Online Social Networking Technologies, HIV Knowledge, and Sexual Risk and Testing Behaviors Among Homeless Youth

This study evaluates associations between online social networking and sexual health behaviors among homeless youth in Los Angeles. We analyzed survey data from 201 homeless youth accessing services at a Los Angeles agency. Multivariate (regression and logistic) models assessed whether use of (and topics discussed on) online social networking technologies affect HIV knowledge, sexual risk behaviors, and testing for sexually transmitted infections (STIs). One set of results suggests that using online social networks for partner seeking (compared to not using the networks for seeking partners) is associated with increased sexual risk behaviors. Supporting data suggest that (1) using online social networks to talk about safe sex is associated with an increased likelihood of having met a recent sex partner online, and (2) having online sex partners and talking to friends on online social networks about drugs and partying is associated with increased exchange sex. However, results also suggest that online social network usage is associated with increased knowledge and HIV/STI prevention among homeless youth: (1) using online social networks to talk about love and safe sex is associated with increased knowledge about HIV, (2) using the networks to talk about love is associated with decreased exchange sex, and (3) merely being a member of an online social network is associated with increased likelihood of having previously tested for STIs. Taken together, this study suggests that online social networking and the topics discussed on these networks can potentially increase and decrease sexual risk behaviors depending on how the networks are used. Developing sexual health services and interventions on online social networks could reduce sexual risk behaviors.     

HIV Risk Behavior Among HIV-Infected Men Who have Sex with Men in Bangkok, Thailand

We assessed prevalence of sexually transmitted infection (STIs), sexual risk behaviors, and factors associated with risk behaviors among HIV-infected MSM attending a public STI clinic serving MSM in Bangkok, Thailand. Between October 2005–October 2007, 154 HIV-infected MSM attending the clinic were interviewed about sexual risk behaviors and evaluated for STIs. Patients were examined for genital ulcers and had serologic testing for syphilis and PCR testing for chlamydia and gonorrhea. Results showed that sexual intercourse in the last 3?months was reported by 131 men. Of these, 32% reported anal sex without a condom. STIs were diagnosed in 41%. Factors associated with having sex without a condom were having a steady male partner, having a female partner and awareness of HIV status <1?month. Sexual risk behaviors and STIs were common among HIV-infected MSM in this study. This highlights the need for increased HIV prevention strategies for HIV-infected MSM.     

HIV, STIs, and sexual behaviors among men who have sex with men in Phnom Penh, Cambodia.

A probability sample of 206 men who have sex with men from 16 sites in Phnom Penh were surveyed about sexual behaviors and tested for HIV and sexually transmitted infections (STIs). HIV and syphilis prevalence was 14.4% and 5.5%, respectively. Out of the total sample, 81% reported anal sex with any male partners in the past 6 months, and 61.2% reported having had vaginal sex. In the past 6 months, 82.8% of the sample reported having male partners who paid them to have sex. Self-reported sexual orientation did not match well with self-reported sexual behavior. Significant risk factors for HIV infection were anal sex with multiple partners, unprotected vaginal sex with commercial female partners in the past month, and any STI. Complex sexual networks indicate that men who have sex with men act as a bridge between higher and lower HIV prevalence populations. Better prevention efforts structured around behaviors rather than sexual identities are needed.     

Avoidance,Anxiety, and Sex: The Influence of Romantic Attachment on HIV-Risk among Pregnant Women

Most unprotected sex occurs in close relationships. However, few studies examine relational factors and sexual risk among high-risk populations. Romantic Attachment Theory states that individuals have cognitive working models for relationships that influence expectations, affect, and behavior. We investigated the influence of attachment avoidance and anxiety on sexual beliefs (e.g., condom use beliefs, self-efficacy), behavior (e.g., condom use, multiple partners, unprotected sex with risky partners), and sexually transmitted infections (STIs) among 755 high-risk, young pregnant women (ages 14a€“25) recruited from urban prenatal clinics. Attachment anxiety predicted sexual beliefs, condom use, and unprotected sex with risky partners controlling for demographic variables. Sexual beliefs did not mediate the relationship between attachment orientation and sexual behavior. Current relationship with the father of the baby did mediate the effect of attachment anxiety on multiple partners and STIs. Results indicate the importance of including general relational factors, such as attachment, in HIV prevention.     

