Economic,Legal, and Social Hardships Associated with HIV Risk among Black Men who have Sex with Men in Six US Cities

We assessed whether economic, legal, and social hardships were associated with human immunodeficiency virus (HIV) risk among a sample of Black men who have sex with men (MSM) and whether associations were moderated by city of residence. The study analyzed baseline and follow-up data from HIV Prevention Trials Network 061 (N = 1553). Binary logistic regression assessed associations between hardships and HIV risk indicators. Multivariate regressions were used to test if city of residence had a moderating effect for hardships and HIV risks. Adjusted analyses showed that Black MSM with recent job loss were more likely to engage in condomless insertive anal intercourse (adjusted odds ratios (AOR) = 1.37, 95 % CI 1.01–1.87) and that those with recent financial crisis were more likely to have had two or more male sexual partners in the past 6 months (AOR = 1.65; 95 % CI 1.18–2.29). Black MSM with recent convictions were more likely to have a sexually transmitted infection at 6 months (AOR = 3.97; 95 % CI 1.58–9.94), while those who were unstably housed were more likely to have a sexually transmitted infection at 12 months (AOR = 1.71; 95 %CI 1.02 = 2.86). There were no city of residence and hardship interaction effects on HIV risks. Hardships are important factors that influence HIV risk for Black MSM. Integrating strategies that address structural factors that influence HIV risk may enhance HIV prevention interventions implementation efforts.     

Adolescent Experiences of Violence and Relation to Violence Perpetration beyond Young Adulthood among an Urban Sample of Black and African American Males

The purpose of this study is to determine if experiences of physical violence during early and late adolescence (12–21 years) places urban Black males at increased risk for interpersonal violence perpetration beyond young adulthood (30 years and older). Participants of this cross-sectional study were Black and African American men (N = 455) between the ages of 30 and 65 years, recruited from four urban clinical sites in the Northeast. Multivariate logistic regression models were used to analyze the relation of adolescent experiences of violence to: (1) past 6 month street violence involvement and (2) past year intimate partner violence perpetration. Ten percent of the sample reported that they experienced adolescent victimization. Men reporting adolescent victimization were significantly more likely to report past 6-month street violence involvement (Adjusted Odds Ratio (AOR) = 3.2, 95 % CI = 1.7–6.3) and past 6 month intimate partner violence perpetration (AOR = 2.8, 95 % CI = 1.8–5.4) compared to men who did not report such victimization. Study findings suggest that in order to prevent adulthood perpetration of violence, more work is needed to address experiences of victimization among young Black males, particularly violence experienced during adolescence.     

HIV Sexual Risk Behavior among Black Men Who Meet Other Men on the Internet for Sex

Using the Internet to meet sexual partners is associated with increased HIV risk behavior, including substance use, sex with multiple or anonymous partners, and unprotected anal sex (UAS), among diverse samples of MSM, yet little is known about Internet use and HIV risk among Black MSM specifically. In 2008, a sample of 197 Black MSM completed an interviewer-administered assessment and voluntary HIV counseling and testing. One fifth of the sample (20 %) reported meeting a sexual partner via the Internet in the past 12 months. Men who met sexual partners over the Internet had significantly more male sex partners (M = 13.44, SD = 20.01) than men who did not meet partners in this manner (M = 4.11, SD = 4.14, p < 0.001) and reported significantly higher rates of UAS (p < 0.05). Adjusting for sociodemographic and other HIV-related covariates, factors significantly associated with the increased odds of engaging in at least one episode of UAS with a male partner in the past 12 months included: meeting sexual partners on the Internet, identifying as gay, and lower knowledge about HIV transmission. These findings highlight the unique HIV risk behaviors among Black MSM meeting sexual partners via the Internet and warrant tailoring of prevention activities to address the specific behaviors and social influences that may contribute to increased HIV spread among this population.KEYWORDS: MSM, Internet, African American/Black, HIV, Sexual risk     

Reciprocal Sex Partner Concurrency and STDs among Heterosexuals at High-Risk of HIV Infection

