The feminine ideal and transactional sex: Navigating respectability and risk in Swaziland

Women who engage in transactional sex are not only at increased risk of HIV and intimate partner violence, but also face social risks including gossip and ostracism. These social and physical risks may be dependent on both what a woman expects and needs from her partner and how her community perceives the relationship. Gender theory suggests that some of these social risks may hinge on whether or not a woman's relationship threatens dominant masculinity. 

We conducted a qualitative study in Swaziland from September 2013 to October 2014 to explore transactional sex and respectable femininity through the lens of hegemonic gender theory. Using cultural consensus modeling, we identified cultural models of transactional sex and conducted 16 in-depth interviews with model key informants and 3 focus group discussions, for a total of 41 participants. 

We identified 4 main models of transactional relationships: One typified by marriage and high social respectability, a second in which women aspire towards marriage, a third particular to University students, and a fourth "sugar daddy" model. Women in all models expected and received significant financial support from their male partners. However, women in less respectable relationships risked social censure and stigma if they were discovered, in part because aspects of their relationship threatened hegemonic masculinity. 

Conversely, women who received male support in respectable relationships had to carefully select HIV risk reduction strategies that did not threaten their relationship and associated social status. Research and programming efforts typically focus only on the less socially respectable forms of transactional sex. 

This risks reinforcing stigma for women in relationships that are already considered socially unacceptable while ignoring the unique HIV risks faced by women in more respectable relationships.

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By:  Fielding-Miller R1, Dunkle KL2, Jama-Shai N2, Windle M3, Hadley C3, Cooper HL3.

• 1University of California, San Diego, 9500 Gillman Drive #0507, San Diego, CA 92093, United States. Electronic address: rfieldingmiller@ucsd.edu.
• 2South African Medical Research Council, 1 Soutpansberg Road, Pretoria, 0001, South Africa.
• 3Emory University, 201 Dowman Drive, Atlanta, GA 30322, United States.
• Soc Sci Med. 2016 Apr 7;158:24-33. doi: 10.1016/j.socscimed.2016.04.005 

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Family-Based HIV & Sexually Transmitted Infection Risk Reduction for Drug-Involved Young Offenders: 42-Month Outcomes

This study tested a family-based human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention approach integrated within an empirically supported treatment for drug-involved young offenders, Multidimensional Family Therapy (MDFT). 

A randomized, controlled, two-site community-based trial was conducted with 154 youth and their parents. Drug-involved adolescents were recruited in detention, randomly assigned to either MDFT or Enhanced Services as Usual (ESAU), and assessed at intake, 3, 6, 9, 18, 24, 36, and 42-month follow-ups. Youth in both conditions received structured HIV/STI prevention in detention and those in MDFT also received family-based HIV/STI prevention as part of ongoing treatment following detention release. Youth in both conditions and sites significantly reduced rates of unprotected sex acts and STI incidence from intake to 9 months. They remained below baseline levels of STI incidence (10%) over the 42-month follow-up period. 

At Site A, adolescents who were sexually active at intake and received MDFT showed greater reduction in overall frequency of sexual acts and number of unprotected sexual acts than youth in ESAU between intake and 9-month follow-ups. These intervention differences were evident through the 42-month follow-up. Intervention effects were not found for STI incidence or unprotected sex acts at Site B. 

Intensive group-based and family intervention in detention and following release may reduce sexual risk among substance-involved young offenders, and a family-based approach may enhance effects among those at highest risk. Site differences in intervention effects, study limitations, clinical implications, and future research directions are discussed.

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By:  Rowe CL1, Alberga L1, Dakof GA1, Henderson CE2, Ungaro R1, Liddle HA1.

