Sex in the Era of COVID-19 in a U.S. National Cohort of Cisgender Men,Transgender Women,and Transgender Men Who Have Sex with Men: April–May 2020

Since the emergence of the COVID-19 pandemic, there has been an increasing body of research focused on the effects that measures like stay-at-home orders and social distancing are having on other aspects of health, including mental health and sexual health. Currently, there are limited extant data on the effects of the pandemic on sexual and gender minorities. Between April 15, 2020, and May 15, 2020, we invited participants in an ongoing U.S. national cohort study (Together 5000) to complete a cross-sectional online survey about the pandemic, and its effects on mental and sexual health and well-being (n?=?3991). Nearly all (97.7%) were living in an area where they were told they should only leave their homes for essentials. Most (70.1%) reported reducing their number of sex partners as a result of the pandemic. Among the 789 participants prescribed HIV pre-exposure prophylaxis (PrEP), 29.9% said they stopped taking their PrEP entirely, and 14.2% started selectively skipping doses. For those who had been taking PrEP, discontinuing PrEP was associated with having no new sex partners (β?=?0.90, 95% CI 0.40–1.40). Among the 152 HIV-positive participants, 30.9% said they were unable to maintain an HIV-related medical appointment because of the pandemic and 13.8% said they had been unable to retrieve HIV medications. Additionally, 35.3% of participants were experiencing moderate to severe anxiety because of the pandemic and 36.7% reported symptoms of depression. In a multivariable logistic regression, reporting a new sex partner in the prior 30 days was significantly associated with being aged 30 or older (vs. not, AOR?=?1.21), being Black (AOR?=?1.79) or Latinx (AOR?=?1.40, vs. white), and being unsure if they had been in close contact with someone diagnosed with COVID-19 (AOR?=?1.32, vs. no contact). It was unassociated with COVID-19-induced anxiety, depression, or knowing someone hospitalized with COVID-19. The pandemic has caused disruptions in sexual behavior (partner reduction) as well as difficulties navigating PrEP and HIV care continua. Findings will guide more comprehensive public health responses to optimize HIV prevention and treatment in the era of COVID-19.

     

‘I am not a man’: Trans-specific barriers and facilitators to PrEP acceptability among transgender women

ABSTRACT

The frequent conflation of transgender (‘trans’) women with ‘men who have sex with men (MSM)’ in HIV prevention obscures trans women's unique gender identities, social and behavioural vulnerabilities, and their disproportionately high rates of HIV infection. Pre-exposure prophylaxis (PrEP) is an efficacious biomedical HIV prevention approach. However, trans women are underrepresented in PrEP research, and are often aggregated with MSM without consideration for their unique positions within sociocultural contexts. This study examined PrEP acceptability among trans women via three focus groups and nine individual interviews (total N?=?30) in San Francisco. While knowledge of PrEP was low, interest was relatively high once participants were informed. Due to past negative healthcare experiences, ability to obtain PrEP from a trans-competent provider was cited as essential to PrEP uptake and adherence. Participants noted that PrEP could address situations in which trans women experience reduced power to negotiate safer sex, including sex work. Trans-specific barriers included lack of trans-inclusive marketing of PrEP, prioritisation of hormone use, and medical mistrust due to transphobia. Findings underscore the importance of disaggregating trans women from MSM in HIV prevention strategies to mitigate disparate risk among this highly vulnerable population.     

