Background. Transgender women (transwomen) in the United States have been shown to have high HIV risk with Black and Hispanic transwomen being particularly vulnerable. Growing research on transgender men (transmen) also shows increased HIV risk and burden, although not as much is known for this transgender population. Objectives. This systematic review estimates the prevalence of self-reported and laboratory-confirmed HIV infection, reported sexual and injection behaviors, and contextual factors associated with HIV risk of transgender persons living in the United States. Search Methods. We searched the HIV Prevention Research Synthesis database and MEDLINE, EMBASE, PsycINFO, CINAHL, and Sociological Abstracts databases from January 2006 to March 2017 and January 2006 to May 2017, respectively. Additional hand searches were conducted in December 2017 to obtain studies not found in the literature searches. Selection Criteria. Eligible reports were published US-based studies that included transgender persons and reported HIV status. Data collection and analysis. Data were double-coded and quality assessed. We used random-effects models employing the DerSimonian–Laird method to calculate overall prevalence of HIV infection, risk behaviors, and contextual factors for transwomen, transmen, and race/ethnicity subgroups. Main Results. We reviewed 88 studies, the majority of which were cross-sectional surveys. Overall laboratory-confirmed estimated prevalence of HIV infection was 9.2% (95% confidence interval [CI] = 6.0%, 13.7%; κ = 24). Among transwomen and transmen, HIV infection prevalence estimates were 14.1% (95% CI = 8.7%, 22.2%; κ = 13) and 3.2% (95% CI = 1.4%, 7.1%; κ = 8), respectively. Self-reported HIV infection was 16.1% (95% CI = 12.0%, 21.2%; κ = 44), 21.0% (95% CI = 15.9%, 27.2%; κ = 30), and 1.2% (95% CI = 0.4%, 3.1%; κ = 7) for overall, transwomen, and transmen, respectively. HIV infection estimates were highest among Blacks (44.2%; 95% CI = 23.2%, 67.5%; κ = 4). Overall, participation in sex work was 31.0% (95% CI = 23.9%, 39.0%; κ = 39). Transwomen (37.9%; 95% CI = 29.0%, 47.7%; κ = 29) reported higher participation in sex work than transmen (13.1%; 95% CI = 6.6%, 24.3%; κ = 10; P = .001). Most outcomes indicated high heterogeneity in the overall and subgroup analyses. Conclusions. The availability of more data allowed us to calculate estimates separately for transwomen and transmen. HIV prevalence estimates for US transwomen were lower than previous estimates, but estimates for HIV prevalence and participation in sex work were higher when compared with transmen. Evidence gaps remain for transmen and the syndemic relationship of HIV, risky behaviors, and contextual factors specific to the transgender experience. Public Health Implications. This study highlights gender disparities for HIV and risky sexual behavior, as well as evidence gaps that exist for transmen. Tailored programs and services for the transgender population need to be developed to encourage use of and access to HIV prevention services.

CONTEXT Increasingly, health care providers are using approaches targeting parents in an effort to improve adolescent sexual and reproductive health. Research is needed to elucidate areas in which providers can target adolescents and parents effectively. Parental monitoring offers one such opportunity, given consistent protective associations with adolescent sexual risk behavior. However, less is known about which components of monitoring are most effective and most suitable for provider-initiated family-based interventions. OBJECTIVE We performed a meta-analysis to assess the magnitude of association between parental monitoring and adolescent sexual intercourse, condom use, and contraceptive use. DATA SOURCES We conducted searches of Medline, the Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Cochrane, the Education Resources Information Center, Social Services Abstracts, Sociological Abstracts, Proquest, and Google Scholar. STUDY SELECTION We selected studies published from 1984 to 2014 that were written in English, included adolescents, and examined relationships between parental monitoring and sexual behavior. DATA EXTRACTION We extracted effect size data to calculate pooled odds ratios (ORs) by using a mixed-effects model. RESULTS Higher overall monitoring (pooled OR, 0.74; 95% confidence interval [CI], 0.69–0.80), monitoring knowledge (pooled OR, 0.81; 95% CI, 0.73–0.90), and rule enforcement (pooled OR, 0.67; 95% CI, 0.59–0.75) were associated with delayed sexual intercourse. Higher overall monitoring (pooled OR, 1.12; 95% CI, 1.01–1.24) and monitoring knowledge (pooled OR, 1.14; 95% CI, 1.01–1.31) were associated with greater condom use. Finally, higher overall monitoring was associated with increased contraceptive use (pooled OR, 1.42; 95% CI, 1.09–1.86), as was monitoring knowledge (pooled OR, 2.27; 95% CI, 1.42–3.63). LIMITATIONS Effect sizes were not uniform across studies, and most studies were cross-sectional. CONCLUSIONS Provider-initiated family-based interventions focused on parental monitoring represent a novel mechanism for enhancing adolescent sexual and reproductive health.

Recent work has explored the intersection between sexual health (as construed by the World Health Organization and others) and public health domains of action in the United States of America. This paper reports the narrative results of a systematic review of sexual health intervention effects on public health-relevant outcomes. To qualify, interventions had to be based on the principles: (1) that sexual health is intrinsic to individuals and their overall health and (2) that relationships reflecting sexual health must be positive for all parties concerned. Outcomes were classed in domains: knowledge, attitudes, communication, healthcare use, sexual behavior and adverse events. We summarized data from 58 studies (English language, adult populations, 1996–2011) by population (adults, parents, sexual minorities, vulnerable populations) across domains. Interventions were predominantly individual and small-group designs that addressed sexual behaviors (72%) and attitudes/norms (55%). They yielded positive effects in that 98% reported a positive finding in at least one domain: 50% also reported null effects. The most consistently positive effects on behaviors and adverse events were found for sexual minorities, vulnerable populations, and parental communication. Whether via direct action or through partnerships, incorporating principles from existing sexual health definitions in public health efforts may help improve sexual health.

2-year colleges may require additional support with providing sexual health care. Improvements could entail increasing express testing, extra-genital STI testing, and LARC.

In the second of two companion papers, we conducted a meta-analysis of sexual health interventions in three domains. The interventions chosen for the meta-analysis were a subset of studies presented in a narrative review (the first of the two companion papers); these in turn were selected on the basis of fit to principles derived from the World Health Organization (WHO) and other definitions of sexual health. Studies (n=20) were drawn from Medline and PsycINFO databases (English language, adult populations, 1996-2011) and fell into three domains: knowledge, attitudes, and sexual behaviors. We estimated intervention effects via Hedges' g, using the random-effects approach. Initial estimates revealed a large effect for knowledge, g=1.32 (95% CI=0.51-2.14), and smaller effects for attitude change, g=0.17 (0.11-0.24) and behavior, g=0.21 (0.13-0.29). After removing outliers to produce more precise estimates, the final effect sizes for knowledge, attitudes, and sexual behavior were, respectively, 0.25 (0.03-0.48), 0.18 (0.12-0.24), and 0.18 (0.11-0.24). Interventions yielded positive effects across populations and in all the domains studied.

With a minimal investment of resources, school nurses can become important sources of SRH information and condoms for male high school students.

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