Desire for pregnancy and risk behavior in young HIV-positive women

This cross-sectional study utilized data from 130 young women with behaviorally acquired HIV to examine the association between desire for pregnancy (DFP) and both sociodemographic variables and sexual risk behaviors. A single item was utilized to assess DFP. Bivariate and multivariate regression analyses were conducted. At the bivariate level, DFP was associated with increased rates of intercourse, decreased condom use, increased partner concurrency, increased rates of unprotected sex with a nonconcordant partner, and a higher number of previous sexually transmitted infections (STIs). Multivariate analyses suggested that DFP was associated with increased likelihood of recent intercourse, condom-unprotected sex, and oral sex. DFP was related to few sociodemographic variables but was associated with having fewer children currently, a history of victimization, and decreased rates of disclosure of HIV status. The few sociodemographic variables that were associated with DFP suggest that social relationships may play a role in DFP. DFP was associated with sexual behaviors that may place young women at risk for STI acquisition and secondary HIV transmission to partners. Health care providers should assess DFP in routine HIV care, providing education about fertility options, interventions for vertical transmission, family planning, and risk reduction counseling.     

High Risk Behaviors and Sexually Transmitted Infections Among Men in Tanzania

We assessed the association between risk behaviors and sexually transmitted infections (STIs) among men. We interviewed 794 men randomly selected from Moshi district of Tanzania. Blood and urine samples were tested for STIs. About 46% of the men tested positive for at least one STI including human immunodeficiency virus (HIV-1), herpes simplex virus (HSV-2), syphilis, chlamydia, trichomonas, and mycoplasma infection. Multiple sexual partners, casual sex, alcohol abuse, and older age were associated with higher odds of having an STI. Effective STI prevention programs in sub-Saharan Africa should have components aimed at addressing modifiable risk behaviors in men.     

Perceptions of sexual risk behaviours and substance abuse among adolescents in South Africa: a qualitative investigation

The study examined South African adolescents' beliefs and attitudes regarding drug use, sexual risk behaviour and relationships between the two behaviours. Eleven single-gender focus groups were held among male and female Grade 8 and 11 students from three schools in Cape Town. The adolescents' opined that drugs' reinforcing effects were the main factor underlying their use, and that sexual risk behaviours resulted from girls' limited power in sexual relationships and boys' perceived invulnerability to HIV infection and the positive status associated with having multiple partners. Drug use was considered to exacerbate underlying vulnerabilities to risky sexual behaviour mainly due to drugs' effects on adolescents' inhibitions, rational thinking, and safer sex negotiation skills. The findings suggest that adolescent HIV intervention programmes should address the risks posed by drug use on sexual behaviour.     

Psychosocial Characteristics and Sexual Behaviors of People in Care for HIV Infection: An Examination of Men Who Have Sex with Men, Heterosexual Men and Women

Few studies have examined the psychosocial factors associated with sexual transmission behaviors among HIV-positive men who have sex with men (MSM), heterosexual men (MSW) and women. We enrolled 1,050 sexually active HIV-positive patients at seven HIV clinics in six US cities as part of a clinic-based behavioral intervention. We describe the sexual transmission behaviors and examine demographic, clinical, psychosocial, and clinic prevention variables associated with unprotected anal or vaginal intercourse (UAVI). Twenty-three percent of MSM, 12.3% of MSW and 27.8% of women engaged in UAVI with partners perceived to be HIV-negative or of unknown serostatus. Among MSM and MSW, having multiple partners and lower self-efficacy were associated with increased odds of UAVI. Self-rating one’s health status as excellent/very good was a risk factor for UAVI among MSM. Among women, binge drinking and stressful life events were associated with UAVI. These findings identify variables that warrant attention in targeted interventions.     

Vulnerable but feeling safe: HIV risk among male rural-to-urban migrant workers in Chengdu, China

