Due to life-enhancing effects of antiretroviral therapy, HIV-positive persons have the potential for long life comparable to their uninfected peers. Older women (age 50+) living with HIV (OWLH) are often an under-recognized aging group. We conducted a systematic review to examine psychosocial factors that impact how OWLH live, cope, and age with HIV. Initial key word search yielded 1527 records, and 21 studies met our inclusion criteria of original quantitative or qualitative research published between 2013 and 2016 with results specific to OWLH. These focused on health care and self-management, sexual health and risk, stigma, loneliness, mental health (depression, substance use), and protective factors (coping, social support, well-being). Due to the scarcity of studies on each topic and inconclusive findings, no clear patterns of results emerged. As the number of OWLH continues to grow, more research, including longitudinal studies, is needed to fully characterize the psychosocial factors that impact aging with HIV.
Study Objective To examine differences in factors associated with contraceptive use between younger and older adolescent age groups, which has not previously been well described. Design Age group-specific analyses were performed on cross-sectional survey data to identify factors associated with any contraceptive use at last sex among younger (14- to 16-year-old) and older (17- to 19-year-old) sexually active African American female adolescents; interaction analyses were used to assess whether these associations differed by age. Setting Adolescent reproductive health clinic in Atlanta, Georgia. Participants Sexually active African American female adolescents 14-19 years of age. Interventions No intervention tested; cross-sectional design. Main Outcome Measure Self-reported contraceptive use during most recent vaginal sex with a male partner. Results The prevalence of contraceptive use at last sex was identical in both groups; however, factors associated with contraceptive use differed according to age. The only factor associated with contraceptive use in both age groups was involvement in decisions about sexual health in the most recent relationship. Associations between factors and contraceptive use significantly differed according to age. History of sexually transmitted infection, age difference with partner, discussion of condoms with partner, and concurrent partners were important factors among younger adolescents; worry about pregnancy and discussion of birth control with partner were important among older adolescents. Conclusion Factors associated with contraceptive use at last sex differ according to adolescent age; this should be considered when designing counseling and interventions for teens, as well as research.
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Laura M. Mercer Kollar;
Teaniese Davis;
Jennifer L. Monahan;
Jennifer A. Samp;
Valerie B. Coles;
Erin L. P. Bradley;
Jessica Sales;
Sarah K. Comer;
Timothy Worley;
Eve Rose;
Ralph Diclemente
Sexual risk reduction interventions are often ineffective for women who drink alcohol. The present study examines whether an alcohol-related sexual risk reduction intervention successfully trains women to increase assertive communication behaviors and decrease aggressive communication behaviors. Women demonstrated their communication skills during interactive role-plays with male role-play partners. Young, unmarried, and nonpregnant African American women (N = 228, ages 18-24) reporting unprotected vaginal or anal sex and greater than three alcoholic drinks in the past 90 days were randomly assigned to a control, a sexual risk reduction, or a sexual and alcohol risk reduction (NLITEN) condition. Women in the NLITEN condition significantly increased assertive communication behavior compared to women in the control condition, yet use of aggressive communicative behaviors was unchanged. These data suggest assertive communication training is an efficacious component of a sexual and alcohol risk reduction intervention. Public health practitioners and health educators may benefit from group motivational enhancement therapy (GMET) training and adding a GMET module to existing sexual health risk reduction interventions. Future research should examine GMET’s efficacy in combination with other evidence-based interventions within other populations and examine talking over and interrupting one’s sexual partner as an assertive communication behavior within sexual health contexts.
OBJECTIVES: To characterize factors associated with dual method use in a sample of adolescent women.
METHODS: We conducted a cross-sectional survey of sexually active African American females aged 14–19 years attending an urban Title X clinic in Georgia in 2012 (N=350). Participants completed a computerized survey assessing contraceptive and condom use at last two sexual encounters with their most recent partner. Dual method use was defined as use of a hormonal contraceptive or intrauterine device (IUD) plus condom. We applied multinomial logistic regression, using generalized estimating equations, to examine the adjusted association between dual method use (versus use of no methods or less effective methods alone, e.g. withdrawal) and select characteristics.
