Recent Sexual Behavior Research Articles

Incidence and Clearance of Penile High-Risk Human Papillomavirus Infection and Their Determinants Among HIV-Negative Men Who Have Sex With Men.

Men who have sex with men (MSM) are at increased risk of anogenital human papillomavirus (HPV) infections. We aimed to assess the incidence and clearance of penile high-risk HPV (hrHPV) infections and their determinants among HIV-negative MSM living in the Netherlands. Between 2010 and 2015, HIV-negative MSM were semiannually tested for penile HPV and completed detailed questionnaires on health and sexual behavior. Self-collected penile swabs were tested for HPV DNA using SPF10-PCR DEIA/LiPA25 system. Type-specific hrHPV incidence (IR) and clearance rates (CR) were calculated for 12 hrHPV types (HPV-16, HPV-18, HPV-31, HPV-33, HPV-35, HPV-39, HPV-45, HPV-51, HPV-52, HPV-56, HPV-58, and HPV-59). Determinants of incidence and clearance of HPV-16 and HPV-18, separately, and combined 7 hrHPV types covered by the nonavalent vaccine were assessed by Poisson regression using generalized estimating equations for combined hrHPV types. We included 638 HIV-negative MSM, with a median age of 38 (interquartile range, 33-43) years. HPV-16 had an IR of 4.9/1000 person-months of observation at risk (PMO; 95% confidence interval [95% CI], 3.8-6.3) and CR of 90.6/1000 PMO (95% CI, 60.7-135.1). The IR and CR of HPV-18 were 3.4/1000 PMO (95% CI, 2.5-4.5) and 119.2/1000 PMO (95% CI, 76.9-184.8), respectively. Age and condom use during insertive anal sex were not associated with hrHPV incidence, whereas high number of recent sex partners was. The relatively high IR and low CR of penile HPV-16 and HPV-18 among HIV-negative MSM correlates with their high prevalence and oncogenic potential. Incident HPV infections were associated with recent sexual risk behavior.

Exploring Condom Use Behaviors Among African American Adolescent Boys in the Deep South.

Risky sexual behaviors among adolescents can increase adverse outcomes including unplanned pregnancy or contraction or transmission of disease. Adolescents who engage in risky sexual activities are at increased risk for adverse health and social outcomes compared to those who do not engage. Despite declines in adolescent pregnancy and birth rates, the diagnosis of sexually transmitted infections (STIs) is steadily increasing among adolescents. Moreover, African American adolescent boys in the United States, specifically in the southeastern region are disproportionally at greater risk for STIs, and STI diagnosis within this population has increased over time, compared to their white counterparts. This study sought to identify factors associated with condom use among adolescent boys in the Deep South. Using data from the Mobile Youth Survey, a longitudinal adolescent community-based survey, this study assessed the relationship between personal, behavioral, and environmental factors and condom use among African American adolescent boys (14–19 years). Younger participants (14–15 and 16–17) were more likely to use a condom during the last sexual intercourse compared to older participants (18–19 years). High positive attachment to boy/girlfriend was associated with increased condom use. The number of sexual partners, age at their first sexual encounter, recent sexual behavior, and having an STI were also associated with increased condom use among participants. The study provides further insights into factors associated with condom use among African American adolescent boys and results can inform the development of sexual health interventions.

Intimate partner violence by men living with HIV in Cameroon: Prevalence, associated factors and implications for HIV transmission risk (ANRS-12288 EVOLCAM).

Intimate partner violence (IPV) against women is frequent in Central Africa and may be a HIV infection risk factor. More data on HIV-positive men (MLHIV) committing IPV are needed to develop perpetrator-focused IPV and HIV prevention interventions. We investigated the relationship between IPV and HIV transmission risk and IPV-associated factors. We used data from the cross-sectional survey EVOLCam which was conducted in Cameroonian outpatient HIV structures in 2014. The study population comprised MLHIV declaring at least one sexual partner in the previous year. Using principal component analysis, we built three variables measuring, respectively, self-reported MLHIV-perpetrated psychological and physical IPV (PPV), severe physical IPV (SPV), and sexual IPV (SV). Ordinal logistic regressions helped investigate: i) the relationship between HIV transmission risk (defined as unstable aviremia and inconsistent condom use) and IPV variables, ii) factors associated with each IPV variable. PPV, SPV and SV were self-reported by 28, 15 and 11% of the 406 study participants, respectively. IPV perpetrators had a significantly higher risk of transmitting HIV than non-IPV perpetrators. Factors independently associated with IPV variables were: i) socio-demographic, economic and dyadic factors, including younger age (PPV and SPV), lower income (PPV), not being the household head (SPV and SV), living with a main partner (SPV), and having a younger main partner (SPV); ii) sexual behaviors, including ≥2 partners in the previous year (PPV and SPV), lifetime sex with another man (SPV), inconsistent condom use (SV), and >20 partners during lifetime (SV); iii) HIV-related stigma (PPV and SV). IPV perpetrators had a higher risk of transmitting HIV and having lifetime and recent risky sexual behaviors. Perpetrating IPV was more frequent in those with socioeconomic vulnerability and self-perceived HIV-related stigma. These findings highlight the need for interventions to prevent IPV by MLHIV and related HIV transmission to their(s) partner(s).

