Unprotected Sex Research Articles

Characteristics and associations between sexting and high-risk sexual behaviors among college students in Jiangxi Province, China.

Background To explore the characteristics, influencing factors, and associations between sexting and high-risk sexual behaviors among college students in Jiangxi Province, China, providing a basis for promoting sexual health education and preventing high-risk sexual behaviors among college students. Methods A convenient sampling method was used to conduct an anonymous survey on 13,976 students from 15 universities in Jiangxi Province from November to December 2023. Chi-squared tests and binary logistic regression analyses were employed to investigate the influencing factors and associations between sexting and high-risk sexual behaviors. Results The reported rates of sexting and high-risk sexual behaviors among college students were 12.7% and 11.0%, respectively. Regression results indicated that the influencing factors for both behaviors included sex, grade, major, sexual orientation, knowledge of HIV/AIDS and family upbringing methods (P -values all Conclusion The prevalence of sexting and high-risk sexual behaviors among college students in Jiangxi Province should not be overlooked, and those with sexting experiences are more likely to engage in high-risk sexual behaviors. Educators should enhance sexual health education and safety control of sexual behaviors among college students.

Gambling in Connecticut adolescents: Prevalence, socio-demographic characteristics, trauma exposure, suicidality, and other risk behaviors.

Adolescent gambling is a public health concern and has been linked to suicidality, various risk behaviors, and poor health outcomes. However, there is a limited understanding of specific risk and protective factors that may influence gambling behavior in Connecticut adolescents, especially in changing gambling environments. This study examines relationships between adolescents reporting gambling in the past-year and a range of health risk behaviors including vaping, traumatic experiences, academic performance, and receipt of social support. Data from the 2019 Youth Risk Behavior Survey in Connecticut high school students stratified by gambling status were examined in bivariate and multivariate analyses. Among 1,807 adolescents, past-year gambling was reported by 453 individuals [25.4%; 95% confidence interval [CI] = 22.7-28.1%]. Gambling prevalence was higher among older males and lower in adolescents of Asian origin. Gambling was further associated with suicidality and risk behaviors including substance use, smoking [traditional tobacco and electronic vapor use], risky use of digital technologies, unsafe sex, and aggressive behaviors. Gambling was also associated with traumatic experiences, depression/dysphoria, poor academic performance, and less familial social support. The results provide an up-to-date estimate of the current prevalence and correlates of gambling among Connecticut adolescents. The results provide recent estimates of the prevalence and correlates of gambling among Connecticut adolescents. The findings highlight the need for further investigation of specific factors like social support that help with designing and implementing tailored interventions.

Acceptability and Efficacy of an Adapted School-Based Dialectical Behavioral Therapy Skills Group for Adolescents: A Qualitative Perspective.

Adolescence is characterized by heightened emotion dysregulation, impulsivity, and engagement in high-risk behaviors, such as substance use, violence, and unprotected sexual activity. Dialectical Behavioral Therapy for Adolescents (DBT-A) is an evidence-based intervention that targets emotion regulation and impulsivity among adolescents, proven effective at decreasing high-risk behaviors. However, limited research exists on adolescents' perceptions of DBT-A, particularly in schools. The current study aimed to understand adolescents' perspectives on a DBT-A skills group delivered within urban high schools in a midwestern state. The study sample of 18 youth (mean age 14.7; 66.7% male; 38.9% Black) completed individual semi-structured qualitative interviews assessing their perspectives on the DBT-A skills group. Interview topics included the program's impact on youths' daily lives, risk-taking behaviors, skill acquisition, and general feedback about the group. Fifteen of the eighteen participants (86%) reported acceptability of the program, expressing that they enjoyed the content and would recommend the group to peers. Participants observed positive impacts on their daily lives, including self-reported enhanced ability to regulate their emotions, communicate with teachers, effectively adapt their mindsets and motivations, and make healthy relationship decisions. Additionally, some noted an increased feeling of connection to their peers following the group. Delivering the DBT-A skills group in schools was shown to have high rates of acceptability among youth and resulted in improved emotion regulation and reduced impulsivity. Further research is needed to assess long-term effects of this program and to identify best training practices for school staff to implement and sustain the program long-term.

Risk factors associated with human Mpox infection: a systematic review and meta-analysis

BackgroundMpox emerged as a significant global public health concern during the 2022–2023 outbreak, impacting populations in both endemic and non-endemic countries. This study reviews and synthesises evidence on the risk...

Comparison of levonorgestrel in different forms and copper intrauterine devices for emergency contraception: A systematic review and meta-analysis.

