships between Penile-Vaginal Intercourse Frequency and Condom/Contraceptive Use from 2009 to 2018: Findings from the National Survey of Sexual Health and Behavior

Objectives

To examine changes over time in event-level condom/contraceptive use and the association between past year penile-vaginal intercourse frequency and event-level condom/contraceptive use.

Methods

Data were from the 2009 and 2018 National Survey of Sexual Health and Behavior, an online probability survey of U.S. adolescents and adults.

Results

Use of condoms and highly effective hormonal contraceptives decreased while long-acting reversible contraceptive use increased from 2009 to 2018 among adults. Increased penile-vaginal intercourse frequency was associated with decreased use of most contraceptive methods but an increase in condom use for adolescents.

Conclusions

Sexual frequency should be considered when assessing condom/contraceptive use.

Sexual Health among Youth in Residential Care in Spain: Knowledge, Attitudes and Behaviors

Adolescents in the child welfare system often face multiple maladaptive experiences that predispose them to worse sexual health outcomes. This study aims to (1) describe the sexual health of adolescents in Spanish residential care by exploring their sexual knowledge, attitudes toward sexuality, and sexual behaviors and (2) to find out whether there are certain characteristics that make a subgroup particularly vulnerable to engaging in risky sexual behaviors. A total of 346 adolescents recruited from 47 Spanish residential care facilities (34.1% girls, 65.9% boys) aged between 11 and 19 years old completed some self-report instruments. Descriptive analyses and tests to prove gender and age differences were conducted. Their knowledge of sexuality was lower than observed in the general adolescent population, their attitudes more negative, and their tendency to engage in risky sexual behaviors higher. Girls made very infrequent use of condoms, while boys had more sexist attitudes and made habitual use of withdrawal. Although more than 20% of them had experienced sexual exchange activities before the age of 13 until 17, they did not use condoms systematically. The low level of knowledge, the early initiation of sexual exchange activities, and the scarce use of protection methods, together with sexist attitudes, place this group in a situation of great vulnerability, increasing the risk of unwanted pregnancies, sexually transmitted infections, and even teen dating violence.

Associations of a Multilevel School Health Program and Health Outcomes Among Lesbian, Gay, and Bisexual Youth

Lesbian, gay, and bisexual (LGB) adolescents are often at higher risk than their heterosexual peers for adverse sexual health, violence, mental health, and substance use outcomes. Schools are a vital resource for enhancing protective behaviors and reducing risk behaviors. Sixteen school districts selected schools to implement a sexual health program (exposed) or usual programming (unexposed). We analyzed LGB student health outcomes using 2015 and 2017 Youth Risk Behavior Surveys. Analyses compared LGB student health outcomes by exposure status across time points using a multilevel approach. Program exposure was associated with decreased odds of ever having sex, ever testing for HIV, and using effective hormonal birth control, and an increased odds of condom use. There were no significant findings among secondary violence, mental health, and substance use outcomes. This evaluation highlights the potential for schools to reduce sexual risk behaviors among LGB youth, and opportunities to improve access to health services.

Sexual behaviours and their associated factors among young people in the Dodowa Health and Demographic Surveillance Site (DHDSS) in Ghana

Objective

This paper describes sexual behaviours and their associated factors among young people.

Design

The study design is cross-sectional.

Setting

Dodowa Health and Demographic Surveillance Site (DHDSS) in Ghana's Shai-Osudoku and Ningo Prampram districts.

Participants

Young people aged 10 to 24 years, median age 17 years.

Outcome measures

Self-reported to have ever had sex, non-use of a condom at last sex, and ever been pregnant or gotten someone pregnant.

Results

Of the 1689 young people; 42% reported having ever had sex, not using a condom at last sexual activity (64%), and ever been pregnant or gotten someone pregnant (41%). The proportion of non-use of condoms at last sex was high across all age groups but was highest (93%) in a small proportion of 10 to 14-year-olds who have ever had sex. Higher proportions of females than males; were reported to have ever had sex (46%), not using a condom at their last sex (66%) and ever been pregnant or getting someone pregnant (56%). Age group (20 to 24), females, primary or junior high school, living alone and lower household socio-economic status were risk factors associated with all three outcome measures.

Conclusion

Risky sexual behaviour is high among young people in the Dodowa HDSS. Therefore, interventions that promote safer sexual practices and help young people make timely decisions on their sexual and reproductive health care needs are required.

