Life Chances Research Articles

Greater PGT-A utilization in IVF clinics does not improve live birth rates but relates to IVF center ownership: a preliminary report.

This study aims to assess whether increased utilization for preimplantation genetic testing for aneuploidy (PGT-A) relates to improved live birth rates in IVF and whether IVF clinic ownership relates to PGT-A utilization. In a retrospective cohort study involving > 90% of US IVF clinics reporting to the Center for Disease Control and Prevention (CDC), stratified for ages (< 35, 35-37, 38-40, 41-42, and ≥ 43 years), and with reference point cycle start, we investigated whether PGT-A utilization related to live birth rates and ownership format as either physician-, academic/hospital/military, or equity/venture capital (VC) owned clinics. The lowest PGT-A-utilizing clinics reported significantly better live birth rates than the highest-utilizing clinics. Youngest patients (under age 35) were most adversely affected by high PGT-A utilization. Clinic ownership, moreover, is significantly related to the utilization of PGT-A, with equity and/or venture capital (VC)-owned clinics being significantly overrepresented among high-utilizing clinics in comparison to clinics owned by private physicians or by academia, hospitals, and the military. PGT-A, overall, reduces live birth chances in IVF, with the risks of adverse outcome effects increasing with growing PGT-A utilization in primarily younger women under age 35. Equity/VC ownership favors increasing PGT-A utilization in comparison to private physician and academic/hospital/military clinic ownership. These findings suggest intervention strategies to reverse excessive PGT-A utilization.

Supplemental Material for Life Chances in College: The Landscape of Food and Housing Insecurity for Trans* Students

Supplemental Material for Life Chances in College: The Landscape of Food and Housing Insecurity for Trans* Students

A Study on Educational Status of Dalit Women through B.R. Ambedkar Perspective: A Special Reference to the Dharwad District in Karnataka

I measure the progress of a community by the degree of progress which women have achieved – Dr. B.R. Ambedkar Education is only key instrument for bringing about a social order based on value of equality and social justice. The State’s special promotional efforts have undoubtedly resulted in educational progress for the Scheduled Caste (SC) especially in regions where policy implementation combined with the dynamism of reform, and most crucially with anticaste, dalit, and religious conversion movements. In the state is withdrawing from social sectors of education, health and delegating its social commitments and responsibilities to private agencies. There is already enough indication that basic educational needs of the SC women’s getting seriously undermined under the new dispensation adversely affecting life chances of vast sections of those who have yet to make the shift to first generation learning. Total SC population 8.6 as per the 2011, beside women constitutes 48% of the total population of India. The principle of gender equity is enshrine in Indian Constitution in its preamble, fundamental, rights, fundamental duties and directive principles and also reducing the gender gap in overall education level. But till now women especially, SC women’s facing more problems in our society because of, properly they won’t reach government policy, scheme and education. Karnataka states achievements in education have been quite remarkable, and the state is moving towards universal literacy at a steady pace. The literacy rate increased from 66.64 % in 2001 to 2011 75.6 %, with the female literacy rate increasing more swiftly than the male literacy rate. Overall, the gender disparity in literacy is declining rather perceptibly and the decline is much more evident in the less economically developed districts of the state. However, the significant point is the increase in total as well as female literacy among the SC women’s, though still at lower pace as compared to the overall population for the country. Hence, this paper is discussion in education status of rural and urban SC women in Dharwad district. A major limitation of the analysis is the inability to provide a comprehensive picture covering all states of the country. The analysis puts forward key issues that merit serious consideration as well as the major recommendations of them.

Pathway Plans – telling my story?

Pathway planning concerns the transition of young people leaving care to independent living and adulthood. This article is based on doctoral research (Stewart, 2009) into the pathway planning process introduced under the Children (Leaving Care) Act 2000 (OPSI, 2000). The research concentrated on the key components of education, training and employment. In particular, it investigated whether such planning could improve the life chances of female care leavers who are teenage parents. Central to the process are the young person’s aspirations and sense of identity, both fundamental to career planning. This article reflects on two key aspects that emerged from the investigations and are pertinent to the practice of career guidance: the value of adopting a narrative framework as developed by Leiblich et al. (1998) when conducting interviews with the young people; and how participation in the pathway planning process supported the young people in exploring, reflecting and re-defining their sense of self.