HIV prevalence is increasing in China. The proportion of infection attributable to heterosexual sex in China is also on the rise. The scale of internal migration for work is likely to be one of the factors contributing to these changing patterns, but little is known about HIV-related knowledge, perceptions and risk behaviours of China's migrant workers. This study aimed to investigate HIV-related knowledge, attitudes and risk behaviours of male rural-to-urban migrant workers in Chengdu and to identify factors associated with risk behaviours. In 2005, a cross-sectional questionnaire survey was completed by 163 male construction- and factory-based migrant workers aged 18-35 years. With a mean age of 26 years, just 30% had completed senior middle school and 47% were currently married. Respondents were highly mobile, worked long hours and were relatively poorly paid. As migrants, their access to urban services and benefits was restricted, making it difficult for family members to join them. Knowledge of HIV transmission was generally poor and discriminatory attitudes towards people with HIV were commonplace. Seventy-five percent were sexually experienced, among whom 88% had had sexual relations in the last 12 months. Of these, 30% had had two or more partners and 20% had paid for sex. Just 36% had used a condom during the most recent sexual encounter with a sex worker. Around 70% thought it was 'impossible' for them to become infected, yet a significant sub-group were engaging in sexual behaviours that place them at risk of infection with HIV and sexually transmitted infections (STIs). Logistic Regression found a significant association between having multiple sexual partners and both education level and marital status. Education was also found to be significantly associated with purchasing sex. Targeted HIV-prevention programs for male migrant workers in Chengdu, especially for those who are single and less educated, are urgently needed.     

Alcohol Use and Sexual Risk Behaviors and Outcomes in China: A Literature Review

This review systematically examines the empirical evidence regarding the association between alcohol use and sexual risk behaviors and outcomes among the Chinese population in mainland, China. Articles published in English (n = 11) and in Chinese (n = 7) from 1980 to 2008 documented consistent associations between alcohol use and several sexual risk behaviors, sexual coercion, sexual violence, and HIV/STIs across both the general population and high-risk groups, except for men having sex with men. This review suggests that alcohol use is associated with diverse sexual risk behaviors and outcomes across a variety of social groups in China, consistent with the evidence from the Western countries and Sub-Saharan Africa. Alcohol use is an important but under-researched correlate of sexual risk behaviors and outcomes in China. This review indicates the importance of research assessing alcohol use among both genders and with standardized measures, and suggests the importance of integrating alcohol use control in sexual risk reduction and prevention efforts in China.     

Age differences in sexual risk behaviors and related factors among people living with HIV in Guangxi,China

Sexual risk behaviors by people living with HIV (PLHIV) can result in secondary HIV transmission and other health problems. Given the dearth of research on age differences in sexual behaviors among PLHIV, the objective of the study is to compare sexual risk behaviors and related factors among PLHIV by age groups. Data used in the current study were derived from a cross-sectional survey conducted from 2012 to 2013 in Guangxi, China. PLHIV were selected randomly from 12 sites with the largest number of HIV/AIDS cases. The 2,987 PLHIV completing the survey were included in the study. Participants were asked about key sociodemographic characteristics, health condition, same-sex behavior, and sexual risk behaviors (number of sex partners, condom use consistency, and change in condom use after HIV diagnosis). Univariate logistic regression analyses were conducted to evaluate associations of sexual risk behaviors with age and other factors. Those variables with a p-value of less than 0.2 were entered into multivariate logistic regression models. All statistical analyses were conducted using SAS 9.4. Differences in sexual risk behaviors across age groups were observed. Compared with their younger counterparts, who were ≥?50 years of age were more likely to have multiple partners, use condoms inconsistently, and use condoms less than before HIV diagnosis. Moreover, lower education attainment, being in the lowest or highest category of income, having a sero-concordant or sero-unknown steady partner or no steady partner, and having contracted HIV from steady or casual/commercial partners, or through injection drug use appeared to be predictive of at least one of the sexual risk behaviors examined in the study. The findings call for HIV prevention interventions to be tailored to different age groups. The interventions that can help reduce unprotected sex among older PLHIV are urgently needed.     

Gender Based Violence as a Risk Factor for HIV-Associated Risk Behaviors Among Female Sex Workers in Armenia

This cross-sectional study identified the prevalence of gender based violence (GBV) and examined its association with sexual risk behavior among female sex workers (FSWs). Among 120 participants between ages 20 and 52, a total of 56.7 % reported lifetime GBV. Multivariate analyses revealed that GBV was significantly associated with inconsistent condom use, unprotected sex, condom misuse, fear of client reaction to requests of condom use, self-reported history of STIs, and earlier age of initiation of sex work. GBV must be considered an urgent public health priority among FSWs in Armenia. Interventions addressing FSWs, in addition to targeting skill-based, sexual risk reduction must also introduce a discourse among FSWs, sexual partners, clients and community members about the role of GBV in HIV-associated risk behaviors and infection. Structural level initiatives must address economic opportunities for women, health-sector policies and responses to FSWs’ health needs, law enforcement training and societal norms toward women.     