Inconsistent findings on the relationship of sex partner concurrency to infection with HIV and other sexually transmitted diseases (STDs) may result from differences in how sex partner concurrency is conceptualized. We examine the relationship of reciprocal sex partner concurrency (RSPC) to diagnosed STDs among heterosexuals. Heterosexually active adults (N = 717) were recruited for a cross-sectional study using respondent-driven sampling (RDS) from high-HIV-risk areas in New York City (NYC, 2006–2007) and interviewed about their sexual risk behaviors, number of sex partners, last sex partners, and STD diagnoses (prior 12 months). RSPC was when both the participant and her/his last sex partner had sex with other people during their sexual relationship. Odds ratios (OR), adjusted odds ratios (aOR), and 95 % confidence intervals (95%CI) were estimated by logistic regression. The sample was 52.4 % female, 74.3 % Black; median age was 40 years. RSPC was reported by 40.7 % and any STD diagnoses by 23.4 %. Any STDs was reported by 31.5 % of those reporting RSPC vs. 17.9 % of those who did not (OR = 2.11, 95%CI = 1.49–3.0). Any STDs was independently associated with RSPC (aOR = 1.54, 95%CI = 1.02–2.32), female gender (aOR = 2.15, 95%CI = 1.43–3.23), having more than three sex partners (aOR = 1.72, 95%CI = 1.13–2.63), and unprotected anal sex (aOR = 1.65, 95%CI = 1.12–2.42). Heterosexuals in high-HIV-risk neighborhoods in sexual partnerships that involve RSPC are at greater risk of STDs and, potentially, HIV. RSPC, in addition to sexual risk behaviors and the number of sex partners, may facilitate the heterosexual spread of HIV through STD cofactors and linkage into larger STD/HIV sexual transmission networks.     

The Concrete Jungle: City Stress and Substance Abuse among Young Adult African American Men

Substance use is prevalent among African American men living in urban communities. The impact of substance use on the social, psychological, and physical health of African American men has important public health implications for families, communities, and society. Given the adverse consequences of alcohol and drug abuse within communities of color, this study evaluated the relationship between city stress, alcohol consumption, and drug use among African American men. Eighty heterosexual, African American men, 18 to 29 years old, completed psychosocial risk assessments that assessed substance use and city stress. Multiple logistic regression analyses, controlling for age, indicated that participants reporting high levels of urban stress, relative to low levels of urban stress, were more likely to report a history of marijuana use (AOR = 5.19, p = .05), history of ecstasy and/or GHB use (AOR = 3.34, p = .04), having family/friends expressing strong concerns about their illicit drug use (AOR = 4.06, p = .02), and being unable to remember what happened the night before due to drinking (AOR = 4.98, p = .01). African American men living within the confines of a stressful urban environment are at increased risk for exposure to and utilization of illicit substances. Culturally competent public health interventions for substance use/abuse should address psychological factors, such as stress and neighborhood violence.     

Application of Syndemic Theory to Black Men Who Have Sex with Men in the Multicenter AIDS Cohort Study

This study analyzed data from a large prospective epidemiologic cohort study among men who have sex with men (MSM), the Multicenter AIDS Cohort Study, to assess syndemic relationships among Black MSM in the cohort (N = 301). We hypothesized that multiple interconnections among psychosocial health conditions would be found among these men, defining syndemic conditions. Constituents of syndemic conditions measured included reported depression symptoms, sexual compulsiveness, substance use, intimate partner violence (IPV), and stress. We found significant evidence of syndemics among these Black men: depression symptoms were independently associated with sexual compulsiveness (odds ratios [OR]: 1.88, 95% CI = 1.1, 3.3) and stress (OR: 2.67, 95% CI = 1.5, 4.7); sexual compulsiveness was independently associated with stress (OR: 2.04, 95% CI = 1.2, 3.5); substance misuse was independently associated with IPV (OR: 2.57, 95% CI = 1.4, 4.8); stress independently was associated with depression symptoms (OR: 2.67, 95% CI = 1.5, 4.7), sexual compulsiveness (OR: 2.04, 95% CI = 1.2, 3.5) and IPV (OR: 2.84, 95% CI = 1.6, 4.9). Moreover, men who reported higher numbers of syndemic constituents (three or more conditions) reportedly engaged in more unprotected anal intercourse compared to men who had two or fewer health conditions (OR: 3.46, 95% CI = 1.4–8.3). Findings support the concept of syndemics in Black MSM and suggest that syndemic theory may help explain complexities that sustain HIV-related sexual transmission behaviors in this group.     

