J. Dennis Fortenberry's research while affiliated with Indiana University School of Medicine and other places

Purpose HIV treatment as prevention is effective for reducing the risk of HIV transmission and the messaging campaign, undetectable = untransmittable, is gaining recognition. As youth living with HIV (YLWH) who have condomless sex may acquire and potentially transmit other sexually transmitted infections (STIs), the purpose of this study was to ass...

Maintenance in HIV care is important to achieve optimal personal health and HIV viral load suppression for young people living with HIV (PLWH). We assessed the relationship between incarceration and missed visits in a longitudinal data cohort of PLWH (n = 910), ages 12–24, from 14 adolescent trial network sites across the US. The time from study en...

Using data from 600 adolescents (14-17 years old) from the 2015 National Survey of Sexual Health and Behavior, we examined the prevalence and demographic correlates of adolescents’ romantic activities (ie, group dating, dyadic dating, and relationship involvement) and their confidence in avoiding unwanted romantic experiences. Overall, 55.8% of ado...

Delayed linkage to care deprives youth living with HIV of the benefits of HIV treatment and risks increased HIV transmission. Developing and testing linkage-to-care models that are capable of simultaneously addressing structural and individual obstacles are necessary to attain national goals for timely linkage of newly diagnosed youth to care. We a...

Objectives: To explore perceptions of condoms associated with complete use and evaluate relationships between condom perceptions, condom use, and sexual quality. Methods: Using data from a U. S. nationally representative probability sample, we assessed individuals’ condom use perceptions and related characteristics of their most recent sexual event...

BACKGROUND Minor adolescents and young adults bear a disproportionate burden of incident HIV infections in the United States. Young sexual and gender minorities, especially those who identify as African American, account for 80% of incident infections in youth. Despite their high burden of new HIV infections, minor adolescents are often excluded fr...

Background Despite the high burden of new HIV infections in minor adolescents, they are often excluded from biomedical HIV prevention trials, largely owing to the ethical complexities of obtaining consent for enrollment. Researchers and ethics regulators have a duty to protect adolescents—as a special category of human subjects, they must have prot...

Much work on sexual health has emphasized adverse outcomes such as sexually transmitted infections/HIV, unintended pregnancy, and sexual violence. Although these objectives are of continued importance, they reflect a global tendency to focus on negative sexual health outcomes. Far less prominent in health promotion, policy, and programing is a sust...

Using data from 78 sexting-experienced adolescents from the 2015 National Survey of Sexual Health and Behavior, we describe sexting frequency, sexting partners, sexual relationships with such partners, and characteristics associated with sexting. Most (59.2%) respondents sexted at most monthly, usually with romantic partners (62.0%). About 41% of s...

Research on sexual satisfaction tends to focus mostly on heterosexual women and women in monogamous relationships. Sexual satisfaction among sexual minority women and women who are nonmonogamous or not partnered is under-researched. Through an online survey, we gathered data from 334 cisgender sexual minority women in various relationship configura...

Purpose The purpose of this study was to characterize the composition of vaginal bacterial communities in a cohort of black adolescent women and to determine how the species composition of these communities correlates with levels of estradiol, glycogen, and stress. Methods Twenty-one black adolescent women were sampled longitudinally. The composit...

Background: Rectal infection with Chlamydia trachomatis (CT) is frequent in women who deny receptive anal sex and is thought to arise from autoinoculation of the rectum from vaginal secretions. An alternate hypothesis is that oral sex inoculates and establishes gastrointestinal tract infection. Distinguishing these hypotheses is difficult in women...

Women who have sex with women and men (WSWM) are less likely to use effective contraception and more likely to experience unintended pregnancies than their exclusively heterosexual peers. The authors examined contraception use among a community sample of 80 WSWM (defined as genital contact with at least one cisgender man and woman during the past 1...

Sexual orientation is a multi-dimensional concept, at a minimum comprised of sexual identity, sexual attraction, and sexual behavior. Our study aimed to assess relationships among self-identified sexual identity, sexual attraction, and sexual behaviors in a probability sample of adults in the U.S. and to identify associated factors with diverse pat...

Research demonstrates health disparities between gender-minority individuals and cisgender individuals. These disparities arise from multiple sources, including negative health care experiences. This study examines interactions between transgender and gender non-binary (TGGNB) individuals and their health care providers. We analyzed 119 participant...