A Qualitative Study of Medical Mistrust,Perceived Discrimination,and Risk Behavior Disclosure to Clinicians by U.S. Male Sex Workers and Other Men Who Have Sex with Men: Implications for Biomedical HIV Prevention

Access to biomedical HIV prevention technologies such as pre-exposure prophylaxis (PrEP) requires individuals to disclose risk behavior to clinicians, but experiences of discrimination and medical mistrust may limit disclosure among male sex workers and other MSM. We explored experiences of perceived discrimination, medical mistrust, and behavior disclosure among male sex workers compared to other men who have sex with men (MSM). We conducted 56 interviews with MSM and compared findings about medical mistrust, discrimination, and disclosure for 31 men who engaged in sex work vs. 25 men who did not. MSM who engaged in sex work reported more medical mistrust and healthcare discrimination due to issues beyond MSM behavior/identity (e.g., homelessness, substance use, poverty). MSM who did not report sex work described disclosing sex with men to clinicians more often. Both subgroups reported low PrEP awareness, but willingness to disclose behavior to obtain PrEP. Medical mistrust and perceived discrimination create barriers for sexual behavior disclosure to clinicians, potentially impeding access to PrEP and other forms of biomedical HIV prevention. These barriers may be higher among male sex workers compared to other MSM, given overlapping stigmas including sex work, substance use, homelessness, and poverty. An intersectionality framework for understanding multiple stigmas can help to identify how these dynamics may limit access to biomedical HIV prevention among male sex workers, as well as suggesting strategies for addressing stigmas to improve the delivery of PrEP and other HIV prevention approaches in this population.     

Trust,Familiarity, Optimism,and Pleasure: Australian Gay Men Accounting for Inconsistent HIV Prevention Practices in the PrEP Era

Despite an increase in the range of effective HIV risk reduction strategies that are available, some gay and bisexual men (GBM) do not use any of them consistently. Understanding why GBM do not always use a protective strategy may help develop more effective responses. Semi-structured interviews with 24 sexually active GBM in Sydney, Australia were conducted and analyzed using thematic analysis. The main characteristics of encounters featuring little or no use of HIV risk reduction strategies were familiarity and trust with partners, pleasure and intoxication, expectations that partners were using HIV pre-exposure prophylaxis or treatment as prevention, and in some cases feelings of inevitability about acquiring HIV. An increase in pleasure and a reduction in anxiety about sex were noted by some GBM who had commenced PrEP. Encouraging GBM to adopt a strategy such as PrEP and to use it consistently may be easier by emphasizing benefits to mental health and the quality of sex and intimacy it can offer. However, even with the increased availability of effective biomedical HIV risk reduction strategies, not all GBM are able to consistently manage HIV risk and some continue to hold optimistic and potentially inaccurate beliefs about sexual partners that may increase HIV risk.

     

The Ashodaya PrEP project: Lessons and implications for scaling up PrEP from a community-led demonstration project among female sex workers in Mysore,India

ABSTRACT

To inform PrEP roll out, Ashodaya Samithi, a sex workers’ collective, conducted a community-led prospective demonstration project among female sex workers in Mysore and Mandya, India. Following a community preparedness phase and pre-screening, participants were recruited for clinical screening and enrolment, provided PrEP as part of combination HIV prevention, and followed for 16 months. Adherence was measured by self-reported pill intake and by tenofovir blood level testing among a subset of participants. Of the 647 participants enrolled, 640 completed follow-up. Condom use remained stable and no HIV seroconversions occurred. Self-reported daily PrEP intake over the last month was 97.97% at the end of the study. Tenofovir blood levels >40?ng/mL (consistent with steady state dosing) were detected among 80% (n?=?68/85) and 90.48% (n?=?76/84) of participants at month 3 and 6, respectively. Our study holds important insights for rolling out PrEP in community settings as part of targeted HIV prevention interventions.     

The Roles of Body Image,Sexual Motives,and Distraction in Women’s Sexual Pleasure