HIV Disclosure and Sexual Transmission Behaviors among an Internet Sample of HIV-positive Men Who Have Sex with Men in Asia: Implications for Prevention with Positives

The relationship between HIV disclosure and sexual transmission behaviors, and factors that influence disclosure are unknown among HIV-positive men who have sex with men (MSM) in Asia. We describe disclosure practices and sexual transmission behaviors, and correlates of disclosure among this group of MSM in Asia. A cross-sectional multi-country online survey was conducted among 416 HIV-positive MSM. Data on disclosure status, HIV-related risk behaviors, disease status, and other characteristics were collected. Multivariable logistic regression was used to identify significant correlates of disclosure. Only 7.0% reported having disclosed their HIV status to all partners while 67.3% did not disclose to any. The majority (86.5%) of non-disclosing participants had multiple partners and unprotected insertive or receptive anal intercourse with their partners (67.5%). Non-disclosure was significantly associated with non-disclosure from partners (AOR?=?37.13, 95% CI: 17.22, 80.07), having casual partners only (AOR?=?1.91, 95% CI: 1.03, 3.53), drug use before sex on a weekly basis (AOR: 6.48, 95% CI: 0.99, 42.50), being diagnosed with HIV between 1 and 5?years ago (AOR?=?2.23, 95% CI: 1.05, 4.74), and not knowing one's viral load (AOR?=?2.80, 95% CI: 1.00, 7.83). Given the high HIV prevalence and incidence among MSM in Asia, it is imperative to include Prevention with Positives for MSM. Interventions on disclosure should not solely focus on HIV-positive men but also need to include their sexual partners and HIV-negative men.     

HIV treatment optimism and sexual risk behaviors among HIV positive African American men who have sex with men

The association between HIV treatment optimism--beliefs about susceptibility to transmit HIV, motivation to use condoms, and severity of HIV--and sexual risk behavior was examined among HIV-positive African American men who have sex with men (MSM). Participants were 174 men recruited in four major metropolitan areas of the United States to participate in a weekend HIV risk reduction intervention. Baseline results revealed that beliefs in less susceptibility to transmit HIV and less motivation to use condoms were significantly associated with more unprotected anal intercourse among serodiscordant casual partners. Less motivation to use condoms also predicted more unprotected insertive and receptive anal sex and was more important than susceptibility beliefs in predicting these behaviors. Suggestions are offered of ways to better inform HIV-positive African American MSM about their misperceptions about HIV treatment and how their level of optimism about HIV treatment may diminish or encourage condom use.     

Predictors of AIDS-preventive behavior among homosexually active men: a longitudinal study

Predictors of adoption of safer sexual behaviors were examined in a cohort of 278 homosexually active men with stable HIV-antibody status followed over 12 months at a Boston community health center. The behaviors examined included: (1) restriction of partners to one monogamous or steady relationship and (2) among men who maintained multiple or non-steady partners, the avoidance of unprotected receptive and insertive anogenital contact. For each behavior, men who adopted consistently safer behavior were compared with those who remained unsafe, using bivariate analyses and multiple logistic regression modelling. The strongest predictor of all behaviors was the initial level of the unsafe behavior. After controlling for this, weak effects of several health beliefs were found, including perceived susceptibility and medical efficacy. Men who became aware of a positive HIV-antibody test result and who reported greater effort to change their behavior were more likely to adopt safer insertive anogenital contact. In this generally well-educated cohort with high levels of knowledge about AIDS, adoption of safer sexual behaviors is best predicted from previous levels of unsafe behavior.     

Maternal HIV Serostatus, Mother–Daughter Sexual Risk Communication and Adolescent HIV Risk Beliefs and Intentions

Daughters of HIV-positive women are often exposed to the same factors that placed their mothers at risk. This cross-sectional study (N = 176 dyads) examined HIV status, parent-teen sexual risk communication (PTSRC), and daughters’ abstinence and condom use beliefs and intentions. Maternal HIV status was not associated with PTSRC. Path analyses show that maternal depression was associated with PTSRC behavioral and normative beliefs; relationship satisfaction was associated with PTSRC normative and control beliefs. Control beliefs were solely predictive of maternal PTSRC intention. PTSRC was associated with adolescent behavioral and normative beliefs. Abstinence beliefs were associated with abstinence intentions; condom beliefs were associated with condom use intentions. Relationship satisfaction was associated with adolescent control beliefs about both abstinence and condom use. There is a need for interventions that help HIV-positive mothers recognize their daughter’s HIV risk and provide them with relationship building and parent process skills to help reduce these risks.     

