Tequila at Sunrise: Spring Break Travel Motivations and Risk Behaviors of American Students in Acapulco, Mexico

Little research has been completed regarding spring break motivations and behaviors of American students in foreign destinations, specifically in Mexico. This paper looks at push and pull motivations in relation to drug and alcohol consumption and findings indicate greater drug and alcohol use among those who selected “party reputation” and “to go wild” as travel motivations. Binge drinking, sexual activity, and drug use among students on spring break in Acapulco, Mexico were also analyzed and compared to past findings within the United States. Results suggest that students are involved in heavy alcohol consumption and significant drug use. Additionally, high rates of sexual activity occur on spring break and results suggest low condom use, placing students at higher risks for the contraction of sexually transmitted infections.

The effectiveness of an enhanced congnitive behavioral intervention in improving behavioral outcomes related to HIV prevention

This study analyzed outcomes of an enhanced cognitive-behavioral intervention with dually diagnosed severely mentally ill adults. It specifically addressed the improvement of attitudes, skills, self-efficacy to use condoms and the heightening of condom use. The data were analyzed via a randomized three-group repeated measures design composed of the experimental (E-CB), standard care (SC) comparison or a no-treatment control condition as the between-subjects variable and pre-post measure as the within-subjects variable. The ECB focused on cooperative, application, hands-on, skill-building and role-playing activities for sexual assertiveness, negotiation in risk-taking and proper condom use. The SC comparison, was didactic in its approach and addressed risk- taking and proper condom use in one session, but did not involve application approaches to problem-solving risky situations or condom use. Multiple assessments were conducted at pre-, post- and six months post-intervention. The analysis indicated that the E-CB intervention led to more favorable attitudes toward condoms and to improved and maintained skills regarding their use by participants six months after the intervention compared to the standard care and control groups. No significant improvements in self-efficacy were found. A repeated measures ANOVA conducted on the transformed values of percentage of vaginal condom use indicated no significant differences between the experimental and standard care conditions but both had a significantly higher mean percentage vaginal condom use than the control group, averaged across pre- and six-month post-intervention. No gender differences were seen in attitudes, skills or self-efficacy to use condoms. This study shed light upon the effectiveness of the instructional approach for the enhancement of attitudes, skills and self-efficacy outcomes related to HIV prevention. For heightened effectiveness, future approaches must address multiple factors impacting learning in this population.

Examination of Personality, Social and Cognitive Factors on the Co-Occurrence of Health Risk Behaviors among Multi-Problem Youth: The Utility of An Integrative Framework

Research has identified a number of putative risk factors that places adolescents at incrementally higher risk for involvement in alcohol and other drug (AOD) use and sexual risk behaviors (SRBs). Such factors include personality characteristics such as sensation-seeking, cognitive factors such as positive expectancies and inhibition conflict as well as peer norm processes. The current study was guided by a conceptual perspective that support the notion that an integrative framework that includes multi-level factors has significant explanatory value for understanding processes associated with the co-occurrence of AOD use and sexual risk behavior outcomes. This study evaluated simultaneously the mediating role of AOD-sex related expectancies and inhibition conflict on antecedents of AOD use and SRBs including sexual sensation-seeking and peer norms for condom use. The sample was drawn from the Enhancing My Personal Options While Evaluating Risk (EMPOWER: Jonathan Tubman, PI), data set (N = 396; aged 12-18 years). Measures used in the study included Sexual Sensation-Seeking Scale, Inhibition Conflict for Condom Use, Risky Sex Scale. All relevant measures had well-documented psychometric properties. A global assessment of alcohol, drug use and sexual risk behaviors was used. Results demonstrated that AOD-sex related expectancies mediated the influence of sexual sensation-seeking on the co-occurrence of alcohol and other drug use and sexual risk behaviors. The evaluation of the integrative model also revealed that sexual sensation-seeking was positively associated with peer norms for condom use. Also, peer norms predicted inhibition conflict among this sample of multi-problem youth. This dissertation research identified mechanisms of risk and protection associated with the co-occurrence of AOD use and SRBs among a multi-problem sample of adolescents receiving treatment for alcohol or drug use and related problems. This study is informative for adolescent-serving programs that address those individual and contextual characteristics that enhance treatment efficacy and effectiveness among adolescents receiving substance use and related problems services.