• 1Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL.
• 2Department of Psychology, Sam Houston State University, Huntsville, TX.
• Fam Process. 2016 Feb 16. doi: 10.1111/famp.12206 

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A Group-Based Sexual Risk Reduction Intervention for Men Who Have Sex with Men in Ho Chi Minh City, Vietnam: Feasibility, Acceptability, and Preliminary Efficacy

An emerging HIV epidemic can be seen among men who have sex with men (MSM) in Vietnam. There are currently no evidence-based behavioral sexual risk reduction interventions for MSM in this setting. 

Between October 2012 and June 2013, 100 high-risk MSM from Ho Chi Minh City were enrolled in an open pilot trial to assess feasibility and acceptability of a group-based, manualized sexual risk reduction intervention, and to preliminarily examine changes in primary and secondary outcomes. 

Participants completed a behavioral assessment battery and HIV testing at baseline, 3, and 6 months post-baseline. Over 80.0 % of the sample was <25 years old and 77.0 % identified as Bong kin ("hidden," masculine-appearing). Feasibility and acceptability of the program was evidenced by 87.0 % retention for the intervention sessions, 78.0 % completion of the 6 month assessment, and positive responses on evaluation forms and qualitative exit interviews. 

There was a decline in the number of condomless anal sex acts from baseline (6.32) to 3 month (2.06) and 6 month (2.49) follow-up (p < .0001). These data support the need for further testing of this group-based, behavioral HIV prevention intervention to reduce sexual risk behavior among MSM in Vietnam in a randomized controlled efficacy trial.

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By:   Mimiaga MJ^1,2,3,4, Closson EF^5,6, Biello KB^7,8,5, Nguyen H⁹, Nguyen QH^9,10, Oldenburg CE¹¹, Lan HT¹², Safren SA^5,13, Mayer KH^5,14, Colby DJ¹⁰.

¹Department of Epidemiology and Behavioral & Social Health Sciences, Brown University School of Public Health, Providence, RI, USA. matthew_mimiaga@brown.edu.

²Institute for Community Health Promotion, Brown University, Providence, RI, USA. matthew_mimiaga@brown.edu.

³Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. matthew_mimiaga@brown.edu.

⁴The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA. matthew_mimiaga@brown.edu.

⁵The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA.

⁶Department of Social and Environmental Health, The London School of Hygiene and Tropical Medicine, London, UK.

⁷Department of Epidemiology and Behavioral & Social Health Sciences, Brown University School of Public Health, Providence, RI, USA.

⁸Institute for Community Health Promotion, Brown University, Providence, RI, USA.

⁹Harvard AIDS Initiative in Vietnam, Ho Chi Minh City, Vietnam.

¹⁰Center for Applied Research on Men and Health, Ho Chi Minh City, Vietnam.

¹¹Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

¹²The Life Centre, Ho Chi Minh City, Vietnam.

¹³Department of Psychology, The University of Miami, Miami, FL, USA.

¹⁴Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

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Impact of ASUMA Intervention on HIV Risk Behaviors among Puerto Rican Adolescents

The purpose of this manuscript is to assess and compare HIV risk behaviors among early adolescents after a three-year pilot study. 

A total of 135 public and private junior high schools students completed the intervention protocol. A self-administered questionnaire was given at baseline and at the end of the third year (fourth measure). Descriptive and inferential analyses were performed using SPSS 20.0.

About 60% of the students were 14 years old at the fourth measure. The proportion of students that did not report at least one HIV risk behavior at baseline and those that reported any risk behavior at the fourth measure was lower in the intervention group (45.0%) than in the control group (54.5%). The proportion of students that reported at least one HIV risk behavior at baseline and those that did not report any HIV risk behavior at the fourth measure was higher in the intervention group than in the control group (33.3% vs. 8.3%). 

The proportion of students engaging in HIV risk behaviors was higher in the control group than in the intervention group at the fourth measure, suggesting that A Supportive Model for HIV Risk Reduction in Early Adolescence (ASUMA) intervention might be a promising initiative to reduce adolescents' engagement in HIV risk behaviors.

