Public Sexually Transmitted Disease Clinics Research Articles

Pay-it-forward gonorrhea and chlamydia testing among men who have sex with men and male STD patients in China: the PIONEER pragmatic, cluster randomized controlled trial protocol

BackgroundGonorrhea and chlamydia are the most common sexually transmitted diseases (STDs) among men who have sex with men (MSM) in China. Previous studies have shown pay-it-forward (PIF) interventions to be associated with a substantial increase in gonorrhea and chlamydia test uptake compared to standard-of-care. We propose a 'pay-it-forward' gonorrhea and chlamydia testing randomized controlled trial (PIONEER). The trial would evaluate the effectiveness of two pay-it-forward strategies in promoting testing uptake compared to the standard of care (in which men pay for their tests out-of-pocket) among MSM and male STD patients in China.MethodsPIONEER will be a three-armed, pragmatic cluster randomized controlled trial (RCT), conducted across 12 clinics (six MSM-led and six public STD clinics) to compare the effectiveness of three implementation strategies. Each facility will be randomized to a standard pay-it-forward intervention of gonorrhea/ chlamydia testing with minimal encouragement for testing, a community-engaged pay-it-forward arm, or a control arm where men pay for their tests out-of-pockets. The primary outcome will be dual gonorrhea/chlamydia test uptake. Secondary outcomes will include syphilis testing, amount donated in pay-it-forward, number of positive gonorrhea and chlamydia tests, and measures of antimicrobial resistance. A sequential transformative mixed methods design will be used to evaluate the implementation process in type 2 effectiveness-implementation hybrid design. Data sources will include survey on acceptability, and feelings and attitudes towards the interventions among participants; testing and treatment uptake data from clinic records, WeChat records, and qualitative data to gain insights into men's perceptions and attitudes towards the pay-it-forward, mechanisms driving uptake, and donating behaviors. Implementers and organizers will be interviewed about fidelity and adherence to protocol, sustainability of pay-it-forward intervention, and barriers and facilitators of implementing the intervention.DiscussionPIONEER will substantially increase gonorrhea/chlamydia testing among MSM in China, providing an innovative and new financial mechanism to sustain STD screening among sexual minorities in low- and middle-income countries. This study will answer compelling scientific questions about how best to implement pay-it-forward and the individual and organizational characteristics that moderate it.Trial registration: The study with identification number NCT05723263 has been registered on clinicaltrials.gov/.

Awareness of and Interest in Pre-Exposure Prophylaxis among Patients Receiving Services at Public Sexually Transmitted Disease Clinics in an Urban Setting.

The goal of this study was to assess awareness of, interest in, and sources of knowledge about pre-exposure prophylaxis (PrEP) among 1,464 HIV-uninfected patients from public STD clinics in Baltimore. Logistic regression analyses were conducted to examine factors associated with PrEP awareness and interest. Results suggest PrEP awareness and interest in knowing more about PrEP was highest among men who reported sex with men or with both men and women. White patients were more likely to be aware of PrEP than African American patients, and those reporting consistent condom use were more likely to have heard about PrEP than those who never used condoms. The major source of knowledge about PrEP was health care providers. Findings can inform future prioritization of locally targeted PrEP programs to enhance access to and uptake of PrEP among those most at risk for HIV transmission.

Impact of COVID-19 Lockdowns on Sexual Health Care Utilization and STD Reporting, Maricopa County.

The Maricopa County Department of Public Health (MCDPH) Sexually Transmitted Disease (STD) Clinic remained operational during a 6-week statewide Coronavirus Disease 2019 (COVID-19) Stay-at-Home Order. The present study sought to evaluate the effect of the Stay-at-Home Order on countywide STD reporting and uptake of sexual health services. We compared countywide daily median STD reporting and MCDPH STD clinic attendance across 3 timeframes; (1) Pre-Lockdown (01/01/2020–03/30/2020); (2) Lockdown (03/31/2020–05/15/2020); and (3) Post-Lockdown (05/16/2020–12/31/2020). STD reporting was characterized as incident chlamydia, gonorrhea, and primary and secondary syphilis. Clinic attendance was characterized as clients visiting through express testing or provider visits. Differences in STD reporting and clinic attendance were evaluated using non-parametric testing. Comparing Pre-Lockdown to Lockdown, we observed significant declines in the daily median chlamydia case reporting (−22%) and clinic express testing attendance (−29%). Comparing Lockdown to Post-Lockdown, we observed significant increases in daily median chlamydia and gonorrhea case reporting (+20%, +15%; respectively) and clinic express testing and provider visits (+42%, +20%; respectively). No significant difference was observed in countywide syphilis reporting across the 3 timeframes. Declines in STD reporting were observed countywide during the lockdown and were concurrent with declines in attendance observed at the MCDPH STD Clinic. Maintenance of clinic operations during the lockdown allowed for continued uptake of STD testing, diagnosis, treatment, and partner services. This study of sexual health care utilization at the public STD clinic in Maricopa County, Arizona, found reduced testing and provider visits contributed to lower countywide STD reporting during the Arizona COVID-19 Stay-at-Home Order.