Funding

No funding was obtained for this paper.

Effectiveness of a Safe Sex Education Module in Improving Condom Use among People Living with HIV: A Randomised Controlled Trial

The Human Immunodeficiency Virus (HIV) epidemic in Malaysia has transitioned to occurring through more sexual transmission than injecting drugs in 2018. According to reports, the increase was caused by poor condom compliance and a lack of health programmes to prevent sexually transmitted infections (STIs) among people living with HIV (PLWH). The purpose of the study was to create, implement, and evaluate the impact of a safe sex education module on condom use among PLWH. A single-blinded, parallel randomised controlled trial was conducted at Seremban district. The intervention group received additional health information geared toward safe sex education based on Social Cognitive Theory (SCT). The study primary analysis was the intention to treat, and the overall effects of the intervention were assessed using a generalised linear mixed model (GLMM). There was no significant difference between groups in terms of sociodemographics, sexual history, mean condom usage frequency score, or STI incidence at the study baseline. Receiving the module was linked to increased condom usage frequency (β = 1.228, % CI = 0.850, 1.606). When compared to conventional treatment provided in Seremban health clinics, this module effectively increases condom usage frequency among PLWH.

Association between Sociodemographic Factors and Condom Use among Migrant Sex Workers in Chiang Mai, Northern Thailand

Thailand has the highest HIV burden in the Asia-Pacific region, with the majority of cases occurring in specific populations. Migrant Sex Workers (MSWs) in Thailand are an important population for HIV risk, yet there has been limited literature on this group and their protective sexual behavior. A cross-sectional study was conducted among 396 MSWs 18−49 years old from 23 sex work-identified venues in Chiang Mai. Participants were surveyed on their own sociodemographic information, health behavior, sexual risk behavior, quality of life, and depression. Male respondents were significantly younger than females (p = 0.003). Most respondents were from Myanmar and were ethnic Shan. In the month preceding the survey, 17.0% of MSWs had consistent condom use with regular partners, 53.7% with casual partners, and 87.9% with clients. Condom use was least practiced with regular partners and most practiced with clients (17% and 87.9%, respectively; p < 0.001). There was a significant positive association between condom use and starting high school (χ2 = 8.08, p = 0.018). Education was the only variable that was significantly correlated with condom use with any sexual partner (OR = 0.41; 95%CI 0.20−0.82). Findings of the study indicate that further efforts are needed to promote condom use among migrant sex workers and their sexual partners in Thailand.

Use of a Practitioner-Friendly Behavior Model to Identify Factors Associated with COVID-19 Vaccination and Other Behaviors

The lack of capacity for the design and implementation of behavioral interventions in low-and-middle income countries (LMICs) has been recognized by the World Health Organization (WHO) and other global health institutions. There is a need to task-shift, to translate social and behavioral science concepts into "practitioner-friendly" models-models which can be used by intervention designers, implementers, and evaluators with limited technical and financial resources. We illustrate the use of the Fogg Behavior Model (FBM), a model identified as being easy for practitioners to adopt in low-resource settings. The study uses data across four different behaviors in Nigeria, Pakistan, and India. The behaviors examined are COVID-19 vaccine uptake, condom use, iron folate use, and modern contraceptive use. The data are from surveys of healthcare workers (HCWs), married men, women of reproductive age, and adolescents, respectively. The FBM states that behavior happens when both motivation and ability are present, and a prompt occurs. In other words, persons with high motivation and high ability are the first to adopt a behavior. We created a categorical variable for motivation and ability and tested whether high motivation and high ability are associated with a greater likelihood of adopting a behavior. In Nigeria, HCWs with high motivation and high ability had 27 times higher odds of being vaccinated. In Pakistan, married men with high motivation and high ability had 35 times higher odds of condom use with their wives. In India, women with high motivation and high ability had 9 times higher odds of iron folate use. In Nigeria, adolescents and young women with high motivation and high ability had 8 times higher odds of contraceptive use. The study findings suggest that the FBM has the potential to be applied in low resource settings for the design, implementation, and evaluation of behavioral interventions. Rigorous testing of the FBM using data from experimental or quasi-experimental studies is recommended.

