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The incidence of the Human Immunodeficiency Virus (HIV) is highest in the southern states of the United States (US), with adolescents in this region being one of the most affected populations in the country. A limited amount of information is available on adolescent HIV risk behaviors in the southern states, specifically focusing on race and gender. The purpose of this study was to use the Centers for Disease Control and Prevention’s National Youth Risk Behaviors Survey (YRBS) for high school students in the southern states for 2011 and 2013 to examine the influence of race and gender on 1) early sexual initiation, 2) number of sexual partners, and 3) condom use. Descriptive statistics and multiple logistic regression was used for the analysis. A total of 6,244 (6.7%) students reported early sexual initiation, 13,121 (14.1%) reported having multiple sex partners, and 11,820 (41.1%) reported condom use in southern states for 2011 and 2013. Minority males were greater than 10 times more likely to engage in early sexual initiation compared to white females (OR-10.40; 95% Confidence Interval (CI)-9.03-11.98). Minorities and males were more likely to have multiple sex partners compared to whites and females (OR- 1.84; CI-1.73-1.95, OR-2.20; CI-2.07-2.34, respectively). Minority males were over 2 times more likely to use condoms compared to white females (OR-2.04; CI-1.87-2.23). There was a statistically significant association between the three sexual health behaviors and psychosocial factors, such as dating violence, forced sex, body weight perception, and substance use before sex. Gender and race along with psychosocial factors were associated with HIV risk behaviors for high school students in the southern states. These preliminary findings could potentially be used to target HIV/AIDS awareness and preventative actions to populations affected by the HIV burden in the southern states.

The purpose of the current study was to explore the relation between a culture specific theory of resiliency (TRIOS: Time, Rhythm, Improvisation, Oratory & Spirituality) and sexual health outcomes (Sexual Risk History, HIV Testing & Attitudes and Beliefs, Partner Information & Condom Self-Efficacy) among Black women. Participants were 124 Black women recruited from a larger sexual health intervention study. TRIOS was hypothesized to be correlated with outcomes and predict unique variance in outcomes beyond measures of Self-Esteem & Racial Identity. Time, Improvisation and Spirituality were hypothesized to uniquely predict limited sexual risk history, healthy HIV testing attitudes and beliefs, fewer risk indicators among sex partners, & higher condom self efficacy. The psychometric structure of TRIOS within the sample was examined. Tests included a Correlation Matrix, two sets of four Hierarchical Regressions and an Exploratory Factor Analysis. Correlations were found between TRIOS components and Sexual Risk History and Condom Self-Efficacy. Time and Improvisation uniquely predicted declines in Risky Sexual History. Rhythm uniquely predicted declines in Condom Self-Efficacy. Effects of Oratory were mixed. Methodological limitations and implications for interventions and future research were discussed.

Hispanic youth living in the U.S. share a disproportionate burden of risk for HIV, other STIs, and teen pregnancies. They also tend to report lower rates of condom use and higher rates of inconsistent condom use than other racial/ethnic groups. Furthermore, immigrant Hispanic adolescents experience a unique burden of sexual risk compared to their non-immigrant counterparts. These negative sexual health outcomes can severely derail the overall health, social mobility, and life opportunities of these adolescents. Social researchers have tried to explain these sexual risk disparities using the concept of immigrant acculturation, which is broadly defined as the process of adopting the cultural values and beliefs of a host society. Immigrant acculturation has been shown to play a key role in shaping youth attitudes and behaviors, including sexual risk behaviors (see Lee & Hahm, 2010). Yet, studies have largely overlooked the contextual components of acculturation that have been proposed in theoretical literature, specifically characteristics of the immigrant's receiving community. Furthermore, studies have not adequately explored the influence of acculturation on two crucial measures of sexual risk: teen pregnancy norms and condom use. Therefore, the current dissertation consists of two unique studies that examine the influence of acculturation, at both the individual and neighborhood level, on Hispanic adolescent teen pregnancy norms and condom use over time. The aim is to fill these important gaps in the literature and expand on earlier explanations of the relationship between cultural, place, and long-term sexual health. Both studies use nationally-representative data from the National Longitudinal Study of Adolescent to Adult Health. Overall, findings suggest an immigrant advantage for both teen pregnancy norms and condom use, although this advantage functions differently for males and females. Furthermore, the studies demonstrate the importance of including contextual measures of acculturation into studies related to Hispanic adolescent sexual health.

HIV infection is a significant public health concern, particularly among young men who have sex with men (YMSM). Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV infection among YMSM when taken as prescribed. However, there may be unintended behavioral consequences associated with PrEP initiation, with previous studies finding associations between PrEP use and increased sexual risk behaviors such as condomless anal sex (CAS). Further, problematic alcohol use, to which YMSM are particularly vulnerable, may also play a role in increasing sexual risk as engaging in sexual behaviors while under the influence of alcohol has been associated with CAS and other sexual risk behaviors. Previous literature has proposed risk compensation theory as a basis for this change in sexual risk behaviors following PrEP initiation. However, results have been mixed, and fewer studies have examined risk compensation specifically among YMSM or explored the role of alcohol-related sexual behaviors in this relationship. The present study aims to examine risk compensation theory as a mechanism for the relationship between PrEP initiation and alcohol-related sexual behaviors among YMSM. We hypothesized that the trajectory of PrEP initiation would be positively associated with alcohol-related sexual behaviors across 18 months. Consistent with hypothesis, a combined latent difference score and latent trajectory model revealed a positive association between PrEP initiation and alcohol-related sexual behaviors between baseline and 18-month follow-up in a sample of YMSM. These results are consistent with previous research identifying a high-risk period following PrEP initiation among an already vulnerable group (YMSM), with implications for risk assessment and interventions targeting alcohol-related sexual behaviors among YMSM. This study also highlights the role of alcohol use in increasing sexual risk following PrEP initiation. Findings may aid in reducing adverse sexual outcomes among YMSM who initiate PrEP and ultimately contribute to the minimization of sexual health disparities among YMSM.

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Two significant public health concerns that threaten both the physical and mental health of African-American women are Intimate Partner Violence (IPV) and Human Immunodeficiency Virus (HIV). African-American women (AAW) in the south carry the greatest burden of HIV and disproportionately represent the region with an incidence of 71% for new HIV infections, and elevated rates of morbidity and mortality. In 2013, the murder rate among AAW was 2.5 times higher than it was among Caucasian women. Most of the published studies that explored the association between IPV and HIV had mixed populations, did not explore topics unique to AAs, or were qualitative studies. The aim of this study was to assess the associations between colorism, IPV, and high-risk sexual behaviors (HRSB)/HIV-risk among AAW and determine if colorism was a mediator in the IPV-HRSB relationship. The theory of power and gender and the social cognitive theory provided the theoretical framework of this study. The dissemination of this self-assessed quantitative, cross-sectional survey design was to a homogeneous sample of 143 women. The analysis of the variables used correlation statistics and linear regression. Findings revealed a significant relationship between IPV-HRSB (r = .882, p =.001), colorism-IPV (r2 = .371, p = .001) and colorism-HRSB (r = .377, p = .001); however, colorism did not mediate the IPV-HRSB relationship. This study has implications for positive social change in that practitioners may gain a better understanding of colorism's influence on IPV and HRSB, and may serve to modify existing programs. This knowledge may subsequently help to decrease adverse behaviors that are unique to AAW prone to IPV with an increased HIV-risk as a result of colorism.

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