Trust is experienced almost constantly in all forms of social and interpersonal relationships, including sexual relationships, and may contribute both directly and indirectly to sexual health. The purpose of this review is to link three aspects of trust to sexual health: (1) the role of trust in sexual relationships; (2) the role of trust in sexual...

Introduction Although researchers recognize that sharing disparate data can improve population health, barriers (technical, motivational, economic, political, legal, and ethical) limit progress. In this paper, we aim to enhance the van Panhuis et al. framework of barriers to data sharing; we present a complementary solutions-based data-sharing proc...

This poster describes results of a novel intervention to improve youth's linkage to HIV care

Using data from the 2014 National Survey of Sexual Health & Behavior, a probability survey of Americans aged 14+, we assessed the prevalence and correlates of kissing, cuddling, and massage during 1493 individuals’ most recent sexual event from the past year. Most respondents reported kissing (87%) and cuddling (70%); fewer (23%) reported massage....

Background HIV-positive women in the United States can have healthy pregnancies and avoid transmitting HIV to their children. Yet, little is known about the extent to which HIV care providers' reproductive health practices match women's pregnancy desires. Accordingly, we explored young HIV-positive women's pregnancy desires and reproductive health...

Purpose: Youth living with HIV (YLHIV) in the United States (U.S.) account for nearly one-third of new HIV infections and face significant barriers to care engagement; only 25% are virally suppressed. Healthcare transition (HCT) from pediatric/adolescent to adult-oriented care can be particularly disruptive. Accordingly, we prospectively examined...

Objective: To examine, in a probability sample of undergraduate students, characteristics of students’ most recent sexual experiences (including alcohol use) as well as their experiences with non-consensual sex. Participants: In January and February 2015, 22,046 students were invited to participate in an anonymous, cross-sectional, Internet-based s...

Criminal justice practices in the USA disproportionately affect sexual and racial/ethnic minority men, who are at higher risk of incarceration. Previous research demonstrates associations between incarceration and sexual risk behaviors for men who have sex with men (MSM). However, little of this work focuses on young MSM (YMSM), particularly HIV-in...

Objective To examine knowledge of Zika transmission and risk perception and to assess variability by condom use in a probability sample of sexually-active adults in the United States. Methods Data for this study came from the 2016 wave of the National Survey of Sexual Health and Behavior, a nationally representative probability sample of adults in...

Objectives Feelings of intimacy, perceptions of partner concurrency (PPC) and perceptions of risk for an STD (PRSTD) are meaningful and dynamic attributes of adolescent sexual relationships. Our objective was to examine whether variations in these STI-associated feelings and perceptions predicted incident Chlamydia trachomatis and/or Neisseriagonor...

Background: Studies link sexual health to lower sexual risk in adolescent women, yet no empirical literature evaluates these associations in adolescent men.Methods:Data were drawn from a longitudinal cohort study of sexual relationships and sexual behaviour among adolescent men (n=72; 14-16 years) in the US. Participants contributed quarterly partn...

Bisexual parents have been notably absent from prior research on parenting, despite comprising the largest proportion of parents among “lesbian, gay, and bisexual” (LGB) individuals. Indeed, recent national probability data indicate that young bisexual women are more likely than their heterosexual counterparts to report having at least one child. I...

Purpose: Linkage of HIV-negative youth to prevention services is increasingly important with the development of effective pre-exposure prophylaxis that complements behavioral and other prevention-focused interventions. However, effective infrastructure for delivery of prevention services does not exist, leaving many programs to address HIV prevent...

Previous research has suggested that sexually aggressive behavior and sexual HIV risk behavior are associated. Childhood sexual abuse (CSA) is a well-established risk factor for both types of problematic sexual behavior. Negative affect (i.e., anxiety, depression, and anger) is a less well-studied risk factor, but it has been theorized to relate to...

It is important for both individual- and population-level health that HIV-infected individuals progress through the Care Continuum. However, HIV-infected youth frequently disengage from care during transition from pediatric/adolescent to adult care; only 50% remain in adult care after 1 year. Understanding how providers define and approach a succes...

Background: Beneficial HIV treatment outcomes require success at multiple steps along the HIV Continuum of Care. Youth living with HIV are a key population, and sites in the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) are known for modeling optimum HIV adolescent care. Methods: A longitudinal cohort study conducted at 14...