Intimate Partner Violence and Sexual Agency in a Nationally Representative Sample of Women and Girls in the Philippines

This study examined the prevalence of intimate partner violence (Intimate Partner Violence) and its associations with sexual agency among women and adolescent girls in the Philippines. Data came from the 2017 Philippines National Demographic and Health Survey (DHS), a nationally representative, cross-sectional survey of women and girls ages 15-49. Participants included 11,727 women and girls who reported having a current male partner. Survey measures included three indicators of Intimate Partner Violence (physical, sexual, emotional), ability to refuse sex, ability to insist on condom use, perception that a husband/boyfriend can be justified in hitting or beating his wife/girlfriend, and sociodemographic characteristics. Descriptive and multivariable statistical analyses were conducted, with survey weightings used to account for the complex survey design. Overall, 23.9% reported Intimate Partner Violence in their current partnership (10.1% physical violence, 3.4% sexual violence, 19.0% emotional violence), 11.2% believed a husband or partner could be justified in hitting or beating their wife, 10.5% reported being unable to refuse sex with their partner, and 20.4% were unable to ask their partner to use a condom. In multivariable analyses, experiences of sexual (OR .68; 95% CI .50, .92), physical (OR .83; 95% CI .68, 1.02), and emotional violence (OR .69; 95% CI .58, .81) were associated with lower adjusted odds of being able to ask a partner to use a condom. When placed in the same model, emotional violence had the strongest association with lower odds of negotiating condom use with partner (OR .70; 95% CI .57, .85). Perception that a husband/boyfriend can be justified in hitting or beating his wife/girlfriend was associated with lower ability to refuse sex and ask a partner to use a condom. Findings indicate a need for further investment in interventions to prevent Intimate Partner Violence and support the sexual health and agency of women and girls who have experienced Intimate Partner Violence in the Philippines.

Condomless sex under the influence differs by class rank in college students

OBJECTIVE

College students, particularly first-year students, are at risk for alcohol misuse and alcohol-related consequences (e.g., condomless sex). Our objective was to determine if first- and second-year students were more or less likely to report any act of condomless sex under the influence of alcohol than third- and fourth-year students.

PARTICIPANTS

Participants (N = 447) were undergraduate students recruited from a private institution in Massachusetts.

METHODS

Logistic regression models were used to analyze differences in reported acts of condomless sex under the influence of alcohol in the past 30 days, by class rank.

RESULTS

First- and second-year students had lower odds (OR 0.40, 95% CI: 0.252-0.648) of reporting condomless sex under the influence of alcohol than third- and fourth-year students.

CONCLUSIONS

Implications from these results can contribute to understanding sexually transmitted infections in the college population.

"I Said Maybe We Should Use a Condom, and Then that Just Went South": Exploring Condomless Sex among Formerly Incarcerated Black Men in New York City, USA

More than 600,000 incarcerated individuals are released annually in the United States; a large proportion are Black men incarcerated for drug-related offenses, including drug use and possession. Formerly incarcerated Black men report elevated rates of condomless sex and sexually transmitted infections, including human immunodeficiency virus (HIV). The purpose of this study was to explore condom usage among Black men who were formerly incarcerated for drug-related offenses and living in New York City (NYC). Using a semi-structured interview guide, in-depth interviews were conducted with 26 formerly incarcerated Black men. Interviews were audio-recorded, transcribed, and entered into NVivo, then manually coded utilizing thematic analysis methods. The following four themes were identified: partner type and length of the relationship affected condom use; diminished pleasure was a barrier for condom use; challenges with ill-fitting and poor-quality condoms; and the withdrawal method was used as an HIV prevention technique. Our findings suggest that formerly incarcerated Black men are engaging in condomless sex post-incarceration. Greater exposure to prevention messages and targeted interventions with content that includes interpersonal and condom use skill-building, methods to increase pleasurable condom use, information on HIV and STI transmission modes, and access to pre-exposure prophylaxis (PrEP) may be beneficial for this population.

College-attending young men's sexual and reproductive health knowledge, attitudes and practices

ObjectiveMale involvement in contraceptive practice remains low. Family planning and pediatric health associations have recommended an emphasis on long-acting reversible contraceptives (LARC) in clinical counseling with adolescents and young adults, raising concerns about the resulting adverse impact on sexually transmitted infection (STI) rates. Participants: College-attending men responded to an internet based questionnaire (n=31) and a phone-based qualitative interview (n=25). Methods: Our survey solicited attitudes toward and knowledge of contraceptive methods and assessed communication practices with sexual partners regarding use of contraception and disease prevention. Results: Knowledge about female methods of contraception was low, with a comparatively high level of knowledge about Plan B. Parents and health care providers were cited as the most helpful sources of information. Conversations about protection with sexual partners were reported by most men, due mainly to fear of unplanned pregnancy, not STI. Conclusion: Addressing couple communication and dual protection among college-attending men needs greater emphasis.

