Understanding the Socio-demographic Factors Surrounding Young Peoples' Risky Sexual Behaviour in Ghana and Kenya

Exploring HIV risk perception mechanisms among youth in a test-and-treat trial in Kenya and Uganda

Understanding risk perception and risk-taking among youth can inform targeted prevention efforts. Using a health beliefs model-informed framework, we analysed 8 semi-structured, gender-specific focus group discussions with 93 youth 15-24 years old (48% male, 52% female), drawn from the SEARCH trial in rural Kenya and Uganda in 2017-2018, coinciding with the widespread introduction of PrEP. Highly connected social networks and widespread uptake of antiretrovirals shaped youth HIV risk perception. Amid conflicting information about HIV prevention methods, youth felt exposed to multiple HIV risk factors like the high prevalence of HIV, belief that people with HIV(PWH) purposefully infect others, dislike of condoms, and doubts about PrEP efficacy. Young women also reported minimal sexual autonomy in the context of economic disadvantages, the ubiquity of intergenerational and transactional sex, and peer pressure from other women to have many boyfriends. Young men likewise reported vulnerability to intergenerational sex, but also adopted a sexual conquest mentality. Comprehensive sexuality education and economic empowerment, through credible and trusted sources, may moderate risk-taking. Messaging should leverage youth's social networks to spread fact-based, gender- and age-appropriate information. PrEP should be offered alongside other reproductive health services to address both pregnancy concerns and reduce HIV risk.

Risky sexual behavior and associated factors among reproductive age women in eastern African countries: a multilevel analysis of the recent demographic and health survey

INTRODUCTION

Risky sexual behavior exposes an individual to the risk of contracting sexually transmitted infections including human immunodeficiency virus (HIV). Even though risky sexual behavior is a devastating problem in low- and middle-income countries, studies on risky sexual behavior and associated factors among reproductive-age women in Eastern African countries are limited. Therefore, this study aimed to assess the magnitude of risky sexual behavior and associated factors among reproductive-age women in Eastern African countries that help to target high-risk groups and set appropriate intervention.

METHOD

The appended and recent Demographic and Health Survey dataset of 10 Eastern African countries from 2012 to 2022 was used for data analysis. A total of 111,895 participants were included in this study as a weighted sample. Associated factors were determined using a multilevel mixed-effects logistic regression model. Significant factors in the multilevel mixed-effect logistic regression model were declared significant at p-values < 0.05. The adjusted odds ratio (AOR) and confidence interval (CI) were used to interpret the results.

RESULT

The overall magnitude of risky sexual behavior among reproductive-age women in Eastern African countries was 28.16% (95% CI 27.90%, 28.43%), which ranged from 3.80% in Ethiopia to 67.13% in Kenya. In the multivariable analysis, being a younger woman, being an educated woman, being tested for human immunodeficiency virus, having work, drinking alcohol, and being an urban dweller were factors that were significantly associated with higher odds of risky sexual behavior.

CONCLUSION

The overall magnitude of risky sexual behavior among reproductive-age women in Eastern African countries was high. Individual-level (being a younger woman, being an educated woman, being tested for human immunodeficiency virus, having work, and drinking alcohol) and community-level (being an urban dweller) variables were associated with higher odds of risky sexual behavior. Therefore, policymakers and other stakeholders should give special consideration to urban dwellers, educated, worker and younger women. Better to improve the healthy behavior of women by minimizing alcohol consumption and strengthening HIV testing and counseling services to reduce the magnitude of risky sexual behavior.

Determination of risky sexual behaviors and associated factors of Turkish young women

Risky sexual behaviors of young women cause significant reproductive health problems. Therefore, it is vital to evaluate the sexual attitude and behavior characteristics of young women, their changes over the years, and the effects of information sources such as family, media, and friends, which play an effective role in bringing about changes in sexual behavior of young women. This study was planned to evaluate young women's premarital sexual behaviors and related factors in Turkiye between 01.11.2021 and 01.05.2022. It is designed as a descriptive correlation study conducted with 1.430 young women studying at universities in 30 metropolitan cities in Turkiye. The study data were collected using the "Participant Information Form" and the "Premarital Risky Sexual Behavior Assessment Scale for Young Women." This study showed that parents' educational status and geographical region was related to the young women's mean score and the subdimension score of the Premarital Sexual Behavior Assessment Scale for Young Women (PSAS-YW) (p < .001). Furthermore, young women's top source of information about sexuality was internet media (80 percent, n = 1144), and the least source was their fathers (2.9 percent, n = 41). There is a relationship between where young women spend most of their lives, the geographical region where their families live, and the risk of sexual behavior. The study observed that the geographical region where young women's parents live was effective in risky sexual behavior. While less risky sexual behavior was observed, primarily in the country's east, this rate increased in the western parts. Furthermore, while it was determined that young people mainly acquire sexual information through the media-internet or friends, it was observed that the participants in this group had the highest rate of risky sexual behavior. The age variable explained only 2 percent of the change in risky sexual behavior, and there was a linear increase between the mother's education level and the risky sexual behavior score of young women.