Spatial Mobility,Alcohol Use,Sexual Behavior and Sexual Health Among Males in India

This paper examines the linkages of permanent migration, temporary mobility and alcohol consumption with risky sexual behavior and sexually transmitted infections (STIs) including HIV infection among males in India using a nationally representative dataset. The study shows that non-migrant men and migrant men do not differ significantly in any indicator of risky sexual behavior and STIs. Temporary long duration mobile men reported significantly more often than the non-mobile men or short duration mobile men that they had sex with multiple sex partners during their lifetime as well as sex with a high risk partner and had paid sex in the 12 months preceding the survey. Males who drank alcohol almost every day notwithstanding with their migration or mobility status were most prone to lifelong as well as more recent sexual risk behavior. Controlling for sociodemographic characteristics long duration mobile men and men who used alcohol almost daily had higher sexual risk behaviors and STI infections. Further migration and mobility did not show any significant relationship with tested HIV prevalence among males in India, controlling for sociodemographic characteristics. Males who had lifetime multiple sex partners were at the highest risk of tested HIV infection controlling for sociodemographic characteristics, migration, mobility, alcohol use and STI infection. Interventions focusing on HIV prevention in India need to target both non-migrant and migrant men, particularly those who drink alcohol more frequently or daily. Targeted interventions are required for temporary mobile men, particularly for those mobile men who have to stay away from their homes continuously for a longer duration. Long duration mobile men are most prone to regular alcohol use and risky sexual behavior.     

Sexually transmitted infections among women who have sex with women

Women who have sex with women (WSW) are a diverse group with variations in sexual identity, sexual behaviors, sexual practices, and risk behaviors. WSW are at risk of acquiring bacterial, viral, and protozoal sexually transmitted infections (STIs) from current and prior partners, both male and female. Bacterial vaginosis is common among women in general and even more so among women with female partners. WSW should not be presumed to be at low or no risk for STIs based on sexual orientation, and reporting of same-sex behavior by women should not deter providers from considering and performing screening for STIs, including chlamydia, in their clients according to current guidelines. Effective delivery of sexual health services to WSW requires a comprehensive and open discussion of sexual and behavioral risks, beyond sexual identity, between care providers and their female clients.     

Social and behavioural factors associated with risky sexual behaviours among university students in nine ASEAN countries: a multi-country cross-sectional study

While university students are potential human resources, this population group is particularly involved in health risk behaviours. Preventing risky sexual behaviours among them would contribute to prevention of HIV, sexually transmitted infections (STIs), and unwanted pregnancies, which have posed a great burden on population health. This study was therefore conducted to identify social and behavioural factors associated with risky sexual behaviours among university students in nine ASEAN countries. A multi-country, cross-sectional study was conducted in 2015 among university students by a network of researchers in the selected countries. A convenient sampling method and stratified random sampling procedures were employed to select universities and students, respectively. A structured questionnaire was translated into national languages of the participating countries and used to collect data from the selected students in the classrooms. Using STATA, Chi-square test was used to test differences in proportions, and multinomial logistic regression analyses were performed to obtain relative risk ratios and 95% confidence intervals. Multivariate logistic regression analysis was performed with to identify independent social and behavioural factors associated with non-condom use at last sexual intercourse. In total, 8,836 students with a mean age of 20.6 (SD?=?2.0) participated in the study. Most of them (98.5%) were unmarried. In all countries, male students were significantly more likely to have two or more sexual partners in the past 12 months compared to female students (4.8% vs. 1.1%, p?p?=?0.01). Results of multivariable logistic regression analyses showed that students who reported having two or more partners in the past 12 months were significantly more likely to be male, be aged between 20–30, be current tobacco smokers, be binge drinkers, have severe depressive symptoms, and have been in a physical fight in the past 12 months, compared to students who reported having less than two sexual partners in the past 12 months. Health intervention programmes to prevent and control STIs, especially HIV infection, should focus on university students having the social and behavioural characteristics that are associated with risky sexual behaviours.