Impact of the COVID-19 pandemic on sexual behaviour and welfare of HIV preexposure prophylaxis users: a mixed-method study

COVID-19 pandemic can affect people using HIV preexposure prophylaxis (PrEP). To assess its consequences on PrEP users' sexual behaviour and welfare, we conducted a mixed-method study. A self-administered questionnaire was given to PrEP users during scheduled consultation in Tourcoing Hospital from February to May 2021. In addition, a qualitative study included 14 participants who took part in semi-structured in-depth interviews (IDIs). Ninety-four PrEP users completed the questionnaire. During lockdown, 62% of participants continued PrEP. After lockdown release, the average number of sexual intercourses and partners increased from 6 ± 12 to 13 ± 17 intercourses/month (p < 0.001) and from 3 ± 11 to 11 ± 34 partners/month (p < 0.001). Similarly, the proportion of PrEP users who engaged in group sex, sex with alcohol or chemsex increased respectively from 28% to 55% (p < 0.001), 28% to 45% (p < 0.001) and 28% to 38% (p < 0.001). Analysis of IDIs revealed emotional deprivation and sexual frustration during the lockdown. After its release, frequent clandestine chemsex parties and curfew forcing overnight stay increased fears of intimate violence and overdoses. In conclusion, PrEP users reduced their sexual activity during the lockdown. Its release led to an increase in sexual risk-taking. Social distancing measures could favour medical and social harm of sexual risk-taking.

Adverse childhood experiences and risky behaviors in male college students

Objective: The current study examined associations between ACEs and health-risk behaviors in male college students.Participants:795 men who attended a large southern public university.Method:One-way ANOVA was used to explore whether the ACEs of sexual abuse, exposure to interparental violence, household mental illness, and household substance abuse significantly affected male college students' high risk drinking, number of sexual partners, and/or impulsivity.Results:Sexual abuse was significantly associated with all three measured outcomes and had the strongest associations of all assessed ACEs. Exposure to interparental violence was significantly associated only with number of sexual partners. Household substance abuse was significantly associated with high risk drinking and number of sexual partners. A simple linear regression revealed that for each additional ACE, students in the sample increased their risky behaviors.Conclusions:Results confirm a dose-response between ACEs and negative outcomes. Mindfulness training, policy/funding advocacy, and trauma-informed support are discussed as implications.

Identifying sexual risk-taking and ill health in the meeting with young people-experiences of using an assessment tool

BACKGROUND

Identifying young people exposed to sexual risk-taking or violence is fundamental, when seeking to strengthen their health. However, young people seldom share sexual health concerns or experiences of violence with healthcare professionals (HCPs). Studies evaluating how use of a risk assessment tool influences the dialogue about sexual health and violence are sparse.

AIMS

The aim of this study was to explore HCPs' experiences of using the SEXual health Identification Tool (SEXIT) in encounters with young people at Swedish youth clinics.

METHOD

Three focus group interviews were conducted with 21 HCPs from nine youth clinics, where SEXIT had been introduced. Data were analysed using thematic content analysis.

RESULTS

Three themes were identified. The theme, Facilitates dialogue about sexuality and vulnerability, describes how the questionnaire pertaining to SEXIT helped to normalise and help both HCPs and young people to take part in the dialogue about sensitive issues. Need for a trustful encounter presents HCPs' ethical concerns regarding how the questionnaire affects the integrity of young people and trust-making. Sensitive topics entail challenges describes HCPs' challenges when dealing with sensitive issues. Additionally, it describes needs for knowledge and collaboration when targeting vulnerable young people.

CONCLUSIONS

The HCPs stated that using SEXIT developed their ability to address sensitive issues and helped both them and young people to take part in the dialogue about sexuality and exposure to violence. SEXIT involves experiences of ethical concerns regarding integrity and trust-making. It also entails challenges in having dialogues about sensitive issues, how to deal with risk assessment outcomes and in improvements regarding inter-professional collaborations.

Violent Victimization and Adolescents' Attitudes Toward Romantic Relationships and Sexual Activity

Violent victimization in adolescence spurs risk-taking behaviors (e.g., violent offending and substance use/abuse), undermines mental well-being, disrupts developmental transitions, and even has interpersonal and relational consequences. Adolescent victims initiate earlier and progress faster through sexual and romantic relationships. Because the reasons for the links between victimization and relationship behaviors remain unclear, we explored how violent victimization might shape how adolescents think and feel about intimate/romantic relationships. We focus specifically on interest in forming relationships and expectations about intimate/sexual activity occurring within relationships. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health; n = 10,570 [54% girls; 56% non-Hispanic white; ages 11-18]), we found that adolescent victims of violence were more pessimistic about marriage and more favorable toward sexual activity, with patterns varying by age at victimization and gender. Late adolescent victims were marginally more interested in romantic relationships but were pessimistic about marriage. Early adolescent and girl victims were less favorable toward sexual activity in relationships, while later adolescent and boy victims were more permissive. Violent victimization may foster problematic attitudes toward intimate relationships, which may account for previously observed increased involvement in risky relational and sex behaviors.

