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Minority stress theory suggests enhanced HIV risk for those experiencing social marginalization, while an intersectionality framework posits that forms of marginalization may interact. The purpose of this paper is to understand how race/ethnicity- and gender-based discrimination may impact HIV risk among transgender or transsexual (trans) people.

The Trans PULSE project – a community-based research study in Ontario, Canada – used respondent-driven sampling to survey 433 trans participants, including 35 Aboriginal persons and 62 non-Aboriginal persons of colour. Descriptive and regression analyses were weighted to adjust for recruitment probabilities.

Most Aboriginal persons (65 per cent, 95 per cent CI: 37-90) and persons of colour (90 per cent, 95 per cent CI: 74-100) reported at least one experience of racism or ethnicity-based discrimination, and the vast majority had experienced transphobia (90 and 92 per cent, respectively). Among non-Aboriginal trans persons of colour, experiences of racism and transphobia interacted in increasing odds of engagement in high-risk sex. Increases in experience of one type of discrimination had strongest effects on HIV risk when coupled with high levels of the other.

Persons of colour were ethno-racially diverse; it is possible that different experiences of racism, with divergent effects, were collapsed. Odds ratios may overestimate actual risk ratios.

While some sub-groups of trans people of colour have been identified as highly vulnerable to HIV, few studies have explored the impact of discrimination. This paper explores the roles of two types of discrimination in engendering HIV-related risk, and suggests potential limits to resiliency in the face of high levels of discrimination targeting multiple facets of identity.

School-going young people in South Africa engage in HIV risk behaviour despite high levels of HIV knowledge and a variety of interventions focusing on HIV prevention. The lack of empirical evidence on the effectiveness of current interventions leaves programme implementers with little consensus about how best to prevent HIV infection among young people. This research was done to explore factors underlying HIV risk of young people with the aim of developing HIV prevention in the third decade of the epidemic. Focus group discussions were conducted with young people, educators and parents in eight schools in four provinces of the country. A thematic analysis revealed risk factors especially on the interpersonal and community level. Peer pressure, gender norms and culture, poverty and financial gain and a culture of alcohol use were prominent themes. Negative family relationships, lack of role models and lack of sexual education from home contributed to risk behaviour. Community processes such as exposure to media, lack of recreational facilities, and an erosion of supportive culture and community structures created an environment which did not support healthy behaviour. Factors that prevented risk behaviour were identified as self-respect, open communication with parents, implementation of school programmes, positive peer pressure and a focus on young people's future. Prevention programmes should therefore not only focus on individual factors but should be multi-layered interventions involving various community structures aimed at changing the social ecology in communities to support an alternative lifestyle for young people.

Older adults’ sexual health is becoming an increasingly important component of healthy aging in the wake of the HIV/AIDS epidemic and rising infection rates among this age cohort. The increase in HIV/AIDS diagnoses in the older adult population ignites the need to understand the reasons why older adults are omitted from HIV/AIDS prevention education policy.

This chapter examines the social forces that influence HIV/AIDS policy at the state and community levels. Through qualitative methodology and analysis, including interviews with state policymakers and managers of AIDS service organizations in four Midwestern states (n=31), I look for trends and patterns as to whether or not older adults are considered as an “at-risk” group for HIV infection.

Findings reveal that HIV/AIDS policy may be impacted by enduring sexual scripts about older adults. To some extent both state policymakers and AIDS service organization personnel adhere to stereotypes about older adults’ sexuality and sexual activity, which is then implemented in their health promotion activities. The result is that gaps exist in HIV/AIDS prevention education for older adults, despite the fact that current trends show an increase in new HIV infections and AIDS diagnoses among people over the age of 50.

While this is an exploratory study of the available HIV/AIDS prevention education and health promotion activities for older adults, as well as the viewpoints of state policymakers and AIDS service organization personnel, the findings do indicate the need for additional research on the potentially dangerous sexual behaviors – lack of HIV testing, low condom usage, multiple partners – exhibited by older adults. Future research involving interviews with older adults, physicians, and medical personnel may add new perspectives to the current research.

