STD Prevention Programs Research Articles

Predictors of STD Screening From the Indigenist Stress-Coping Model Among Native Adults With Binge Substance Use.

ObjectiveThe American Indian/Alaska Native (AI/AN) population in the U.S. is thriving in spite of settler colonialist efforts of erasure. AI/AN people, however, continue to experience persistent health disparities including a disproportionate burden of substance use and sexually transmitted diseases/infections (STDs/STIs), as well as a disproportionate lack of public health STD screening services and STD prevention interventions grounded in AI/AN social contexts, experiences, and epistemologies. The present study explored how stressors and protective factors based on the Indigenist Stress Coping framework predict STD screening outcomes among Native adults.MethodsWe analyzed baseline self-report data from 254 Native adults ages 18–55 years with recent binge substance use who were enrolled in an evaluation of “EMPWR,” a two-session STD risk reduction program in a rural, reservation-based community in the U.S. Southwest. Logistic regression models with robust variance were used to estimate odds ratios of lifetime STD testing for the theoretical stressors and cultural buffers.ResultsA little over half the sample were males (52.5%, n = 136), with a mean age of 33.6 years (SD = 8.8). The majority (76.7%, n = 195) reported having ever been screened for STD in their life. Discrimination score were significantly associated with lifetime STD testing: The higher discrimination was associated with lower odds of STD testing in the fully adjusted model (aOR = 0.40, 95%CI: 0.18, 0.92). The effects of AI/AN-specific cultural buffer such as participation in traditional practices on STD testing outcomes was in the expected positive direction, even though the association was not statistically significant. Household size was significantly associated with STD screening: The higher the number of people lived together in the house, the higher the odds of STD testing in the fully adjusted model (aOR = 1.19, 95%CI: 1.04, 1.38).ConclusionOur findings suggest that STD prevention programs should take into consideration AI/AN-specific historical traumatic stressors such as lifetime discrimination encounters and how these interact to drive or discourage sexual health services at local clinics. In addition, larger household size may be a protective factor functioning as a form of social support, and the extended family's role should be taken into consideration. Future research should consider improvement in measurements of AI/AN enculturation constructs.

Effects of mental health and substance use disorder symptoms on the association between STDs and sexual identity: evidence from the 2017–2019 National Survey on Drug Use and Health

BackgroundSexually transmitted disease (STD) cases are rising in the USA, especially among sexual and gender minorities, despite the availability of numerous STD prevention programs. We examined the differences in STD prevalence among sexual and gender minority subgroups with major depressive episode symptoms and substance use dependence.MethodsWe combined 2017, 2018, and 2019 National Survey on Drug Use and Health (NSDUH) public-use data on adults (N = 127,584) to conduct weighted multivariable logistic regression and margins analyses.ResultsApproximately 2.05% of the population reported having STDs. The population that had major depressive episode symptoms (AOR = 1.70, 95% CI = 1.46, 1.99), alcohol use dependence (AOR = 1.79, 95% CI = 1.49, 2.16), illicit drug use other than marijuana use dependence (AOR = 2.25, 95% CI = 1.73, 2.92), or marijuana use dependence (AOR = 1.90, 95% CI = 1.57, 2.31) had higher odds of contracting STDs compared to their counterparts. Lesbian/gay (AOR = 2.81, 95% CI = 2.24, 3.54) and bisexual (AOR = 1.95, 95% CI = 1.60, 2.37) individuals had higher odds of contracting STDs. Lesbians/gays with major depressive episode symptoms, alcohol use dependence, or illicit drug use other than marijuana use dependence had the highest probability of having STDs, compared to bisexuals and heterosexuals with major depressive episode symptoms, alcohol use, or illicit drug use other than marijuana use dependence. Bisexuals with marijuana use dependence had the highest probability of STD contraction compared to their lesbian/gay and heterosexual counterparts. Within each sexual identity subgroup, the probability of having STDs was higher for individuals with major depressive episode symptoms, or dependence on alcohol use, illicit drug use other than marijuana use, or marijuana use compared to their counterparts.ConclusionMajor depressive episode symptoms, substance use dependence, and sexual and gender minority status had higher risks for STD diagnosis, particularly for sexual and gender minorities with major depressive episode symptoms or substance use dependence. Tailored interventions based on major depressive episode symptoms and substance use dependence may reduce the prevalence of STD, especially among sexual and gender minorities.

P2.145 Adherence to Repeated Home Screening For Bacterial Vaginosis and STIs Among Young Women Participating in the BRAVO Randomized Clinical Trial

BackgroundThe BRAVO trial is an ongoing study designed to determine whether bi-monthly home-screening and treatment for asymptomatic bacterial vaginosis (BV) reduces risk of urogenital chlamydia and gonorrhoea infections in young...

