Behavioral and neurobiological effects of GnRH agonist treatment in mice-potential implications for puberty suppression in transgender individuals.

In the United States, ~1.4 million individuals identify as transgender. Many transgender adolescents experience gender dysphoria related to incongruence between their gender identity and sex assigned at birth.

Stigma Associated with Classical Congenital Adrenal Hyperplasia in Women's Sexual Lives.

The risk of intersex-related stigma often serves as social indication for "corrective" genital surgery, but has not been comprehensively documented. In preparation for the development of an intersex-specific stigma assessment tool, this qualitative project aimed to explore stigma in girls and women with classical congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. As part of a comprehensive follow-up project, 62 adult women with classical CAH (age range 18-51 years) took part in an open-ended retrospective interview focusing on the impact of CAH and its treatment on various aspects of girls' and women's lives.

Syndrome-Related Stigma in the General Social Environment as Reported by Women with Classical Congenital Adrenal Hyperplasia.

Stigma defined as "undesired differentness" (Goffman, 1963) and subtyped as "experienced" or "enacted," "anticipated," and "internalized" has been documented for patients with diverse chronic diseases. However, no systematic data exist on the association of stigma with somatic intersexuality. The current report concerns women with classical congenital adrenal hyperplasia (CAH), the most prevalent intersex syndrome, and provides descriptive data on CAH-related stigma as experienced in the general social environment (excluding medical settings and romantic/sexual partners) during childhood, adolescence, and adulthood.

Gay father surrogacy families: relationships with surrogates and egg donors and parental disclosure of children's origins.

Objective: To study the nature and quality of relationships between gay father families and their surrogates and egg donors and parental disclosure of children's origins.

Design: Cross-sectional study.

Setting: Family homes.

Gender, empowerment, and health: what is it? How does it work?

As the HIV/AIDS epidemic has progressed, the role of gender inequality in its transmission has become increasingly apparent. Nearly half of those living with the virus worldwide are women, and women's subordination to men increases their risk of infection and makes it harder for them to access treatment once infected. Men, too, suffer from harmful gender norms-the expectation that they will behave in ways that heighten their risk of HIV infection and that they will be cavalier about seeking health care increases their vulnerability to the disease.

Lack of understanding of acute HIV infection among newly-infected persons-implications for prevention and public health: The NIMH Multisite Acute HIV Infection Study: II.

Acute/early HIV infection is a period of high HIV transmission. Consequently, early detection of HIV infection and targeted HIV prevention could prevent a significant proportion of new transmissions. As part of an NIMH-funded multisite study, we used in-depth interviews to explore understandings of acute HIV infection (AHI) among 34 individuals diagnosed with acute/early HIV infection in six US cities.

Leadership development and HIV/AIDS.

Leadership development among all sectors addressing HIV/AIDS has come to be recognized as a critically important endeavor as the HIV pandemic moves into its fourth decade. Globally, there is a tremendous need for well-trained leaders in healthcare, research, policy, programme management, activism and advocacy, especially in countries and settings with high HIV prevalence and limited human resource capacity. This article examines the growing need for HIV/AIDS leadership development, and describes and assesses a number of current initiatives that focus on leadership development in a variety of populations and settings.

A review of HIV/AIDS system-level interventions.

The escalating HIV/AIDS epidemic worldwide demands that on-going prevention efforts be strengthened, disseminated, and scaled-up. System-level interventions refer to programs aiming to improve the functioning of an agency as well as the delivery of its services to the community. System-level interventions are a promising approach to HIV/AIDS prevention because they focus on (a) improving the agency's ability to adopt evidence-based HIV prevention and care programs; (b) develop and establish policies and procedures that maximize the sustainability of on-going prevention and care efforts; and (c) improve decision-making processes such as incorporating the needs of communities into their tailored services.

Predictors of attrition among high risk HIV-infected participants enrolled in a multi-site prevention trial.

