The Association of Religiosity,Sexual Education,and Parental Factors with Risky Sexual Behaviors Among Adolescents and Young Adults

This study examined the association of religiosity, sexual education and family structure with risky sexual behaviors among adolescents and young adults. The nationally representative sample, from the 2002 National Survey of Family Growth, included 3,168 women and men ages 15–21 years. Those who viewed religion as very important, had frequent church attendance, and held religious sexual attitudes were 27–54% less likely to have had sex and had significantly fewer sex partners than peers. Participants whose formal and parental sexual education included abstinence and those from two-parent families were 15% less likely to have had sex and had fewer partners.     

Psychological and socio-demographic variables associated with sexual risk behavior for sexually transmitted infections/HIV

New diagnoses of sexually transmitted infections (STIs) and HIV are rising in the adult population. The main objective of this study was to analyze whether knowledge of STIs/HIV, worry about STIs/HIV and pregnancy, and self-efficacy to refuse sex are predictors of sexual risk behaviors among Spanish young and adults. The study sample was composed of 1,106 young and adults of both sexes aged between 17 and 55 years. Results showed that being single, homosexual, having been tested for HIV, having previously contracted an STI, having a college education and earning a monthly income of €900 or more were the characteristics associated with higher scores in knowledge of STIs/HIV. Self-efficacy to refuse sex predicted most vaginal and anal sexual behaviors (i.e., age at vaginal and anal sex initiation and the number of couples that have remained vaginal sex). We also found that participants with greater knowledge of STIs/HIV reported older age at vaginal sex initiation and higher condom use in the first vaginal sexual contact. We consider that these findings can be useful for the development of STI/HIV prevention programs.     

Integrated Cognitive-Behavioral Therapy for Social Anxiety and HIV/STI Prevention for Gay and Bisexual Men: A Pilot Intervention Trial

Given the alarmingly high HIV and sexually transmitted infection (STI) incidence among gay and bisexual men (GBM) worldwide, there is a critical need for HIV prevention interventions specifically for GBM. Social anxiety, or anxiety about being evaluated in interpersonal situations, is a risk factor for condomless anal sex (CAS) among GBM (e.g., Hart & Heimberg, 2005; Hart, James, Purcell, & Farber, 2008). Social anxiety may also increase substance use in sexual situations, which is another risk factor for HIV/STIs in this risk group (Semple, Strathdee, Zians, McQuaid, & Patterson, 2011). The goal of the Sexual Confidence Study was to provide initial evidence of efficacy for a 10-session integrated cognitive-behavioral therapy for social anxiety, substance use management in sexual situations, and HIV sexual risk reduction for HIV-negative GBM. Diagnostic and self-report assessments were completed at baseline, posttreatment, 3-month follow-up, and 6-month follow-up. In this open trial design, we observed a 50% reduction in engagement in HIV/STI sexual risk behavior at 6-month follow-up. We also observed large uncontrolled treatment effect sizes for reductions in social anxiety disorder and problematic alcohol use. These preliminary findings suggest that the present treatment may offer an efficient way of concurrently reducing social anxiety, problematic alcohol use, and the risk of contracting HIV and STIs via CAS with serodiscordant partners among HIV-negative GBM.     

The Relationships among Childhood Maltreatment,Emotion Regulation,and Sexual Risk Taking in Men from Urban STD Clinics

This study sought to examine the relationships among emotion regulation difficulties, childhood maltreatment, and risky sexual behavior in a sample of 320 heterosexual men recruited from urban sexually transmitted disease clinics. Overall childhood maltreatment and several specific types of child abuse were significantly associated with emotion dysregulation, number of sexual partners, and sexually transmitted infection (STI) diagnosis. There was evidence of an additive effect of multiple forms of maltreatment on difficulties with emotion regulation and sexual risk taking. Impulse control difficulties and access to emotion regulation strategies, two components of emotion dysregulation, were related to measures of risky sexual behavior. Furthermore, limited access to emotion regulation strategies mediated the relationship between frequency of childhood sexual abuse and a greater number of lifetime sexual partners. This study has important implications for developing effective interventions to reduce the spread of STIs and HIV by expanding affect regulation and distress tolerance strategies among men who have experienced childhood maltreatment.     

Risky sexual behavior among married alcoholic men.

