Sexually Transmitted Infection Risk Behaviors Research Articles

Latent Class Analysis of Sexual Partnerships and Substance Use Across Generations.

Sexually transmitted infections (STIs) remain an important public health concern for people of all age groups, with older age groups experiencing a notable increase in STI burden. Historically, most research into STI risk behaviors has focused on adolescents and young adults, leaving a paucity of research on the ways STI risk factors change over the life course. Additionally, age and cohort trends in STI risk factors can be challenging to investigate with standard statistical tools as they can be collinear and are subject to sociocultural and generational influences. To help address these issues, we used multi-group latent class analysis to identify and compare risk behavior profiles defined by responses to three sexual activity and three substance use variables, across and within four age groups. We identified six behavior profiles in the unstratified dataset and five behavior profiles in each of the four age stratified groups. The five behavior profiles identified in each of the age categories appear to reflect a similar set of five underlying profile "archetypes," with the exact composition of each age category's five profiles varying in the magnitude that specific behaviors are endorsed. Interestingly, despite the similarity of profiles across the four age groups, analyses indicate that the experience of belonging to any one of these five archetypes differs by age group. This variance is likely due group specific age, period, and cohort effects, and may indicate that, when estimating one's STI risk, it is better to compare them to their peers than to the population as a whole.

Herpes, Syphilis, and Human Immunodeficiency Virus Coinfection Among Transgender Women in Central Brazil.

Background Human herpesvirus 2 (HSV-2) is a major cause of sexually transmitted infections (STIs) worldwide and often occurs synergistically with syphilis, and human immunodeficiency virus (HIV) infection. Transgender women (TGW) are disproportionately affected by STIs. The aim of this study was to estimate the prevalence of HSV-2 monoinfection, and HSV-2, syphilis, and HIV coinfection (triple infection) among TGW in Central Brazil. Methods A seroprevalence survey was conducted among TGW in Central Brazil from 2018 to 2019. Participants were recruited using respondent-driven sampling and interviewed about their sociodemographic characteristics and STI risk behaviors, and were tested for antibodies to HSV-2, Treponema pallidum, and HIV. Multivariable logistic regression models were used to identify variables associated with HSV-2 monoinfection and triple infection. Results Of the 431 participants, 345 (80%) were positive for HSV-2 antibodies, of whom 36 were HSV-2 immunoglobulin M–positive, and 340 were HSV-2 immunoglobulin G–positive. Human herpesvirus 2 and HIV coinfection, HIV and syphilis coinfection, and triple infection were detected in 38 participants (9.0%), 58 participants (13.8%), and 27 participants (6.4%), respectively. Report of a previous STI was associated with a decreased risk of HSV-2 monoinfection (adjusted odds ratio, 0.39), and an increased risk of triple infection (adjusted odds ratio, 4.4). Participants who reported sex not only with men had a 2.42-fold increased risk of triple infection. Conclusions The high prevalence of HSV-2, syphilis, and HIV coinfection among TGW is a cause for concern. Transgender women should be screened for HIV and other STIs. Further studies of risk factors for triple infection among TGW are warranted.

Sexually Transmitted Infection Transmission Dynamics During the Coronavirus Disease 2019 (COVID-19) Pandemic Among Urban Gay, Bisexual, and Other Men Who Have Sex With Men.