Sexual risk behaviors and HIV risk among Americans aged 50 years or older: a review.

Although HIV-related sexual risk behaviors have been studied extensively in adolescents and young adults, there is limited information about these behaviors among older Americans, which make up a growing segment of the US population and an understudied population. This review of the literature dealing with sexual behaviors that increase the risk of becoming HIV-infected found a low prevalence of condom use among older adults, even when not in a long-term relationship with a single partner. A seminal study by Schick et al published in 2010 reported that the prevalence of condom use at last intercourse was highest among those aged 50-59 years (24.3%; 95% confidence interval, 15.6-35.8) and declined with age, with a 17.1% prevalence among those aged 60-69 years (17.1%; 95% confidence interval, 7.3-34.2). Studies have shown that older Americans may underestimate their risk of becoming HIV-infected. Substance use also increases the risk for sexual risk behaviors, and studies have indicated that the prevalence of substance use among older adults has increased in the past decade. As is the case with younger adults, the prevalence of HIV infections is elevated among ethnic minorities, drug users (eg, injection drug users), and men who have sex with men. When infected, older adults are likely to be diagnosed with HIV-related medical disorders later in the course of illness compared with their younger counterparts. Physicians are less likely to discuss sexual risk behaviors with older adults and to test them for HIV compared with younger adults. Thus, it is important to educate clinicians about sexual risk behaviors in the older age group and to design preventive interventions specifically designed for older adults.

Neural Mechanisms of Young Adult Sexual Decision-Making and Risk Behavior

Sexual risk behavior among young adults is a serious public health concern; 50% will contract a sexually transmitted infection (STI) before the age of 25. The current study collected self-report personality and sexual history data, as well as neuroimaging, experimental behavioral (e.g., real-time hypothetical sexual decision making data), and self-report sexual arousal data from 120 heterosexual young adults ages 18-26. In addition, longitudinal changes in self-reported sexual behavior were collected from a subset (n = 70) of the participants. The primary aims of the study were (1) to predict differences in self-report sexual behavior and hypothetical sexual decision-making (in response to sexually explicit audio-visual cues) as a function of ventral striatum (VS) and amygdala activity, (2) test whether the association between sexual behavior/decision-making and brain function is moderated by gender, self-reported sexual arousal, and/or trait-level personality factors (i.e., self-control, impulsivity, and sensation seeking) and (3) to examine how the main effects of neural function and interaction effects predict sexual risk behavior over time. Our hypotheses were mostly supported across the sexual behavior and decision-making outcome variables, such that neural risk phenotypes (heightened reward-related ventral striatum activity coupled with decreased threat-related amygdala activity) were associated with greater lifetime sexual partners at baseline measured and over time (longitudinal analyses). Impulsivity moderated the relationship between neural function and self-reported number of sexual partners at baseline and follow up measures, as well as experimental condom use decision-making. Sexual arousal and sensation seeking moderated the relationship between neural function and baseline and follow up self-reports of number of sexual partners. Finally, unique gender differences were observed in the relationship between threat and reward-related neural reactivity and self-reported sexual risk behavior. The results of this study provide initial evidence for the potential role for neurobiological approaches to understanding sexual decision-making and risk behavior. With continued research, establishing biomarkers for sexual risk behavior could help inform the development of novel and more effective individually tailored sexual health prevention and intervention efforts.

Les technologies de l'information et de la télécommunication (TIC) pour la promotion de la santé sexuelle et reproductive (SSR) au sein des jeunes des Premières Nations du Québec : faisabilité et pistes d'intervention