Women with body image concerns are more likely to experience sexual difficulties (e.g., with arousal, lubrication, orgasm). However, the processes by which body image impacts sexual well-being are poorly understood. We theorized that women with negative body image are less likely to view sex in terms of reward, leading them to have weaker approach sexual motives (i.e., to pursue positive experiences such as pleasure). Rather, women with negative body image may have sex to avoid personal insecurities and negative emotions, leading them to have stronger avoidance sexual motives (i.e., to cope with negative affect or to avoid partner conflict). In turn, we theorized that stronger approach sexual motives may allow women to be more focused on erotic cues during sex, thereby enhancing sexual pleasure, whereas avoidance motives may lead to greater distraction, interfering with sexual pleasure. Women (N?=?1619) were recruited from online venues and reported on their body image and most recent sex. We found that body dissatisfaction was associated with weaker self-focused approach motives and in turn more distraction. Additionally, body dissatisfaction was associated with stronger self- and partner-focused avoidance motives and in turn more distraction. In turn, more distraction was associated with less pleasure and worse sexual function. To the best of our knowledge, this is the first investigation of whether body image in women is associated with their sexual motives. Findings highlight the importance of sexual motives in explaining the link between body image and sexual pleasure and function.

     

Nutrition Support Team Intervention Improves Activities of Daily Living in Older Patients Undergoing In-Patient Rehabilitation in Japan: A Retrospective Cohort Study

The effect of nutrition support on activities of daily living (ADL) in individuals aged ≥75 years requiring rehabilitation is unknown. This study aimed to investigate the effect of nutrition support on ADL improvement in older patients undergoing in-patient rehabilitation in Japan. This retrospective cohort study was performed in 175 patients aged ≥75 years. The nutrition support team (NST) intervened in 85 cases. ADL was evaluated by the functional independence measure (FIM). We analyzed the effects of NST intervention on FIM efficiency. Multiple linear regression analysis revealed that NST intervention (standard partial regression coefficient, β?=?0.164; 95% confidence interval [CI] 0.003–0.229; P?=?0.044), energy intake at admission (β?=?0.179; 95% CI, 0.000–0.016; P?=?0.043), body mass index (BMI) at admission (β?=?0.227; 95% CI, 0.005–0.046; P?=?0.014), and cerebrovascular disease (β?=??0.238; 95% CI, ?0.298 to ?0.063; P?=?0.003) were independently associated with FIM efficiency. NST intervention, energy intake, and BMI on admission may affect ADL improvement in older patients undergoing in-patient rehabilitation.     

Willingness to use mental health counseling and antidepressants in older Korean Americans: the role of beliefs and stigma about depression

Objectives: Despite a high prevalence of mental health problems, racial/ethnic minorities are often reluctant to seek mental health services. Their reluctance may be shaped by cultural beliefs and stigma about mental health. The present study examined how beliefs and stigma about depression (e.g. disbelief in depression as a health-related condition, perception of depression as a normal part of aging, and/or depression as a sign of personal weakness/family shame) pose barriers to older Korean Americans’ willingness to use mental health counseling and antidepressants.

Method: Data were drawn from surveys with 420 Korean American older adults (M_age=?71.6, SD?=?7.6) living in the New York City metropolitan area in 2010. Using a separate logistic regression model, the role of beliefs and stigma about depression in predicting participants’ willingness to receive mental health counseling and to take antidepressants was tested. Based on Andersen’s behavioral health service use model, the analysis was conducted in consideration of predisposing characteristics (age, gender, marital status, education, and acculturation), mental health needs (anxiety, depressive symptoms, and self-rated mental health), and enabling/hindering factors (beliefs and stigma).

Results: Similar proportions of the sample (69–70%) indicated their willingness to use mental health counseling or antidepressants. Willingness was more likely among participants who had beliefs about depression as a health-related concern (OR?=?1.94, 95% CI?=?1.15?3.27 for mental health counseling; OR?=?4.47, 95% CI?=?2.59?7.70 for antidepressants) and less likely among those who associated depression with family shame (OR?=?.55, 95% CI?=?0.33?0.91 for mental health counseling; OR?=?.56, 95% CI?=?0.33?0.95 for antidepressants).

Conclusion: In addressing mental health problems and promoting the use of mental health services, cultural beliefs and stigma shared within an ethnic community should be considered. Given that disbelief in the medical model of depression and family shame reduced willingness to use mental health counseling and antidepressants, promoting mental health literacy for older immigrants could be beneficial.     

