Sexually Transmitted Disease Rates Research Articles

HIV Rates and Risk Behaviors Are Low in the General Population of Men in Southern India but High in Alcohol Venues

As the HIV epidemic continues to expand in India, empiric data are needed to determine the course of the epidemic for high-risk populations and the general population. Two probability surveys were conducted in Chennai slums among a household sample of men and alcohol venue patrons ("wine shops") to compare HIV and other sexually transmitted disease (STD) prevalence and to identify STD behavioral risk factors. The wine shop sample (n = 654) had higher rates of HIV and prevalent STDs (HIV, herpes simplex virus 2 [HSV-2], syphilis, gonorrhea, or chlamydia) compared with the household sample (n = 685) (3.4% vs. 1.2%, P = 0.007 and 21.6% vs. 11.8%, P < 0.0001, respectively). High-risk behaviors in the household sample was rare (<4%), but 69.6% of wine shop patrons had >2 partners, 58.4% had unprotected sex with a casual partner, and 54.1% had exchanged sex for money in the past 3 months. A multivariate model found that older age, ever being married, ever being tested for HIV, and having unprotected sex in the past 3 months were associated with STD prevalence in wine shop patrons. Prevalent HIV and STDs, and sexual risk behaviors are relatively low among the general population of men. We found that men who frequent alcohol venues practice high-risk behaviors and have high rates of STDs, including HIV, and may play an important role in expanding the Indian epidemic.

A Randomized Trial of Metronidazole in Asymptomatic Bacterial Vaginosis to Prevent the Acquisition of Sexually Transmitted Diseases

ABSTRACT Bacterial vaginosis (BV)—the most common form of vaginitis throughout the world—has been associated with adverse outcomes including HIV infection and other sexually transmitted diseases (STDs). One reason for this may be the absence of hydrogen peroxide-producing lactobacilli that inhibit bacterial growth. At present, treatment of asymptomatic BV is not routinely recommended. This goal of this prospective study was to determine whether treating BV lessens the risk of STDs. Participants were 107 African American women with asymptomatic BV whose mean age was 25 years. Fifty-three of them were assigned randomly to apply intravaginal metronidazole gel at bedtime for 5 days and subsequently twice a week for 6 months. These women and the 54 who were only observed were followed up for a total of 12 months. Significantly longer times preceded the development of STD in women using metronidazole gel. Six-month rates of STD were 2.29 per person-year in the observed group and 1.58 per person-year in the actively treated women, a statistically significant difference. No such difference was apparent in the last 6 months of the study after treatment ended. Overall rates of STD for the entire 12-month period were 1.64 and 1.31, respectively, in the observation and treatment groups. The only significant difference in the distribution of individual pathogens was a greater frequency of chlamydia infection in the observed group. This is the first study to demonstrate that the prevention and treatment of asymptomatic BV lowers the risk of chlamydia infection. While it remains necessary to confirm these findings, especially in more diverse populations, the present findings suggest that routine treatment be considered for women with BV even if there are no symptoms.

Intimate partner violence and sexually transmitted disease symptoms in a national sample of married Bangladeshi women

Objectives To assess associations of intimate partner violence (IPV) with women’s sexually transmitted disease (STD) symptoms, and to clarify biological and behavioral mechanisms underpinning heightened STD rates among abused women. Methods A cross-sectional investigation of married couples ( n = 2865) sampled via the Bangladesh Demographic Health Survey. Results Over one third (38%) of married Bangladeshi women experienced physical or sexual IPV in the 12 months preceding the survey. Victimization was bivariately associated with vaginal irritation/discharge, pelvic pain during intercourse, genital sores/ulcers, and vaginal discharge with odor (OR 1.39–2.09). IPV demonstrated an independent effect on vaginal irritation with discharge (adjusted OR 1.34) and vaginal discharge with odor (adjusted OR 2.08) after accounting for STD exposure (i.e., husbands’ recent STD). Conclusions IPV elevates married Bangladeshi women’s STD symptoms beyond the risk represented by husbands’ STD alone, suggesting that high rates of STD among abusive men and the context of violence itself both relate to abused women’s STD risk.