Assessing the performance of international pre-exposure prophylaxis (PrEP) eligibility guidelines in a cohort of Chinese MSM, Beijing, China 2009 to 2016.

IntroductionPrEP is a powerful HIV prevention tool, and locally relevant eligibility criteria are necessary to optimize the prevention impact of PrEP. We assessed performance of existing national and international PrEP eligibility criteria to predict future HIV seroconversion among MSM in Beijing, China.MethodsParticipants were MSM aged ≥18 years who enrolled in a cohort study between July 2009 and March 2016. Participants completed HIV testing, syphilis testing, and a questionnaire on recent sexual health behaviours at each follow‐up visit and were followed until HIV seroconversion or dropout. We assessed PrEP eligibility at the most recent follow‐up visit prior to the final study visit. Participants were classified as indicated for PrEP (or not) based on criteria from guidelines from Europe, Korea, South Africa, Taiwan, the United Kingdom, United States and the World Health Organization. To compare guideline performance, we calculated sensitivity, specificity, Youden’s Index (YI), Matthew’s Correlation Coefficient (MCC), F1 scores and diagnostic odds ratios. For each guideline, performance measures were compared to random allocation of PrEP by randomly selecting a proportion of participants equal to the proportion indicated.ResultsThere were 287 (17∙3%) incident HIV seroconversions among 1663 MSM. The number of men indicated for PrEP from different guidelines ranged from 556 (33∙4%) to 1569 (94∙2%). Compared to random allocation, sensitivity of algorithms to predict seroconversion ranged from slightly worse (−4∙7%) to 30∙2% better than random. However, in absolute terms, none of the sensitivity values increased by more than 11% when compared to random allocation. For all guidelines, specificity was not meaningfully better than random allocation. No guidelines had high binary classification performance measures.ConclusionsThe performance of international indication guidelines in this sample was only slightly better than random allocation. Using such guidelines to screen out MSM self‐identifying as interested in PrEP could lead to misallocation of resources and to good candidates for PrEP being denied access. For settings in which international guidelines perform poorly, alternative indication approaches should be considered.

Rates of New Human Papillomavirus Detection and Loss of Detection in Middle-aged Women by Recent and Past Sexual Behavior.

Understanding the source of newly detected human papillomavirus (HPV) in middle-aged women is important to inform preventive strategies, such as screening and HPV vaccination. We conducted a prospective cohort study in Baltimore, Maryland. Women aged 35-60 years underwent HPV testing and completed health and sexual behavior questionnaires every 6 months over a 2-year period. New detection/loss of detection rates were calculated and adjusted hazard ratios were used to identify risk factors for new detection. The new and loss of detection analyses included 731 women, and 104 positive for high-risk HPV. The rate of new high-risk HPV detection was 5.0 per 1000 woman-months. Reporting a new sex partner was associated with higher detection rates (adjusted hazard ratio, 8.1; 95% confidence interval, 3.5-18.6), but accounted only for 19.4% of all new detections. Among monogamous and sexually abstinent women, new detection was higher in women reporting ≥5 lifetime sexual partners than in those reporting <5 (adjusted hazard ratio, 2.2; 95% confidence interval, 1.2-4.2). Although women remain at risk of HPV acquisition from new sex partners as they age, our results suggest that most new detections in middle-aged women reflect recurrence of previously acquired HPV.

Online socializing among men who have sex with men and transgender people in Nairobi and Johannesburg and implications for public health-related research and health promotion: an analysis of qualitative and respondent-driven sampling survey data.