Home-Based Testing for Sexually Transmitted Infections: Leveraging Online Resources During the COVID-19 Pandemic.

Home-Based Testing for Sexually Transmitted Infections: Leveraging Online Resources During the COVID-19 Pandemic.

Individual and Partnership Factors Associated with Heterosexual Anal Intercourse Among Attendees of Public Sexually Transmitted Disease Clinics in Los Angeles County.

Heterosexual anal intercourse (HAI) is an understudied sexual behavior and poses unique challenges to the prevention of sexually transmitted diseases (STDs). This study aimed to explore individual and partnership characteristics associated with HAI. This study used data collected from 243 young people who attended STD clinics in Los Angeles County between April 2012 and May 2014. Participants reported on sexual behaviors with their last three sexual partners. Hierarchical, mixed effects, repeated-measures analyses were used to assess partner-level (demographic) and individual-level (demographic and behavioral) factors associated with recent (past 6months) HAI. Thirty-two percent of participants (n = 243) reported HAI with at least one recent sex partner, and 49% reported ever having anal intercourse (AI). After adjusting for demographic characteristics, HAI was more than twice as likely to occur in relationships (n = 503) lasting more than a year compared to relationships lasting less than one month. HAI was also more likely to occur in relationships where intimate partner violence (IPV) was reported either as IPV initiated by the respondent (aOR = 2.18, 95% CI 1.08-4.41) or IPV initiated by the partner (aOR = 2.38, 95% CI 1.27-4.47). Among our participants, a substantial proportion reported HAI in the recent past 6months and nearly half reported lifetime AI. Notably, our results indicate the importance of relationship contexts for people engaging in HAI and highlight the increased risk of STD/HIV transmission in the context of relationships with intimate partner violence victimization and perpetration.

The Availability and Feasibility of Chemsex Services Within Sexually Transmitted Disease Clinics in the Netherlands: A Cross-Sectional Survey Among Sexually Transmitted Disease Nurses.

Chemsex-using illicit drugs during sex-is prevalent among men who have sex with men (MSM) and associated with sexual and mental health harms. Sexually transmitted disease (STD) clinics are a frequently visited and trusted health care facility for MSM. This study assessed the frequency and extent to which chemsex is addressed by Dutch STD nurses. Of the 24 Dutch public STD clinics, an online questionnaire was distributed in 20 STD clinics (83%) in 2019; the questionnaire was sent to 191 STD nurses, of whom 108 (57%) completed the questionnaire. The main outcome was addressing chemsex during regular MSM consultations, measured on a 5-point Likert scale (never-always). Items measuring knowledge, attitude, self-efficacy, and the social norm were also measured on a 5-point Likert scale (totally disagree-totally agree). Of the 108 participating STD nurses, 77 (71%) addressed chemsex regularly or always during MSM consultations. In general, STD nurses indicated to have sufficient knowledge about chemsex (mean [SD], 3.6 [0.5]) and a positive attitude toward addressing chemsex (mean [SD], 4.3 [0.5]). A need for training on chemsex was reported by 82 (76%) STD nurses, especially in signaling problematic chemsex (56/82; 68%). Three STD clinics (15%) had a protocol on addressing chemsex, and 3 STD clinics (15%) had referral pathways to addiction care. Sexually transmitted disease nurses from Dutch STD clinics regularly addressed chemsex during MSM consultations. Our results show relevance of educating STD nurses on signaling problematic chemsex and arranging referral pathways to addiction care to optimize chemsex related health care.

Sexually transmitted disease services and third-party payer reimbursement: Attitudes, knowledge, and current practices among 60 health departments/districts. Why does this matter to public health nurses?

