Unprotected Sexual Behavior Research Articles

Drug Use Behaviors and the Risk of HIV Infection Among Drug Users in China Between 2014 and 2021: Cross-Sectional Study.

Drug users are a high-risk group for HIV infection and are prominent HIV carriers. Given the emergence of new drugs, we explored current drug-using behaviors, HIV infections, and the correlation between drug-using behaviors and HIV infection risk among drug users from 2014 to 2021. We aimed to identify the prevalence of HIV infection risk among drug users and explore drug use behaviors based on the updated data, which could provide evidence for the precision of HIV prevention strategies among drug users. Data were collected from sentinel surveillance of drug users in rehabilitation centers and communities in Hangzhou (2014-2021), including sociodemographic characteristics, HIV awareness, drug use, risky sexual behaviors, and HIV infection status. Multivariate logistic regression was used to identify the factors influencing HIV infection and risky sexual behaviors among drug users. In total, 5623 drug users (male: n=4734, 84.19%; age: mean 38.38, SD 9.94 years) were included. New drugs dominated among the participants (n=3674, 65.34%). The main mode of drug use was noninjection (n=4756, 84.58%). Overall, for 27.45% (n=1544) of injected drugs in the last month before the investigation, the average daily injection frequency was 3.10 (SD 8.24). Meanwhile, 3.43% of participants shared needles. The incidence of sexual behaviors after drug use was 33.13% (n=1863), with 35.75% (n=666) of them using a condom in the last time. Overall, 116 participants tested positive for HIV antibodies (infection rate=2.06%). New drug users exhibited more postuse sexual behaviors than traditional drug users (odds ratio [OR] 7.771, 95% CI 6.126-9.856; P<.001). HIV-aware drug users were more likely to engage in risky sexual behaviors (OR 1.624, 95% CI 1.152-2.291; P=.006). New-type drug users were more likely to engage in unprotected sexual behavior (OR 1.457, 95% CI 1.055-2.011; P=.02). Paradoxically, drug users with greater HIV awareness were more prone to engaging in unprotected sexual behavior (OR 5.820, 95% CI 4.650-7.284; P<.001). Women engaged less in unprotected sex than men (OR 0.356, 95% CI 0.190-0.665; P=.001). HIV rates were higher among injecting drug users (OR 2.692, 95% CI 0.995-7.287; P=.04) and lower among drug users who used condoms during recent sex than those who did not (OR 0.202, 95% CI 0.076-0.537; P=.001). Higher education levels were associated with higher HIV infection rates. However, there was no significant correlation between HIV cognition level and HIV infection. New drug types and noninjection were the main patterns in last 7 years. Using new types of drugs, rather than traditional drugs, was associated with an increased risk of HIV infection. Injection drug use was a risk factor for HIV infection. HIV awareness among drug users was high, but the incidence of risky sexual behaviors remained high. Therefore, it is important to promote the behavioral transformation of high-risk populations from cognition to attitude, and then to taking protective measures.

Religion, Geography, and Risky Sexual Behaviors Among International Immigrants Living in China: Cross-Sectional Study.

Behavioral differences exist between countries, regions, and religions. With rapid development in recent decades, an increasing number of international immigrants from different regions with different religions have settled in China. The degrees to which sexual behaviors-particularly risky sexual behaviors-differ by religion and geographical areas are not known. We aim to estimate the associations of religion and geographical areas with sexual behaviors of international immigrants and provide evidence for promoting the sexual health of international immigrants. A cross-sectional study was conducted via the internet with a snowball sampling method among international immigrants in China. In our study, risky sexual behaviors included having multiple sexual partners and engaging in unprotected sex. Descriptive analysis was used to analyze the basic characteristics of international immigrants as well as their sexual behaviors, religious affiliations, and geographical regions of origin. Multivariate binary logistic regression analyses with multiplicative and additive interactions were used to identify aspects of religion and geography that were associated with risky sexual behaviors among international immigrants. A total of 1433 international immigrants were included in the study. South Americans and nonreligious immigrants were more likely to engage in risky sexual behaviors, and Asian and Buddhist immigrants were less likely to engage in risky sexual behaviors. The majority of the Muslims had sexually transmitted infection and HIV testing experiences; however, Muslims had a low willingness to do these tests in the future. The multivariate analysis showed that Muslim (adjusted odds ratio [AOR] 0.453, 95% CI 0.228-0.897), Hindu (AOR 0.280, 95% CI 0.082-0.961), and Buddhist (AOR 0.097, 95% CI 0.012-0.811) immigrants were less likely to report engaging in unprotected sexual behaviors. Buddhist immigrants (AOR 0.292, 95% CI 0.086-0.990) were also less likely to have multiple sexual partners. With regard to geography, compared to Asians, South Americans (AOR 2.642, 95% CI 1.034-6.755), Europeans (AOR 2.310, 95% CI 1.022-5.221), and North Africans (AOR 3.524, 95% CI 1.104-11.248) had a higher probability of having multiple sexual partners. The rates of risky sexual behaviors among international immigrants living in China differed depending on their religions and geographical areas of origin. South Americans and nonreligious immigrants were more likely to engage in risky sexual behaviors. It is necessary to promote measures, including HIV self-testing, pre-exposure prophylaxis implementation, and targeted sexual health education, among international immigrants in China.