Prevalence of risk factors for human immunodeficiency virus among sexually active women in Rwanda: a nationwide survey

BACKGROUND

The Human Immunodeficiency Virus (HIV) remains a global health burden, and despite the advancements in antiretroviral therapy and various strategies employed to curb HIV infections, the incidence of HIV remains disproportionately high among women. Therefore, this study aimed to determine the prevalence of the risk factors for the acquisition of HIV among sexually active women in Rwanda.

METHODS

Secondary data from the 2020 Rwanda Demographic Health Survey, comprising 10,684 sexually active women, was used. Multistage stratified sampling was employed to select the study participants. Multivariable logistic regression was conducted to determine the associated risk factors using the SPSS (version 25).

RESULTS

Of the 10,684 sexually active women, 28.7% (95% confidence interval (CI): 27.5-29.4) had at least one risk factor for HIV acquisition. Having no education (AOR = 3.65, 95%CI: 2.16-6.16), being unmarried (AOR = 4.50, 95%CI: 2.47-8.21), being from female-headed households (AOR = 1.75, 95%CI: 1.42-2.15), not having health insurance (AOR = 1.34, 95%CI: 1.09-1.65), no HIV test history (AOR = 1.44, 95%CI: 1.01-2.08), being from the poorest wealth quintile (AOR = 1.61, 95%CI: 1.14-2.27) and lack of exposure to mass media (AOR = 1.30, 95%CI: 1.07-1.58) were associated with higher odds of exposure to at least one HIV acquisition risk factor. In contrast, age groups of 25-34 (AOR = 0.56, 95%CI: 0.44-0.71) and 35-44 years (AOR = 0.62, 95%CI: 0.48-0.80), rural residence (AOR = 0.63, 95%CI: 0.49-0.81) and being from the western region (AOR = 0.67, 95%CI: 0.48-0.94) were associated with less odds of exposure to at least one HIV acquisition risk factor.

CONCLUSION

More than a quarter of sexually active women in Rwanda had exposure to at least one risk factor for HIV acquisition. There is a need to maximize the use of mass media in disseminating HIV prevention and behavioral change messages. Engagement of religious leaders and promotion of HIV testing, especially among the never-testers, may be vital strategies in successful HIV prevention programs.

Sexual Behavior Patterns of Black Young Adults in Georgia: Results from a Latent Class Analysis

The state of Georgia ranks first in the rate of new diagnosis of HIV/AIDS, yet studies focused on understanding the drivers of this epidemic in the most at-risk groups outside the Atlanta Metropolitan Statistical Area (MSA) remain sparse. Among the many consequences of this is the inability to effectively design tailored intervention programs that appropriately address the reduction of HIV/AIDS and other STDS in the state. Reducing disparities in HIV/AIDS remains an important goal in the National HIV/AIDS Strategy. Given the disproportionate burden of the HIV/AIDS epidemic among Blacks in the state of Georgia, there is a significant need to focus research attention on the sexual behavior of young people that predisposes them to increased risk of HIV/AIDS infection. The current study used latent class analysis (LCA) to examine the sexual behavior patterns of Black young adults living in Georgia. LCA results revealed a two-class fit with distinct sexual behavior patterns. Gender and educational attainment emerged as significant predictors of class membership. Our findings contribute to the vast literature showing that sexual behavior patterns of Black young adults are not homogenous, and underscore the significance of socio-demographic and contextual factors in shaping sexual risk behavior.