Revisiting the healthy immigrant effect with diabetes risk in Canada: why race/ethnicity matters

ABSTRACT

Objective: Evidence shows that recent immigrants are healthier than the native-born population, a phenomenon known as the healthy immigrant effect. With increasing duration of stay, this health gap significantly narrows as immigrants’ health deteriorates to either resemble or become worse than the host population. However, little is known about the category of immigrants for whom this decline is most pronounced since the extant research largely considers immigrants as a homogeneous group, thus overlooking important racial/ethnic differences.

Design: Using data from the 2014 Canadian Community Health Survey (CCHS), we categorised immigrants by race/ethnicity and duration of stay in Canada and compared them to their native-born white Canadian counterparts on the likelihood of having a chronic health condition, using type 2 diabetes (T2D) as a case.

Results: In the base model, recent visible minority (i.e. non-white or non-Caucasian) immigrants and recent white immigrants were less likely than the native-born white Canadian population to have T2D (recent visible minority immigrants OR?=?0.46, CI?=?0.27–0.79, p?=?0.005; recent white immigrants OR?=?0.26, CI?=?0.11–0.64, p?=?0.003). The odds of having T2D were significantly higher for long-term immigrants than the native-born white Canadian population (long-term visible minority immigrants OR?=?1.59, CI?=?1.27–2.00, p?=?0.000; long-term white immigrants OR?=?1.74, CI?=?1.44–2.10, p?=?0.000). In the multivariate model, long-term visible minority immigrants were about 2.3 times more likely than their white Canadian born counterparts to have T2D (CI?=?1.86–2.96, p?=?0.000). Long-term visible minority immigrants were about 2.1 times more likely than long-term white immigrants to have T2D (CI?=?1.49–2.94, p?=?0.000)

Conclusion: Immigrants’ health deterioration varies significantly across ethnic categories in Canada. Interventions for facilitating the integration of visible minority immigrants may help reduce these health inequities.     

Associations among Sexual Activity,Relationship Types,and Health in Mid and Later Life

Despite a growing amount of research on sexuality in mid and later life, relatively little is known about the associations among sexual activity, relationship types, and health. This paper analyzes data from the Survey of Health, Ageing and Retirement in Europe (SHARE) for the subpopulation of respondents residing in the Czech Republic (N?=?1304, 49% women; M_age?=?69.1, SD_age?=?8.0). Hierarchical ordinal regression models showed that persons who stayed in newly formed or less traditional relationship types, such as dating, Living-Apart-Together (LAT) relationships, and cohabitation, reported a higher frequency of sexual activity than married people. Overall, the dating and LAT relationship group displayed the highest sexual frequency and the lowest incidence of chronic diseases. People in marriages and cohabitation were comparable with respect to the number of chronic diseases. The findings suggest that sexual activity is intertwined with later-life relationships and sexual frequency may vary according to the relationship type. Future research may benefit from probing the extent to which partnered sex is important for maintaining bonds between older partners with separate households.

     

基于路径分析探讨MSM暴露前预防用药自信度对用药意愿影响

目的 利用结构方程模型（SEM）取向的路径分析模型分析MSM暴露前预防（PrEP）用药自信度对用药意愿的影响。方法 采用滚雪球法在乌鲁木齐市招募MSM 550人，并进行问卷调查。根据专业知识及用药自信度、用药意愿多因素分析结果，使用SEM方法构建路径分析模型。结果 完成调查MSM 513人。修正后路径分析方程模型拟合良好，修正后拟合指数GFI=0.993、RMSEA<0.001、AGFI=0.984。用药自信度对用药意愿存在直接影响；性伴对PrEP的态度、用药受性伴影响程度及积极情绪不仅对用药意愿有直接影响，并通过影响用药自信度对用药意愿存在间接效应；性行为的角色、认为艾滋病严重程度、艾滋病预防行为对PrEP用药意愿存在直接效应；人群艾滋病感染比例对用药意愿无直接效应，但通过影响用药自信度而存在间接效应。结论 MSM暴露前预防用药自信度对用药意愿存在影响，可对MSM开展针对性干预措施，提高MSMPrEP用药自信度及用药意愿；相对于传统多因素回归分析，利用SEM取向的路径分析能够更好的揭示自变量与因变量之间的中介效应。     