Unprotected Risky Sex Among Men with Opioid Dependence: Is More Needed to Be Done?

Background and Objectives: Risky behaviors are common among patients with substance use disorders. Knowing the determinants of risky sexual behaviors can identify individuals who may benefit from targeted interventions. The primary aim of the study was to assess unprotected risky sexual behavior and its sociodemographic and clinical correlates in treatment-seeking opioid-dependent patients. Methods: A cross-sectional exploratory study was done on 112 married treatment-seeking opioid-dependent male patients. A semi-structured proforma consisting of sociodemographic and clinical details was used to assess sexual behavior, other risky behaviors like injecting drug use (IDU), and knowledge of and attitude toward risky sexual behavior. Results: The mean age of the sample was 34.1 years, and that at first sexual intercourse was 18.6 years. History of unprotected risky sex (unprotected sex with a casual partner or female sex worker or person having a sexually transmitted disease or with males or having sex for rewards) was present in 30 patients (26.8% of the sample). Unprotected risky sex was found to be significantly associated with younger age at first sexual encounter ( p = .010), more sexual partners ( p &lt; .001), greater frequency of masturbation ( p = .031), and watching pornography ( p = .028). However, it was not found to be related to other risky behaviors such as IDU ( p = .210) and sex under intoxication ( p = .149) and also did not vary between treatment-naïve and under-treatment populations ( p = .434). No significant relationship was found between knowledge and attitude about risky sexual behavior and unprotected risky sex in the present sample. Conclusion: Risky sexual behavior in opioid-dependent patients is a concern, as this may be an additional mode of transmission of blood-borne viruses apart from IDU. Safe sex practices need to be emphasized in this population, and efforts at behavioral changes are desirable.

Mpox reinfection: A rapid systematic review of case reports

BackgroundMpox re-emerged worldwide with the multi-country outbreaks that occurred in May 2022, threatening the public health of human beings. MethodsThis rapid systematic review summarized mpox reinfection cases documented. Electronic databases (PubMed, MedRxiv, and Social Science Research Network) were searched without time limitation, using the keywords “mpox,” “monkeypox,” & “reinfection,” “reoccur,” “reoccurrence,” “episode,” and “relapse”. All laboratory-confirmed cases of mpox reinfection published in the literature were included in this study. ResultsA total of seven publications (nine cases) from Africa, Europe, and South America were included. All mpox reinfection cases were male, with a median age of 36; 88.89% of cases had unprotected sexual behaviors with other males before each illness episode. The average onset interval between the two episodes was about 4 months. Perianal lesions and lymphadenopathy were major symptoms in both episodes, and no differences in clinical severity were reported between the two episodes. The mean duration of the two episodes was approximately 22 days and 13 days, respectively; which the mean duration of the second episode was shorter than the first infection (t = 2.17, p = 0.0487). Sexually transmitted infections were commonly concurrent among most cases, accounting for 55.6% and 77.8% in the two episodes, respectively. Full vaccination against mpox was rare among reinfection cases. ConclusionA second infection is possible even in a short period. Reinforcing monitoring, reducing high-risk behaviors, and heightening health education regarding mpox for high-risk populations are crucial to limit mpox spread, including persons with a history of mpox infection.