Below:  A Supportive Model for HIV Risk Reduction in Early Adolescence (ASUMA) theoretical framework

Full article at:   http://goo.gl/KbkJP9

By:   Fernandez-Santos DM1, Miranda-Diaz C2, Figueroa-Cosme WI3, Ramon RO4, Mayor AM5, Rios-Olivares E6, Hunter-Mellado RF7.

• 1Internal Medicine Department, Universidad Central del Caribe, School of Medicine, PO BOX 60327, Bayamon 00960-6032, Puerto Rico. diana.fernandez@uccaribe.edu.
• 2Internal Medicine Department, Universidad Central del Caribe, School of Medicine, PO BOX 60327, Bayamon 00960-6032, Puerto Rico. christine.miranda@uccaribe.edu.
• 3Internal Medicine Department, Universidad Central del Caribe, School of Medicine, PO BOX 60327, Bayamon 00960-6032, Puerto Rico. wanda.figueroa@uccaribe.edu.
• 4Internal Medicine Department, Universidad Central del Caribe, School of Medicine, PO BOX 60327, Bayamon 00960-6032, Puerto Rico. raul.ramon@uccaribe.edu.
• 5Internal Medicine Department, Universidad Central del Caribe, School of Medicine, PO BOX 60327, Bayamon 00960-6032, Puerto Rico. amayorb@hotmail.com.
• 6Internal Medicine Department, Universidad Central del Caribe, School of Medicine, PO BOX 60327, Bayamon 00960-6032, Puerto Rico. eddy.rios@uccaribe.edu.
• 7Internal Medicine Department, Universidad Central del Caribe, School of Medicine, PO BOX 60327, Bayamon 00960-6032, Puerto Rico. robert.hunter@uccaribe.edu.
• Int J Environ Res Public Health. 2015 Dec 23;13(1). pii: E60. doi: 10.3390/ijerph13010060.

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Incarcerated Women’s Relationship-based Strategies to Avoid Drug Use After Community Re-Entry

While recent research has stressed the supportive role that family and friends play for incarcerated persons as they re-enter the community, drug-using incarcerated women re-entering the community often have to rely on family, community, and intimate relationships that have played a role in their substance abuse and criminalization. 

This study conducted qualitative analysis of clinical sessions with rural, drug-using women (N = 20) in a larger prison-based HIV risk reduction intervention in Kentucky during 2012-2014 to examine incarcerated women’s perceptions of the role of their family, community, and intimate relationships in their plans to decrease their substance abuse upon community re-entry. 

Women stressed the obstacles to receiving support in many of their family and drug-using relationships after community re-entry. Nonetheless, they asserted that changes in their relationships could support their desires to end their substance abuse by setting limits on and using their positive relationships, particularly with their children, to motivate them to change. Interventions to promote incarcerated women’s health behavior changes—including substance abuse—must acknowledge the complex social environments in which they live.

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By:  Claire Snell-Rood PhD^a*, Michele Staton-Tindall PhD, MSW^b &Grant Victor MSW^b

• ^a University of Kentucky College of Medicine, Department of Behavioral Science, 108 Medical Behavioral Science Building, Lexington, KY 40536-0086
• ^b University of Kentucky College of Social Work, 619 Patterson Office Tower, Lexington, Kentucky, 40506-0027 

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HIV/AIDS: A Persistent Health Issue for Women and Children in Mid and Far Western Nepal

This article reviews the effect of male migration on the spread of HIV infections in mid and far-western Nepal. It explains the link between male mobility and HIV in women and children. Materials were collected by a systematic search of the databases and the websites of national and international agencies. HIV infection amongst male migrants was found to be high. 

Their risk behaviors such as unprotected sex with multiple partners and sex workers increase the risk of HIV infection. Substance abuse, loneliness, separation from families, peer pressure, long working hours and poor living conditions are factors that promote unsafe sex. Literacy and awareness about HIV is a key measure to decrease the prevalence of the disease and reduce social stigma among people affected. 

