African American Parent-Son Sexual Communication Among a College Sample

To investigate whether reports of parent-child sexual communication (PCSC) varied by parental gender, education and living environments among African American adolescent and young male students attending a historically black university (n=146).

DESIGN AND METHODS

Using secondary data a paired t-test was used to determine mean differences for PCSC by gender. Factorial ANOVA was calculated to examine the interaction between PCSC and living environment.

RESULTS

Overall African American mothers were significantly more likely to engage in PCSC with their sons than African American fathers (t(68)=4.143, p<0.001). African American fathers from suburban areas were significantly more likely to engage in PCSC with their sons than urban fathers (t(137)=-2.295, p=0.023). No significant difference in PCSC by parental educational level was found.

CONCLUSION

Findings from this research suggest that African American mothers continue to be the primary conversant in PCSC with their sons. Additional research is needed to understand the role that living environment (urban vs. suburban) plays in the father PCSC process.

PRACTICE IMPLICATIONS

PCSC can play an important role in reducing adolescent sexual risk behaviors. Nurses should encourage and support PCSC among African American parents and their adolescent and young adult sons.

Suboptimal HIV Testing Uptake Among Men Who Engage in Commercial Sex Work with Men in Asia

PURPOSE

Men who have sex with men and are sex workers (MSMSW) are disproportionately affected by the growing and emerging HIV epidemic. As sex work and same-sex behavior are heavily stigmatized and often illegal in most Asian countries, HIV research focusing on MSMSW has been limited. The goal of this analysis is to examine HIV testing practices and identify correlates of HIV testing among MSMSW in Asia.

METHODS

The Asia Internet MSM Sex Survey, an online cross-sectional survey of 10,861 men who have sex with men (MSM), was conducted in 2010. Data on sociodemographic characteristics, HIV testing behaviors, and sexual behaviors were collected. Five hundred and seventy-four HIV-negative/unknown respondents reported receiving payment for sex with men at least once in the past 6 months and were included in this analysis. Multivariable logistic regression was conducted to identify independent correlates of HIV testing in the past year.

RESULTS

About half (48.6%) of the participants had been tested for HIV at least once within the past year, and 30.5% had never been tested. We also found that MSMSW participants who engaged in risky behaviors were less likely to be tested.

CONCLUSION

While one might expect a high HIV testing rate among MSMSW due to the risks associated with engaging in sex work, we found that HIV testing uptake is suboptimal among MSMSW in Asia. These results suggest that targeted HIV prevention and testing promotion among MSMSW are needed.

The Validity of Truant Youths' Marijuana Use and Its Impact on Alcohol Use and Sexual Risk Taking

Few studies investigating the validity of marijuana use have used samples of truant youth. In the current study, self-reports of marijuana use are compared with urine test results for marijuana to identify marijuana underreporting among adolescents participating in a longitudinal Brief Intervention for drug-involved truant youth. It was hypothesized that marijuana underreporting would be associated with alcohol underreporting and engaging in sexual risk behaviors. The results indicated marijuana underreporting was significantly associated with self-denial of alcohol use, but not associated with sexual risk behavior. Also, there was an age effect in marijuana use underreporting such that younger truant youth were more likely to underreport marijuana use, compared to older truant youth. Implications for policy and future research are discussed.

HIV risk and sexual health among female migrants in China

Sexual behavior is the dominant mode of HIV transmission in China, and young female migrants are among the populations at highest risk. This article examines how HIV-related risk behaviors among female migrants might vary according to workplace settings. Participants were young female migrants recruited from three workplace settings-factories, restaurants and entertainment venues. In a cross-sectional survey, we assessed 457 participants' sociodemographic characteristics, HIV/AIDS-related knowledge, condom use knowledge, sexual behaviors, condom use behavior and reproductive health factors. Participants working in entertainment venues were significantly more likely than those working in factories and restaurants to report sexual behavior, unprotected sex, multiple pregnancy terminations and sexually transmitted infections (STI). However, participants working in factories and restaurants reported significantly lower levels of HIV/AIDS knowledge, condom use knowledge, condom use self-efficacy and history of HIV/AIDS counseling and testing. Independent correlates of unprotected sex included employment in an entertainment venue, abortion history and sexual self-efficacy. Independent correlates of STI or genitourinary tract infection included employment in an entertainment venue, abortion history, recent migration and recent unprotected sex. These findings indicate a need for sexual and reproductive health interventions prioritizing young female migrants, and call for programs that can be incorporated into different workplace settings.