Differences in Sexual Behaviors, HIV Testing, and Willingness to Use PrEP between Gay and Bisexual Men Who Have Sex with Men in China

Objectives: Accumulating evidence suggests that there may be differences in sexual behaviors, condom use, and HIV prevention service utilization (e.g., HIV testing, PrEP use) between gay and bisexual men, but this remains under-explored, especially among gay and bisexual men in China. Methods: We surveyed 4,142 gay and bisexual men on a geosocial networking app in China. Results: In adjusted model, bisexual men were less likely to have received HIV testing in their lifetime (AOR = .62, 95% CI [.53, .72]) or to have received a recent HIV test (AOR = .78, 95% CI [.68, .90]). Conversely, among those who reported having had anal sex in the past six months, bisexual men were more likely to report consistent condom use than gay men (OR = 1.38, 95% CI [1.17, 1.62]). Compared with gay men, bisexual men were significantly less likely to be aware of PrEP (AOR = .62, 95% CI [.52, .74]) and significantly less willing to use PrEP (AOR = .58, 95% CI [.46, .73]). Conclusions: Tailored HIV prevention interventions are needed to address bisexual men's needs in the context of the unique sociocultural influences on sexual behavior in China.

The International Sexual Health And REproductive Health during COVID-19 (I-SHARE) Study: A Multicountry Analysis of Adults from 30 Countries Prior to and During the Initial Coronavirus Disease 2019 Wave

BACKGROUND

There is limited evidence to date about changes to sexual and reproductive health (SRH) during the initial wave of coronavirus disease 2019 (COVID-19). To address this gap, our team organized a multicountry, cross-sectional online survey as part of a global consortium.

METHODS

Consortium research teams conducted online surveys in 30 countries. Sampling methods included convenience, online panels, and population-representative. Primary outcomes included sexual behaviors, partner violence, and SRH service use, and we compared 3 months prior to and during policy measures to mitigate COVID-19. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence.

RESULTS

Among 4546 respondents with casual partners, condom use stayed the same for 3374 (74.4%), and 640 (14.1%) reported a decline. Fewer respondents reported physical or sexual partner violence during COVID-19 measures (1063 of 15 144, 7.0%) compared to before COVID-19 measures (1469 of 15 887, 9.3%). COVID-19 measures impeded access to condoms (933 of 10 790, 8.7%), contraceptives (610 of 8175, 7.5%), and human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing (750 of 1965, 30.7%). Pooled estimates from meta-analysis indicate that during COVID-19 measures, 32.3% (95% confidence interval [CI], 23.9%-42.1%) of people needing HIV/STI testing had hindered access, 4.4% (95% CI, 3.4%-5.4%) experienced partner violence, and 5.8% (95% CI, 5.4%-8.2%) decreased casual partner condom use (moderate certainty of evidence for each outcome). Meta-analysis findings were robust in sensitivity analyses that examined country income level, sample size, and sampling strategy.

CONCLUSIONS

Open science methods are feasible to organize research studies as part of emergency responses. The initial COVID-19 wave impacted SRH behaviors and access to services across diverse global settings.

Knowledge of sexual partner's HIV serostatus and the practice of safer sex among heterosexual men of African descent in London, Ontario

Objective: Poor knowledge of sexual partners' HIV status is a major contributing factor in the heterosexual spread of HIV in Canada. This study examined knowledge of sexual partner's HIV serostatus and the practice of safer sex among self-identified heterosexual African, Caribbean and Black (ACB) men in London, Ontario.Design: A cross-sectional data was collected from 156 heterosexual ACB men in London. The negative log-log link function was fitted to estimate the relationship between knowledge of sexual partner's HIV status and condom use among ACB men.Results: Findings show that ACB men who know their sexual partner's HIV status are less likely to use condoms compared to men who do not know the serostatus of their sexual partner, controlling for other theoretically relevant covariates. In addition, the findings show that sexually active, single ACB men are less likely to use condoms. On the other hand, ACB men with higher education, employed and with income over 60 thousand dollars a year have a higher likelihood of using condoms.Conclusions: Heterosexual ACB men who used condoms even when they did not know their sexual partners' HIV status could be explained as a resilience-building strategy in response to their increasing HIV vulnerabilities. Heterosexual ACB men's use of condoms is further associated with socioeconomic factors including income, employment and education that need to be addressed for an improved safer sex.