我国24个城市男男性行为者HIV暴露前预防用药现状及相关因素分析

目的了解我国MSM对HIV暴露前预防(PrEP)的认知和用药现状及影响因素。方法 2021年8月25日至9月5日通过男性社交平台Blued 7.5软件在我国24个城市招募MSM 2 447人参与线上问卷调查, 调查内容包括社会人口学、PrEP知晓和用药与高危性行为等信息。采用三分类二水平logistic回归分析MSM的PrEP用药相关因素。采用SPSS 24.0和SAS 9.4软件进行统计学分析。结果在MSM研究对象2 447人中, 听说过PrEP者1 712人(69.96%), 曾用药者437人(17.86%), 正在用药者274人(11.20%), 停用者163人(6.66%);437人曾用药者多数采用了按需用药方式, 用药方案采用替诺福韦+恩曲他滨的占61.88%(388/627), 人均用量为1.12片/周, 获取药物以互联网为主, 选择药物更关注PrEP用药的预防效果;163人停药最常见原因是认为没有HIV感染的风险。logistic回归分析结果显示, MSM中PrEP用药与年龄、月均收入、最近1年发生无保护肛交、最近1年使用助性剂和被诊断出患有性病等因素存在统计学关联, 其...     

Negotiating sexual safety in the era of biomedical HIV prevention: relationship dynamics among male couples using pre-exposure prophylaxis

Up to two-thirds of new cases of HIV transmission between gay, bisexual and other men who have sex with men in the USA are attributed to primary relationships. Understanding the relationship dynamics and sexual agreements of male-male couples can provide insight into HIV transmission patterns and prevention needs in this population. The daily use of antiretroviral pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV, but its negotiation and use within social and intimate relationship contexts remain understudied. We conducted semi-structured qualitative interviews with 20 male couples (n = 40 men) in which at least one partner was either using or in the process of initiating PrEP. Congruent with a theoretical focus on social theories of relationships and negotiated risk, couples were interviewed about relationship dynamics, trust, communication and sexual health practices, including their perception and use of PrEP. Overall, we found that couples showed heightened trust and communication when establishing open, sexual agreements and demonstrated high awareness of sexual risks and health practices in the context of PrEP use. This study demonstrates how understanding relationship dynamics can better inform HIV prevention and sexual health promotion efforts for male couples at risk of HIV.     

HIV Pre-Exposure Prophylaxis (PrEP) in a Brazilian Clinical Setting: Adherence,Adverse Events,Sexual Behavior,and Sexually Transmitted Infections

Tenofovir/emtricitabine (TDF/FTC) has been used as pre-exposure prophylaxis (PrEP) in preventing HIV infection. PrEP is an effective prevention tool as demonstrated in clinical trials and studies in clinical practice and was incorporated into the Brazilian public health system in December 2017. The present study was a prospective cohort that included 219 PrEP users monitored over a 10 month follow-up period in a capital city in Northeastern Brazil. Data were collected from the PrEP users’ electronic medical records platform made available by the Brazilian Health Ministry. During the observation period, there was good user retention to the prevention program (84%) and there was high adherence to medication (90%). Almost half the users (49%) presented an adverse event, although these were mild and transient, 30 days after starting prophylaxis. There was a significant reduction in creatinine clearance (p?<?.001), from 104.9 to 83.5 mL/min; however, there was no need for drug discontinuation. Throughout the cohort, there was no significant change in the number of sexual partners, but the use of condoms during sexual intercourse decreased (p?<?.001). There was a non-significant increase in the incidence of syphilis (p?=?.08), and there was a 50% decrease in reporting signs and symptoms of sexually transmitted infections. No cases of HIV infection were observed. PrEP proved to be an effective tool in HIV prevention, presenting few complications of adverse events.