Sexuality in Adults With ADHD: Results of an Online Survey

Establishing a secure sexual identity is a major developmental goal of an individual's transition from childhood to adolescence and the years that follow. Attention deficit/hyperactivity disorder (ADHD) as a neurodevelopmental disorder defined by the core symptoms of inattention, hyperactivity, and impulsivity, but also with emotional dysregulation, oppositional behaviors, or disorganization appearing early in life, can affect several areas of an individual's personal and social development, including sexual health. Yet, the scientific knowledge about the relationship between ADHD and sexual functioning is still scarce. Using an anonymous online survey, we compared different sexual behaviors including risky sexual behaviors, hypersexual behaviors, and sexual dysfunctions between 206 individuals with (n = 139) and without (n = 76) ADHD. Individuals with ADHD reported significantly more hypersexual behaviors than non-ADHD individuals, whereas no differences were found concerning risky sexual behaviors or sexual dysfunctions. In women with ADHD, hypersexual behaviors, sexual risk-taking as well as sexual dysfunctions were closely related to symptoms of emotional dysregulation, impulsivity, and oppositional symptoms. In men with ADHD, the associations between ADHD symptomatology and the sexuality-related measures were less clear, however, signs of emotional dysregulation seemed to be relevant as well. Since individuals with ADHD seem to be at an increased risk of some peculiarities in sexual behavior, sexuality-related issues should be routinely addressed during clinical consultations to provide more holistic treatment in order to enhance individual well-being and quality of life.

Time Horizons, Drug Use, and Risky Sex in Young Women from Poor Urban Areas

Aims

Emerging adulthood is marked by elevated risk-taking, and young people living in disadvantaged urban areas experience disproportionately more negative outcomes. Using a sample of young African American women living in such communities, this cross-sectional observational study investigated the hypothesis that greater substance use and sexual risk-taking would be associated with present-dominated time perspectives and higher delay discounting.

Methodology

Young women (N = 223, M age = 20.4 years) from disadvantaged urban areas were recruited using Respondent Driven Sampling, a peer-driven recruitment method. Structured field interviews assessed substance use, sexual practices, and risk/protective factors, including time perspectives (Zimbardo Time Perspective Inventory [ZTPI]) and behavioral impulsivity (delay discounting task).

Results

Regression models showed that present hedonism time perspectives were related to sexual risk-taking and substance involvement, whereas discounting was associated only with sexual risk-taking (ps < .05). Future time perspectives were not associated with either risk behavior.

Conclusions

Risk behaviors among young African American women living in disadvantaged urban areas appear to be related to hedonistic rewards available in the present without considering future outcomes. Future research should investigate experimentally if lengthening time perspectives and enriching views of possible futures may aid risk reduction in this population.

Factors Associated with Lack of HIV Testing among Latino Immigrant and Black Patients at 4 Geographically and Demographically Diverse Emergency Departments

The need for HIV testing in US emergency departments (EDs) has not been assessed, particularly among Latino immigrants and Blacks. We surveyed Latino immigrant and Black 18 to 64-year-old patients at 4 EDs about demographic characteristics, HIV testing history, and health literacy. A subset of patients was further surveyed on HIV risk-taking behaviors. Of the 2,265 participants, 24% had never been tested for HIV. Latino immigrants were more likely than Blacks never to have been tested for HIV (28% vs. 16%). In multivariable logistic regression, for Latino immigrants, male gender and lower health literacy were associated with no previous HIV testing. Among the 1,141-participant subset providing HIV risk-taking behavior data, 23% reported at least one risk factor and of those with at least one risk factor, 23% had never been tested for HIV. There remains a need for HIV testing among adult Latino immigrant and Black patients in US EDs.

Factors Associated with the Discordance between Perception of Being HIV Infected and HIV Sexual Risk Taking among Social Media-Using Black, Hispanic, and White Young Men Who Have Sex with Men

Among HIV-uninfected, social media-using black, Hispanic, and white young men who have sex with men (YMSM) who had condomless anal sex but had not been HIV tested within the past year, we aimed to determine the extent of discordance between perception of having an undiagnosed HIV infection and HIV risk-taking behaviors. Despite reporting condomless anal sex without HIV testing, 64% of 358 YMSM participants perceived having an undiagnosed HIV infection as "unlikely" and 12% as "impossible." Having a primary care provider and being Hispanic were associated with greater discordance. Interventions to decrease the discordance between perceived and actual HIV risk are needed for this higher HIV risk population.