BackgroundThe impact of coronavirus disease 2019 (COVID-19) mitigation measures on sexually transmitted infection (STI) transmission and racial disparities remains unknown. Our objectives were to compare sex and drug risk behaviors, access to sexual health services, and STI positivity overall and by race during the COVID-19 pandemic compared with pre-pandemic among urban sexual minority men (MSM).MethodsSexually active MSM aged 18–45 years were administered a behavioral survey and STI testing every 3-months. Participants who completed at least 1 during-pandemic (April 2020–December 2020) and 1 pre-pandemic study visit (before 13 March 2020) that occurred less than 6 months apart were included. Regression models were used to compare during- and pre-pandemic visit outcomes.ResultsOverall, among 231 MSM, reports of more than 3 sex partners declined(pandemic-1: adjusted prevalence ratio 0.68; 95% confidence interval: .54–.86; pandemic-2: 0.65, .51–.84; pandemic-3: 0.57, .43–.75), substance use decreased (pandemic-1: 0.75, .61–.75; pandemic-2: 0.62, .50–.78; pandemic-3: 0.61, .47–.80), and human immunodeficiency virus/preexposure prophylaxis care engagement (pandemic-1: 1.20, 1.07–1.34; pandemic-2: 1.24, 1.11–1.39; pandemic-3: 1.30, 1.16–1.47) increased. STI testing decreased (pandemic-1: 0.68, .57–.81; pandemic-2: 0.78, .67–.92), then rebounded (pandemic-3: 1.01, .87–1.18). Nei­ther Chlamydia (pandemic-2: 1.62, .75–3.46; pandemic-3: 1.13, .24–1.27) nor gonorrhea (pandemic-2: 0.87, .46 1.62; pandemic-3: 0.56, .24–1.27) positivity significantly changed during vs pre-pandemic. Trends were mostly similar among Black vs. non-Black MSM.ConclusionsWe observed sustained decreases in STI risk behaviors but minimal change in STI positivity during compared with pre-pandemic. Our findings underscore the need for novel STI prevention strategies that can be delivered without in-person interactions.

Erectile Dysfunction Medication Prescription: STI and Risk Behavior in Men with HIV

IntroductionErectile dysfunction (ED) is a common diagnosis in up to 50% of men with HIV and prescription of erectile dysfunction medication (EDM) has been variably associated with increased risk behaviors and acquisition of sexually transmitted infections (STIs). AimWe measured the association of EDM prescription with bacterial STI testing, STI infection and sexual behavior among men engaged in HIV care. MethodsA retrospective cohort study was conducted among HIV-infected men in care at an urban HIV clinic in Birmingham, Alabama between 2008 and 2016. Paired data analysis was used to compare STI testing and behavioral outcomes during the 12-month period before and after EDM prescription. Main Outcome MeasuresOur study outcomes were STI testing and infection rates for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC) and incident syphilis as well as risk behaviors before and after EDM prescription. ResultsOf 2924 HIV-infected men engaged in care, 589 (20%) initiated EDM with a new prescription from a clinic provider during the study period. During the year after EDM prescription, all STI testing rates decreased: CT (OR = 0.76; 95% CI: 0.58 - 1.01; P = .06), GC (OR = 0.76; 95% CI: 0.58 - 1.01; P = .06), and syphilis (OR = 0.28; 95% CI: 0.20 - 0.38; P < .001). A total of 43 STIs were detected in this study (10 CT, 8 GC, and 25 syphilis) and 42/43 occurred among men who have sex with men (MSM). Sexual activity rates were high before and after EDM (87.6% vs 82.9%; P = .08), and consistent condom use was rare (6.6% in both time periods). After EDM prescription, the median number of sexual partners in the past 6 months decreased from 2 to 1 among MSM and was stable at 1 among men who have sex with women. Clinical ImplicationManagement of ED in HIV clinic provides an excellent opportunity to discuss risk reduction, safer sex practices, and the importance of routine STI screening to prevent HIV/STI transmission. Strength & LimitationsThis study provides insight into a common but understudied clinical scenario-ED in men with HIV-in an urban clinic population that is representative of the Southeastern United States. Adherence for ED medication was not assessed and STI risk behaviors were self-reported. ConclusionEDM prescription did not lead to any detectable change in risk behavior in this setting but bacterial STI was common among MSM who were tested.Heudebert JP, Tamhane A, Burkholder GA, Dionne-Odom J. Erectile Dysfunction Medication Prescription: STI and Risk Behavior in Men with HIV. J Sex Med 2019;16:691–700.