IntroductionThere is little published literature about gay, bisexual and other men who have sex with men and transgender individuals (MSM and TG)’s use of social media in sub‐Saharan Africa, despite repressive social and/or criminalizing contexts that limit access to physical HIV prevention. We sought to describe MSM and TG’s online socializing in Nairobi and Johannesburg, identifying the characteristics of those socializing online and those not, in order to inform the development of research and health promotion in online environments.MethodsRespondent‐driven sampling surveys were conducted in 2017 in Nairobi (n = 618) and Johannesburg (n = 301) with those reporting current male gender identity or male sex assigned at birth and sex with a man in the last 12 months. Online socializing patterns, sociodemographic, sexual behaviour and HIV‐testing data were collected. We examined associations between social media use and sociodemographic characteristics and sexual behaviours among all, and only those HIV‐uninfected, using logistic regression. Analyses were RDS‐II weighted. Thirty qualitative interviews were conducted with MSM and TG in each city, which examined the broader context of and motivations for social media use.ResultsMost MSM and TG had used social media to socialize with MSM in the last month (60% Johannesburg, 71% Nairobi), mostly using generic platforms (e.g. Facebook), but also gay‐specific (e.g. Grindr). HIV‐uninfected MSM and TG reporting riskier recent sexual behaviours had raised odds of social media use in Nairobi, including receptive anal intercourse (adjusted OR = 2.15, p = 0.006), buying (aOR = 2.24, p = 0.015) and selling sex with men (aOR = 2.17, p = 0.004). Evidence for these associations was weaker in Johannesburg, though socializing online was associated with condomless anal intercourse (aOR = 3.67, p = 0.003) and active syphilis (aOR = 13.50, p = 0.016). Qualitative findings indicated that while online socializing can limit risk of harm inherent in face‐to‐face interactions, novel challenges were introduced, including context collapse and a fear of blackmail.ConclusionsMost MSM and TG in these cities socialize online regularly. Users reported HIV acquisition risk behaviours, yet this space is not fully utilized for sexual health promotion and research engagement. Effective, safe and acceptable means of using online channels to engage with MSM/TG that account for MSM and TG’s strategies and concerns for managing online security should now be explored, as complements or alternatives to existing outreach.

Do peer social relationships mediate the harmful effects of a housing mobility experiment on boys' risky behaviors?

PurposeThe purpose of this study was to understand why a housing mobility experiment caused harmful effects on adolescent boys' risky behaviors. MethodsMoving to Opportunity (MTO) (1994–2010) randomly assigned volunteer families to a treatment group receiving a Section 8 rental voucher or a public housing control group. Our outcome was a global risky behavior index (RBI; measured in 2002, n = 750 boys) measuring the fraction of 10 items the youth engaged in, 6 measuring past 30-day substance use and 4 measuring recent risky sexual behavior. Potential mediators (measured in 2002) included peer social relationships (e.g., peer drug use, peer gang membership). ResultsThe voucher treatment main effect on boys' RBI was harmful (B (SE) = 0.05 (0.02), 95% CI 0.01, 0.08), and treatment marginally increased having friends who used drugs compared to controls (B (SE) = 0.67 (0.23), 95% CI 0.22, 1.12). Having friends who used drugs marginally mediated the MTO treatment effect on RBI (indirect effect: B (SE) = 0.02(.01), 95% CI −0.002, 0.04), reducing the total treatment effect by 39%. ConclusionsIncorporating additional supports into housing voucher programs may help support teenage boys who experience disruptions to their social networks, to buffer potential adverse consequences of residential mobility.

Age at first intercourse, number of partners and sexually transmitted infection prevalence among Danish, Norwegian and Swedish women: estimates and trends from nationally representative cross-sectional surveys of more than 100000 women.