HIV/STD prevalence and test uptake among african in Guangzhou, China: an analysis of data from hospital-based surveillance

Human immunodeficiency virus (HIV) and sexually transmitted diseases (STDs) cause substantial morbidity and mortality both in African and China. However, there is limited data available on the prevalence of HIV/STDs and the uptake of testing experience ever during in China among African migrants. A venue-based survey was conducted at a tertiary hospital in Guangzhou to investigate the prevalence of HIV/STDs through laboratory testing and identify the associated factors. A total of 200 eligible participants completed the survey and bring into the analysis from April to October 2019, and the temporary visitors were excluded. The prevalence rates of HIV, syphilis, NG, CT, and HBsAg among the participants were 1.0%, 2.5%, 1.0%, 1.5%, and 5.5%, respectively. The overall reported rate of HIV/STD testing was 37.0%, with rates of 23.0% for HIV, 16.5% for syphilis, 12.5% for NG, 6.5% for genital herpes, 5.0% for condyloma acuminata, and 2.5% for CT. HIV/STD testing was associated with living environment in Guangzhou, having medical insurance in China, and utilizing health services in China in the past year. HIV/STDs are prevalent among Africans in Guangzhou, and the epidemic is likely to spread due to a significant proportion of unprotected sexual behaviors and low rates of HIV/STD testing. Urgent interventions, including targeted health education, promotion of health service utilization, and active surveillance of HIV/STDs, are needed to reduce the risk of HIV/STD transmission.

Migration experiences and reported commercial and non-commercial sexual behaviors among newly diagnosed HIV infections in China: a cross-sectional study

BackgroundMigration is known to influence human health. China has a high migration rate and a significant number of people who are HIV-positive, but little is known about how these factors intersect in sexual risk behaviors.ObjectiveThis study aimed to explore sexual risk behaviors between migrants and non-migrants among newly diagnosed HIV infections, and assess the changes of sexual risk behaviors with length of stay in the current city of migrants.MethodsA cross-sectional questionnaire was conducted among people newly diagnosed with HIV from July 2018 to December 2020 who lived in Zhejiang Province. In the study, sexual risk behaviors included having multiple sexual partners and unprotected sexual behaviors (in commercial sexual behaviors, non-commercial sexual behaviors, heterosexual behaviors, and homosexual behaviors). Binary logistic regression models were employed to explore the influencing factors of sexual risk behaviors, measured by multiple sexual partners and unprotected sexual partners.ResultsA total of 836 people newly diagnosed with HIV/AIDS were incorporated in the study and 65.31% (546) were migrants. The percentages of non-commercial sexual behaviors among migrants were statistically higher than those of non-migrants. Commercial heterosexual behavior was higher among non-migrants compared with migrants. The proportion of study participants having unprotected sexual behaviors and multiple sexual partners with commercial/non-commercial partners was both higher among migrants compared with non-migrants. Among migrants, the likelihood of sexual risk behaviors in both commercial and non-commercial sex increased in the first 3 years and reduced after 10 years. Compared with non-migrants, migrants were statistically associated with multiple sexual partners [P = .007, odds ratio (OR) = 1.942]. However, migrants did not exhibit a significant difference in unprotected sexual behaviors compared with non-migrants. In addition, migrants aged between 18 and 45 years who relocated to the current city in the past 2–3 years tended to have multiple sexual partners (P < .05).ConclusionsPeople newly diagnosed with HIV engaged in different sexual risk behaviors among migrants and non-migrants and more attention should be paid to migrants. For non-migrants, it is urgent to promote the prevention of commercial sexual behaviors. For migrants, prevention of non-commercial sexual behaviors and universal access to health care especially for new arrivals who migrated to the current city for 2–3 years are needed. Moreover, sexual health education and early HIV diagnosis are necessary for the entire population.

Sexual behaviours and correlates of condom use among HIV-discordant couples from eastern China: a cross-sectional study

ObjectivesTo investigate sexual behaviours among HIV-discordant heterosexual couples and assess the correlates of condom use at the couple level.DesignCross-sectional study.SettingSeven prefectures along the Yangtze River in the Anhui Province, China.ParticipantsWe...

Vulnerability to HIV Infection Among International Immigrants in China: Cross-sectional Web-Based Survey.