Sexual risk behaviors and HIV risk among Americans aged 50 years or older: a review

Although HIV-related sexual risk behaviors have been studied extensively in adolescents and young adults, there is limited information about these behaviors among older Americans, which make up a growing segment of the US population and an understudied population. This review of the literature dealing with sexual behaviors that increase the risk of becoming HIV-infected found a low prevalence of condom use among older adults, even when not in a long-term relationship with a single partner. A seminal study by Schick et al published in 2010 reported that the prevalence of condom use at last intercourse was highest among those aged 50–59 years (24.3%; 95% confidence interval, 15.6–35.8) and declined with age, with a 17.1% prevalence among those aged 60–69 years (17.1%; 95% confidence interval, 7.3–34.2). Studies have shown that older Americans may underestimate their risk of becoming HIV-infected. Substance use also increases the risk for sexual risk behaviors, and studies have indicated that the prevalence of substance use among older adults has increased in the past decade. As is the case with younger adults, the prevalence of HIV infections is elevated among ethnic minorities, drug users (eg, injection drug users), and men who have sex with men. When infected, older adults are likely to be diagnosed with HIV-related medical disorders later in the course of illness compared with their younger counterparts. Physicians are less likely to discuss sexual risk behaviors with older adults and to test them for HIV compared with younger adults. Thus, it is important to educate clinicians about sexual risk behaviors in the older age group and to design preventive interventions specifically designed for older adults.

Sexual scripts and sexual risk behaviors among Black heterosexual men: development of the Sexual Scripts Scale

Sexual scripts are widely shared gender and culture-specific guides for sexual behavior with important implications for HIV prevention. Although several qualitative studies document how sexual scripts may influence sexual risk behaviors, quantitative investigations of sexual scripts in the context of sexual risk are rare. This mixed methods study involved the qualitative development and quantitative testing of the Sexual Scripts Scale (SSS). Study 1 included qualitative semi-structured interviews with 30 Black heterosexual men about sexual experiences with main and casual sex partners to develop the SSS. Study 2 included a quantitative test of the SSS with 526 predominantly low-income Black heterosexual men. A factor analysis of the SSS resulted in a 34-item, seven-factor solution that explained 68% of the variance. The subscales and coefficient alphas were: Romantic Intimacy Scripts (α = .86), Condom Scripts (α = .82), Alcohol Scripts (α = .83), Sexual Initiation Scripts (α = .79), Media Sexual Socialization Scripts (α = .84), Marijuana Scripts (α = .85), and Sexual Experimentation Scripts (α = .84). Among men who reported a main partner (n = 401), higher Alcohol Scripts, Media Sexual Socialization Scripts, and Marijuana Scripts scores, and lower Condom Scripts scores were related to more sexual risk behavior. Among men who reported at least one casual partner (n = 238), higher Romantic Intimacy Scripts, Sexual Initiation Scripts, and Media Sexual Socialization Scripts, and lower Condom Scripts scores were related to higher sexual risk. The SSS may have considerable utility for future research on Black heterosexual men's HIV risk.

Sex differences in associations of school connectedness with adolescent sexual risk-taking in Nova Scotia, Canada

BACKGROUND

Associations of lower school connectedness have been seen with adolescent sexual risk behaviors, but little is known about gender differences with respect to these relationships. Understanding any such differences could contribute to better supporting the school environment to promote youth sexual health.

METHODS

We used provincially representative cross-sectional data from 1415 sexually active students in grades 10 to 12 in Nova Scotia, Canada, to determine whether lower school connectedness was associated with students' sexual risk behaviors using multivariate logistic regression, stratifying by sex.

RESULTS

In boys, lower connectedness was associated with three risk behaviors, having  ≥ 2 partners in the previous year (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.01-1.13), no condom use at last intercourse (OR 1.06; 95% CI 1.01-1.12), and having unplanned intercourse due to substance use (OR 1.09; 95% CI 1.03-1.15). No such associations were seen in girls.

CONCLUSIONS

These results demonstrate that gender differences may exist for associations of school connectedness and sexual risk behaviors; connectedness may be more important for boys than for girls in this area of adolescent health. Educators should consider gender differences when designing interventions to maximize youth sexual health through school-based interventions. Further research on school connectedness and risk-taking should examine genders separately.