A randomized trial of metronidazole in asymptomatic bacterial vaginosis to prevent the acquisition of sexually transmitted diseases

The purpose of this study was to determine whether treatment of bacterial vaginosis (BV) decreases the incidence of sexually transmitted diseases (STDs). Women with asymptomatic BV were studied prospectively to determine the effect of treatment of BV for the prevention of STD. Women were assigned randomly to observation or treatment and prophylaxis with intravaginal metronidazole gel. Women were screened monthly for STDs. Women who were assigned randomly to receive metronidazole gel had a significantly longer time to the development of STDs compared with women in the observation group (P = .02). The 6-month STD rate was 1.58 per person-year (95% CI, 1.29, 1.87) for women in the metronidazole gel group vs 2.29 per person-year (95% CI, 1.95, 2.63) for women in the observational group. The difference in STD rates was driven by a significant difference in the number of chlamydial infections (P = .013). Treatment and twice-weekly prophylactic use of intravaginal metronidazole gel resulted in significantly fewer cases of chlamydia.

The Adult Film Industry: Time to Regulate?

The United States adult film industry produces 4,000–11,000 films and earns an estimated $9–$13 billion in gross revenues annually [1]. An estimated 200 production companies employ 1,200–1,500 performers [2]. Performers typically earn $400–$1,000 per shoot and are not compensated based on distribution or sales. Los Angeles County is the largest center for adult film production worldwide. In 1988 the California Supreme Court, in People v. Freeman, found adult film production to be protected as free speech under the First Amendment, since such films were not considered obscene based on prevailing community standards. Unlike other legal but highly regulated activities such as gambling and commercial sex work in Nevada, the adult film industry was legalized in California through case law, not by statute, and has for the most part escaped governmental oversight. Regulation of the industry has been limited to prevention of child pornography. Title 18, Section 2257 of the United States Code of Regulations explicitly prohibits performers under age 18 and provides for civil and criminal prosecutions for any violation [3]. Adult film production companies are required to have a Custodian of Records to document and retain records of the age of all performers, to enforce the age entry restriction. Adult film performers engage in prolonged and repeated sexual acts with multiple sexual partners over short periods of time, creating ideal conditions for transmission of HIV and other sexually transmitted diseases (STDs). All the more concerning, high-risk practices are on the rise [4]. These practices include sex acts that involve simultaneous double penetration (double-anal and vaginal–anal intercourse) and repeated facial ejaculations. At the same time, condom use is reportedly low in heterosexual adult films—approximately 17% for adult performers [5]. In 2004, only two of the 200 adult film companies required the use of condoms for all penile–anal and penile–vaginal penetration [2]. Performers report that they are required to work without condoms to maintain employment. These practices lead to high transmission rates of STDs and occasionally HIV among performers. After four performers contracted HIV in 1998, Sharon Mitchell, a former adult film performer, founded Adult Industry Medical (http://www.aim-med.org), a clinic to counsel and screen performers monthly for HIV using a PCR test (Figure 1). It was expanded later to include other STD testing. The testing program began as an effort to reduce transmission of infections through early diagnosis, treatment, and “quarantine” should a performer test positive for HIV. Performers are required in most cases to pay for all screening tests, and to sign a consent form that permits disclosure of their test results to other performers and producers before filming. Both of these practices are explicitly prohibited under California Occupational Safety and Health Administration (Cal/OSHA) regulations. HIV-positive female performers are permanently excluded from participating in adult films. Figure 1 Screenshot of the Web site of Adult Industry Medical Health Care Foundation

Social capital and rates of gonorrhea and syphilis in the United States: Spatial regression analyses of state-level associations