Sexual behavior at the population level impacts on public health. Recent representative sexual behavior data are lacking. Cross-sectional surveys in 2005 and 2012 on women age 18-45years randomly selected from the general population in Denmark (n=40804), Norway (n=30331) and Sweden (n=32114). Median (interquartile range) age at first intercourse was 16 (15-18)years in Denmark, 17 (16-18)years in Norway, and 17 (15-18)years in Sweden. Women in the most recent birth cohort had sexual debut at the lowest age, and were most likely to have sexual debut before the legal age of consent. Proportions with debut age ≤14 years among women born 1989-1994 vs 1971-1976, odds ratio (95% confidence interval) were: 18.4% vs 10.9%, 1.95 (1.74-2.18) in Denmark, 12.9% vs 6.3%, 2.38 (2.01-2.82) in Norway, 17.8% vs 11.4%, 1.75 (1.55-1.98) in Sweden. Median (interquartile range) number of lifetime sexual partners was 6 (3-10) in Denmark, 5 (2-10) in Norway, and 6 (3-11) in Sweden. The proportion of women reporting >10 sexual partners was also highest in the most recent survey. The percentage with odds ratio (95% confidence interval) in 2012 vs 2005 surveys were: 24.9% vs 22.8%, 1.13 (1.07-1.18) for Denmark; 23.8% vs 19.8%, 1.27 (1.19-1.34) for Norway; and 28.3% vs 23.8%, 1.31 (1.24-1.38) for Sweden. Similarly, the proportion of women reporting ever having had a sexually transmitted infection among women age <30 years were: 29.4% vs 26.4%, 1.21 (1.13-1.31) in Denmark, 28.9% vs 25.0%, 1.20 (1.10-1.31) in Norway, and 29.4% vs 22.2%, 1.45 (1.33-1.58) in Sweden. Scandinavian women reported lower age at first intercourse in younger birth cohorts. Moreover, they reported more lifetime sexual partners and a higher prevalence of ever having a sexually transmitted infection in 2012 than in 2005. Our findings may inform the interpretation of trends in outcomes associated with sexual health, and public health policies.

2321 Treatment of Hepatitis C in an Immunosuppressed Patient With Malignancy

INTRODUCTION: The prevalence of hepatitis C (HCV) is estimated to be 1-1.5% in patients with cancer. Direct-acting antivirals (DAA’s) have been shown to be a safe and effective option for treatment of HCV in patients with concurrent malignancy. However evidence for the use of DAAs in combination with b-cell depleting agents is lacking. We present a complicated case of a patient with lymphoma and HCV, who was treated simultaneously with rituximab and DAA therapy. CASE DESCRIPTION/METHODS: A 57-year-old male presented with recurrent angioedema due to acquired C1 esterase deficiency. Workup led to a bone marrow biopsy showing marginal zone lymphoma (MZL). He was pulsed with dexamethasone with plan to start rituximab. HCV screening was negative. Just prior to rituximab dose, he was found to have jaundice. Labs revealed an AST 2195, ALT 4828, total bili 5.1, alk phos 120, platelets 9k. Liver ultrasound showed hepatomegaly. He reported recent high risk sexual behavior. Initial workup revealed negative hepatitis A/B/C antibodies, ferritin 10.6k, negative autoimmune workup, and an HCV viral load of 31 million copies. His liver tests improved and he was seen in clinic where liver elastography showed a kPa of 17.7 (IQR 21%). He was started on a 12-week course of glecaprevir/pibrentasvir. Follow up HCV antibody was positive three weeks later. His clinical course was further complicated by ITP treated with IVIG, dexamethasone, rituximab and ultimately splenectomy. Course was also complicated by renal failure due to secondary minimal change disease and neuropathy due to AIDP/CIDP. He received additional dexamethasone and IVIG for these conditions. One month later he completed DAA therapy, LFTs normalized, and his HCV viral load was &lt; 12. Two days after completing HCV therapy he was admitted to the ICU with septic shock of unclear etiology, ultimately resulting in death. DISCUSSION: Our patient’s workup was suggestive of acute HCV given initial negative antibody with eventual seroconversion. A 12-week course of glecaprevir/pibrentasvir was chosen, as there was uncertainty regarding whether or not cirrhosis was present. Aggressive immunosuppression was given concomitantly for the MZL, as well as other immune-mediated diseases. His sepsis-related death was felt to be due to prolonged hospitalization in an immunosuppressed state rather than DAA therapy. Larger scale studies are needed to further inform optimal treatment of HCV in patients receiving immunosuppressive therapy, in the setting of malignancy.

Acceptability and Feasibility of a Telehealth Intervention for Sexually Transmitted Infection Testing Among Male Couples: Protocol for a Pilot Study.