Racial and Ethnic Differences in the Relationship Between Risk-Taking and the Effectiveness of Adolescents' Contraceptive Use

CONTEXT

Little is known about whether adolescents' risk-taking in areas other than sex is associated with the effectiveness of their contraceptive method use, or whether any such associations vary by race and ethnicity.

METHODS

Data from the 2011, 2013 and 2015 National Youth Risk Behavior Surveys were used to examine nonsexual risk behaviors and contraceptive method choice among 5,971 sexually active females aged 13-18. Risk-taking profiles for White, Black and Hispanic adolescents were identified using latent class analysis. Multinomial logistic regression was used to estimate the associations between these risk profiles and use of less- or more-effective contraceptive methods at last sexual intercourse.

RESULTS

Three distinct risk-taking profiles were identified for White and Hispanic adolescents and two for Black adolescents. Compared with their counterparts in the low-risk "abstainer" group, White adolescents in the "high substance use and violence" group were less likely to use condoms alone (relative risk, 0.4) or a prescription contraceptive paired with condoms (0.3) rather than no contraceptive at all, and more likely to use withdrawal or no method rather than condoms alone (2.4 each). However, higher risk-taking among Whites was positively associated with using prescription contraceptives rather than condoms (1.9). Among Black and Hispanic females, lower risk-taking was associated only with more condom use.

CONCLUSIONS

Future studies should examine whether interventions designed to reduce adolescent risk-taking improve the effectiveness of contraceptive use, particularly among White females. However, efforts to increase Black and Hispanic adolescents' use of more-effective contraceptives should target barriers other than risk-proneness. Perspectives on Sexual and Reproductive Health, 2020, 52(4):TK, doi:10.1363/psrh.12165.

Depression and HIV Transmission Risk among Methamphetamine-Using Men who have Sex with Men

BACKGROUND

Methamphetamine use is associated with disproportionate risk of HIV infection and increased risk of depression among sexual minority men. The purpose of the study was to estimate the association between clinical depression diagnoses and sexual risk-taking among cisgender men who have sex with men (MSM) who use methamphetamine.

METHOD

From March 2014 through January 2016, 286 MSM who use methamphetamine but were not seeking treatment for methamphetamine use disorder were enrolled to participate in a technology-based randomized controlled trial to reduce methamphetamine use and HIV sexual risk behaviors; participants were assessed for major depressive episodes (MDE) and persistent depressive disorder (PDD) at baseline. Multivariate clustered zero-inflated negative binomial regression analyses of condomless anal intercourse (n=282; 1,248 visits) estimated the association between this baseline diagnostic result and engagement in sexual risk-taking over time.

RESULTS

Participants predominantly identified as non-white (80%), averaged 42 years of age, and reported a HIV prevalence rate of 46%. Engagement in sexual risk-taking consistently demonstrated a positive curvilinear relationship with clinical depression severity, such that, for example, participants without clinical depression (59% of the sample; coef.=1.16) and those with MDE (36% of the sample; coef.=1.45) both demonstrated elevated rates of condomless anal sex with anonymous partners relative to participants with PDD (5% of the sample; analytical reference category; both coef. p<0.05). Data also demonstrated a trend (p = 0.053) of reduced sexual risk-taking with main partners among participants diagnosed with MDE (coef.=-0.94).

CONCLUSIONS

Methamphetamine use among participants in this study inverted the functional form of the relationship between depression and sexual risk among MSM observed in prior studies. Whereas low-grade depression has been associated with increased sexual risk-taking in prior samples of MSM, methamphetamine upends this relationship, such that the greatest engagement in sexual risk-taking occurred among those diagnosed with MDE at baseline. Additional research is warranted to clarify how methamphetamine influences sexual risk-taking among MSM with/without comorbid depression.

Differences in hope, core self-evaluations, emotional well-being, and health risk behaviors in freshman university students

The purpose of this cross-sectional anonymous survey study was to explore differences in hope, core self-evaluations (CSE), emotional well-being, health risk behaviors, and academic performance by gender, race, and social desirability in a sample of freshman university students. Four hundred and ninety-five freshmen ages 18 to 21 (M age 18.4), 67% female attending a large public university in the Northeast participated in the study. A Health Risk Behavior Score, with scores ranging from 3 to 9, was calculated by creating risk categories for drug use, alcohol use, and sexual risk-taking. Hope and health risk behaviors did not differ by gender, however, men reported higher CSE and emotional well-being. There were racial differences in hope, CSE, emotional well-being, and health risk behaviors. Nurses and researchers should consider gender and racial differences when designing or implementing hope interventions. Future researchers should compare their findings with ours for patterns or convergence and divergence and aim for larger representative samples of nonwhite groups. These are necessary next steps to advance the understanding of the role hope may play in promoting mental health among diverse college students.