Prevalence and Factors Associated with Risky Sexual Behaviors Among Sexually Active Female Adolescents in Zambia

Despite decades long commitment to women's reproductive health rights, sexually transmitted diseases and unintended pregnancies continue to be major public health concerns in sub-Saharan Africa. In order to provide an evidence base for future policy and services, this study aims to explore the prevalence and factors associated with risky sexual behaviors (RSB) among sexually active Zambian female adolescents using a nationally representative sample. Data on females, aged 15-19 (n = 3000), were obtained from the 2018 Zambia Demographic and Health Survey, an interviewer-administered, nationally representative survey that used multistage sampling. The study conducted multiple logistic regression to explore the correlates of RSB. Of the 3000 respondents, 49.7% (1490) reported ever having sexual intercourse of which 71.1% reported engaging in RSB. Among sexually active female adolescents, the following RSB percentage were reported: intercourse before age 16 (50.6%), nonuse of condoms at last intercourse (37.8%), engaging in transactional sex (6.2%), alcohol use at last intercourse (4.6%), and multiple sexual partners (1.9%). Educational attainment and household wealth showed strong inverse trends with RSB risk and there were notably large geographic differences in RSB within Zambia (22.1% in Lusaka region vs. 62.4% in Western province). The multiple logistic regression results revealed that those who were younger, unmarried, with less than secondary education, without access to Internet, and residents of Western Zambia were significantly more likely to have engaged in RSB (AOR: 1.74-7.69, p < 0.05). Given the negative health outcomes associated with RSB, Zambian adolescent health care programs may strategically target limited resources to the identified risk groups.

Health-seeking behaviours of young women with sexually transmitted infections: Analysis of the 2014 Ghana Demographic and Health Survey

BACKGROUND

Young people are at a disproportionately higher risk for sexually transmitted infections (STIs) due to biological factors, low awareness and limited access to sexual and reproductive health information and services. Untreated STIs can lead to major complications, including HIV, congenital infections, infertility, permanent disability and mortality. This study aimed to identify the salient factors associated with health-seeking behaviours of young women with a history of STIs in Ghana.

METHODS

We analysed data from the 2014 Ghana Demographic and Health Survey. In all, we analysed data from a weighted sample of 742 young women with a history of STIs. At the univariate level, frequencies and percentages were computed, while Chi-square analysis was computed at the bivariate level. Both crude and adjusted odds ratios were computed at the multivariable level using binary logistic regression.

RESULTS

The findings showed that the majority (72%) of the participants sought treatment for STIs. Among the participants who sought treatment for STIs (n = 532), 26% sought treatment at a public hospital/polyclinic, 34% sought treatment at a chemical/drug store and 10% self-medicated. Seeking treatment for STIs was significantly associated with older age (20-24yrs), and higher socioeconomic and educational status.

CONCLUSION

This study demonstrated that majority of the young women sought treatment for STIs. Seeking treatment for STIs was influenced by socio-demographic factors. These findings have implications for sexual and reproductive health policies and interventions in Ghana.

Psychological Factors and Sexual Risk Behaviors: A Multidimensional Model Based on the Chilean Population

Human immunodeficiency virus (HIV) is a global health problem, with sexual risk behaviors (SRB) being the main routes of spreading the virus. Evidence indicates that different psychological factors influence SRB (e.g., attitude towards condoms, sexual self-concept, sexual sensation seeking, knowledge of sexual risk behaviors, risk perception). This study proposes an explanatory model of sexual risk behaviors in young people and adults. The sample consisted of 992 young people and adults aged between 18 and 35 years. The model presented good levels of fit (X² = 3311.433, df = 1471, CFI = 0.964, TLI = 0.959, RMSEA = 0.036), explaining 56% of the variance of sexual activity with multiple partners, 77% of the inadequate use of protective barriers, and 58.8% of sexual activity under the influence of alcohol or drugs from a set of psychological factors in self-report measures. The details of the results offer novel contextual evidence for the prioritization of prevention-oriented psychosocial interventions.

Individual and community-level determinates of risky sexual behaviors among sexually active unmarried men: A multilevel analysis of 2016 Ethiopian Demographic and Health Survey

Background

In Ethiopia, HIV/AIDS continues to be a major public health problem mostly due to the high prevalence of risky sexual behaviors. However, research on risky sexual behavior and its determinants among unmarried men (never married, widowed, and divorced) who are highly vulnerable to risky sexual behavior was limited. Therefore, this study aimed to assess the magnitude of risky sexual behavior and its determinants among non-married men using a nationally representative sample.