Retaining high-risk individuals is critical for HIV prevention trials. The current analyses examined predictors of trial dropout among HIV-infected men and women in a multi-site HIV prevention trial. Results indicated that dropouts (n = 74) were more likely to be younger, depressed, and not taking antiretroviral therapy (ART) than those who continued (n = 815).

Perceptions of adolescents' sexual behavior among mothers living with and without HIV: does dyadic sex communication matter?

Previous studies suggest that mothers can help adolescents make responsible sexual decisions by talking with them about sexual health. Yet, it is not clear how and when mothers make decisions about talking with their adolescents about sex. We sought to determine: (1) the accuracy of mothers' and adolescents' predictions of adolescents' age of sexual debut; and (2) if mothers' beliefs about their adolescents' sexual behavior affected the frequency of mother-adolescent communication about sexual topics and, in turn, if mother-adolescent communication about sexual topics affected mothers' accuracy in predicting adolescents' current and future sexual behavior.

Medication adherence and sexual risk behavior among HIV-infected adults: implications for transmission of resistant virus.

As more people are living long-term with HIV there are growing concerns about specific behaviors that can affect both personal and the public health. This study examined the relationship between antiretroviral therapy (ART) adherence and sexual risk behavior and their association with psychosocial and health factors among a diverse sample of 2,849 HIV-infected adults. Only 8.

Sexual scripts of women: a longitudinal analysis of participants in a gender-specific HIV/STD prevention intervention.

Project FIO (The Future Is Ours) was a three arm randomized controlled HIV prevention intervention trial carried out with heterosexually-active women in a high seroprevalence area of New York City. The trial was effective and women in the eight-session intervention arm were significantly more likely to report decreased unsafe sex or no unsafe sex compared to controls at one month and one year post-intervention. The current investigation was a qualitative analysis of women's sexual scripts at baseline and one year follow-up for a randomly selected subsample of participants in Project FIO.

Going beyond "ABC" to include "GEM": critical reflections on progress in the HIV/AIDS epidemic.

A considerable number of studies have sought to identify what factors accounted for substantial reductions in HIV seroprevalence after several countries deployed "ABC" (abstinence, be faithful, condom use) strategies. After much public discourse and research on ABC success stories, the Joint United Nations Programme on HIV/AIDS 2004 epidemic report indicated that nearly 50% of infected people worldwide were women, up from 35% in 1985. In light of the feminization of HIV/AIDS, we critically assess the limitations of ABC strategies.

The Bolger conference on PDE-5 inhibition and HIV risk: implications for health policy and prevention.

Introduction: Recent reports have linked the use of phosphodiesterase type 5 (PDE-5) inhibitors with increased rates of high-risk sexual behavior and HIV transmission in some individuals.

Aim: A National Institute of Mental Health (NIMH)-funded, multidisciplinary conference was convened to evaluate scientific research, clinical and ethical considerations, and public policy implications of this topic.

Main Outcome Measures: Published and unpublished findings on effects of PDE-5 inhibitors on sexual behavior; published guidelines and management recommendations.

Depressive symptomatology among HIV-positive women in the era of HAART: a stress and coping model.

Objective: An enhanced stress and coping model was used to explain depression among HIV-positive women in healthcare and community settings where highly active anti-retroviral treatment (HAART) was commonplace.

Method: HIV-infected women in four cities (N=978) were assessed, cross-sectionally, for mental and physical health, stress, social support, and other background factors.

Results: Self-reported level of depressive symptomatology was high.

Gender development in women with congenital adrenal hyperplasia as a function of disorder severity.