As the baby boomers continue to age and challenge cultural stereotypes of sexual behaviors among older adults, research in the area of sexual health and HIV/AIDS prevention education will remain an important component of healthy aging. This research begins what will ultimately be a necessary conversation.

The purpose of this paper is to assess the rates of HIV risk-taking behavior and sexual violence among clients with co-occurring addiction and intimate partner violence (IPV). The current study also aims to determine whether HIV risk-taking behaviors (e.g. trading sex for money or drugs, having unprotected sex with multiple partners) differ among substance using IPV offenders with and without a history of sexual aggression.

Secondary analyses were conducted from Easton et al.’s (2017) randomized controlled trial of substance use domestic violence treatment among substance using IPV offenders. Correlational analyses were conducted to assess the relationship between pre-treatment sexual aggression, HIV risk-taking behaviors, substance use and aggression. Analyses of covariance were conducted in order to determine differences in participants’ HIV risk-taking behaviors based on their history of sexual aggression while controlling for hours of contact with the female partners.

In a sample of 63 participants, males with higher rates of sexual aggression were more likely to engage in sexual risk-taking behaviors. This study encountered a correlation between pre-treatment risk-taking behavior and verbal and physical aggression, as well as a correlation between pre-treatment risk-taking behaviors and cocaine use. Results neither suggest a relationship between sexual aggression and alcohol use nor HIV risk-taking behaviors and alcohol use at pre-treatment.

The present study is limited by sample size and power.

This study is among the first of its kind to investigate HIV risk-taking behaviors among substance using offenders of IPV. This study provides support for the inclusion of treatment targeting HIV risk-taking behaviors among IPV offenders.

Previous studies have shown a link between mental health functioning and involvement in HIV risk practices. The present research examines how well one specific group of men who have sex with other men (MSM) fare in terms of their mental health functioning, and then focuses on how mental health functioning relates to HIV risk practices in this population. The study was based on a national random sample of 332 MSM who use the Internet to seek men with whom they can engage in unprotected sex. Data collection was conducted via telephone interviews between January 2008 and May 2009. Depression is more common among men in this population than in the adult male population-at-large. All other measures of mental health functioning that were examined (self-esteem, impulsivity, current life satisfaction, optimism about the future) indicated low rates of mental health problem. Contrary to expectations, in nearly all instances, mental health functioning was not related to HIV risk practices.

More work needs to be done to understand the causes of depression among these men, and to assess how, if at all, depression relates to risk practices in this population. These findings suggest that factors other than mental health problems must be considered if one wishes to understand HIV risk taking in this population.

This paper aims to examine the impacts of immigration processes on the HIV risk faced by mainland Chinese immigrants in Canada.

Drawn from a larger qualitative study on the vulnerability to HIV of recent immigrants to Canada, the data presented were collected through individual, face‐to‐face, semi‐structured, in‐depth interviews with 34 mainland‐Chinese immigrant adults who perceived themselves as facing sexual health risks (including HIV infection) through engaging in unsafe sex.

Immigration processes have not only exposed these immigrants to a HIV risk that they did not face in China; they have also compromised their capacity to effectively respond to it. In light of various settlement difficulties, HIV risk is neither the only nor the most urgent challenge that they have faced in their post‐immigration lives.

The HIV risk under discussion must be understood by situating it in the processes of immigration, settlement, and transnational connections, all of which have shaped not only the dynamics of HIV risk but, also, these individuals' capacities to respond to that risk. Owing to its small‐size purposive sample, the results of this study may not be generalizable for Chinese immigrants in Canada as a whole.

Greater attention should be given to the intersections between immigrants' vulnerability to HIV and settlement processes and to holistic approaches that take into account the changing contexts and dynamics of HIV risk.

This exploratory study will contribute to knowledge of the HIV risk Chinese immigrants in Canada face – a little‐known topic.

