A qualitative exploration of minority stress, mental health, and sexual health among Arab immigrant sexual minority men in the United States.

OBJECTIVES: To examine experiences of immigration, sexual minority stressors, and mental health and sexual health among first-generation (born outside of the United States) Arab immigrant sexual minority men (SMM) in the United States. METHOD: We conducted in-depth one-on-one virtual interviews with 16 cisgender men residing in different U.S. states. Interview transcripts were analyzed using thematic analysis to identify the most salient themes and relationships among them. RESULTS: The experiences of Arab immigrant SMM centered around five themes: "my whole plan was to come to the U.S. to be open to who I am," "not fitting in" (homophobia, racism, sexual racism, xenophobia), "a lot of impact on my mental health," sexual health (inconsistent condom use, multiple sexual partners, preexposure prophylaxis use, testing), and coping strategies. CONCLUSIONS: Participants reported multiple forms of stressors related to their intersectional identities that affected their mental health, sexual health, and coping strategies. Many stressors were experienced before immigrating to the United States; however, several stressors persisted, and some new ones emerged after immigration. Results call for the development of mental health interventions informed by the unique experiences of Arab immigrant SMM and integrated within community-based organizations to foster adaptive coping strategies, social support, and community belonging. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Centering PrEP: utilizing ADAPT-ITT to inform group PrEP care for sex workers in Chicago.

BACKGROUND: Sex workers, those who trade sex for monetary or nonmonetary items, experience high rates of HIV transmission but have not been adequately included in HIV prevention and Pre-Exposure Prophylaxis (PrEP) adherence program development research. Community-empowered (C.E.) approaches have been the most successful at reducing HIV transmission among sex workers. Centering Healthcare (Centering) is a C.E. model proven to improve health outcomes and reduce health disparities in other populations, such as pregnant women, people with diabetes, and sickle cell disease. However, no research exists to determine if Centering can be adapted to meet the unique HIV prevention needs of sex workers. OBJECTIVE: We aim to explain the process by which we collaboratively and iteratively adapted Centering to meet the HIV prevention and PrEP retention needs of sex workers. METHODS: We utilized the Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, Testing (ADAPT-ITT) framework, a model for adapting evidence-based interventions. We applied phases one through six of the ADAPT-ITT framework (Assessment, Decision, Adaptation, Production, Topical Experts, Integration) to the design to address the distinct HIV prevention needs of sex workers in Chicago. Study outcomes corresponded to each phase of the ADAPT-ITT framework. Data used for adaptation emerged from collaborative stakeholder meetings, individual interviews (n = 36) and focus groups (n = 8) with current and former sex workers, and individual interviews with care providers (n = 8). In collaboration with our community advisory board, we used a collaborative and iterative analytical process to co-produce a culturally adapted 3-session facilitator's guide for the Centering Pre-exposure Prophylaxis (C-PrEP +) group healthcare model. RESULTS: The ADAPT-ITT framework offered structure and facilitated this community-empowered innovative adaptation of Centering Healthcare. This process culminated with a facilitator's guide and associated materials ready for pilot testing. CONCLUSIONS: In direct alignment with community empowerment, we followed the ADAPT-ITT framework, phases 1-6, to iteratively adapt Centering Healthcare to suit the stated HIV Prevention and PrEP care needs of sex workers in Chicago. The study represents the first time the first time Centering has been adapted to suit the HIV prevention and PrEP care needs of sex workers. Addressing a gap in HIV prevention care for sex workers, Centering PrEP harnesses the power of community as it is an iteratively adapted model that can be piloted and replicated regionally, nationally, and internationally.

A Scoping Review of Cancer Interventions with Arab Americans.

This scoping review provides an overview of cancer interventions implemented with Arab Americans across the cancer control continuum, including an examination of outcomes and implementation processes. The search strategy included database searching and reviewing reference lists and forward citations to identify articles describing interventions with Arab adults living in the US, with no restrictions on date of publication or research methodology. The review included 23 papers describing 12 unique cancer interventions. Most interventions focused on individual-level determinants of breast and cervical cancer screening; used non-quasi-experimental research designs to evaluate intervention effectiveness; and demonstrated improvements in short-term cancer screening knowledge. Implementation processes were less commonly described. Most interventions were culturally and linguistically tailored to communities of focus; were delivered in educational sessions in community settings; engaged with the community mostly for recruitment and implementation; and were funded by foundation grants. Suggestions for research and intervention development are discussed.