Street Workers and Internet Escorts: Contextual and Psychosocial Factors Surrounding HIV Risk Behavior among Men Who Engage in Sex Work with Other Men

Sex work has been associated with elevated risk for HIV infection among men who have sex with men (MSM) in many settings. This mixed methods study examined sexual risk among MSM sex workers in Massachusetts, collecting formative data on HIV risk behavior by sex worker type in order to gain a better understanding of how to tailor prevention interventions to this unique and high-risk subgroup of MSM. Two groups of MSM sex workers were recruited between January and March 2008: street workers (n = 19) and internet escorts (n = 13). Participants completed a semistructured qualitative interview and quantitative psychosocial assessment battery; interviews were conducted until redundancy in responses was achieved. Almost one third (31%) were HIV-infected. The majority of participants (69%) reported at least one episode of unprotected serodiscordant anal sex (either insertive or receptive) with a mean of 10.7 (SD = 42.2) male sex partners of an unknown or different HIV serostatus in the past 12 months. Salient findings included: (a) internet sex workers reported being paid substantially more for sex than street sex workers; (b) inconsistent condom use, high rates of unprotected sex, and low rates of HIV status disclosure with sex work partners for both internet and street workers; general perceptions of a lack of trust on the part of sex work partners (i.e., telling them what they want to hear), offers of more money for unprotected sex; (c) contextual differences in risk taking: internet sex workers reported that they are more likely to engage in sexual risk-taking with noncommercial sex partners than sex partners who pay; (d) HIV status and STI history: two street workers became infected in the context of sex work, and 25% of the entire sample had never been tested for sexually transmitted infections (STI); and (e) motivations and reasons for doing sex work, such as the “lucrativeness” of sex work, as a means to obtain drugs, excitement, power, “why not?” attitude, and because social norms modeled this behavior. Study findings can be used to generate hypotheses for designing and providing tailored primary and secondary prevention interventions for this at-risk subgroup of MSM.     

Differences in Substance Use, Psychosocial Characteristics and HIV-Related Sexual Risk Behavior Between Black Men Who Have Sex with Men Only (BMSMO) and Black Men Who Have Sex with Men and Women (BMSMW) in Six US Cities

We assessed associations in substance use, psychosocial characteristics, and HIV-related sexual risk behaviors, comparing characteristics of Black men who only have sex with other men only (BMSMO; n = 839) to Black men who have sex with men and women (BMSMW; n = 590). The study analyzed baseline data from the HIV Prevention Trials Network Brothers Study (HPTN 061), a feasibility study of a multi-component intervention for Black MSM in six US cities. Bivariate analyses compared BMSMO to BMSMW along demographics, substance use, psychosocial characteristics, and HIV-related sexual risk behaviors. Logistic regression models then assessed multivariable associations between being BMSMW and the odds of engaging in HIV-related sexual risk behaviors. Adjusted analyses revealed that BMSMW remained more likely to have unprotected anal intercourse while under the influence of alcohol (AOR: 1.45; 95 % CI:1.11–1.90) and were more likely to receive money/drugs for sex (AOR: 2.11; 95 % CI:1.48–3.03), compared to BMSMO. Substance use is an important factor to be considered when developing risk-reduction interventions for BMSMW. Structural interventions that address factors that may contribute to exchange sex among these men are also warranted.     

Experiences of Racial Discrimination &; Relation to Violence Perpetration and Gang Involvement among a sample of Urban African American Men

Objective To examine racial discrimination and its relation to violence involvement among a sample of urban African American men. Methods Participants of this cross-sectional study were African American men (N = 703) between the ages of 18 and 65 years, recruited from four urban community health centers and two hospital-based clinics within an urban center in the Northeast. Multivariate logistic regression models were used to assess the relation of reported racial discrimination to recent perpetration of intimate partner violence (IPV), street violence involvement, and gang involvement. Racial discrimination was measured via 7 items assessing everyday and lifetime experiences of racial discrimination. Results In logistic regression models adjusted for age and homelessness, men reporting high levels of discrimination (scores above the sample median) were significantly more likely to report IPV perpetration (Adjusted Odds Ratio (AOR) = 1.9; 95% Confidence Interval (CI): 1.2–2.9) and street violence involvement (AOR = 1.5; 95% CI: 1.1–2.2) as compared to men reporting lower levels of discrimination. No relation was found between experiencing discrimination and gang involvement. Conclusions Findings showcase the potential relevance of racial discrimination to efforts focused on reducing racial disparities related to violence.     