We conducted spatial regression analysis to account for spatial clustering of sexually transmitted diseases (STDs) and to examine the state-level association between social capital (using Putnam's public use data set) and rates of gonorrhea and syphilis. We conducted the analysis for the 48 contiguous states of the United States for 1990, 1995, and 2000 and controlled for the effects of regional variation in STD rates, and for state variation in poverty, income inequality, racial composition, and percentage aged 15–34 years. We compared the results of the spatial regression analysis with those of ordinary least squares (OLS) regression. Controlling for all population-level variables, the percentage of variation explained by the OLS regression and by the spatial regression were similar (mid-90s for gonorrhea and low-70s for syphilis), the standardized parameter estimates were similar, and the spatial lag parameter was not statistically significant. Social capital was not associated with STD rates when state variation in racial composition was included in the regression analysis. In this analysis, states with a higher proportion of residents who were African-American had higher STD rates. When we did not control for racial composition, regression analysis showed that states with higher social capital had lower STD rates. We conjecture that sexual networks and sexual mixing drive the association between social capital and STD rates and highlight important measurement and research questions that need elucidation to understand fully the relationship between social capital and STDs.

Availability of High School Extracurricular Sports Programs and High‐Risk Behaviors

The Surgeon General has called for an expansion of school-based extracurricular sports programs to address the obesity epidemic. However, little is known about the availability of and participation in high school extracurricular sports and how participation in these sports is related to high-risk behaviors. We surveyed Los Angeles County public high schools in 2002 to determine the number of extracurricular sports programs offered and the percentage of students participating in those programs. We used community data on rates of arrests, births, and sexually transmitted diseases (STDs) among youth to examine associations between risk behaviors and participation in sports programs. The average school offered 14 sports programs, and the average participation rate was 39% for boys and 30% for girls. Smaller schools and schools with higher percentages of disadvantaged students offered fewer programs. The average school offering 13 or fewer programs had 14% of its students participating, while the average school offering 16 or more programs had 31% of its students participating in sports. Controlling for area-level demographics, juvenile arrest rates and teen birth rates, but not STD rates, were lower in areas where schools offered more extracurricular sports. Opportunities for participation in high school extracurricular sports are limited. Future studies should test whether increased opportunities will increase physical activity and impact the increasing overweight problem in youths.

Sexually Transmitted Diseases and Immigration in Spain

Sexually transmitted diseases (STD) are a high priority problem on a global scale, with more than 330 million cases reported each year. 1 This is due both to their impact on the physical and mental health of sufferers, and to their repercussions on fertility, neoplasia, and transmission of the human immunodeficiency virus (HIV). Since the middle of the 1990s, the European Union (EU) has experienced a significant and sustained increase in STDs, especially acute bacterial STDs, with increases focused among the youth population, ethnic minorities, and gay men. 2 But we find monitoring systems are highly heterogeneous and in general deficient when attempting to compare trends in the distribution of STD between countries. 3 Only the United Kingdom has a national network of STD centers whose statistics are integrated into national monitoring programs. In other EU countries, including Spain, information is based on a mixture of sentinel surveillance and compulsory notifications from clinics or laboratories without even a standard definition of cases. In Spain, epidemiological surveillance of STDs is undertaken nationally on a weekly basis with contributions from the autonomous communities under the system of diseases requiring obligatory declaration. This has estimated coverage of 50% of all cases diagnosed and uses most up to date microbiological information system to process data from 46 laboratories in 12 autonomous communities covering 25% of the population. 3 Despite underreporting, these systems have remained stable over time, and they are therefore sensitive to change. Thus, data collected in recent years show a clear increase in rates of notifiable STDs (though with a slight delay in relation to other EU countries), above all syphilis, which has shown an increase since 2003 (Figure 1). 4 However, as no population data is supplied, these systems do not allow for the identification of risk groups. Other valuable information is obtained through a network of free voluntary attendance STD centers, which provide more extensive information on STDs and associated syndromes (viral STDs, urethritis, cervicitis), as well as sociodemographic data and information on sexual behavior,