RESULTS: Dual methods were used by 20.6% of participants at last sexual intercourse and 23.6% at next to last sexual intercourse. Having a previous sexually transmitted disease (STD) (aOR 2.30, 95%CI 1.26–4.18), negative attitudes towards pregnancy (aOR 2.25, 95%CI 1.19–4.28) and a mother who gave birth as a teen (aOR 2.34, 95%CI 1.21–4.52) were associated with higher odds of dual method use. Having no health insurance (aOR 0.39, 95%CI 0.18–0.82), ≥ 4 lifetime sexual partners (aOR 0.42, 95%CI 0.22–0.78), sex at least weekly (aOR 0.54, 95%CI 0.29–0.99), and agreeing to monogamy with the most recent partner (aOR 0.40, 95%CI 0.16–0.96) were associated with decreased odds of dual method use.
CONCLUSIONS: Dual method use was uncommon in our sample. Efforts to increase use of dual methods should address individual and relationship factors.
This exploratory descriptive study examined perceived vulnerabilities to human papillomavirus (HPV) and the correlation to factors influencing vaccine beliefs and vaccine decision making in young Hispanic males attending a large public urban university. Only 24% of participants believed that the HPV vaccine could prevent future problems, and 53% said they would not be vaccinated. The best predictors of HPV vaccination in young Hispanic men were agreement with doctor recommendations and belief in the vaccine’s efficacy. Machismo cultural norms influence young Hispanic men’s HPV-related decision making, their perceptions of the vaccine, and how they attitudinally act on what little HPV information they have access to. This study provides culturally relevant information for the development of targeted health education strategies aimed at increasing HPV vaccination in young Hispanic men.
Objective: This study sought to articulate pathways between constructs from the theory of gender and power and their associations with sexual behavior. Design: The data were collected preintervention during a randomized controlled HIV prevention trial. Participants were 701 sexually active, unmarried African American females, aged 14-20, who were not pregnant, and were recruited from three health clinics in a southeastern US city. Structural equation modeling was used for the analyses. Main Outcome Measure: Self-reported condom use. Results: Theoretical associations yielded a well-fitting structural model across initial and cross-validation samples. A significant amount of variance was explained for the variables of condom use (R2 = .31, .18), partner communication (R2 = .30, .26), substance use during sex (R2 = .32, .51), and negative personal affect (R2 = .36, .48). Partner communication (.35, .38) was the strongest predictor of condom use, negative personal affect (-41, -37) was the strongest predictor of partner communication, and physical risk (.54, .54) was the strongest predictor of negative personal affect. Conclusion: This model provides evidence to support both direct and indirect associations between social and behavioral risk factors and condom use. Associations between theory of gender and power constructs and condom use can facilitate future development and analyses of interventions based on this theory.
The current study examined and compared the willingness of young Black men who have sex with men (YBMSM) to accept pre-exposure prophylaxis (PrEP), adult male circumcision, and condoms for reducing their risk of HIV acquisition. The majority (67%) reported unprotected receptive anal sex in the last six months. About three-quarters (71%) would accept using PrEP if it was 100% effective. Cost influenced PrEP acceptance with 19% indicating acceptance at $100 per month co-pay. Of those not circumcised, 50% indicated willingness if circumcision was 100% effective. Acceptance of circumcision decreased markedly to 17% with co-pays of $100. About 73% of men were willing to use condoms if they were 100% effective and 50% indicated a willingness at the cost of $10 per month. The findings suggest that condom use promotion strategies should remain at the forefront of public health efforts to control HIV incidence among YBMSM.
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Irene Kuo;
Carol E. Golin;
Jing Wang;
Danielle F. Haley;
James Hughes;
Sharon Mannheimer;
Jessica Justman;
Anne Rompalo;
Paula Frew;
Adaora A. Adimora;
Lydia Soto-Torres;
Sally Hodder
Background: Substance use is associated with HIV sexual risk behaviors, yet few studies have examined substance use patterns longitudinally. We evaluated the types and frequency of substances used over a six-month period among U.S. women at risk for HIV acquisition.
