What’s Gender Got to Do With It? Sexual Double Standards and Power in Heterosexual College Hookups

Although college hookups are typically enjoyable for both men and women, heterosexual hookups often involve inequitable power dynamics that privilege men (e.g., women perform sexual acts to please partners and/or succumb to pressure for intercourse). Some scholars have attributed this power imbalance to the traditional double standard. However, recent studies have indicated college students typically endorse egalitarian standards—and some endorse a reverse double standard in which they negatively judge men more than women for engaging in the same sexual behavior. 

Using Online College Social Life Survey data (N = 11,077) I examined relationships between endorsement of double standards and power in hookups. Because contemporary students often believe double standards exist in society but not in their own minds, I also examined relationships between feeling negatively judged for hooking up and power. 

Most respondents endorsed egalitarian standards, but women were more likely than men to feel judged for hooking up. Feeling judged was a significant predictor of power disadvantages for women and men; endorsing a double standard disparaging one’s own gender was significant among men. 

Findings suggest contemporary relevance of the traditional double standard and highlight differences between women’s and men’s endorsement of double standards disparaging their own gender.

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By:  Heather Hensman Kettrey^a*

• ^a Peabody Research Institute, Vanderbilt University

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The Male Factor: Outcomes from a Cluster Randomized Field Experiment with a Couples-Based HIV Prevention Intervention in a South African Township

Highlights

• Men in the couples arm were less likely to report heavy drinking at 6-months.
• Men in the couples arm were more likely to report past-month consistent condom use.
• Women tested at twice the prevalence of HIV (26%) as men (13%).
• At 6-months, HIV incidence was significantly lower among women in the intervention.
• Couples-based interventions focusing on intersecting HIV risks can improve outcomes.

BACKGROUND:

This study examined the effects of the Couples Health CoOp intervention on heavy drinking, condom use, and HIV incidence.

METHODS:

Thirty neighborhoods from one South African township were cluster randomized into three intervention arms: Couples Health CoOp (CHC), Women's Health CoOp/Men's Health CoOp (WHC/MHC), or a comparison arm. We recruited 290 men from informal drinking establishments who reported drinking alcohol regularly. We also recruited their main heterosexual sex partners.

RESULTS:

At 6-month follow-up, men in the CHC arm were less likely to report heavy drinking (OR 0.47, 95% CI: 0.25, 0.90) and were more likely to report consistent condom use during the past month (OR 2.66, 95% CI: 1.23, 5.76) than men in the comparison arm. At baseline, 26% of women and 13% of men were HIV-infected; at 6-month follow-up, 16 females and 5 males had seroconverted. HIV incidence was significantly lower among women in the CHC arm (IRR 0.22, 95% CI: 0.04, 1.01) than in the WHC/MHC arm.

CONCLUSIONS:

A couples-based intervention focusing on intersecting risks for HIV can improve biobehavioral outcomes, underscoring the importance of engaging couples together in HIV prevention.

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By:  Wechsberg WM1, Zule WA2, El-Bassel N3, Doherty IA4, Minnis AM5, Novak SD2, Myers B6, Carney T7.

• 1RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States; University of North Carolina, Chapel Hill, NC, United States; Department of Psychology in the Public Interest, North Carolina State University, Raleigh, NC, United States; Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States. Electronic address: wmw@rti.org.
• 2RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States.
• 3Columbia University School of Social Work, New York, NY, United States.
• 4RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States; University of North Carolina, Chapel Hill, NC, United States.
• 5RTI International, 351 California Street, San Francisco, CA, United States.
• 6Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
• 7Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa. 
• Drug Alcohol Depend. 2016 Apr 1;161:307-15. doi: 10.1016/j.drugalcdep.2016.02.017. Epub 2016 Feb 18.

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Determinants of Heterosexual Adolescents Having Sex with Female Sex Workers in Singapore

OBJECTIVES:

We assessed the proportion of and socio-ecological factors associated with ever having had sex with female sex workers (FSWs) among heterosexual adolescents. We also described the characteristics of the adolescents who reported inconsistent condom use with FSWs.