Condom Refusal and Young Black Men: the Influence of Pleasure,Sexual Partners,and Friends

The study investigated pleasure-related, partner-related, and social normative correlates of recent condom refusal in young Black men (YBM). A cross-sectional study of YBM (N = 561) attending clinics treating sexually transmitted diseases in three cities was conducted. Mean age was 19.6 years (SD = 1.87). Nearly one of every two young men (46.8 %) indicated recent refusal to use a condom after a request from their partner. Significant findings included the following: partner-related beliefs “I feel closer to my partner without a condom” (OR = 2.52, 95 % confidence interval (CI) = 1.65–3.83) and “condoms make sex hurt for the female partner” (OR = 1.69, 95 % CI = 1.14–2.52), a scale measure of pleasure-related beliefs (OR = 2.58, 95 % CI = 1.73–3.84), and a scale measure of negative social beliefs associated with condom usage (OR = 1.05, 95 % CI = 1.00 – 1.10). Interventions addressing pleasure-related, partner-related, and social normative beliefs as barriers to condom use are warranted for YBM.     

Injecting Risk Behavior among Traveling Young Injection Drug Users: Travel Partner and City Characteristics

Young injection drug users (IDUs), a highly mobile population, engage in high levels of injecting risk behavior, yet little is understood about how such risk behavior may vary by the characteristics of the cities to which they travel, including the existence of a syringe exchange program (SEP), as well as travel partner characteristics. In 2004–2005, we conducted a 6-month prospective study to investigate the risk behavior of 89 young IDUs as they traveled, with detailed information gathered about 350 city visits. In multivariable analyses, travel to larger urban cities with a population of 500,000–1,000,000 was significantly associated with injecting drugs (adjusted odds ratio (AOR) = 3.71; 95 % confidence interval (CI), 1.56–8.82), ancillary equipment sharing (AES; AOR = 7.05; 95 % CI, 2.25–22.06) and receptive needle sharing (RNS; AOR = 5.73; 95 % CI, 1.11–27.95), as compared with visits to smaller cities with populations below 50,000. Region of the country, and the existence of a SEP within the city visited, were not independently associated with injecting drugs, AES, or RNS during city visits. Traveling with more than one injecting partner was associated with injecting drugs during city visits (AOR = 2.77; 95 % CI, 1.46–5.27), when compared with traveling alone. Additionally, both non-daily and daily/almost daily alcohol use during city visits were associated with AES (AOR = 3.37; 95 % CI, 1.42–7.68; AOR = 3.03; 95 % CI, 1.32–6.97, respectively) as compared with no alcohol consumption. Traveling young IDUs are more likely to inject when traveling with other IDUs and to engage in higher risk injection behavior when they are in large cities. Risk behavior occurring in city visits, including equipment sharing and alcohol consumption, suggests further need for focused interventions to reduce risk for viral infection among this population.     

Neighborhood-Level Factors Associated with Physical Dating Violence Perpetration: Results of a Representative Survey Conducted in Boston, MA

Neighborhood-level characteristics have been found to be associated with different forms of interpersonal violence, but studies of the relationship between these characteristics and adolescent dating violence are limited. We examined 6 neighborhood-level factors in relation to adolescent physical dating violence perpetration using both adolescent and adult assessments of neighborhood characteristics, each of which was aggregated across respondents to the neighborhood level. Data came from an in-school survey of 1,530 public high school students and a random-digit-dial telephone survey of 1,710 adult residents of 38 neighborhoods in Boston. Approximately 14.3% of the youth sample reported one or more acts of physical aggression toward a dating partner in the month preceding the survey. We calculated the odds of past-month physical dating violence by each neighborhood-level factor, adjusting for school clustering, gender, race, and nativity. In our first 6 models, we used the adolescent assessment of neighborhood factors and then repeated our procedures using the adult assessment data. Using the adolescent assessment data, lower collective efficacy (AOR = 1.95, 95% CI = 1.09–3.52), lower social control (AOR = 1.92, 95% CI = 1.07–3.43), and neighborhood disorder (AOR = 1.19, 95% CI = 1.05–1.35) were each associated with increased likelihood of physical dating violence perpetration. However, when we used the adult version of the neighborhood assessment data, no neighborhood factor predicted dating violence. The implications and limitations of these findings are discussed.     

