In Eastern and Southern Africa (ESA), there is heterogeneity within adolescent mothers’ (AMs’) sexual relationships. However, existing studies focus on single relationship characteristics, even though these characteristics do not operate in isolation. Moreover, no studies have examined multilevel predictors of AMs’ relationships. Identifying and characterizing typologies by multilevel factors can inform targeted interventions to lower HIV risk. Data are from the Population-based HIV impact Assessment (PHIA) Project on AMs (15–19 years) from 9 ESA countries (N = 2,761). We conducted multilevel latent class analysis to identify relationship typologies at the AM and community (PHIA cluster) levels, multinomial logistic regression to characterize typologies by multilevel predictors, and multivariable generalized estimating equations (GEE) log-binomial regression to calculate prevalence ratios of HIV for relationship typologies. There were 3 typologies: married with minimal transactional sex (61

PURPOSE:Academic physicians play an essential role in training the next generation of physicians and delivering care. However, few empirical studies compare academic and nonacademic physicians. This exploratory study examined differences in demographic and training characteristics, work patterns, and COVID-19 work effects. METHOD:Data from the Association of American Medical Colleges' 2022 National Sample Survey of Physicians were collected from May to November 2022 and analyzed. US academic physicians were classified using 2 definitions: (1) academic affiliation (faculty appointment at a medical school or affiliation with an academic health center or teaching hospital) and (2) faculty appointment at a medical school. Three domains were examined: (1) demographic and training characteristics, (2) work patterns, and (3) COVID-19 work effects. RESULTS:Among 5,834 physicians, 2,659 (45.6%) were academically affiliated physicians and 2,028 (34.8%) were physicians with a faculty appointment. Minimal differences in demographics and training background exist. More academically affiliated physicians were moderate telehealth users (1,011 [38.0%] vs 1,002 [31.6%]; P < .001), worked with physician assistants (1,228 [46.2%] vs 1,275 [40.2%]; P < .001) and nurse practitioners (1,386 [52.1%] vs 1,300 [41.0%]; P < .001), cared for a higher proportion of Medicaid patients (mean [SD], 18.2 [17.9] vs 14.1 [15.9]; P < .001), and had practice zip code that had higher unmet needs scores (mean [SD], 48.9 [21.5] vs 45.5 [20.9]; P < .001) compared with nonacademically affiliated physicians. Furthermore, academically affiliated physicians reported fewer COVID-19-related impacts on their work status (444 [16.7%] vs 674 [21.2%]; P < .001). Results were similar for physicians with faculty appointments. CONCLUSIONS:Differences in work patterns and patient populations distinguish academic from nonacademic physicians. Findings highlight the unique contributions and practice models of academic physicians and can inform tailored strategies to support physicians' well-being, optimize care delivery, and guide workforce planning.

Adolescents are the future leaders of our world. Ensuring their health and wellbeing-now and in the future-is one of the strongest mechanisms available to safeguard the collective future of humanity and to secure a more just society and a healthier and more productive planet. Investments in the current generation of 10-24-year-olds will reap a triple dividend, with benefits for young people today, the adults they will become, and the next generation of children they will parent. These potential benefits are particularly relevant for Africa and Asia, where around 82% of the world's adolescents currently live, a proportion that is projected to rise to 85% by 2100.

Of the three Intersectional Discrimination Index (InDI) scales, only the anticipated discrimination measure (InDI-A) has been subjected to factorial analysis to date. This study expands upon such evaluation by assessing the internal validity of the lifetime day-to-day (InDI-D) and major discrimination (InDI-M) scales, in addition to further examining the anticipated discrimination measure. For each InDI scale, administered to diverse Canadian (n = 1,065) and U.S. (n = 1,518) samples in 2016, we determined the number of underlying factors, estimated item loadings, and assessed residual correlations. We also examined the correlation between the InDI-D and InDI-M, and the degree to which the three InDI measures are invariant across Canada and the United States. We show that the InDI is characterized by three good-fitting unidimensional measures, moderate to strong loadings, and five pairs of potentially redundant items. There is considerable but not excessive overlap between the InDI-D and InDI-M, and estimates of anticipated, day-to-day, and major discrimination are invariant across countries. Given these findings, we suggest that the InDI measures have good internal validity both in Canada and the United States. To further develop the scales, future studies should evaluate their scalar properties and external validity concerning health. Additionally, these studies should determine whether the measures provide discrimination estimates that are meaningfully comparable across groups at the intersections of different social statuses and positions.