La répartition des taux de prévalence des infections transmissibles sexuellement et par le sang (ITSS) et du VIH/SIDA au Canada présente de grandes inégalités entre les différents groupes socioculturels. Les Autochtones font partie des populations qui en payent le plus lourd tribut. Par rapport à cette situation, le plan directeur 2007-2017 de la commission de la santé et des services sociaux des Premières Nations du Québec et du Labrador (CSSSPNQL) identifie clairement le VIH/SIDA comme une problématique prioritaire de santé. La stratégie autochtone sur le VIH/SIDA estime que pour être efficaces, les interventions visant la prévention du VIH/SIDA doivent cibler divers groupes, au nombre desquels la jeunesse autochtone est une cible particulière. En ce sens, la familiarité des jeunes générations avec la technologie positionne l’utilisation des technologies de l’information et de la communication (TIC) comme une avenue fortement prometteuse dans le domaine de la prévention du VIH/SIDA chez les adolescents et jeunes adultes. Nous avons réalisé une synthèse des connaissances dans ce domaine novateur suivant une méthodologie suggérée par la Collaboration Cochrane dans le but de documenter l’efficacité et les facteurs d’adoption des interventions utilisant les TIC pour la prévention des ITSS/VIH/SIDA et la promotion de la santé sexuelle et reproductive auprès des adolescents et jeunes adultes. Les résultats de cette revue systématique ont permis d’élaborer et de mener, en partenariat avec la CSSSPNQL, un projet de recherche visant à évaluer la faisabilité de telles interventions au sein des adolescents et jeunes adultes de communautés des Premières Nations (PN) du Québec. En complément à cette étude de faisabilité et dans le but de formuler des recommandations en vue de la conception d’interventions utilisant les TIC et fondées autant sur les données probantes que sur les réalités des jeunes des PN, nous avons entrepris une dernière étude visant à identifier les facteurs sous-jacents du port du condom chez les 13-18 ans de communautés des Premières Nations du Québec. Nous avons discuté, dans la présente thèse, les résultats de ces études ainsi que divers enjeux du partenariat de recherche avec les parties prenantes des PN ayant participé à notre projet. Les implications pratiques de nos résultats, en matière de recherche et d’intervention, sont à discuter avec notre principale partenaire, la CSSSPNQL, afin d’en optimiser les retombées pour les populations des PN.

Conocimientos, actitudes y prácticas en la salud sexual y la salud reproductiva: propuesta de una escala psicométrica

En este artículo se presenta el resultado del análisis de validez y confiabilidad de las escalas propuestas para medir conocimientos, actitudes y prácticas en salud sexual y salud reproductiva de la población estudiantil de la Universidad Nacional. La escala inicial estuvo conformada por 288 ítemes divididos en cuatro dimensiones (salud sexual, salud reproductiva, VIH/ SIDA e infecciones de transmisión sexual y uso del condón) y cada dimensión en tres categorías (conocimientos, actitudes y prácticas). El tratamiento de la escala inició con un análisis de validez aparente a partir de la evaluación de 12 personas expertas en la temática, luego se procedió con un análisis de factores, uno de correlación y se terminó con un análisis de confiabilidad que arrojó un Alfa de Cronbach de 0.9290, para concluir que la escala tiene una excelente consistencia interna. Finalmente, se construyó una nueva escala con 128 ítemes agrupados en las tres categorías y las cuatro dimensiones propuestas. Abstract In this document, the results of the validity and reliability analysis of the scales propose to measure knowledge, attitudes and practices in sexual health and reproductive health of the students of the Universidad Nacional, are presented. The scale was primarily composed of 288 items divided in four dimensions (sexual health, reproductive health, HIV/AIDS and sexual transmitted diseases, and condom use), and each dimension in three categories (knowledge, attitudes and practices). The treatment of the scale began with a face validity analysis from the evaluation of 12 experts and then with a factor analysis, correlation analysis and finished with a reliability analysis that gave a result a Cronbach coefficient of 0.9290, leading to the conclusion that the scale has an excellent internal consistency. Finally, a new scale was constructed with 128 items, gathered in the three categories and four dimensions proposed.

Interpreting and dismissing the relevance of the “wait and wipe” finding from the circumcision studies conducted in Africa

Some of the secondary findings from the circumcision studies conducted in Africa, are both interesting and difficult to explain. This paper focuses on the finding that uncircumcised men who waited for ten minutes after sexual intercourse and then wiped their penises using a dry cloth, had lower rates of HIV infection compared to those who cleaned using a wet cloth or those who cleaned within three minutes of having intercourse. The paper also focuses on the finding on men who became infected and yet they reported no sexual acts or 100% condom use. Interpretations that have been provided so far in trying to explain these two interesting findings are somewhat inadequate. Because of the inadequate interpretation that has been provided, anti-circumcision lobbyist are presenting the “wait and wipe strategy” as an alternative to circumcision for HIV prevention. In this paper, we argue that waiting for ten minutes and wiping with a dry cloth does not prevent men from becoming infected by HIV. We therefore attempt to present some alternative views.