Purpose There is a persistent HIV epidemic among sexual and gender minority adolescents in the U.S. Oral pre-exposure prophylaxis (PrEP) is an efficacious prevention strategy, but not yet approved for minors. Minors' access to biomedical HIV prevention technologies is impeded by the ethical and legal complexities of consent to research participatio...

Purpose: The HIV Care Continuum highlights the need for HIV-infected youth to be tested, linked, and maintained in lifelong care. Care engagement is important for HIV-infected youth in order for them to stay healthy, maintain a low viral load, and reduce further transmission. One point of potential interruption in the care continuum is during heal...

HIV-infected adolescents have disproportionately low rates of care retention and viral suppression. Approximately half disengage from care while transitioning to adult clinics, in part due to fragmented care systems and lack of streamlined protocols. We conducted 58 qualitative interviews with social service and health care providers across 14 Adol...

Importance: Youths aged 13 to 24 years old living with human immunodeficiency virus (HIV) are less likely than adults to receive the health and prevention benefits of HIV treatments, with only a small proportion having achieved sustained viral suppression. These age-related disparities in HIV continuum of care are owing in part to the unique devel...

Importance: Most human immunodeficiency virus (HIV)-infected youths are unaware of their serostatus (approximately 60%) and therefore not linked to HIV medical or prevention services. The need to identify promising and scalable approaches to promote uptake of HIV testing among youths at risk is critical. Objective: To evaluate a multisite HIV te...

Adolescent-physician communication about sexual behaviors, sexuality, and protective behaviors is vital for the support of sexual minorities and the prevention of sexually transmitted infections and unintended pregnancies. The objective of this review is to identify sexual topics that physicians and adolescents discuss during medical encounters and...

This chapter explores the psychosocial and behavioral factors associated with variation in contraceptive use among adolescents. Because regular use of contraception may be seen both as a conventional behavior and as a health-protective behavior, analyses assess the association between psychosocial conventionality and positive health orientation, on...

The National HIV/AIDS Strategy emphasizes rapid care linkage and engagement for HIV-infected individuals, though many adolescents are never tested, delay entering care, and frequently drop out. We conducted 183 staff interviews at 15 adolescent medicine clinics (baseline, n = 64; Year 1, n = 60; Year 2, = 59). We used a constant comparative themati...

Longitudinal data were used to examine the relationship of psychosocial unconventionality—rejection of societal norms and a propensity to engage in nonconforming behavior—to early initiation of sexual intercourse in an urban sample of 1,330 White, Hispanic, and African-American male and female middle-school and high-school students. Measures of unc...

Disclosure of sexual identity among sexual minority women is related to better outcomes and improved quality of care. The existing literature on sexual minority women’s experiences of identity disclosure and related interactions with healthcare providers draws little distinction between different groups of sexual minority women, despite the differe...

Purpose: Sexual satisfaction is positively associated with relationship satisfaction and other factors influencing intimate partner relationships. Further, outness, the extent to which an individual makes their sexual orientation known to family, friends, and others, impacts sexual risk behaviors, and may play a role in sexual fulfillment (feeling...

Purpose: Structural discrimination is associated with negative health outcomes among sexual minority populations. Recent changes to state-level and national legislation provide both the opportunity and the need to further explore the impact of legislation on the health indicators of sexual minorities. Using an ecosocial theory lens, the present re...

Methods: Adult men (n=156) and women (n=192) completed thrice-daily electronic diaries assessing individual- and partner-specific attributes and non-coital or coital sexual behaviours. Sexual motivations were: interest in sex, feeling in love with partner, wanted to have sex and partner wanted to have sex. The outcome variable was: sexual behaviou...

Background: Biomedical HIV prevention research with minors is complicated by the requirement of parental consent, which may disclose sensitive information to parents. We examine the experience of principal investigators (PIs) and study personnel who faced this complicated ethical issue in the first biomedical HIV prevention study that allowed minor...

Background: Adolescent women are disproportionately impacted by the adverse outcomes associated with sexual activity, including sexually transmitted infections (STI). Condoms as a means of prevention relies on use that is free of usage failure, including breakage and/or slippage. This study examined the daily prevalence of and predictors of condom...

Ideal partner traits and how they relate to a young woman's current partner and relationship is a knowledge gap in the literature. The objectives of this study were 1) to assess any differences in interpersonal characteristics between a young woman or her partner and relationship and 2) to examine the impact of this difference on sexual monogamy, c...