Emergency contraception serves as the only dependable method for women to prevent pregnancy following unprotected sex. Among emergency contraception methods, the copper intrauterine device provides continuous, highly effective contraception for over a decade. This study aimed to evaluate the effectiveness, safety, and side effects of the copper intrauterine device over methods containing levonorgestrel for emergency contraception. We conducted a systematic review and meta-analysis and systematically searched PubMed, Embase and the Cochrane Central Register of Controlled Trials databases. Five studies, involving a total of 1,510 patients, were included in our meta-analysis, with 511 receiving the copper intrauterine device. Our findings indicate that the copper intrauterine device is more effective than methods containing levonorgestrel for emergency contraception (OR=0.16; 95% CI=0.04 to 0.62; P=0.60; I2=0%). Additionally, levonorgestrel-containing methods were preferable among women who underwent EC compared to the intervention group (OR=0.29; 95% CI=0.15 to 0.55; P<0.01; I2=79%) and the use of an effective method of contraception after EC was higher in the Cu-IUD group compared to the control group (OR=2.93; 95% CI=1.99 to 4.30; P=0.38; I2=0%). The copper intrauterine device is highly effective and offers long-term contraception for women using it as emergency contraception. However, the use of oral levonorgestrel continues to be the method with the highest rate of preference by women.

Discussion of HIV and Other Sexually Transmitted Infections With Sex Partners of Nigerian Men Who Have Sex With Men and Transgender Women: Implications for Interventions to Promote Safer Sex Practices.

Discussion of HIV and other sexually transmitted infections among sex partners facilitates risk reduction. We evaluated HIV/STI-related communications, including broad assessment of any self-reported discussion of the topic and specific discussion of each partner's HIV status, among a historically marginalized and presently criminalized community of sexual and gender minorities (SGM) in Nigeria. From 2013 to 2018, we enrolled SGM aged 18+ years in Lagos or 16+ years in Abuja who reported anal sex with men. At enrollment and 3-, 9-, and 15-month follow-up visits, participants were asked about their sexual behaviors and communications with main sexual partners (MSP) and casual sexual partners (CSP). Questions included "have you talked with your [MSP/CSP] about sexually transmitted infections and HIV?" Multivariable robust Poisson regression with generalized estimating equations was used to estimate adjusted relative risks (aRRs) and 95% confidence intervals (CIs) for factors potentially associated with HIV/STI-related communications with some or all of each type of sexual partner. Among 2795 SGM enrolled with median age 23 years (interquartile range 20-27), questions about HIV/STI-related communications with MSP were answered by 2436 (87.2%) and with CSP by 2398 (85.9%) SGM. Communication with MSP was reported by 68.1% (1659/2436), of whom 897 (54.1%) discussed their own HIV status and 925 (55.8%) discussed their partner's status. Communication with CSP was reported by 43.9% (1052/2398), of whom 389 (37.0%) discussed their own HIV status and 385 (36.6%) discussed their partner's status. Among participants with both MSP and CSP, HIV/STI-related communication with MSP was more common among participants with higher than secondary education [aRR 1.40 (95% CI: 1.24 to 1.58)], who were divorced/separated/widowed [aRR 1.19 (95% CI: 1.06 to 1.33)], who discussed their HIV status with CSP [aRR 1.18 (95% CI: 1.10 to 1.25)], discussed CSP's HIV status [aRR 1.20 (95% CI: 1.13 to 1.27)], and used a condom at last sex with CSP [aRR 1.16 (95% CI: 1.08 to 1.25)]. HIV/STI-related communication with CSP was more common among participants with higher than secondary education [aRR 1.36 (95% CI: 1.12 to 1.66)], who were divorced/separated/widowed [aRR 1.38 (95% CI: 1.13 to 1.69)], who discussed their HIV status with MSP [aRR 1.47 (95% CI: 1.27 to 1.69)], who discussed CSP's HIV status [aRR 1.22 (95% CI: 1.06 to 1.40)], and used a condom at last sex with CSP [aRR 1.22 (95% CI: 1.08 to 1.38)]. HIV/STI-related communications with main and casual sex partners were both associated with safer sex with CSP. HIV prevention and treatment programs for SGM should promote open communications in sexual relationships and consider deployment of modern strategies to facilitate disclosure, especially in settings with criminalizing legislation.

Sexual Practices and HIV Prevention Strategies Used by Female Sex Workers in Lagos, Nigeria: An Assessment of the Willingness to Use a Microbicide.

Female sex workers have a 13-fold higher risk of acquiring HIV than women who do not engage in sex work. The willingness and acceptability of a product is crucial for the development of microbicides. This research aimed to evaluate the sexual practices, existing HIV prevention methods, and willingness to use a microbicide for HIV prevention among female sex workers in Nigeria. We also explored factors that might influence their willingness to use a new microbicide product. A cross-sectional study was conducted among female sex workers recruited from brothels within Lagos-Nigeria, in which participants were selected via purposive sampling over a period of five-months. An interviewer-administered, semi-structured questionnaire was used to obtain information. Descriptive statistics were used to present the results, and a multiple logistic regression model was used to determine the factors associated with willingness to use a microbicide. A total of 461 female participants with a mean-age of 29.63 ± 8.8 years were included in the analysis of which 34.3% had >4 sexual partners, 91.8% used condoms, 53.6% engaged in anal sex, 69.6% had experienced condom rupture, and 31% would "accept unprotected sex" if the male partner refuses to use a condom. Approximately 43% had received PEP, of which only 15% completed the one-month PEP-regimen. On the other hand, 64.6% had taken PrEP medications, of which 28% admitted skipping doses. Although 41% were concerned about male partner acceptance, a total of 95% will be willing to use a microbicide. The number of sexual partners ([aOR] 1.555; 95% Cl 1.035-2.335), use of condoms ([aOR] 4.701; 95% Cl 1.418-15.584), and condom rupture experience ([aOR] 2.550; 95% Cl 1.817-7.959) were associated with greater odds of willingness to use an HIV microbicide. There is a high level of willingness to use a future microbicide among the female commercial sex workers in this study. In addition, majority of the participants will prefer a microbicide product that is female controlled, affordable, and provided as an over-the-counter medication. This cohort of women engage in high-risk sexual practices and play a significant role in HIV prevention efforts. Therefore, their product preferences and concerns should be considered in microbicide development to enhance the acceptability, adherence, and efficacy of future microbicides.