The Health Needs of Sexual and Gender Minority Migrant Women in the United States: A Scoping Review.

Purpose: This scoping review characterizes the peer-reviewed evidence on the health of first-generation sexual and gender minority (SGM) migrant women to the United States and identifies research gaps and future priorities. Methods: On February 1, 2022, the following databases were searched: PubMed (MEDLINE), Embase, CINAHL Plus with Full Text, APA PsycINFO, and PAIS Index. Primary research studies based in the United States, in English, on first-generation SGM migrants (i.e., immigrants, refugees, asylum seekers) were included. Gray literature and review articles were excluded. Health outcome data were not extracted from nonbinary populations nor transgender men. Themes were generated using qualitative content analysis. Results: Thirty-three studies were reviewed, most were qualitative, and 11 focused on transgender women migrants (especially from Latin America), while only one was exclusively on sexual minority women (SMW) migrants. Premigration experiences of violence and discrimination were linked to high prevalence rates of post-traumatic stress disorder, depression, and anxiety. Postmigration stressors included lack of educational and employment opportunities, reduced access to social services, and experiences of stigma and discrimination, which were also associated with the development of depressive symptoms. Transgender women migrants reported not seeking formal medical care, given a lack of gender-affirming services and insurance resulting in reliance on unsafe informal care networks for hormone therapy and feminization procedures. Conclusion: Future interventions should focus on fostering social support networks of SGM migrant women to help improve their mental health outcomes. Research priorities should include studies on SMW migrants and more quantitative research that could identify additional health needs (i.e., sexual health) of SGM migrant women.

A Community-Academic Partnership to Explore and Address Cancer Disparities in Southwest Chicago Arab Americans.

BACKGROUND: Despite the need to consider multiple sources of evidence to guide locally and culturally relevant interventions, few studies have documented the process by which evidence is integrated. OBJECTIVES: We leveraged a community-academic partnership to describe a participatory approach to integrating community and academic sources of evidence to inform cancer programming priorities in the Arab American (ArA) community in Southwest Chicago. METHODS: Informed by Intervention Mapping, this study comprised three phases led by community and academic partners: 1) qualitative assessment of cancer-related priorities through eight focus groups with 48 ArA community members, 2) a focused literature review to identify models of cancer interventions implemented with ArAs, and 3) integration of focus group and literature review findings and development of a strategy for a community-based cancer program administered by the community partner. RESULTS: Focus groups revealed attitudes and beliefs across the cancer control continuum. The literature review highlighted two cancer interventions utilizing education, community health workers, and patient navigation components. Through facilitated discussions with community partners, we integrated community and academic sources of evidence to develop a comprehensive cancer program plan that is informed by the data we generated as well as our community partners' preferences and organizational capacity. CONCLUSIONS: Our participatory approach for integrating community and academic sources of evidence generated a locally relevant strategy to address cancer burden in the ArA community in Chicago. We discuss the benefits and challenges of utilizing this approach in intervention development.

Experiences of stigma, mental health, and coping strategies in Lebanon among Lebanese and displaced Syrian men who have sex with men: A qualitative study.

BACKGROUND: In Lebanon, men who have sex with men (MSM) face high rates of stigma, discrimination, and violence. Minority stress, or the unique stressors related to anti-MSM stigma and discrimination, negatively impacts the mental health of MSM. These stressors are heightened for those with intersectional minority identities such as displaced Syrian MSM in Lebanon. METHODS: In this qualitative study conducted in 2020-21, part of a larger study focused on the mental and sexual health risks among MSM, we collected qualitative data from Lebanese and displaced Syrian MSM living in Lebanon and analyzed reports of their experiences with stigma, mental health, and coping strategies. We conducted semi-structured, in-depth interviews with 12 displaced Syrian MSM and 13 Lebanese MSM. RESULTS: Our findings highlight how MSM in Lebanon navigate stigma and the mental health risks that result. Common stressors among Lebanese and displaced Syrian MSM were related to finances, sexual orientation discrimination, and social isolation. Comparing the two groups, we found that stressors specific to displaced Syrian MSM were related to adverse childhood experiences, recent exposure to the Syrian war, displacement, and discrimination in Lebanon based on their intersectional identities as MSM and Syrians. For Lebanese participants, the most common stigma coping strategies were avoidance, drinking alcohol, using drugs, or having sex. As for displaced Syrian MSM, the most common stigma coping strategy was seeking the freely available mental health services offered to them through non-governmental organizations. CONCLUSION: Our findings suggest that increased targeted mental health and social support interventions, informed by the unique experiences of Lebanese and displaced Syrian MSM, are highly needed to improve the coping and mental health resources of all MSM in Lebanon.