METHODS:

This is a cross-sectional study (response rate: 73%) of 300 heterosexually active male adolescents of 16 to 19 years attending a national STI clinic in Singapore between 2009 and 2014. We assessed the ecological factors (individual, parental, peer, school and medial influences) and sexual risk behaviors using a self-reported questionnaire. Poisson regression was used to obtain the adjusted prevalence ratios (aPR) and confidence intervals (CI).

RESULTS:

The proportion of heterosexual male adolescents who had ever had sex with FSWs was 39%. Multivariate analysis showed that significant factors associated with ever having had sex with FSWs were sex initiation before 16 years old (aPR 1.79 CI: 1.30-2.46), never had a sexually active girlfriend (aPR 1.75 CI 1.28-2.38), reported lower self-esteem score (aPR 0.96 CI: 0.93-0.98), higher rebelliousness score (aPR 1.03 CI: 1.00-1.07) and more frequent viewing of pornography (aPR 1.47 CI: 1.04-2.09). Lifetime inconsistent condom use with FSWs was 30%.

CONCLUSIONS:

A significant proportion of heterosexual male adolescents attending the public STI clinic had ever had sex with FSWs. A targeted intervention that addresses different levels of influence to this behavior is needed. This is even more so because a considerable proportion of adolescents reported inconsistent condom use with FSWs, who may serve as a bridge of STI transmission to the community. National surveys on adolescent health should include the assessment of frequency of commercial sex visits and condom use with FSWs for long-term monitoring and surveillance.

Below:  Percentage of sexually active adolescents aged 16–19 years who used condom inconsistently with female sex workers in the past year by country of female sex workers

Below:  Percentage of sexually active adolescents aged 16–19 years who used condom inconsistently with female sex workers in the past year by type of female sex workers

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

By:  Ng JY¹, Wong ML¹.

¹Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.

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Efforts to Find Heterosexual HIV in San Francisco, 2007-2013

Nationally heterosexuals are an HIV prevention priority. In addition to case based HIV surveillance, behavioral surveillance surveys are conducted among heterosexuals living in high AIDS morbidity neighborhoods. 

We report on risk behaviors and HIV prevalence among "high-risk" heterosexuals in San Francisco. National HIV Behavioral Surveillance System is coordinated by the CDC and implemented in 21 health jurisdictions. The studies were conducted in 2006, 2010 and 2013 in San Francisco. Respondent driven sampling was used to sample participants. Eligible persons were 18-50 years old and had sex with at least one opposite gender partner in the past year. We obtained samples of 371, 421, 165 heterosexuals in 2007, 2010 and 2013, respectively. Some demographics varied across the 3 years. 

Residential neighborhoods changed, homelessness and healthcare coverage increased. Binge drinking, cocaine and heroin use increased while methamphetamine use declined. There were no changes in numbers of partners, unprotected vaginal intercourse or unprotected anal intercourse. Commercial sex work increased. 

Even with "fine tuning" of eligibility criteria to attempt to find heterosexual HIV cases, we estimate that HIV prevalence was 0.3, 0.2 and 2.4 % in 2007, 2010 and 2013 respectively. The increase was not statistically significant. 

For the present, effective prevention among persons in the populations most severely affected by HIV remains the priority, for their own benefit and to prevent transmission to other vulnerable populations to which they may be connected.

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By:  Raymond HF1, Jin H2, Scheer S2, Ick TO2, McFarland W2.

• 1San Francisco Department of Public Health, 25 Van Ness, Suite 500, San Francisco, CA, 94102, USA. hfisher.raymond@sfdph.org.
• 2San Francisco Department of Public Health, 25 Van Ness, Suite 500, San Francisco, CA, 94102, USA.
• AIDS Behav. 2015 Dec;19(12):2317-24. doi: 10.1007/s10461-015-1047-5 

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Prevalence and Correlates of Heterosexual Anal Intercourse among Men and Women, 20 U.S. Cities

Heterosexual anal intercourse (HAI) is not an uncommon behavior and it confers a higher risk of HIV transmission than vaginal intercourse. 

We examined data from heterosexuals recruited in 20 US cities for the 2013 National HIV Behavioral Surveillance system. We assessed correlates of reporting HAI in the previous year. Then, among people reporting HAI in the past year, we assessed what event-level factors are associated with having HAI at last sex. 