Occurrence of human papillomavirus (HPV) type replacement by sexual risk-taking behaviour group: Post-hoc analysis of a community randomized clinical trial up to 9 years after vaccination (IV)

Oncogenic non-vaccine human papillomavirus (HPV) types may conceivably fill the vacated ecological niche of the vaccine types. The likelihood of this may differ by the risk of acquiring HPV infections. We examined occurrence of HPV types among vaccinated and unvaccinated subgroups of 1992-1994 birth cohorts with differing acquisition risks up to 9 years post-implementation of HPV vaccination in 33 Finnish communities randomized to: Arm A (gender-neutral HPV16/18 vaccination), Arm B (girls-only HPV16/18 vaccination and hepatitis B-virus (HBV) vaccination of boys), and Arm C (gender-neutral HBV vaccination). Out of 1992-1994 born resident boys (31,117) and girls (30,139), 8,618 boys and 15,615 girls were vaccinated, respectively, with 20-30% and 50% coverage in 2007-2009. In 2010-2013, 8,868 HPV16/18 and non-HPV vaccinated females, and in 2014-2016, 5,574 originally or later (2010-2013) HPV16/18 vaccinated females attended two cervical sampling visits, aged 18.5 and 22-years. The samples were typed for HPV6/11/16/18/31/33/35/39/45/51/52/56/58/59/66/68 using PCR followed by MALDI-TOF MS. HPV prevalence ratios (PR) between Arms A/B vs. C were calculated for Chlamydia trachomatis positives (core-group), and negatives (general population minus core group). At both visits the vaccine-protected HPV type PRs did not significantly differ between the core-group and non-core group. Among the vaccinated 18-year-olds, HPV51 occurrence was overall somewhat increased (PR_core = 1.4, PR_non-core. = 1.4) whereas the HPV52 occurrence was increased in the core-group only (PR_core = 2.5, PR_non-core = 0.8). Among the non-HPV vaccinated 18-year-olds, the HPV51/52 PRs were higher in the core-group (PR_core = 3.8/1.8, PR_non-core = 1.2/1.1). The 22-year-olds yielded no corresponding observations. Monitoring of the sexual risk-taking core-group may detect early tendencies for HPV type replacement.

Parenting Influences on Adolescent Sexual Risk-taking: Differences by Child Welfare Placement Status

Positive parenting behaviors and parent-child relationships reduce sexual risk-taking among youth, but these associations may differ for adolescents in the child welfare system. Using two cohorts of a national longitudinal dataset of youth, the authors employed linear probability modeling to investigate associations of caregiver-child closeness, monitoring, and dating communication with youth's sexual initiation, sexual partners, and unprotected intercourse over the subsequent 12 months. Moderation by placement status (non-relative foster care, kinship care, or birth parent care) was then tested. Closeness was negatively associated with risk-taking. Monitoring was positively associated with new sexual partners among youth in birth parent care, but negatively associated with new partners for youth in out-of-home care. Dating communication was positively associated with sexual initiation and additional sexual partners, and with unsafe sex among non-relative foster youth. In sum, caregiver relationships and parenting behaviors may matter differently for maltreated and foster youths' sexual risk-taking.

The Role of Sex-Related Alcohol Expectancies in Alcohol-Involved Consensual and Nonconsensual Sex Among Women of Asian/Pacific Islander and Women of European Race/Ethnicity

Alcohol-involved sexual experiences, including incapacitated sexual assault and alcohol-involved sex, are major public health concerns among college women. Further, racial/ethnic diversity among college students is increasing, particularly with regard to increases in college students of Asian/Pacific Islander (API) race/ethnicity. Of relevance, evidence suggests differences in sexual assault rates across ethnicities and cultures; however, no known study to date has examined differences by ethnicity and first language in expectancies and experiences specifically surrounding alcohol and sex. The current study sought to examine differences in incapacitated sexual assault, alcohol-involved sex, and heavy episodic drinking, as well as differences in sex-related alcohol expectancies among native English-speaking college women of European (EU) race/ethnicity, native English-speaking women of API race/ethnicity, and non-native English-speaking women of API race/ethnicity (NNES-API). EU reported higher frequency of heavy episodic drinking, alcohol-involved sex, and incapacitated sexual assault compared to API and NNES-API. In addition, API reported more frequent alcohol-involved sex and incapacitated sexual assault compared to NNES-API, in part due to API's stronger endorsement of sexual disinhibition-related alcohol expectancies (indirect effects: β = -.04, p = .04, and β = -.07, p = .04, respectively). Findings highlight the important role of expectancies in acculturation and influence on actual alcohol-involved sex and sexual assault.