Social inequalities in the twenty-first century: gaps in access to resources, technology and a sustainable future

The article considers new forms of social inequality, interest in which emerged mainly in the late twentieth and early twenty-first century. Special attention is paid to the analysis of global, digital and environmental inequality. The reasons of sociological interest to these problems are considered, the most important of which are the technological progress, changes in the ways of assessing the level of social inequality, as well as the transformation of research optics and tools of cognition, including the emergence of artificial intelligence technologies.The main characteristics of the new forms of social inequality, their interrelation, levels and measurement criteria are presented. The article describes several perspectives of studying global social inequality. In sociological literature, most of them are related to the transition from the study of the nation-state as a key unit of analysis to the study of global social space. The analysis of digital inequality and the problem of the social divide now appears as a combination of several levels of research and is related to the consideration of access to technology, possession of digital skills, and the life chances and opportunities. Environmental pollution and climate change have led to research interest in socio-environmental inequalities, which are related to the unequal distribution of environmental risks. Environmental neo-colonialism is examined in the context of analyzing environmental inequalities as a factor that rein forces social inequalities.The article concludes that further sociological study of social inequality issues is necessary, analyzes the role of sociology in addressing these issues and actualizing the data.

Cost-Effectiveness of Computer-Assisted Cognitive Behavioral Therapy for Depression Among Adults in Primary Care

Approximately 1 in 5 adults are diagnosed with depression in their lifetime. However, less than half receive help from a health professional, with the treatment gap being worse for individuals with socioeconomic disadvantage. Computer-assisted cognitive behavioral therapy (CCBT) is an effective and convenient strategy to treat depression; however, its cost-effectiveness in a sociodemographically diverse population remains unknown. To evaluate the cost-effectiveness of clinician-supported CCBT compared with treatment as usual (TAU) in a primary care population with a substantial number of patients with low income, limited computer or internet access, and lack of college education. This economic evaluation was a randomized clinical trial-based cost-effectiveness analysis. The trial was conducted at the Departments of Family and Geriatric Medicine and Internal Medicine at the University of Louisville. Enrollment occurred from June 24, 2016, to May 13, 2019. Participants had mild to moderate depression and were followed up for 6 months after treatment completion. The last follow-up assessment was conducted on January 30, 2020. Statistical analysis was performed from August 2023 to August 2024. CCBT intervention was provided for 12 weeks and included 9 modules ranging from behavioral activation and cognitive restructuring to relapse prevention strategies, supported by telephonic sessions with a clinician, in addition to TAU, which included standard clinical management in primary care. The primary health outcome was quality-adjusted life years (QALYs), estimated using the Short-Form 12 questionnaire (SF-12). The secondary outcome was treatment response, defined as at least 50% improvement in the Patient Health Questionnaire. The intervention cost included sessions with mental health clinicians and the cost of the CCBT software, plus the cost of loaner computer and internet data plan for low-resource households. An incremental cost-effectiveness ratio (ICER) was computed, while adjusting for baseline scores, age, and sex. The cost-effectiveness acceptability curve presented the probability of CCBT being cost-effective for a range of willingness-to-pay values. Among the 175 primary care patients included in this study, 148 (84.5%) were female; 48 (27.4%) were African American, 2 (1.2%) were American Indian or Alaska Native, 4 (2.5%) were Hispanic, 106 (60.5%) were White, and 15 (8.6%) were multiracial; and the mean (SD) age was 47.03 (13.15) years. CCBT was associated with better quality of life and higher chance of treatment response at the posttreatment and 6-month time points, compared with the TAU group. The ICER for CCBT was $37 295 (95% CI, $22 724-$66 546) per QALY, with a probability of 89.4% of being cost-effective at a willingness-to-pay threshold of $50 000/QALY. The ICER per case of treatment response was $3623 (95% CI, $2617-$5377). In this trial-based economic evaluation, CCBT was found to be cost-effective, compared with TAU, in primary care patients with depression. As this study included individuals with low income and with limited internet access who are underrepresented in cost-effectiveness studies, it has important policy implications for addressing unmet needs in sociodemographically diverse populations.

Borders, Citizenship, and Global Inequality: What Barriers, Pushbacks, and Passport Controls Reveal About Our Understanding of the Equality of Humankind

Abstract Borders are ubiquitous. As invisible lines, they contribute to a functioning world order and guarantee security for the people. In the form of walls and fences, they divide society and establish strongholds of prosperity that are not accessible to everyone. A similar effect can be observed in connection with the concept of citizenship, which binds people fatefully to a particular territory and thus significantly determines an individual’s life chances. This article shows how borders and their protection as well as the concept of citizenship challenge fundamental ideas of justice and traces discourses that seek to evolve the current border and citizenship regimes into a more universal and just form of human coexistence.