Sexually explicit media on the internet: a content analysis of sexual behaviors, risk, and media characteristics in gay male adult videos

Recent research suggests that viewing sexually explicit media (SEM), i.e., adult videos, may influence sexual risk taking among men who have sex with men. Despite this evidence, very little is known about the content of gay male SEM on the Internet, including the prevalence of sexual risk behaviors and their relation to video- and performer-characteristics, viewing frequency, and favorability. The current study content analyzed 302 sexually explicit videos featuring male same-sex performers that were posted to five highly trafficked adult-oriented websites. Findings revealed that gay male SEM on the Internet features a variety of conventional and nonconventional sexual behaviors. There was a substantial prevalence of unprotected anal intercourse (UAI) (34 %) and was virtually the same as the prevalence of anal sex with a condom (36 %). The presence of UAI was not associated with video length, amateur production, number of video views, favorability, or website source. However, the presence of other potentially high-risk behaviors (e.g., ejaculation in the mouth, and ejaculation on/in/rubbed into the anus) was associated with longer videos, more views, and group sex videos (three or more performers). The findings of high levels of sexual risk behavior and the fact that there was virtually no difference in the prevalence of anal sex with and without a condom in gay male SEM have important implications for HIV prevention efforts, future research on the role of SEM on sexual risk taking, and public health policy.

Assessment of risky sexual behaviors and risk perception among youths in western Ethiopia: the influences of family and peers: a comparative cross-sectional study

BACKGROUND

Ethiopia is a developing country with a demographic profile dominated by young population with in the ages of 15-24, constituting one third of the total population. Only little has been explored about the role of parenting process and peers in protecting youths from risky sexual behaviors. Thus, this study tried to assess risky sexual behaviors, risk perception and the influences of family and peers for possible interventions among youths in western Ethiopia.

METHODS

The study applied a comparative cross-sectional design triangulated with qualitative study. A pre-tested, structured, interviewer administered questionnaire was used to gather data. SPSS software version 20 was used to perform descriptive statistics, univariate, bivariate and multivariable logistic regression analyses.

RESULTS

Over one third of in-school and 41.4% out-of-school youths reported unprotected sex during the 12 months period prior to interview. More than one third of in-school youths (37.1%) reported to have two and more than two lifetime sexual partners compared to 32.6% of out-of-school youths. Out-of-school youths feel that they are at higher risk of getting HIV than in-school youths (AOR = 2.93; 95% CI: 1.45, 4.35). Youths who had high family connectedness were less likely to commence sexual activity and have multiple sexual partners than their counterparts (AOR = 1.98; 95% CI: 0.63, 0.94) and (AOR = 2.79; 95% CI: 1.24, 4.43) respectively. Having pressure from peer to have sex was significantly associated with having multiple sexual partners (AOR = 2.82; 95% CI: 1.62, 2.49).

CONCLUSION

A substantial proportion of out-of-school youths engaged in risky sexual behaviors than in-school youths. Parents and peers play a role in shaping the behavior of youths. Consequently, the dimension of good parental process and positive peer factors has to be strengthened.

Risk perceptions of STIs/HIV and sexual risk behaviours among sexually experienced adolescents in the northern part of Lao PDR

BACKGROUND

Young people in Laos are more vulnerable to STIs/HIV due to their sexual risk behaviours, low perceptions of risk and their socio-cultural environments. Perceived risk of contracting STIs/HIV is crucial for the assessment of their risk regarding their actual sexual risk behaviors. Thus, the objective of this paper is to explore perceptions of risk related to STIs/HIV and identify factors associated with this perceived risk among adolescents.

METHODS

This was a cross sectional study of sexually experienced adolescents aged 14 to 19 years old in the Luangnamtha province. The multistage sampling techniques were used for selecting 1008 adolescents aged 14-19 years old. Of these, 483 respondents reported having had sexual experience was selected for analysis. Univariate and Logistic regression were performed.

RESULT

Six per cent of respondents reported ever having had anal sex. Slightly less than two thirds initiated their first sexual intercourse before age 15. Two thirds of the sexually experienced males reported two or more sexual partners during their lifetime with the mean 3.1+3.65 while only twelve per cent of girls reported this cumulative number of partners. Slightly more than half (57.6%) regarded themselves to have no risk at all with 17.2 per cent considered themselves to have low risk. Respondents had poor knowledge on STIs/HIV. Factors associated with risk perception of getting STIs were: being male, high level of knowledge about STIs and having had symptoms of STIs in last six months. Perceived risk of getting HIV was significantly associated with being male, having more knowledge about STIs and HIV.

CONCLUSION

Adolescents in this study engaged in sexual risk behaviours, but they have low perception of risk getting STI/HIV. Socio-demographic factors, knowledge of STIs/HIV, and the level of exposure to STIs were the main determinants of the risk perception of STIs/HIV. Our finding supports the need to target adolescents in Luangnamtha province for HIV prevention intervention by addressing inaccurate perception of risk and increasing their knowledge on STIs/HIV.