Impulsivity and Problem Drinking in College: Examining the Mediating Role of Sex-Related Alcohol Expectancies and Alcohol Use at Sex

BACKGROUND

Dispositional impulsivity has been consistently implicated as a risk factor for problem drinking among college students and research suggests that this relationship may be explained in part by alcohol expectancies. A subset of alcohol expectancies, sex-related alcohol expectancies, is particularly linked to problem drinking among college students. The acquired preparedness model of risk postulates that people with dispositional impulsivity develop stronger sex-related alcohol expectancies, are subsequently more likely to drink at problematic levels in sexual situations, and thus, engage in more problem drinking.

OBJECTIVES

Using this model, the current study examined whether sex-related alcohol expectancies and alcohol use at sex mediated the relationship between impulsivity and problem drinking among college students.

METHODS

College students (N = 101) completed self-report measures of alcohol use, sex-related alcohol expectancies, and five dimensions of impulsivity: negative urgency, positive urgency, sensation seeking, lack of premeditation, and lack of perseverance.

RESULTS

Two facets of impulsivity-sensation seeking and lack of premeditation-provided unique contributions to problem drinking. Sex-related alcohol expectancies significantly mediated the effects of lack of premeditation and sensation seeking on problem drinking. In support of the acquired preparedness model, the relationship between the impulsivity traits and problem drinking was serially mediated by sex-related alcohol expectancies and alcohol use at sex.

CONCLUSIONS

Results suggest that sensation seeking and lack of premeditation continue to be areas of intervention for problem drinking among college students, and implicate sex-related alcohol expectancies as an area of intervention for alcohol use at sex and problem drinking.

Effect of housing relocation and neighborhood environment on adolescent mental and behavioral health

BACKGROUND

This study examined whether relocating from a high-poverty neighborhood to a lower poverty neighborhood as part of a federal housing relocation program (HOPE VI; Housing Opportunities for People Everywhere) had effects on adolescent mental and behavioral health compared to adolescents consistently living in lower poverty neighborhoods.

METHODS

Sociodemographic, risk behavior, and neighborhood data were collected from 592 low-income, primarily African-American adolescents and their primary caregivers. Structured psychiatric interviews were conducted with adolescents. Prerelocation neighborhood, demographic, and risk behavior data were also included. Hierarchical Linear Modeling (HLM) was used to test associations between neighborhood variables and risk outcomes. HLM was used to test whether the effect of neighborhood relocation and neighborhood characteristics might explain differences in sexual risk taking, substance use, and mental health outcomes.

RESULTS

Adolescents who relocated of HOPE VI neighborhoods (n = 158) fared worse than control group participants (n = 429) on most self-reported mental health outcomes. The addition of subjective neighborhood measures generally did not substantively change these results.

CONCLUSIONS

Our findings suggest that moving from a high-poverty neighborhood to a somewhat lower poverty neighborhood is not associated with better mental health and risk behavior outcomes in adolescents. The continued effects of having grown up in a high-poverty neighborhood, the small improvements in their new neighborhoods, the comparatively short length of time they lived in their new neighborhood, and/or the stress of moving appears to worsen most of the mental health outcomes of HOPE VI compared to control group participants who consistently lived in the lower poverty neighborhoods.

Sexually explicit online media and sexual risk among men who have sex with men in the United States

This study aimed to describe sexually explicit online media (SEOM) consumption among men who have sex with men (MSM) in the United States and examine associations between exposure to unprotected anal intercourse (UAI) in SEOM and engagement in both UAI and serodiscordant UAI. MSM in the U.S. who accessed a men-seeking-men website in the past year (N = 1,170) were recruited online for a cross-sectional, Internet-based survey of sexual risk and SEOM consumption. In the 3 months prior to interview, more than half (57 %) of the men reported viewing SEOM one or more times per day and almost half (45 %) reported that at least half of the SEOM they viewed portrayed UAI. Compared to participants who reported that 0-24 % of the SEOM they viewed showed UAI, participants who reported that 25-49, 50-74, or 75-100 % of the SEOM they viewed portrayed UAI had progressively increasing odds of engaging in UAI and serodiscordant UAI in the past 3 months. As SEOM has become more ubiquitous and accessible, research should examine causal relations between SEOM consumption and sexual risk-taking among MSM as well as ways to use SEOM for HIV prevention.