Evidence Supporting the Use of Text Messaging for Partner Services

To the Editor: STD/HIV partner services need to adapt to changes in how people are communicating. More than 70% of US adults now use text messaging or short message service (SMS).1 Earlier this year, Kachur et al. provided examples of how disease intervention specialists (DISs) have used SMS for case management and partner services in New York.2 Here, we summarize our experiences at Multnomah County Health Department (Portland, OR) using SMS for partner services and report quantitative data on its utility. In Fall 2010, local DISs began a project to use SMS immediately after a phone call to cases and before mailing letters and making field visits. The project objectives were to (1) develop local procedures for using SMS for partner services, building on national guidelines3; and (2) implement these procedures for HIV, syphilis, and gonorrhea cases to reduce the need for mailings and field visits. We developed detailed local procedures from the national guidelines. They included explicit instructions that no protected health information be sent via SMS and provided messages to use for each of 3 attempts. For example, the first message is “I am with Multnomah County and I have information regarding an urgent health matter. Please call me at (phone number).” The goal of SMS is for clients to call back, so our procedures indicated that if a case responds with another text, DISs should call the case or send another text asking case to call. The procedures were approved by the local health officer and Health Insurance Portability and Accountability Act (HIPAA) officer. We purchased 2 mobile phones that allow for backing up messages, copying, and pasting messages from a master menu, remotely deleting messages, and password-protecting the phone. Our 5 local DISs are able to share the phones. When a DIS sends SMS, s/he simply needs to keep the phone near them and be available for an hour to answer incoming SMS or calls. Results to date have been promising. During January–September 2011, we sent an SMS to 149 clients immediately after a phone call; 56% of cases responded with a call after receiving the SMS. This response rate was more than 50% for HIV, early syphilis, and gonorrhea. DISs have indicated that cases respond to SMS within 10 to 15 minutes. In contrast, DISs usually wait 3 to 4 days for a response to a letter. Only one case responded that they did not want to be contacted by SMS. We found SMS to be a very useful way for DISs to reach cases, reducing the need for mailing letters and making field visits. Local DISs were initially resistant to use SMS because of discomfort with the phone technology, but this was addressed through one-on-one technical training. Once DISs used SMS several times and successfully reached cases, they became very enthusiastic about the approach. DISs are also using SMS to reach partners, and anecdotally, that is going well, but we do not yet have quantitative data to report. We recommend other STD prevention programs to use SMS for partner services. Juan Mendez, MA STD/HIV/Hep C Program Multnomah County Health Department Portland, Oregon Julie Maher, PhD Program Design and Evaluation Services Multnomah County Health Department and Oregon Public Health Division Portland, Oregon

P1-S5.04 HSV-2 Prevalence and Incidence among Stable HIV-1 Discordant Couples in Nairobi, Kenya

BackgroundTo describe HSV-2 prevalence, incidence and their correlates among stable HIV-1 discordant heterosexual couples enrolled in an HIV-1 prevention cohort study in Nairobi, Kenya.MethodsBetween 2007 and 2009, 469 HIV-1 discordant...

Characteristics of Sexual Behavior in Spanish Adolescents

The aim of this study is to describe some characteristics of the sexual behavior of adolescents in Spain and to compare these characteristics according to gender, using a cross-sectional survey. Participants were 1.279 male and female adolescents who reported having had sexual intercourse. A questionnaire about sexual behavior was applied at their high schools and during school hours. Data were collected between 2006 and 2007. Mean age at the onset of sexual intercourse was 14.8 years in males and 15.0 years in females. Males and females were different according to the type of partner at the last sexual intercourse: 63.0% of males had a steady partner compared to 90.5% of females (p < 0.01). The mean number of sexual partners during the last 12 months was higher in males than in females (M = 2.1 and M = 1.5 partners, for males and females, respectively, p < 0.01). 50.0% of males had sexual intercourse under the effects of drugs versus 39.3% of females (p < 0.01). STD and HIV prevention programs should be designed considering the differences according to adolescents' sex.

Variables sociodemográficas y conductas de riesgo en la infección por el VIH y las enfermedades de transmisión sexual en adolescentes: España, 2007

The development of HIV and STD prevention programs needs information about sexual behaviour. The aim of this study is to analyze whether there were differences in HIV/STD risk behaviours according to type of high school (public/private), gender and age in adolescents. A representative sample of 4.456 adolescents participated. To select the participants, a stratified random sampling considering Spanish regions and type of high school was used. It is a cross-sectional survey study. The percentage of adolescents that did not use condoms at first sexual intercourse was higher in private than in public high schools (chi(2) (1)=5,06; p=0,02). Adolescents who were between 17 and 18 years old had the highest percentage of non condom use at last sexual intercourse (chi(2) (2)= 6,90; p=0,03). A higher percentage of males than females had a casual partner at last sexual intercourse (chi(2) (1)=127,79; p=0,00). A higher number of adolescents of private high schools than adolescents of public high schools had used drugs at last sexual intercourse (chi(2) (1)=5,72; p=0,02), as well as males compared to females (chi(2) (1)=36,37; p=0,00). Differences in HIV risk behaviours according to sociodemographic variables are shown. Therefore, taking into account sociodemographic factors in sexual education programs focused on adolescents seems to be necessary.