The fall and rise of parental financial investments during the COVID‐19 pandemic

AbstractObjectiveThis research note investigates changes in American parents' financial investments in children during the COVID‐19 pandemic, as well as whether and how changes in parents' spending varied based on parental education.BackgroundParents purchase goods, experiences, and services that shape children's human capital and life chances. Socioeconomic differences in parental expenditures on children represent an important pathway for perpetuating inequality across generations. The COVID‐19 pandemic disrupted children's lives in ways that may have changed these levels of investment.MethodThe 2015–2022 Consumer Expenditure Survey (CEX) is used to describe spending on five key categories of investments in children's human capital (educational spending, extracurricular activities and lessons, computers and tablets, formal childcare, informal childcare) overall and by parental education. Mediation analysis assesses the extent school closures explain these changes.ResultsChildcare and extracurricular expenditures initially decreased significantly and then gradually recovered to pre‐pandemic levels by the end of 2021. Cutbacks were primarily among more educated families. However, spending on schooling increased in 2021 and computer and tablet purchases spiked in 2020, particularly among more educated families. Mediation analysis suggests that when expenditures were most affected by the pandemic (in 2020), school closures explained 50%–70% of those changes.ConclusionThis note provides evidence that during the pandemic socioeconomic inequalities in child‐related spending decreased in some categories of spending (e.g., childcare and extracurriculars) and increased in others (e.g., computers and tablets). Many changes appeared short‐term, but changes in education point to possible longer‐term shifts in parents' preferences about children's educational environments.

Gendered Taxation: IMF Tax Advice and the Unintended Disempowerment of Women

Case research points to the gendered effects of the value added tax (VAT), which may particularly disadvantage women by crowding out their economic participation. A key driver of VAT introductions has been the International Monetary Fund (IMF). To counterbalance of-payments woes, IMF advice for cash-stripped countries has frequently focused on shifting toward broad-based consumption taxes while lowering trade taxes and corporate income taxes. We expect this tax policy advice – while ostensibly gender-blind – to contribute in practice to a deterioration in women’s socioeconomic well-being. To test this hypothesis, we construct a panel dataset for 147 countries from 1980 to 2016 and estimate the effect of IMF programs on women’s economic participation, education and health. Accounting for selection effects, we find that women’s life chances deteriorate relative to men’s if a country undergoes an IMF program with tax conditionality. We corroborate these findings to demonstrate the mechanism underlying these effects by showing a negative effect of IMF-induced de jure VAT adoption on women’s life chances. We provide complementary individual-level evidence from the World Values Surveys based on 98 countries from 1981 to 2019. We show that during an IMF program with tax conditionality, women are significantly less satisfied with home life and report more material hardships. Our results provide evidence of the potential for unintended consequences of IMF revenue prescriptions for women, supporting calls for increased attention to gender-responsive budgeting.

An Intersectional Approach to Family Life: Reflections on Same-Sex Marriage, Familisation Risks, and Defamilisation Risks in Mainland China

This article focuses on how the policy on same-sex marriage and a person’s social locations impact upon Chinese lesbians’ life chances and welfare. Bringing the familisation and defamilisation literature, which has predominantly focused on heterosexual populations and families, into dialogue with an intersectionality perspective, we map the ways in which gender, sexuality, and class intersect in shaping lesbians’ experiences of defamilisation and familisation risks. The findings, drawn from interviews conducted in Beijing, China, reveal that the absence of legalised same-sex marriage, coupled with a lack of familial and societal recognition of same-sex relationships, exposes lesbians to both defamilisation and familisation risks, leading to difficulties in choosing whether and how to participate in the family. The intersectionality lens guides us to move beyond the heterosexual/homosexual boundary and to rethink the possibility of welfare alliances that can improve the welfare of not only lesbians but also other groups of women and minorities.