Association of Discrimination-Related Trauma With Sexual Risk Among HIV-Positive African American Men Who Have Sex With Men

Objectives. We investigated whether 1 form of traumatic stress, discrimination-related trauma (e.g., physical assault because of race), was associated with unprotected anal intercourse, especially when compared with non–discrimination-related trauma, among African American men who have sex with men.Methods. A convenience sample of 131 HIV-positive African American men who have sex with men receiving antiretroviral treatment completed audio computer-assisted self-interviews that covered unprotected anal intercourse, interpersonal trauma, and whether trauma was because of discrimination on the basis of race/ethnicity, HIV serostatus, or sexual orientation.Results. Sixty percent reported at least 1 interpersonal trauma; they attributed at least 1 trauma to being gay (47%), African American (17%), or HIV positive (9%). In a multivariate regression, experiencing discrimination-related trauma was significantly associated with unprotected anal intercourse (adjusted odds ratio [AOR] = 2.4; 95% confidence interval [CI] = 1.0, 5.7; P = .04), whereas experiencing non–discrimination-related trauma was not (AOR = 1.3; 95% CI = 0.6, 3.1; P = .53).Conclusions. HIV-positive African American men who have sex with men experience high levels of discrimination-related trauma, a stressor associated with greater risk taking. HIV prevention interventions should consider the potential damaging effects of discrimination in the context of trauma.HIV disproportionately affects African American men who have sex with men (MSM). Twenty-eight percent of African American MSM are estimated to be HIV positive, compared with 16% of White MSM1 and 2% of the general African American male population.2 Young African American males (aged 13–29 years) who have sex with males have had a higher increase in HIV incidence in recent years than has any other racial/ethnic subgroup in the United States.3 Rates of unprotected anal intercourse (UAI) fail to account for racial/ethnic disparities in HIV prevalence.4 However, UAI remains the highest risk factor for HIV transmission among MSM. Understanding the sociocultural variables associated with UAI among African American MSM is likely to be important for developing appropriate HIV prevention strategies for this population. One such sociocultural variable is interpersonal trauma, including childhood sexual abuse (CSA),5 intimate partner violence,6 forced sex,7 and other physical assault. Interpersonal violence disproportionately affects African Americans in general8 as well as MSM.9,10 Although few studies have examined forced sex and physical assault among African American MSM, several have reported a higher prevalence of CSA among African American MSM than among White MSM.9,11 Furthermore, MSM who experience trauma may be more likely to engage in sexual risk behaviors. For example, 1 study reported that MSM with a history of CSA had more sexual contacts and acts of UAI than did MSM who had no history of CSA.11Other research suggests that African American MSM are faced with multiple forms of discrimination associated with their HIV serostatus, race, and sexual orientation12 and that such discrimination may sometimes be experienced as interpersonal trauma. A qualitative study of 87 African American MSM reported that victims may perceive experiences of CSA to be related to their sexual orientation.13 A small quantitative study of a convenience sample of 56 HIV-positive patients recruited from an AIDS treatment clinic reported that of HIV-positive men of color and MSM who reported intimate partner violence, slightly more than one quarter believed that their abuse was related to their HIV serostatus.14The minority stress model posits that social discrimination leads to excess stress among minority persons, which may be more damaging than are other types of stressors because discrimination on the basis of one’s social group may threaten individuals’ core sense of identity.15–18 Consistent with this model, a survey of lesbians and gays found that those who had experienced a bias-related crime showed worse mental health consequences (e.g., symptoms of depression, anxiety, anger, and posttraumatic stress) than did those who had experienced non–bias-related crimes.19 The effect of social discrimination on mental health outcomes has been well documented across various populations, including people living with HIV.12,20 Furthermore, some research indicates an association of perceived social discrimination with sexual risk among MSM,21–28 but none has included an examination of the distinct association of discrimination-related trauma with sexual risk behavior, beyond the effects of other types of trauma. The minority stress model suggests that social discrimination–related trauma would have a greater association with sexual risk than would trauma alone. Although previous research has indicated an association of sexual risk with both trauma5–7 and chronic discrimination,21–28 the effects of trauma resulting from discrimination on sexual risk do not appear to have been investigated in the literature.We examined the association of prior trauma with sexual risk among African American MSM living with HIV. In multivariate models, we examined the distinct effects of discrimination-related and -unrelated interpersonal trauma on sexual risk. We were especially interested in assessing whether experiences of discrimination-related interpersonal trauma had a unique association with UAI beyond variables related to sexual risk in previous research. We were also interested in whether there was a distinct association of UAI with discrimination-related interpersonal trauma beyond any association with interpersonal trauma in general (including discrimination-related and -unrelated interpersonal trauma). Such findings would suggest a need to focus on the added effects of discrimination from interpersonal trauma in both research and secondary HIV prevention interventions targeting this population.     