The Sexual Health Needs of Adolescent Boys Involved in a Pregnancy

PurposeLittle is known about fatherhood in middle adolescence. To better understand their sexual health needs, we describe relationship characteristics, perception of masculinity, and associated sexually transmitted infection (STI) risk behaviors in a community-based sample of urban middle adolescent boys who have fathered a child or been involved with a pregnancy. MethodsWe used venue-based sampling to recruit 339 boys (aged 14–17 years) in neighborhoods with high STI prevalence. We administered a brief survey on sexual relationship and pregnancy history, STI risk, juvenile justice involvement, and masculinity. ResultsFifteen percent had either fathered a child or been involved with a pregnancy. In multivariate analysis, controlling for age and ethnicity, adolescent fathers were more likely to be involved with juvenile justice and engage in STI risk behaviors. These included condom nonuse and partner checking a cell phone. Although of borderline significance, older partners, past STI testing, and drug or alcohol use at last sex improved model fit. ConclusionAdolescent fathers have distinct relational and sexual health needs. Their specific needs should be targeted by prevention programs.

Community Engagement and Venue-Based Sampling in Adolescent Male Sexually Transmitted Infection Prevention Research

ObjectivesMiddle adolescent males are a difficult group to recruit for community sexually transmitted infection (STI) prevention research. We describe a process of community engagement, and venue-based sampling of 14–17-year-old adolescent males, and compare rates of STIs and STI risk behaviors by venue. MethodsCommunity engagement consisted of (1) informational meetings with organizations; (2) participation in community meetings and events; (3) hiring community members as study personnel; and (4) an adolescent advisory board recruited from the community. Venues were identified and assessed at different times of the day and days of the week using a structured tool. At selected venues, males ages 14–17 years were invited to participate in a brief survey and provide a urine sample and an optional anal swab for DNA-based STI testing. ResultsVenues were assessed (n = 249), and 31 were selected for recruitment, including parks, apartment complexes, community events, entertainment venues, a community school, and community programs for LGBT (gay, lesbian, bisexual, transgender) and adjudicated youth. We enrolled 667 participants, average age 15.7 years. Participants reported high rates of sexual and STI risk behaviors, but had low rates of STIs. These rates differed by venue, with more structured venues recruiting youth reporting fewer STI risk behaviors and less structured venues within the highest STI prevalence zip code recruiting youth reporting more STI risk behaviors. ConclusionVenue-based sampling is a feasible mechanism to target recruitment and enrollment adolescent males with high STI risk behaviors in community settings, with risk profiles varying by setting.

Risk behaviors for sexually transmitted infections in noninjecting drug users: A cross-sectional study.

The objective of this study was to investigate risk behaviors for sexually transmitted infections (STIs) in noninjecting drug users (NIDUs), using STI diagnosis history as an indicator. A cross-sectional study was conducted in 323 NIDUs of two facilities for alcohol and/or drug dependence treatment in the Goiás State, Central Brazil. All participants were interviewed about risk behaviors and STI history. Multivariable analysis was performed in order to identify predictors of STIs. Adjusted prevalence ratio (APR) with confidence intervals of 95% was obtained using a Poisson regression model. Prevalence of self-reported STIs in the previous 12 months was 25.4% (95% confidence interval [95% CI]: 21.0-30.4%). A multivariable model verified that age (APR: 1.01; 95% CI: 1.00-1.01), sexual contact with partners diagnosed with STIs (APR: 1.27; 95% CI: 1.12-1.45) and injecting drug users (IDUs) (APR: 1.14; 95% CI: 1.14; 95% CI: 1.01-1.31), exchange sex for money and/or drugs (APR: 1.12; 95% CI: 1.02-1.21), and a history of sexual violence (APR: 1.04; 95% CI: 1.04-1.32) were predictors of STIs. Elevated rates of STI history and risk behaviors were observed in NIDUs, supporting the vulnerability of this group for these infections. Public policies and health outreach should be intensified in this population, principally regular STI testing of individuals in treatment for drug dependence and their sexual partners.