The current study explored whether the wives of men entering alcoholism treatment are at risk for sexually transmitted infections (STIs) exposure as a result of their husbands' sexual risk behaviors. The extramarital relationships of married alcoholic men entering outpatient treatment (n = 125) were compared with those of a demographically matched community sample of nonalcoholic married men (n = 125). The proportion of alcoholic men who reported 1 or more extramarital affairs in the previous year (14%) was significantly higher than that of the community sample (4%). Additionally, only 2 alcoholic husbands and 1 nonalcoholic husband reported that his wife was aware of the extramarital relationship. For both groups, none of the men who engaged in extramarital relationships reported consistent use of condoms when having sexual intercourse with their wives or with their extramarital partners. These results suggest that wives of alcoholic men are unknowingly placed at risk for indirect exposure to STIs as a result of their husbands' sexual risk behaviors. Thus, infidelity in treatment-seeking alcohol-abusing men represents a significant public health issue.     

Social context,sexual practices,and risks for HIV transmission among men who have sex with men: The south beach health survey

In a population-based sample of 193 men who had sex with men in South Beach, Miami-Dade County, Florida, two indicators of social context—choice of sexual relationships and perceived HIV-infection status—were used to analyze residents who engaged in certain sexual practices with their partners. The vast majority (88.6%) of respondents reported engagement in anal sex during the previous 12 months; 20.2% reported unprotected anal intercourse (UAI) with ejaculation with any partner and 12.4% reported UAI with ejaculation with one or more casual partners. Findings supported the hypothesis that primary partner relationships and perceived HIV status are important variables for understanding engagement in UAI with ejaculation. Men who engaged in such behaviors with casual partners were more likely to have negative attitudes towards condoms, report difficulty communicating desires for safer sex, disagree with the belief that AIDS is fatal, and be intoxicated during anal intercourse. Men who reported engaging in anal intercourse, but who never shared unprotected ejaculations, were most likely to be unknowingly infected with HIV, suggesting that many men may become infected while following what they believe to be “safer sex practices.” In designing effective interventions, public health authorities need to take into account socially embedded risk-negotiating practices.     

The Use of Protection for Sexually Transmitted Infections (STIs) and Unwanted Pregnancy among Norwegian Heterosexual Young Adults 2009

This paper explores the use and none-use of condoms among young heterosexual adults in Norway. To what extent do young heterosexuals use condoms and other types of contraception, and in which context does the use take place? What are the motives underlying both use and non use of condoms? The results are based on a 2009 national web panel survey among 16–24 year-olds in Norway (n = 871). Most respondents reported having met their most recent sex partner via friends or family, and 62% referred to the sex partner as a sweetheart. One out of two claimed they had not used condoms during the first sexual intercourse with this partner. A factor analysis revealed 2-D of motivation for not using condoms, referred to here as ‘Fear of Suspicion’ and ‘Mutual Trust’. Multiple linear regression analysis revealed that, when controlled for gender, age, and number of sex partners in one’s life, ‘Mutual Trust’ had a statistically significant relationship to coital frequency and the number of years coitally active. None of the predictor variables had a statistically significant relationship with “Fear of Suspicion”. The most commonly reported motives for the most recent sexual intercourse were having been ‘sexually aroused’ and ‘in love’. A total of 56% reported using hormonal contraception, while 20% used condoms. The most important reasons for not using condoms were: ‘used other contraception’, ‘did not worry about STIs’, ‘more pleasurable without’, ‘had none available’, and ‘unprepared for intercourse’. The most important reasons for condom use were to ‘avoid pregnancy’, ‘avoid STIs’, and ‘avoid HIV’.     