Sexual Behaviors of Non-gay Identified Non-disclosing Men Who Have Sex with Men and Women

The sexual behaviors of non-gay identified men who have sex with men and women (MSMW) who do not disclose their same-sex behavior to their female partners (referred to by some as men "on the down low") were examined, including the potential for these men to serve as a "bisexual bridge" for HIV and STD acquisition and transmission. Self-reported sexual behavior data were collected as part of an exploratory study of an ethnically diverse (41% African American, 35% Latino, 22% White, and 2% Asian) sample of 46 non-gay identified, non-disclosing MSMW in New York City. Men reported significantly more male than female sexual partners, but more frequent sex with females. The prevalence and frequency of unprotected sex did not differ significantly between male and female partners in the past 3 months. Men reported risk behavior more often with steady female and steady male partners (e.g., wives, girlfriends, boyfriends) than with more casual male and female partners (regular uncommitted partners, one-night stands). Men, especially African American/Black men, were significantly less likely to report receptive sexual behaviors with men than insertive behaviors. Unprotected sex was common with male and female partners in the past 3 months (e.g., 35% of anal sex with men; 50% of vaginal sex). Indeed, 22% of the sample (38% of those who had both recent males and female partners) reported both unprotected vaginal sex and unprotected anal sex with a male partner during the past 3 months. Although the study was limited by a small convenience sample, the findings suggest that non-gay identified non-disclosing MSMW are at risk for the acquisition and transmission of HIV and STDs, and may serve as a potential bridge, suggesting the need for further research and intervention targeting this unique population.     

Sexual Partnering and HIV Risk among Black Men Who Have Sex with Men: New York City

Black men who have sex with men (MSM) are disproportionately affected with HIV in the US. Limited event-specific data have been reported in Black MSM to help understand factors associated with increased risk of infection. Cross-sectional National HIV Behavioral Surveillance Study data from 503 MSM who reported ≥1 male sexual partner in the past year in New York City (NYC) were analyzed. Case-crossover analysis compared last protected and last unprotected anal intercourse (UAI). A total of 503 MSM were enrolled. Among 349 tested for HIV, 18% were positive. Black MSM (N = 117) were more likely to test HIV positive and not know their HIV-positive status than other racial/ethnic groups. Case-crossover analysis of 208 MSM found that men were more likely to engage in protected anal intercourse with a first time partner and with a partner of unknown HIV status. Although Black MSM were more likely to have Black male partners, they were not more likely to have UAI with those partners or to have a partner aged >40 years. In conclusion, HIV prevalence was high among Black MSM in NYC, as was lack of awareness of HIV-positive status. Having a sexual partner of same race/ethnicity or older age was not associated with having UAI among Black MSM.     

Food Insufficiency, Substance Use, and Sexual Risks for HIV/AIDS in Informal Drinking Establishments, Cape Town, South Africa

HIV/AIDS is concentrated in impoverished communities. Two critical aspects of poverty are food insufficiency and substance abuse, and both are associated with sexual risks for HIV/AIDS in southern Africa. The current study is the first to examine both hunger and substance use in relation to sexual risks for HIV infection in South African alcohol serving establishments. Anonymous venue-based intercept surveys were completed by men (n = 388) and women (n = 407) patrons of six informal drinking places (e.g., shebeens) in Cape Town, South Africa. Food insufficiency and its more extreme form hunger were common in the sample, with 24 % of men and 53 % of women experiencing hunger in the previous 4 months. Multiple regression analyses showed that quantity of alcohol use was related to higher rates of unprotected sex for men and women. Trading sex to meet survival needs was related to food insufficiency and methamphetamine use among men but not women. Food insufficiency and substance use may both contribute to HIV risks in South African shebeens. However, the influence of hunger and substance use on sexual risks varies for men and women. Interventions to reduce HIV transmission risks may be bolstered by reducing both food insufficiency and substance use.     