The rising number of migrants worldwide, including in China given its recent rapid economic development, poses a challenge for the public health system to prevent infectious diseases, including sexually transmitted infections (STIs) caused by risky sexual behaviors. The aim of this study was to explore the risky sexual behaviors of international immigrants living in China to provide evidence for establishment of a localized public health service system. Risky sexual behaviors were divided into multiple sexual partners and unprotected sexual behaviors. Basic characteristics, sexual knowledge, and behaviors of international immigrants were summarized with descriptive statistics. Multivariate logistic regression analyses were used to identify factors associated with risky sexual behaviors, and the associations of demographic characteristics and risk behaviors with HIV testing and intention to test for HIV. In total, 1433 international immigrants were included in the study, 61.76% (n=885) of whom had never heard of STIs, and the mean HIV knowledge score was 5.42 (SD 2.138). Overall, 8.23% (118/1433) of the participants had been diagnosed with an STI. Among the 1433 international immigrants, 292 indicated that they never use a condom for homosexual sex, followed by sex with a stable partner (n=252), commercial sex (n=236), group sex (n=175), and casual sex (n=137). In addition, 119 of the international immigrants had more than three sex partners. Individuals aged 31-40 years were more likely to have multiple sexual partners (adjusted odds ratio [AOR] 2.364, 95% CI 1.149-4.862). Married participants were more likely to have unprotected sexual behaviors (AOR 3.096, 95% CI -1.705 to 5.620), whereas Asians were less likely to have multiple sexual partners (AOR 0.446, 95% CI 0.328-0.607) and unprotected sexual behaviors (AOR 0.328, 95% CI 0.219-0.492). Women were more likely to have taken an HIV test than men (AOR 1.413, 95% CI 1.085-1.841). Those who were married (AOR 0.577, 95% CI 0.372-0.894), with an annual disposable income >150,000 yuan (~US $22,000; AOR 0.661, 95% CI 0.439-0.995), considered it impossible to become infected with HIV (AOR 0.564, 95% CI 0.327-0.972), and of Asian ethnicity (AOR 0.330, 95% CI 0.261-0.417) were less likely to have an HIV test. People who had multiple sexual partners were more likely to have taken an HIV test (AOR 2.041, 95% CI 1.442-2.890) and had greater intention to test for HIV (AOR 1.651, 95% CI 1.208-2.258). International immigrants in China exhibit risky sexual behaviors, especially those aged over 30 years. In addition, the level of HIV-related knowledge is generally low. Therefore, health interventions such as targeted, tailored programming including education and testing are urgently needed to prevent new HIV infections and transmission among international immigrants and the local population.

Influence factors associated with health risk behaviors of middle school students in the poverty area of China: An observational study.

We aim to investigate the status and influence factors of health risk behaviors among middle school students and explore the relationship between social support, family care, and the health risk behaviors.The study was conducted in 3 middle schools in the Fan county located in the Puyang city. Independent measures were applied to assess adolescent health risk behaviors, perceive social support, and family care. Multiple regression analysis was used to analyze the main factors that affect adolescent health risk behaviors.The total scores of health risk behaviors were 53.87 ± 9.97, and all kinds of health risk behaviors were very common. The highest score was health-compromising (2.45 ± 0.43), and the lowest score was unprotected sex behaviors (1.07 ± 0.28). Multiple regression analysis showed that sex (P < .001), grade (P < .001), parent relationships (P < .001), father’s occupation (P = .035), mother’s education level (P = .011), social support (P < .001), affection (P < .001), and growth (P = .003) were the main factors of health risk behaviors, accounting for 25.3%.The health risk behaviors among middle school students in Fan county should attract the attention of education administration, schools, and parent due to the varied influencing factors. Related interventions should be conducted to reduce the severity and frequency of adolescent health risk behaviors and protect the health and growth of adolescents. In order to better analyze the health risk behaviors of middle school students, we will incorporate more influencing factors and carry out further causal analysis in the future.

Do impulsivity and biological sex moderate associations between alcohol-related sexual willingness and behavior among young adults?

This study examined three-way interactions between baseline levels of willingness to engage in alcohol-related sexual behaviors, facets of impulsivity (i.e., urgency, lack of premeditation, and sensation seeking) and biological sex on alcohol-related sexual behaviors 6 months later. Participants were a sample of high-risk 18–25 year olds (N = 321, mean age 22.44) from a larger randomized controlled trial with eligibility criteria including engaging in unprotected sexual behavior after drinking alcohol within the past month at baseline. Results indicated females reporting high urgency and willingness levels were the most likely to engage in alcohol-related sex and to use a condom/dental dam after drinking. Males reporting low urgency levels and high sensation seeking and willingness levels engaged in more alcohol-related sex compared to females. Interventions to decrease alcohol-related sexual behavior by reducing willingness could incorporate sex-specific and impulsivity-related content, particularly related to urgency.

Effectiveness of a Cognitive Behavioral Randomized Controlled Trial for People Living with HIV Who are Heavy Drinkers: The Holistic Health Recovery Program (HHRP) Trial in Miami.