Sexual satisfaction is commonly defined and discussed in physiological terms of arousal and orgasm. Yet this narrow discourse does not accommodate the complex, multidimensional, and interpersonal aspects of sexual experience. To broaden and deepen our understanding of sexual satisfaction, we employed McClelland’s (2014) holistic four-factor framewo...

Collecting information on sexual identity is critical to ensuring the visibility of minority populations who face stigmatization and discrimination related to sexual identities. However, it is challenging to capture the nuances of sexual identity with traditional survey research methods. Using a mixed-methods approach, we gathered data on the sexua...

Purpose: Developmental models link sexual well-being to physical, mental/emotional, and social well-being, yet little empirical literature evaluates these relationships in adolescents. Better understanding of how and when sexuality complements other aspects of health may yield important points to enhance existing health education and prevention ef...

Previous studies have demonstrated that Neisseria gonorrhoeae sialylates the terminal N-acetyllactosamine present on its lipooligosaccharide (LOS) by acquiring CMP-N-acetyl-5-neuraminic acid upon entering human cells during infection. This renders the organism resistant to killing by complement in normal human serum. N-acetyllactosamine residues on...

This study assessed the prevalence of sexual behaviors among a nationally representative sample of Latino men and women in the United States (US) (N = 432) including Spanish language data collection. Prior studies of sexual health among US Latinos have consisted of convenience samples, and focused mainly on assessing risk behaviors. We consider a b...

Routine HIV screening, linkage, and retention in health care are nodes of the HIV continuum of care and goals of the National HIV/AIDS Strategy. However, up to 80% of youth are unaware of their HIV status, 29% are linked to and less than 50% are engaged in HIV health care, and fewer maintain viral suppression. To fill these gaps and to address the...

Design and methods: During a large multi-method Care Initiative program evaluation, three annual visits were completed at each site from 2010-2012 and conducted 174 semi-structured interviews with clinical and program staff (baseline n=64, year 1 n=56, year 2=54). Results: The results underscore the value of adhering to recent American Academy o...

We have almost no data on how and when couples stop using condoms. This qualitative study investigated the process of condom discontinuation. From November 2013 to April 2014, a total of 25 women living in a college town in the Midwest, ages 18 to 25, participated in semistructured interviews centered around three domains: partner interactions, con...

There is a critical need to understand the interplay between relationship trust and public health outcomes. The purpose of this study was to develop an understanding of emerging adult women's processes of establishing trust in sexual relationships. Twenty-five women aged 18-24 years participated in semi-structured interviews. Throughout the intervi...

Although a large body of previous research has examined sexual behavior and its relation to risk in men of diverse sexual identities, most studies have relied on convenience sampling. As such, the vast majority of research on the sexual behaviors of gay and bisexual men, in particular, might not be generalizable to the general population of these m...

Objective: To examine how the time from HIV testing to care referral and from referral to care linkage influenced time to care engagement for newly diagnosed HIV-infected adolescents. Methods: We evaluated the Care Initiative, a care linkage and engagement program for HIV-infected adolescents in 15 U.S. clinics. We analyzed client-level factors,...

"…adolescents are less satisfied with their romantic relationship, but not necessarily their sexual relationship, with online partners compared to those with partners met on-line." With this observation, Blunt et al. (this issue) contribute to a more refined, clinically relevant research agenda for adolescents' sexual well-being. I shall make other...

Study objective: To assess condom use as a function of number of coital events in newly formed sexual relationships. Methods: Participants who reported at least one new partner during the 12-week study interval (n = 115; ages 18-29 years; 48% women; 90% African American) completed weekly sexually transmitted infections testing and 3 times daily...

Little is known about current attitudes toward having sex during pregnancy in the United States. It is possible that pregnant women and their sexual partners hold beliefs and have feelings during this time that might lead to sexual and relational distress. Two new scales, Maternal Sex during Pregnancy and Partner Sex during Pregnancy were developed...

Unlabelled: Background Relationship characteristics and day-to-day variation in affective state have been associated with HIV risk behaviour. However, no research has assessed the impact of these factors on event-level condom use among women engaging in transactional sex. Methods: Twenty-six women engaging in transactional sex were enrolled in a...

We sought to determine, in a sample of 2,813 HIV seronegative young men who had sex with other men age 18-24, whether physical satisfaction would explain emotional satisfaction during first anal intercourse and whether emotional satisfaction would impact having sex with a partner a second time. Emotional satisfaction was mostly explained by physica...