Vulnerabilidades de gênero, práticas culturais e infecção pelo HIV em Maputo

A construção social do gênero feminino em Moçambique está baseada na submissão ao homem, influenciando a vulnerabilidade de gênero à infecção pelo HIV. Objetivou-se analisar a percepção de pessoas vivendo com HIV/aids (PVHA) e de profissionais de saúde (PS), da cidade de Maputo, em relação à vulnerabilidade de gênero e infecção pelo HIV. Participaram 33 PVHA e 15 PS, selecionados por conveniência, mediante a realização de grupos focais e de entrevistas semiestruturadas. Dois eixos temáticos nortearam a análise: vulnerabilidade de gênero e práticas culturais tradicionais. A análise de conteúdo dos relatos verbais permitiu concluir que a vulnerabilidade feminina é maior, segundo a quase totalidade dos participantes, delineando categorias como submissão da mulher, dificuldade para negociar o uso do preservativo e influência das práticas culturais. O estudo possibilitou compreender melhor o contexto de vulnerabilidades que afetam cidadãos de Maputo, em especial as mulheres, em um país de prevalência elevada da epidemia. ____________________________________________________________________________________ ABSTRACT

Violência contra as mulheres trabalhadoras do sexo e vulnerabilidade ao HIV/AIDS em 10 cidades brasileiras

Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2016.

Predictors of Adolescent Sexual Intentions and Behavior: Attitudes, Parenting, and Neighborhood Risk

The current study was a cross-sectional examination of data collected during an HIV risk reduction intervention in south Florida. The purpose of the study was to explore the relationships between neighborhood stress, parenting, attitudes, and adolescent sexual intentions and behavior. The Theory of Planned Behavior was used as a model to guide variable selection and propose an interaction pathway between predictors and outcomes. Potential predictor variables measured for adolescents ages 13-18 (n=196) included communication about sex, parent-family connectedness, parental presence, parent-adolescent activity participation, attitudes about sex and condom use, neighborhood disorder, and exposure to violence. Outcomes were behavioral intentions and sexual behavior for the previous eight months. Neighborhood data was supplemented with ZIP Code level data from regional sources and included median household income, percentage of minority and Hispanic residents, and number of foreclosures. Statistical tests included t-tests, Pearson’s correlations, and hierarchical linear regressions. Results showed that males and older adolescents reported less positive behavioral intentions than females and adolescents younger than 16. Intentions were associated with condom attitudes, sexual attitudes, and parental presence; unprotected sexual behavior was associated with parental presence. The best fit model for intentions included gender, sexual attitudes, condom attitudes, parental presence, and neighborhood disorder. The unsafe sexual behavior model included whether the participant lived with both natural parents in the previous year, and the percent of Hispanic residents in the neighborhood. Study findings indicate that more research on adolescent sexual behavior is warranted, specifically examining the differentials between variables that affect intentions and those that affect behavior. A focus on gender and age differences during intervention development may allow for better targeting and more efficacious interventions. Adding peer and media influences to the framework of attitudes, parenting, and neighborhood may offer more insight into patterns of adolescent sexual behavior risk.