This study evaluates the impact of an intervention targeting high-risk behaviors among diverse, alcohol-using adults living with HIV (N = 267) from 2009 to 2013 in Miami, FL. The intervention took place in a group setting for eight sessions over 4 weeks and was compared to a didactic health promotion group. Assessments were conducted pre-intervention, post-intervention, and at 3, 6, and 12months follow-up. Intervention participants (48% of sample) evidenced greater knowledge about HIV, more condom self-efficacy, and greater intentions to use condoms after participation. This was particularly noteworthy because associations among knowledge about HIV, more condom self-efficacy, and greater intentions to use condoms were negatively associated with intervention status at baseline. Participants also reported fewer heavy drinking days after participating in the intervention than those in the control group. Greater HIV knowledge, more condom self-efficacy and intentions to use condoms predicted more condom assertiveness; greater intentions to use condoms predicted fewer unprotected sexual behaviors. These findings underscore the importance of taking a comprehensive, multi-systemic approach to address risky behaviors in high-risk, diverse populations.

The association between HIV disclosure, spousal testing and unprotected vaginal intercourse within marriage among HIV positive married MSM in China

ABSTRACT Disclosure of HIV status can encourage spouses of people diagnosed with HIV to prioritize HIV prevention. However, few studies have reported the HIV disclosure status of married men who have sex with men (MSM) and their female spouses. The purpose of this study was to describe the prevalence of HIV disclosure, and whether it was associated with spouses’ HIV testing uptake and unprotected vaginal intercourse within marriage for MSM living with HIV (HIV + MSM) in China. A cross-sectional study was conducted in three Chinese cities. Of 309 participants, only 31.1% of men had disclosed their HIV status to spouses. About 80% of participants reported that their spouses had been tested for HIV. A small proportion of men (9.1%) had unprotected sex with their spouse after HIV diagnosis. Multivariate analyses indicated HIV disclosure was positively associated with HIV testing uptake of spouses, but there was no significant association between HIV disclosure and unprotected marital sexual behaviors for HIV + MSM. The findings indicated that HIV disclosure to spouses is uncommon among married HIV + MSM in China, and HIV disclosure is associated with increased uptake of HIV testing among spouses of MSM, but it does not decrease the unprotected sexual behaviors in marriage.

Factors Influencing Temporary Sexual Behavior in Patients with Gonorrhea in STD Clinics

Objective: To explore risk factors influencing temporary sexual behavior among gonorrhea patients in STD clinics, and to adapt gonorrhea prevention and control strategies accordingly. Methods: From August to October 2018, gonorrhea patients in 14 STD clinics across7 prefectures (cities) with high incidence of gonorrhea in Yunnan Province were screened and sampled to investigate potential risk factors. After pre-screening, a total of 179 gonorrhea patients were recruited (88.3% male).Multivariate logistic regression analysis model was performed to analyze the risk factors of temporary sexual behavior. Results: Multivariate logistic regression analysis results revealed that 55.2% of gonorrhea patients aged ≤40 years had temporary sexual behavior, 53.1% of whom had the most recent sexual intercourse were temporary sexual partners, and 53.1% were male (OR=3.765, 95%CI=1.259~11.253, P=0.018), single (OR=3.141, 95%CI=1.589~6.208, P=0.001), multiple sexual partners (≥2 persons)within the past month (OR=4.119,95%CI=1.829~9.278, P=0.001) , which were identified as the major significant risk factors for temporary sexual behavior. Conclusion: Temporary sexual behavior infection of gonorrhea patients is mainly associated with high-risk behaviors including unprotected sexual behavior and multiple sexual partners. For effective intervention and prevention, sexual education such as safe sex measurements and healthy sexual behaviors and be adopted by STD clinics and general public advocacy.

The Assessment of Misconceptions of HIV/AIDS, Stigma to HIV and Perceived Susceptibility to HIV/AIDS in Iranian University Students

Background: AIDS is a sexually transmitted disease that can expose a person at risk with the onset of unprotected sexual behavior from adolescence. This study aimed to assess the misconceptions of HIV/AIDS, stigma in adolescents infected with AIDS and the perceived threats of HIV/AIDS in the Iranian college students. Methods: This cross sectional study was performed in Shahroud city, Iran. 1500 female and male students in the age bracket of 18-24 were included in the study. Multistage sampling was employed. After obtaining permission from the universities and stating the objective of the study, the questionnaires (HIV misconception, Stigma to HIVand PerceivedSusceptibility to HIV/AIDS) were distributed to students during the end of lecture time upon the agreement of the education officials and were then collected after 15 minutes. To ensure that the information provided remain confidential, students were asked not to write down their names and fields of study. Data were analyzed using SPSS software, version 20 and descriptive-analytical statistics, such as percentage, mean scores, t-test Spearman, and chi-squared and Pearson tests. Results: The results showed that 919 students (61.2%) were female and 539 students (36.1%) were male. The results of the present study indicated that there is false information and beliefs on AIDS among the Iranian adolescents and 592 students (40.7%) answered correctly. Considering the perceived threat of AIDS, the results indicated that in response to the item "unprotected sex put the adolescents at risk of sexual transmitted diseases" 416 (45.8%) female students and 321 (60.5%) male students answered totally opposite, indicating significant difference between the two genders (P=0.00). Conclusion: It is suggested to provide students with more information through mass media and discussions between students, teachers and parents. Training should increase the youth sensitivity to AIDS, as well as promoting sexual relationships until marriage or healthy and safe sex.

