Trajectory Analysis of the Campus Serial Rapist Assumption

IMPORTANCE:

Rape on college campuses has been addressed recently by a presidential proclamation, federal legislation, advocacy groups, and popular media. Many initiatives assume that most college men who perpetrate rape are serial rapists. The scientific foundation for this perspective is surprisingly limited.

OBJECTIVE:

To determine whether a group of serial rapists exists by identifying cohesive groups of young men, indicated by their trajectories of rape likelihood across high school and college.

DESIGN, SETTING, AND PARTICIPANTS:

Latent class growth analysis of the 2 largest longitudinal data sets of adolescent sexual violence on college campuses using 2 distinct groups of male college students. The first group was used for derivation modeling (n = 847; data collected from August 1990 through April 1995) and the second for validation modeling (n = 795; data collected from March 2008 through May 2011). Final data analyses were conducted from February 16, 2015, through February 20, 2015.

MAIN OUTCOMES AND MEASURES:

Rape perpetration assessed using the Sexual Experiences Survey.

RESULTS:

Across samples, 178 of 1642 participants (10.8%) reported having perpetrated at least 1 rape from 14 years of age through the end of college. A 3-trajectory model best fit both the derivation and validation data sets. Trajectories reflected low or time-limited (92.6% of participants), decreasing (5.3%), and increasing (2.1%) rape patterns. No consistently high trajectory was found. Most men who perpetrated a rape before college were classified in the decreasing trajectory. During college, the increasing trajectory included 14 men (15.2%) who reported having perpetrated a rape, the decreasing trajectory included 30 men (32.6%), and the low or time-limited included 48 men (52.2%). No participant in the low or time-limited trajectory reported perpetrating a rape during more than 1 period. Most men (67 [72.8%]) who committed college rape only perpetrated rape during 1 academic year.

CONCLUSIONS AND RELEVANCE:

Although a small group of men perpetrated rape across multiple college years, they constituted a significant minority of those who committed college rape and did not compose the group at highest risk of perpetrating rape when entering college. Exclusive emphasis on serial predation to guide risk identification, judicial response, and rape-prevention programs is misguided. To deter college rape, prevention should be initiated before, and continue during, college. Child and adolescent health care professionals are well positioned to intervene during the early teenage years by informing parents about the early onset of nonconsensual sexual behavior.

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By:  Swartout KM¹, Koss MP², White JW³, Thompson MP⁴, Abbey A⁵, Bellis AL¹.

¹Department of Psychology, Georgia State University, Atlanta.

²Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson.

³Department of Psychology, University of North Carolina at Greensboro, Greensboro.

⁴Institute on Family and Neighborhood Life, Clemson University, Clemson, South Carolina.

⁵Department of Psychology, Wayne State University, Detroit, Michigan.

JAMA Pediatr. 2015 Dec;169(12):1148-54. doi: 10.1001/jamapediatrics.2015.0707.

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Alcohol use, risky sexual behavior, and condom possession among bar patrons

HIGHLIGHTS

• Bar patrons' intentions to engage in unsafe sex varied by sex and BrAC.
• Significant predictors of condom possession were gender, race, age and BrAC level.

PURPOSE:

The current study seeks to: 1) assess the relationship between alcohol consumption and intentions to engage in unprotected sex in an uncontrolled environment, and 2) to identify if covariates (race, age, sex, breath alcohol content (BrAC), intentions to engage in sex, hazardous drinking rates) are significant predictors of condom possession during time of uncontrolled alcohol consumption.

METHODS:

Data were collected from 917 bar patrons to assess alcohol use using the Alcohol Use Disorders Identification Test (AUDIT-C), BrAC levels, intentions to engage in risky sex, and condom possession. Correlational analysis and hierarchical binary logistic regression was conducted using SPSS.