     

Evaluation of a Web-Based Sexual Health Education Program for Individuals with Visual Impairments

Individuals with visual impairments often do not receive adequate sexual health care. In order to improve their health, they need to be better informed. The purpose of this study was to assess the web-based sexual health education prepared for individuals with visual impairments regarding quality, content and usability. Views of 16 experts were taken to assess the web content and quality of the study. Of them, eight were nurses in sexuality and sexual health and eight were experts in education of individuals with visual impairments and Web Accessibility Criteria. In order to evaluate usability, the sample comprised 35 individuals with visual impairments who met the inclusion criteria. Data were collected using a Personal Information Form, the DISCERN Guide, Web-Based Sexual Health Education Web Content Evaluation Form, System Availability Scale and Website Evaluation Form for Individuals with Visual Impairments. The quality and content of the website were found appropriate (Respectively: Kendall’s W?=?0.899, p?=?0.000; Kendall’s W?=?0.441, p?=?0.000). The usability of the website was determined as high (x??±?SD?=?97.00?±?2.8). The most useful modules in the website were determined as sexual health and rights and human body and development. Web-based sexual health education for health professionals may be used as an education method for the individuals with visual impairments.

     

Validation of an Event-Level,Male Sexual Pleasure Scale (EMSEXpleasure) Among Condom-Using Men in the U.S.

Sexual pleasure is a key determinant of condom use. We developed and validated a male, event-level sexual pleasure scale (EMSEXpleasure) among a sample of condom-using men in the U.S. in order to facilitate improved measurement of sexual pleasure. Based on an expert panel process, a 12-item scale was developed. An online sample of 169 men who have sex with men and 162 men who have sex with women were recruited. Factor analysis yielded a two-factor solution that matched domains identified a priori by the expert panel, general pleasure and condom-specific pleasure, indicating internal validity of the instrument. One item was deleted from the scale due to poor validity performance. The overall EMSEXpleasure scale, and each subscale, had high (> 0.8) Cronbach’s alpha coefficients, indicating internal reliability. The scale demonstrated convergent validity, with theoretically related constructs associated both with individual scale items and with scale totals. Overall relationship quality (b 3.0, 95% CI 2.0, 4.0), sexual relationship quality (b 2.9, 95% CI 2.0, 4.0), foreplay quality (b 7.5, 95% CI 2, 13), positive feelings about condoms (b 18.8, 95% CI 15, 23), and erection problems while using condoms (b ? 17.9, 95% CI ? 22, ? 14) were associated with the EMSEXpleasure scale in expected directions. The validated EMSEXpleasure event-level scale may be advantageous for future assessments of the ephemeral experience of sexual pleasure, including clinical trials of condoms and other interventions, because it can be used immediately after sex, potentially limiting recall error.     

Factors associated with young people's attendance at an IPV prevention intervention in informal settlements in South Africa: A prospective analysis

ABSTRACT

Understanding factors shaping attendance at behavioural interventions is critical for programmatic planning. Through the Stepping Stones and Creating Futures intervention trial amongst young (18-30) women and men to reduce intimate partner violence and strengthen livelihoods, we prospectively assessed factors associated with intervention attendance. Baseline data were collected between September 2015 and September 2016 among 677 women and 675 men. For women, in multinomial models, compared to high attenders, medium (β?=??0.04, p?=?0.001) and low (β?=??0.05, p?=?0.003) attenders had lived less time in the community, medium attenders were more likely to have children (β?=?0.97, p?=?0.001), and low attenders had less gender-equitable attitudes (β?=??0.57, p?=?0.035). For men, in multinomial models, compared to high attenders, medium attenders were more likely to have completed secondary school (β?=?1.48, p?=?0.011) and to have worked in the past three months (β?=?0.64, p?=?0.021). Low attenders had lived for a shorter period in the community (β?=??0.06, p?=?0.005), and were more likely to have worked in the past three months (β?=?0.66, p?=?0.041) compared to high attenders. Attendance was shaped by structural factors, and gender-specific factors, and these need to be incorporated into future interventions.     

