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The purpose of this paper is to examine patterns of drug use among a cohort of drug treatment-seeking drug-using gay men and other men who have sex with men (MSM), and whether these activities differ between, or predict, HIV status.

Cross-sectional study was conducted in a specialist club drug clinic in London covering 407 consecutive attendees who identified as MSM. Substance use, including injecting drug use (IDU), associated sexual activity and self-reported HIV status were measured by clinical interview and National Drug Treatment Monitoring System data tool.

Over a 45-month period, 407 MSM attended the clinic. In total, 62.1 per cent were HIV positive, 48.9 per cent had injected drugs, 14.9 per cent reported needle sharing and 73.3 per cent used drugs to facilitate sex. The most commonly reported problem drugs were GHB/GBL (54.3 per cent) methamphetamine (47.7 per cent) and mephedrone (37.8 per cent). HIV status was associated with methamphetamine, mephedrone, IDU, sharing equipment, using drugs to facilitate sex, older age and older age of drug initiation, as well as Hepatitis C virology (HCV) status. Use of methamphetamine, HCV infection, older age and IDU predicted HIV positive status in a logistic regression model.

The findings describe a constellation of risk factors including high levels of IDU, sharing of equipment and high-risk sexual activity in a population with high rates of HIV positive serology. They also provide further evidence for a link between HIV infection and use of methamphetamine.

The authors suggest a need for greater awareness of HIV-related risk activities and promotion of HIV prevention strategies for MSM by both sexual health and drug treatment services.

This paper is amongst the very first studies of its nature.

The behavior of British youth abroad has caused considerable concern over recent years. This is because many British youth engage in binge drinking, drug use, sex behavior and other risk behaviors – especially in the Balearics, Spain. While research has documented levels of alcohol use, drug use, risk and sex behaviors on these islands, it tends to rely on survey data. This article aims to offer some contextualization to the British youth holiday experience and to examine why such behaviors might take place.

The study uses ethnographic methods (observation, open‐ended focus groups) with British youth in San Antonio, Ibiza. Over the course of one week in July 2010, 17 focus groups were undertaken (n=97 aged between 17 and 31). Observations were conducted in bars, clubs, beaches, and general tourist areas.

The data suggest that young people engage in these behaviors not only to escape the constraints of work and family but also because they are exciting. The data also indicate that these behaviors appeared to help British youth construct life biographies which were integral to their identity construction. The findings are also considered within the social context of Ibiza which also played a role in promoting these behaviors.

No ethnographic research exists on the topic of British youth and their behaviors abroad. Previous research is mostly epidemiological survey research which does not adequately consider the social meaning and context for the behavior of British youth abroad.

This study explored the effectiveness of sex education lessons developed for six graders by the local community and experts.

Three lesson plans were developed based on a focus group discussion with students, parents, and teachers and then revised based on experts' feedback. The finalized three lessons were taught to 102 sixth graders in three different primary schools. Pre-test and post-test the students' sex education understanding was measured, and a 5-point Likert scale questionnaire was used to measure overall sexual attitude and awareness. The participants engaged in a semi-structured interview after each lesson, supplemented with researchers' notes. Descriptive statistics and t-tests, and the comparative method were used to analyze quantitative and qualitative data, respectively.

The sex education knowledge of participants at the three schools improved significantly (p < 0.01) after completing the learning units. Students also expressed satisfaction with the media, activities, and discussions during these sex education classes. The created learning units improved students' sexual attitude and awareness.

Further long-term follow-up studies are needed to determine if there is retention of knowledge, attitudes, and awareness.

There should be more sex education programs at the earlier primary school level, especially in risky regions. Compulsory sex education curriculum in primary schools needs to be adjusted for each school by using a constructivist approach.

This study is unique because it was designed to better fit a specific school’s context and the contents were adapted to be taught by a teacher with minimal training required.

Amid widespread social and cultural shifts and advocacy toward lesbian, gay, bisexual, and transgender (LGBT) rights remain a hidden population of homeless adolescents who are cast out from families and communities because of their sexual and gender orientation. The result is an over-representation of LGBT adolescents among the homeless in the United States. The purpose of this paper is to provide a review of literature and research which explores the status and needs of LGBT homeless adolescents in the United States.