The IN·clued Program: A Randomized Control Trial of an Effective Sex Education Program for Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Youths

PurposeThe IN·clued: Inclusive Healthcare – Youth and Providers Empowered, program is an educational intervention designed to reduce unintended pregnancies and sexually transmitted diseases among lesbian, gay, bisexual, transgender, queer, and questioning youths. The goals are to increase sexual health knowledge, healthcare self-efficacy, and sexual healthcare use, and to reduce unprotected sexual behaviors. MethodsThrough funding from the federal Office of Adolescent Health Teen Pregnancy Prevention Initiative, IN·clued was evaluated using a cluster randomized control trial. The study took place in 16 states with 1,401 youths; 1,182 of whom (84.4%) completed surveys one year after the workshop. This analysis uses an intent-to-treat framework using ordinary least squares regressions to estimate the effects on each outcome. ResultsOne year after the workshop, compared with the control youths, a significantly smaller proportion of IN·clued participants had vaginal sex without a condom in the past three months and did so significantly fewer times. Youths who received IN·clued demonstrated significantly higher knowledge and healthcare self-efficacy scores. A significantly greater proportion of the program youths had been to a doctor or clinic for and received contraception or birth control. A significantly greater proportion of the program youths reported feeling they could advocate for their own relevant sexual health care. ConclusionsIN·clued sought to change risky sexual behaviors, sexual health knowledge, receipt of sexual health care services, and self-efficacy regarding health care and achieved these goals. Findings were extremely positive with a population that has been neglected in sex education programs.

Beliefs and misconceptions about contraception and condom use among adolescents in south-east Nigeria

BackgroundMisconceptions about the usefulness of condoms and other contraceptives still expose many unmarried adolescents to the risk of unwanted teenage pregnancies and sexually-transmitted infections (STIs). This study explored beliefs and misconceptions about condoms and other contraceptives among adolescents in Ebonyi state, south-east Nigeria.MethodA qualitative study was undertaken in six local government areas in Ebonyi state, southeast Nigeria. Data were collected within a period of one month from in and out-of-school adolescents aged 13–18 years using twelve focus group discussions (FGD). The data were analyzed using the thematic framework approach.ResultMajority of the adolescents were knowledgeable about methods of contraception, how they are used and their modes of action. They were also knowledgeable about the dual effects of condoms in prevention of pregnancy and STIs. However, some misconceptions that were expressed by some adolescents were that pregnancy could be prevented by the use of (i) hard drugs, (ii) laxatives, (iii) white chlorine, and (iv) boiled alcoholic beverages. Condoms were described by some adolescent boys as reusable. Condoms were also perceived by some adolescents to reduce sexual pleasure, and this opinion was mostly held by boys. Coitus interruptus (withdrawal method) was therefore considered more preferable than condoms for prevention of pregnancy.ConclusionAlthough majority adolescents have knowledge about contraception and condom use, some misconceptions still persist. These misconceptions put many adolescents at increased risk for pregnancy and STIs which are detrimental to their health and wellbeing. Concerted efforts should be made through educational and behaviour change interventions in schools and within communities to debunk persisting misconceptions about contraception including the use of condom, and properly educate adolescents on safe sex practices.Plain English summaryAdolescents engage in unprotected sexual intercourse and other risky sexual behaviours because of some mistaken beliefs and wrong impressions about how to prevent unwanted pregnancy. These risky sexual behaviours predispose adolescents to sexually transmitted infections, unsafe abortion and other reproductive health problems.In this qualitative study, we explored some of these mistaken beliefs about condoms and other methods of preventing pregnancy. During focus group discussions, adolescents identified modern contraceptive methods, and described their modes of action and how they are used. They also discussed their contraceptive preferences and perceived effects of condoms on sexual pleasure.Although some of these adolescents were able to correctly mention various types of contraceptives and their modes of action, there were numerous wrong impressions. Hard drugs, laxatives, white chlorine and boiled alcoholic beverage were listed as emergency contraceptive methods. Emergency pills were perceived to work by flushing away spermatozoa from a girl’s system after sexual intercourse. Male condoms were perceived to be potentially dangerous because they could break and enter into the body of the female sexual partner. Some adolescent boys had the notion that particular brands of male condoms could be washed and reused. Notions about condom use and sexual pleasure varied for girls and boys. Some adolescent girls perceived that condom use during sex increases sexual pleasure because of the assurance of being protected from STIs and pregnancy. Adolescent boys were of the opinion that condoms interfere with the pleasure of direct ‘flesh to flesh’ contact during sex. There was a general belief that contraceptive use in early age reduces fertility prospects for boys and girls.Mistaken beliefs about methods of preventing pregnancy persist among adolescents, and this raises concerns about the quality of information they receive. Concerted efforts should be made to debunk these wrong beliefs and properly educate adolescents on safe sex practices.