BackgroundGay, bisexual, and other men who have sex with men (MSM) are at elevated risk for acquiring sexually transmitted infections (STIs) in the United States, especially chlamydia and gonorrhea. While research has indicated main partners over casual partners may play a central role in STI risk, the frequency of STI screening among MSM couples is particularly low. Self-sample collection for chlamydia and gonorrhea screening has been shown to be highly accurate, and at-home STI testing has been shown to be highly acceptable among diverse populations. However, there is little research exploring the feasibility and acceptability of at-home chlamydia and gonorrhea screening among MSM couples. Our pilot study aims to help evaluate the viability of this screening modality as an intervention tool for MSM couplesObjectiveThe objective of this study was to assess the feasibility and acceptability of an at-home chlamydia and gonorrhea sample collection and remote lab testing program among a sample of 50 MSM couples living in the United States.MethodsThis pilot study enrolled 50 MSM couples, ranging from 18-40 years old and living in the United States, who participated in a larger at-home HIV testing randomized controlled trial. Participating couples completed a pretest instructional video call and then had the option of completing at-home sample collection across three bodily sites (rectal swab, pharyngeal swab, and urine sample) for remote chlamydia and gonorrhea lab testing. For participants who completed any sample collection, they received their results via a posttest video call. All participants completed an online survey examining satisfaction and acceptability of the home testing process, experience with logistics, willingness to test at home in the future, recent sexual risk behavior, STI testing history, and linkage to care. A subset of 10 couples completed an in-depth interview about their attitudes towards the sample collection process, different decisions they made while collecting their samples, and their experience accessing treatment (for those who received a positive result).ResultsRecruitment began in September 2017, and as of March 2019 a total of 50 couples have been enrolled. Overall, 49/50 couples have returned their samples and completed the posttest delivery call, and 10 in-depth interviews have been completed and transcribed.ConclusionsScreening MSM couples at home for chlamydia and gonorrhea and providing video-facilitated results delivery may offer a tailored approach to address the increasing prevalence of these STIs. By collecting data on how MSM couples experience at-home STI screening, this project will provide valuable insight into the utility of such a service delivery program to public health interventionists and researchers alike.International Registered Report Identifier (IRRID)DERR1-10.2196/14481

Missed opportunities for prevention and treatment of hepatitis C among persons with HIV/HCV coinfection

ABSTRACT Hepatitis C (HCV) and HIV have common modes of transmission but information about HCV transmission risk, prevention, and treatment among persons with coinfection is lacking. The Medical Monitoring Project produces nationally representative estimates describing adults with diagnosed HIV in the United States. Using medical record data recorded during 6/2013–5/2017, we identified persons with detectable HCV RNA documented during the past 24 months. Among persons with coinfection, we described HCV transmission risk factors and receipt of HCV prevention services during the past 12 months and prescription of HCV treatment during the past 24 months. Overall, 4.9% had documented active HCV coinfection, among whom 30.2% were men who have sex with men (MSM), 6.7% reported injection drug use, and 62.1% were prescribed HCV treatment. Among MSM, 45.5% reported condomless anal sex and 42.3% received free condoms. Among persons who used drugs, 30.8% received drug or alcohol counseling, and among persons who injected drugs, 79.2% received sterile syringes. Among persons with HIV/HCV coinfection, recent drug injection was uncommon and most received sterile syringes. However, 1 in 3 were MSM, of whom half reported recent HCV sexual transmission risk behaviors. More than one-third of those with coinfection were not prescribed curative HCV treatment.

Sex differences in HPV immunity among adults without cancer

ABSTRACT The incidence of human papillomavirus (HPV)-associated head and neck cancers is rising, particularly among men. Whether observed epidemiological differences in sex are explained by differences in sexual exposure and/or by immune response is unclear. In this cross-sectional, multi-institutional study, seroprevalence of antibodies to HPV L1 capsid antigen was compared by patient characteristics among 374 adult patients without cancer. A significantly higher seroprevalence was observed among women compared with men for HPV16 (OR = 2.96, 95% CI = 1.21–7.21) and HPV18 (OR = 2.84, 95% CI = 1.06–7.60) L1 antibodies. This difference persisted for HPV16 after controlling for lifetime and recent sexual behavior. After controlling for sex, HPV16 and HPV18 L1 seroprevalence was also significantly associated with higher number of lifetime (HPV16 OR = 1.05, 95% CI = 1.01–1.08; HPV18 OR = 1.04, 95% CI = 1.01–1.08) and recent (HPV16 OR = 1.54, 95% CI = 1.15–2.07; HPV18 OR = 1.40, 95% CI = 1.07–1.82) oral but not vaginal sexual partners. These findings potentially suggest a more robust immune response to HPV16/18 among women compared with men that may not be explained by differences in number of sexual partners, and thereby presumably HPV exposure. The independent association of HPV16/18 L1 seroprevalence with higher number of oral sexual partners suggests a possible role for site of mucosal exposure in the HPV immune response.