To understand the experiences of LGBT adolescents leading up to and during homelessness, I provide a thematic and critical review of four decades of research to connect our understanding of the LGBT homeless experience with institutional and collective efforts that work to promote their well-being.

Bringing together this body of literature, I explore four interrelated questions. First, has the rate of homelessness increased for LGBT adolescents in recent decades? Second, what is the experience of LGBT adolescents who become homeless? Third, what role does advocacy and support play in ameliorating the difficulties these young people face? Finally, what role can future research and policy play in shaping the well-being of LGBT adolescents who become homeless?

Understanding the experience of homeless LGBT adolescents and the collective advocacy efforts designed to promote their well-being offers insight into the intersection of symbolic, inter-personal, and institutional forces which shape their trajectories.

Brazil’s street-based drug use is mostly characterized by non-injection psychostimulant (e.g. crack-cocaine) drug use in Brazil, with limited interventions and service availability. Recently, an influx of multi-ethnic migrants within an urban drug scene in Sao Paulo was associated with heroin use, a drug normatively absent from Brazil. The purpose of this paper is to characterize and compare heroin use-related characteristics and outcomes for an attending sub-sample of clients from a large community-based treatment centre (“CRATOD”) serving Sao Paulo’s local urban drug scene.

All non-Brazilian patients (n = 109) receiving services at CRATOD for 2013–2016 were identified from patient files, divided into heroin users (n = 40) and non-heroin users (n = 69). Based on chart reviews, select socio-demographic, drug use and health status (including blood-borne-virus and other infections per rapid test methods) were examined and bi-variately compared. Multi-variate analyses examined factors independently associated with heroin use.

Most participants were male and middle-aged, poly-drug users and socio-economically marginalized. While heroin users primarily originated from Africa, they reported significantly more criminal histories, drug (e.g. injection) and sex-risk behaviors and elevated rates of BBV (e.g. Hepatitis C Virus and HIV). A minority of heroin users attending the clinic was provided methadone treatment, mostly for detoxification.

This study documented information on a distinct sample of mostly migration-based heroin users in Sao Paulo, Brazil. Based on the local experience, global migration dynamics can bring changes to established drug use cultures and services, including new challenges for drug use-related related behaviors and therapeutic interventions that require effective understanding and addressing.

There is an immense public health concern about the effects of binge drinking across the Western world, in particular about British youth on holiday abroad. While existing UK research has shed some light on binge drinking and its consequences, this has largely been restricted to surveys. Therefore, an analysis of the social context of British youth and binge drinking abroad currently remains absent. This article attempts to fill that gap by offering an insight into the social context of binge drinking in a holiday resort in Ibiza. It is based on ethnographic fieldwork and makes use of one field note to highlight what Hunt and colleagues (2010) refer to as ‘important relationships between youth, pleasure and context’, to explore the social interactions of binge‐drinking British youth abroad.

The purpose of this paper is to explore incarcerated women's awareness, beliefs, and experiences with human papillomavirus (HPV) infection and vaccination.

Researchers conducted focus groups with 45 incarcerated women in an urban Midwestern US jail to assess how women talked about their Papanicolaou (Pap) test screening and abnormal Pap test follow-up experiences. Some focus group questions specifically assessed individual awareness, beliefs, and experiences with HPV infection and vaccination. Based on these data, the authors described participants’ awareness of HPV, as well as used open coding to ultimately extract themes related to beliefs and experiences with HPV infection and vaccine.

While all 45 participants reported experiencing an abnormal Pap test event within the last five years, only two-thirds of participants (n=30) reported having heard of the HPV infection. Several themes emerged from the analysis of the data: the women's beliefs about cause and severity of HPV; frustration with age requirements of the vaccine; varied experiences with vaccinations for themselves and their children; the impact of media exposure on knowledge; and desire for more HPV infection and vaccine information.

Incarcerated women's awareness and limited experiences with HPV infection and vaccination may be a barrier to adequate screening and cervical cancer prevention. This study has implications for the development of cervical health education for this high-risk group of women, who are four to five times as likely to have cervical cancer as non-incarcerated women.

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.

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.