Patient-reported outcomes in physical, cognitive, and sexual health in early-onset gastrointestinal cancers (EOGIC).

72 Background: Incidence of early-onset (ages 18-49) gastrointestinal cancers is alarmingly increasing. To assess unmet needs in health-related quality of life (HRQoL), we conducted this pilot study using PRO measures in patients with EOGIC. Methods: Patients ages 18-49 with any GI cancer seen at our center during a clinic visit were invited to participate in this cross-sectional study. Validated PRO tools PROMIS 29+2, GP5 from FACT-G, AYA Sexual Health PRO Battery and Adult Neuro-QOL Cognitive Function short form were administered. Participants’ PROMIS 29+2 responses were scored to generate a T score, and two-tailed t-tests were used to compare T scores with the average score from a large general US population. The electronic medical record was reviewed to collect demographic, diagnosis and treatment information. Results: 39 (85% response rate) patients were enrolled from 03-08/24. Table 1 describes demographics, diagnoses, and treatment. In the PROMIS 29+2, EOGIC patients reported significantly lower physical function and higher anxiety, depression, fatigue and pain interference compared to the general US population: t-score (T-test p-value) 40.4 (p 0.0003), 57.7 (p 0.005), 55.7 (p 0.017), 55.1 (p 0.033) and 58.5 (p 0.0001), respectively. 56% reported being at least somewhat “bothered by side effects of treatment,” and this measure has a known correlation with clinician reported adverse events. Regarding sexual health (SH) in prior 30 days, 79% of participants felt less whole or “damaged” due to their disease, 64% were sexually active, 56% had some distress due to change in SH, and 50% were worried about their romantic relationship(s). Patients identified discussing safe sex with low counts, body image, contraception and addressing sexual problems as areas of unmet need during their care. They reported not receiving counseling from their care teams: only 15% discussed safe sex with low counts, 28% contraception, 13% STI prevention, and 18% discussed effect of cancer on body image. No significant change in cognitive functioning over the preceding 7 days was reported in this study. Conclusions: PROs are an important tool in clinical and survivorship care of young patients with GI cancers. We discovered that decreased physical function, increased anxiety, depression, fatigue and pain significantly effect HRQoL patients with EOGIC. We also found high unmet need to address sexual health in patients with EOGIC. Our ongoing work aims to better understand and address these needs for our patients. Demographic, diagnostic, and therapeutic characteristics of participants. Age At study participation 24-49 median 43 Gender Female 26 66.7% Primary cancer Colorectal 19 48.7% Pancreatic 5 12.8% Biliary tract cancers 5 12.8% Esophageal/Gastric 3 7.7% Other (including anal, NET, GIST, appendiceal) 7 17.9% Stage Metastatic 22 56.4% Treatment On any active treatment 24 61.5% On chemotherapy 20 51.2%

College drinking and sexual health behaviors at a rural northeastern institution: Implications for tailored multilevel intervention

Objective College students experience elevated rates of alcohol and sexual risk behaviors, but underrepresentation of rural institutions precludes tailored intervention. This study characterizes prevalence and short-term alcohol-sex risk at a rural institution. Participants Undergraduates at a rural northeastern university. Method Online health behavior surveys at Time 1 (T1; N = 327) and Time 2 (T2; n = 150, M interval=34 ± 7 days). Results 75% reported lifetime, 73% past-year, and 65% past-month drinking at T1. Despite past-month sexual risk behavior (48% without barrier, 31% under influence of alcohol/drugs, 12% without querying STI status), only 23% endorsed past-year STI testing. Drinking students were more likely than non-drinking peers to endorse all sexual risk behaviors. T1 drinking was associated with T2 sex, sex under the influence of alcohol/drugs, and unprotected sex. Conclusions College drinking predicted short-term sexual risk behaviors at this rural institution, suggesting potential unique risk mechanisms. Findings may inform multilevel, culture-centered intervention for students attending rural universities.