Unincorporation in counties as a political determinant of health: An exploration of five states

Local government policies and practices shape the context of the places that can alter a population's life chances through socioeconomic factors, built environments, and healthcare access. County governments, one of the most ubiquitous U.S. political structures, impact health outcomes within their jurisdiction through multiple policy levers and pathways. By identifying which political determinants within counties are associated with variation in life expectancy and premature death, we can better intervene on modifiable factors. One overlooked political determinant from public health studies is the county's responsibility as the primary local government for approximately a third of the U.S. population and 93% of land in unincorporated areas. To conduct an ecological study and assess associations between county population health and county responsibility for unincorporated areas and populations, we created and tested two county indicators of unincorporation. Multilevel multivariable regression results showed that larger proportions of unincorporated land within a county are associated with lower average county life expectancy. More testing of the measurement is needed to understand the relationship between unincorporation, county government, and population health outcomes.

INTRODUCTION: Africa's quest for inclusion: Trends and patterns

Social inclusion is a multifaceted concept and is a critical pillar for transformative economic development. Its opposite, social exclusion entails the lack of or denial of resources, rights, goods and services, and the inability to participate in normal relationships and activities, available to people in a society, whether in economic, social, cultural, or political contexts. It affects the quality of life of individuals, the equity and cohesion of society and the lived experiences of citizens (Levitas, Pantazis, Fahmy, Gordon, Lloyd, &amp; Patsios, 2007). Social inclusion, considers the terms of engagement of individuals and or groups in society, assessing the ability of the system to improve the capability, opportunity, and dignity of those disadvantaged based on their identity (World Bank, 2024). The inability of individuals or communities to make meaningful and consistent contributions reflects their exclusion. Exclusion can be based on age, gender, occupation, ethnicity, race, religious beliefs, citizenship, disability, or sexual orientation (World Bank, 2024). There are differing levels of exclusion. When exclusion is deep, it is characterised by a lack of access to one or more domains resulting in severe negative consequences to quality of life, well-being, and future life chances (Levitas et al., 2007).

Class and Ethno-Gender Differences in Education and Labour Market Position—An Intersectional Analysis of Ethnic Integration in the UK

This paper analyses the socio-economic disadvantages of women from different ethnic minority heritages in the UK. Using data from the Labour Force Survey (2014–2023), which contains detailed information on parental class and respondents’ socio-economic conditions, we examine four domains of life chances which are crucial for ethnic integration: educational attainment at the degree level, risks of unemployment, access to professional-managerial (salariat) position and earning power. We proceeded with the gross differences and then examined the differences by ethno-gender status and parental class combinations, controlling for many confounding factors. We also examined the net ethno-gender differences over the life course and the trends of social fluidity over the period covered and across the ethno-gender groups. We found that women from all ethnic origins were doing well in education but faced multiple disadvantages in the labour market, especially in access to the salariat and in earning power. Women of Pakistani/Bangladeshi heritages faced pronounced unemployment risks, especially at the earlier life stages. There is a significant increase in fluidity over the period covered, but this is marked by considerable ethnic and class differences, with Black Caribbean, Black African, Pakistani and Bangladeshi women from more advantaged class origins being unable to secure advantaged class positions and those from working-class families unable to make long-range upward mobility as effectively as White men. Overall, Bangladeshi, Pakistani, Black African and Black Caribbean women are found to be considerably disadvantaged, but there are also signs of social progress.

Identify high-risk DOR women ≤ 35 years old following assisted reproduction technology through cutoffs of anti-mullerian hormone and antral follicle counts