Experiences of Sex Workers in Chicago during COVID-19: A Qualitative Study.

COVID-19 exacerbated health disparities, financial insecurity, and occupational safety for many within marginalized populations. This study, which took place between 2019 and 2022, aimed to explore the way in which sex workers (n = 36) in Chicago were impacted by COVID-19. We analyzed the transcripts of 36 individual interviews with a diverse group of sex workers using thematic analysis. Five general themes emerged regarding the detrimental impact of COVID-19 on sex workers: (1) the impact of COVID-19 on physical health; (2) the economic impact of COVID-19; (3) the impact of COVID-19 on safety; (4) the impact of COVID-19 on mental health; and (5) adaptive strategies for working during COVID-19. Participants reported that their physical and mental health, economic stability, and safety worsened due to COVID-19 and that adaptive strategies did not serve to improve working conditions. Findings highlight the ways in which sex workers are particularly vulnerable during a public health crisis, such as COVID-19. In response to these findings, targeted resources, an increased access to funding, community-empowered interventions and policy changes are needed to protect the health and safety of sex workers in Chicago.

Intimate partner violence prevention amongst Arab American young adults in Chicago: Implications for intervention development.

AIMS: Intimate partner violence (IPV) rates in the Arab American community are high, and there are gaps in the understanding of young adults' perspectives on IPV and its prevention. The aims of this study are to describe Arab American young adults' perspectives on the design of IPV prevention programmes and to document and explore their understanding and experiences with IPV. DESIGN: This exploratory study was part of a larger community-based participatory mixed-method study (QUAL-quan) amongst Arabs in Chicago and focused on young adult participants (18-25 years). METHODS: Participants (n = 44) completed an IPV survey about IPV perpetration and victimization, dating violence norms, conflict management skills, gender stereotyping, and belief in the need for help. From four focus groups (22 participants), we explored Arab American young adults' perspectives on IPV prevention programme development. RESULTS: Participants supported the adaptation and development of a youth-centred IPV prevention intervention that is community-based, culturally informed, and inclusive of multiple Arab community stakeholders. The survey results indicated multiple experiences with psychological and physical dating violence victimization (76.3% and 47.2%) and perpetration (62.2% and 27%). CONCLUSION: Arab American young adults in Chicago are exposed to high rates of IPV. Community-based participatory approaches are needed to develop IPV prevention interventions that centre community needs. IMPACT: Intimate partner violence is a significant public health problem; nearly 1 in 4 women have experienced IPV at some point in their life, and about 70% of those experiencing IPV, experience their first victimization before the age of 25. Arab American young adults experience high rates of IPV victimization and perpetration, requiring urgent attention. Participants proposed various community-based strategies to develop IPV prevention programmes that include multiple community stakeholders. Community-based organizations and researchers, schools and religious institutions could establish collaborations to ensure the adaptation and development of community-informed IPV prevention programmes.

A qualitative exploration of young adults' perceptions of a new intervention for alcohol use disorder.