The Critical Role of Penicillin in Syphilis Treatment and Emerging Resistance Challenges

Syphilis, a global healthcare burden, is a sexually transmitted infection caused by the spirochete Treponema pallidum, a spiral-shaped, Gram-negative obligate human pathogen. Despite its easy identification and treatability, the disease affects over 50 million people worldwide, with 8 million new cases in the 15–49 age group annually, as per the WHO 2024 report. If left untreated, syphilis progresses through its primary, secondary, latent, and tertiary stages, causing severe complications like neurosyphilis, congenital syphilis, and organ damage. The first-line treatment, penicillin, faces challenges, including logistical issues, shortages, allergic reactions, and patient non-compliance. Secondary treatment options are sparse, and there are reported cases of T. pallidum strains resistant to those antibiotics. The absence of an effective vaccine for syphilis has led to efforts to control its spread through sexual education, condom usage, and post-exposure prophylaxis with doxycycline, which raises concerns about antimicrobial resistance (AMR). The continued reliance on penicillin and the increasing rates of doxycycline post-exposure prophylaxis (DoxyPEP) use have both contributed to concerns about AMR development. Recent works pointing to emerging antibiotic resistance and treatment failures highlight the urgent need for new antibiotics to manage syphilis effectively and reduce dependency on penicillin. This review has focused on the shortcomings and limitations of penicillin treatment, recently identified antimicrobial-resistant strains of T. pallidum, and case studies where its application failed to treat the disease adequately.

P-139. Characteristics of Veteran Travelers at the Clement J. Zablocki Veterans Affairs Medical Center

Abstract Background Travel location, demographics, and the type of travel are critical determinants of the pre-travel consultation. Veterans represent a unique subpopulation of the US. They earn higher average salaries than their non-veteran counterpart and have access to free healthcare. This puts them in a position to spend more on personal travel, yet there is a paucity of data on veterans' travel preferences and habits. In this study, we examined veteran travel characteristics to provide information on how best provide pre-travel consultation. Methods This is a retrospective chart review of veterans who presented to the Clement J Zablocki Veterans Affairs Medical Center (VAMC) infectious disease clinic for a pre-travel consultation between 7/1/2017 and 4/11/2023. Results Of the 181 veterans in this study, 150 were male, 29 were female, and two were unknown. The mean traveler was 55.62 years old. Asia (n=87, 48.1%) was the most frequently traveled continent, followed by Africa (n=47, 26%). Veterans were independently traveling (n=121, 67%) for durations greater than one week (n=164, 91%), with 13.3% traveling for at least 2-3 weeks. Within Asia, 23% (n=20) traveled to the Philippines, 26% (n=23) to Vietnam, and 17% (n=15) traveled to Thailand, of these 67% traveled for 4 weeks or more (n=29, 67%). Conclusion According to data collected in 2020 by the United Nations World Tourism Organization (UNWTO), the world's top 10 destinations are all within Europe and North America and account for 40% of all global travel. In addition, most group travel is generally one week long. Comparatively, veterans travel longer, more independently, and to more diverse parts of the world. Veteran travel clinics need to be equipped to discuss risks or longer term travel including international health care, safe sex practices and vaccines such as rabies and Japanese encephalitis. Disclosures All Authors: No reported disclosures

Empowerment in prevention: a qualitative inquiry into Black girl-centred strategies for reducing HIV/STI and drug misuse risk

Black girls in the United States are disproportionately diagnosed with sexually transmitted infections (STIs), which can increase the risk of contracting HIV (human immunodeficiency virus), compared to adolescent girls of other races. Therefore, this study was designed to understand barriers to impactful HIV/STI and substance use prevention programmes for Black girls. Data was collected between October 2021 and June 2022 from twelve focus groups which included (N = 62) participants who identified as Black and female between the ages of 13 and 18 years old. Using intersectionality theory as a guiding framework, the data were analysed thematically. The analysis revealed three themes: 1) need for parent-child discussions on sex; 2) stigma in schools; 3) suggestions for Black girl-centred prevention programming. Participants described minimal discussion about sex in their household as well as STI/HIV and substance abuse stigma as barriers to impactful sex education. They also indicated that current substance use and STI/HIV prevention interventions are not tailored to the experience of Black girls and offered suggestions for improvement. In sum, participants pointed out several barriers to existing sex education and substance abuse prevention programs. Findings revealed that HIV and drug use prevention information and knowledge may be best received from older peers in small private settings that can allow for intimate discussion and sharing of reliable information on HIV education, aetiology, and safer sexual practices. In addition, the study findings support the need to develop a racial and gender-specific prevention programming that fosters peer relationships, social support, and empowerment-based principles.