Globally, adolescent mothers are at increased risk for postpartum depression (PPD). In Kenya, 15

Introduction: Cash transfers can reduce adolescent girls and young women's (AGYW) risk of intimate partner violence (IPV). In our own cash transfer intervention (HPTN 068), AGYW who received a cash transfer were less likely to experience IPV than non -recipients, in part because the cash reduced their engagement in sexual partnerships. This mixed -methods study builds on earlier findings to examine whether the protective effects were sustained after the cash ended and when the cash transfer was the most impactful. Methods: HPTN 068 was an experimental HIV prevention intervention trial. AGYW who participated completed 3 annual surveys during the intervention and an additional survey 2.5 years post -intervention. We used log -binomial regression models to assess the durability of the cash transfer on outcomes and included an interaction term in models to examine when effects were largest. We analyzed qualitative interviews conducted after the cash ended to contextualize findings. Results: Post -intervention, the relative risk of physical IPV was lower among AGYW who received it compared to those who did not, but not statistically significant (RR: 0.83, 95% CI: 0.62, 1.10). AGYW who received the cash transfer also had a lower relative risk of ever having had sex and of having any sexual partner in the last 12 months (RR: 0.94, 95% CI: 0.88, 1.01; RR: 0.94; 95% CI: 0.88, 0.99, respectively). The protective effect of the cash transfer on physical IPV was highest in Years 1 and 2 (RR: 0.64; 95% CI: 0.55-0.75 and RR: 0.65; 95% CI: 0.55-0.77, respectively). Qualitative data corroborated the quantitative findings. Conclusion: The cash transfer reduced AGYW's risk of IPV, though effects were attenuated after the cash ended. Provision of cash during adolescence - a period when AGYW are highly susceptible to IPV and HIV - may empower them in their current relationship and yield long term health benefits.

Background Adolescent girls in Africa have poorer maternal health outcomes than older women partly because they are less likely to access antenatal and facility-based delivery care. Mistreatment and abuse of adolescents during facility-based childbirth can further negatively impact their use of maternal healthcare services. Yet studies on this topic are limited. As a result, patterns of mistreatment and abuse, their association with care satisfaction, and the intention to use health facilities for future births or recommend facilities to others are poorly understood. This study estimates the prevalence of mistreatment and abuse of adolescent girls during facility-based childbirth in low-income settlements in an urban area. It also examines whether experiencing mistreatment and abuse during facility-based childbirth is associated with care satisfaction, willingness to recommend the facility to others, and intention to use the facility for subsequent childbirths.Methods We used cross-sectional data collected from 491 adolescent mothers recruited through a household listing in an informal settlement in Nairobi, Kenya. Girls self-reported their experience of physical and verbal abuse, stigma and discrimination, lack of privacy, detainment (baby or mother detained in the clinic due to inability to pay user fees), neglect and abandonment during childbirth. Descriptive statistics were used to summarise the categorical variables while binary logistic regression models were used to examine the association between experience of mistreatment and abuse and care satisfaction, willingness to recommend the facility to others and intention to use the facility for subsequent childbirths.Results About one-third of adolescent mothers (32.2%) reported physical abuse, verbal abuse or stigma and discrimination from health providers. 1 in 10 reported neglect and abandonment during childbirth, and about a quarter (24%) reported a lack of privacy. Detainment was reported by approximately 17% of girls. Report of any physical abuse, verbal abuse, and stigma and discrimination was significantly associated with a lower likelihood of satisfaction with care (Adjusted Odds ration (AOR) 0.24; 95% CI 0.15 to 0.38), intention to use the facility for future births (AOR 0.32; 95% CI 0.22 to 0.48) and willingness to recommend the facility to others (AOR 0.23; 95% CI 0.15 to 0.36). Neglect and abandonment during childbirth, and lack of privacy were significantly associated with lower odds of being satisfied with the care, intention to use the facility for future births, and the willingness to recommend the facility to others. Experience of detention was associated with a lower likelihood of intention to use the facility for future births (AOR 0.55; 95% CI 0.34 to 90), but not with the willingness to recommend the facility to others or overall satisfaction with care.Conclusions Mistreatment and abuse of adolescent girls during childbirth are common in the study setting and are associated with lower levels of satisfaction with care, intention to use the facility for future births, or recommend it to others. Preservice and in-service training of health workers in the study setting should address the need for respectful care for adolescents.

