Associations between intimate partner violence,violence-related policies,and HIV diagnosis rate among women in the United States

PurposeTo assess the association between state-level intimate partner violence (IPV) prevalence and HIV diagnosis rates among women in the United States and investigate the modifying effect of state IPV health care policies.MethodsData on HIV diagnosis rates were collected from HIV surveillance data from 2010 to 2015, and IPV prevalence data were collected from the National Intimate Partner and Sexual Violence Survey from 2010 to 2012. States were coded for IPV health care policies on training, screening, reporting, and insurance discrimination.ResultsStates with higher IPV prevalence was associated with higher HIV diagnoses among women (B = 0.02; 95% confidence interval [CI] = 0.003, 0.04; P = .02). State policies were a significant effect modifier (B = −0.05; 95% CI = −0.07, −0.02; P < .001). Simple slopes revealed that the association between IPV and HIV diagnosis rates was stronger in states with low IPV protective health care policies (B = 0.09; CI = 0.06, 0.13; P < .001) and moderate IPV protective policies (B = 0.05; 95% CI = 0.02, 0.07, P < .001), but not in states with high IPV protective policies (B = −0.009; 95% CI = −0.04, 0.02; P = .59).ConclusionsHIV prevention programs should target IPV and link to community resources. IPV-related policies in the health care system may protect the sexual health of women experiencing IPV.     

性感觉寻求与青少年男男性行为人群危险性行为的关系

目的 研究25岁及以下青少年男男性行为人群(YMSM)性感觉寻求与其艾滋病相关危险性行为的关系。方法 于2013年5-11月通过互联网宣传、外展活动以及例行的艾滋病自愿咨询检测服务招募403名YMSM, 采用匿名问卷调查, 回收375份(93.05%)有效问卷。结果 YMSM中有37.9%首次同性性行为未使用安全套, 最近6个月有55.7%发生多性伴行为, 51.7%有“419”(一夜情)行为, 5.6%有群交行为。性感觉寻求与首次同性性行为未使用安全套、多性伴行为、“419”行为、群交行为呈正相关(偏相关系数分别为0.247、0.218、0.296、0.252)。分别以首次同性性行为未使用安全套、多性伴行为、“419”行为、群交行为作为因变量进行logistic回归分析, 结果显示性感觉寻求高者更有可能发生以上危险性行为。结论 青少年性感觉寻求水平对危险性行为有影响, 应加强基于人群性感觉寻求分析的艾滋病相关知识及行为教育, 强化艾滋病相关危险性行为的风险意识, 从而更有效开展YMSM艾滋病干预。     

HIV Sexual Risk and Syndemics among Women in Three Urban Areas in the United States: Analysis from HVTN 906

Limited data are available on the longitudinal occurrence of syndemic factors among women at risk for HIV infection in the USA and how these factors relate to sexual risk over time. HVTN 906 was a longitudinal study enrolling 799 HIV-uninfected women in three cities. Assessments were done at baseline, 6, 12, and 18 months to assess syndemic factors (low education, low income, unemployment, lack of health insurance, housing instability, substance use, heavy alcohol use, partner violence, incarceration) and sexual risk outcomes. For each sexual risk outcome, a GEE model was fit with syndemic factors or syndemic score (defined as sum of binary syndemics, ranging from 0 to 9), visit, study site, age and race/ethnicity as predictors to examine the multivariable association between syndemic factors and outcomes over time. Odds of unprotected sex while drunk or high were significantly higher when women reported lack of health insurance, substance and heavy alcohol use and partner violence. Housing instability, substance and heavy alcohol use, partner violence and recent incarceration were associated with higher odds of having multiple sexual partners. Odds of sex exchange were significantly higher in the presence of unemployment, housing instability, low education, lack of health insurance, substance and heavy alcohol use, partner violence and incarceration. Housing instability, substance and heavy alcohol use, and partner violence were significantly associated with higher odds of unprotected anal sex. Odds of having a recent STI were significantly higher when women reported housing instability and partner violence. There were significantly higher odds of the reporting of any risk outcomes during follow-up with higher syndemic score. This study highlights a group of women experiencing multiple poor social and health outcomes who need to be the focus of comprehensive interventions.     