Methods: Women reporting unprotected sex with a man in the previous six months and at least one other personal or partner HIV risk characteristic enrolled in a multisite cohort study and completed interviews about substance use at study visits. Prevalence and frequency of substance use at the baseline and six-month visits were compared and correlates of decreased substance use at the six-month visit were assessed.
Results: Of 2099 women enrolled, 1882 had substance use data at baseline and six-months. Of these, 76.1% reported using at least one drug or binge drinking in the previous six months; 37.5% were frequent and 38.6% non-frequent substance users. Binge drinking was most frequently reported (63.3%), followed by cocaine (25.0%) and opioids (16.5%). Fifty-five percent of opiate users and 30% of cocaine users reported daily/almost daily use. At the six-month visit, 40.5% reported a decrease in frequency of use. Adjusting for income and type of drug used, poly-substance users were less likely to decrease frequency of use compared to those who only used one substance.
Conclusion: A substantial decrease in frequency of substance use over time was observed in this cohort. Poly-substance users were less likely to reduce frequency of use over time, suggesting that specific substance use interventions targeting these users are warranted.
Background Adolescents with a history of psychiatric disorder(s) are particularly vulnerable to contracting sexually transmissible infections (STIs) as a result of psychological and emotional states associated with higher rates of risky sexual behaviour. The present study examined gender differences in sexual risk behaviours and STI among adolescents in mental health treatment. Methods: Three hundred and seventy nine sexually active adolescents, aged 1318 years, from a larger multisite study, who received mental health treatment during the past year, completed an audio computer-assisted self interview assessing sociodemographics, psychiatric symptomatology and HIV/STI risk behaviours, and provided urine specimens tested for STI. Results: After controlling for covariates, multivariate logistic regression models indicated that female adolescents were more likely to have had an HIV test (adjusted odds ratio (AOR)≤3.2, P≤0.0001), obtain their HIV test results (AOR≤2.9, P≤0.03), refuse sex out of fear for STI acquisition (AOR≤1.7, P≤0.04), or avoid a situation that might lead to sex (AOR≤2.4, P≤0.001), and were less likely to have a casual sex partner (AOR≤0.40, P≤0.002). Additionally, females were more likely to report inconsistent condom use (AOR≤2.60, P≤0.001) and have a STI (AOR≤9.1, P≤0.0001) than their male counterparts. Conclusions: Female adolescents receiving mental health treatment were more than nine times as likely to have an STI and more likely to use condoms inconsistently. The standard of care for mental health practice for adolescents should include referrals for STI screening and treatment as well as assessment and discussion of risky sexual behaviours as part of the treatment plan when indicated. Effective programs should address gender-specific communication and behavioural skills.
Background:
African American women experience increased rates of sexually transmitted diseases and HIV. The use of alcohol may increase sexual risk behaviors among this population.
Purpose:
This paper provides a review and critique of the literature examining the association between alcohol use and sexual risk behaviors among African American females including a: (a) synthesis of research findings from adolescent, college-aged/early adulthood, and adult samples; (b) methodological critique of the literature; and (c) guidance for future research.
Methods:
We reviewed 32 studies examining the association between alcohol use and sexual risk behaviors among African American females across developmental periods.
Results:
Similar to previous association studies, results suggest that increased use of alcohol is associated with increased sexual risk practices among African American females. Further, even non-abuse levels of drinking among African American females, at all ages, were related to increased sexual risk-taking.
Conclusions:
Future studies should seek to recruit samples that more fully reflect the diversity of African American women’s experiences across the lifespan. Given the association between alcohol use and/or abuse and the prevalence of STI/HIV-associated risk behaviors and adverse biological outcomes (i.e., STIs, including HIV) among African American females across the lifespan, there is a clear need to develop and evaluate prevention research efforts tailored for this subgroup.