Safer Sex Self-Efficacy Among Women With Experiences of Intimate Partner Violence

Women who have experienced intimate partner violence (IPV) are more likely to engage in risky sexual behaviors that increase the likelihood of adverse sexual health outcomes, including HIV acquisition. This study explored key predictors of safer sex self-efficacy in a sample of racially/ethnically diverse abused women. A total of 173 women were recruited from domestic violence agencies and completed a battery of measures that assessed risk factors associated with HIV risk. Both individual- and relationship-level predictors of safer sex self-efficacy were examined, including IPV, partner dependence, HIV knowledge, condom attitudes, self-esteem, and alcohol use. Hierarchical linear regression analysis results indicated several key predictors for safer sex self-efficacy, including IPV (B = -0.01, p < .05), partner dependence (B = -0.45, p < .001), condom attitudes (B = 0.63, p < .001), and alcohol use (B = - 0.24, p < .05). It is evident that a number of individual- and relationship-level factors affect the degree of safer sex self-efficacy among abused women. In work with this population, researchers and clinicians should intentionally attend to the identified predictors to most effectively address the needs of these women.

Intimate Relationships and HIV Infection Risks Among Shan Female Sex Workers From Myanmar in Chiang Mai, Thailand: A Qualitative Study

This study aimed to investigate HIV risks among female sex workers (FSWs) who were from the Shan ethnic group, and how they relate to complex relationships with inconsistent condom use. The study was conducted using in-depth interviews with 17 Shan FSWs (aged 18-45 years old) in Chiang Mai. Intimate relationships between participants and regular clients/steady partners were found to facilitate inconsistent condom use. Participating Shan FSWs sustained intimacy with regular clients not only for economic ends but also for emotional support. Gender norms and male power dominated condom use decision making. Some participants lacked proper HIV preventive knowledge regarding condom breakage and HIV risks. Effective intervention and proper HIV preventive practices should address these intimate contexts. Capacity building among women would assist FSWs to make choices that protect them from HIV/STDs infections. Couples-based HIV interventions addressing emotional intimacy is an urgent need for HIV communication and service delivery in Thailand.

Condom use education, promotion and reasons for condom use: Perspectives of healthcare providers and young adults in Vhembe district, Limpopo province

BACKGROUND

Condom use is a critical component of a comprehensive and sustainable approach to the prevention of unintended pregnancies and sexually transmitted infections (STIs) (including HIV). Despite government making condoms freely available in the healthcare facilities in Vhembe district, there are reports of an increase in teenage pregnancies and STIs, including HIV, amongst young adults. The aim of the study was to gain an in-depth understanding of condom use promotion and reasons of condom use amongst young adults in Vhembe district, in Limpopo province.

METHODS

A descriptive phenomenological design was used to explore the reasons for promoting condom use amongst young adults themselves and from the perspectives of healthcare providers who are critical role players in condom education and provision. Purposive sampling was used to sample young adults and healthcare providers at three of Vhembe district's primary healthcare facilities. Individual semi-structured interviews were conducted, after which thematic data analysis was used to develop themes and subthemes.

RESULTS

Two superordinate themes emerged from data analysis, namely approaches to promote condom use and reasons for condom use. Two themes emerged in respect of approaches for promotion of condom use: information sharing in the form of education, the distribution of informative material, and the adoption of a multi-sectoral approach. Self-protection emerged as a reason for condom use, to prevent disease, pregnancy and 'u wela', and was indicative of not trusting a sexual partner.

CONCLUSION

To effectively promote condom use, a multidisciplinary team approach involving nurses, lay counsellors and peer educators need to be strengthened at local primary health facilities in order to facilitate the distribution of condoms and educate young adults on consistent condom use.