Background It is estimated that 38.8% of mothers develop postpartum depression (PPD) in South Africa. While empirical evidence documents an association between intimate partner violence (IPV) victimization in pregnancy and PPD among adult women, the association has been underexamined among adolescent mothers (< 19 years). The study’s purpose is to examine whether IPV victimization during pregnancy is associated with PPD among adolescent mothers. Methods Adolescent mothers (14–19 years) were recruited at a regional hospital’s maternity ward in KwaZulu Natal, South Africa between July 2017-April 2018. Participants completed behavioral assessments at two visits (n = 90): baseline (up to 4 weeks postpartum) and follow-up (6–9 weeks postpartum, when PPD is typically assessed). The WHO modified conflict tactics scale was used to create a binary measure of any physical and/or psychological IPV victimization that occurred during pregnancy. Participants with scores ≥ 13 on the Edinburgh Postpartum Depression Scale (EPDS) were classified as having symptoms of PPD. We used a modified Poisson regression with robust standard errors to assess PPD in association with IPV victimization during pregnancy, controlling for relevant covariates. Results Nearly one-half (47%) of adolescent mothers reported symptoms of PPD by 6–9 weeks post-delivery. Further, IPV victimization during pregnancy was highly prevalent (40%). Adolescent mothers who reported IPV victimization during pregnancy had marginally higher risk of PPD at follow-up (RR: 1.50, 95 CI: 0.97–2.31; p = 0.07). The association was strengthened and significant in covariate-adjusted analysis (RR: 1.62, 95 CI: 1.06–2.49; p = 0.03). Conclusions Poor mental health was common among adolescent mothers, and IPV victimization during pregnancy was associated with PPD risk among adolescent mothers. Implementing IPV and PPD routine screenings during the perinatal period may aid in identifying adolescent mothers for IPV and PPD interventions and treatment. With the high prevalence of IPV and PPD in this vulnerable population and the potential negative impact on maternal and infant outcomes, interventions to reduce IPV and PPD are needed to improve adolescent mothers’ well-being and their baby’s health.

Purpose: Adolescent girls (10-19 years) in Eastern and Southern Africa face a high risk of pregnancy and HIV infection. However, few studies have examined whether the profound developmental, social, and economic changes that accompany adolescent motherhood contribute to HIV risk. This study examines the intersection between adolescent motherhood and HIV infection across 10 Eastern and Southern African countries, where over half of all HIV infections occur among adolescent girls. Methods: To evaluate whether adolescent motherhood is associated with HIV infection, we used Demographic and Health Survey data on girls (15-19 years) with HIV test results (N 1/4 19,932) from Eswatini, Kenya, Lesotho, Malawi, Mozambique, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. We examined unweighted bivariate and multivariable associations between adolescent motherhood and HIV using mixed effects logistic regression models that included a country-level random intercept. We examined heterogeneity in the association by testing country-level random slopes using a likelihood ratio test and used intraclass correlation to measure the proportion of total variance explained at the country level. Results: Nearly one fifth of adolescent girls were mothers (range: 9.80%-38.90%), and the HIV prevalence among all adolescent girls was 3.3% (range: 1.03%-10.07%). Relative to nonmothers, adolescent mothers were, on average, older, poorer, and more likely to be married, rural dwellers, and household heads. Adolescent motherhood was positively associated with HIV infection in bivariate and multivariable analyses (odds ratio: 1.87; 95% confidence interval: 1.57-2.23; adjusted odds ratio: 1.53; 95% CI: 1.24-1.89). Discussion: Among adolescents with HIV test results, we observed a robust association between adolescent motherhood and HIV infection across 10 high-burden countries. (C) 2021 Published by Elsevier Inc. on behalf of Society for Adolescent Health and Medicine.