To assess staff attitudes, knowledge, and current practices in billing third-party payers for sexually transmitted disease (STD) services in public health departments/districts. A cross-sectional, online survey was administered to staff at 60 urban and rural health departments/districts. Snowball sampling was used for greater representation. There were 311 staff responses from 56 agencies represented in the data analysis. Of the 311 responses, 106 were public health nurses and seven of the health directors had nursing backgrounds. The survey measured attitudes, knowledge, and current billing practices for STD services. Analysis of data was performed at both individual and agency level. Almost 90% reported it was acceptable to bill insurance. However, 56% felt these services should remain a "free" service in the agency. Most agencies were billing Medicaid for STD services (95%) and 70% bill private third-party payers. Current funding for public STD clinics is not sustainable and other viable income streams such as third-party payer reimbursement must be utilized. Public health nurses play a pivotal role in developing policies and procedures in billing third-party payers for STD and other clinical services. Understanding the interactions between attitudes, knowledge and practice are vital in this development.

Facilitators and barriers for healthcare providers to recommend HPV vaccination to attendees of public sexually transmitted diseases clinics in Hong Kong, China.

BackgroundAttendees of sexually transmitted diseases (STD) clinics could also benefit from HPV vaccination. Healthcare providers’ recommendation is the most effective published method in motivating HPV vaccination initiation. This study was to investigate practice of recommending HPV vaccination to attendees among healthcare providers (doctors and nurses) working in public STD clinics in Hong Kong, China.MethodParticipants were medical doctors, registered nurses and enrolled nurses working in all eight public STD clinics in Hong Kong. All of them (29 doctors and 82 nurses) were approached by telephone. A self-administered questionnaire was mailed to them. A total of 98 completed questionnaires were received (28 doctors and 70 nurses). The study was conducted during January to May, 2018. Using recommendation of HPV vaccination to any attendees in the last year as the dependent variable, univariate and multiple logistic regression models were fitted.ResultsIn the last 12 months, 16.3% and 36.7% of the participants had recommended HPV vaccination to any male attendees and to any female attendees of their clinics; 41.8% had recommended it to either male or female attendees. Adjusting for significant background variables (professions and years of working experience in the clinic), three constructs of the Theory of Planned Behavior were significantly associated with the dependent variable in expected directions. They were: 1) the Positive Attitude Scale (adjusted odds ratios, AOR: 1.20, 95%CI: 1.02, 1.41), 2) the Negative Attitude Scale (AOR: 0.85, 95%CI: 0.77, 0.94), and 3) the Perceived Behavioral Control Scale (AOR: 1.37, 95%CI: 1.08, 1.75).ConclusionSTD clinics are ideal settings that allow healthcare providers to access individuals who are at high-risk of HPV infection and promote HPV vaccination. Health promotion targeting these healthcare providers is warranted to enhance their perceived importance of recommending HPV vaccination. Such promotion should modify their attitudes and perceived behavioral control related to recommending HPV vaccination to attendees.

Factors Associated With Pharyngeal Gonorrhea in Young People: Implications for Prevention.

The objective of this study was to examine the proportion of missed infections and correlates of pharyngeal gonorrhea among young people attending public sexually transmitted disease (STD) clinics. We conducted a case-control study of 245 young men and women between April 2012 and May 2014. Participants were eligible for inclusion if they (1) were 15 to 29 years of age, (2) reported giving oral sex to a partner of the opposite sex in the past 90 days, and (3) attended 1 of 12 public STD clinics in Los Angeles County. Computer-assisted self-interviews were used to collect information on sexual behaviors and tests were conducted for pharyngeal and urogenital gonorrhea. Most participants were younger than 25 years (69%) and more than half were female (56%). We identified a total of 64 cases (27%) of gonorrhea, of which 29 (45%) were a urogenital only infection, 18 (28%) were a pharyngeal only, and 17 (27%) were dually infected at both sites. Pharyngeal testing increased case finding by 39% from 46 to 64 cases. After adjusting for age, sex, and number of sex partners, those who reported consistent pharyngeal exposure to ejaculate/vaginal fluids were 3 times as likely to have pharyngeal gonorrhea as compared with those without this exposure (adjusted odds ratio, 3.1; 95% confidence interval, 1.3-7.5). A large proportion of gonorrhea cases among young people would be missed in the absence of pharyngeal testing. These results have implications for those who provide medical care to clients at STD clinics and highlight the need for pharyngeal screening recommendations and counseling messages related to strategies to reduce exposure to infected fluids.

Improving Insurance and Health Care Systems to Ensure Better Access to Sexually Transmitted Disease Testing and Prevention.