Development of a Measure to Assess What Young Heterosexual Adults Say They Learn About Sex from Pornography

This study involved the development of two new measures to assess what some young heterosexual-identifying adults report learning about sex from pornography. Inventory items were generated from an extensive literature review and six qualitative focus group sessions with young adults (N?=?54) aged 18–29 which explored how pornography could be used as a source of sexual information. A total of 135 items pertaining to sexual learning from pornography were produced, reviewed and categorized by a sample of young adults (n?=?9), and finally reviewed for item and construct relevance by a panel of pornography, sex education and scale development experts (n?=?6). Inventory items were administered to a sample of young adult university students (n?=?1306). Two separate exploratory factor analyses were conducted for the female and male datasets. The final factors were reviewed by a panel of young adults ?=?8) to identify the theme of each factor. Both the SIPI-F and SIPI-M yielded three factors: (1) How to be a good sexual partner, (2) Body aesthetic, and (3) Sexual exploration. Results show that pornography provides information about a range of sex-related topics. Findings also show that more frequent female pornography users reported learning more about how to be a good sexual partner and body aesthetic than less frequent pornography users. The SIPI-F and SIPI-M can be useful for examining a variety of questions regarding the use of pornography as an informal source of sexual information and its correlates.

     

Demographic and socio-cultural correlates of medical mistrust in two Australian States: Victoria and South Australia

Studies on medical mistrust have mainly focused on depicting the association between medical mistrust and access/utilization of healthcare services. The effect of broader socio-demographic and psycho-social factors on medical mistrust remains poorly documented. The study examined the effect of broader socio-demographic factors, acculturation, and discrimination on medical mistrust among 425 African migrants living in Victoria and South Australia, Australia. After adjusting for socio-demographic factors, low medical mistrust scores (i.e., more trusting of the system) were associated with refugee (β=−4.27, p<0.01) and family reunion (β=−4.01, p<0.01) migration statuses, being Christian (β=−2.21, p<0.001), and living in rural or village areas prior to migration (β=−2.09, p<0.05). Medical mistrust did not vary by the type of acculturation, but was positively related to perceived personal (β=0.43, p<0.001) and societal (β=0.38, p<0.001) discrimination. In order to reduce inequalities in healthcare access and utilisation and health outcomes, programs to enhance trust in the medical system among African migrants and to address discrimination within the community are needed.     

Alcohol Consumption and Risky Sexual Behavior Among Persons Attending Alcohol Consumption Venues in Gaborone,Botswana

Alcohol use is a known key risk factor associated with risky sexual behavior that contributes to HIV transmission. This cross-sectional study used time location sampling to investigate alcohol use and risky sexual behaviors that occurred after ingesting alcohol among 609 patrons of alcohol venues in Gaborone, Botswana. Alcohol Use Disorders Identification Test (AUDIT) scores were categorized as low (1–7), medium (8–15), and high (16+) for analysis. Logistic regression models stratified by gender assessed the association between alcohol use and condom use at last sex after drinking alcohol. Among females, the odds of condom use during last sex after drinking alcohol were significantly lower for high compared to low AUDIT scores (AOR?=?0.17, 95 % CI 0.06–0.54). Among males, factors significantly associated with condom use at last sex after alcohol use were low levels of education (primary level compared to university and above AOR?=?0.13; 95 % CI 0.03–0.55) and beliefs that alcohol use did not increase risky sexual behaviors (AOR?=?0.26; 95 % CI 0.11–0.62). HIV prevention interventions should target females and emphasize sexual risks associated with alcohol use.