Dual-centered ANCOVA: Resolving contradictory results from Lord's paradox with implications for reducing bias in longitudinal analyses

IntroductionValid causal inferences are necessary to use developmental research to improve adolescent outcomes. What type of change should be analyzed to approximate causal inferences from longitudinal data? Difference-score and ANCOVA-type analyses often produce contradictory results, a problem known as Lord's paradox. This study investigates 2-group, 2-wave difference-score analyses and ANCOVA, and introduces a method that produces consistent results, namely dual-centered ANCOVA, which is compared to pretest matching. MethodsThese methods are tested first on two datasets simulated to fit each of Lord's contrasting results. The methods are then applied to data investigating the longitudinal associations of parent-adolescent discussions about sexual risks on subsequent unprotected sexual behaviors in 4753 American adolescents (62.2% whites). ResultsThe results replicate Lord's contradictory results for all datasets. Dual-centered ANCOVA and pretest matching both produce consistent results, but dual-centered ANCOVA replicates the original results for difference-score analyses, whereas pretest matching replicates the original ANCOVA results. Thus, the two sets of consistent results differ from each other as much as the original discrepancy rather than reducing bias. ConclusionThe least biased analysis is the one whose null hypothesis best approximates a plausible change pattern to represent a no-treatment effect. When difference-score analyses are thought to approximate valid causal inferences as closely as ANCOVA-type analyses, dual-centered ANCOVA estimates the difference-score effect while retaining the advantages of ANCOVA in statistical power and covariate inclusion. These findings are widely applicable to longitudinal analyses that incorporate one or both of these basic methods to analyze change.

Communicating the risk of contracting Zika virus to low income underserved pregnant Latinas: A clinic-based study.

Frequent travel between the Southern border states in the USA, Mexico, and Latin American countries increases the risk of the Zika virus (ZIKV) spread. Patient education on virus transmission is fundamental in decreasing the number of imported cases, particularly among pregnant women. The study used cross-sectional methodology to investigate information sources and knowledge concerning the ZIKV virus among 300 under-served pregnant Latinas recruited from prenatal care clinics in the North Texas region. Bivariate and multiple logistic regression models were used to investigate associations between the primary outcomes and patient characteristics. Physicians, nurses, and families are the major sources for pregnancy information, while media/internet (65%) and physician/nurse (33%) are the main sources for ZIKV information. Less than one-half of the mothers reported that their physician/nurse did not discuss safe sexual practices or inquired about their sexual practices. A considerable proportion of women from the community clinic were neither warned nor queried about travel to ZIKV risk countries. There is an overall understanding of Zika virus transmission, symptoms, complications, and recommended guidelines. Younger age and single mother status are risk factors for lack of ZIKV knowledge. Foreign-born mothers are 2.5-3.0 times more likely to have knowledge on disease transmission, symptoms, and microcephaly condition. While, younger mothers (18-24) are less likely to have knowledge of ZIKV infection symptoms (fever, rash and pink eye) and transmission of infection via unprotected sexual (vaginal, anal, or oral) behavior, compared to older mothers. Interventions are needed to heighten the knowledge of ZIKV, particularly among women of reproductive age and their male partners in the community health care setting. Our study underscores the need for health care providers to be trained in delivering messages to enhance risk perception during health emergencies to vulnerable and underserved families (lower economic background, language ability, and culture). During health emergencies, clinics must disseminate crucial information via multi modalities to ensure messages reach the targeted patients.