Risky Sexual Behaviour Among Married and Cohabiting Women and its Implication for Sexually Transmitted Infections in Mahikeng,South Africa

Risky sexual behaviour continues to be the main means through which sexually transmitted infections (STIs) and HIV are spread in South Africa. However few studies have assessed risky sexual behaviour among married and cohabiting women in this high HIV prevalence country. The aim of this study was therefore to assess the prevalence and identify the predictors of risky sexual behaviour among married and cohabiting women in Mahikeng Local Municipality where HIV is generalized. The study used cross-sectional mixed methods data obtained from 568 women responding to a survey and 33 women participating in in-depth interviews in 2012. All the women were aged 18–49 years, married or cohabiting and were residing in rural and urban areas of Mahikeng Local Municipality at the time of the study. The data was analyzed by the use of the Chi square statistic and a parsimonious binary logistic regression model, and the thematic content analysis method. The study found that 4 in 10 of the women experienced risky sexual behaviour, which was significantly predicted by being in marriage or cohabitation for <5 years, having a partner working in agriculture, government and mining sectors, having sex to achieve motherhood, having the perception by the women that they were unlikely to contract STIs, having the belief that partners have the right to use force to obtain sex and having partners who were unwilling to use condoms. All the above predictors were exacerbated by culturally sanctioned gender inequality and structural factors. The findings suggest that risky sexual behaviour is prevalent among married and cohabiting women in the study area which has serious implication for the marital transmission of STIs and HIV. We suggest interventions that enhance gender equality in sexual decisions and initiatives that encourage men to change their sexual beliefs and values.     

HIV Testing Experience and Risk Behavior Among Sexually Active Black Young Adults: A CBPR-Based Study Using Respondent-Driven Sampling in Durham,North Carolina

African Americans are disproportionately affected by the HIV epidemic inclusive of men who have sex with men, heterosexual men, and women. As part of a community‐based participatory research study we assessed HIV testing experience among sexually active 18–30 year old Black men and women in Durham, NC. Of 508 participants, 173 (74 %) men and 236 (86 %; p = 0.0008) women reported ever being tested. Barriers to testing (e.g., perceived risk and stigma) were the same for men and women, but men fell behind mainly because a primary facilitator of testing—routine screening in clinical settings—was more effective at reaching women. Structural and behavioral risk factors associated with HIV infection were prevalent but did not predict HIV testing experience. Reduced access to health care services for low income Black young adults may exacerbate HIV testing barriers that already exist for men and undermine previous success rates in reaching women.     

Is it Too Soon to Meet? Examining Differences in Geosocial Networking App Use and Sexual Risk Behavior of Emerging Adults

Location-based geosocial networking smartphone applications (GSN apps) have become a popular way to meet romantic and casual sex partners. Although first used primarily by men who have sex with men (MSM), GSN apps are now commonly used in the population at large, particularly among emerging adults. Although, these apps may potentially contribute to increases in STI/HIV incidence, previous research linking GSN app use to sexual risk behavior has been mixed, with some suggesting app users report greater sexual risk behavior and others suggesting less. The present paper details findings of two studies with independent samples of emerging adults. The first, a pilot study, examined GSN app use among young MSM (n = 64) to identify possible within-group factors relating dating app use to sexual risk behavior. Results indicated that the time app users spent talking to each other through the app before meeting in person (time before meeting) was related to engagement in sexual risk behavior. Those who talked less before meeting in person engaged in more sexual risk behaviors than those who spent more time talking before meeting in person. The second study sought to expand upon this finding in a more representative sample of GSN app users (n = 129) and compared sexual risk behavior and impulsivity to non-users (n = 88). There were no differences in sexual risk behavior between GSN app users and non-users. However, when examining app users by time before meeting, those with a shorter time before meeting were more impulsive and more likely to report sexual risk behavior. These findings highlight the importance of understanding GSN app use in the spread of STIs/HIV among emerging adults.     

Mental health correlates of HIV risk behaviour and STIs/HIV infection among university students from 22 low,middle and high income countries

The aim of this study was to determine mental health correlates of HIV risk behaviour and self-reported STIs/HIV infection among university students in 22 low, middle and high income countries. Data on mental health and HIV risk were collected from 16 567 undergraduate university students (mean age 20.9, SD = 2.9) from 23 universities in 22 countries across Asia, Africa and the Americas. Results indicate that overall 16.8% of the students had two or more sexual partners in the past 12 months, and among the sexually active, 73.7% had inconsistently used a condom in the past three months with their primary sexual partner, 3.2% had ever been diagnosed with a sexually transmitted infection (STI) and 0.6% had been diagnosed with HIV. In multivariate logistic regression poorer mental health and child abuse (physical and sexual) were associated with HIV risk behaviour, and child abuse (physical and sexual) was associated with STI and HIV positive diagnoses.     