P-499. HIV Risk Perception, Substance Use, and Sexual Practices Among Circuit Party Attendees

Abstract Background Circuit parties are large-scale dance events catering to the LGBTQ+ community. Research suggests high rates of HIV and substance use among participants. This study explores HIV knowledge, awareness of prevention services, perceived and actual HIV risk among attendees of the White Party, a circuit party held in California with an estimated 30,000 participants. Methods Data were gathered from 137 attendees who visited a health booth, where interested individuals completed a self-administered survey on a tablet computer. The survey used the validated Minority AIDS Initiative (MAI) Adult Questionnaire assessing demographics, perceived risk related to substance use and sexual activities, and self-reported risk behaviors in these domains. Following survey completion, participants received a non-monetary incentive (event merchandise). Results The average age of respondents was 38 years, with 26% identifying as Hispanic, 63% as White, 8% as Black, and 17% as Asian. Bivariate and multivariable logistic regression analyses were conducted to explore associations between knowledge of HIV status, awareness of HIV prevention resources, reports of unprotected sex, and the number of sexual partners. Younger participants and those with lower income levels were less likely to know their HIV status. Similarly, Hispanic respondents and those with lower income levels were less likely to know how to access HIV and SUD prevention. A higher perceived risk did not reduce a high incidence (82%) of unprotected sex. Individuals with a history of intimate partner violence (IPV) (18%) were more likely to engage in unprotected sex. Additionally, non-injection substance use was correlated with binge drinking and a higher number of sexual partners. Conclusion This study highlights the need for comprehensive interventions at LGBTQ+ events, addressing substance use and HIV risk simultaneously. Interventions focusing on raising awareness of HIV risks may not be effective in changing behavior. Available interventions should include screening and support for IPV, prioritizing HIV testing among younger attendees, offering culturally tailored outreach in Spanish, and addressing socioeconomic barriers to accessing prevention services. Disclosures All Authors: No reported disclosures

P-468. Prevalence and Associated Factors of Patients Presenting with Advanced HIV Disease in Tertiary Hospital in Bangkok

Abstract Background Late entry to healthcare services for HIV patients leads to adverse outcomes and increased mortality particularly advanced HIV disease (AHD) who first presented with opportunistic infection (OI). However, epidemiological data on AHD among Thai patients in suburban government hospital during the Treat-All era was lacking and required to guide the healthcare strategies. This study aims to assess the prevalence, clinical characteristics and risk factors of patients presenting with AHD at Bhumibol Adulyadej Hospital, a tertiary hospital in Bangkok. Methods A retrospective cross-sectional study was conducted among newly diagnosed adult HIV patients from 1 October 2019 to 30 September 2023, through electronic chart review. The WHO clinical staging 3-4 was used to define AHD. Logistic regression was used to identify factors associated with AHD. Results Among 372 patients, 40.32% presented with AHD, with a median CD4 cell count of 36 (IQR 13-137) cells/mm3. Most of the newly diagnosed HIV patients were single males residing in the hospital’s service area. AHD patients were predominantly aged 30-59 years (62.00%) and identified through clinical suspicious testing (88.67%) rather than voluntary counseling testing (VCT). Risk factors of AHD included ages 30-59 years (adjusted OR (aOR) 1.94 [95%CI 1.13-3.34]) and &amp;gt; 59 years (aOR 4.58 [95%CI 1.49-14.06]), clinical suspicious testing (aOR 11.98 [95%CI 6.61-21.71]), unprotected sex (aOR 1.74 [95%CI 1.01-2.98]), and partner seropositive (aOR 0.18 [95%CI 0.05-0.62]). One-year mortality was significantly higher in AHD who were diagnosed from 2019-2022 (20.31% V.S. 9.88%, p=0.011). The most common OIs among AHD were tuberculosis (54.00%), pneumocystis pneumonia (40.67%) and cryptococcosis (17.33%) consecutively. Conclusion Presenting with AHD was common and associated with high mortality. VCT plays a minor role in the study population. The early HIV infection detection program remains needed in all risk groups but should target heterosexual males aged &amp;gt; 30. Disclosures All Authors: No reported disclosures

P-169. Comprehensive Sexuality Education in Secondary Schools and Syphilis Incidence by Country: An Ecological Study

Abstract Background Comprehensive sexuality education (CSE) is essential curriculum covering sexual and reproductive health topics, including transmission of sexually transmitted infections. CSE has been added as a Sustainable Development Goal (SDG) indicator (4.7.2) and is becoming more widespread, but the relationship between degree of CSE implementation and incidence of STIs has not been previously described. The aim of this study was to investigate whether countries with more widespread CSE in secondary schools have lower incidence rates of syphilis than those with limited CSE.Table 1:Percent of secondary schools implementing CSE in 2018 vs. median syphilis incidence in 2019. Methods We used CSE implementation estimates from WHO as described in the 2021 UNESCO report: The Journey Towards Comprehensive Sexuality Education. This report utilizes data from multiple surveys to produce an estimate of the percent of secondary schools providing CSE by country in 2018, categorized as “0-25%”, “26-50%”, “51-75%”, or “76-100%”. We used syphilis incidence rates from the Global Burden of Disease Study 2019. We conducted a multivariable Poisson regression evaluating the relationship between percent of schools with CSE and syphilis incidence, adjusting for WHO region and income level. Results CSE data were available for 66 countries, all of which had syphilis incidence estimates available (Table 1). Countries that reported CSE in fewer than 25% of secondary schools had a syphilis incidence that was 1.83 (95% CI 1.78 – 1.89) fold higher than countries with CSE in greater than 25% of schools. This difference was attenuated but remained significant after adjusting for region and income level with a relative rate of 1.40 (CI 1.36 – 1.44). Each increase in CSE category was associated with a 26.6% (CI 25.9 – 27.4) relative reduction in syphilis incidence rate (Figure 1). This reduced to 7.1% (CI 6.2 – 8) when adjusted for region and income level. Conclusion More widespread CSE is associated with lower syphilis incidence, likely by reducing unsafe sex practices, although a causal relationship cannot be inferred given study design. These findings suggest that countries with the greatest need for CSE are the ones with the most limited availability. Further research on this topic would be beneficial to more thoroughly evaluate how CSE programs impact rates of syphilis and other STIs. Disclosures All Authors: No reported disclosures