RESULTS:

Correlational analyses indicated a negative relationship between AUDIT-C scores (r=-0.115, p=0.001), BrAC (r=-0.08, p=0.015), and intentions to use a condom. Over 70% of participants intended to use a condom if they engaged in sex; however, only 28.4% had a condom to use. The regression analysis indicated the predictive model (χ²=114.5, df=8, p<0.001) was statistically significant, and correctly classified 72.9% of those in possession of a condom.

CONCLUSIONS:

Alcohol consumption was associated with intentions to have unprotected sex; however, intentions to engage in protected sex and condom possession were higher for males and those with higher BrAC levels.

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By:  Chaney BH1, Vail-Smith K2, Martin RJ3, Cremeens-Matthews J4.

• 1East Carolina University, Department of Health Education & Promotion, 3105 Carol G. Belk Building, Greenville, NC 27858, United States. Electronic address: chaneye@ecu.edu.
• 2East Carolina University, Department of Health Education & Promotion, 3208 Carol G. Belk Building, Greenville, NC 27858, United States. Electronic address: vailsmithk@ecu.edu.
• 3East Carolina University, Department of Health Education & Promotion, 2206 Carol G. Belk Building, Greenville, NC 27858, United States. Electronic address: martinry@ecu.edu.
• 4East Carolina University, Department of Health Education & Promotion, 2302 Carol G. Belk Building, Greenville, NC 27858, United States. Electronic address: cremeensj@ecu.edu. 
• Addict Behav. 2016 Apr 6;60:32-36. doi: 10.1016/j.addbeh.2016.03.035.

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The Use of Cash Transfers for HIV Prevention - Are We There Yet?

Poverty and social inequality are significant drivers of the HIV epidemic and are risk factors for acquiring HIV. As such, many individuals worldwide are at risk for new HIV infection, especially young women in East and Southern Africa. By addressing these drivers, social protection programmes may mitigate the impact of poverty and social inequality on HIV risk. 

There is reason to believe that social protection can be used successfully for HIV prevention; social protection programmes, including cash transfers, have led to positive health outcomes and behaviour in other contexts, and they have been used successfully to promote education and increased income and employment opportunities. 

Furthermore, cash transfers have influenced sexual behaviour of young women and girls, thereby decreasing sexual risk factors for HIV infection. When HIV outcomes have been measured, several randomised controlled trials have shown that indirectly, cash transfers have led to reduced HIV prevalence and incidence. 

In these studies, school attendance and safer sexual health were directly incentivised through the cash transfer, yet there was a positive effect on HIV outcomes. In this review, we discuss the growth of social protection programmes, their benefits and impact on health, education and economic potential, and how these outcomes may affect HIV risk. 

We also review the studies that have shown that cash transfers can lead to reduced HIV infection, including study limitations and what questions still remain with regard to using cash transfers for HIV prevention.

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By:  Taaffe J1, Cheikh N1, Wilson D1.

• 1 The World Bank Group , Washington , DC , USA. 
• Afr J AIDS Res. 2016 Mar;15(1):17-25. doi: 10.2989/16085906.2015.1135296.

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Sexual Practices, Fertility Intentions, and Awareness to Prevent Mother-to-Child Transmission of HIV among Infected Pregnant Women at the Yaounde Central Hospital

INTRODUCTION:

The sexual and reproductive health of people living with HIV is fundamental for their well-being. Antiretroviral therapy and reproductive technologies have significantly improved quality of life of people living with HIV in developed countries. In sub-Saharan Africa, the epicenter of HIV, the sexual practices and fertility of women infected with HIV have been understudied.

AIM:

To assess the sexual behavior, fertility intentions, and awareness of preventing mother-to-child transmission of HIV in pregnant women with HIV-negative partners in Yaounde Central Hospital (Yaounde, Cameroon).

METHODS:

A cross-sectional survey using a semistructured, interviewer-administered questionnaire was conducted at the antenatal unit and HIV clinic in 2014.

MAIN OUTCOME MEASURES:

Ninety-four pregnant women infected with HIV provided consistent information on (i) sociodemographic characteristics, (ii) sexual and fertility patterns, (iii) awareness of preventing mother-to-child transmission of HIV, and (iv) their unmet needs.