BackgroundFemales with diminished ovarian reserve (DOR) have significantly lower cumulative live birth rates (CLBRs) than females with normal ovarian reserve. A subset of young infertile patients, whose ovarian reserve is declining but has not yet met the POSEIDON criteria for DOR, has not received the attention it merited. These individuals have not been identified in a timely manner prior to the initiation of assisted reproductive technology (ART), leading to suboptimal clinical pregnancy outcomes. We categorized this overlooked cohort as the “high-risk DOR” group.ObjectiveThe primary aim of this study was to identify high-risk DOR patients through anti-Mullerian hormone (AMH) and antral follicle counts (AFCs).MethodsA total of 10037 young women (≤ 35 years old) who underwent their first initial oocyte aspiration cycle at a single reproductive medicine center were included and further classified into three groups, based on the thresholds for AMH and AFC established through receiver operating characteristic (ROC) analysis and in alignment with the POSEIDON criteria. Two ROC analyses were performed to identify the cutoff values of AMH and AFC to obtain one viable embryo (one top-quality embryo or one viable blastocyst). The cutoffs of ROC were measured by sensitivity and specificity. The primary outcome was the cumulative live birth rate (CLBR) per oocyte aspiration cycle. The secondary outcomes included the number of oocytes retrieved and the number of viable embryos formed. Pearson’s chi-square tests were conducted to compare the clinical outcomes among the three groups. Furthermore, univariate logistic regression analyses were performed to investigate the associations between ovarian reserve and clinical outcomes. All of the above comparisons between the high-risk DOR and NOR were further confirmed by propensity score matching (PSM) (1:1 nearest-neighbor matching, with a caliper width of 0.02).ResultsAccording to the ROC analyses and POSEIDON criteria, the present study identified a population of high-risk DOR patients (1.20 ng/mL < AMH values < 2.50 ng/mL, with 6 ≤ AFC ≤ 10; n = 682), and their outcomes were further compared to those of DOR patients (positive control, AMH values ≤ 1.2 ng/mL, and/or AFC ≤ 5; n = 1153) and of NOR patients (negative control, 2.5 ng/mL ≤ AMH values ≤ 5.5 ng/mL, and 11 ≤ AFC ≤ 20; n = 2649). Patients in the high-risk DOR group had significantly lower CLBRs than those in the NOR group (p < 0.001) but higher CLBRs than those in the DOR group (p < 0.001). Logistic regression further demonstrated that high-risk DOR was associated with a lower likelihood of cumulative live birth chance (OR 0.401, 95% CI: 0.332–0.486, p < 0.001) than NOR was, with a greater likelihood of cumulative live birth chance (OR 1.911, 95% CI:1.558–2.344, p < 0.001) than DOR was. To investigate the effects of embryo development stage, the outcomes of D3 embryos and blastocysts were analyzed separately. Significant differences in pregnancy outcomes were detected only in D3 embryo ET cycles among the three groups (high-risk DOR vs. NOR, all p < 0.05; DOR vs. NOR, all p < 0.05). DOR/high-risk DOR did not influence the pregnancy loss rates or pregnancy outcomes (clinical pregnancy rates and ongoing pregnancy rates) per positive HCG cycle (all p > 0.05). After PSM, the differences in ovarian response and pregnancy outcomes between the high-risk DOR and NOR groups were consistent with the results before PSM.Conclusion(s)Our study revealed that the CLBR of the high-risk DOR patients was significantly lower than that of females with normal ovarian reserve and greater than that of females with DOR. The values of AMH ranging from 1.2 to 2.5 and AFC ranging from 6 to 10 appeared to constitute meaningful thresholds in females with mildly reduced ovarian reserve.

Examining trends in school segregation in compulsory and upper secondary education in Sweden: the showcase of an urban school market

ABSTRACT Educational success is central to the life chances of young people, but increasing differences in student achievement between schools are commonly attributed to increasing school segregation. The aim of the study was to examine the trends in socioeconomic, ethnic, and academic segregation in compulsory and upper secondary education in the Gothenburg school market between 1998 and 2020. Utilizing register data from the Gothenburg Longitudinal Database (n = 1 662 166), the study showed that school segregation intensified over time and across education levels, particularly in the Gothenburg municipality and upper secondary education. The geography of upper secondary education becomes more clustered after stricter upper secondary qualifications are implemented. These findings are discussed in relation to the Swedish school reforms that resulted in the materialization and expansion of the school market with a significant increase in school provisions, leading to the (re-)production of unjust geographies.

Tackling inequalities in preconception health and care: barriers, facilitators and recommendations for action from the 2023 UK preconception EMCR network conference.

Reducing inequalities in preconception health and care is critical to improving the health and life chances of current and future generations. A hybrid workshop was held at the 2023 UK Preconception Early and Mid-Career Researchers (EMCR) Network conference to co-develop recommendations on ways to address inequalities in preconception health and care. The workshop engaged multi-disciplinary professionals across diverse career stages and people with lived experience (total n = 69). Interactive discussions explored barriers to achieving optimal preconception health, driving influences of inequalities and recommendations. The Socio-Ecological Model framed the identified themes, with recommendations structured at interpersonal (e.g. community engagement), institutional (e.g. integration of preconception care within existing services) and environmental/societal levels (e.g. education in schools). The co-developed recommendations provide a framework for addressing inequalities in preconception health, emphasising the importance of a whole-systems approach. Further research and evidence-based interventions are now needed to advance the advocacy and implementation of our recommendations.

One-to-one counselling and school attendance in the UK: a single group pre-post study

ObjectiveAbsence rates remain high in UK schools, with negative implications for attainment, life chances and inequality. Reasons for non-attendance are complex but include psychosocial factors. Few UK-based studies have evaluated...