HIV incidence rates in South Africa are extremely high, particularly postpartum. However, there is limited knowledge of women's HIV risk behavior postpartum. Women in age-disparate relationships may be less able to negotiate safe sex postpartum than women whose partners are similar ages because they have less relationship power. The study's purpose is to test whether being in an age-disparate relationship predicts postpartum unsafe sex and to explore relationship control and intimate partner violence (IPV) as explanatory mechanisms. Data are obtained from 516 HIV-negative participants who completed a survey during pregnancy and at 14 weeks postpartum as part of a longitudinal study in Durban. Age variables, relationship control, and IPV during pregnancy were included in a multivariate model predicting unsafe sex postpartum. We also assessed whether the hypothesized mediators explained the association between being in an age-disparate relationship and unsafe sex postpartum by using indirect effect analysis with bootstrapping. Women's mean age was 24.34 years (range = 18.03-45.36); the mean difference in ages in relationships was 3.19 years (range = -6.1 to 30.1). More than a quarter reported unsafe sex postpartum (27%). Age-disparate relationship, lower relationship control, and higher IPV were each longitudinally associated with unsafe sex. Relationship control, but not IPV, mediated the association between age-disparate relationship and unsafe sex (indirect effect [B] = 0.01, 95% confidence interval [CI] = [0.0002, 0.0283]). Age disparity, relationship control, and IPV all contributed to unsafe sex postpartum. Interventions that reduce the formation of age-disparate relationships and increase women's relationship power in pregnancy are needed to reduce women's HIV risk in the postpartum period.

BACKGROUND:State legislators make policy decisions that influence children's exposure to adverse childhood experiences (ACEs), such as child maltreatment, and their effects on behavioral health. Effective dissemination of scientific research can increase the likelihood that legislators' decisions are aligned with evidence to prevent ACEs and their consequences, and effective dissemination requires legislators to engage with dissemination materials. Informed by the elaboration likelihood model of persuasive communication and Brownson's Model of Dissemination Research, we tested the hypothesis that inclusion of economic evidence and local data would increase legislator engagement with dissemination materials about evidence-supported policies related to ACEs and behavioral health.METHODS:A three-arm randomized dissemination trial was conducted. A university researcher e-mailed dissemination materials which contained evidence about ACEs and behavioral health problems to state legislators (two e-mails sent 2 weeks apart, 12,662 e-mails delivered to 6509 legislators). The e-mail subject lines, text, and policy brief content were manipulated across the study arms. The intervention condition received state-tailored data about rates of ACEs and state-tailored economic evidence about the costs of ACEs for public systems, the enhanced control condition received state-tailored data and not economic evidence, and the control condition received national data and not economic evidence. Outcomes were rates of e-mail views, policy brief link clicks, requests for researcher consultation, and mentions of child maltreatment terms in legislators' social media posts.RESULTS:For the first e-mail, the e-mail view rate was 42.6% higher in the intervention than in the enhanced control condition (22.8% vs. 14.8%) and 20.8% higher than in the control condition (22.8% vs. 18.5%) (both p < .0001). Similar results were observed for the second e-mail. These differences remained significant after adjustment for demographic differences across study conditions in individual-level models, but not multilevel models. There was a significant interaction between the experimental condition and political party (p < .0001) in which the intervention increased e-mail view rates among Democrats but not Republicans. The intervention had no effect on policy brief link clicks or requests for consultation and a mixed effect on social media posts.CONCLUSIONS:Inclusion of state-tailored economic evidence in dissemination materials can increase engagement with research evidence among Democrat, but not Republican, legislators. Dissemination strategies tailored for legislators' political party affiliation may be needed.

Up to two-thirds of South African adolescent mothers drop out of school, which increases their HIV risk and other poor health outcomes. Despite variability in adolescent mothers' schooling trajectories, we have a limited understanding of their re-enrollment in school following the life-changing circumstance of childbirth. In this paper, we draw on qualitative interviews (n = 16) and quantitative surveys (n = 109) with adolescent mothers (aged 14-19) who had recently given birth to describe how access to individual and social resources contributes to their resilience following childbirth and thus affects their ability to re-enroll in school. Nearly all the adolescent mothers in our study expressed a desire to return to school, and most of their families also emotionally supported adolescent mothers in these goals. Despite mothers' high hopes and familial emotional support, only half of the adolescent mothers re-enrolled in the first six months following childbirth. Adolescent mothers' re-entry trajectories were strongly affected by institutional support and by family members' provision of instrumental support. To a lesser extent, support from partners and peers also played a role in re-enrollment. Multilevel interventions to maximise resilience following the onset of early motherhood may facilitate return to school and positively influence adolescent mothers' health and well-being.