Detection of Rectal Chlamydia trachomatis in Heterosexual Men Who Report Cunnilingus.

Rectal infection with Chlamydia trachomatis (CT) is frequent in women who deny receptive anal sex and is thought to arise from autoinoculation of the rectum from vaginal secretions. An alternate hypothesis is that oral sex inoculates and establishes gastrointestinal tract infection. Distinguishing these hypotheses is difficult in women. In men, autoinoculation is unlikely and heterosexual men frequently perform oral sex, but rarely participate in receptive anal exposure behaviors. We enrolled high-risk men with and without nongonococcal urethritis who presented to a sexually transmitted infection clinic in Indianapolis, Indiana. Urine and rectal swabs were collected and tested for urogenital and rectal CT, Neisseria gonorrhoeae (NG), and Mycoplasma genitalium (MG). Men completed surveys concerning symptoms, sexual orientation, and detailed recent and lifetime oral and anal sexual behaviors. Rectal CT was detected in 2/84 (2.4%) heterosexual men who reported cunnilingus, but no lifetime receptive anal behaviors. All of the men who denied receptive anal behaviors were negative for rectal NG and MG. In homosexual and bisexual men, rectal CT prevalence was high (9.7%), and rectal NG (4.8%) and MG (4.8%) were also detected. We detected rectal CT infections in heterosexual men who reported cunnilingus but denied receptive anal behaviors. Oral sex may be a risk factor for rectal CT infection via oral inoculation of the gastrointestinal tract.

Does Incident Circumcision Lead to Risk Compensation? Evidence From a Population Cohort in KwaZulu-Natal, South Africa.

BackgroundVoluntary medical male circumcision reduces men’s risk of HIV acquisition and may thus increase HIV risk-related sexual behaviors through risk compensation. We analyze longitudinal data from one of Africa’s largest population cohorts using fixed effects panel estimation to measure the effect of incident circumcision on sexual behaviors.SettingKwaZulu-Natal, South Africa.MethodsAn open population cohort of men were followed from 2009 to 2015. Men self-reported their circumcision status and sexual behavior annually. We used linear regression models with individual-level fixed effects to measure the effect of incident circumcision on recent sex (past 12 months) and sexual behaviors that increase HIV risk (not using a condom at last sex, never using condoms with the most recent sexual partner, concurrent sexual partners at present, and multiple sexual partners in the past 12 months). We controlled for potential time-varying confounders: calendar year, age, education, and sexual debut.ResultsThe 5,127 men in the cohort had a median age of 18 years (IQR 16 to 24) at cohort entry. Over the study period, almost one in five of these men (19.4%) became newly circumcised. Incident circumcision affected neither recent sex (percentage point change [PP] 0.0, 95%CI −1.2 to 1.3) nor sexual behaviors that increase HIV risk (PP −1.6, 95%CI −4.5 to 1.4).ConclusionThe data from this study strongly reject the hypothesis that circumcision affects sexual risk taking. Risk compensation should not serve as an argument against increased and accelerated scale-up of circumcision in this and similar communities in South Africa.