Demographic, psychosocial, and contextual factors associated with sexual risk behaviors among young sexual minority women

Young sexual minority women are at risk for negative sexual health outcomes, including sexually transmitted infections and unintended pregnancies, yet little is known about these risks. We examined factors that may influence sexual risk from a psychosocial and contextual perspective. Analyses were conducted to examine within group relationships between sexual behaviors, negative outcomes, and related factors in a sample of young sexual minority women. Participants (N = 131) were young (mean = 19.8) and diverse in terms of race/ethnicity (57% non-White). Sex under the influence, having multiple partners, and having unprotected sex were common behaviors, and pregnancy (20%) and sexually transmitted infection (12%) were common outcomes. Risk behaviors were associated with age, alcohol abuse, and older partners. Results support the need for further research to understand how these factors contribute to risk in order to target risk reduction programs for this population.

The relationships of sexual identity, hazardous drinking, and drinking expectancies with risky sexual behaviors in a community sample of lesbian and bisexual women

This study examined the influence of demographic characteristics, sexual identity, hazardous drinking, and sexuality/intimacy enhancement alcohol expectancies on rates of risky sexual behaviors in a community sample of women who self-identified as lesbian, mostly lesbian, and bisexual (N = 349). Structured interview data were collected as part of a larger longitudinal study of sexual minority women's health, the Chicago Health and Life Experiences of Women study. We used structural equation modeling, controlling for demographic characteristics, to evaluate the influence of sexual identity, hazardous drinking, and alcohol-related sexuality/intimacy enhancement expectancies on sexual risk behaviors. Controlling for demographic characteristics and for sexual identity, higher levels of both hazardous drinking and sexuality/intimacy enhancement alcohol expectancies were associated with higher sexual risk scores. The final model predicted 36% of the variance in risky sexual behavior scores. Our findings regarding the central role of alcohol use and sexuality/intimacy enhancement expectancies in sexual risk behaviors among sexual minority women are consistent with previous research focusing on predominantly heterosexual women. Future efforts at sexual risk reduction in sexual minority women will need to address the influences of alcohol use and drinking-related expectancies on sexual behaviors and decision making.

Sexual partner accumulation from adolescence through early adulthood: the role of family, peer, and school social norms

PURPOSE

An early age of sexual initiation and sexual activity with multiple partners are risk factors for an array of detrimental outcomes. Drawing on social norms theory, this study assessed the role of subjective and descriptive social norms from parents, peers, and schoolmates on trajectories of sexual partner accumulation from early adolescence through early adulthood.

METHODS

Data were drawn from the in-home survey sample of Add Health, following 14,797 youth from adolescence through early adulthood. Social norms data were drawn from youth, parent, schoolmate, and school administrator reports. Multi-level growth models assess how parent, peer, and school social norms predicted initial levels and growth in sexual partner accumulation.

RESULTS

Parent and peer approval of youth sexual behavior, as well as lower perceived negative repercussions of pregnancy, predicted greater initial levels and greater growth over time in the accumulation of sexual partners. Similarly, youth attending schools with a greater proportion of sexually experienced schoolmates reported higher initial levels of sexual partners. In contrast, greater parental warnings regarding negative consequences of sex predicted heightened sexual partner accumulation. Some moderation by youth gender and age emerged as well.

CONCLUSIONS

Results highlight the role of both subjective and descriptive social norms, suggesting the importance of understanding and seeking to influence the social beliefs and expectations of youth and their families.

HIV risk among women from domestic violence agencies: prevalence and correlates

The co-occurrence of HIV and intimate partner violence is a significant public health problem. Although these intersecting epidemics have been examined in various populations, limited data exist among recently abused women seeking services from domestic violence agencies. Our study examined sexual risk behaviors among 103 predominantly low-income, urban women receiving services from domestic violence agencies. Results showed that 42% of women engaged in risky sexual behavior (e.g., inconsistent condom use, sexually transmitted disease diagnosis, sex with more than one partner) in the previous 3 months. Multivariable analyses revealed that women who engaged in sexual risk behaviors were more likely to have never been married, experienced greater fear of abuse when negotiating condom use, used substances before sex, and had lower self-esteem compared to abused women who did not engage in sexual risk behaviors. Results underscore the need to integrate sexual risk screening and risk reduction programs into domestic violence agencies for women.