HIV is a major public health issue especially in Nepal with migration playing a major role in its spread. Negligence to sexual health and lack of comprehensive knowledge on the disease among male migrants are the major obstacles that have exacerbated the disease. 

There is a need for further research on the existing HIV cases affecting women and children of these two regions to get a clear picture of the gravity of the disease.

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By:  Awasthi KR1, Adefemi K1, Tamrakar M2.

• 1School of Public Health Faculty of Health Sciences Curtin University, Bentley 6102, WA.
• 2Department of Dentistry Kathmandu University School of Medical Sciences Dhulikhel, Kavre. 

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Brief Report: HIV Prevention by Australian Gay and Bisexual Men with Casual Partners: The Emergence of Undetectable Viral Load as One of a Range of Risk Reduction Strategies

We analyzed the HIV risk reduction strategies (RRS) used by Australian gay and bisexual men with casual partners. 

Among 1346 men who reported any condomless anal intercourse with casual partners, 75% frequently practiced at least one RRS. The most common RRS was serosorting, frequently practiced by 55% of HIV-positive and 47% of HIV-negative participants. 

Condoms were frequently (but inconsistently) used by 17% of HIV-positive, 41% of HIV-negative, and 30% of untested participants. Relying on an undetectable viral load was frequently practiced by 58% of HIV-positive participants. 

Strategic positioning, withdrawal, and non-HIV-positive men taking antiretroviral medication were less common strategies.

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By:  Holt M1, Lea T, Mao L, Zablotska I, Prestage G, de Wit J.

• 1*Centre for Social Research in Health, UNSW Australia, Sydney, Australia; †The Kirby Institute, UNSW Australia, Sydney, Australia; and ‡Social and Organizational Psychology, Utrecht University, Utrecht, the Netherlands. 

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Effectiveness of a Peer-Assisted Multicomponent Behavioral Intervention in HIV Risk Reduction among Female Entertainment Workers in China

This study examined the effectiveness of a behavioral intervention that combined cognitive and social influence approaches. 

The intervention consisted of small group sessions targeting HIV knowledge, protection motivation, behavioral skills, and social influences of risk reduction. The control was an attention-controlled HIV/STI health education and counseling. Two-group comparisons were conducted to assess the effectiveness of the intervention; risk reduction over time was analyzed to determine the sustainability of the effectiveness. 

The analyses revealed that the intervention was effective in reducing/increasing HIV risk/protective behaviors and the effect was sustainable. While participants in the control reported a greater reduction/increase in risk/protective behaviors 3-month post-intervention, the initial strong effect quickly faded and completely disappeared 12-month post-intervention. 

By contrast, the moderate initial effect of the intervention was not only sustained but actually strengthened over time. The intervention was well received by participants and holds promise for HIV risk reduction behavior change among female entertainment workers in China.

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By: Yang X1, Xia G2.

• 1Old Dominion University, Norfolk, Virginia.
• 2Shanghai Academy of Social Sciences.  

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Lessons Learned from Delivering Imara, an HIV/STI Risk Reduction Intervention for African American Girls in Juvenile Detention

A critical need exists for efficacious interventions to reduce sexual risk and sexually transmitted infections (STIs) among African American girls in juvenile detention. Adapting evidence-based interventions is one strategy for developing interventions that might protect detained African American girls from adverse sexual health outcomes. 

To support development and implementation of evidence-based HIV/STI prevention interventions for this population, this qualitative study describes lessons learned from delivering Imara, an adapted HIV/STI prevention intervention for detained African American girls. Program implementation includes one-on-one sessions in the detention facility that offer logistical advantages; provide intervention contact inside the facility, soon after release, and frequently thereafter; address STI treatment for girls and their sexual partners; tailor intervention content based on individual risk and learning needs; and identify and acknowledge girls' competing priorities. 

These lessons are discussed in the context of challenges encountered and solutions for addressing the challenges, and in terms of the structure and content of the intervention. The lessons learned from delivering Imara exemplify the continuous process of adapting an existing intervention for a new population and setting.