RESULTS:

Although sexual desire had significantly changed since their HIV diagnosis, the women were highly sexually active. Approximately 19% of women had more than one sexual partner and 40% had regular unprotected sex during the 12-month period before the interviews (P < .0001). Twenty-nine percent of women preferred intermittent sexual intercourse and inconsistent condom use to delay pregnancy, but the abortion rate remained high. Age, marital status, and education affected women's awareness of mother-to-child transmission (P < .05); and no association existed between the number of living children and future pregnancies (r_s = -0.217; P = .036).

CONCLUSION:

HIV-infected women living with HIV-negative partners in Cameroon expressed high sexual and fertility intentions with several unmet needs, including safer sexual practices and conception. Incorporating and supporting safe sexual educational practices and conception services in maternal care can decrease risky sexual behavior and vertical transmission.

Full article at:   http://goo.gl/RE0oku

By:  Kuete M1, Yuan H2, He Q3, Tchoua Kemayou AL4, Ndognjem TP4, Yang F2, Hu Z2, Tian B2, Zhao K2, Zhang H2, Xiong C5.

• 1Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Yaounde Central Hospital, Faculty of Medicine and Biomedical Sciences, The University of Yaounde, Yaounde, Messa, Cameroon.
• 2Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
• 3Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
• 4Yaounde Central Hospital, Faculty of Medicine and Biomedical Sciences, The University of Yaounde, Yaounde, Messa, Cameroon.
• 5Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. Electronic address: clxiong951@sina.com. 
• Sex Med. 2016 Mar 19. pii: S2050-1161(16)00031-3. doi: 10.1016/j.esxm.2016.01.004.

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The Prevalence of Syphilis from the Early HIV Period Is Correlated with Peak HIV Prevalence at a Country Level

BACKGROUND:

Could we have predicted national peak HIV based on syphilis prevalence in the 1990s? Earlier studies have shown positive correlations between various sexually transmitted infections at different population levels. In this article, we test the hypothesis that there was a residual variation in the national prevalence rates of syphilis and that these rates could predict subsequent peak HIV prevalence rates.

METHODS:

This analysis uses linear regression to evaluate the country-level relationship between antenatal syphilis prevalence (1990-1999) and peak HIV prevalence. Antenatal syphilis data were taken from an Institute for Health Metrics and Evaluation database on the prevalence of syphilis in low-risk populations. Peak HIV prevalence was calculated based on data taken from the Global Health Observatory Data Repository of the World Health Organization.

RESULTS:

A moderately strong association is found for the 76 countries with data available (R = 0.53, P < 0.001). The association was weakened but remained significantly positive when we adjusted for the type of syphilis testing used.

CONCLUSIONS:

Syphilis prevalence in the 1990s predicted approximately 53% of the variation in peak HIV prevalence. Populations with generalized HIV epidemics had a higher prevalence of syphilis in the pre-HIV period. This finding provides additional rationale to carefully monitor sexual behavior, sexual networks, and sexually transmitted infection incidence in these populations.

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By:  Osbak KK1, Rowley JT, Kassebaum NJ, Kenyon CR.

• 1From the *HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium; †London, United Kingdom; ‡Institute for Health Metrics and Evaluation, Seattle Children's Hospital, University of Washington, Seattle, WA; and §Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, South Africa. 
• Sex Transm Dis. 2016 Apr;43(4):255-7. doi: 10.1097/OLQ.0000000000000422.

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Measuring Implicit Sexual Response Biases to Nude Male and Female Pictures in Androphilic and Gynephilic Men

Snowden, Wichter, and Gray (2008) demonstrated that an Implicit Association Test and a Priming Task both predicted the sexual orientation of gynephilic and androphilic men in terms of their attraction biases towards pictures of nude males and females. For both measures, relative bias scores were obtained, with no information on the separate response biases to each target gender. 