Estimated Effectiveness and Cost-Effectiveness of Federally Funded Prevention Efforts on Gonorrhea Rates in the United States, 1971???2003, Under Various Assumptions About the Impact of Prevention Funding

Reported gonorrhea incidence rates in the United States declined by 75% from 1975 to 2003 after implementation of a federally funded gonorrhea control program in the mid-1970s. The purpose of this study was to (1) estimate national gonorrhea rates that might have occurred from 1971 to 2003 had there been no federally funded sexually transmitted disease (STD) prevention activities and (2) calculate crude estimates of the cost-effectiveness of these prevention activities. Hypothetical gonorrhea rates had there been no federally funded prevention efforts from 1971 to 2003 were estimated based on (1) the amount of federal funding allocated to state and local health departments for STD prevention and (2) a published estimate of the impact of funding on STD rates in the United States. Standard methods of cost-effectiveness analysis were used to calculate the cost per case of gonorrhea prevented. Under base case assumptions about the impact of prevention funding on gonorrhea rates drawn from a published study, prevention efforts were cost saving, meaning that the program costs were less than the averted costs of treating gonorrhea and its associated sequelae. Over the 33-year period, an estimated 32 million cases of gonorrhea were averted by prevention efforts. STD prevention efforts appeared to be cost saving when considering only the benefits of gonorrhea prevention. If other benefits were considered (such as the prevention of other STDs), the estimated effectiveness and cost-effectiveness of STD prevention in the United States would be even greater.

Short-Term Effect of a Cultural Adaptation of Voluntary Counseling and Testing Among Female Sex Workers In China: A Quasi-Experimental Trial

This study evaluates the efficacy of cultural adaptation of a voluntary counseling and testing (VCT) intervention, in increasing condom use and decreasing rates of sexually transmitted diseases (STDs) among a group of female sex workers (FSWs) in Guangxi, China. This intervention is modeled after the "state-of-the-science" VCT program that was developed and evaluated by the Center for Disease Control and Prevention's Project RESPECT. Four hundred FSWs were assigned to either an intervention group receiving the VCT intervention or a control group receiving standard of care STD testing and treatment. Data were collected at baseline and 6 months postintervention. Outcome measures included HIV/STD related knowledge and perceptions, condom use, and history of STDs. Five common STDs were screened and tested through clinical examination and laboratory testing to serve as biomarkers. After controlling for potential confounders and baseline differences, the VCT intervention group was significantly higher than the control group in HIV/STD related knowledge (p < .0001) and consistent condom use with clients (odds ration [OR] = 2.23; 95% confidence interval [CI] = 1.26-3.96) at 6 months follow-up. In addition, the intervention group had a significantly lower infection rate of STDs than the control group at follow-up (OR = 0.44; 95% CI = 0.24-0.80). This quasi-experimental trial provides evidence that the brief VCT intervention, through appropriate cultural adaptation, can be efficacious in increasing condom use and reducing STD infection rate among FSWs in China.

Contributing Factors to the Spread of Sexually Transmitted Diseases

Abstract. Economists have long studied the determinants and effects of income transfers. This article examines an indirect effect of welfare payments on participating individuals: an increase in the incidence of sexually transmitted disease (STD) rates.Several studies have found a significant and positive link between the size of welfare benefits and out‐of‐wedlock fertility rates. Higher welfare payments reduce the cost of bearing and raising a child, and thus reduce the full cost of engaging in unprotected sex. An unintended consequence of unprotected sex is exposure to contagious diseases. This implies that states with higher welfare payments per child will experience higher rates of STDs.We test this hypothesis using statewide data on the incidence of three types of bacterial STDs, chlamydia, gonorrhea, and syphilis, for the years 1994 through 1998. The empirical specification is based on the standard microeconomic model of utility‐maximizing behavior. The included explanatory variables are demographic proxies reflecting differences in state population characteristics. These characteristics capture unobservable or intrinsically unmeasureable differences in the perceived costs and benefits of engaging in unprotected sex.The explanatory variable of primary interest is the size of the real welfare payment per recipient. Our empirical results indicate that states with higher real welfare payments are associated with greater rates of STDs.