Prenatal-onset classical congenital adrenal hyperplasia (CAH) in 46,XX individuals is associated with variable masculinization/defeminization of the genitalia and of behavior, presumably both due to excess prenatal androgen production. The purpose of the current study was threefold: (1) to extend the gender-behavioral investigation to the mildest subtype of 46,XX CAH, the non-classical (NC) variant, (2) to replicate previous findings on moderate and severe variants of 46,XX CAH using a battery of diversely constructed assessment instruments, and (3) to evaluate the utility of the chosen assessment instruments for this area of work. We studied 63 women with classical CAH (42 with the salt wasting [SW] and 21 with the simple virilizing [SV] variant), 82 women with the NC variant, and 24 related non-CAH sisters and female cousins as controls (COS).

Revisiting "Success": Posttrial analysis of a gender-specific HIV/STD prevention intervention.

Alongside the recognized need to foster the development of innovative gender-specific HIV interventions, researchers face the urgent need to further understand how current interventions do or do not work. Few studies build posttrial qualitative analysis into standardized interview assessments in randomized controlled trials in order to bolster an assessment of how interventions work. The current investigation is a posttrial qualitative analysis carried out on a randomly selected subsample (N = 180), representing 50% of women who participated in a 3-arm randomized controlled trial known as Project FIO (The Future Is Ours).

Health and health care among male-to-female transgender persons who are HIV positive.

Recent studies have reported high rates of HIV infection among male-to-female transgender persons, but little research has examined how male-to-female transgender persons manage living with HIV. We compared demographic and health characteristics of 59 male-to-female transgender persons who were HIV positive with 300 nontransgender control subjects who were HIV positive. We found several demographic differences between the groups but no significant differences in HIV-related health status.

The Healthy Living Project: an individually tailored, multidimensional intervention for HIV-infected persons.

The NIMH Healthy Living Project (HLP), a randomized behavioral intervention trial for people living with HIV, enrolled 943 individuals, including women, heterosexual men, injection drug users, and men who have sex with men from Los Angeles, Milwaukee, New York, and San Francisco. The intervention, which is based on qualitative formative research and Ewart's Social Action Theory, addresses three interrelated aspects of living with HIV: stress and coping, transmission risk behavior, and medication adherence. Fifteen 90-minute structured sessions, divided into 3 modules of five sessions each, are delivered to individuals.

"Throwing the dice": pregnancy decision-making among HIV-positive women in four U.S. cities.

Context: Although AIDS-related deaths among U.S. women have decreased, the number of HIV-positive women, especially of reproductive age, has increased.

Beyond the male condom: the evolution of gender-specific HIV interventions for women.

As the number of HIV infections in women has increased, there has been a concomitant recognition that prevention efforts to reduce sexual transmission must address the gendered context in which risk behavior occurs. This paper provides a longitudinal perspective on the emergence of the HIV epidemic in U.S.

HIV transmission risk behavior among men and women living with HIV in 4 cities in the United States.

Determining rates of HIV transmission risk behavior among HIV-positive individuals is a public health priority, especially as infected persons live longer because of improved medical treatments. Few studies have assessed the potential for transmission to the partners of HIV-positive persons who engage in high-risk activities. A total of 3723 HIV-infected persons (1918 men who have sex with men [MSM], 978 women, and 827 heterosexual men) were interviewed in clinics and community-based agencies in Los Angeles, Milwaukee, New York City, and San Francisco from June 2000 to January 2002 regarding sexual and drug use behaviors that confer risk for transmitting HIV.

HIV-prevention-related sexual health promotion for heterosexual men in the United States: pitfalls and recommendations.

Although the male condom remains the most commonly used method of HIV prevention, sexual health promotion interventions directed toward heterosexuals in the United States have focused primarily on women. In this paper, we discuss limitations of the utility of various HIV-prevention-related sexual health promotion messages as they pertain to the sexual behavior of heterosexual men. We also present several key considerations for the development of sexuality-based HIV health promotion directed toward this population, including the importance of developing HIV risk reduction messages that are responsive to (1) their predominant sexual and safer sex behavioral patterns; (2) the societal gender roles, norms, and scripts that guide heterosexual interactions; and (3) developmental and cultural influences on sexual behavior.