Factors associated with multiple sexual partners among first-year students in a South African university

University students are at greatest risk of contracting sexually transmitted diseases and HIV, due to multiple sex partners. However, first-year students are arguably, the most susceptible to sexually transmitted infections and HIV. The study examined the factors associated with multiple sexual partners among 348 first-year students aged 17 to 24 years old in a rural university in 2016. Data were collected on the demographic characteristics and sexual behaviours of the respondents in the one-month preceding the survey. Data were analysed using descriptive statistics and binary logistic regression. The results revealed that 23.5% of the respondents had multiple sexual partners in the last 30 days. The binary logistic regression model showed that male [OR=7.4, 95% CI: 2.9-18.7]; being a member of students' organisational structures [OR=3.4, 95% CI: 1.3-8.7] and younger age at sexual debut [OR=3.5, 95% CI: 1.3-9.6] were positively associated with multiple sexual partners. Furthermore, significant associations were found between multiple sexual partners, alcohol consumption [OR=2.9, 95% CI: 1.2-7.1), and being uncertain about their cultural perceptions [OR=3.4, 95% CI: 1.2-9.7] on multiple sexual partners. However, high religiosity [OR=0.4, 95% CI: 0.1-0.9)] was negatively associated with multiple sexual partners. Given that we found that a significant number of students were engaged in risky sexual behaviour, innovative behavioural change is expected by emphasising sexual fidelity, good values and responsible consumption alcohol to first year students as part of orientation package. Promotion of condom use should be intensified to protect first year students. Finally, since religiosity is an important practice in the daily life of the study population, integrating the religiosity components into sexual risk-prevention interventions could prove beneficial.

A qualitative exploration on accounts of condom-use negotiation with clients: challenges and predicaments related to sex work among street-based female sex workers in Ekurhuleni District, South Africa

INTRODUCTION

female sex workers (FSWs) are the key vulnerable populations since they carry the high burden of HIV and sexually transmitted infections (STIs). However, the vulnerability of street-based FSWs to HIV/STIs is much higher than that of the establishment-based FSWs. The study aimed to explore street-based FSWs' condom negotiation skills, barriers to condom use as well as the challenges and predicaments they face on a daily basis.

METHODS

an exploratory qualitative approach using focus group discussions was conducted among FSWs working in a major provincial road in a district of Gauteng Province. Thematic content analysis using NVivo version 10 software was conducted.

RESULTS

the age range of the FSWs was 19 to 44 years. The themes that emerged from the data on challenges to negotiation and condom use among FSWs revealed the ways condoms are used in early sex work and over time, ways of enforcing condom used, preferred types of condoms and the predicaments to working in the sex trade. FSWs gained experience of negotiating condom use over time in their work. Both female and male condoms were available and accurate insertion of condoms was reported. Male condom was preferred. Condom use strategies included direct request; using health-information messages; charging more for condomless sex; and refusing condomless sex. The FSW reported the risks of violent attacks of unregulated street-based environment.

CONCLUSION

condom negotiation strategies illustrated that peer-education and sharing experiences among themselves were beneficial for protective sexual behaviours. Peer-education benefits and peer-interactions yielded assertive attitudes and behaviours of demanding and/or enforcing condom use.

Psychological Effects of Abuse, Partner Pressure, and Alcohol: The Roles of in-the-Moment Condom Negotiation Efficacy and Condom-Decision Abdication on Women's Intentions to Engage in Condomless Sex

Women's experiences of intimate partner violence (IPV) from their male partners can include psychological, physical, and sexual control and abuse. The psychological effects of abuse (PEA) include terror, shame, and loss of power and control in relationships. While women's experiences of IPV are associated with decreased condom use, limited research has examined the impact of PEA on women's condom use. Intoxicated (breath alcohol content [BrAC] = .10%) versus sober women were evaluated to test the hypothesis that PEA would interact with intoxication and scenario-context partner pressure to forgo condom use and be associated with intentions to engage in condomless sex. After beverage administration, community women (N = 405) projected themselves into a computerized scenario depicting a male partner exerting high or low pressure for condomless sex. In-the-moment condom negotiation self-efficacy and condom-decision abdication-letting the man decide on condom use-were assessed. Path analysis examined the direct and indirect effects of PEA, alcohol, and partner pressure conditions on condomless sex intentions. PEA increased condomless sex intentions indirectly through decreased condom negotiation self-efficacy. Intoxication increased condomless sex intentions indirectly through decreased condom negotiation self-efficacy and increased condom-decision abdication. Intoxicated women in the low pressure condition were more likely to abdicate the condom decision than women in the high pressure condition. Women who have experienced greater PEA may benefit from interventions focusing on how condom negotiation self-efficacy, condom-decision abdication, and intoxication influence sexual decision-making.