Knowledge of HIV transmission risk behavior, and perceptions of risk among Haitian women living in Miami, Florida

This study was conducted to gain a more comprehensive understanding of HIV risk among Haitian women. The variables measured were: knowledge of HIV transmission, sexual risk behaviors, and perceptions of risk among Haitian women. The sociocultural aspect of the Haitian women's lives with regard to their risky behaviors was also examined. A total of 101 Haitian women (aged 25-53) who attended two comprehensive health clinics were interviewed. A combined questionnaire derived from both the ARM-Q and the RBA was used. In general, the women had good knowledge of the sexual transmission of HIV I AIDS and indicated that they were susceptible to HIV infection. However, knowledge and perceptions of risk were not translated into sexual risk-reduction behaviors with their partners. Multiplicity of partners and low incidence of condom use were the two major sexual risk factors isolated in this study. Results indicate Haitian women were more likely to use condoms if they possessed greater HIV knowledge and their sexual partners held more positive attitudes toward using condoms. Also, Haitian women may have failed to protect themselves because behavior changes could have involved threats to their social and economic survival, relationships and culturally sanctioned roles. This suggests the need to include male partners in HIV prevention interventions with Haitian women. Future research should focus on preventing high-risk behavior by improving knowledge, altering the male partners' attitudes toward condoms, and enhancing communication and negotiation skills. Nursing implications and recommendations for culturally sensitive and relevant AIDS prevention efforts are discussed.

Sexually transmitted infection incidence among adolescents in Ireland

Objective: The burden of sexually transmitted infections (STIs) rests with young people, yet in Ireland there has been very little research into this population. The purpose of this study was to determine the incidence rate and establish risk factors that predict STI occurrence among adolescents in Ireland. Design: Routine diagnostic, demographic and behavioural data from first-time visits to three screening centres in the southwest of Ireland were obtained. Univariate and multivariable logistic regression models were used to assess risk factors that predict STI occurrence among adolescents. Results: A total of 2784 first-time patients, aged 13–19 years, received 3475 diagnoses between January 1999 and September 2009; 1168 (42%) of adolescents had notifiable STIs. The incidence rate of STIs is 225/100 000 person-years. Univariate analysis identified eligible risk factors (p<0.2) for inclusion in the multivariable model. Multivariable logistic regression showed the dominant risk factors for STI diagnosis to be: males who sometimes [odds ratio (OR) 2.02] or never (OR 1.83) use condoms; and females 18–19 years (OR 2.26) and 16–18 years (OR 1.8), with 2 (OR 1.33) or 3+ (OR 1.56) partners in the last 12 months, who are non-intravenous drug users (OR 0.72), are most likely to receive a positive STI diagnosis. Conclusions: STI diagnosis has become increasingly common in Ireland. The proportion of notifications among those aged under 20 years is increasing. These data illustrate the significance of age, condom use and number of sexual partners as risk factors for STI diagnosis. Furthermore, providing data for the first time, we report on the high incidence rate of STIs among adolescents in Ireland. The high levels of risk-taking behaviour and STI acquisition are highlighted and suggest that there is a need for an integrated public health approach to combat this phenomenon in the adolescent population.

Modelo predictivo para uso del condón y consumo de alcohol como conductas de riesgo relacionadas con el contagio de VIH/SIDA en trabajadoras sexuales de Bogotá- 2015