Describes how HIV and AIDS are carried and spread, particularly for high‐risk groups, but adds that it is not only behavioural but also those behaviours in conjunction with others. Employs figures and tables for added explanation and emphasis. Chronicles some individual case studies showing different “risk” behaviours and types of “unsafe” practices. Makes clear that the use of varied types of education are of major importance in the fight against ignorance and nonchalance in the battle against AIDS.

For decades, northern Thailand has been a hub for migration in the Greater Mekong Sub-region, particularly for migrants from Myanmar. HIV prevalence among Myanmar/Burmese migrants is higher than in the general Thai population. This study aims to focus on Shan migrants living with HIV in Chiang Mai, the metropolitan centre of northern Thailand and to examine two related aspects: migrants’ sexual risk behaviour and their HIV knowledge and beliefs. The study aims to understand circumstances in which mobility increases HIV risk behaviour and prevalence.

Using a qualitative study, the authors conducted in-depth interviews in 2017 with 43 HIV-infected Shan migrants (21 males and 22 females), and 29 health-care providers who work in district hospitals in Chiang Mai.

The authors found that social and economic vulnerability associated with migration, and AIDS-related mortality, increased migrants’ likelihood of having multiple serial partners. Confusion about HIV symptoms, stigmatization of HIV positive women and low risk perceptions, particularly among men, increased their risk behaviours.

To the best of the authors’ knowledge, this paper is the first to study the way of life, sexual behaviour and HIV knowledge and beliefs of Shan Migrants from Myanmar Living with HIV in Thailand.

In most countries, HIV and AIDS rates are higher among inmates than in the general population. As part of a series of studies aimed at examining the plausible links between HIV and incarceration in a State prison system in the United States (US), the present study examined pre‐incarceration sexual and injection drug use behaviours of inmates and their demographic correlates. Two‐hundred‐andsixteen female and 260 male inmates randomly selected from 17 Illinois State prisons completed a structured questionnaire. Findings indicate that the rate of inconsistent condom use with multiple anal and vaginal sexual partners among study participants ranged from 11 to 49%. Fourteen per cent of the women and 25% of the men reported ever injecting drugs, while 13% of the women and 7% of the men had ever shared needles. Demographic correlates of risk behaviours differed between gender and for specific behaviours. The findings indicate that persons entering prison generally exhibit risk behaviours that may increase their chances of acquiring HIV. Comprehensive HIV prevention programmes should be made available to inmates in US prisons and be accessible to them upon release. Studies are needed to examine how individual and structural factors interact to increase HIV and incarceration risk.

The purpose of this paper is to describe HIV-related risk behavior and knowledge of HIV among inmates of Kerobokan prison Bali, Indonesia.

A cross-sectional survey of inmates of using a structured questionnaire and sample framework to reflect narcotic use among inmates and the prison gender mix.

Among 230 inmates recruited to the study self-reported prevalence of injecting drug use was 7.4 percent (95 percent CI 4.0-10.8percent). Respondents who participated in a prison based methadone treatment program were all still injecting drugs, these made up 13/17 of the IDU. In total, 47 percent (95 percent CIs 45-55 percent) of respondents who reported injecting also reported sharing needles within the last week. Sexual intercourse while in prison was reported by 3.0 percent (95 percent CI 0.82-5.26 percent) of study respondents. One-third of non-injectors were unaware of the preventative role of condom use. This study suggests that despite harm reduction initiatives within Kerobokan prison HIV risk behavior continues and there is a considerable lack of awareness of the importance of condom use in preventing HIV.

The authors relied on self-reported risk behavior that may be subject to reporting bias. The sampling strategy may not reflect the true ratio inmates using or not using narcotics.

The current harm reduction approach, including methadone substitution treatment should be optimized within the Indonesian prison setting.

This is the first study reporting HIV-related risk behavior from an Indonesian prison with an established methadone substitution program.