BACKGROUND: Due to the rising prevalence of alcohol use disorders among young adults, the need for effective and accessible interventions has become increasingly imperative. In acknowledgment of this issue, we developed a novel intervention known as contingency management plus problem solving therapy (CM-PST). The aim of the current study was to gain insight into the perspectives on the effectiveness of the newly developed CM-PST using focus group discussion among young adults who consume alcohol regularly. MATERIALS AND METHODS: The study employed a qualitative research design, utilizing focus group discussions as the primary data collection method. Participants described their perceptions regarding the newly developed CM-PST. Semi-structured focus group sessions were conducted via Zoom in November 2022. A total of 19 young adults, aged 18-24 years old, participated in five focus group sessions. Data were analyzed using deductive content analysis. RESULTS: Participants demonstrated overall positive attitudes toward the novel intervention, recognizing the potential benefits, it could offer in terms of alcohol use reduction and emotional well-being. They emphasized the importance of incentives in motivating behavioral changes, as well as the practicality of problem-solving techniques in addressing everyday challenges. Additionally, participants provided valuable insights into potential barriers and implementation challenges, highlighting the need for flexible and personalized approaches to accommodate individual preferences and needs. CONCLUSIONS: The results of this study contribute to the growing body of literature on innovative intervention approaches for young adults facing alcohol use issues. The findings shed light on the acceptability and perceived effectiveness of the CM-PST intervention from the perspective of the target population.

Engaging Vulnerable Populations in Community-based Participatory Research: Lessons Learned.

BACKGROUND: Community-based participatory research (CBPR) is effective in addressing health disparities. Lack of inclusion of vulnerable populations in research perpetuates systemic inequities. Community-academic partnership must represent the voices and experiences of marginalized populations. OBJECTIVE: To inform future research by sharing lessons learned from community-academic partnerships among three distinct vulnerable populations: Arab youth, Black girls and women, and sex workers. METHODS: Community-based participatory researchers use reflexivity to identify and describe lessons learned when working with three vulnerable populations. LESSONS LEARNED: Lessons learned focus on power sharing and community partnership which facilitated CBPR. We also describe how institutional roadblocks such as tenure and promotion timelines, institutional review board approval and erasure, stigmatization, and funding impede CBPR. CONCLUSIONS: These lessons provide insight for future researchers to consider as they aim to develop strong and equitable community partnerships. Power sharing is required to maintain equitable community partnerships. Balancing community needs with academic expectations is essential to sustain funding. Emphasizing cultural safety and collaboration can address institutional roadblocks.

Sexual Function and Mood Disorders Among Menopausal Women: A Systematic Scoping Review.

BACKGROUND: Changes in sex hormones during menopause may have detrimental effects on a woman's sexual function and cause mood disorders. The treatment of both conditions is a challenge in gynecology. AIM: To review the published literature on sexual function and mood disorders among peri- and postmenopausal women. METHODS: The review is based on the methodological framework of scoping reviews. We searched electronic databases including Medline (PubMed), Scopus, Embase, and Web of Science (WoS). Publications that reported data about the relationship between sexual function and mood disorders among menopausal women were included in the review. The search was not subject to any limitation in terms of time or method. OUTCOMES: The main outcome measures used for the review were sexual dysfunction and mood disorders. RESULTS: We found 106 total records. After a full-text screening we included 19 studies from 1986 to 2020 based on various methodologies; the majority of the studies16 were cross-sectional. Investigations that addressed the symptoms of mood disorders and some domains of sexual function showed a close relationship between sexual dysfunction and mood disorders among menopausal women. CLINICAL IMPLICATIONS: In clinical practice, it would be appropriate to screen women for at least one mood disorder or sexual dysfunction. If a woman suffers from either, it will be necessary to assess for a further disorder as well. STRENGTHS & LIMITATIONS: The review was based on a detailed search of the published literature concerning mood disorders and sexual dysfunction among menopausal women compared to women of reproductive age. Despite the clinical importance of the subject, the number of studies eligible for inclusion in the review are rather small. Further investigation of the topic is clearly warranted. CONCLUSIONS: While the association between sexual dysfunction and mood disorders appears to be bidirectional, future studies will have to investigate the specific mechanisms by which sexual dysfunction could lead to mood disorders (or vice versa). Future studies should specifically address sexual dysfunctions and attitudes of partners, BMI, family support, sleep, and multiparity. Azam Rahmani, Elahe Afsharnia, Julia Fedotova, Shirin Shahbazi, Arezoo Fallahi, Leila Allahqoli, Reza GhaneipoklGheshlagh, Sarah Abboud, Ibrahim Alkatout. Sexual Function and Mood Disorders Among Menopausal Women: A Systematic Scoping Review. J Sex Med 2022;19:1098-1115.

Strategies to address structural and institutional barriers to success among students of color in nursing programs.