The development of conventional sexual partner trajectories among african american male adolescents

African American male youth disproportionately report involvement with multiple sexual partners, which increases their risk for sexually transmitted infections and initiation of unplanned pregnancies. Little is known about the developmental precursors of sexual partner trajectories among African American male youth. Moreover, few studies focus on the many African American youth who evince highly conventional sexual partner trajectories, i.e., youth who have only one partner or abstain from sexual activity across time. Using four waves of data from a longitudinal study, we hypothesized that an accumulation of social and economic disadvantages in early adolescence would negatively influence youths' conventional sexual partner trajectories in late adolescence. We expected these disadvantages to affect youths' receipt of protective family processes and their reports of a set of intrapersonal processes (self-regulation, hope, and low levels of anger) linked to generally conventional behavior. Hypotheses were tested with data from 315 African American male youth from 11 to 18.5 years of age and their primary caregivers. Our results supported the hypotheses. Socioeconomic disadvantages during preadolescence predicted less involvement in conventional sexual partner trajectories from ages 16 to 18.5 years. This association was mediated by protective family processes and a set of interrelated intrapersonal protective processes. Preventive interventions designed to promote protective parenting and intrapersonal processes can be expected to promote sexual behavior trajectories characterized by abstinence or relations with very few partners.

Factors Related to Sexual Self-Efficacy among Thai Youth Living with HIV/AIDS

Studies of sexual behavior among HIV-infected Thai youth show conflicting results due to the different ages of the respondents. This study examined the relationships between sexual self-efficacy and risk behaviors among 92 HIV-positive Thai youth aged 14 to 21 years. A questionnaire previously validated in Thailand measured sexual self-efficacy. There were low levels of sexual activity with 13 respondents having sex in the last 6 months. The sexual self-efficacy scales were inversely related to the risk behaviors of having sex, having multiple partners, and drinking alcohol in the last 6 months. The scores of the sexual self-efficacy scale and its subscales were significantly lower in those aged 17 to 21 than in 14 to 16. Sexual risk behaviors were significantly higher in those aged 17 to 21 than in 14 to 16. These findings suggest that interventions to increase sexual self-efficacy should be emphasized as HIV-infected Thai youth reach late adolescence.

Aripiprazole for the treatment of methamphetamine dependence: a randomized, double-blind, placebo-controlled trial

AIMS

To test aripiprazole for efficacy in decreasing use in methamphetamine-dependent adults, compared to placebo.

DESIGN

Participants were randomized to receive 12 weeks of aripiprazole or placebo, with a 3-month follow-up and a platform of weekly 30-minute substance abuse counseling.

SETTING

The trial was conducted from January 2009 to March 2012 at the San Francisco Department of Public Health.

PARTICIPANTS

Ninety actively using, methamphetamine-dependent, sexually active adults were recruited from community venues.

MEASUREMENTS

The primary outcome was regression estimated reductions in weekly methamphetamine-positive urines. Secondary outcomes were study medication adherence [by self-report and medication event monitoring systems (MEMS)], sexual risk behavior and abstinence from methamphetamine.

FINDINGS

Participant mean age was 38.7 years, 87.8% were male, 50.0% white, 18.9% African American, and 16.7% Latino. Eighty-three per cent of follow-up visits and final visits were completed. By intent-to-treat, participants assigned to aripiprazole had similar reductions in methamphetamine-positive urines as participants assigned to placebo [risk ratio (RR) 0.88, 95% confidence interval (CI): 0.66-1.19, P = 0.41]. Urine positivity declined from 73% (33 of 45 participants) to 45% (18 of 40) in the placebo arm and from 77% (34 of 44) to 44% (20 of 35) in the aripiprazole arm. Adherence by MEMS and self-report was 42 and 74%, respectively, with no significant difference between arms (MEMS P = 0.31; self-report P = 0.17). Most sexual risk behaviors declined similarly among participants in both arms (all P > 0.05). There were no serious adverse events related to study drug, although participants randomized to aripiprazole reported more akathisia, fatigue and drowsiness (P < 0.05).

CONCLUSION

Compared with placebo, aripiprazole did not reduce methamphetamine use significantly among actively using, dependent adults.

Parallel Development of Risk Behaviors in Adolescence: Potential Pathways to Co-occurrence

This study used data from 5,382 adolescents from the 1997 U.S. National Longitudinal Survey of Youth (NLSY97) to investigate developmental pathways of alcohol use, marijuana use, sexual risk behaviors, and delinquency across ages 14 to 20, examine interrelationships among these risk behaviors across adolescence, and evaluate association between risk behavior trajectories and depressive symptoms in adolescence. Group-based dual trajectory modeling, examining trajectories of two outcomes over time, revealed strong interrelationships among developmental trajectories of the four risk behaviors, and indicated potential pathways to co-occurring risk behaviors. Adolescents with higher levels of alcohol use or marijuana use were more likely to engage in higher levels of early sexual risk-taking and delinquency. Moreover, adolescents involved in higher levels of delinquency were at higher risk for engaging in early sexual risk-taking. Also belonging to the highest risk trajectory of any of the four risk behaviors was positively associated with depressive symptoms in adolescence.