Thirty percent of women and 35 % of men reported HAI in the past year. Among people who had HAI in the past year, those who had HAI at last sex were more likely to have a partner who was HIV-positive or of unknown status or to have exchanged money or drugs for sex at last sex. 

Information that highlights the risk of HIV transmission associated with HAI would complement existing HIV prevention messages focused on heterosexuals in the U.S.

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By:  Hess KL1, DiNenno E2, Sionean C2, Ivy W2, Paz-Bailey G2; NHBS Study Group.

• 1Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS-E47, Atlanta, GA, 30329, USA. xgm0@cdc.gov.
• 2Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS-E47, Atlanta, GA, 30329, USA. 

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HIV and Hepatitis C Virus Infection and Risk Behaviors among Heterosexual, Bisexual, and Lesbian Women Who Inject Drugs in Australia

PURPOSE:

Women who inject drugs (WWID) are vulnerable to a range of harms, including exposure to sexually transmitted and blood-borne infections, abusive relationships, physical and sexual violence and mental health issues. Lesbians and bisexual women are at greater risk than heterosexual women for substance use disorders. This study aimed to compare a large sample of heterosexual, bisexual, and lesbian WWID and to identify correlates of sexual orientation.

METHODS:

The Australian Needle and Syringe Program (NSP) Survey is an annual cross-sectional survey. People who inject drugs (PWID) who attend NSP services are invited to complete a brief self-administered questionnaire and provide a capillary dried blood spot. Of 22,791 survey respondents between 2004-2013, one third were women (n=7,604). Analyses were restricted to the first participation record for each respondent.

RESULTS:

Of the 5,378 individual women, 4,073 (76%) identified as heterosexual, 1,007 (19%) identified as bisexual, and 298 (6%) identified as lesbian. HIV prevalence was low (<1.0%). More than half (56%) had been exposed to hepatitis C virus (HCV), with prevalence highest among bisexual women (59%). In adjusted analysis, bisexual women had significantly greater odds of initiating injection at a younger age (AOR 1.44, 95% CI 1.19-1.73), and reporting public injection (AOR 1.44, 95% CI 1.21-1.73) and receptive sharing of drug preparation equipment (AOR 1.20, 95% CI 1.00-1.44). Bisexual women (AOR 1.42, 95% CI 1.07-1.88) and lesbians (AOR 1.63, 95% CI 1.10-2.44) had significantly greater odds of reporting sex work than their heterosexual counterparts.

CONCLUSION:

Results contribute to the literature on HIV and HCV transmission risk among WWID. Analysis of the relationship between sexual orientation and risk behavior identified bisexual orientation as independently associated with increased risk. Services that target PWID need to recognise and address a broad range of sexual identities and behaviors. Future research should explore reasons for increased risk in sexual minority women.

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By:  Iversen J1, Dolan K2, Ezard N3,4, Maher L1.

• 1 Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute, Faculty of Medicine, University of New South Wales Australia , Sydney, Australia .
• 2 Program of International Research and Training, National Drug and Alcohol Research Centre, University of New South Wales Australia , Sydney, Australia .
• 3 Alcohol and Drug Service, St. Vincent's Hospital , Sydney, Australia .
• 4 Faculty of Medicine, University of New South Wales Australia , Sydney, Australia 
• LGBT Health. 2015 Jun;2(2):127-134. Epub 2015 Apr 16. 

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School-Based Strategies to Reduce Suicidal Ideation, Suicide Attempts, and Discrimination among Sexual Minority and Heterosexual Adolescents in Western Canada

This study explored the relationships between the existence of and length of time since implementation of school-based Gay-Straight Alliances (GSAs) and explicit anti-homophobic bullying policies in secondary schools across British Columbia, Canada, with experiences of anti-gay discrimination, suicidal ideation and attempts among lesbian, gay, bisexual (LGB), mostly heterosexual, and exclusively heterosexual students. 