Methods

The analysis was done on 5680 sexually active unmarried men aged 15–59 years using data from the 2016 Ethiopia Demographic Health Survey (EDHS). The main outcome variable was risky sexual behavior which defined as having at least one of the following: multiple sexual partners; initiation of sex before the age of 18 years; inconsistent condom use in the last 12 months; alcohol consumption at last sex. Multivariable generalized linear mixed-effects regression was employed to identify variables associated with risky sexual behavior.

Result

The overall magnitude of risky sexual behavior was 26.9% (95% CI; 25.7, 28.0). Currently employed (AOR = 2.49, 95% CI = 1.64–3.77), history of HIV testing (AOR = 2.51, 95% C = 1.95–3.23), drinking alcohol almost every day (AOR = 5.49, 95 CI = 2.73–11.02), and using Internet daily (AOR = 1.99, 95% CI = 1.06–3.74) increase the odds of risky sexual behavior. Whereas, primary education (AOR = 0.44, 95% CI = 0.32–0.61), secondary education level (AOR = 0.46, 95% CI = 0.29–0.72) and a high proportion of community-level media exposure (AOR = 0.42, 95% CI = 0.12–0.75) decrease the odds of risky sexual behavior.

Conclusion

In general, a significant proportion of sexually active unmarried men in Ethiopia have practiced risky sexual behavior. An intervention should be designed which are against the factors found to increase the odds of risky sexual behavior to reduce the incidence of HIV and other sexually transmitted infections.

Risky sexual behaviours and HIV testing among young people in Ghana: evidence from the 2017/2018 Multiple Indicator Cluster Survey

Background

Young people have a higher chance of experimenting with sex before marriage, thus they engage in risky sexual behaviours that predispose them to HIV infections. The objective of this study was to assess the relationship between engaging in risky sexual behaviours and the uptake of HIV testing services among young people in Ghana.

Methods

We analysed secondary data from the 2017/2018 Ghana Multiple Indicator Cluster Survey, which collected data on population and health indicators across the previous ten regions of Ghana, using a Computer Personal Assisted Interviewing application. Data were analysed using descriptive statistics, Chi-square test and Binomial Logistic regression.

Results

Seventy-nine per cent (79%) of young women and 68% of young men did not use a condom during last sexual intercourse. In addition, 68% of young women and 87% of young men had not tested for HIV. Young women (AOR = 2.19; 95% CI 1.56–3.07) and young men (AOR = 3.38; 95% CI 1.18–9.64) aged 20–24 years had a higher likelihood of being tested for HIV compared to those aged 15–19 years. Young women with junior high school education (AOR = 2.03; 95% CI 1.08–3.81) were more likely to test for HIV compared with those who had pre-primary/no formal education. In addition, young women who were never married or in a union (AOR = 0.39; 95% CI 0.27–0.56) had 61% of reduced odds of being tested for HIV compared with those who were currently married or in a union. There was no significant association between risky sexual behaviours and HIV testing (p > 0.05).

Conclusion

This study demonstrated that condom use among sexually active young people was low. The uptake of HIV testing services was below expectation. Age, educational status, marital status and exposure to the mass media were the salient factors influencing the uptake of HIV testing among young people. Stakeholders should implement interventions to help increase the uptake of HIV testing and condom use among young people in Ghana.

Sub-Sahara Africa is the only region in the world where the number of young people continues to increase greatly. Many of the new HIV infections among young people across the world happen in sub-Saharan Africa. Young people engage in unsafe sexual behaviours, such as having sex without a condom, beginning sexual intercourse at an early age and having sex with many partners, which increases their chance of getting infected with HIV. Testing for HIV helps in the early discovery of the virus which is crucial for effective HIV management and prevention. Increasing HIV testing is one of the health issues cherished by global health leaders. However, little is known about whether young people who engage in unsafe sexual behaviours utilize HIV testing services. The analysed data were collected as part of the 2017/2018 Multiple Indicator Cluster Survey across all the regions of Ghana. Our findings showed that many of the sexually active young people who participated in the survey had not tested for HIV, hence did not know their HIV status. Making matters worse, many of them engaged in unsafe sexual behaviours, such as unprotected sexual intercourse. Young people aged 20–24 years, those with higher education and married young women were more likely to utilize HIV testing services. To help end HIV as a public health threat by 2030, it is very necessary for stakeholders to educate young people about the dangers associated with unsafe sexual behaviours as well as encourage them to know their HIV status.