"When you got nothing to do, you do somebody": A community's perceptions of neighborhood effects on adolescent sexual behaviors

This study explores community members’ perspectives regarding the relationship between neighborhood characteristics and adolescent sexual behaviors in two rural, African American communities. The data were collected as part of a community needs assessment to inform the development of HIV prevention interventions in two contiguous counties in northeastern North Carolina, USA. We conducted eleven focus groups with three population groups: adolescents and young adults aged 16–24 (N = 38), adults over age 25 (N = 42), and formerly incarcerated individuals (N = 13). All focus groups were audio-recorded, transcribed and analyzed using a grounded theory approach to content analysis and a constant comparison method. Six major themes emerged from the discussions linking neighborhood context and adolescents sexual behavior: the overwhelming absence of recreational options for community members; lack of diverse leisure-time activities for adolescents; lack of recreational options for adolescents who are dating; adolescent access to inappropriate leisure time activities that promote multiple risk behaviors; limited safe environments for socializing; and cost-barriers to recreational activities for adolescents. In addition, lack of adequate parental supervision of adolescents’ time alone and with friends of the opposite sex, as well as ineffective community monitoring of adolescent social activities, were thought to create situations that promoted sexual and other risk behaviors. These findings allowed us to develop a conceptual model linking neighborhood structural and social organization factors to adolescent sexual behaviors and provided insights for developing interventions tailored to address local socioeconomic realities.     

Incarceration and High-Risk Sex Partnerships among Men in the United States

Incarceration is associated with multiple and concurrent partnerships, which are determinants of sexually transmitted infections (STI), including HIV. The associations between incarceration and high-risk sex partnerships may exist, in part, because incarceration disrupts stable sex partnerships, some of which are protective against high-risk sex partnerships. When investigating STI/HIV risk among those with incarceration histories, it is important to consider the potential role of drug use as a factor contributing to sexual risk behavior. First, incarceration’s influence on sexual risk taking may be further heightened by drug-related effects on sexual behavior. Second, drug users may have fewer economic and social resources to manage the disruption of incarceration than nonusers of drugs, leaving this group particularly vulnerable to the disruptive effects of incarceration on sexual risk behavior. Using the 2002 National Survey of Family Growth, we conducted multivariable analyses to estimate associations between incarceration in the past 12 months and engagement in multiple partnerships, concurrent partnerships, and unprotected sex in the past 12 months, stratified by status of illicit drug use (defined as use of cocaine, crack, or injection drugs in the past 12 months), among adult men in the US. Illicit drug users were much more likely than nonusers of illicit drugs to have had concurrent partnerships (16% and 6%), multiple partnerships (45% and 18%), and unprotected sex (32% and 19%). Analyses adjusting for age, race, educational attainment, poverty status, marital status, cohabitation status, and age at first sex indicated that incarceration was associated with concurrent partnerships among nonusers of illicit drugs (adjusted prevalence ratio (aPR) 1.55, 95% confidence interval (CI) 1.06–2.22) and illicit drug users (aPR 2.14, 95% CI 1.07–4.29). While incarceration was also associated with multiple partnerships and unprotected sex among nonusers of illicit drugs (multiple partnerships: aPR 1.66, 95% CI 1.43–1.93; unprotected sex: aPR 1.99, 95% CI 1.45–2.72), incarceration was not associated with these behaviors among illicit drug users (multiple partnerships: aPR 1.03, 95% CI 0.79–1.35; unprotected sex: aPR 0.73, 95% CI 0.41–1.31); among illicit drug users, multiple partnerships and unprotected sex were common irrespective of incarceration history. These findings support the need for correctional facility- and community-based STI/HIV prevention efforts including STI/HIV education, testing, and care for current and former prisoners with and without drug use histories. Men with both illicit drug use and incarceration histories may experience particular vulnerability to STI/HIV, as a result of having disproportionate levels of concurrent partnerships and high levels of unprotected sex. We hypothesize that incarceration works in tandem with drug use and other adverse social and economic factors to increase sexual risk behavior. To establish whether incarceration is causally associated with high-risk sex partnerships and acquisition of STI/HIV, a longitudinal study that accurately measures incarceration, STI/HIV, and illicit drug use should be conducted to disentangle the specific effects of each variable of interest on risk behavior and STI/HIV acquisition.     