232. Associations Between Alcohol Use And Condom/Contraceptive Use Among College Students

Alcohol use has generally been associated with risky sexual behaviors among adolescents. However, studies to date have largely focused on condom use and HIV/STI risk related to alcohol use. Given this limitation and the increased accessibility of long-acting reversible contraceptives (LARC) in the past several years, our aim was to explore associations between recent alcohol use and condom/contraceptive behaviors among college students. The present analysis uses baseline data collected for an RCT testing a brief clinical intervention to reduce alcohol-related sexual violence risk at twenty-eight college campuses. Students ages 18-24 seeking care at participating college health or counseling centers were eligible (n=2291). Baseline surveys completed prior to their clinical visit measured demographics, alcohol use (number of days that drank any alcohol and days that binge drank (4/5+ drinks in 2 hours for women/men) in the past 30 days), and recent sexual behaviors (frequency of condom use, contraceptive use at last vaginal sex for self/partner). Participants who were missing biological sex (n=3) or never had vaginal sex (n=572) were excluded. Descriptive statistics characterized recent alcohol and contraceptive use behaviors. Logistic regression models tested associations between alcohol use patterns and condom/contraceptive use and were stratified by biological sex. Models accounted for campus-level clustering and adjusted for race/ethnicity, age, and self/partner use of alcohol at last sexual encounter. Participants (n=1716) were mostly female (75%) and non-Hispanic white (68%), Hispanic (14%) or Black (11%), with mean age 20.1 years (SD=1.5). Median number of drinking days and binge drinking days were 3.35 (IQR: 0.53-7.34) and 0.41 (IQR: 0-2.77), respectively. Half of men (52%) and women (48%) reported consistent condom use when having sex in the past 4 months. Few women (8%) and men (3%) reported (partner) LARC use at last sex; 63% and 56% reported other hormonal contraceptive use, respectively. In adjusted logistic regression models, number of drinking days among women (7+ days: AOR=0.55, 95%CI 0.37-0.82) and number of binge drinking days among women (4+ days: AOR=0.52 [0.39-0.71]) and men (4+ days: AOR=0.58 [0.35-0.95]) were all associated with less consistent condom use. Among women, drinking 7+ days was associated with using any hormonal contraception at last sex (AOR=1.64 [1.02-2.63]) and, in particular, non-LARC hormonal contraceptives (AOR=1.69 [1.09-2.61]). A novel finding in this study is that college women who drink frequently (but not necessarily binge drink) were more likely to use a hormonal method of contraception compared to those with lower alcohol consumption; these same women, however, were also half as likely to use condoms consistently compared to their counterparts who are not frequent drinkers. This suggests that while these women may be at increased risk for STIs, they have some measure of protection from unintended pregnancy. Alcohol use among men was not associated with reports of their partners’ use of hormonal contraception, but reduced condom use among binge drinking men suggest they may still be at risk for STIs.

The Influence of Partner Status and Sexual Behavior on College Women’s Consent Communication and Feelings

The topic of sexual consent has permeated mainstream discourse as a mechanism used to decrease rates of sexual assault and increase sex-positive communication. Women’s external consent behaviors are frequently examined; however, research exploring their internal consent and feelings associated with sexual activity is understudied. The purpose of this study was to understand how partner status and sexual behavior at most recent sexual activity influence women’s external/internal consent and feelings during sexual activity. Three hundred and ninety women completed a survey on consent, partner status, and most recent sexual behavior. Internal and external consent differed by partner status for women who engaged in vaginal-penile sex, but not genital and oral sex. Feelings associated with the sexual act were different within each behavior group and partner status. Women with a serious dating partner reported stronger feelings related to sexual activity, higher internal consent feelings, and increased use of nonverbal external consent cues. Partner status appears to influence factors of interest for vaginal-penile sex, but not genital and oral sex. Findings from this study can inform prevention efforts to increase sex-positive communication around consent.

Do Sexual Minorities Receive Appropriate Sexual and Reproductive Health Care and Counseling?

Sexual minority women (SMW) are less likely to use sexual and reproductive health care services and receive contraceptive counseling than their heterosexual peers. The role of recent sexual partners and the type of information provided when SMW access health services are unclear. The National Survey of Family Growth 2006-2015 was used to document sexual orientation disparities in the use of sexual and reproductive health services and counseling in clinical settings among 20,703 women. We incorporate data on sexual partners in the past 12 months to investigate whether recent sex with men was associated with health care seeking behavior and reproductive counseling. Eight-seven percent of the sample reported a male partner in the past 12 months, including 83% of bisexual women and 17% of lesbian women. In clinical settings, 48% of women reported birth control counseling at pregnancy or Pap tests, 49% reported a condom consult at an sexually transmitted diseases (STD) screening, and 9% reported emergency contraception counseling at a Pap test. Logistic regression models show that lesbian women were less likely than heterosexual women to have been given a contraceptive prescription or received contraceptive counseling, but were more likely to have received an STD test. In clinical settings, lesbian women were less likely to receive contraceptive counseling at pregnancy tests, and lesbian women without male partners were less likely to have a counseling about condom use at STD-related visits compared with heterosexual women. At least some women and providers adjust health care seeking behaviors and information provided to women based upon recent sexual behavior histories. More work is needed to understand why disparities in reproductive health services and contraceptive use persist among SMW who engage in sex with men.