Analyses of the province-wide random cluster-stratified 2008 B.C. Adolescent Health Survey (n =21,70 8) compared students in schools with GSAs or policies implemented at least 3 years, and less than 3 years, with those in schools without GSAs or anti-homophobia policies, using multinomial logistic regression, separately by gender. LGB students had lower odds of past year discrimination, suicidal thoughts and attempts, mostly when policies and GSAs had been in place for 3+ years; policies had a less consistent effect than GSAs. Heterosexual boys, but not girls, also had lower odds of suicidal ideation and attempts in schools with longer-established anti-homophobic bullying policies and GSAs. 

Given consistently higher documented risk for suicidal ideation and attempts among LGB and mostly heterosexual adolescents, prevention efforts should be a priority, and school-level interventions, such as GSAs, may be an effective approach to reducing this risk, while also offering prevention benefits for heterosexual boys.

Full article at:   http://goo.gl/B75Fpi

By:  Elizabeth M. Saewyc, Ph.D, RN, FSAHM, FCAHS, Chiaki Konishi, Ph.D., Hilary A. Rose, Ph.D., and Yuko Homma, Ph.D.

Elizabeth M. Saewyc, Professor of Nursing and Adolescent Medicine, and Director of the Stigma and Resilience Among Vulnerable Youth Centre (http://www.saravyc.ubc.ca/), at the University of British Columbia School of Nursing, T201-2211 Wesbrook Mall, Vancouver, B.C., Canada, V6T 2B5. Office Telephone: (604) 822 -7505. Fax: (604) 822-7466;

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Non-Suicidal Self-Injury & Suicidal Thoughts & Behaviors in Heterosexual & Sexual Minority Young Adults

OBJECTIVE:

Despite consistently greater rates of non-suicidal self-injury (NSSI) and suicidal thoughts and behaviors (STBs; i.e., suicidal ideation, method/plan, and attempts) in lesbian, gay, and bisexual (LGB) individuals, prevalence, characteristics, and relations between these dangerous thoughts and behaviors are equivocal. The present study sought to examine and compare the rates of NSSI and STBs in a large sample of sexual minority and majority young adults.

METHODS:

Participants were 12,422 college students (ages 18-29; 57.3% female) who self-reported demographic characteristics, NSSI frequency, the number of NSSI forms used, the number of NSSI functions, as well as STB history (i.e., ideation, method/plan, and attempts). Each participant's degree of SA was assessed via a 7-point scale (i.e., K0-K6) from Alfred Kinsey's research of sexual attraction and sexual experiences. This scale was collapsed to create five categories of SA: exclusively other SA (K0), mostly other SA (K1/2), equally other and same SA (K3), mostly same SA (K4/5), and exclusively same SA (K6).

RESULTS:

Consistent with previous research, we found that being a sexual minority young adult was associated with significantly higher odds of STBs compared to being a heterosexual young adult. In addition, compared to the exclusively other SA group (K0), being in the mostly other SA group (K1/2), equally other and same SA group (K3), or mostly same SA group (K4/5) was associated with significantly higher odds of NSSI engagement. Among those with NSSI, we found that the number of NSSI forms was significantly associated with suicide attempts, but was not associated with either suicidal ideation or suicide method/plan in the mostly other SA group (K1/2) or in the equally other and same SA group (K3). We also found a significant curvilinear relation between NSSI frequency and STBs in the mostly other SA group (K1/2) and between NSSI frequency and suicide method/plan and attempt in the exclusively other SA group (K0). In addition, we revealed specificity with regard to the relation between the number of lifetime NSSI episodes and risk for STBs among the equally other and same SA (K3), mostly same SA (K4/5), and exclusively same SA (K6) groups.

CONCLUSION:

Our findings suggest that among sexual minority young adults, equally other and same SA individuals may be at higher risk of NSSI and STBs than their sexual minority counterparts. In addition, these findings extend previous research by suggesting that the relations between NSSI frequency, number of forms, and number of functions and STBs might vary according to SA. A multi-theory based explanation is provided to explain the key findings and the study implications are discussed.

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By:  Tsypes A1, Lane R2, Paul E3, Whitlock J3.