P-1405. Drivers of Unplanned Pregnancy among Women with HIV in the Northern and Southern United States

Abstract Background National estimates from 1986-2015 show that the proportion of unplanned pregnancies among women with HIV (WWH) is high at 78% and that Black/African American women are disproportionately impacted. We aimed to evaluate the prevalence of unplanned pregnancy using a contemporary cohort of pregnant and postpartum WWH (2019-2024), and identify the individual, interpersonal, community and societal factors associated with pregnancy planning.Table 1.Sociodemographic, sociocultural, and psychosocial variables in a cohort of pregnant and postpartum women (2019-2024)Footnote: social support (Likert scale 1=never 5=always), HIV provider trust (Likert scale 1=strongly disagree 5=strongly agree), self-efficacy (additive scale 0=cannot do at all 10=completely certain can do), HIV related stigma (additive 0=never experienced 9=heavily experienced) Methods We performed a secondary data analysis of cross-sectional surveys from an on-going randomized controlled trial testing a peer-led behavioral intervention to improve postpartum retention in HIV care. WWH were recruited from six sites in the northeast and southern US. We used unadjusted and adjusted logistic regression to estimate the association between study outcome, pregnancy planning (“Were you planning to get pregnant?” Yes/No) and individual/interpersonal (self-efficacy, social support, HIV provider trust, HIV related stigma) and community/societal (race, ethnicity, marital status, income, employment) factors.Table 2.Factors associated with pregnancy planning among women with HIV Results To date, a total of 137 women (83% Black, 7% White, 10% Asian, American Indian/Alaska Native, Native Hawaiian/Pacific Islander categorized as other race; 14% Hispanic ethnicity) enrolled in the trial and were included in this analysis. The proportion of unplanned pregnancy was high at 73%. Among WWH with unplanned pregnancy, 90% were Black, 4% were White, 6% were women of other race (p=0.002). While Black women had significantly reduced odds of pregnancy planning (OR 0.18, 95% CI 0.046-0.68), married women (OR=3.33, 95% CI 1.26-8.85), women with higher income (OR=1.27, 95% CI 1.03-1.57) and those with employment (OR 2.33, 95% CI 1.08-5.03) had higher odds of pregnancy planning. In the fully adjusted model, Black race (aOR 0.11 95% CI 0.02 -0.48) was the only factor negatively associated with pregnancy planning. Conclusion Unplanned pregnancy among women with HIV and its disproportionate burden on Black women continues to be an area we have yet to make significant progress. Interventions addressing social determinants of unplanned pregnancy and racial disparities are needed to improve reproductive health care for WWH. Disclosures William R. Short, MD, Gilead: Grant/Research Support|Janssen: Honoraria|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Honoraria Rachel Scott, MD,MPH,FACOG, DHHS Perinatal Guidelines: Board Member|UW STD Prevention Training Center (UW STD PTC): Honoraria|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support|Vindico CME: Honoraria

P-1401. Association Between Intimate Partner Violence and Antiretroviral Adherence Among Pregnant Women Living with HIV