Over 2 million renters in the United States are legally evicted annually, and even more renters experience other landlord-related forced moves each year. While past research has documented an association between legal eviction and HIV risk, no studies have examined the relationship between forced moves and sexual partnership dynamics longitudinally, or the pathways through which forced moves impact such risk. Addressing this gap is imperative, particularly given inequities that place Black renters and women at disproportionate risk of eviction. This study leverages data from a longitudinal cohort study of 282 adults in New Haven to examine whether landlord-related forced moves reported at baseline (including, but not limited to, legal eviction) is associated with HIV sexual risk reported six months later. We use bootstrapped path analyses to examine intimate partner violence (IPV) victimization and perpetration as potential mediators. One-fifth of participants (21.2%) had experienced a landlord-related forced move at baseline. At follow up, nearly two-thirds (63.8%) reported at least one HIV sexual risk factor, one in seven (14.2%) reported IPV victimization, and one in ten (10.3%) reported IPV perpetration. Individuals who reported landlord-related forced moves were more likely to report IPV victimization (standardized beta = 0.19, SE = 0.08, p = .02) and IPV perpetration (beta = 0.25, SE = 0.09, p = .003). Both IPV victimization and perpetration mediated the association between landlord-related forced moves and HIV sexual risk (indirect victimization effect, beta = 0.09, SE = 0.05, p = .06; indirect perpetration effect, beta = 0.16, SE = 0.07, p = .02), though IPV victimization was only marginally significant. In conclusion, IPV is itself a negative consequence of forced moves that also contributes to other negative health effects, like HIV risk. Therefore, providers should offer violence screening and referral for clients who have recently faced a forced move. Simultaneously, policy-level solutions to prevent eviction and increase housing affordability are urgently needed to address the rising burden - and inequitable distribution - of evictions among low-income renters.