Relationship between new-type drug use and high risk sex behavior in men who have sex with men

Objective: To understand the relationship between new-type drug use and high risk behavior in men who have sex with men (MSM) in Shandong province. Methods: Cross-sectional surveys was conducted to collect the information about demographics, sexual and drug use behaviors of MSM and HIV-related services in MSM in three sentinel surveillance sites in Shandong from April to July in 2019. Blood samples were taken from the MSM for serological tests of HIV antibody and syphilis antibody. Results: A total of 1 203 MSM were included in this study. The average age of the MSM was 30.2±8.9 years. Among these MSM, 67.7% (815) were unmarried; 66.9% (805) had education level of college or above; 62.2% (721/1 160) had unprotected sex behaviors and 16.3% (189/1 160) had group sex behavior in the past six months and 54.2% (652/1 203) ever used new-type drugs. HIV infection and syphilis prevalence rates were 3.1% (37/1 203) and 4.7% (56/1 203), respectively. Multivariable logistic analysis indicated that MSM who had unprotected anal sex in the past six months were more likely to be from Qingdao (aOR=1.59, 95%CI:1.13-2.23), with education level of high school or below (aOR=1.61, 95%CI: 1.20-2.16), with male sex partners from bars/dance halls or other venues (aOR=1.69, 95%CI: 1.06-2.69), with HIV knowledge awareness score <6 (aOR=1.55, 95%CI: 1.01-2.37), with ≥2 sex partner in the past week (aOR=1.48, 95%CI: 1.12-1.95), to have group sex behaviors in the past six months (aOR=2.43, 95%CI:1.61-3.67) and to use new-type drugs (aOR=1.46, 95%CI: 1.11-1.91). MSM who had group sex were more likely to have following features: being from Qingdao (aOR=2.21, 95%CI: 1.45-3.38), non-Shandong residents (aOR=2.13, 95%CI: 1.28-3.55), HIV knowledge awareness score ≥6 (aOR=3.11, 95%CI: 1.55-6.25), ever having unprotected anal sex behaviors (aOR=2.60, 95%CI: 1.71-3.96) and ever having male commercial sex (aOR=3.38, 95%CI: 1.92-5.95) in the past six months, ever using new-type drugs (aOR=2.71, 95%CI: 1.82-4.04), and never having HIV testing in the past year (aOR=2.66, 95%CI: 1.59-4.43). Conclusion: New-type drug use is common in MSM in Shandong. The use of new-type drugs promotes unprotected sex and group sex in MSM. Surveillance and intervention measures targeting this population should be strengthened.

HIV infection and associated factors of male sex workers among men who have sex with men

Objective: This study aimed to discover the HIV infection and associated factors among male sex workers (MSW) who provide sexual services for men. Data from this study thus can be used to provide evidence for designing related intervention programs. Methods: In this observational study, MSW were recruited from May to July, 2019 in KTV venues in Wuxi, China. A questionnaire was used to collect information with blood sample collected and tested for HIV and syphilis. EpiData 3.0 and SPSS 17.0 software were used to clean up data and statistical analysis. Results: A number of 500 MSW were involved including 243 (48.6%) heterosexual and 257 (51.4%) homosexual MSW. The overall HIV prevalence was 5.4%(27/500) among all the MSW. there were significant differences between the HIV prevalence rates, the heterosexual MSW (3.3%, 8/243) and the homosexual MSW (7.4%, 19/257)(χ(2)=4.112, P=0.043). In the past 3 months, 28.0% (72/257) of the homosexual MSW mainly engaged in receptive anal sex which was higher than 11.5%(28/243) of the heterosexual MSW. Compared to 15.6% (40/257) of the homosexual MSW who engaged in heterosexual behavior, a higher proportion of 98.4% (239/243) was noticed among the heterosexual MSW. Higher percentage (44.9%, 109/243) appeared among the heterosexual MSW who had not been tested for HIV than the homosexual MSW (20.6%, 53/257). Results from logistic regression multivariate analysis showed that age ≥30 (aOR=7.54, 95%CI: 2.53-37.11), having unprotected anal sexual practice (aOR=3.76, 95%CI:1.15-12.23), having anal sex after drinking alcohol (aOR=10.91, 95%CI: 2.29-51.87) and syphilis tested positive (aOR=8.23, 95%CI:1.29-52.51) were risk factors associated with HIV infection among the heterosexual MSW. Having unprotected anal sexual behavior (aOR=2.94, 95%CI: 1.17-7.37), having group anal sex (aOR=4.08, 95%CI:1.05-15.81), without record on HIV testing (aOR=6.58, 95%CI: 2.01-18.06) and syphilis tested positive (aOR=4.55, 95%CI: 1.15-18.06) were risk factors associated with HIV among the homosexual MSW. Conclusions: High HIV prevalence was discovered among both heterosexual and homosexual MSW in Wuxi, China. Differences in sexual behaviors between these two groups should be considered when designing targeted HIV intervention programs for these populations.