Correlates of Drug Dealing in Female Methamphetamine Users

Female drug dealers have been a neglected population despite their potentially elevated risk for social, legal, family, and psychological health problems. This study examined correlates of drug-dealing behavior in a sample of 209 female methamphetamine users in San Diego, CA. Twenty-five percent of the sample reported dealing methamphetamine in the past 2 months. Women who dealt methamphetamine were significantly more likely than their nondealing counterparts to have started using illicit drugs before the age of 13 years (68 % versus 44.7 %, p = .003); to have been introduced to methamphetamine by a parent (15.1 % versus 5.8 %, p = .037); and to report currently using methamphetamine to stay awake (84.9 % versus 64.7 %, p = .004), enhance self-confidence (62.3 % versus 45.5 %, p = .025), and feel more attractive (54.7 % versus 38.5 %, p = .029). In a multivariate logistic regression, factors independently associated with methamphetamine dealing were: having a spouse or live-in partner (Adjusted Odds Ratio, AOR = 2.89), using methamphetamine with a broader range of types of person (AOR = 1.46), and reporting lower levels of emotional support (AOR = 0.57). These findings suggest that female methamphetamine dealers are in urgent need of access to substance use treatment, therapies to enhance self-worth and emotional support, and family-based substance use prevention interventions for dependent children and those at risk.     

Correlates of Lifetime History of Purchasing Sex Services by Men in Saint Petersburg and Leningrad Oblast,Russia

Commercial sex workers (CSWs) in the Russian Federation are at high risk of HIV infection and transmission as a result of unsafe sexual and injecting behaviors. Their clients might be at increased risk of acquiring HIV; however, little is known about the population of men purchasing sex services. This study aims to investigate factors associated with a history of purchasing sex services by men in Saint Petersburg and Leningrad Oblast, Russian Federation. Data were collected as part of a cross-sectional study offering free anonymous rapid HIV testing in Saint Petersburg and Leningrad Oblast in 2014; in total, 3565 men aged 18 years and older provided information about their behaviors associated with risk of acquiring HIV during face-to-face interviews. Prevalence of CSW use in our study was 23.9 %. Multivariable analyses using log-binomial regression were stratified by self-reported HIV testing during the 12 months preceding the study interview. In both strata, older age, multiple sex partners, and a history of sex with an injection drug user (IDU) were associated with an elevated prevalence ratio (PR) for history of purchasing sex services, although the strength of the association differed by strata. Among men who reported recent HIV testing, condom use (PR = 1.22, 90 % confidence interval (CI) 1.0, 1.48) was associated with a history of purchasing sex services, and among men who did not report recent HIV testing, having a consistent sex partner was associated with purchasing sex services (PR = 1.23, 90 % CI 1.1, 1.37). The high prevalence of CSW service use and associations found in this study raise serious concerns about potential for sexual HIV transmission and should be investigated more closely.     

Neighborhoods and Infectious Disease Risk: Acquisition of Chlamydia during the Transition to Young Adulthood

Adolescents and young adults have the highest rates of sexually transmitted infections (STIs) in the USA despite national priority goals targeting their reduction. Research on the role of neighborhoods in shaping STI risk among youth has increased in recent years, but few studies have explored the longitudinal effects of neighborhoods on STI acquisition during the adolescent to young adult transition. The aims of this study were to examine: (1) the longitudinal relationships between the neighborhood context (poverty, residential instability, and racial/ethnic concentration) of exposure during adolescence and young adults’ acquisition of chlamydia, and (2) the extent to which sexual risk behaviors and depression over the transition from adolescence to young adulthood mediate the relationship between the neighborhood context of exposure during adolescence and young adults’ acquisition of chlamydia. A longitudinal observational design was employed using data from the National Longitudinal Study of Adolescent Health (Add Health), waves 1–3 (1994–2002). The sample was composed of 11,460 young adults aged 18 to 27 years. Neighborhood measures during adolescence were derived from the 1990 US Census appended to adolescents’ interview data. Chlamydia infection was measured via urine assay at wave 3 and 4.6 % of the young adults in the sample tested positive for chlamydia. Multilevel logistic regression analyses were conducted adjusting for numerous neighborhood and individual risk factors. Multivariate findings indicated exposure to neighborhood poverty during adolescence increased the likelihood of a positive urine test for chlamydia during young adulthood (AOR = 1.23, 95 % CI = 1.06, 1.42), and the association was not mediated by sexual risk behaviors or depression. Further research is needed to better understand the pathways through which exposure to neighborhood poverty contributes to chlamydia over the life course as are comprehensive STI prevention strategies addressing neighborhood poverty.