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1.  Concurrent sexual partnerships among African American women in Philadelphia: results from a qualitative study 
Sexual health  2012;9(3):288-296.
African American women are disproportionately affected by HIV/AIDS. Concurrent sexual partnerships may contribute to racial disparities in HIV infection. Little is known about attitudes and practices related to concurrency among African American women and the social, structural and behavioral factors that influence concurrency.
We recruited 19 heterosexual African American women engaging in concurrent sexual partnerships from a public health clinic in Philadelphia in 2009. We conducted in-depth interviews exploring social norms, attitudes and practices about concurrency, and the structural, social and behavioral factors influencing concurrent sexual partnerships. Grounded theory guided interview protocols and data analysis.
Seventeen women reported one main and one or more non-main partners; two reported no main partners. Many women used condoms more frequently with non-main than main partners, noting they trust main partners more than non-main partners. Social factors influencing concurrency included social normalization of concurrency, inability to negotiate partners’ other concurrent partnerships, being unmarried, and not trusting main and non-main partners. Not trusting partners and the community at large were the most commonly cited reasons that women engaged in concurrent partnerships. Structural factors included economic dependence on partners, partners’ dependence on women for economic support and housing, and incarceration that interrupted partnerships. Behavioral factors including alcohol and cocaine use influenced concurrency.
Social, structural, and behavioral factors strongly influenced these African American women’s concurrent sexual partnerships. Many evidence-based interventions (EBIs) disseminated by the US Centers for Disease Control and Prevention (CDC) focus largely on behavioral factors and may fail to address the social and structural factors influencing African American women’s sexual networks. Novel HIV prevention interventions that address the social determinants of African American women’s HIV risks in addition to conventional HIV risk- taking behaviors are urgently needed.
PMCID: PMC4203371  PMID: 22697147
Concurrency; HIV/AIDS; Incarceration
2.  Social, Structural and Behavioral Drivers of Concurrent Partnerships among African American Men in Philadelphia 
AIDS care  2011;23(11):1392-1399.
African Americans face disproportionately higher risks of HIV infection. Concurrent sexual relationships, or sexual partnerships that overlap in time, are more common among African Americans than individuals of other races and may contribute to racial disparities in HIV infection. However, little is known about attitudes, norms and practices among individuals engaged in concurrent partnerships. Little is also known about the processes through which structural, behavioral and social factors influence concurrent sexual relationships. We recruited 24 heterosexual African American men involved in concurrent sexual relationships from a public health clinic in Philadelphia. We conducted in-depth interviews exploring these men's sexual practices; social norms and individual attitudes about concurrency; perceived sexual health risks with main and non-main partners; and the social, structural and behavioral factors contributing to concurrent sexual relationships. Twenty-two men reported having one main and one or more non-main partners; two reported having no main partners. Respondents generally perceived sexual relationships with non-main partners as riskier than relationships with main partners and used condoms far less frequently with main than non-main partners. Most participants commented that it is acceptable and often expected for men and women to engage in concurrent sexual relationships. Social factors influencing participants’ concurrent partnerships included being unmarried and trusting neither main nor non-main partners. Structural factors influencing concurrent partnerships included economic dependence on one or more women, incarceration, unstable housing, and unemployment. Several men commented that individual behavioral factors such as alcohol and cocaine use contributed to their concurrent sexual partnerships. Future research and interventions related to sexual concurrency should address social and structural factors in addition to conventional HIV risk-taking behaviors.
PMCID: PMC3202040  PMID: 21981345
3.  Randomized Clinical Trial of Motivational Enhancement of Substance Use Treatment Among Incarcerated Adolescents: Post-Release Condom Non-Use 
Evaluated impact of motivational enhancement (ME) of substance abuse treatment compared to relaxation training (RT) on sex without condoms (overall and involving substance use) 3 months following release among incarcerated adolescents. This randomized clinical trial involved 114 incarcerated adolescents from the Northeast. Regression analyses determined if treatment condition, baseline levels of depressive symptoms, and their interaction predicted condom non-use 3 months post-release, controlling for baseline condom non-use. Among those who reported fewer baseline depressive symptoms, those in ME condition reported significantly less condom non-use, in general and involving marijuana use compared with those in RT condition. Periods of incarceration represent opportunities to help juvenile detainees reduce behaviors that impact their health and the health of those with whom they interact in the community.