Despite ongoing national efforts and advances in testing and treatment, sexually transmitted diseases (STDs) including human immunodeficiency virus (HIV), chlamydia, gonorrhea, and syphilis remain a significant public health challenge in the United States.1 Approximately 20 million cases of STDs and 40,000 cases of HIV are diagnosed annually,2,3 contributing an estimated $15.6 billion in total direct healthcare costs each year.4 As of 2015, new cases of syphilis, gonorrhea, and chlamydia are at the highest peak in the past decade.1 STDs and HIV infections continue to disproportionately impact historically marginalized individuals, including African American/Black, Hispanic/Latino, and sexual minority groups.1,5 Improved efforts are needed to address HIV/STD prevention, including facilitating testing and treatment approaches while minimizing barriers. There are a number of barriers to HIV/STD testing and prevention, including pre-exposure prophylaxis (PrEP) for reducing risk of HIV infection,6–9 that may be effectively addressed through reduced costs, elimination of unnecessary prior authorization requirements, and enhanced privacy in electronic medical records (EMRs). Cost and privacy barriers to STD care have historically been addressed by public STD clinics that, unlike traditional primary care or private sector settings, have provided anonymous services at no or minimal costs.10 However, declining public health funds, rising healthcare costs, and increased numbers of insured individuals following Medicaid expansion have pushed many settings to implement payment structures, including billing insurance for services.7,10–12 Thus, clinics previously providing services free of charge regardless of insurance status have adopted insurance use requirements that, while offsetting the burden of decreasing public health dollars, present a new set of challenges to patients. Paramount among these barriers is the out-of-pocket cost of services in the form of insurance copayments, coinsurance, and deductibles. Studies on patient willingness to use insurance at publicly funded STD clinics found that patients consistently report out-of-pocket costs as a major impediment to using insurance for STD services.7,13 Furthermore, patients with insurance may not want to use their insurance due to confidentiality concerns.7,13 In this commentary, we describe how insurance policies and currently employed EMRs deter patients, especially those from disadvantaged groups, from engaging in HIV/STD testing and prevention. We conclude with potential solutions that can aid healthcare practices, health information technology experts, and policymakers in improving access to these services.

State Laws Related to Billing Third Parties for Health Care Services at Public Sexually Transmitted Disease Clinics in the United States

Health departments (HDs) cite state laws as barriers to billing third parties for sexually transmitted disease (STD) services, but the association between legal/policy barriers and third-party HD billing has not been examined. This study investigates the relationship between laws that may limit HDs' ability to bill, clinic perceptions of billing barriers, and billing practices. Two surveys, (1) clinic managers (n = 246), (2) STD program managers (n = 63), conducted via a multiregional needs assessment of federally funded HD clinics' capacity to bill for STD services, billing/reimbursement practices, and perceived barriers were combined with an analysis of state laws regarding third-party billing for STD services. Statistical analyses examined relationships between laws that may limit HDs' ability to bill, clinic perceptions, and billing practices. Clinic managers reported clinics were less likely to bill Medicaid and other third parties in jurisdictions with a state law limiting their ability to bill compared with respondents who billed neither or 1 payer (odds ratio [OR], 0.31; 95% confidence interval [CI], 0.10-0.97) and cited practical concerns as a primary barrier to billing (OR, 2.83; 95% CI, 1.50-5.37). The STD program managers report that the staff believed that STD services should be free (OR, 0.34; 95% CI, 0.13-0.90) was associated with not billing (not sure versus no resistance to billing); confidentiality concerns was not a reported barrier to billing among either sample. Practical concerns and clinic staff beliefs that STD services should be free emerged as possible barriers to billing, as were laws to a lesser extent. Attempts to initiate HD billing for STD services may benefit from staff education as well as addressing perceived legal barriers and staff concerns.

The Diagnosis of Nongonococcal Urethritis in Men: Can There Be a Universal Standard?

The Diagnosis of Nongonococcal Urethritis in Men: Can There Be a Universal Standard?