Routine HIV clinic visit adherence in the African Cohort Study

Background

Retention in clinical care is important for people living with HIV (PLWH). Evidence suggests that missed clinic visits are associated with interruptions in antiretroviral therapy (ART), lower CD4 counts, virologic failure, and overlooked coinfections. We identified factors associated with missed routine clinic visits in the African Cohort Study (AFRICOS).

Methods

In 2013, AFRICOS began enrolling people with and without HIV in Uganda, Kenya, Tanzania, and Nigeria. At enrollment and every 6 months thereafter, sociodemographic questionnaires are administered and clinical outcomes assessed. Missed clinic visits were measured as the self-reported number of clinic visits missed in the past 6 months and dichotomized into none or one or more visits missed. Logistic regression with generalized estimating equations was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between risk factors and missed visits.

Results

Between January 2013 and March 2020, 2937 PLWH were enrolled, of whom 2807 (95.6%) had initiated ART and 2771 had complete data available for analyses. Compared to PLWH 50+, missed clinic visits were more common among those 18–29 years (aOR 2.33, 95% CI 1.65–3.29), 30–39 years (aOR 1.59, 95% CI 1.19–2.13), and 40–49 years (aOR 1.42, 95% CI 1.07–1.89). As compared to PLWH on ART for < 2 years, those on ART for 4+ years were less likely to have missed clinic visits (aOR 0.72, 95% CI 0.55–0.95). Missed clinic visits were associated with alcohol use (aOR 1.34, 95% CI 1.05–1.70), a history of incarceration (aOR 1.42, 95% CI 1.07–1.88), depression (aOR 1.47, 95% CI 1.13–1.91), and viral non-suppression (aOR 2.50, 95% CI 2.00–3.12). As compared to PLWH who did not miss any ART in the past month, missed clinic visits were more common among those who missed 1–2 days (aOR 2.09, 95% CI 1.65–2.64) and 3+ days of ART (aOR 7.06, 95% CI 5.43–9.19).

Conclusions

Inconsistent clinic attendance is associated with worsened HIV-related outcomes. Strategies to improve visit adherence are especially needed for young PLWH and those with depression.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12981-021-00425-0.

Do sexual expectancies and inhibitions predict high-risk sexual behaviours? Evidence from a cross-sectional survey among young psychoactive substance users in informal settlements in Kampala, Uganda

BACKGROUND

Psychoactive substance use is a public health challenge among young people in informal settlements. Though rarely examined, psychoactive substance use is linked to sexual expectancies and inhibitions, and consequently high-risk sexual behaviours. This study examined the association between sexual expectancies and inhibitions, and high-risk sexual behaviours among young psychoactive substance users (PSUs) in informal settlements in Kampala, Uganda.

METHODS

This cross-sectional study recruited 744 young PSUs from informal settlements in Kampala. Respondent driven sampling was used to recruit respondents. A 'modified' Poisson regression model was used for inferential statistics. Data were analysed using the Stata 14 software.

RESULTS

Of the 744 study participants, 45.6% believed that psychoactive substance use improves sexual performance; 43.3% believed that psychoactive substances make sex more pleasurable, and 53.3% believed that psychoactive substances give courage or confidence to approach a partner for sex. The belief that psychoactive substance use improves sexual performance (PR 1.14, 95% CI: 1.01-1.30), increases the likelihood of engaging in sex (PR 1.20, 95% CI: 1.04-1.40) or gives courage or confidence to approach a sexual partner (PR 1.21, 95% CI: 1.05-1.39) were associated with having sex while under the influence of psychoactive substances. The belief that a psychoactive substance user under the influence of psychoactive substances is more likely to engage in sex (PR 1.48, 95% CI: 1.15-1.90), and likely to find it difficult to refuse sex (PR 1.28, 95% CI: 1.06-1.55) were positively associated with engaging in multiple sexual partnerships. The belief that one easily forgets to use a condom when under the influence of psychoactive substances was positively associated with inconsistent condom use (PR 1.26, 95% CI: 1.09-1.45).