Emergency Department Sexually Transmitted Disease and Human Immunodeficiency Virus Screening: Findings from a National Survey

Objectives: To use a previously conducted national physician survey to determine the extent of human immunodeficiency virus (HIV) and sexually transmitted disease (STD) screening by emergency physicians compared with physicians practicing in other settings (primary care offices, hospital ambulatory care clinics, or other). Methods: From the survey responses, the authors determined the percentage of emergency physicians and physicians not practicing in EDs screening various patient groups for syphilis, gonorrhea, chlamydia, and HIV. Additional data from the survey (for practice location, physician gender, and patient demographics of race and gender) were used in multivariate logistic regressions to determine adjusted odds ratios (ORs). Results: Of 3,838 survey respondents providing answers to all questions analyzed for this study, 401 (10.5%) practiced in an emergency department. Of the remaining 3,437 physicians, 89% practiced in primary care offices or hospital ambulatory care clinics. Based on unadjusted ORs, emergency physicians were less likely than physicians not practicing in EDs to screen for all STDs and HIV in all patient groups (men, nonpregnant women, and pregnant women), although the differences in screening rates in male patients for chlamydia or gonorrhea were not significant. The adjusted ORs varied from 0.136 (for HIV screening of pregnant women) to 1.177 (for gonorrhea screening of pregnant women). All adjusted ORs that were significant at p < 0.05 were < 1.0. Conclusions: Although prior research has shown that STD and HIV rates are relatively high in emergency department patients compared with the population as a whole, screening rates are lower than in other settings. Addressing barriers may increase screening rates.

Emergency Department Sexually Transmitted Disease and Human Immunodeficiency Virus Screening: Findings from a National Survey

To use a previously conducted national physician survey to determine the extent of human immunodeficiency virus (HIV) and sexually transmitted disease (STD) screening by emergency physicians compared with physicians practicing in other settings (primary care offices, hospital ambulatory care clinics, or other). From the survey responses, the authors determined the percentage of emergency physicians and physicians not practicing in EDs screening various patient groups for syphilis, gonorrhea, chlamydia, and HIV. Additional data from the survey (for practice location, physician gender, and patient demographics of race and gender) were used in multivariate logistic regressions to determine adjusted odds ratios (ORs). Of 3,838 survey respondents providing answers to all questions analyzed for this study, 401 (10.5%) practiced in an emergency department. Of the remaining 3,437 physicians, 89% practiced in primary care offices or hospital ambulatory care clinics. Based on unadjusted ORs, emergency physicians were less likely than physicians not practicing in EDs to screen for all STDs and HIV in all patient groups (men, nonpregnant women, and pregnant women), although the differences in screening rates in male patients for chlamydia or gonorrhea were not significant. The adjusted ORs varied from 0.136 (for HIV screening of pregnant women) to 1.177 (for gonorrhea screening of pregnant women). All adjusted ORs that were significant at p < 0.05 were < 1.0. Although prior research has shown that STD and HIV rates are relatively high in emergency department patients compared with the population as a whole, screening rates are lower than in other settings. Addressing barriers may increase screening rates.

STD Treatment: How Can It Improve HIV Prevention in the South?