Implementation of Preexposure Prophylaxis for Human Immunodeficiency Virus Prevention Among Men Who Have Sex With Men at a New England Sexually Transmitted Diseases Clinic

Preexposure prophylaxis (PrEP) is efficacious in preventing human immunodeficiency virus (HIV) among men who have sex with men (MSM). We assessed PrEP uptake among MSM presenting for services at a sexually transmitted diseases (STD) clinic. Men who have sex with men presenting to the Rhode Island STD Clinic between October 2013 and November 2014 were educated about, and offered, PrEP. We categorized PrEP engagement using an implementation cascade to describe gaps in uptake which described MSM who: (1) were educated about PrEP, (2) indicated interest, (3) successfully received follow-up contact, (4) scheduled an appointment, (5) attended an appointment, and (6) initiated PrEP (ie, received a prescription). Bivariate and multivariable logistic regression models were used to examine predictors of PrEP initiation. A total of 234 MSM were educated about PrEP; of these, 56% expressed interest. Common reasons for lack of interest were low HIV risk perception (37%), wanting more time to consider (10%), concern about side effects (7%), and financial barriers (3%). Among those interested, 53% followed up. Of those, 51% scheduled an appointment. The most common reason patients did not schedule an appointment was low HIV risk perception (38%). Seventy-seven percent of those with an appointment attended the appointment; of those, 93% initiated PrEP. Patients with higher HIV-risk perception (adjusted odds ratios, 2.17; 95% confidence interval, 1.29-3.64) and a history of sex with an HIV-positive partner (adjusted odds ratios, 7.08; 95% confidence interval, 2.35-21.34) had significantly higher odds of initiating PrEP. Low HIV-risk perception was the most significant barrier to PrEP uptake among MSM attending a public STD clinic.

Incidence and Predictors of HIV Infection Among Men Who Have Sex with Men Attending Public Sexually Transmitted Disease Clinics, New York City, 2007–2012

We examined five annual cohorts (2007-2011) of men who have sex with men (MSM) attending New York City STD clinics who had negative HIV-1 nucleic acid amplification tests (NAATs) on the day of clinic visit. Annual HIV incidence was calculated using HIV diagnoses within 1year of negative NAAT, determined by matching with the citywide HIV registry. Predictors (demographic; behavioral; bacterial STD from citywide STD registry match) of all new HIV diagnoses through 2012 were calculated from Cox proportional hazards models. Among 10,487 HIV NAAT-negative MSM, 371 had an HIV diagnosis within 1year. Annual incidence was 2.4/100 person-years, and highest among non-Hispanic black MSM (4.1/100 person-years) and MSM aged<20years (5.7/100 person-years). Characteristics associated with all 648 new HIV diagnoses included: black race (aHR 2.2; 95% CI 1.6-3.1), condomless receptive anal sex (aHR 2.1; 95% CI 1.5-2.8), condomless insertive anal sex (aHR 1.3; 95% CI 1.1-1.8), and incident STD diagnosis (aHR 1.6; 95% CI 1.3-1.9). MSM attending STD clinics have substantial HIV incidence and report risk behaviors that are highly associated with HIV acquisition. Increased uptake of effective interventions, e.g., pre- and post-exposure prophylaxis, is needed.

A Low-Cost Partner Notification Strategy for the Control of Sexually Transmitted Diseases: A Case Study From Louisiana.

We estimated the costs and effectiveness of implementing a partner notification (PN) strategy for highly prevalent sexually transmitted diseases (STDs) within the Louisiana STD/HIV Program. We carried out a telephone-based PN approach on an experimental basis in 2 public STD clinics in Louisiana from June 2010 to May 2012. We monitored data on the resources used for identifying, tracing, treating, and managing the infected cases and their partners to estimate the intervention costs. Our results indicated that implementation of telephone-based PN should not increase the STD control program's expenses by more than 4.5%. This low-cost PN approach could successfully identify and treat 1 additional infected case at a cost of only $171. We found that the cost per disability-adjusted life year averted (a health outcome measure), because of the adoption of selective screening with partner tracing, was $4499. This was significantly lower than the gross domestic product per capita of the United States, a threshold used for defining highly cost-effective health interventions. Adoption of PN for gonorrhea and chlamydia should be considered a national strategy for prevention and control of these diseases.

P3.260 Difference in Distribution of Chlamydia Trachomatis Genotypes Among Different Provinces: A Pilot Study from Four Provinces in China

The objective of this study was to assess the distribution of Chlamydia trachomatis (C. trachomatis) genovars in male sexually transmitted disease (STD) clinic patients from 1 province in eastern China...