• 1Department of Psychology (https://www.binghamton.edu/psychology/), Binghamton University (SUNY), 4400 Vestal Parkway East, Binghamton, NY 13902. Electronic address: atsypes1@binghamton.edu.
• 2Department of Psychology, St John's University, 8000 Utopia Parkway, Jamaica, NY 11439.
• 3Bronfenbrenner Center for Translational Research, Cornell Research Program on Self-Injury and Recovery, Cornell University, Beebe Hall, 110 Plantations Rd. Ithaca, NY 14853, USA; Department of Human Development, Cornell University, G87 Martha Van Rensselaer Hall, Cornell University, Ithaca, NY 14853, USA.
• Compr Psychiatry. 2016 Feb;65:32-43. doi: 10.1016/j.comppsych.2015.09.012. Epub 2015 Sep 30. 

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Condom Use, Sexual Risk, and Self-Reported STI in a Sample of Older Male Clients of Heterosexual Prostitution in the United States

While there is evidence of increasing rates of sexually transmitted infections (STIs) among older men in the United States, there has been little research on older male clients of female sex providers. The purpose of the current study was to understand the sexual risk behaviors and psychosocial correlates among older men hiring sex providers through provider review websites and discussion boards. 

A convenience sample of 208 male clients ages 60 to 84 completed online surveys about their sexual behavior and psychosocial factors. Participants indicated the most common sexual activities with providers in the past 12 months were 

• receiving condomless fellatio (33.7%) and 
• having penile-vaginal intercourse with a condom (31.7%). 

Although condomless penile-vaginal sex with a provider in the past 12 months was only reported by 2.9%, about half (51%) of the respondents indicated that they had experienced this at least once during their lifetime. This was associated with a preference for providers who do not require condoms, having been previously diagnosed with an STI, and perceiving one's HIV risk to be higher, as well as advancing age and having more emotional relationships with providers. 

Findings demonstrate the need for general and sexual health care practitioners to openly discuss protective measures and strategies for avoiding STIs among their older-to-elderly male patients.

Full article at:   http://goo.gl/koE4fr

By:  Milrod C, Monto M1.

• 1University of Portland (http://www.up.edu/), OR, USA. 
• 
  
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Sexual Motives in Heterosexual Women With and Without Sexual Difficulties

Previous research indicates that women with sexual problems may have different reasons for engaging in sex than women who are not experiencing sexual problems. 

The current study investigated whether reasons for sex differed by women reporting high versus low overall sexual functioning, as assessed by the FSFI. As low desire and inability to achieve orgasm are the two most commonly reported sexual problems for women, the study also investigated whether women with and without problems specifically related to sexual desire or orgasm cited different reasons for sex. 

The sample was comprised of 446 heterosexual women between the ages of 18 and 61 who completed an online questionnaire assessing reasons for sex and sexual functioning. Women with low sexual functioning overall were more likely to endorse insecurity reasons for sex, while women with high sexual functioning overall were more likely to endorse physical reasons for sex. 

Women experiencing low desire specifically were less likely to endorse emotional and physical reasons for sex than women without desire difficulties. Women experiencing orgasm difficulties specifically were more likely to endorse insecurity reasons for sex than women without orgasm difficulties. 

The variance accounted for was low in all cases. This research offers insights into the important but limited role sexual functioning may play in the broader context of women's sexual motivations.

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By:  Watson E1, Milhausen RR2, Wood J3, Maitland S4.

• 1 University of Guelph, Family Relations and Applied Nutrition , 50 Stone Rd East, MacDonald Institute , Guelph , Ontario , Canada.
• 2 University of Guelph, Family Relations and Applied Nutrition, Macdonald Institute , 50 Stone Rd., Guelph , Ontario , N1G 2W1 Canada.
• 3 University of Guelph, Psychology, Blackwood Hall , 50 Stone Rd., Guelph , Ontario , Canada.
• 4 University of Guelph, Family Relations and Applied Nutrition, MacDonald Institute , 50 Stone Rd., Guelph , Ontario , N1G 2W1 Canada.
• J Sex Marital Ther. 2016 Jan 6:0. [Epub ahead of print] 

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Upset Over Sexual versus Emotional Infidelity among Gay, Lesbian, Bisexual, and Heterosexual Adults

One hypothesis derived from evolutionary perspectives is that men are more upset than women by sexual infidelity and women are more upset than men by emotional infidelity. The proposed explanation is that men, in contrast to women, face the risk of unwittingly investing in genetically unrelated offspring. Most studies, however, have relied on small college or community samples of heterosexual participants. 