Drugs,Sex, and Condoms: Identification and Interpretation of Race‐Specific Cultural Messages Influencing Black Gay and Bisexual Young Men Living with HIV

Black gay and bisexual young men carry a disproportionate burden of HIV in the United States. This study explored Black gay and bisexual young men living with HIV's identification and interpretation of race‐specific cultural messages regarding substance use, sexual activity, and condom use. A total of 36 Black gay and bisexual young men living with HIV (ages 16–24, mean = 20.6 years) from four geographically diverse regions of the United States participated in qualitative in‐depth interviews. Results from this study elucidate the ways in which these young men interpret various forms of race‐specific cultural messages and experiences regarding substance use, sexual activity, and condom use. Participants discussed cultural messages and experiences promoting and discouraging condoms and substance use. Regarding sexual activity, only messages and experiences promoting sex were reported. Across all three categories, messages and experiences promoting risk were predominant. Data further revealed that socially transmitted cultural messages received by young men emanated from multiple sources, such as family, peers, sexual partners, community/neighborhood, and the broader society. Race‐specific cultural messages and experiences should be addressed in interventions for this population, and programs should assist young men in developing a critical consciousness regarding these messages and experiences in order to promote health and well‐being.     

Repeat HIV Testing and HIV Transmission Risk Behaviors Among Sexually Transmitted Infection Clinic Patients

HIV testing and counseling expends considerable HIV prevention resources and offers great opportunities for HIV risk reduction. Individuals who are at risk for HIV and have not been HIV tested are the focus of current targeted testing campaigns and yet persons who are repeatedly tested for HIV often continue engaging in high-risk practices. This study examined HIV testing, risk behaviors, and other medical diagnostic testing practices of men (N = 231) and women (N = 86) attending an inner-city sexually transmitted infections (STI) clinic. Results showed that 75 (23%) participants had not yet been tested for HIV, 45 (14%) had been tested once, and 197 (63%) had been tested two or more times. Patients that had not been tested and those who were repeatedly tested were similar in their risk behaviors; both demonstrated significantly greater risks for HIV than persons tested just once, although repeat testers were more likely to have had a past STI. HIV testing history was minimally associated with other medical testing and health protective practices, such as testicular self-examination, mammography, and having had PAP tests. Results support targeting high-risk untested persons for HIV testing and suggest an urgent need for interventions to reduce risk behaviors among STI clinic patients who repeatedly test for HIV.     

Sexually Explicit Media and Sexual Risk Behavior in a Sample of Men Who Have Sex with Men in Norway

The aim of this study was to explore the association between the consumption of sexually explicit media (SEM) depicting condom and non-condom use and HIV/STI-related sexual risk behavior among men who have sex with men (MSM) in Norway. We also explored whether the association between SEM consumption and STI-related sexual risk behavior is mediated by men’s sexual self-esteem and/or condom use self-efficacy. A cross-sectional online survey study was carried out in Norway in 2012. The final sample comprised 529 MSM in Norway. There was a bivariate association between the use of SEM picturing condom use and less STI-related sexual risk behavior. Further, the association between SEM consumption and sexual risk behavior was mediated by condom use self-efficacy. However, SEM did not influence sexual risk behavior via sexual self-esteem. The results offer important cross-cultural validation of recent comparative data from the US and may be used to promote HIV/STI prevention, in the sense that the actors in SEM may serve as role models in managing condom use in sexual contexts.     

Low Prospects and High Risk: Structural Determinants of Health Associated with Sexual Risk Among Young African American Women Residing in Resource-Poor Communities in the South

African American women at increased risk of HIV/sexually transmitted infection (STI) may engage in risky sex as a coping mechanism for depressed economic conditions. This study examines the association between high-risk sexual behavior and structural determinants of sexual health among a sample of young African American women. 237 young African American women (16–19 years old) from economically disadvantaged neighborhoods in North Carolina were enrolled into a randomized trial testing the efficacy of an adapted HIV/STI prevention intervention. Logistic regression analyses predicted the likelihood that young women reporting lack of food at home, homelessness and low future prospects would also report sexual risk behaviors. Young women reporting a lack of food at home (22 %), homelessness (27 %), and low perceived education/employment prospects (19 %) had between 2.2 and 4.7 times the odds as those not reporting these risk factors of reporting multiple sex partners, risky sex partners including older men and partners involved in gangs, substance use prior to sex, and exchange sex. Self-reported structural determinants of sexual health were associated with myriad sexual risk behaviors. Diminished economic conditions among these young women may lead to sexual risk due to hopelessness, the need for survival or other factors.     