Objectives: We sought to estimate rates of sexually transmitted infections (STIs) among criminal offenders in the 1 year after arrest or release from incarceration. Methods: We performed a retrospective cohort study of risk of having a positive STI (chlamydia, gonorrhea, or syphilis) or incident-positive HIV test in the 1 year following arrest o...

Objective: Sex during bleeding is a risk factor for sexually transmitted infection (STI) and other bloodborne viruses, including HIV. We examined daily predictors of adolescent women's male condom use during bleeding-associated vaginal sex. Methods: Adolescent females (N=387; 14-17 years) were recruited from primary care clinics for a longitudin...

Background: Youth development professionals (YDPs) working at community-based organizations (CBOs) can promote adolescent sexual health through programs. This study explored the programs and resources that youth access at CBOs and training YDPs receive. Methods: Twenty-one semi-structured interviews were conducted with YDPs. Qualitative content...

Unlabelled: Background Physician-adolescent sexuality discussions are a recommended element in health maintenance visits, but such discussions - if they occur at all - probably vary by adolescents' characteristics and situations, and physicians' personal beliefs and training. However, little is known about the form and content of physician-adolesc...

Objectives: Assessments of sexual safety often rely on questions about the occurrence of condom use within a designated timeline, assuming that penile-vaginal intercourse (PVI) occurred once at the conclusion of the event. An investigation of all sexual acts and safety strategies that occur during a single event may present a more nuanced picture...

The Adolescent Medicine Trials Network Protocol 113 (ATN113) is an open-label, multisite demonstration project and Phase II safety study of human immunodeficiency virus (HIV) preexposure prophylaxis with 15- to 17-year-old young men who have sex with men that requires adolescent consent for participation. The purpose of this study was to examine fa...

Unlabelled: Background Relative to women who engage in sex with exclusively men or women, women who have sex with women and men (WSWM) are more likely to report a history of sexually transmissible infections. Knowledge of the diversity and specificity of the sexual behaviours in which they engage may provide insight into the behavioural modes of i...

Purpose: While previous research suggests that lubricant use may be common among lesbian- and bisexually-identified women, it remains unclear from this research whether lubricant was being used with a male or female partner. The present study explores the behavioral, emotional, situational, and relational aspects of lesbian- and bisexually-identif...

Unlabelled: Background There is a lack of research that examines event-level lubricant use and outcomes among gay and bisexual men, with the majority of current research addressing lubricant use within the context of sexual risk. Most studies examining sexual health among gay and bisexual men have relied on convenience sampling strategies for part...

IntroductionThe diversity in self-identified lesbian and bisexual women's sexual interactions necessitates better understanding of how and when they integrate personal lubricant into different experiences. However, little is known about lesbian and bisexual women's lifetime lubricant use, particularly at the population level. AimsThe aim of this st...

Physicians can help guide teenagers in their emerging sexuality; however, teens rarely inform physicians about their sexual activity. We audio-recorded annual visits between 365 teenagers and 49 physicians. Before the recorded visit, the teens were asked in a confidential telephone survey whether they had ever engaged in sexual intercourse. Recordi...

Women (N = 138) with histories of illicit drug use were recruited into an electronic diary study that used Android smartphones for data collection. The diary was to be completed each day for 12 weeks using an "app" created in HTML5 and accessed over the Internet via smartphone. Data collection included information on sexual behaviors with up to 10...

Unlabelled: Puberty is an important developmental stage wherein hormonal shifts mediate the physical and physiological changes that lead to menarche, but until now, the bacterial composition of vaginal microbiota during this period has been poorly characterized. We performed a prospective longitudinal study of perimenarcheal girls to gain insight...

HIV vaccine trials with minors will likely require parental permission and informed assent from adolescents. For this to be a valid process, the information needs to be presented in a manner that promotes adolescent comprehension. Previous studies suggest that adolescent comprehension of assent is often insufficient. We developed an interactive web...

Youth development professionals (YDPs) working at community-based organizations are in a unique position to interact with the adolescents because they are neither parents/guardians nor teachers. The objectives of this study were to explore qualitatively what sexual health issues adolescents discuss with YDPs and to describe those issues using the f...

Introduction HIV testing is the portal to serostatus knowledge that can empower linkage to care for HIV treatment and HIV prevention. However, young people's access to HIV testing is uneven worldwide. The objective of this paper is to review the context and concerns faced by youth around HIV testing in low- as well as high-income country settings....