HIV prevalence, risky behaviors, and discrimination experiences among transgender women in Cambodia: descriptive findings from a national integrated biological and behavioral survey

BackgroundTransgender people are disproportionately affected by HIV. Despite their high vulnerability to HIV, lack of adequate epidemiological and surveillance data related to this population in many countries prevents provision of appropriate services. This paper summarizes descriptive findings from a national integrated biological and behavioral survey and discusses policy implications of the findings on HIV prevention among transgender women in Cambodia.MethodsThis cross-sectional study was conducted between December 2015 and February 2016. Participants were recruited from 20 sites in the capital city and 12 provinces of Cambodia using Respondent Driven Sampling (RDS) method. Behavioral data were collected through structured questionnaire interviews, and rapid finger-prick HIV testing was performed. Descriptive data analyses were conducted using STATA.ResultsThis study included 1,375 transgender women with a mean age of 25.9 years (SD = 7.1). The overall prevalence of HIV was 5.9%. The prevalence of HIV was significantly higher among urban participants compared to their rural counterparts (6.5 vs. 2.6%, p = 0.02). Almost one in five (19.6%) had never been tested for HIV prior to the study. Overall, 45.0% reported ever using gender affirming hormones. More than one-third (39.1%) reported not using condoms in their last sex, 29.8% had engaged in sex in exchange for money/gifts, and 14.0% reported that they had experienced at least one symptom of sexually transmitted infections (STI) in the past year. About one in ten (10.1%) reported having used some form of amphetamine-type stimulant drugs, while 6.5% reported having sex during or after using illicit drugs. A significant number of participants experienced sexual abuse (39.2%), losing a job (24.3%), or physical abuse (23.6%) because of their transgender identity. In addition, 82.9 and 88.9% would be willing to use the HIV self-test and pre-exposure prophylaxis (PrEP), respectively, if they become available.ConclusionsThe high prevalence of HIV, STI, and related risk behaviors among transgender women in Cambodia is of great concern, suggesting an urgent need to further expand tailored prevention interventions for this key population focusing on individual, social, and structural drivers of HIV. HIV self-test and PrEP should be explored as a priority.

HIV/STI prevalence study among military conscripts in Estonia.

Risk taking behavior and sexually transmitted infections (STIs) research outcomes vary among militaries. A common theme indicates STI prevalence and risk taking among military personnel is higher than the general population. Alcohol and drug misuse is well documented. From these behaviors, high-risk sexual encounters increase. Exploring STI prevalence, knowledge, and risk behaviors among conscripted military forces, we recruited 584 conscripts from a defense force in Eastern Europe. The observed STI prevalence in the young, male conscripts was equal or less than their non-conscripted counterparts. Military entry screenings could reduce STIs, creating a healthier population. However, these findings remain informative as the notion of high STI rates among military forces is not supported. As this study was one of the first of its type in the region, it demonstrates the ability of a nation to secure their defense forces against HIV/STIs even in the face of increased prevalence within that nation.

Sexual orientation disparities in sexually transmitted infection risk behaviors and risk determinants among sexually active adolescent males: results from a school-based sample.

We examined disparities in risk determinants and risk behaviors for sexually transmitted infections (STIs) between gay-identified, bisexual-identified, and heterosexual-identified young men who have sex with men (YMSM) and heterosexual-identified young men who have sex with women (YMSW) using a school-based sample of US sexually active adolescent males. We analyzed a pooled data set of Youth Risk Behavior Surveys from 2005 and 2007 that included information on sexual orientation identity, sexual behaviors, and multiple STI risk factors. Bisexual-identified adolescents were more likely to report multiple STI risk behaviors (number of sex partners, concurrent sex partners, and age of sexual debut) compared with heterosexual YMSW as well as heterosexual YMSM and gay-identified respondents. Gay, bisexual, and heterosexual YMSM were significantly more likely to report forced sex compared with heterosexual YMSW. Our results provide evidence that sexual health disparities emerge early in the life course and vary by both sexual orientation identity and sexual behaviors. In particular, they show that bisexual-identified adolescent males exhibit a unique risk profile that warrants targeted sexual health interventions.