Predictors of HIV Sexual Risk Behavior among Men Who Have Sex with Men, Men Who Have Sex with Men and Women, and Transgender Women

Men who have sex with men, men who have sex with men and women, and transgender women are at high risk for HIV infection. This study seeks to clarify which known HIV risk factors (partner type, sex location, serodiscordance, multiple sex partners, substance use during sex) contribute to engagement in high-risk (unprotected receptive anal) sex in each population. Data collected from June 2005 through June 2008 indicate all three populations display different HIV sexual risk profiles. The data suggest that HIV-prevention interventions should be individually tailored to address the specific needs of these three highly vulnerable and impacted populations.

The Relationship between Sexual Coping and the Frequency of Sexual Risk among 'At Risk' African American Women

This study examines the relationship between one specific type of avoidant coping behavior-namely, having sex to cope with one's worries or problems-and the frequency with which 'at risk' women engage in risky sexual relations. Face-to-face interviews were conducted with 221 African American women drug abusers in the Atlanta, Georgia metropolitan area. The community identification process was used for recruitment, with additional recruitment done via targeted sampling. A variety of demographic characteristics, background and experiences measures, childhood maltreatment experiences, substance use-related measures, psychosocial and attitudinal items, and relationship characteristics were examined for their influence both on the frequency of engaging in risky sex and the extent to which women had sex to cope. Multivariate analysis revealed that having sex to cope was a statistically-significant predictor of the frequency with which women engaged in risky sexual behaviors. A separate analysis of the predictors of having sex to cope yielded seven items that were important for understanding the extent to which women engaged in sexual coping: age, number of health information sources, amount of physical abuse, reasons for not using condoms, overall attitudes toward condom use, level of partner communication, and the amount of help available from one's support network. The intervention-related implications of these findings are discussed, emphasizing the needs: to target younger women, to target and help survivors of childhood maltreatment to deal with unresolved issues, to make attitudes toward using condoms more conducive, to improve partner communication, and to bolster support network relationships.

Is expanded HIV treatment preventing new infections? Impact of antiretroviral therapy on sexual risk behaviors in the developing world

There have been dramatic increases in access to antiretroviral therapy (ART) across the developing world, and growing public health attention has focused on the possibility of utilizing ART as a means of slowing the global HIV epidemic. The preventive impact of ART will likely depend on decreasing levels of sexual risk behaviors following treatment initiation. The current review study examines the impact of wider access to ART on sexual risk behaviors among HIV-infected individuals in the developing world. The observational studies to date demonstrate that ART is associated with a significant reduction in unprotected sex following treatment initiation. Although data on the impact of ART on possible risk compensation are rapidly expanding across the developing world, more evidence is still needed before we can safely conclude expanded treatment will result in durable decreases in sexual risk behaviors.

Maltreatment clusters among youth in outpatient substance abuse treatment: co-occurring patterns of psychiatric symptoms and sexual risk behaviors

The purpose of the current study was to describe the use of a brief maltreatment assessment instrument to classify adolescents receiving alcohol or other drug (AOD) treatment services based on the extensiveness and severity of prior maltreatment. This goal is significant because maltreatment reduces the effectiveness of AOD treatment and is associated significantly with co-occurring patterns of psychiatric symptoms and sexual risk behaviors. Structured interviews were administered to 300 adolescent treatment clients (202 males, 98 females; M = 16.22 years; SD = 1.13 years) to assess childhood maltreatment experiences, past year psychiatric symptoms, and sexual risk behaviors during the past 180 days. Cluster analysis classified adolescents into unique groups via self-reported sexual abuse, physical punishment, and parental neglect/negative home environment. Significant between-cluster differences in psychiatric symptoms and sexual risk behaviors were documented using MANOVA and chi-square analyses. More severe maltreatment profiles were associated with higher scores for psychiatric symptoms and unprotected intercourse. Significant heterogeneity and distinct types within this treatment sample of adolescents supports the adaptation of selected prevention efforts to promote HIV/STI risk reduction.

Adapting an HIV/STDs Prevention Curriculum to Fit the Needs of Women With Alcohol Problems

Alcohol and drug dependent women are at increased risk for HIV/STDs. This paper discusses how a prevention curriculum, "Safer Sex Skill Building" (SSB), designed to reduce the contraction of HIV/STDs among drug-abusing women, could be modified to fit the needs of alcohol-abusing women in a residential treatment program. Authors modified the SSB by incorporating feedback from expert consultants as well as by engaging study participants in revising the therapy manual in order to create a curriculum that speaks to participants' experiences. Specific steps to assist those who would want to adapt an empirically-based manual-driven treatment intervention are provided.

