Background: Despite global efforts to reduce sexual violence and related health outcomes, including HIV/STI risk, rates of sexual violence remain high. A number of underlying mechanisms, including social and structural factors, may contribute to sexual violence and related health outcomes. Objectives: Specific aims include: 1) assessing associations between substance use and STI diagnosis, and variations in this association based on reported economic hardship among female sex workers (FSW); 2) assessing the intersection between negative gender attitudes, sexual violence victimization, and sexual health outcomes among adolescent and young adult males 3) assessing the association between experiences of sexual harassment and sexual violence among adolescent girls. Methods: Data from three studies were used to achieve these objectives. Aim 1 used longitudinal data collected among 469 FSW in Tijuana and Ciudad Juarez, Mexico. Aim 2 used data from a nationally representative sample of 869 adolescent and young adult males in Haiti. Aim 3 used cross-sectional data from 159 adolescent females in San Diego County. Results: Aim 1 findings demonstrated that substance use and economic status significantly interacted to increase STI risk among FSW. Aim 2 findings revealed that sexual violence victimization and endorsement of negative gender attitudes were independently associated with sexual health outcomes among adolescent and young adult males. Aim 3 findings showed that sexual harassment that occurred both in-person or online was associated with partner and non-partner sexual violence among adolescent females. Conclusions: Study findings highlight the urgent need to address the underlying mechanisms contributing to sexual violence and related health outcomes. Recommendations for programmatic and research efforts to reduce sexual violence are discussed. Ultimately, gender- transformative approaches at the individual, community, and policy level are needed in order to shift the social and cultural norms that perpetuate sexual violence.