Abstract Background Despite increased access to antiretroviral therapy (ART) for women with HIV (WWH), challenges like unaddressed mental health issues and poor postpartum HIV care retention persist. This analysis evaluates whether Intimate Partner Violence (IPV) is related to reduced ART use and adherence, a topic not extensively studied in the US, especially in pregnant WWH. Participant Characteristics and Prevalence of IPV during and before Pregnancy Among Pregnant WWH (N=137) Methods We analyzed secondary data from a multisite US randomized trial of a peer-led behavioral intervention to improve postpartum retention in WWH. Data was collected from the baseline survey: socio-demographic, health, and psychosocial characteristics, using tools such as the Edinburgh Postnatal Depression Scale (EPDS), Adverse Childhood Experiences (ACE) and HIV-related stigma scores, and the WHO Violence Against Women questionnaire to assess IPV. A multivariable logistic regression (MLR) examined associations between IPV timing (lifetime, before or in pregnancy) and type (physical, emotional, or sexual) and ART adherence (self-reported, ≥ 80% of prescribed ART doses in the prior month), adjusting for potential covariates. Forest Plot and Multivariable Logistic Regression of the Association Between IPV and ART Adherence (N = 137) Results A total of 137 pregnant WWH enrolled between March 2020 and March 2024 were included: mean age was 30.5 (SD 5.6); 83% were Black, 14% Hispanic; mean number of pregnancies was 3.31 (SD 2.1); mean number of years with HIV 9.26 (SD 8.7). Twenty women reported not disclosing their HIV status to their partners, 14 due to fear of abandonment, and two due to fear of physical violence. Depression, stigma, and ACEs were prevalent: an EPDS score of ≥ 10 was seen in 45% of women, an ACE score of ≥ 4 in 23%, and 51% reported HIV-related shame. Forty women (29%) reported any lifetime IPV exposure (39, psychological; 13, physical; 4, sexual). Significantly higher EPDS, ACE, and stigma scores were seen in women exposed to IPV (p &amp;lt; 0.02). Physical IPV during pregnancy had the strongest association with decreased ART adherence in pregnancy (aOR=0.10, p=0.02). Psychological IPV and any IPV type during or before pregnancy were also associated with lower odds of adherence in pregnancy. Conclusion We found high IPV rates and a significant negative association with ART adherence among pregnant WWH. These findings highlight the importance to screen for and address IPV in HIV care to improve maternal and child health outcomes. Disclosures William R. Short, MD, Gilead: Grant/Research Support|Janssen: Honoraria|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Honoraria Rachel Scott, MD,MPH,FACOG, DHHS Perinatal Guidelines: Board Member|UW STD Prevention Training Center (UW STD PTC): Honoraria|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support|Vindico CME: Honoraria

P-500. Awareness and preferences for every 2 month long-acting injectable HIV Pre-Exposure Prophylaxis (PrEP) versus daily oral PrEP among cisgender women in the United States and the Dominican Republic

Abstract Background Globally, cisgender women (CGW) represent 53% of people with HIV and 45% of new acquisitions (2022). Female sex workers (FSW) are 30 times more likely to acquire HIV (vs women overall); in the US 54% of new diagnoses in CGW are Black women. HIV pre-exposure prophylaxis (PrEP) coverage in US CGW remains low at 15%. Long-acting injectable (LAI) PrEP may help address inequities and expand use, as 2013-22 CDC data shows 7% of US people prescribed oral PrEP were female compared to 12.5% for injectable PrEP. Presented here is a mixed methods study assessing awareness and preferences for PrEP in CGW. Methods Cross-sectional surveys were conducted among CGW in Washington, DC and Santo Domingo, Dominican Republic (DR) from 11/’22-07/’23. DC CGW were recruited in reproductive health clinics; DR CGW were FSW recruited by peer navigators. CGW were ≥ 18 years, receiving care at the participating clinic and not living with HIV. Results In DC (n=302), 86.4% identified as Black; in the DR (n=300), all identified as mixed race and Latina ethnicity. 71.2% (DC) and 94.3% (DR) never heard of oral PrEP; 91.1% (DC) and 98.3% (DR) never heard of LAI PrEP. 3% (DC) and 1% (DR) had ever used PrEP. Mean number of sex partners (past 6 months, DC) was 2.1, with 6.5% always using a condom [Table 1]. In the DR, always condom use was &amp;gt; 80% for sex with clients, &amp;lt; 42% with steady partners. An interest in using some form of PrEP was 4.8% in DC vs 80.3% in the DR [Figure 1]. Preference for LAI PrEP was 73.2% (DC) and 71% (DR) among all participants [Figure 2]. CGW thought it easier to get to a clinic every 2 months than to take a daily pill (DC, 64.9%; DR, 60.0%;) [Table 2], and would worry more about people discovering PrEP pills than being seen at a PrEP clinic for injections (DC, 59.9%; DR, 55.7%). PrEP service location preferences were family planning or primary care clinics (DC), and pharmacies or sexual health clinics (DR). Self-assessment of potential HIV acquisition was majority not likely/impossible (DC, 88%; DR, 53%); most DC CGW never used PrEP because they had not heard of it. Conclusion Gaps in HIV knowledge, PrEP awareness and uptake exist for CGW. PrEP decision making is multifactorial and varies by population. CGW should be informed of their options and educated about potential reasons for PrEP use in a setting accessible and comfortable to them. Disclosures Aimee A. Metzner, PharmD, AAHIVP, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Alan Oglesby, MPH, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Allison O’Rourke, MPH, ViiV Healthcare: Grant/Research Support Wendy W. Davis, EdM, ViiV Healthcare: Grant/Research Support Rachel Scott, MD,MPH,FACOG, DHHS Perinatal Guidelines: Board Member|UW STD Prevention Training Center (UW STD PTC): Honoraria|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support|Vindico CME: Honoraria Tamara Taggart, PhD, MPH, HealthHIV: Honoraria Deanna Kerrigan, PhD, MPH, ViiV Healthcare: Grant/Research Support

P-1415. Social Determinants of Health and Side Effects Significantly Predict Pre-Exposure Prophylaxis (PrEP) Preferences for Every 2 Month Long-Acting Injectable vs. Daily Oral PrEP among Cisgender Women in the United States and the Dominican Republic