STI Prevalence and Risk Behaviors among Establishment-based and Street-based Sex Workers in Jamaica

Background: Prevalence of sexually transmitted infections (STI) and risk behaviours among street and establishment-based sex workers (SW) were compared. Method: Between August and November 2008, face to face interviews and testing for sexually transmitted infections (STI) were conducted among Jamaican SW recruited by convenience and snowball sampling. Results: Forty-five street-based SW (SBSW) and 231 establishment-based SW (EBSW) were recruited. STI Prevalence was: HIV 4.9%, syphilis 6.2%, gonorrhea 12.7%, Chlamydia trachomatis 23.6%, and Trichomonas vaginalis 35.5%. 56.1% SW had at least one STI and STI prevalence was similar for both groups. Condom use with paying partners was >90% but lower with non-paying partners (33.3% SBSW and 20.8% EBSW, p = 0.166). Streetbased SW had more partners, initiated sex at an earlier age, operated in fewer parishes, and were more likely to have been exposed to prevention interventions. Daily alcohol, marijuana, and ecstasy use were higher among EBSW compared to SBSW (54.6 vs. 24.4%, p<0.001; 63.2% vs. 46.7%, p=0.029; 34.6% vs. 6.7%, p<0.001, respectively). Conclusion: Prevention programmes targeting key populations such as SW must address the different risk profiles of sub-populations. Inclusion of strategies to address substance use is critical for effective STI prevention among Jamaican SW.

Psychosocial Pathways to Sexually Transmitted Infection Risk Among Youth Transitioning Out of Foster Care: Evidence From a Longitudinal Cohort Study

To test the fit of a theoretically driven conceptual model of pathways to sexually transmitted infection (STI) risk among foster youth transitioning to adulthood. The model included (1) historical abuse and foster care experiences; (2) mental health and attachment style in late adolescence; and (3) STI risk in young adulthood. We used path analysis to analyze data from a longitudinal study of 732 youth transitioning out of foster care. Covariates included gender, race, and an inverse probability weight. We also performed moderation analyses comparing models constrained and unconstrained by gender. Thirty percent reported they or a partner had been diagnosed with an STI. Probability of other measured STI risk behaviors ranged from 9% (having sex for money) to 79% (inconsistent condom use). Overall model fit was good (Standardized Root Mean Square Residual of .026). Increased risk of oppositional/delinquent behaviors mediated an association between abuse history and STI risk, via increased inconsistent condom use. There was also a borderline association with having greater than five partners. Having a very close relationship with a caregiver and remaining in foster care beyond age 18 years decreased STI risk. Moderation analysis revealed better model fit when coefficients were allowed to vary by gender versus a constrained model, but few significant differences in individual path coefficients were found between male and female-only models. Interventions/policies that (1) address externalizing trauma sequelae; (2) promote close, stable substitute caregiver relationships; and (3) extend care to age 21 years have the potential to decrease STI risk in this population.

Internet pornography exposure and risky sexual behavior among adult males in the United States

Sexually transmitted infections (STIs) continue to pose a threat to the public health in the United States. Many sexual behaviors increase an individual’s risk of STI contraction. Chief among these are having unprotected sex, having sex with multiple partners, and either paying for sex or having sex for pay. The present study used General Social Survey (GSS) data from 2000, 2002, and 2004 to explore the association between exposure to internet pornography and these STI risk behaviors among adult US males. After controlling for demographic and individual difference covariates, internet pornography consumption was positively associated with having sex with multiple partners, engaging in paid sex, and having had extramarital sex. Internet pornography consumption was unrelated to having unprotected sex. Subsequent GSSs have not asked participants about exposure to internet pornography. As the GSS is the only ongoing, full-probability, national survey assessing social beliefs and behaviors, the present report provides unique insight into the risky sexual behavior patterns of adult male internet pornography consumers in the United States.