The COVID-19 pandemic and the significant disparities experienced by Black, Indigenous, and people of color (BIPOC) in infections, hospitalizations, and deaths associated with the Coronavirus have underscored the imperative to increase the size and diversity of the healthcare workforce, including nursing. Academically focused pipeline development programs have led to some advances in minority recruitment and retention; however, emerging research highlights the importance of extra-academic factors that reduce the sense of belonging and persistence among underrepresented and minority students. The purpose of this manuscript is to describe the diversity, equity, and inclusion goals and activities of a college of nursing located in a minority-serving institution. Here, we emphasize the description of a range of activities aimed at meeting our diversity goals. Further, we highlight the actions initiated in response to emergent "extra-academic" student needs over the past year related to the COVID-19 pandemic and police brutality. The strategies described have implications for improving diversity, equity, and inclusion among higher education institutions in nursing.

Relationships between Thai fathers' self-efficacy to support breastfeeding and exclusive breastfeeding duration.

OBJECTIVE: To determine associations between Thai fathers' self-efficacy to support exclusive breastfeeding and exclusive breastfeeding duration. DESIGN: A descriptive quantitative design was used. PARTICIPANTS AND SETTINGS: The study sample consisted of 205 father-mother couples (410 participants) with an infant who was 6 months old. Data were conducted from well-baby clinics of two hospitals in Thailand's Chiang Mai province from January to March 2020. MEASUREMENT: Each participant completed a sociodemographic questionnaire and Breastfeeding Self-Efficacy Scale (Short-Form). Father participants also completed the Father's Attitude toward Exclusive Breastfeeding questionnaire. FINDINGS: Bivariate correlation analyses of survey data showed that paternal and maternal breastfeeding self-efficacy scores were positively associated with longer duration of exclusive breastfeeding (ρ=0.19 and ρ=0.54, respectively). Paternal self-efficacy scores were also positively correlated with maternal self-efficacy scores (ρ=0.30, p=.01). However, the results of Tobit regression analyses indicated that paternal self-efficacy scores did not moderate the relationship between maternal self-efficacy scores and exclusive breastfeeding duration. Only maternal self-efficacy scores were significantly associated with duration of exclusive breastfeeding (B=.16, p<.01). KEY CONCLUSIONS: This is the first Thai study to assess the relationship between fathers' breastfeeding support self-efficacy and exclusive breastfeeding duration. The results increase our understanding of paternal factors that impact exclusive breastfeeding duration. Although paternal self-efficacy did not moderate the effects of maternal self-efficacy on exclusive breastfeeding duration in this study, paternal self-efficacy positively related to maternal self-efficacy and breastfeeding duration. IMPLICATION FOR PRACTICE: Paternal breastfeeding support self-efficacy should be promoted in co-parenting breastfeeding interventions both antenatal care clinics and postpartum units to promote exclusive breastfeeding and increase Thailand's overall exclusive breastfeeding rate.

Family Sex Communication Among Arab American Young Adults: A Mixed-Methods Study.

There is a significant gap in understanding the sexual health of Arab Americans. The purpose of this study is to explore family sex communication among Arab American young adults and its association with gender and sexual attitudes. We used a parallel mixed methods design and administered an electronic survey (N = 100); a subsample of 24 participants participated in five focus groups. We observed convergence in the findings. Participants reported rare occurrences of family sex communication, with women reporting less comfort than men. Family sex communication was often "unspoken," and reinforced prevailing social norms. Gender differences were reported based on sex communication topics. The most common source of sex information was peers/friends. Focus group participants perceived their parents to be more conservative and less knowledgeable about sex than they were. Future research on strategies to bridge generational differences is needed to promote family-based sex communication, given the multiple teachable moments at home.

Sexual and gender minority health in the Middle East and North Africa Region: A scoping review.