The present study sought to extend this research by assessing both relative and individual implicit biases using the Implicit Relational Assessment Procedure (IRAP). An explicit measure screened for men with androphilic (n = 16) or gynephilic (n = 16) orientations on the dimensions of "sexual attraction," "sexual behavior," "sexual fantasies," "hetero/gay lifestyle," and "self identification." The IRAP involved responding "True" or "False" to pictures of nude males and females as either attractive or unattractive. Participants were required to respond in a manner consistent with their reported sexual orientation for half of the IRAP's test blocks and inconsistent for the other half. Response latencies were recorded and analyzed. 

The IRAP revealed a non-orthogonal pattern of biases across the two groups and had an excellent ability to predict sexual orientation with areas under the curves of 1.0 for the relative bias score and .94 and .95 for the bias scores for the male and female pictures, respectively. Correlations between the IRAP and explicit measures of sexual orientation were consistently high. The findings support the IRAP as a potentially valuable tool in the study of sexual preferences.

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By:  Timmins L1, Barnes-Holmes D2, Cullen C3.

• 1Department of Psychology, Institute of Psychiatry, King's College London, 5th Floor, Bermondsey Wing, Guy's Hospital Campus, London, SE1 9RT, UK. liam.timmins@kcl.ac.uk.
• 2Department of Experimental, Clinical and Health Psychology, Ghent University, Ghent, Belgium.
• 3School of Nursing & Human Sciences, Dublin City University, Dublin 9, Ireland. 
• Arch Sex Behav. 2016 Mar 14.

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Sexual Behavior among Young Carers in the Context of a Kenyan Empowerment Program Combining Cash-Transfer, Psychosocial Support, and Entrepreneurship

This study examined associations between sexual initiation, unprotected sex, and having multiple sex partners in the past year with participation in a three-year empowerment program targeting orphan and vulnerable children (OVC). 

The Kenya-based program combines community-conditioned cash transfer, psychosocial empowerment, health education, and microenterprise development. Program participants (n = 1,060) were interviewed in a cross-sectional design. Analyses used gender-stratified hierarchical logit models to assess program participation and other potential predictors. 

Significant predictors of increased female sexual activity included less program exposure, higher age, younger age at most recent parental death, fewer years of schooling, higher food consumption, higher psychological resilience, and lower general self-efficacy. Significant predictors of increased male sexual activity included more program exposure, higher age, better food consumption, not having a living father, and literacy. 

Findings support a nuanced view of current cash transfer programs, where female sexual activity may be reduced through improved financial status but male sexual activity may increase. Targeting of OVC sexual risk behaviors would likely benefit from being tailored according to associations found in this study. 

Data suggest involving fathers in sexual education, targeting women who lost a parent at a younger age, and providing social support for female OVC may decrease risk of human immunodeficiency virus (HIV) transmission.

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By:  Goodman ML1,2,3, Selwyn BJ2, Morgan RO2, Lloyd LE2, Mwongera M4, Gitari S4, Keiser PH3.

• 1 Sodzo International.
• 2 Division of Management, Policy and Community Health, School of Public Health , University of Texas , Houston.
• 3 Center for Global Health Education , University of Texas Medical Branch , Galveston.
• 4 Community Health Department , Maua Methodist Hospital , Meru County , Kenya.
• J Sex Res. 2016 Mar-Apr;53(3):331-45. doi: 10.1080/00224499.2015.1035429. Epub 2015 Sep 30. 

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Impact of Alcohol Use on Sexual Behavior among Men Who Have Sex with Men & Transgender Women in Lima, Peru

BACKGROUND:

Alcohol use disorders (AUDs) may enhance the likelihood of risky sexual behaviors and the acquisition of sexually transmitted infections (STIs). Associations between AUDs with condomless anal intercourse (CAI) and STI/HIV prevalence were assessed among men who have sex with men (MSM) and transgender women (TW) in Lima, Peru.

