Sociodemographic, behavioral, and clinical characteristics associated with perceived discrimination in healthcare settings among Black persons with diagnosed HIV in the United States.

Research that explores the intra-racial socio-demographic and clinical characteristics associated with perceived discrimination in healthcare settings in the US is lacking. We examined the prevalence of self-reported discrimination in HIV care settings during the past 12 months among Black persons from a nationally representative sample of US adults with diagnosed HIV collected 6/2018-5/2019. We assessed the prevalence of self-reported discrimination in HIV care settings during the past 12 months, perceived reasons for discrimination, and factors associated with discrimination among Black persons with diagnosed HIV (n = 1,631). Overall, 22% reported experiencing discrimination in a healthcare setting; discrimination was most often attributed to HIV status. Those reporting discrimination were younger, MSM, and living at or below the federal poverty level. They also experienced homelessness, incarceration and illicit substance use in the past 12 months, and anxiety and depression symptoms in the past 2 weeks. They were less likely to use ART or report 100% ART dose adherence in the past 30 days. No associations were found with viral suppression. Systems are needed to monitor, evaluate reports of, and address discrimination in healthcare settings. Incorporating anti-discrimination policies and continuing education opportunities for providers and staff may reduce experiences of discrimination among persons with HIV.

First-year college students' alcohol and hookup behaviours: sexual scripting and implications for sexual health promotion.

This study used a sexual scripting framework to analyse data from the Online College Social Life Survey to examine the role of individual, (e.g. gender, race and alcohol use), relational (partner type, condom use behaviours), and contextual factors (sex ratios and fraternity/sorority affiliation) influencing 4,292 first-year college students' hookup experiences. Results suggest that hookups are relatively "safe", with the the majority involving non-penetrative sexual behaviour, condom use, and familiar partners. However, alcohol use affected hookup behaviours and lower levels of condom use were associated with heavy alcohol use, even with less well known partners. Findings point to the importance of interventions that reinforce first-year students' positive behaviours and present them with protective behavioural strategies to use in the context of alcohol, and with repeat or well-known partners to reduce risk and have enjoyable, consensual sexual experiences.

The effects of CenteringPregnancy group prenatal care on postpartum visit attendance and contraception use.

OBJECTIVE: We examined whether Medicaid-enrolled women in CenteringPregnancy group prenatal care had higher rates of (1) postpartum visit attendance and (2) postpartum uptake of contraceptives, compared to women in individual prenatal care. STUDY DESIGN: We linked birth certificates and Medicaid claims for women receiving group prenatal care in 18 healthcare practices and applied preferential-within cluster propensity score methods to identify a comparison group, accounting for the nested data structure by practice. We examined five standardized, claims-based outcomes: postpartum visit attendance; contraception within 3 days; and any contraception, long-acting reversible contraception (LARC), and permanent contraception within eight weeks. We assessed outcomes using logistic regression for two treatment levels: (1) any group attendance compared to no group attendance and (2) attendance at five or more group sessions to at least five prenatal care visits, including crossovers attending fewer than five group sessions (minimum threshold analysis). RESULTS: Women attending at least five group sessions had higher rates of postpartum visit attendance (71.5% vs. 67.5%, p < .05). Women with any group attendance (N = 2834) were more likely than women with individual care only (N = 13,088) to receive contraception within 3 days (19.8% vs. 16.9%, p < .001) and to receive a LARC within eight weeks' postpartum (18.0% vs. 15.2%, p < .001). At both treatment levels, group participants were less likely to elect permanent contraception (5.9% vs. 7.8%, p < 0.001). Women meeting the five-visit group threshold were not more likely to initiate contraception or LARCs within 8 weeks' postpartum. CONCLUSION: Participation in at least five group compared to five individual prenatal care visits is associated with greater rates of postpartum visit attendance. Additional engagement and education in group prenatal care may influence postpartum visit attendance. IMPLICATIONS: Planning for postpartum care and contraception during prenatal care is an important strategy for connecting women to postpartum healthcare. Regardless of prenatal care model, women have low uptake of contraception in the postpartum period. Increased use of group prenatal care with its scheduled family planning discussion may help to increase postpartum contraceptive uptake. This benefit is dependent on availability of postpartum contraception options.

Relationship intentions, race, and gender: Student differences in condom use during hookups involving vaginal sex.