成都市男男性行为人群对重复HIV检测阴性的反应与危险性行为的关联研究

目的 研究成都市MSM对重复HIV检测阴性的反应及与危险性行为的关联。方法 2022年3-5月与成都同乐健康咨询服务中心合作,采用方便抽样方法招募研究对象610名MSM。收集研究对象社会人口学特征、对HIV检测阴性的反应和性行为情况。采用单因素及多因素logistic回归模型分析HIV检测阴性反应与性行为的关联。结果 参加问卷调查579名（94.9%）,纳入研究对象354名（61.1%）,HIV检测阴性反应得分分别为强化安全（17.03±2.20）分、运气（7.50±1.87）分和低风险感知（8.87±3.62）分。多因素logistic回归模型结果显示,强化安全与发生群交呈负相关（aOR=0.80,95%CI：0.67~0.95）;运气与临时性行为（aOR=1.20,95%CI：1.06~1.35）、不坚持使用安全套（aOR=1.21,95%CI：1.06~1.37）、发生群交（aOR=1.26,95%CI：1.00~1.60）和多性伴（aOR=1.24,95%CI：1.09~1.42）与危险性行为呈正相关。低风险感知仅与多性伴（aOR=1.08,95%CI：1.01~1.15）呈正相关。结论 成都市MSM对重复HIV检测阴性反应的强化安全和运气维度认可程度较高,自身风险感知良好。在提供HIV检测和咨询服务期间,干预策略和风险咨询应重视向对运气认可较高的个体倾斜,帮助其树立安全性行为意识,减少侥幸心理带来的负面影响。     

Sex ratio,poverty, and concurrent partnerships among men and women in the United States: a multilevel analysis

PurposeSocial and economic contextual factors may promote concurrent sexual partnerships, which can accelerate population HIV transmission and are more common among African Americans than U.S. Whites. We investigated the relationship between contextual factors and concurrency.MethodsWe analyzed past 12-month concurrency prevalence in the 2002 National Survey of Family Growth and its contextual database in relation to county sex ratio (among respondent's racial and ethnic group), percentage in poverty (among respondent's racial and ethnic group), and violent crime rate. Analyses examined counties with balanced (0.95–1.05 males/female) or low (<0.9) sex ratios.ResultsConcurrency prevalence was greater (odds ratio [OR]; 95% confidence interval [CI]) in counties with low sex ratios (OR, 1.67; 95% CI, 1.17–2.39), more poverty (OR, 1.18; 95% CI, 0.98–1.42 per 10 percentage-point increase), and higher crime rates (OR, 1.04; 95% CI, 1.00–1.09 per 1000 population/year). Notably, 99.5% of Whites and 93.7% of Hispanics, but only 7.85% of Blacks, lived in balanced sex ratio counties; about 5% of Whites, half of Hispanics, and three-fourths of Blacks resided in counties with >20% same-race poverty.ConclusionsThe dramatic Black-White differences in contextual factors in the United States and their association with sexual concurrency could contribute to the nation's profound racial disparities in HIV infection.     

跨性别女性人群心理特征及相关行为分析

目的了解跨性别女性人群的心理特征及相关行为。方法 2016年1月—2017年10月,在山东省采用滚雪球抽样的方法抽取调查对象并进行面对面问卷调查。结果本次共调查160人,调查对象最小19岁,最大44岁,平均年龄27岁(中位数);汉族为主,占93.1%;多数未婚,占80.0%;高中以上文化程度居多,占83.1%;74.4%为非独生子女。性取向选择男性119人,占74.4%,64.3%的人有过无保护性接受性肛交性行为。26人做过变性手术,占16.3%。属于完全女性心理性别者占51.2%,心理性别模糊者占48.8%;两者在婚姻状况(P=0.003)、是否有固定工作(P=0.013)、生活环境(P=0.002)、性取向(P=0.0001)、何种装扮从事社会生活(P=0.0001)、是否与女性发生过性行为(P=0.002)、是否从事商业性行为(P=0.012)、是否做过变性手术(P=0.001)、是否因为跨性别受到过暴力或虐待(P=0.004)等方面差异有统计学意义。结论跨性别女性人群存在感染艾滋病的危险,其心理性别可分为完全女性心理性别和模糊心理性别,前者更有感染艾滋病的风险,建议对该人群开展针对性的宣传教育、干预和检测。     