Crystal methamphetamine use and sexual risk behaviors among HIV-positive and HIV-negative men who have sex with men in South Florida

Using data collected through venue-based sampling in South Florida from 2004 to 2005 as part of the Centers for Disease Control and Prevention-funded National HIV Behavioral Surveillance Among Men Who Have Sex with Men, we estimate the prevalence of crystal methamphetamine use and its association with high-risk sexual behaviors among a large and diverse sample of men who have sex with men (MSM) residing in South Florida. We also examine how these associations differ between HIV-positive and HIV-negative men. Bivariate analyses were used to assess the characteristics of study participants and their sexual risk behaviors by drug use and self-reported HIV status group. Of 946 MSM participants in South Florida, 18% reported crystal methamphetamine use in the past 12 months. Regardless of self-reported HIV status, crystal methamphetamine users were more likely to report high-risk sexual behaviors, an increased number of non-main sex partners, and being high on drugs and/or alcohol at last sex act with a non-main partner. Our findings indicate that crystal methamphetamine use is prevalent among the MSM population in South Florida, and this prevalence rate is similar, if not higher, than that found in US cities that have been long recognized for having a high rate of crystal methamphetamine use among their MSM populations. Notably, the use of crystal methamphetamine among both HIV-positive and HIV-negative MSM is associated with increased HIV-related risk behaviors.

Psychiatric symptom patterns, proximal risk factors, and sexual risk behaviors among youth in outpatient substance abuse treatment

The purpose of the current study was to classify adolescents receiving outpatient treatment for alcohol or other drug (AOD) problems via self-reports of the Diagnostic and Statistical Manual of Mental Disorders (4th ed. American Psychiatric Association, 1994) psychiatric symptoms, and to identify group differences in measures of proximal risk factors for sexual risk behaviors (SRBs) and self-reported SRBs. Structured interviews were administered to 300 adolescent clients (202 males, 98 females; M = 16.22 years; SD = 1.13) receiving treatment services as part of a larger National Institute on Alcohol Abuse and Alcoholism (NIAAA)-funded randomized clinical trial. Ward's method cluster analysis (Ward, 1963) was used to classify adolescents into distinct groups based on psychiatric symptom profiles. A multivariate analysis of variance was used to identify significant between-cluster differences in self-reported SRBs and proximal risk factors for SRB. Substantial heterogeneity in patterns of psychiatric symptoms was documented in this treatment sample. Membership in certain psychiatric symptom clusters was associated with several self-reported SRBs and correlated proximal risk factors. Among youth receiving AOD treatment, interventions to promote HIV/STI risk reduction may need adaptation for those with differing psychiatric profiles.

Alcohol and HIV sexual risk behaviors among injection drug users

We analyzed data from 6341 injection drug users (IDUs) entering detoxification or methadone maintenance treatment in New York City between 1990 and 2004 to test the hypothesis that alcohol use and intoxication is associated with increased HIV sexual risk behaviors. Two types of associations were assessed: (1) a global association (i.e., the relationship between HIV sexual risk behaviors during the 6 months prior to the interview and at-risk drinking in that period, defined as more than 14 drinks per week for males or 7 drinks per week for females), and (2) an event-specific association (i.e., the relationship between HIV sexual risk behaviors during the most recent sex episode and alcohol intoxication during that episode). Sexual risk behaviors included multiple sex partners and engaging in unprotected sex. After adjusting for the effects of other variables, at-risk-drinkers were more likely to report multiple sex partners and engaging in unprotected sex with casual sex partners (both global associations). IDUs who reported both they and their casual partners were intoxicated during the most recent sex episode were more likely to engage in unprotected sex (an event-specific association). We also observed two significant interactions. Among IDUs who did not inject cocaine, moderate-drinkers were more likely to report multiple partners. Among self-reported HIV seropositive IDUs, when both primary partners were intoxicated during the most recent sex episode they were more likely to engage in unprotected sex. These observations indicate both global and event-specific associations of alcohol and HIV sexual-risk behaviors.

HIV/AIDS-related sexual risk behaviors among rural residents in China: potential role of rural-to-urban migration

The relationship between rural-to-urban migration and the spread of HIV is well described, although most studies focus on sexual risk behaviors among rural-to-urban migrants at the urban destination areas. Few studies have examined the sexual risk behaviors of migrants who have returned from urban areas to their rural homes ("return migrants") in comparison with those of local rural residents who have never migrated to cities ("nonmigrants"). This study examines the potential association between rural-to-urban migration and sexual risk behaviors by comparing sexual risk behaviors between 553 return migrants and 441 nonmigrants from same rural communities in China. Findings reveal that, after controlling for sociodemographic characteristics, return migrants in rural areas had higher levels of sexual risk, including unprotected sex, than nonmigrants. Among return migrants, sexual risk behaviors were associated with age, gender, marital status, and number of different jobs they had previously held in the cities. These findings underscore the importance for HIV/AIDS education and prevention efforts targeting the migrant population in urban destinations as well as the return-migrant population in rural areas.