Evaluating a targeted selective speech, language, and communication intervention at scale – Protocol for the Happy Talk cluster randomised controlled trial.

Background In areas of social disadvantage up to 40–50% of children enter preschool with speech and language skills significantly poorer than would be expected for their age. The Happy Talk trial tests if a community embedded, targeted selective speech and language programme that simultaneously engages with parents and early childhood educators, (1) improves language outcomes in children aged between 2 years 10 months and 6 years and (2) is cost effective for the health care system. Method The Happy Talk trial is a large scale cluster randomised trial of a 12-week manualised intervention delivered in pre/school settings serving socially disadvantaged communities, in Ireland. Seventy-two clusters will receive the intervention (12 participants per cluster). Parents and pre/school staff engage in group training and coaching in the form of 12 1-hour sessions for parents and four staff workshops, over the course of the pre/school year. Training/coaching includes core interaction skills (modelling, expanding, balancing questions and comments), early literacy and phonological awareness. Blinded assessments pre- and immediately post-intervention and at 6 months follow up, will measure the primary outcomes of children’s receptive and expressive language and functional impact, and secondary outcomes of quality of life. Parental responsiveness and educator-child interactions will also be evaluated. Discussion This robust study evaluates a public health approach to the delivery of speech language and communication intervention in the ‘real world’ in the community, which focuses on prevention and equity of access. Pilot work indicates that the programme is feasible, acceptable to parents and staff, cost effective, and suitable for implementation at scale. The trial includes a process evaluation, a well-developed economic evaluation and the outcomes are directly relevant to children, families and educators. This work has the potential to improve the long-term outcomes and life chances of people living in social disadvantage. Trial registration clinicaltrials.gov NCT06460090 Trial Management There is a formal governance structure to oversee the conduct and running of the trial, consisting of a trial management group and a steering committee. More details on the composition, roles and responsibilities of each committee can be found in the supplemental material.

Raising post‐secondary education participation of young people transitioning from care: The effects of extended legislative support

AbstractOut‐of‐home care is associated with a range of negative social outcomes for the young people who experience it. The most promising path to improved life chances for care‐experienced young people is arguably through education, especially post‐secondary education. Currently, no national data are collected on the post‐secondary education participation of care‐experienced young people. However, the evidence that exists suggests their participation rate is likely very low. Historically, one reason for post‐secondary participation gaps has been the fact that care ended abruptly at 18 years, forcing care‐experienced young people into independence much faster and earlier than the vast majority of their same‐age peers. The recent extension to care to 21 years for most young people in care across all Australian jurisdictions has changed the out‐of‐home care landscape considerably. A central question is whether the extension of care will, in itself, result in increased post‐secondary education access and success for care‐experienced young people. We address this question through an examination of the current out‐of‐home care and education landscape, including state and territory legislation, Australian Government policy and current post‐secondary settings and outcomes.

EYoung men's experiences of violence and poverty and the relationship to sexually transmissible HIV: a cross sectional study from rural South Africa.

Young (ages 18-35 years) men are inadequately engaged in HIV prevention and treatment globally, including in South Africa, increasing the likelihood of them having sexually transmissible HIV (i.e. living with HIV but with high viral loads). We sought to understand how men's experiences of poverty and violence, impacted on transmissible HIV, directly or indirectly via mental health and substance misuse. Rural communities in northern KwaZulu-Natal, South Africa. Cross-sectional population-based random selection (September 2018-June 2019), assessing transmissible HIV (living with HIV and viral load ≥400 copies/mL) via dried blood spots, and socio-demographic data. Structural equation models (SEM), assessed direct and indirect pathways from food insecurity and violence experience to transmissible-HIV, with mediators common mental disorders, alcohol use, gender inequitable attitudes and perceptions of life chances. 2,086 young (ages 18-36 years) men and 8.6%(n=178) men had transmissible HIV. In SEM no direct pathways between food insecurity, or violence experience, and transmissible HIV. Poor mental health and alcohol use mediated the relationship between violence experience and food insecurity and transmissible HIV. Life chances also mediated the food insecurity to transmissible HIV pathway. There was a high level of transmissible HIV in a representative sample of young men. The analysis highlights the need to address both the proximate 'drivers' poor mental health and substance misuse, as well as the social contexts shaping these among young men, namely poverty and violence experience. Building holistic interventions that adequately engage these multiple challenges is critical for improving HIV among young men.