Abstract Background Significant HIV inequities exist among cisgender women (CGW) across settings. Black CGW in the United States (US) have an HIV diagnosis rate 10.8 times greater than White CGW. Female sex workers (FSW) have 30-times increased odds of acquiring HIV vs. CGW globally. HIV disparities and low pre-exposure prophylaxis (PrEP) uptake in CGW are driven by social determinants such as stigma. As long-acting injectable (LAI) PrEP rolls out, it is critical to understand CGW’s PrEP preferences. Methods Cross-sectional surveys were conducted among CGW who were: ≥18 years and HIV- in Washington, DC, US (n=302) and Santo Domingo, Dominican Republic (DR) (n=300). US CGW [86.4% Black; 30 yrs (mean) were recruited in reproductive health clinics. DR CGW [100% mixed race; 32 yrs (mean)] were FSW recruited by peer navigators. Stepwise multivariate logistic regression assessed demographic, behavioral and social determinants of PrEP preference (every 2-month LAI vs. daily oral) including aggregate measures of perceived PrEP stigma (Table 1) and PrEP medication optimization (Table 2) based on existing HIV scales. Results The majority of CGW preferred LAI vs. daily oral PrEP: 71.0% (DR); 73.2% (DC). In both settings (Table 3), LAI preference was inversely associated with whether they would be bothered by injection site pain or tenderness for a few days to a week (DC AOR 0.54; 95% CI 0.31-0.96; DR AOR 0.46; 95% CI 0.23-0.93). In DC, each additional item considered important in the PrEP optimization scale was associated with a greater odds of LAI PrEP preference (AOR 1.06; 95% CI 1.01-1.10). Having had an HIV test and PrEP stigma were marginally significant (p&amp;lt; 0.10) in DC. In DR, greater odds of LAI preference was associated with prior injectable medication or contraception experience (AOR 2.39; 95% CI 1.37-4.18) and greater alcohol use (AOR 1.90; 95% CI 1.11-3.25); lower odds of LAI preference was associated with PrEP stigma (AOR 0.93; 95% CI 0.88-0.99) and sexual partner violence (AOR 0.39; 95% CI 0.18-0.82). Conclusion Shared and context specific factors drive PrEP preferences among diverse groups of CGW. Social determinants and side effects management should be addressed in tailored interventions to ensure equitable PrEP uptake including LAI PrEP in CGW. Disclosures Deanna Kerrigan, PhD, MPH, ViiV Healthcare: Grant/Research Support Rachel Scott, MD,MPH,FACOG, DHHS Perinatal Guidelines: Board Member|UW STD Prevention Training Center (UW STD PTC): Honoraria|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support|Vindico CME: Honoraria Allison O’Rourke, MPH, ViiV Healthcare: Grant/Research Support Wendy W. Davis, EdM, ViiV Healthcare: Grant/Research Support Aimee A. Metzner, PharmD, AAHIVP, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Alan Oglesby, MPH, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Tamara Taggart, PhD, MPH, HealthHIV: Honoraria

Identifying the Strongest Correlates of Condom Use Among US Adolescents

Condoms are effective at preventing sexually transmitted infections and pregnancy; however, only 52% of sexually active US adolescents used a condom at last intercourse. To examine (1) the association between 36 psychosocial variables and adolescent condom use to determine the strongest correlates of condom use behavior across the literature, (2) heterogeneity of these effects, and (3) the moderating roles of age, gender/sex, race/ethnicity, sexual orientation, and year of study. A systematic search was conducted of studies published between January 2000 and February 2024 using Medline, CINAHL, PsycINFO, and Communication Source databases, plus relevant review articles and unpublished data. Studies were included if they (1) were observational studies of US adolescents (mean sample age <19 years), (2) included adolescent reports of condom use behavior and a correlate of interest, and (3) were available in English after January 2000. Investigators extracted data on participant characteristics, study methods, settings, correlates, condom use outcomes, and study quality. Correlation coefficients and 95% CIs were computed from studies and meta-analyzed using random-effects models. The primary outcome was adolescent-reported condom use behavior. A total of 249 studies with 283 independent samples (251 713 adolescents; weighted mean age, 16.2 years) were synthesized. Twenty-three correlates were significantly associated with adolescent condom use. The correlates of condom use with the largest weighted mean effects were condom use at first sex (Pearson r = 0.47; 95% CI, 0.36-0.56), condom use intentions (Pearson r = 0.42; 95% CI, 0.35-0.48), and condom communication with a partner (Pearson r = 0.41; 95% CI, 0.29-0.52). Safer sex knowledge-a primary focus of many sex education efforts-was not significantly associated with condom use (Pearson r = -0.03; 95% CI, -0.10 to 0.05). Most effects (24 of 31 [77%]) were statistically significantly heterogeneous; age, gender/sex, sexual orientation, and year of study explained heterogeneity in only a few effects. This systematic review and meta-analysis identified the strongest and weakest correlates of adolescent condom use across nearly 25 years of research. These results can be used to refine sexual behavior theory and guide more targeted evidence-based intervention efforts for adolescents.