Rates of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and sexually transmitted diseases (STDs) are disproportionately high in the Southern United States. A high percentage of the population is black, and STD/HIV rates are particularly high among this group. Control and treatment of STDs offers promise as an HIV prevention strategy, and nowhere more than in the South. Identify those specific recommendations for control and treatment of STDs that available evidence indicates can reduce HIV transmission. Review of published literature. Community trials produced inconsistent results but still suggest that STD treatment can reduce HIV transmission in the United States. Treatment of symptomatic STDs among those with HIV-infection should reduce HIV infectivity. There is as yet only limited evidence that STD treatment can reduce HIV susceptibility, although promising studies addressing herpes simplex virus are under way. The unacceptably large racial disparities in STD rates must be addressed, symptomatic STDs among HIV-infected individuals treated, and syphilis prevention activities continued. Detection of unrecognized HIV infections among those seeking STD services should be a priority; identification of those with STDs and acute HIV infection may provide unique HIV prevention opportunities.

The Epidemiology of HIV/AIDS in Women in the Southern United States

We reviewed data from multiple sources to examine distinguishing features of the HIV epidemic among women in the South. The goal of this study was to identify HIV and sexually transmitted disease (STD) prevention research priorities in the South. Cases of HIV/AIDS and STDs were analyzed to compare rates by region and rates in urban versus rural areas. Data from interviews of persons reported with HIV/AIDS from rural areas in 4 southern states compared social and behavioral characteristics of men versus women. The South is characterized by high AIDS and STD rates. The epidemic among southern women is distinguished by the predominance of heterosexually acquired infection, the disproportionate impact on blacks, the high proportion residing in rural areas, and multiple high-risk behaviors. Research to identify determinants of high-risk sex and drug-using behaviors among poor, minority men and women in less urban and rural southern regions is needed.

Sexually Transmitted Diseases in the Southeastern United States: Location, Race, and Social Context

Heterosexual transmission of HIV in the United States appears to be following the epidemiologic pattern of bacterial sexually transmitted diseases (STDs) such as syphilis and gonorrhea, disproportionately affecting blacks in the Southeastern region. Nationwide, rates of syphilis and gonorrhea are nearly 30 times higher in blacks than in whites, and this racial disparity underlies most of the regional and county-level differences in rates. The racial disparity cannot be explained by traditional measures of socioeconomic differences, and it cannot be explained by individual-level determinants of sexual behavior, but rather reflects deeper group-level social and environmental factors for which race is a marker. A theoretical model based on previous ecologic studies is proposed to explain the relationship between racial discrimination and elevated rates of STDs in blacks. Key factors in the model include: 1) chronic joblessness, 2) drug and alcohol marketing, 3) social disorganization (or social capital), and 4) male incarceration.

A Randomized Trial of Clinician-Delivered Interventions Promoting Barrier Contraception for Sexually Transmitted Disease Prevention

The objective of this study was to compare 2 interventions promoting condoms and vaginal microbicides to prevent sexually transmitted disease (STD). Women (N = 427) attending an STD clinic were randomly assigned to 2 clinician-delivered interventions and followed up monthly to assess condom/microbicide use and incidence of gonorrhea, chlamydia, and syphilis. During follow up, condom use rates were 69% (enhanced) and 49% (basic) and microbicide use rates were 44% and 29%, respectively. STD rates did not significantly differ between intervention groups. Perfect condom use (regardless of intervention arm) was associated with a 3-fold decrease in STD rates (relative risk [RR], 0.3; 95% confidence interval [CI], 0.1-0.8). Using a vaginal microbicide during > or =50% of the acts of intercourse was associated with reduced STD rates (RR, 0.5; 95% CI, 0.3-1.0) across intervention groups and condom use categories. The enhanced intervention increased use of condoms and vaginal microbicide; however, STD rates did not decrease because a protective effect was seen only among perfect barrier users, and the enhanced intervention only modestly increased perfect use.