A model of sexual risk behaviors among young gay and bisexual men: longitudinal associations of mental health, substance abuse, sexual abuse, and the coming-out process

Sexual risk behaviors of young gay and bisexual men must be understood within the context of other health concerns (e.g., anxiety, substance abuse), population specific factors (i.e., the coming-out process and gay-related stress), childhood sexual abuse, and other theoretical factors (e.g., safer-sex intentions). The current report proposes and longitudinally examines a model of risk factors for subsequent sexual risk behaviors among young gay and bisexual men in New York City. As hypothesized, more negative attitudes toward homosexuality, more substance abuse symptoms, and poorer intentions for safer sex were directly associated with a greater likelihood of unprotected anal sex over the following year. Furthermore, lower self-esteem, more anxious symptoms, and childhood sexual abuse were related to more unprotected anal sex indirectly through more sexual partners, sexual encounters, and substance abuse symptoms. These findings suggest that interventions targeting sexual risk behaviors of young gay and bisexual men may be more effective if they also address mental health concerns and aspects of the coming-out process.

Masculine gender roles associated with increased sexual risk and intimate partner violence perpetration among young adult men

This study sought to assess the association between traditional masculine gender role ideologies and sexual risk and intimate partner violence (IPV) perpetration behaviors in young men's heterosexual relationships. Sexually active men age 18-35 years attending an urban community health center in Boston were invited to join a study on men's sexual risk; participants (N=307) completed a brief self-administered survey on sexual risk (unprotected sex, forced unprotected sex, multiple sex partners) and IPV perpetration (physical, sexual and injury from/need for medical services due to IPV) behaviors, as well as demographics. Current analyses included men reporting sex with a main female partner in the past 3 months (n=283). Logistic regression analyses adjusted for demographics were used to assess significant associations between male gender role ideologies and the sexual risk and IPV perpetration behaviors. Participants were predominantly Hispanic (74.9%) and Black (21.9%); 55.5% were not born in the continental U.S.; 65% had been in the relationship for more than 1 year. Men reporting more traditional ideologies were significantly more likely to report unprotected vaginal sex in the past 3 months (OR(adj) = 2.3, 95% CI = 1.2-4.6) and IPV perpetration in the past year (OR(adj) = 2.1, 95% CI = 1.2-3.6). Findings indicate that masculine gender role ideologies are linked with young men's unprotected vaginal sex and IPV perpetration in relationships, suggesting that such ideologies may be a useful point of sexual risk reduction and IPV prevention intervention with this population.

Recruiting drug-using men who have sex with men into behavioral interventions: a two-stage approach

Drug-using men who have sex with men (MSM) are at high risk of acquiring or transmitting HIV infection. Efforts to change behaviors in this population have been hampered by difficulties in recruiting drug-using MSM into behavioral interventions. This study sought to develop an effective strategy for recruiting drug-using MSM into behavioral interventions that consist of motivational interviewing alone or motivational interviewing plus contingency management. MSM were recruited through advertising and community outreach into groups to discuss party drugs, party burnout, and sexual behavior, with the intervention subsequently described and enrollment offered in the group setting. Many more eligible MSM responded to advertisements for the discussion groups than advertisements for the interventions, and 58% of those who participated in the discussion groups volunteered for counseling. Men who entered counseling reported high levels of drug use and sexual activity and were racially and ethnically diverse; only 35% were willing to accept drug treatment. Results demonstrate that a two-stage strategy in which drug-using MSM are first recruited into discussion groups before they are offered a behavioral intervention can be an effective way to induce voluntary acceptance of an intervention employing a behavioral risk-reduction approach.

Risk behaviors of youth living with HIV: pre- and post-HAART

OBJECTIVE

To examine the transmission behavior among youth living with HIV (YLH), pre- and post-HAART.

METHODS

Two cohorts were recruited: (1) 349 YLH during 1994 to 1996 and (2) 175 YLH during 1999 to 2000, after the wide availability of HAART. Differences in sexual and substance-use risk acts and quality of life were examined.

RESULTS

Post-HAART YLH were more likely to engage in unprotected sex and substance use, to be more emotionally distressed, and to have lower quality of life than were pre-HAART YLH.

CONCLUSIONS

Targeted interventions for YLH that address reductions in transmission acts and aim to improve quality of life are still needed.