248. Screening For Chlamydia And Gonorrhea And High Risk Sexual Behaviors In Utah’s Juvenile Justice Population July 1, 2015-June 3,0 2018

Abstract

Purpose Youth in the correctional system are a high-risk population with many unmet physical and mental-health needs1. According to the CDC, “Prevalence rates for chlamydia (CT)and gonorrhea (GC) in the correctional setting are consistently among the highest observed in any venue”2. Admission to a correctional facility offers a prime opportunity to screen for medical concerns, including the largely asymptomatic CT/GC infections. CT is the most commonly reported notifiable sexually transmitted infection (STI) in the United States3. In Utah, over 60% of reported CT cases are among persons 15–24 years of age4. GC, though much less common, is also of particular concern due to its rising prevalence in the state, the severity of its sequelae, and its increasing drug resistance5. Additionally, sex trafficking and sexual violence are serious public health problems. Justice-involved youth are at high risk for sex trafficking6. One study in Ohio found that 21% of domestic minor sex trafficking (DMST) victims had spent time in juvenile detention7. Furthermore, JJS youth experience sexual violence at a higher rate than their peers in the community at large1. Both DMST and sexual violence can lead to a host of physical, psychological, and social problems, including engaging in other high-risk behaviors such as drug use and criminal behavior8. Before this project, no data on the CT/GC rates or on high risk sexual behaviors of youth within Utah’s Juvenile Justice System (JJS) had been gathered in a systematic manner that provided a population-based perspective. July 1, 2015 – Jun 30 2018 nurses and staff in all 18 Utah Juvenile Justice facilities verbally screened all youth admitted to their facilities for risk factors for STIs. If the youth met CDC-established, JJS-specific criteria, urine screening for CT/GC was performed. We have conducted 5,412 verbal screenings. Of these who answered the high risk questions and reported sexual activity, 8.14% reported experiencing “forced sex”, 3.23% reported DMST, 27.64% reported having sex with someone not well known, and 27.57% reported never using a condom. We have collected 4,351 urine samples, 9.72% of which screened positive for CT/GC/both. Among females, however, 17.24% were positive. Approximately, 85% of those who screened positive were treated. The remaining 15% are considered treatment pending or were lost to follow up. Given that youth in corrections are more likely than the general population to have inadequate and inconsistent health care1, screening for and treating STIs and addressing other high risk sexual behaviors must be a priority of the medical staff within JJS facilities. Screening on intake for CT and GC offers an opportunity to identify infections, prevent complications, and reduce transmission to the broader community. Furthermore, this screening provides a time for data collection on high-risk behaviors that can be addressed through intervention and education.