In marginalized urban neighborhoods across the USA, Latino youth are disproportionately represented among the growing number of youth gangs. Substance use among gang-involved youth poses both immediate and long-term health risks and can threaten educational engagement, future socioeconomic stability, and desistance. Conventional assessments of gang-affiliated youth and their peer network overlook the possibility that positive peer ties may exist and can foster health promoting behavior norms. Drawing on a positive deviance framework, in this study, we examine the relationship between positive peer network characteristics tied to post-secondary educational aspirations and frequent alcohol and marijuana use among Latino, gangaffiliated youth from a neighborhood in San Francisco. Using generalized estimating equations regression models across 72 peer network clusters (162 youth), we found that having close friends who plan to go to a 4-year college was associated with a lower odds of frequent marijuana and alcohol use (OR 0.27, p=0.02; OR 0.29, p=0.14, respectively) and that this association persisted when adjusting for risk characteristics (OR 0.19, pG0.01; OR 0.25, p=0.12). Public health can advance gang intervention efforts by identifying protective and risk factors associated with non-criminal health outcomes to inform participatory research approaches and asset-based interventions that contribute to building healthy communities.

BackgroundOur previous research in San Francisco's Mission District, a predominantly Latino neighbourhood characterised by high immigration, poverty, and gang-related violence, highlighted diverse partnership patterns among youth and the role of gang affiliation in high-risk sexual activity and pregnancy. 38% of Latino youth reported concurrent partnerships.MethodsWe conducted 33 semi-structured in-depth interviews with immigrant and US-born male and female Latino youth aged 16–21 to explore how the social environment affected partnership formation and STI risk. Participants were recruited from community venues; interviews were conducted in Spanish or English. Interview transcripts were coded in Atlast.ti. We analysed the following themes: relationship fidelity; STI prevention; and concurrency norms (agreement with the statement, Many Mission youth in a relationship are also seeing someone on the side).ResultsParticipants were 48% female; had a mean age of 17.5 years; and 55% were immigrants from Mexico or Central America. 27 of 30 believed that concurrency is widespread, described as “cheating” (having a “main girl with ‘friends with benefits’ on the side”) or resulting from initiating new relationships before ending existing ones or between serial break-ups with a main partner. Infidelity was motivated by machismo, a cultural notion of masculinity that was heightened for men respected for having multiple partners; boredom with a single partner; an ideal that fidelity was only relevant within marriage with cheating expected prior to that; and revenge for known, suspected or pre-emptive cheating. Street gangs introduced distinct reasons for young males preferring multiple, casual partnerships: limited time for relationships because of obligations to the gang first and foremost; disinterest in committed relations to avoid emotional vulnerability given emotional demands of street life; and multiple partners bringing status: “you got more game; you got more reputation.” Young women recognised that having partners in a gang brought social prestige and articulated strategies for increasing intimacy (eg, pregnancy) to draw partners away from the street and strengthen commitment to the relationship. Despite a perception of pervasive concurrency, STI risk perception was low.ConclusionsMany relationship norms and expectations held by youth supported concurrency, highlighting the importance of addressing social influences like gangs in STI prevention.

time of entry into care. MSM who reported church attendance were significantly more likely to present with a CD4 count < 200 cells/ mm 3 (p = 0.013) than MSM who did not. No difference in CD4 count was observed for MSW or WSM when evaluated by report of church attendance. There was a significant interaction between church attendance and sexual behaviour (p = 0.012) on history of previous HIV testing. WSM who attended church were more likely to report previous HIV testing (p = 0.01). MSM who attended church were less likely to report previous HIV testing (unadj p = 0.041) but this difference did not maintain significance in adjusted models. Discussion These findings frame a potentially important interaction between church attendance and sexual behaviour on timing of HIV diagnosis and presentation into care with important implications for individual health outcomes and secondary HIV prevention. Background To examine changes in behavioural outcomes among rural female sex workers (FSWs) involved in a community-based HIV preventive intervention in south India. Methods 14,284 rural FSWs from 1,253 villages that were selected through a process of rapid rural mapping were reached by community workers (called link workers) and FSW peer educators over a period of three years between 2009 and 2012. A community-based model for delivering outreach, medical and referral services was developed and employed. Socio-demographic profiles of the FSWs and programme outputs were captured using an individualised computerised management information system (CMIS). Changes in behaviour were assessed in an anonymised fashion using two rounds of polling booth surveys (PBS) conducted in 2009 and 2012. Results 91% of FSWs were above the age of 25, and 85% had been involved in sex work for two or more years. During the three-year period, 95% of the mapped FSWs were reached at least once, 80.3% received condoms as per need, and 71% received health services for sexually transmitted infections. In 2012, 45% reported having been tested for HIV infection, at least once in the previous six months. The two rounds of PBS showed significant differences in behavioural outcomes. Condom use increased from 60% to 72%, and condom breakage reduced from 30. 2% to 8.4%. Utilization of HIV counselling and testing services increased from 64% to 92.4%, and the proportion of FSWs testing HIV positive declined from 2.3% to 0.17%. Conclusions This community-based model for delivering HIV prevention programmes and services among widely dispersed female sex workers in rural areas was effective. Community-based health workers provided the vital link between marginalised communities in need of services and the formal health system. This model for rural outreach and HIV care could also be applied to many other health problems. Background Associations between social factors and health outcomes have been established for many diseases, including gonorrhoea. Inequalities in gonorrhoea are particularly pronounced; the incidence for non-Hispanic Blacks is 17 times the inciden...