We examined upset over sexual versus emotional jealousy among 63,894 gay, lesbian, bisexual, and heterosexual participants. Participants imagined which would upset them more: their partners having sex with someone else (but not falling in love with them) or their partners falling in love with someone else (but not having sex with them). 

Consistent with this evolutionary perspective, heterosexual men were more likely than heterosexual women to be upset by sexual infidelity (54 vs. 35 %) and less likely than heterosexual women to be upset by emotional infidelity (46 vs. 65 %). This gender difference emerged across age groups, income levels, history of being cheated on, history of being unfaithful, relationship type, and length. 

The gender difference, however, was limited to heterosexual participants. Bisexual men and women did not differ significantly from each other in upset over sexual infidelity (30 vs. 27 %), regardless of whether they were currently dating a man (35 vs. 29 %) or woman (28 vs. 20 %). Gay men and lesbian women also did not differ (32 vs. 34 %). 

The findings present strong evidence that a gender difference exists in a broad sample of U.S. adults, but only among heterosexuals.

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By:  Frederick DA1, Fales MR2.

• 1Department of Psychology, Crean School of Health & Life Sciences, Chapman University, One University Drive, Orange, CA, 92866, USA. enderflies1@aol.com.
• 2Psychology Department, University of California, Los Angeles, CA, USA.
• Arch Sex Behav. 2016 Jan;45(1):175-91. doi: 10.1007/s10508-014-0409-9. Epub 2014 Dec 18. 

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Mortality, Causes of Death and Associated Factors Relate to a Large HIV Population-Based Cohort

INTRODUCTION:

Antiretroviral therapy has led to a decrease in HIV-related mortality and to the emergence of non-AIDS defining diseases as competing causes of death. This study estimates the HIV mortality rate and their risk factors with regard to different causes in a large city from January 2001 to June 2013.

MATERIALS AND METHODS:

We followed-up 3137 newly diagnosed HIV non-AIDS cases. Causes of death were classified as HIV-related, non-HIV-related and external. We examined the effect of risk factors on survival using mortality rates, Kaplan-Meier plots and Cox models. Finally, we estimated survival for each main cause of death groups through Fine and Gray models.

MORTALITY RESULTS:

182 deaths were found [14.0/1000 person-years of follow-up (py); 95% confidence interval (CI):12.0-16.1/1000 py], 81.3% of them had a known cause of death. Mortality rate by HIV-related causes and non-HIV-related causes was the same (4.9/1000 py; CI:3.7-6.1/1000 py), external was lower [1.7/1000 py; (1.0-2.4/1000 py)].

SURVIVAL RESULTS:

Kaplan-Meier estimate showed worse survival in intravenous drug user (IDU) and heterosexuals than in men having sex with men (MSM). Factors associated with HIV-related causes of death include: IDU male and <200 CD4 at diagnosis versus ≥500 CD4. 

Factors associated with non-HIV-related causes of death include: ageing and heterosexual female versus MSM. Factors associated with external causes of death were IDU male and heterosexual male versus MSM.

Below:  Survival curves according to age, origin, educational level, transmission category, CD4, and anti-HCV antibodies.

Full article at:   http://goo.gl/BA6YNr

By:   Garriga C1,2, García de Olalla P1,3, Miró JM4, Ocaña I5, Knobel H6, Barberá MJ5, Humet V7, Domingo P8, Gatell JM4, Ribera E5, Gurguí M8, Marco A7, Caylà JA1,3; Barcelona HIV/AIDS working group.

• 1Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain.
• 2Spanish Field Epidemiology Training Programme, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.
• 3CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
• 4Hospital Clinic- August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain.
• 5Infectious Diseases, Hospital Vall de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
• 6Internal Medicine-Infectious Diseases, Hospital del Mar, Barcelona, Spain.
• 7Direcció General de Serveis Penitenciaris i de Rehabilitació, Departament de Justícia, Barcelona, Spain.
• 8Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
• PLoS One. 2015 Dec 30;10(12):e0145701. doi: 10.1371/journal.pone.0145701

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