Delay in Seeking Care for Sexually Transmitted Diseases in Young Men and Women Attending a Public STD Clinic

Background: Delay in seeking care for sexually transmitted diseases (STDs) has adverse consequences for both the individual and population. We sought to identify factors associated with delay in seeking care for STDs.Methods: Subjects included 300 young men and women (aged 15-24) attending an urban STD clinic for a new STD-related problem due to symptoms or referral for an STD screening. Subjects completed a structured interview that evaluated STD history, attitudes and beliefs about STDs, depression, substance use, and other factors possibly associated with delay. Delay was defined as waiting > 7 days to seek and obtain care for STDs.Results: Nearly one-third of participants delayed seeking care for > 7 days. Significant predictors for delay included self-referral for symptoms as the reason for visit (OR 5.3, 95% CI: 2.58 – 10.98), and the beliefs “my partner would blame me if I had an STD” (OR 2.44, 95% CI: 1.30 – 4.60) and “it’s hard to find time to get checked for STDs” (OR 3.62, 95% CI: 1.95 – 6.69), after adjusting for age, race, sex, and other factors. Agreeing with the statement “would use a STD test at home if one were available” was associated with a decrease in delay (OR 0.24, 95% CI: 0.09 – 0.60).Conclusions: Many young persons delay seeking care for STDs for a number of reasons. Strategies to improve STD care-seeking include encouragement of symptomatic persons to seek medical care more rapidly, reduction of social stigmas, and improved access to testing options.

Difference in Distribution of Chlamydia trachomatis Genotypes among Different Provinces: a Pilot Study from Four Provinces in China

The objective of this study was to assess the distribution of Chlamydia trachomatis genovars in male sexually transmitted disease (STD) clinic patients from 1 province in eastern China (Jiangsu) and 3 provinces in southern China (Guangdong, Guangxi, and Hainan). Urine specimens (n = 140) were collected from 46 public STD clinics in the 4 provinces. Specimens that tested positive for C. trachomatis by polymerase chain reaction were genotyped for the infecting C. trachomatis strain by amplifying and sequencing the genovar-specific ompA gene, which encodes the chlamydial major outer-membrane protein. Nine C. trachomatis genovars were identified from 129 specimens; they consisted of the F (25.6%), E (17.1%), J (16.3%), D (15.5%), G (11.6%), K (5.4%), H (3.9%), I (1.6%), and B (0.8%) genovars. Nine genovars were found in specimens from Guangxi province, 6 were found in specimens from each of Guangdong and Hainan provinces, but only 5 were found in specimens from Jiangsu province. Genovar G/Ga was shown to be endemic among male patients in southern China.

Prior HIV Testing Among STD Patients in Guangdong Province, China

Expanding HIV testing is important among individuals at increased risk for sexual HIV transmission in China, but little is known about prior HIV testing experiences among sexually transmitted disease (STD) patients. This cross-sectional study of 1792 outpatients from 6 public STD clinics in Guangdong Province recorded detailed information about ever having been tested for HIV infection in addition to sociodemographic variables, health seeking, clinical STD history, and HIV stigma using a validated survey instrument. A total of 456 (25.4%) of the STD patients in this sample had ever been tested for HIV infection. STD patients who were male, had higher income, more education, were at City A and City C, received STD services at public facilities, had used intravenous drugs, and had a history of an STD were more likely to ever receive an HIV test in multivariate analysis. Low perceived HIV risk was the most common reason for not receiving an HIV test. Only 7.7% of the sample reported fear of discrimination or loss of face as influencing their lack of HIV testing. Incomplete prior HIV screening among STD patients in China suggests the need for broadening HIV testing opportunities at STD clinics and similar clinical settings attended by those with increased sexual risk.

Mediators of the relation between partner violence and sexual risk behavior among women attending a sexually transmitted disease clinic.

Intimate partner violence (IPV) is associated with a wide range of negative outcomes, including sexual risk behavior. This cross-sectional study explored mediators of the relationship between IPV and risky sexual behavior in 717 women recruited from a sexually transmitted disease (STD) clinic. Participants were recruited from a public STD clinic in upstate New York as part of a randomized controlled trial that was designed to evaluate several sexual risk reduction interventions. They completed an audio computer-assisted self-interview in a private room. Among these women, 18% reported IPV in the past 3 months and 57% reported lifetime experience of IPV. Recent IPV was associated with greater sexual risk, as measured by more episodes of unprotected sex (overall and with a steady partner). Although IPV was associated with depressive symptoms and drug use before sex, these variables did not mediate the relationship between IPV and sexual risk behavior. The results indicate that IPV is common among women who attend an STD clinic and warrants increased attention. Research is needed to better understand the pathways linking IPV and HIV risk in women, to optimize the design of effective interventions.