Adolescents fare worse on the HIV prevention and treatment cascade than adults.[1,2] This disparity may be particularly acute for adolescent minors (i.e. <18 years of age).[3] Current trends show that adolescents, and especially adolescent minors, are a particularly vulnerable population with specific needs that are currently unmet. The under-representation of adolescent minors (especially unemancipated individuals) in HIV research negatively affects the development and evaluation of interventions to improve their health. [4-6] Despite growing consensus regarding the value of conducting HIV research with adolescent minors,[7-9] concerns about perceived barriers to enrolling them persist. Specifically, researchers and adolescent minors in studies have voiced concerns that requiring parental consent might affect adolescent minors’ autonomy and/or confidentiality.[5,10-15] Despite these findings on adolescents’ perceptions of parental consent, no quantitative studies have evaluated whether parental consent negatively affects adolescent minors’ participation in HIV research. In addition, there are scant details describing the consent processes for enrolling adolescent minors into HIV studies.[5,16-18] In this commentary, we describe strategies used to obtain parental consent for adolescent mothers to participate in an HIV prevention intervention and evaluate whether there were differences in enrolment rates of older adolescents compared with adolescent minors, who needed parental consent for study enrolment. We conducted the Mentoring Adolescent Mothers in School (MAMAS) study, a pilot HIV prevention intervention to promote postpartum return to school among adolescent mothers (aged 14 19 years) in Umlazi, a township near Durban, South Africa (SA). Mothers were screened for eligibility at a public hospital maternity ward between July 2017 and April 2018. Parental consent was sought for adolescent minors, with the minor’s permission. In the absence of a parent, a court-appointed guardian could provide consent. Informed consent and/or assent were obtained at the research site (on the hospital grounds) or at home. All adolescents (and parents/guardians of minors) were required to sign consent/assent forms. MAMAS staff implemented three strategies to solicit parental consent. First, staff leveraged the fact that a parent/guardian had to be with the adolescent mother when she was discharged from the hospital. Specifically, staff approached the parent/guardian after discharge activities to describe the intervention, share study materials and solicit parental consent. Second, if the parent/guardian could not stay, staff offered to provide transport after discharge activities to explain the study on the ride home. Lastly, staff also provided flexible clinic hours for the parent/guardian to complete the informed consent process. To address concerns of confidentiality, adolescents (and parents/guardians of minors) were informed during the consent process that collected data would not be disclosed to their parents/guardians, with exceptions per SA laws.[19] Of 464 screened adolescent mothers, 138 were eligible: 57 were adolescent minors (aged 14 17 years) and 81 were older adolescents (aged 18 19). Of eligible participants, 87% (120/138) enrolled in the study: 52 adolescent minors and 68 older adolescents. There was no statistical difference in enrolment rates between adolescent minors and older adolescents (91% (95% CI 81 97) v. 84% (95% CI 74 91), respectively; p=0.31). Our finding that parental consent did not negatively affect enrolment is consistent with studies in other African contexts, wherein some adolescents did not perceive parental consent as a barrier to participation.[15,20,21] Conversely, findings contradict other studies that have explored adolescents’ perceptions on how parental consent might affect their participation in an HIV research study. Adolescent minors in these studies have mentioned the following perceived barriers to participation: parental access to sensitive health information, potential disapproval, and interpretation of their participation as being sexually active or LGBTQ.[10-12,15] The findings and variation in perceptions of consent in existing literature serve as a reminder that adolescent minors comprise a heterogeneous population; soliciting parental consent may therefore differ based on contextual factors. It is possible that obtaining parental consent did not affect adolescent mothers’ participation, because their parents were aware that they were sexually active, given that they had recently been pregnant. However, parental consent may be more difficult to obtain for other groups of adolescents (e.g. sexually active nulliparous or sexual minority), owing to fear of being ostracised by peers or reprimanded by their parents.[5] Furthermore, parental consent may be more difficult to obtain in HIV research studies where the intervention outcome is not education, but is tied to more stigmatised outcomes (e.g. pre-exposure prophylaxis adherence, sexually transmitted infection incidence and/or HIV status). Future research should quantitatively examine differences in participation in intervention studies with explicit HIV-related outcomes among other groups of adolescents. The implementation of appropriate and feasible recruitment and enrolment strategies may be beneficial to the enrolment of adolescent minors in HIV research studies. First, conducting formative research with the target population to determine and implement the most appropriate recruitment strategies[16] could make adolescent minors more comfortable with parental involvement in the consent process. Second, involving other adolescents via social networks may enhance recruitment,[17] while conducting community outreach will improve community buy-in and ensure that parents are on board.[18] Lastly, differentiating between confidential and non-confidential data during the consent process will help adolescent minors understand the parameters of their rights to privacy.[18] Parent-involved enrolment strategies may also maximise adolescent retention. Although involving the parent/guardian was not required for older adolescents (>18 years), MAMAS staff attempted to contact their parents/guardians to share study procedures (with the adolescent’s consent). In-depth interviews with staff revealed that research assistants felt that older adolescents whose parents/ guardians were informed had better retention than those whose parents/guardians could not be reached. This is particularly relevant in countries other than SA which consider adolescent minor mothers to be emanicipated minors who therefore do not require parental consent for study participation. Involving parents/guardians by obtaining their consent and/or simply describing the intervention to them could be beneficial in the uptake of and retention in HIV research among all adolescents. This could also be examined quantitatively in future studies. Our study suggests that soliciting parental consent was not a barrier to adolescent minor mother enrolment in HIV prevention research. Although parental involvement in HIV research may be a concern for some adolescent minors, implementing feasible and accessible enrolment and recruitment strategies may minimise This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