PMCID: PMC2756690  PMID: 19809580
Adolescents; motivational enhancement; substance use; condom non-use; incarcerated populations
4.  Co-Occurring Sexual Risk and Substance Use Behaviors Among Incarcerated Adolescents 
Incarcerated adolescents report greater sexual risk than do nonincarcerated peers. High-risk sexual behavior is associated with substance use. To determine how much sexual risk is combined with substance use, 167 incarcerated adolescents reported on their sexual risk behavior in the year before incarceration that involved alcohol or marijuana. For each risk behavior, marijuana use was more likely than was alcohol use. Marijuana use was more common for higher risk behaviors than for lower risk behaviors. Periods of incarceration provide opportunities for intervening on HIV-relevant risk behaviors among adolescents. The context of substance use within high-risk sexual situations ought to be a focus of interventions for incarcerated adolescents.
PMCID: PMC2743101  PMID: 19756249
adolescents; sexual risk; substance use; incarcerated populations; correctional health
5.  Adolescent Pregnancy Intentions and Pregnancy Outcomes: A Longitudinal Examination 
(a) To examine different methods of assessing pregnancy intention; (b) to identify psychosocial differences between those who indicate pregnancy intentions and those who do not; and (c) to examine the relationship between pregnancy intentions and subsequent pregnancy at 6-month follow-up in nonpregnant (at baseline), sexually experienced adolescent females.
Longitudinal cohort study of 354 sexually experienced female adolescents attending either a STD clinic or HMO adolescent medicine clinic in northern California. Student’s t-tests and regressions examined psychosocial differences between females who reported “any” and “no” pregnancy intentions. ANOVAs examined differences among different combinations of pregnancy plans/likelihood. Chi-square analyses assessed associations between baseline pregnancy intentions and subsequent pregnancy.
Adolescents’ reports of their pregnancy plans and their assessments of pregnancy likelihood differed from one another (χ2 = 50.39, df = 1, p < .001). Pregnancy attitudes and baseline contraceptive use differentiated those with inconsistent pregnancy intentions (Not Planning, but Likely) from those with clear pregnancy intentions (Planning and Likely, and Not Planning and Not Likely) (Pregnancy Attitudes: F [2,338] = 68.96, p < .0001; Contraceptive Use: F [2,308] = 14.87, p < .0001). Suspected pregnancies and positive pregnancy test results were associated with baseline pregnancy intentions (Suspected: χ2 = 19.08, df = 2, p < .01; Positive Results: χ2 = 8.84, df = 2, p = .015).
To reduce adolescent childbearing we must assess pregnancy intentions in multiple ways. Information/education might benefit those female adolescents with inconsistent reports of pregnancy intentions.
PMCID: PMC1602042  PMID: 15581524
Pregnancy intentions; Adolescent females; Attitudes; Intentions; Contraceptive use
6.  Correlates of Partner-Specific Condom Use Intentions Among Incarcerated Women in Rhode Island 
Few studies of incarcerated women have examined potential associations between risky sexual behavior and relationship context factors; thus, little is known about the correlates of intentions to use condoms with main and casual partners among this underserved population.
A sample of 221 women incarcerated in a Rhode Island Department of Corrections facility in 2002–2003 were interviewed. Multiple linear regression analysis was performed to assess associations between selected demographic, psychosocial and behavioral variables and participants’ reported intentions to use condoms with main and casual sexual partners in the first six months after their release.