Background: Researchers in studies from multiple countries suggest that sexual and gender minority people experience high rates of violence, stigma, and discrimination, as well as mistrust of health care providers and systems. Despite growing evidence related to sexual and gender minority health in North America and Europe, we know little about the health of this population in the Middle East and North Africa. Objectives: We aimed to comprehensively examine the literature related to the health of sexual and gender minority people in the Middle East and North Africa and to identify research gaps and priorities. Design: We conducted a scoping review informed by the framework recommended by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) tool. Data sources: We searched the following databases: PubMed (using Medline All on the Ovid platform), PsycINFO (Ovid), CINAHL (Ebsco), and Embase (Ovid). The search strategy combined terms for the geographic region of interest (Middle East and North Africa) and the population of interest (sexual and gender minority). Each was operationalized using multiple search terms and, where available, controlled vocabulary terms. Review Methods: Research articles were identified and assessed for inclusion using an explicit strategy. Relevant information was extracted and synthesized to present a descriptive summary of existing evidence. Results: Research designs of the 98 articles we reviewed included quantitative (n = 73), qualitative (n = 20), and mixed methods (n = 5). Most studies were conducted in Lebanon (n = 33), Pakistan (n = 32), and Iran (n = 23) and focused mainly on gender minority individuals (n = 46) and men who have sex with men (n = 32). Five themes emerged from the review: sexual health (52; 53%); mental health (20; 20%); gender identity (17; 17%); violence and discrimination (7; 7%); and experiences with the healthcare system (2; 2%). Although researchers focused on multiple health outcomes in some studies, we included them under the theme most closely aligned with the main objective of the study. Conclusion: Although our study is limited to few countries in the Middle East and North Africa region, we found that sexual and gender minority individuals face multiple adverse sexual and mental health outcomes and experience high rates of stigma, discrimination, and violence. More research is needed from countries outside of Lebanon, Pakistan, and Iran, including community-based participatory approaches and multi-level intervention development. Nurses and other healthcare providers in the region need training in providing inclusive care for this population.

Perspectives of multisectoral community stakeholders on Arab American cancer patients' needs and suggested interventions.

BACKGROUND: Multilevel barriers can arise after a cancer diagnosis, especially in underserved racial/ethnic minority patient populations, raising the need for diverse and contextually adapted interventions. However, limited data exists on Arab American (ArA) cancer patients' needs, partly due to their racial/ethnic misclassification as Whites. This study leveraged the perspectives of cancer survivors and community stakeholders (i.e., healthcare and community leaders) to identify ArA cancer patients' needs, as well as their preferred intervention strategies to address them. METHODS: Using a hybrid inductive-deductive content analysis approach, we analyzed qualitative data from interviews with 18 ArA community stakeholders recruited through community partners in Chicago. RESULTS: Participants associated cancer stigma to ArA patients' concealment of their diagnosis and aversion to cancer support groups. Economic and language barriers to treatment were emphasized. A lack of resources for ArA cancer patients was also noted and was partly attributed to their misclassification as White. In response to these needs, participants suggested peer mentorship programs to overcome privacy concerns, hospital-based patient navigation to address language and economic barriers in healthcare, diversification of the healthcare workforce to overcome language barriers, and community coalitions to recognize ArA as an ethnic group and increase cancer support resources. Such advocacy will be essential to accurately characterize patients' cancer burden and obtain funding to support community programs and resources. CONCLUSION: Our findings suggest that multilevel interventions at the patient, healthcare, and community levels are needed to address ArA cancer patients' needs.

Results from Project GOLD: A pilot randomized controlled trial of a psychoeducational HIV/STI prevention intervention for black youth.

Black youth face significant disparities in HIV/sexually transmitted infection (STI) disease burden. Mental illness and emotion regulation are ontributors to HIV/STI risk, yet many HIV/STI prevention interventions do not address these factors. Project GOLD was a pilot randomized controlled trial of a psychoeducational HIV/STI prevention intervention designed to address the role of mental illness and emotion regulation in HIV/STI risk among heterosexually active Black youth aged 14-17 (N = 108). Participants were recruited from outpatient mental health treatment programs and general community settings via community partner referrals, face-to-face encounters, flyers and social media. Assessments were conducted pretest, immediate posttest, and at 3-, 6-, and 12-month follow-up. Although there were no statistically significant differences in behavior change from baseline, there were practically significant effect sizes among HIV condition participants when compared to the general health condition (e.g., fewer sexual partners at 6 months). An increase in theoretical mediators (e.g., condom use negotiation beliefs) was sustained at 12 months. HIV condition participants also reported lower depressive symptom severity, with statistical significance noted at immediate post and at 3 months. The findings highlight the importance and challenges of engaging Black youth in culturally and contextually relevant, developmentally and psychologically appropriate HIV/STI prevention interventions.