Objective: To examine the relationship between race, gender, and pre-hookup relationship intentions and college students' participation in condomless vaginal sex. Participants: 3,315 Black and White college students who participated in the Online College Social Life Survey (OCSLS). Methods: Secondary data analysis of the OCSLS using Chi-square and multiple logistic regression analyses. Results: The model revealed that students who did not want a relationship with their hookup partners and students unsure of their relationship intentions were more likely to use condoms during their last vaginal hookup. Further, White and Female students were less likely to have used condoms during their last vaginal hookup.Conclusions: White and female students, as well as students desiring romantic relationships with hookup partners may be at risk for sexually transmitted infections (STIs) due to decreased condom use. However, more research is needed to explore the factors driving STI disparities facing Black students despite higher condom use.

The Use of Technology for Sexually Transmitted Disease Partner Services in the United States: A Structured Review.

BACKGROUND: Since the late 1990s, health departments and sexually transmitted disease (STD) programs throughout the United States have used technologies, such as the Internet and mobile phones, to provide services to persons with a sexually transmitted infection, including human immunodeficiency virus (HIV), and their sex partners, also known as partner services. This study reviewed the published literature to assess and compare partner services outcomes as a result of using technology and to calculate cost savings through cases averted. METHODS: We conducted a structured literature review of all US studies that examined the use of technology to notify persons exposed to an STD (syphilis, chlamydia, gonorrhea), including HIV, by health care professionals in the United States from 2000 to 2017. Outcome measures, including the number of partners notified, screened or tested; and new positives identified, were captured and cost savings were calculated, when data were available. RESULTS: Seven studies were identified. Methods used for partner services differed across studies, although email was the primary mode in 6 (83%) of the 7 studies. Only 2 of the 7 studies compared use of technology for partner services to traditional partner services. Between 10% and 97% of partners were successfully notified of their exposure through the use of technology and between 34% and 81% were screened or tested. Five studies reported on new infections identified, which ranged from 3 to 19. Use of technology for partner serves saved programs between US $22,795 and US $45,362 in direct and indirect medical costs. CONCLUSIONS: Use of technology for partner services increased the number of partners notified, screened or tested, and new infections found. Importantly, the use of technology allowed programs to reach partners who otherwise would not have been notified of their exposure to an STD or HIV. Improved response times and time to treatment were also seen as was re-engagement into care for previous HIV positive patients. Data and outcome measures across the studies were not standardized, making it difficult to generalize conclusions. Although not a replacement for traditional partner services, the use of technology enhances partner service outcomes.

HIV-Prevention Opportunities With GPS-Based Social and Sexual Networking Applications for Men Who Have Sex With Men.

The goal of this study was to gain insight on the sexual health needs of men who have sex with men (MSM) who use GPS-based social and sexual networking mobile applications (apps) and the future utility of app-based interventions. A health educator promoted HIV-testing resources in four popular apps used by MSM. Content analysis was used to identify salient themes that emerged from the conversations. Four major themes were identified: (1) soliciting sexual encounters, (2) relationship building, (3) HIV and STI-testing inquiries, and (4) seeking other sexual health information. The results suggest the intervention's social media-based strategy, respect for community culture, and unobtrusive approach was advantageous in establishing credibility and rapport with app users. These results highlight a need for convenient and discreet methods to access accurate sexual health information and suggest that apps provide an alternative, non-traditional venue for sexual health education in addition to HIV testing promotion.

US Black college women's sexual health in hookup culture: intersections of race and gender.

Approximately 60-80% of college students in the USA report a hookup experience in the form of a casual sexual encounter between individuals without the expectation of a dating or romantic relationship. Given the potential health risk posed by these sexual encounters, the need exists to critically examine this cultural phenomenon on college campuses. Yet, the existing hookup literature is overwhelming White and often exclusive of historically marginalised populations such as Black women. Accordingly, this paper examines the role of the intersecting identities of race and gender and other social factors that influence the sexual health and wellbeing of Black women on US college campuses. Specifically, we explore issues related to the gender ratio disparities present on college campuses, relationship power imbalances, inconsistent condom use and low sexual-risk perception. Moving forward, hookup research needs to utilise an intersectional approach; we offer specific suggestions for the important inclusion of Black women in the broader hookup discourse and future research.

We want what's best for our baby: Prenatal Parenting of Babies with Lethal Conditions.

This article reports on qualitative research into the experience of couples who chose to continue their pregnancies after receiving a lethal fetal diagnosis, and to embrace the parenting of their baby in the shortened time they have. This analysis of interview data is part of a larger research project describing parents' experiences of continuing pregnancy with a known lethal fetal diagnosis (LFD).