Syphilis, Chlamydia, and Gonorrhea Screening in HIV-Infected Patients in Primary Care, San Francisco, California, 2003

The Centers for Disease Control (CDC) recommends sexually transmitted disease (STD) screening among HIV-infected persons in order to reduce HIV transmission. We evaluated the results of routine screening for syphilis and for urogenital, pharyngeal, and rectal gonorrhea (GC) and chlamydia (CT) among asymptomatic HIV-infected patients at an HIV primary care clinic in San Francisco, California. We found 15 new syphilis infections of 814 tested (1.8%) and 60 new cases of CT or GC infection of 586 tested (10.2%), with 88% of GC and CT infections occurring at nonurethral sites. Our study reveals a high rate of asymptomatic STDs among HIV-infected patients in primary care and supports the CDC recommendations to screen HIV-infected patients for STDs at all relevant anatomic sites.

Resistive Efficacy and Multiple Sexual Partners Among American Indian Young Adults: A Parallel-Process Latent Growth Curve Model

Contracting a sexually transmitted disease (STD) is one of the most serious public health issues for adolescents and young adults; rates of STDs among American Indian youth are among the highest of any racial or ethnic group in the United States. Although it is one of the key risk factors for spreading STDs, little is known about individual development of multiple sexual partners in any ethnic group. Drawing from social cognitive theory, this study used latent growth curve modeling with a sample of 518 American Indian adolescents and young adults to delineate the relationship across 4 years between youths' confidence in resisting risk and the number of sexual partners they had. The development of resistive efficacy was similar across genders: Although women reported higher levels at all time points, both genders increased across time. Men reported relatively stable levels of sexual partners; women had fewer sexual partners initially, but the number increased significantly and then decelerated. Further, the 2 trajectories had significant interdependence: Both intercepts and slopes were negatively related to each other across construct, suggesting that increasing resistive efficacy was related to decreasing number of sexual partners.

HIV/STD Risk Reduction Interventions for African American and Latino Adolescent Girls at an Adolescent Medicine Clinic

Adolescent girls in the United States and around the world are at a heightened risk for sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). To determine the efficacy of a skill-based HIV/STD risk-reduction intervention in reducing self-reported unprotected sexual intercourse among African American and Latino adolescent girls. Randomized controlled trial with 3-, 6-, and 12-month follow-ups. Sexually experienced African American and Latino adolescent girls recruited from the adolescent medicine clinic of a children's hospital serving a low-income inner-city community (N = 682, mean age, 15.5 years); 88.6% were retained at the 12-month follow-up. Three 250-minute interventions based on cognitive-behavioral theories and elicitation research: an information-based HIV/STD intervention provided information necessary to practice safer sex; a skill-based HIV/STD intervention provided information and taught skills necessary to practice safer sex; or a health-promotion control intervention concerned with health issues unrelated to sexual behavior. Primary outcome measure was self-reported frequency of unprotected sexual intercourse; secondary outcomes included the frequency of sexual intercourse while intoxicated, the number of sexual partners, biologically confirmed STDs, and theoretical mediator variables, including the intention to use condoms, beliefs about using condoms, and condom-use knowledge. No differences between the information intervention and the health control intervention were statistically significant. Skills-intervention participants (mean [SE], 2.27 [0.81]) reported less unprotected sexual intercourse at the 12-month follow-up than did information-intervention participants (mean [SE], 4.04 [0.80]; P = .03), or health control-intervention participants (mean [SE], 5.05 [0.81]; P = .002). At the 12-month follow-up, skills-intervention participants (mean [SE], 0.91 [0.05]) reported fewer sexual partners (P = .04) compared with health control-intervention participants (mean [SE], 1.04 [0.05]) and were less likely to test positive for STD (mean [SE], 10.5% [2.9%]) than were health control-intervention participants (mean [SE], 18.2% [2.8%]; P = .05). No differences in the frequency of unprotected sexual intercourse, the number of partners, or the rate of STD were observed at the 3- or 6-month follow-up between skill-intervention participants and information-intervention or health control-intervention participants. Skill-based HIV/STD interventions can reduce sexual risk behaviors and STD rate among African American and Latino adolescent girls in clinic settings.