The policies of U.S. local public housing authorities influence which populations have access to stable housing, an important resource for health. We assessed whether the restrictiveness of local public housing authority policies related to people with criminal justice histories-a population at high risk for HIV/STIs-were associated with HIV/STI rates at the local-level. An ecological analysis was conducted using data from 107 local public housing authority jurisdictions. The independent variable was a score that quantified the presence/absence of eight policies related to the ability of people with criminal justice histories to obtain and retain public housing. The dependent variables were county-level rates of HIV, gonorrhea, syphilis, and chlamydia. Ordinary least squares regression with state fixed effects was used. We find that the restrictiveness of housing authority policies towards people with criminal justice histories were significantly associated with higher HIV and gonorrhea rates, but not syphilis or chlamydia. For example, local housing authorities with a policy score more restrictive than the median score had an additional 6.05 cases of HIV per 100,000 population (32.9% increase relative to the mean rate) and 84.61 cases of newly diagnosed gonorrhea (41.3% increase). Local public housing authority policies related to people with criminal justice histories could affect HIV/STI risk at the population-level. These policies should be considered in studies and interventions at the intersection of housing, health, and justice involved populations.

Objectives. To quantify variation in the restrictiveness of local public housing authority policies related to the admission and eviction of people with criminal justice histories.Methods. We conducted content analysis of housing authority policy documents for US cities with a population of 100 000 or more (n = 152). Factor analysis identified policy provisions to create a restrictiveness score (range = 0-8). We explored associations between restrictiveness scores and city-level measures of racial/ethnic diversity, racial/ethnic neighborhood segregation, ideology, and public housing scarcity.Results. Eight policy provisions, 6 relating to consideration of mitigating circumstances, explained 71.0% of the variance in housing authority policy provisions related to criminal justice histories. We observed small but significant positive associations between restrictiveness scores and racial/ethnic diversity (r = 0.22) and neighborhood segregation (r = 0.18). There was no correlation between restrictiveness scores of housing authorities within the same state (intraclass correlation = 0.0002).Conclusions. Housing authority policies vary substantially regarding the circumstances under which people with criminal justice histories can obtain and retain public housing. Exposure to constellations of policy provisions that might institutionalize health inequities and increase health risk among people with criminal justice histories can be quantified through a systematic process.

Women, and specifically, adolescents, are at high risk of HIV and STIs during the postpartum period. Biological and behavioral factors contribute to adolescents' susceptibility. However, the influence of behavioral factors, like intimate partner violence (IPV), on postpartum STI acquisition has been understudied. The study's purpose is to determine whether IPV victimization during pregnancy predicts incident STIs in the first 6 months postpartum. Adolescent mothers (14-19 years) were recruited at a township hospital's maternity ward near Durban. Adolescent mothers who were HIV-negative and had no laboratory-diagnosed STIs at baseline (6 weeks postpartum) were included in the analysis (n = 61). We used a modified Poisson regression with robust standard errors to assess differences in postpartum STI risk by IPV victimization during pregnancy controlling for covariates. At baseline, 25 (41%) adolescent mothers reported IPV victimization during pregnancy. Adolescent mothers who reported IPV during pregnancy were at higher risk of receiving an STI diagnoses at 6 months postpartum (aRR: 4.43; 95% CI: 1.31-14.97). Our findings heighten understanding of HIV risk among a vulnerable subset of adolescent girls: adolescent mothers. Non-combined interventions that help young mothers and their partners navigate partnership dynamics to reduce IPV and STIs are needed to reduce HIV risk.

Purpose: The aim of the study was to characterize sexual relationships in pregnancy and HIV risk behavior in the first 14 weeks postpartum among adolescent (aged <18 years), young adult (aged 18-24 years), and adult women (>24 years). Methods: We use bivariate and multivariate statistical tests to describe differences across adolescent (n = 29), young adult (n = 263), and adult women (n = 207). Results: In pregnancy, adolescents were in significantly less stable relationships and had higher risk partners than young adult or adult women. At 14 weeks postpartum, adolescents were significantly more likely to think their partners were having concurrent relationships since delivery and were likely to have lower relationship power than adult women. Furthermore, young adults were significantly more likely to return to sex and report physical intimate partner violence in the first 14 weeks postpartum than adult women. Conclusions: Adolescent mothers may benefit from interventions that promote empowerment and the development of healthy relationship skills. Young adult women may benefit from interventions to delay early postpartum engagement in unprotected sex and prevent intimate partner violence exposure. All women, regardless of age group, may benefit from interventions that increase access to pre-exposure prophylaxis and partner's access to HIV testing during the perinatal period. (C) 2020 Society for Adolescent Health and Medicine. All rights reserved.