Basic deprivation and involvement in risky sexual behaviour among out-of-school young people in a Lagos slum

Research has shown that in countries such as Nigeria many urban dwellers live in a state of squalour and lack the basic necessities of food, clothing and shelter. The present study set out to examine the association between forms of basic deprivation--such as food deprivation, high occupancy ratio as a form of shelter deprivation, and inadequate clothing--and two sexual outcomes--timing of onset of penetrative sex and involvement in multiple sexual partnerships. The study used survey data from a sample of 480 girls resident in Iwaya community. A survival analysis of the timing of onset of sex and a regression model for involvement in multiple sexual partnerships reveal that among the forms of deprivation explored, food deprivation is the only significant predictor of the timing of onset of sex and involvement in multiple sexual partnerships. The study concludes that the sexual activities of poor out-of-school girls are partly explained by their desire to overcome food deprivation and recommends that government and non-governmental-organisation programmes working with young people should address the problem of basic deprivation among adolescent girls.

Associations Between Psychiatric Impairment and Sexual Risk Behavior Among Teens in Mental Health Treatment

AIMS

To assess the associations of sexual risk behavior with psychiatric impairment and individual, peer, and partner attitudes among adolescents receiving mental health treatment.

METHODS

Adolescents (N=893, 56% female, 67% African American) completed assessments of psychiatric impairment, rejection sensitivity, peer norms, HIV knowledge, perceived vulnerability, self-efficacy and condom use intentions. Two structural equation models were used to test the study hypotheses; one for sexually active youth and one for non-active youth.

RESULTS

For non-active youth, psychiatric impairment influenced self-efficacy and condom use intentions via peer norms, rejection sensitivity, and perceived vulnerability. Among the sexually active youth, sexual risk was related to impairment and previous condom use.

DISCUSSION

These results suggest that individual, peer, and partner factors are related to impairment and to sexual risk attitudes, but depend on previous sexual experience.

The influence of sexually explicit online media on sex: do men who have sex with men believe they "do what they see"?

Over the past two decades, men who have sex with men (MSM) have engaged in increasing consumption of MSM-specific sexually explicit online media (i.e., online pornography). Furthermore, the amount of MSM-specific sexually explicit online media portraying unprotected anal intercourse (UAI) has increased, raising concerns about HIV transmission among the actors and the potential encouragement of risky sex among consumers. The influence of sexually explicit online media on sexual risk-taking, at present largely understudied, could lead to new avenues for innovative HIV-prevention strategies targeting at-risk MSM. In this preliminary assessment, in-depth qualitative interviews were conducted with 16 MSM in the Seattle area to elucidate MSM's perceptions about the influence of sexually explicit online media on their own and other MSM's sexual behaviors. Participants reported that sexually explicit online media: (1) plays an educational role, (2) increases comfort with sexuality, and (3) sets expectations about sexual behaviors. While participants overwhelmingly reported not feeling personally influenced by viewing UAI in sexually explicit online media, they believed viewing UAI increased sexual risk-taking among other MSM. Specifically, participants reported that the high prevalence of UAI in sexually explicit online media sends the message, at least to other MSM, that (1) engaging in UAI is common, (2) UAI is acceptable and "ok" to engage in, and (3) future partners will desire or expect UAI. Overall, this preliminary assessment indicates that sexually explicit online media exposure may have both positive (e.g., helping MSM become more comfortable with their sexuality) and negative (e.g., normalizing UAI) impacts on the sexual health of MSM and may be useful in the development of novel HIV-prevention interventions.

Daddy's little girl goes to college: an investigation of females' perceived closeness with fathers and later risky behaviors

OBJECTIVE

The present study investigated the extent to which father-daughter relationships predicted risk-taking in a sample of female college students. Specifically, this study examined whether female adolescents' models of father psychological presence predicted substance use and sexual risk-taking, over and above impulsivity, depression, and other risky behaviors.

METHODS

A sample of 203 female college students were administered several scales assessing father psychological presence, sexual risk-taking, substance use, impulsivity, and depression.

RESULTS

Father psychological presence did predict sexual risk-taking and illicit drug use (but not alcohol use) after controlling for impulsivity, other risky behavior, and mood. Further, when grouped into low and high levels of psychological presence, those in the low group were more likely to engage in a variety of risky behaviors than those who perceived high psychological presence.

CONCLUSION

Consistent with evolutionary perspectives, paternal psychological presence may function as protection against risky behavior.

A Five Step Process for Interactive Parent-Adolescent Communication About HIV Prevention: Advice from Parents Living With HIV/AIDS

AIM

This study investigated how parents living with HIV communicated about HIV prevention with their 10-18 year old children.

METHODS

Interviews with 76 mothers and fathers were analyzed for (1) their experiences discussing HIV prevention with adolescents, and (2) advice on how to best broach HIV-related topics.