Human papillomavirus vaccine-related risk perceptions and subsequent sexual behaviors and sexually transmitted infections among vaccinated adolescent women

ObjectiveTo examine the association between risk perceptions after human papillomavirus (HPV) vaccination and sexual behaviors and sexually transmitted infection (STI) diagnosis over 30 months following vaccination.MethodsParticipants included 112 sexually experienced girls aged 13–21 years who were enrolled at the time of first HPV vaccination and completed ⩾2 of 4 follow-up visits at 2, 6, 18, 30 months and including 30 months. At each visit, participants completed surveys assessing risk perceptions (perceived need for safer sexual behaviors, perceived risk of STIs other than HPV) and sexual behaviors. STI testing was done at 6, 18, and 30 months. Outcomes were condom use at last intercourse with main male partner, number of sexual partners since last study visit, and STI diagnosis. Associations between risk perceptions and sexual behaviors/STIs were examined using generalized linear mixed models.ResultsMean age was 17.9 years; 88% were Black; 49% had a history of STI at baseline. Scale scores for perceived need for safer sexual behaviors did not change significantly over time. Scale scores for perceived risk of STIs other than HPV significantly changed (p = 0.027), indicating that girls perceived themselves to be more at risk of STIs other than HPV over 30 months following vaccination. Multivariable models demonstrated that greater perceived need for safer sexual behaviors following vaccination was associated with condom use (p = 0.002) but not with number of partners or STI diagnosis. Perceived risk of STIs other than HPV was not associated with the three outcomes.ConclusionsThe finding that perceived risk for STIs other than HPV was not associated with subsequent sexual behaviors or STI diagnosis is reassuring. The association between perceived need for safer sexual behaviors and subsequent condom use suggests that the HPV vaccination visit is an important opportunity to reiterate the importance of safer sexual behaviors to sexually experienced girls.     

Gender-based violence and HIV sexual risk behavior: Alcohol use and mental health problems as mediators among women in drinking venues, Cape Town

Gender-based violence is a key determinant of HIV infection among women in South Africa as elsewhere. However, research has not examined potential mediating processes to explain the link between experiencing abuse and engaging in HIV sexual risk behavior. Previous studies suggest that alcohol use and mental health problems may explain how gender-based violence predicts sexual risk. In a prospective study, we examined whether lifetime history of gender-based violence indirectly affects future sexual risk behavior through alcohol use, depression and post-traumatic stress disorder (PTSD) in a high-risk socio-environmental context. We recruited a cohort of 560 women from alcohol drinking venues in a Cape Town, South African township. Participants completed computerized interviews at baseline and 4 months later. We tested prospective mediating associations between gender-based violence, alcohol use, depression, PTSD, and sexual risk behavior. There was a significant indirect effect of gender-based violence on sexual risk behavior through alcohol use, but not mental health problems. Women who were physically and sexually abused drank more, which in turn predicted more unprotected sex. We did not find a mediated relationship between alcohol use and sexual risk behavior through the experience of recent abuse or mental health problems. Alcohol use explains the link between gender-based violence and sexual risk behavior among women attending drinking venues in Cape Town, South Africa. Efforts to reduce HIV risk in South Africa by addressing gender-based violence must also address alcohol use.     

Using cross-classified multilevel models to disentangle school and neighborhood effects: An example focusing on smoking behaviors among adolescents in the United States

BackgroundDespite much interest in understanding the influence of contexts on health, most research has focused on one context at a time, ignoring the reality that individuals have simultaneous memberships in multiple settings.MethodUsing the example of smoking behavior among adolescents in the National Longitudinal Study of Adolescent Health, we applied cross-classified multilevel modeling (CCMM) to examine fixed and random effects for schools and neighborhoods. We compared the CCMM results with those obtained from a traditional multilevel model (MLM) focused on either the school and neighborhood separately.ResultsIn the MLMs, 5.2% of the variation in smoking was due to differences between neighborhoods (when schools were ignored) and 6.3% of the variation in smoking was due to differences between schools (when neighborhoods were ignored). However in the CCMM examining neighborhood and school variation simultaneously, the neighborhood-level variation was reduced to 0.4%.ConclusionResults suggest that using MLM, instead of CCMM, could lead to overestimating the importance of certain contexts and could ultimately lead to targeting interventions or policies to the wrong settings.     