Objetivo: Determinar un modelo predictivo para uso del condón y consumo de alcohol como conductas de riesgo relacionadas el contagio de VIH/Sida en mujeres trabajadoras sexuales de la ciudad de Bogotá en el año 2015. Métodos Estudio de tipo transversal con diseño observacional, se tomaron 255 mujeres trabajadoras sexuales de la ciudad de Bogotá; La información analizada fue tomada del estudio realizado en cinco ciudades de Colombia en el año 2015, las hipótesis planteadas se soportaron en la asociación entre las condiciones sociodemográficas, de conocimiento, practicas, hábitos, apoyo social y de ocupación propia de las mujeres trabajadoras sexuales que podían explicar y predecir la adopción de conductas riesgosas para VIH/sida como son el uso del condón y el consumo de alcohol en ejercicio de su ocupación. Resultados El promedio de edad de inicio en el trabajo sexual fue 22,1±7,1 años, tres cuartas partes son solteras y residen en estrato dos y tres; el 96,5% dijo usar el condón con el último cliente y el 27,8% de ellas consumió alcohol durante su último servicio. En la conducta de riesgo uso del condón, se encontraron asociados entre otras, la edad [OR=1,10(1,03-1,17)], vivir en estrato dos [OR=7,7(1,5-39,5)], el ingreso por trabajo sexual [OR=1,0(1,0-1,0)], la disponibilidad del condón para el servicio [OR=0,03(0,008-0,16)] y contar con otro método de planificación (ligadura de trompas) [OR=4,47(1,0-18,3)]. En la conducta de riesgo consumo de alcohol, se encontró asociado ente otros: estrato socioeconómico dos [OR=5,8(1,54-22,3)], nivel de escolaridad secundaria [OR=0,12(0,16-0,96)], vivir con otros familiares [OR=3,45(1,7-7,02)], ingreso por trabajo sexual [OR=1,0(1,0-1,0)] y el sitio donde se ofrece el servicio [OR=0,07(0,04-0,15)]. Después de ajustar, se encontró que las variables que mejor explican el uso del condón fueron edad [OR=1,1(1,02-1,17)] y disponibilidad del condón [OR=0,04(0,008-0,024)], el modelo tuvo poca sensibilidad 33,3% y buena capacidad predictiva (84,6%). Las variables que mejor explicaron el consumo de alcohol durante el servicio fueron edad [OR= 0,95(0,91-0,98)], Número de clientes por semana [OR=0,9(0,90-0,98)], sitio donde ofrece el servicio [OR=7,1(3,45-14,8)], y estrato socioeconómico [OR=1,8 (0,90-3,83)], resultando un modelo con buena sensibilidad (71,8%) y buena capacidad predictiva (86,4%). Conclusiones Aspectos como la edad, el estrato socioeconómico, escolaridad, estado civil, ingreso económico por trabajo sexual, edad de inicio en el trabajo sexual, número de clientes antiguos en la última semana, disponibilidad del condón para prestar el servicio y ligadura de trompas como método diferente de planificación, se asociaron estadísticamente con el uso del condón. Sin embargo al ajustar las variables solo la edad y la disponibilidad del condón se mantuvieron como variables explicativas. Cabe anotar, que aunque el modelo mostró buena capacidad predictiva (84,6%), la precisión en sus estimaciones fue baja debido a la poca frecuencia del no uso del condón con el ultimo cliente (3,5%), y la sensibilidad del modelo apenas fue del 33,3%. Por otro lado, factores como la edad, el estrato socioeconómico, nivel educativo, ingreso económico, sitio de oferta del servicio, composición familiar, número de hijos, número de clientes atendidos en la última semana y número de clientes antiguos mostraron asociación estadística con el consumo de alcohol. Sin embargo, al ajustar las variables solo edad, estrato socioeconómico, sitio donde se ofrece el servicio y número de clientes por semana mantuvieron asociación estadística; observándose además que el estrato socioeconómico (uno y dos) y sitio donde se ofrece el servicio (establecimiento), son factores de riesgo para el consumo de alcohol en ejercicio de la ocupación y la poca edad y un número reducido de clientes por semana se comportan como factores de protección para el consumo de alcohol. El modelo predictivo que se desarrolló para la conducta de riesgo de consumo de alcohol, con una sensibilidad del 71,8% y un poder predictivo del 86,4%. .

Use of a condom in sex relations by HIV carriers

Para estudar a ocorrência da utilização do preservativo masculino em relações sexuais pelos portadores do HIV, foram entrevistados 132 indivíduos, sendo 82 homens e 50 mulheres. A maioria do Estado de São Paulo e algumas de outras regiões do País, atendidas na Faculdade de Medicina de Botucatu. As mulheres eram mais jovens, tinham menor escolaridade, pior qualificação profissional que os homens, e ainda, maior proporção era de viúvas, separadas, desquitadas e divorciadas. Verificou-se que 43,9% dos homens e 72% das mulheres foram contaminados pela via sexual, mas apenas 41,2% dos primeiros e 31,8% das mulheres referiram utilização do preservativo após o diagnóstico de infecção, a maioria de homens e mulheres preferindo observar abstinência sexual. Os resultados permitem concluir que ainda há necessidade de se manter informação continuada sobre a importância do uso do preservativo, além de se garantir sua distribuição gratuita, pelos baixos níveis de instrução e qualificação profissional dos indivíduos. Sugerem, ainda, que as campanhas de divulgação de medidas preventivas considerem as diferenças sociais e culturais das mulheres que se infectam.