CONCLUSION

Psychoactive substance use expectancies associated with high-risk sexual behaviours included the belief that psychoactive substances improve sexual performance and improve confidence in approaching a sexual partner. Psychoactive substance use inhibitions associated with high-risk sexual behaviours included an increased likelihood of engaging in sexual intercourse, difficulties in refusing to engage in sexual intercourse, and forgetting to use condoms while intoxicated. Interventions targeting a reduction in high-risk sexual behaviour should integrate the impact of psychoactive substance use on sexual behaviour.

Self-reported sexually transmitted infections among sexually active men in Ghana

Background

In sub-Saharan Africa, sexually transmitted infections (STIs) other than HIV are major public health problems. This study, therefore, sought to assess the prevalence and factors associated with self-reported STIsamong sexually active men in Ghana.

Methods

Data from the 2014 Ghana demographic and health survey wereused to conduct the study. This research included a total of 3051 sexually active men aged 15–59 years. Self-reported STI was the outcome variable. The data were analyzed using both descriptive (frequencies and percentages) and inferential (binary logistic regression) analysis.

Results

The prevalence of self-reported STIs in the past 12 months preceding the survey was 6.0% (CI:4.7–6.8). Compared to men aged 45-59 years, those aged 25–34 (aOR = 2.96, CI: 1.64–5.35), 15–24 (aOR = 2.19, CI: 1.13–4.26), and 35–44 (aOR = 2.29, CI: 1.23–4.24) were more likely to report an STI. Men who had 2 or more sexual partners apart from their spouse were more likely to report an STI compared to those with no other partner apart from spouse (aOR = 4.24, CI: 2.52–7.14). However, those who had their first sex when they were 20 years and above (AOR = 0.66, CI: 0.47–0.93) and men who read newspaper/magazine had lower odds (aOR = 0.53, CI: 0.37–0.77) of reporting STIs compared to those who had sex below 20 and those who did not read newspaper/magazine respectively.

Conclusion

The study has revealed a relatively low prevalence of self-reported STI among sexually active men in Ghana. Sexually active men aged 25–34 years, those whose age at first sex is below 20 years and those with two or more sexual partners apart from their spouse had higher odds of reporting STIs. However, reading a newspaper was found to be positive in reducing the odds of reporting STIs. To reduce STIs among sexually active men in Ghana, it is important for health systems and stakeholders to consider these factors and put in place measures to mitigate those that put men at risk of STIs and encourage the adoption of the protective factors. Mass media can be used as a useful avenue for encouraging men to report STIs in order to avoid transmitting them to their partners. 

Advancing research for HIV prevention among African, Caribbean and Black men: Protocol for a multisite cross-sectional study in Ontario (weSpeak study)

In Ontario, African, Caribbean, and Black (ACB) men account for almost 60% of the estimated number of HIV-positive people (through heterosexual contact), although they constitute less than 5% of the province's population. However, current HIV research, programming and policy in Ontario are not aligned with heterosexual ACB men's healthcare needs and interests, and fail to engage them in community responses to HIV. weSpeak is a multisite (Ottawa, Toronto, London, and Windsor) project that is aims to: 1. assess the sociocultural and socio-political conditions that contribute to HIV related health disparities among ACB men, 2. examine social and behavioral vulnerabilities to HIV among ACB men, including their social identities related to race, class, gender and sexualities, 3. community engagement and mobilization part of the project, and 4. generate, appraise and share new knowledge, and support its translation into intervention and practice. This will be a mixed method study comprising focus groups, in-depth interviews, and a survey to meet the data objectives. All data collection activities will take place at the same time in 4 cities in 3 sequential phases: 1. focus groups, 2. in-depth interviews, and 3. a questionnaire survey. Service providers will participate in the concept mapping exercise to review the research findings and develop program, policy, and community-based initiatives to promote resilience and meaningfully engage heterosexual ACB men in community responses to HIV survey. This study will provide evidence on: 1. heterosexual ACB men's experience of structural disadvantage and psychological factors is associated with HIV vulnerability. 2. heterosexual ACB men with greater internal resilience and social resources show greater risky behaviors, and 3. a conceptual Model of HIV vulnerability linking the potential internal and external factors that interact to influence HIV vulnerability. This study will lead to better understanding of the structural determinants and the psychosocial risk factors of HIV transmission among ACB men in Ontario which will aid in designing evidence-based intervention programs, and thereby reduce their higher vulnerability to HIV and its associated consequences.