Neighborhood Environment, Sexual Risk Behaviors and Acquisition of Sexually Transmitted Infections Among Adolescents Diagnosed with Psychological Disorders

The association between neighborhood environment and prevalence of STIs, sexual partner variables and condom use among adolescents with psychological disorders was examined. Cross-sectional data in three urban areas of the US (Southeast, Northeast and Midwest) were obtained from 384 sexually active male and female participants who provided urine samples for laboratory-confirmed testing of Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis. A total of 15.4% of participants tested positive for one of the three STIs. Results indicated that relative to adolescents living in low risk neighborhood environments, those living in high risk environments were significantly more likely to have a STI and to report having casual partners. Findings suggest that in high risk neighborhoods, STI acquisition may be less dependent on condom use and more dependent on other contextual factors. The importance of expanding public health research to include assessment of neighborhood context as a determinant of sexual risk-taking is emphasized.     

Cognitive,Behavioral, and Personality Correlates of HIV-Positive Persons' Unsafe Sexual Behavior1

This study examined sexually risky behaviors of HIV-positive men and women within the framework of social cognitive theory. Condom use was found to be associated with high self-efficacy, positive influeces from social models, and specific condom use expectancies. As risky sexual behavior may be the manifestation of a more general pattern of risk taking that emerges from personality dispositions such as impulsiveness or psychoticism, this possibility was explored with discriminant analyses. Self-reported impulsivity, substance abuse, promiscuity, and deception served as markers of the presumed disposition. While these variables did not reliably distinguish between consistent and inconsistent condom users, they did enhance significantly the classification of individuals who, during the past 6 months, had been sexually abstinent, monogamous, or nonmonogamous. Those who reported more sex partners scored higher on impulsivity, disclosed more involvement with illegal drugs, and showed greater willingness to mislead potential partners about their sexual history than monogamous or sexually abstinent persons with HIV.     

Psychosocial Impact of Familial Adenomatous Polyposis on Young Adults: A Qualitative Study

The aim of this study was to explore in detail the psychosocial impact of either having familial adenomatous polyposis (FAP) or being at risk for FAP amongst young adults. In-depth interviews were conducted with eleven individuals aged 18–35 with a clinical or genetic diagnosis of, or at risk of developing FAP. While being at risk did not seem to have a major psychosocial impact upon clinically unaffected participants, clinically affected individuals discussed a number of major stressors including issues in relation to changes in body image and physical functioning as a result of surgery, concerns about discussing FAP with new partners, difficulties in relation to childbearing decision-making, and impact on employment. Genetic counseling was described as being highly effective in providing support, but most participants were not aware of any other support services. Providing longer-term support through ongoing genetic counseling appears necessary to adequately address the ongoing challenges faced by young adults who are dealing with FAP.     

Examining the relationship between use of sexually explicit media and sexual risk behavior in a sample of men who have sex with men in Norway

The purpose of this study was to investigate consumption patterns of gay‐oriented sexually explicit media (SEM) among men who have sex with men (MSM) in Norway, with a particular emphasis on a possible relationship between gay SEM consumption and HIV risk behavior. Participants included 529 MSM living in Norway recruited online to complete a SEM consumption and sexual risk survey. Of the 507 participants who responded to the all items measuring exposure to SEM, 19% reported unprotected anal intercourse with a casual partner (UAI) in last 90 days, and 14% reported having had sero‐discordant UAI. Among those with UAI experience, 23% reported receptive anal intercourse (R‐UAI) and 37% reported insertive anal intercourse (I‐UAI). SEM consumption was found to be significantly associated with sexual risk behaviors. Participants with increased consumption of bareback SEM reported higher odds of UAI and I‐UAI after adjusting for other factors using multivariable statistics. MSM who started using SEM at a later age reported lower odds of UAI and I‐UAI than MSM who started earlier. Future research should aim at understanding how MSM develop and maintain SEM preferences and the relationship between developmental and maintenance factors and HIV sexual risk behavior.