METHODS:

MSM and TW were eligible to participate based on a set of inclusion criteria which characterized them as high-risk. Participants completed a bio-behavioral survey. An AUDIT score ≥8 determined AUD presence. Recent STI diagnosis included rectal gonorrhea/chlamydia, syphilis, and/or new HIV infection within 6 months. Prevalence ratios (PR) were calculated using Poisson regression.

RESULTS:

Among 312 MSM and 89 TW, 45% (181/401) had an AUD. Among those with an AUD, 164 (91%) were hazardous/harmful drinkers, and 17 (9%) had alcohol dependence. Higher CAI was reported by participants with an AUD vs. without, (82% vs. 72% albeit not significant). Reporting anal sex in two or more risky venues was associated with screening AUD positive vs. not (24% vs. 15%, p=0.001). There was no difference in recent STI/HIV prevalence by AUD status (32% overall). In multivariable analysis, screening AUD positive was not associated with CAI or recent STI/HIV infection.

CONCLUSIONS:

In our sample AUDs were not associated with CAI or new HIV infection/recent STI. However higher prevalence of CAI, alcohol use at last sex, and anal sex in risky venues among those with AUDs suggests that interventions to reduce the harms of alcohol should be aimed toward specific contexts.

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By:  Herrera MC1, Konda KA2, Leon SR3, Deiss R4, Brown B5, Calvo GM6, Salvatierra HJ7, Caceres CF6, Klausner JD1.

• 1Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
• 2Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA. Electronic address: kkonda@mednet.ucla.edu.
• 3Partners in Health, Director of Research, Lima, Peru.
• 4Division of Infectious Diseases, Naval Medical Center San Diego, CA, USA.
• 5Division of Clinical Sciences, Center for Healthy Communities, University of California, Riverside, CA, USA.
• 6Unit of Health, Sexuality and Human Development, School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru.
• 7Alberto Barton Health Center, Health Directorate of Callao, Lima, Peru. 
• Drug Alcohol Depend. 2016 Feb 16. pii: S0376-8716(16)00060-0. doi: 10.1016/j.drugalcdep.2016.01.030.

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Placebo and Nocebo Effects in Sexual Medicine: An Experimental Approach

Few studies have investigated placebo and nocebo effects in a human sexuality context. Studying placebo and nocebo responses in this context may provide insight in their potential to modulate sexual drive and function. 

To examine such effects in sexual medicine, 48 healthy, male, heterosexual participants were divided into four groups. Each group received instruction to expect stimulating effects, no effect, or an inhibitory effect on sexual functions. Only one group received the dopamine agonist cabergoline, all other groups received placebo or nocebo. Modulations in sexual experience were examined through an established experimental paradigm of sexual arousal and masturbation-induced orgasm during erotic film sequences with instruction to induce placebo or nocebo effects. Endocrine data, appetitive, consummatory, and refractory sexual behavior parameters were assessed using the Arizona Sexual Experience Scale (ASEX) and the Acute Sexual Experience Scale (ASES). 

Results showed increased levels of sexual function after administration of cabergoline showing significant effects for several parameters. Placebo effects were induced only to a small degree. No negative effects on sexual parameters in the nocebo condition were noted. This paradigm could only induce small placebo and nocebo effects. This supports the view that healthy male sexual function seems relatively resistant against negative external influences.

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By:  Krüger TH1, Grob C2, de Boer C1, Peschel T1, Hartmann UH1, Tenbergen G1, Schedlowski M3.

• 1 Hannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of Clinical Psychology & Sexual Medicine , Hannover , Germany.
• 2 Axel Springer GmbH, Health Portal Onmeda.de , Cologne , Germany.
• 3 University Hospital Essen, Institute of Medical Psychology and Behavioral Immunobiology , Hufelandstrasse 55, Essen , 45122 Germany. 

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Association of Alcohol Misuse with Sexual Identity and Sexual Behavior in Women Veterans

BACKGROUND:

Sexual minority women report greater alcohol misuse than heterosexual women in the general population, with more pronounced differences found among younger age groups. It is unknown whether these differences exist among women veterans.