A randomized clinical efficacy trial of a psychosocial intervention to strengthen self-acceptance and reduce HIV risk for MSM in India: study protocol

BackgroundMen who have sex with men (MSM) in India are a key group at risk for HIV acquisition and transmission. They are also an extremely marginalized and stigmatized population, facing immense psychosocial stressors including, but not limited to, stigma, homophobia, discrimination, criminalization, low self-esteem, low self-acceptance, distress, and, as a result, high rates of mental health problems. Although these multi-level psychosocial problems may put MSM at high risk for HIV acquisition and transmission, currently HIV prevention interventions in India do not address them. This paper describes the design of a psychosocial intervention to reduce HIV risk for MSM in India.MethodsFunded by the National Institute of Mental Health, this study is a two-arm randomized clinical efficacy trial of a self-acceptance based psychosocial HIV prevention intervention, informed by the minority stress model and syndemic theory, that was developed with extensive community-based formative work and input from the Indian MSM community and key informants who are knowledgeable about the experiences faced by MSM in India. Participants are MSM in Chennai and Mumbai who endorsed recent sexual behaviors placing them at high risk for HIV/sexually transmitted infection (STI) acquisition and transmission. Enrolled participants are equally randomized to either 1) the experimental condition, which consists of four group and six individual counseling sessions and includes standard of care HIV/STI testing and counseling, or 2) the standard of care condition, which includes HIV/STI testing and counseling alone. The primary outcomes are changes in the frequency of condomless anal sex acts and STI incidence (syphilis seropositivity and urethral, rectal, and pharyngeal gonorrhea and chlamydia infection. Major study assessment visits occur at baseline, 4-, 8-, and 12-months.DiscussionHIV prevention interventions that address the psychosocial stressors faced by MSM in India are needed; this study will examine the efficacy of such an intervention. If the intervention is successful, it may be able to reduce the national HIV/AIDS burden in India while empowering a marginalized and highly stigmatized group.Trial registrationClinicalTrials.gov Identifier: NCT02556294, registered 22 September 2015.

Sexual and reproductive health behavior and unmet needs among a sample of adolescents living with HIV in Zambia: a cross-sectional study

BackgroundAdolescents living with HIV face challenges, such as disclosure of HIV status, adherence to antiretroviral therapy, mental health, and sexual and reproductive health (SRH). These challenges affect their future quality of life. However, little evidence is available on their sexual behaviors and SRH needs in Zambia. This study aimed at assessing their sexual behaviors and SRH needs and identifying factors associated with marriage concerns and a desire to have children.MethodsThis cross-sectional study was conducted at the University Teaching Hospital from April to July 2014. We recruited 200 adolescents aged 15–19 years who were aware of their HIV-positive status. We collected data on their first and recent sexual behavior, concerns about marriage, and desire to have children. We used the Generalized Linear Model to identify factors associated with having concerns about marriage and desire to have children. We performed thematic analysis with open-ended data to determine their perceptions about marriage and having children in the future.ResultsOut of 175 studied adolescents, 20.6% had experienced sexual intercourse, and only 44.4% used condoms during the first intercourse. Forty-eight percent had concerns about marriage, and 87.4% desired to have children. Marriage-related concerns were high among those who desired to have children (adjusted relative risk [ARR] = 2.51, 95% CI = 1.02 to 6.14). Adolescents who had completed secondary school were more likely to desire to have children (ARR = 1.35, 95% CI = 1.07 to 1.71). Adolescents who had lost both parents were less likely to want children (ARR = 0.80, 95% CI = 0.68 to 0.95). Thematic analysis identified that major concerns about future marriage were fear of disclosing HIV status to partners and risk of infecting partners and/or children. The reasons for their willingness to have children were the desire to be a parent, having children as family assets, a human right, and a source of love and happiness.ConclusionsZambian adolescents living with HIV are at risk of engaging in risky sexual relationships and have difficulties in meeting needs of SRH. HIV care service must respond to a wide range of needs.

Factors associated with partner notification of STIs in men who have sex with men on PrEP in France: a cross-sectional substudy of the ANRS-IPERGAY trial

ObjectivesPartner notification (PN) is a useful public health approach to enhance targeted testing of people at high risk of HIV and other STIs, and subsequent linkage to care for those...