海南省农村妇女性观念及性行为问卷调查

目的 了解农村妇女性观念和性行为现状及其影响因素。方法 采用分层整群抽样横断面调查设计。用听录音回答和调查员询问填写问卷两种不同的资料收集方法对海南省某县606名农村妇女进行问卷调查。结果 25％的妇女认可一般的婚前性行为,认可结婚对象婚前发生性行为的妇女占34％。自报发生过婚前性行为的妇女占15％,4％报告发生过婚前人工流产。5％的妇女报告曾在月经期发生过性行为。认可婚外性行为的妇女占4％,3％的妇女认可卖淫,对需要钱的妇女卖淫表示认可的妇女占3％。没有妇女报告发生过婚外性行为或卖淫行为。两种资料收集方法结果差异无统计学显著性意义。logistic回归分析显示低年龄、低文化程度、汉族与对婚前性行为的态度有正关联,低年龄与发生婚前性行为有正关联。结论 在农村人群中应更早地开展性健康教育,并应具有针对性。在研究中,听录音回答的调查方法并未增加敏感问题调查结果的真实性。     

梅州市一所高校学生性观念及性行为调查

目的了解梅州市嘉应学院医学院大学一年级男、女生的性观念及性行为，为开展有效的大学生性健康教育提供依据。方法使用自行设计的调查问卷，对梅州市嘉应学院医学院1840名大学一年级男、女生进行调查。结果有33．69％的学生希望在大学期间有性行为，42．93％的学生赞成上学期间的性行为，4．34％的学生上学期间有过性行为，男、女生在以上项目中的差异有统计学意义（P〈0．05）；男生在获取性知识的途径主要为电子媒体和书刊杂志，女生主要为书刊杂志和同伴，二者之间有统计学意义（P〈0．05）。结论大学一年级是性意识性观念形成的关键时期，应及时开展性健康教育，但在教育方式和内容上男、女生应有所区别。     

Concurrent sexual partnerships among women in the United States

BACKGROUND: The marked racial disparity in sexually transmitted infection (STI) rates in the United States remains inadequately explained. One important factor may be concurrent sexual partnerships (relationships that overlap in time), which can transmit STIs more rapidly through a population than does sequential monogamy. METHODS: To determine prevalence, distribution, and correlates of U.S. women's involvement in concurrent partnerships, we analyzed sexual partnership data reported by the 10,847 women, age 15-44 years, in the 1995 National Survey of Family Growth. Overlapping sexual partnership dates were determined by computer program and visual review of the data. RESULTS: Prevalence of concurrent partnerships since January 1991 was 12% overall. Prevalence was lowest among currently married respondents (4%) and highest among those who were formerly married (22%), never married (19%), in the lowest income stratum (17%), age 18-24 years when interviewed (23%), or who first had sexual intercourse at age 12 or 13 (35%). Prevalence was 21% among blacks, 11% among whites, 8% among Hispanics, and 6% among Asian American and Pacific Islanders. Multiple logistic analysis substantially weakened the relationship between concurrency and black race (OR = 1.2; 95% CI = 1.1-1.4). CONCLUSIONS: Marital status in particular is strongly related to concurrency; thus, lower marriage rates among blacks and the associated higher concurrency of sexual partners may contribute to racial disparities in STI rates.     

大学生性行为与医学教育相关性分析

目的分析大学生对婚前性行为的态度、知识与行为现状,探究与医学教育相关性,为制定干预策略提供依据。方法分阶段整群抽取北京8所高校2 026名大学生进行匿名自填问卷调查。结果认为大学生婚前性行为应采取避孕措施的医学生占92.2%,非医学生占82.9%(P<0.01);避孕知识回答正确率医学生均高于非医学生(P值均<0.01);自我报告发生过性行为的大学生中,意外妊娠发生率医学生为19.5%,非医学生为17.9%(P>0.05)。结论大学生对婚前性行为的态度和知识与医学教育相关,行为现状与医学教育无关。高校大学生婚前性行为问题不容乐观,急需干预措施。