RESULTS

Interactive conversations, where both parents and adolescents participated, were regarded as effective. Parents emphasized that adolescents should have a "voice" (be able to voice their concerns) and a "choice" (have a variety of effective prevention strategies to choose from) during HIV-related talks.

DISCUSSION

A five step process for interactive communication emerged as a result of these discussions.

IMPLICATIONS

Health care professionals can facilitate adolescent sexual health by encouraging parents to actively involve their children in discussions about HIV prevention.

CONCLUSION

Future HIV prevention programs could benefit by providing parents with appropriate tools to foster interactive discussions about sexual health with adolescents.

Reducing shame in a game that predicts HIV risk reduction for young adult MSM: a randomized trial delivered nationally over the Web

INTRODUCTION

Men who have sex with men (MSM) often face socially sanctioned disapproval of sexual deviance from the heterosexual "normal." Such sexual stigma can be internalized producing a painful affective state (i.e., shame). Although shame (e.g., addiction) can predict risk-taking (e.g., alcohol abuse), sexual shame's link to sexual risk-taking is unclear. Socially Optimized Learning in Virtual Environments (SOLVE) was designed to reduce MSM's sexual shame, but whether it does so, and if that reduction predicts HIV risk reduction, is unclear. To test if at baseline, MSM's reported past unprotected anal intercourse (UAI) is related to shame; MSM's exposure to SOLVE compared to a wait-list control (WLC) condition reduces MSM's shame; and shame-reduction mediates the link between WLC condition and UAI risk reduction.

METHODS

HIV-negative, self-identified African American, Latino or White MSM, aged 18-24 years, who had had UAI with a non-primary/casual partner in the past three months were recruited for a national online study. Eligible MSM were computer randomized to either WLC or a web-delivered SOLVE. Retained MSM completed baseline measures (e.g., UAI in the past three months; current level of shame) and, in the SOLVE group, viewed at least one level of the game. At the end of the first session, shame was measured again. MSM completed follow-up UAI measures three months later. All data from 921 retained MSM (WLC condition, 484; SOLVE condition, 437) were analyzed, with missing data multiply imputed.

RESULTS

At baseline, MSM reporting more risky sexual behaviour reported more shame (r s=0.21; p<0.001). MSM in the SOLVE intervention reported more shame reduction (M=-0.08) than MSM in the control condition (M=0.07; t(919)=4.24; p<0.001). As predicted, the indirect effect was significant (point estimate -0.10, 95% bias-corrected CI [-0.01 to -0.23] such that participants in the SOLVE treatment condition reported greater reductions in shame, which in turn predicted reductions in risky sexual behaviour at follow-up. The direct effect, however, was not significant.

CONCLUSIONS

SOLVE is the first intervention to: (1) significantly reduce shame for MSM; and (2) demonstrate that shame-reduction, due to an intervention, is predictive of risk (UAI) reduction over time.

Twelve-month follow-up of advance provision of emergency contraception among teenage girls in Sweden-a randomized controlled trial

OBJECTIVE

The objective of this study was to evaluate the effect of an intervention with advance provision of emergency contraceptive pills (ECP), condoms, and extended information to a targeted group of teenage girls, compared with a control group, 12 months after intervention.

MATERIAL AND METHODS

A randomized controlled trial among 420 girls, 15-19 years old, requesting emergency contraception at a youth clinic in Sweden was carried out. Data were collected by a questionnaire at the initial visit and structured telephone interviews 12 months after enrolment. Differences between the intervention group and the control group regarding ECP use, time interval from unprotected intercourse to ECP intake, contraceptive use, and sexual risk-taking were analysed.

RESULTS

One year after the intervention 62% of the girls could be reached for follow-up. The girls in the intervention group reported a shorter time interval (mean 15.3 hours) from unprotected intercourse to ECP intake compared to the control group (mean 25.8 hours) (p = 0.019), without any evidence of decreased use of contraceptives or increased sexual risk-taking.

CONCLUSION

Even up to 12 months following the intervention, advance provision of ECP at one single occasion, to a specific target group of adolescent girls, shortens the time interval from unprotected intercourse to pill intake, without jeopardizing contraceptive use or increasing sexual risk-taking. Considering the clinical relevance of these results, we suggest that advance provision of ECP could be implemented as a routine preventive measure for this target group.