The Impact of Health Education Counseling on Rate Of Recurrent Sexually Transmitted Infections in Adolescents

Adolescents are among the highest risk group for nearly all sexually transmitted infections (STIs), and experience high rates of repeat infections. Health education interventions have been shown to decrease STI risk behaviors and increase protective behaviors including condom use.

Sexual Orientation Disparities in Sexually Transmitted Infections: Examining the Intersection Between Sexual Identity and Sexual Behavior

The terms MSM (men who have sex with men) and WSW (women who have sex with women) have been used with increasing frequency in the public health literature to examine sexual orientation disparities in sexual health. These categories, however, do not allow researchers to examine potential differences in sexually transmitted infection (STI) risk by sexual orientation identity. Using data from the National Longitudinal Survey of Adolescent Health, this study investigated the relationship between self-reported STIs and both sexual orientation identity and sexual behaviors. Additionally, this study examined the mediating role of victimization and STI risk behaviors on the relationship between sexual orientation and self-reported STIs. STI risk was found to be elevated among heterosexual-WSW and bisexual women, whether they reported same-sex partners or not, whereas gay-identified WSW were less likely to report an STI compared to heterosexual women with opposite sex relationships only. Among males, heterosexual-identified MSM did not have a greater likelihood of reporting an STI diagnosis; rather, STI risk was concentrated among gay and bisexual identified men who reported both male and female sexual partners. STI risk behaviors mediated the STI disparities among both males and females, and victimization partially mediated STI disparities among female participants. These results suggest that relying solely on behavior-based categories, such as MSM and WSW, may mischaracterize STI disparities by sexual orientation.

“Bridge population”: sex workers or their clients? – STI prevalence and risk behaviors of clients of female sex workers in China

As the HIV/AIDS epidemic and the spread of sexually transmitted infections (STIs) in China has come to the forefront of public health attention, female sex workers (FSWs) and their clients (CFSWs) are becoming increasingly important to HIV/STI prevention efforts. This secondary analysis uses data abstracted from the Chinese Health and Family Life Survey 1999–2000 to report prevalence rates of two STIs as well as sexual risk behaviors for CFSWs – men who paid for sex with FSWs in the past 12 months – in comparison with men who had not patronized FSWs. Among 1879 Chinese CFSWs who completed anonymous interviews and urine testing, 152 (6.3%, weighted) said they had paid for sex in the past 12 months and 18.8% of CFSWs (weighted) tested positive for gonorrhea. CFSWs were 10 times more likely to have an STI (either self-reported or tested) than non-client Chinese men, and they were equally likely to use condoms inconsistently with their spouses. This study highlights the importance of studying CFSWs who use condoms inconsistently and do not practice safe sex with their spouse as a potential bridge population. Prevention and intervention efforts should target this bridge population and include education on HIV/AIDS and STI transmission, condom promotion, marriage counseling, destigmatization of HIV and STIs, and promotion of STI diagnosis and treatment.

Laboratory-Diagnosed Sexually Transmitted Infections in Former Foster Youth Compared With Peers

The objective of this study was to evaluate the association between having resided in foster care and risk for sexually transmitted infection (STI) during young adulthood. Multiple regression analyses were performed by using Waves I to III of the National Longitudinal Study of Adolescent Health (1994-2002) to evaluate the association between foster care status and STI biomarkers and risk behaviors. Female (N = 7563) and male participants (N = 6759) were evaluated separately. Covariates in all models included baseline age, race, ethnicity, parental education level, parental income level, and average neighborhood household income level. Female participants who had been in foster care were more likely to have Trichomonas (odds ratio [OR]: 3.23 [95% confidence interval (CI): 1.45-7.23) but not gonorrhea or chlamydia and reported increased sexual risk behaviors compared with nonfostered peers. Male participants who had been in foster care were more likely to have both gonorrhea (OR: 14.28 [95% CI: 2.07-98.28]) and chlamydia (OR: 3.07 [95% CI: 1.36-6.96]) but not Trichomonas and did not report a higher risk for most sexual risk behaviors than nonfostered peers. Results suggest that individuals who have been in foster care are at increased risk for STIs during young adulthood. The pattern of exposure may differ between male and female individuals. If findings are confirmed, they suggest that health care providers who work with these youth should adjust their STI screening practices. Child welfare agencies should also consider targeted interventions to reduce STI risk in this population.