OBJECTIVE:

We evaluated differences in alcohol misuse across two dimensions of sexual orientation (identity and behavior) among women veterans, and examined whether these differences were modified by age.

METHODS:

Women veterans were recruited via the internet to participate in an online survey. Participants provided information on their self-reported sexual identity and behavior and responded to the validated 3-item Alcohol Use Disorders Identification Test-Consumption questionnaire (AUDIT-C). Regression models were used to compare the prevalence of alcohol misuse (AUDIT-C ≥ 3) and severity (AUDIT-C scores) across sexual identity and behavior and to test effect modification by age.

RESULTS:

Among the 702 participants (36% lesbian/bisexual), prevalence and severity of alcohol misuse varied by both sexual identity and behavior, but there were significant interactions with age. Prevalence and severity of alcohol misuse were higher among relatively younger self-identified lesbians compared to heterosexual women. Similarly, both prevalence and severity of alcohol misuse were generally higher among younger women who had any sex with women compared to those who had sex only with men. Conclusions/Importance: In this online study of women veterans, younger sexual minority women were more likely to screen positive for alcohol misuse, and they had more severe alcohol misuse, than their heterosexual counterparts. Prevention and treatment efforts focused specifically on sexual minority women veterans may be needed.

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By:  Lehavot K1,2,3,4, Williams EC1,4, Millard SP2, Bradley KA1,4,5, Simpson TL2,3,6.

• 1a VA Health Services Research & Development, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound , Seattle , Washington , USA.
• 2b Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System , Seattle , Washington , USA.
• 3c Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle , Washington , USA.
• 4d Department of Health Services, University of Washington , Seattle , Washington , USA.
• 5e Group Health Research Institute , Seattle , Washington , USA.
• 6f Center of Excellence in Substance Abuse Treatment and Education (CESATE), VA Puget Sound Health Care System , Seattle , Washington , USA. 
• Subst Use Misuse. 2016 Jan 22:1-14.

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Population Sexual Behavior and HIV Prevalence in Sub-Saharan Africa: Missing links?

OBJECTIVES:

Patterns of sexual partnering should shape HIV transmission in human populations. Our objective was to assess empirical associations between population casual-sex behavior and HIV prevalence, and between different measures of casual-sex behavior.

METHODS:

An ecologic study design was applied to nationally-representative data, that of the Demographic and Health Surveys, in 25 countries in sub-Saharan Africa. Spearman rank correlation was used to assess different correlations for males and females and their statistical significance.

RESULTS:

Correlations between HIV prevalence and means and variances of the number of casual-sex partners were positive, but small and statistically insignificant. The majority of correlations across means and variances of the number of casual-sex partners were positive, large, and statistically significant. However, all correlations between the means, as well as variances, and the variance of unmarried females were weak and statistically insignificant.

CONCLUSIONS:

Population sexual behavior was not predictive of HIV prevalence across these countries. Nevertheless, the strong correlations across means and variances of sexual behavior suggest that self-reported sexual data are self-consistent and convey valid information content. Unmarried female behavior seemed puzzling, but could be playing an influential role in HIV transmission patterns.

Full PDF article at:   http://goo.gl/k0QtVu  Abstract: http://goo.gl/rkvsXB

By:  Omori R1, Abu-Raddad LJ2.

• 1Division of Bioinformatics, Research Center for Zoonosis Control, Hokkaido University, Sapporo, Hokkaido, 001-0020, Japan; Infectious Disease Epidemiology Group, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar; Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, USA; JST, PRESTO, 4-1-8 Honcho, Kawaguchi, Saitama, 332-0012, Japan. Electronic address: omori@czc.hokudai.ac.jp.
• 2Infectious Disease Epidemiology Group, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar; Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, USA; College of Public Health, Hamad bin Khalifa University, Doha, Qatar. Electronic address: lja2002@qatar-med.cornell.edu. 

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