A Latent Class Analysis of Maternal Responsiveness and Autonomy-Granting in Early Adolescence: Prediction to Later Adolescent Sexual Risk-Taking

The present study sought to extend empirical inquiry related to the role of parenting on adolescent sexual risk-taking by using latent class analysis (LCA) to identify patterns of adolescent-reported mother responsiveness and autonomy-granting in early adolescence and examine associations with sexual risk-taking in mid- and late-adolescence. Utilizing a sample of 12- to 14-year-old adolescents (N = 4,743) from the 1997 National Longitudinal Survey of Youth (NLSY97), results identified a four-class model of maternal responsiveness and autonomy-granting: low responsiveness/high autonomy-granting, moderate responsiveness/moderate autonomy-granting, high responsiveness/low autonomy-granting, high responsiveness/moderate autonomy-granting. Membership in the low responsiveness/high autonomy-granting class predicted greater sexual risk-taking in mid- and late-adolescence compared to all other classes, and membership in the high responsiveness/ moderate autonomy-granting class predicted lower sexual risk-taking. Gender and ethnic differences in responsiveness and autonomy-granting class membership were also found, potentially informing gender and ethnic disparities of adolescent sexual risk-taking.

Profiles of executive functioning: associations with substance dependence and risky sexual behavior

The present investigations applied a theoretical perspective regarding the impact of executive functioning (EF) on sexual risk among substance users, using a methodological approach designed to examine whether EF subtypes differentially predict behavior patterns. Participants included 104 substance-using HIV-negative gay and bisexual men. Participants completed 5 neuropsychological assessment tasks selected to tap discrete EF components, and these data were linked to data on substance dependence and behavioral reports of substance use and sexual risk in the past 30 days. Cluster analysis identified 3 EF subtypes: (a) high performing (good performance across all measures); (b) low performing (poor performance across all measures); and (c) poor IGT performance (impairment on the Iowa Gambling Task [IGT] and its variant, but good performance on all other tasks). The 3 subtypes did not differ in amount of substance use, but the low-performing subtype was associated with greater rates of substance dependence. The low-performing subtype reported the highest rates of sexual behavior and risk, while the poor-IGT-performance subtype reported the lowest rates of sexual risk taking. Global associations between substance use and sexual risk were strongest among the low-performing subtype, but event-level associations appeared strongest among individuals in the high-performing subtype. These data suggest complex associations between EF and sexual risk among substance users, and suggest that the relationship between substance use and sexual risk may vary by EF subtypes.

Evidence for a Syndemic in Aging HIV-positive Gay, Bisexual, and Other MSM: Implications for a Holistic Approach to Prevention and Healthcare

The theory of syndemics has been widely applied in HIV prevention studies of gay, bisexual, and other MSM over the last decade. Our investigation is the first to consider the applicability of the theory in a sample of aging (ages 50 and over) HIV-positive MSM, which is a growing population in the United States. A sample of 199 men were actively recruited and assessed in terms of mental health and drug use burden, as well as sexual risk behaviors. Bivariate and multivariable analyses indicate a high level of association between psychosocial burdens (i.e., drug use and mental health) and same-sex unprotected sexual behaviors, providing initial support for the applicability of the theory of syndemics to this population. Further support can be seen in participants' narratives. Findings suggest the mutually reinforcing nature of drug use, psychiatric disorders, and unprotected sexual behavior in older, HIV-positive, gay, bisexual, and other MSM, highlighting the need for holistic strategies to prevention and care among this population of older and sexually active individuals. In short, the generation of gay men who came of age in the late 1970s and 1980s, "the AIDS Generation," are continuing to mature such that further efforts must be enacted to meet the multidimensional nature of these men's physical, mental, and sexual health needs.

Concepts of risk among young Swedes tested negative for HIV in primary care

OBJECTIVE

To explore why young adults test for HIV, how they construct the HIV risk, and what implications testing has for them.

DESIGN

Six tape-recorded focus-group interviews were transcribed verbatim and analysed according to a grounded theory approach.

SUBJECTS AND SETTING

Women and men between 18 and 24 years of age were recruited from a youth clinic in northern Sweden in 2004-05 after being tested and found to be HIV negative.

RESULTS

A core category--reconsidering risk and four categories--HIV: a distant threat; the risk zone; responsibility: a gendered issue; a green card-- emerged. HIV was described as being far away. Stereotypical images of risk actors emerged but were perceived to be clichés. "Ordinary" people including themselves were also considered at risk. Many had event-driven reasons for testing for HIV, multiple partners being one. One closer risk zone was "the bar"; a dating milieu that often was expected to include "one-night stands" for both women and men. Responsibility for testing was a gendered issue: it was "natural" for women, while men rather "escaped from responsibility". A resistance towards testing was revealed among young men. Receiving a negative HIV test result was "a green card", confirming healthiness and providing relief. Most informants felt "clean" and discussed how to restart with renewed ambitions.

CONCLUSIONS

As participating in focus-group interviews was apparently an "eye-opener" for many, a counselling conversation reconsidering risk following an HIV test might be a good idea. Liberal HIV testing among young men and women could evoke insights and maturation and start a process of reflections concerning their sexual risk-taking behaviour.