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By: Davis TL1, Boyce LS2, Rose E2, Swartzendruber A3, DiClemente R3, Gelaude D4, Fasula AM4, Carry M4.

• 1Emory University, Atlanta, GA, USA Center for AIDS Research, Emory University, Atlanta, GA Morehouse College, Atlanta, GA, USA teaniese.davis@morehouse.edu.
• 2Emory University, Atlanta, GA, USA.
• 3Emory University, Atlanta, GA, USA Center for AIDS Research, Emory University, Atlanta, GA.
• 4Centers for Disease Control and Prevention, Atlanta, GA, USA. 

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Intimate Partner Violence and Human Immunodeficiency Virus Risk among Black and Hispanic Women

Approximately 80% of new HIV infections among U.S. women are among black/African American and Hispanic women. HIV risk may be associated with intimate partner violence (IPV); data regarding IPV for women in high-HIV prevalence areas are scarce.

Heterosexual women and their male partners in cities with high HIV prevalence were enrolled. During 2006-2007, participants completed interviews about HIV risk factors and IPV (physical violence or forced sex) experiences. Data were analyzed during 2012-2013 using multivariate logistic regression to identify individual- and partner-level IPV correlates.

Of 1,011 female respondents, 985 (97.4%) provided risk factor and demographic data. Most were non-Hispanic black/African American (82.7%); living at or below poverty (86.7%); and tested HIV-negative (96.8%). IPV-physical violence was reported by 29.1%, and IPV-forced sex by 13.7%. Being married/living with a partner; non-injection drug use; and ever discussing male partners' number of current sex partners were associated with IPV-physical violence. Women reporting concurrent sex partners and ever discussing number of male partners' past sex partners were associated with IPV-forced sex. Feeling comfortable asking a male partner to use condoms was associated with decreased IPV-physical violence and -forced sex.

Prevention interventions that enhance women's skills to decrease HIV and IPV risk are important strategies for decreasing racial/ethnic disparities among women.

Via: http://ht.ly/S8l3j 

By: Morales-Alemán MM1, Hageman K1, Gaul ZJ2, Le B1, Paz-Bailey G1, Sutton MY3.

• 1Division of HIV/AIDS Prevention, CDC, Atlanta, Georgia.
• 2Division of HIV/AIDS Prevention, CDC, Atlanta, Georgia; ICF International, Atlanta, Georgia.
• 3Division of HIV/AIDS Prevention, CDC, Atlanta, Georgia

The MyPEEPS Randomized Controlled Trial: A Pilot of Preliminary Efficacy, Feasibility & Acceptability of a Group-Level, HIV Risk Reduction Intervention for Young Men Who Have Sex with Men

An exigent need exists for HIV prevention intervention research targeting young men who have sex with men (MSM) – a group of young adults that, despite composing the highest and most racially disproportionate rates of HIV incidence, has been least often the focus of behavioral intervention research. This pilot study tested a group-based HIV primary prevention intervention for young MSM to evaluate its initial efficacy, feasibility, and acceptability. Participants were randomized (N=101; aged 16-20 years) to one of two group-level, HIV and STI education programs: controls participated in a non-interactive, lecture-based program while intervention participants took part in a highly interactive program tailored to young MSM aged 16-20. Sexual risk and social cognitive outcomes were assessed at baseline, and 6- and 12 weeks post-intervention. Over the entire follow-up period, intervention participants were less likely than controls to engage in any sexual behavior while under the influence of substances (p<0.05), and also observed in this group was a decreasing trend of unprotected anal sex while under the influence of substances (p=.08). Follow-up differences between groups on social cognitive outcomes favored the intervention group, though these differences were non-significant. Acceptability ratings were modest. A 6-session behavioral intervention tailored to young MSM, aged 16-20, is feasible, acceptable, and demonstrates evidence of preliminary efficacy in reducing sexual risk, specifically sexual risk while under the influence of substances.

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