Marital Status and Sexually Transmitted Infections Among African Americans

This article assesses the relationship between low marriage rates and racial disparities in sexually transmitted infection (STI) rates. Data from the 2002 National Survey of Family Growth was used to examine the prevalence of sexual risk behaviors by marital status. Logistic regression was used to examine whether racial differences in marriage patterns help account for racial disparities in STI rates. Results indicate that the 12-month prevalence of multiple partners and high-risk partnerships was lowest among currently married, intermediate among cohabiting, and highest among formerly and never-married respondents. Of all racial/ethnic groups, African Americans were least likely to be married. In multiple logistic analyses adjustment for marriage attenuated the association between race and STI risk behaviors for African Americans. Low marriage rates may be an important contributing factor to racial/ethnic disparities in STI rates, particularly for African Americans.

Sexual and Drug Use Risk Behaviors of Long-Haul Truck Drivers and Their Commercial Sex Contacts in New Mexico

Long-haul truck drivers and their commercial sex contacts (CCs) have been associated with the spread of sexually transmitted infections (STIs) in the developing world. However, there is a paucity of information about the STI risk behaviors of these populations in the U.S. We conducted a qualitative phase of a two-phase study to gather information about STI-related risk behaviors in drivers and their CCs in New Mexico. Between July and September 2004, we conducted face-to-face unstructured and semistructured qualitative interviews at trucking venues, health department facilities, and a community-based organization to solicit information on sexual behavior and condom and illicit drug use. The interviews were audiotaped, transcribed, reviewed for quality control, and then coded and analyzed for emerging themes using NVivo software. Thirty-three long-haul truck drivers and 15 CCs completed the interview. The truck drivers were mostly male and non-Hispanic white with a mean age of 41 years. The majority of the CCs were female, the largest percentage was Hispanic, and the mean age was 36 years. Data suggested risky sexual behavior and drug use (i.e., inconsistent condom use, illicit drug use including intravenous drug use, and the exchange of sex for drugs) that could facilitate STI/human immunodeficiency virus (HIV) and hepatitis virus transmission. Results also showed a low knowledge about STIs and lack of access to general health care for both populations. Additional studies are needed to further assess risk and inform the development of prevention interventions and methods to provide STI/HIV and other medical services to these populations.

Depressive Symptoms and Sexual Risk Behavior in Young, Chlamydia-Infected, Heterosexual Dyads

Purpose To examine associations between depressive symptoms and dyad-level sexual risk behavior in young heterosexual dyads with sexually transmitted infection (STI). Methods Chlamydia-positive 14–24-year-old, heterosexually active outpatients and their opposite-sex partners completed an assessment that included demographics, past and recent STI risk behaviors, and the Beck Depression Inventory (BDI). Participants in the top 25% of BDI scores within gender were categorized as depressed. Variables were created to identify dyads in which the female or male partner was depressed, as well as a measure of concordance of depression between partners. Dyad-level STI risk variables were created from the STI risk characteristics reported by each dyad member, and associations between these and the depression variables were analyzed. Results The 130 dyads were comprised of young men and women at high STI risk. One-third of dyads had at least one depressed partner. Dyads in which the female partner was depressed had greater partner age difference, greater total number of lifetime partners, and one or more partners reporting substance use within 2 hours before sex, compared with dyads in which the female partner was not depressed. Dyads in which the male partner was depressed were more likely than the nondepressed-male dyads to report substance use before sex. All dyads in which both partners were depressed reported substance use before sex. Conclusions In young, chlamydia-infected, heterosexual dyads, depressive symptoms, especially in women, is related to increased dyad-level STI risk, including greater partner age difference, more partners, and substance use before sex.