Condom use at last sex with a main partner, sexually transmitted disease (STD) history, no strong desire to currently be pregnant, belief that others influence one’s health and perceived STD risk were positively associated with women’s intention to use condoms with main partners. Pregnancy history was negatively associated with intention to use condoms with a main partner. Condom use at last sex with a casual partner was positively associated with intention to use condoms with casual partners, whereas binge drinking and believing in the role of chance in determining one’s health were negatively associated with intention to use condoms with casual partners.
Whether incarcerated women define a partner as main or casual may influence their decisions about the need to protect themselves by using condoms. Programs that focus on the importance of condom use with all partners could greatly benefit incarcerated women and the communities to which they return.
PMCID: PMC1351210  PMID: 15888401
7.  Perceived STD Risk, Relationship and Health Values in Adolescents’ Delaying Sexual Intercourse with New Partners 
Sexually transmitted infections  2004;80(2):130-137.
To examine the amount of time adolescents waited to have intercourse with past partners (main and casual), and intentions to delay with future partners. To determine psychosocial factors which predict delay intentions among adolescent males and females with future partners (main and casual).
Adolescent STD clinic attendees were approached before clinical appointments to participate in an interview. Data from 205 participants who had previous experience with both main and casual partners were used in the current study.
Adolescents waited less time to have intercourse with most recent casual than with most recent main partners (χ2 = 31.97, p<.0001). The amount of time waited with past partners was shorter than intended time to wait in future relationships (medians of 1 month vs. 2 months (main) [t=3.47, p<.001]; medians of 2 weeks vs. 1 month (casual), [t=6.14, p<.0001]). Factors influencing intentions to delay intercourse with future main partners differed by gender; males’ were negatively influenced by importance of sex in relationships, while females’ were positively influenced by importance of intimacy in relationships, perceived risk of STDs, and health values.
Implications for designing interventions for adolescent males and females are discussed.
PMCID: PMC1351212  PMID: 15054176
Adolescents; sexual intercourse delay; partner types
8.  Intravenous Drug Users’ HIV-Risk Behaviors with Primary/Other Partners 
The objective of this study was to determine how injection drug users’ (IDUs) HIV-risk behavior differs with primary and other sex partners. Interviews were conducted with injection drug users from a needle exchange program (n = 243). Those with one sexual partner were more likely to report never using condoms with primary partners than were those with more than one partner (74% vs. 54%, p < 0.001). Those with more than one partner differed, between primary and other sexual partners, in their disclosure of HIV and IDU status, condom use, and drug use in combination with sex. Primary sexual partners of IDUs are placed at risk from IDUs’ risk behavior with other sexual partners. Those planning HIV-risk reduction interventions for IDUs should consider risk behavior with primary partners separately from behavior with other partners. Evaluation of intervention effects should use partner-specific assessments of risk behavior.
PMCID: PMC1351211  PMID: 15230073
Injection drug user; HIV; Partner—specific; Drugs; Needle exchange
9.  Psychosocial Correlates of Adolescent Males’ Pregnancy Intention 
Pediatrics  2005;116(3):e414-e419.
To identify psychosocial differences between sexually experienced male adolescents who indicate intentions to get someone pregnant and those who do not.
Cross-sectional study of 101 sexually experienced adolescent males recruited from an STD clinic in northern California. Student’s t-tests and regressions examined psychosocial differences between males who reported any intention versus no intention to get someone pregnant in the next six months. ANOVAs examined differences among different combinations of pregnancy plans/likelihood.
Adolescents’ reports of their plans for getting someone pregnant differed from their assessments of the likelihood that they would do so (χ2 = 24.33, df = 1, p < .0001). Attitudes toward pregnancy and participants’ mothers’ educational attainment differentiated those with clear pregnancy intentions (Planning, and Likely) from those with clear intentions to avoid pregnancy (Not Planning & Not Likely)
To reduce the rates of adolescent childbearing, males’ pregnancy intentions must be assessed and asked about in multiple ways.
PMCID: PMC1351209  PMID: 16140687
Adolescent Males; Pregnancy Intentions; Psychosocial Variables

Results 1-9 (9)