Prevalence of syphilis and HIV infections among men who have sex with men from different settings in Shenzhen, China: implications for HIV/STD surveillance

HIV/STD surveillance system data are important for developing prevention and control programmes for men who have sex with men (MSM), now a core group in Chinese HIV/STD surveillance activities. MSM...

An HIV, STD, and Hepatitis Prevention Program for Young Men Leaving Prison: Project START

The rates of HIV, STD, and hepatitis infection are high among persons entering prisons, and many of these persons engage in high-risk behaviors after release. Therefore, innovative programs that reduce risk behaviors after release are urgently needed. Project START developed and evaluated two interventions designed for young men leaving prison. This article describes both interventions: the single-session intervention and the enhanced intervention. The single-session intervention focused on HIV/STD/hepatitis prevention only. The enhanced intervention consisted of two prerelease and four postrelease sessions that focused on HIV/STD/hepatitis prevention and more broadly on health and reintegration into the community. Specific procedures used to implement the interventions in correctional settings are described. Process data describing intervention attendance and fidelity to the intervention protocols are presented. Implications for future intervention studies are discussed.

The Short-Term Effects of a Computer-Based Pregnancy, STD, and HIV Prevention Program

A computer- and Internet-based intervention was designed to influence several variables related to the prevention of pregnancy, STDs, and HIV in rural adolescents. Three-hundred and thirty-eight tenth-graders enrolled in two rural public high schools participated in this field experiment. Results indicate that students in the experimental school had greater knowledge, greater condom negotiation efficacy, greater situational efficacy, and more favorable attitudes toward waiting to have sex than students in the control school. In tandem, the results suggest that computer-based programs may be a cost-effective and easily replicable means of providing teens with basic information and skills necessary to prevent pregnancy, STDs, and HIV.

Adolescents’ Discussions About Contraception or STDs with Partners Before First Sex

Limited research has examined the individual, family and relationship factors that determine whether teenagers discuss contraception or STDs with their sexual partners before having sex for the first time. Logistic regression analyses of data from 1,426 teenagers who participated in Waves 1 (1995) and 2 (1996) of the National Longitudinal Study of Adolescent Health and who had first sex between waves examined factors influencing whether respondents discussed contraception or STDs with their partner before first sex, and whether these factors differ by gender. Fifty-three percent of females and 45% of males discussed contraception or STDs before having first sex. The greater respondents' perceived condom knowledge and the greater their communication with their parents about everyday life, the higher their odds of discussing contraception or STDs before first sex (odds ratio, 1.2 for each). Being black was positively associated with sexual communication before first sex (1.9); as the number of dating activities and score on a test of verbal ability increased, so did the odds of such communication (1.6 and 1.02, respectively). The predictors of discussions about contraception or STDs did not differ by gender. By increasing teenagers' knowledge about condoms and other methods of contraception, pregnancy and STD prevention programs can help to encourage communication among teenage partners before the initiation of sexual intercourse. Programs should also encourage conversations between parents and teenagers, even when not about sex.

Exploring Latino men's HIV risk using community-based participatory research.

To explore sociocultural determinants of HIV risk and identify potential intervention approaches among adult Latino men. Using community-based participatory research for study design and implementation and data analysis, 7 focus groups were conducted with members of a soccer league in central North Carolina. Five themes emerged, including perceived barriers to accessing health care, the role of hegemonic masculinity in risk, and potentially effective intervention approaches to health promotion and disease prevention. Latino soccer leagues may provide an effective social network with which to partner to design, implement, and evaluate interventions to reduce sexual risk among Latino men, who have been inaccessible in conventional HIV/ STD prevention programs.

The Primacy of Gender in STD and HIV Prevention Programmes

Intervention projects aimed at preventing STD and HIV generally tend to target women sex workers and through them their clients. This approach sees women sex workers as agents of change, with the attendant burden, but has failed to recognise gender issues surrounding sexual health, particularly power relations existing in society. While gender justice is a recognised legitimate concern, the discourse has excluded sex workers from its purview making them the moral 'other'. Sexual health projects implemented currently in different parts of Kerala are not sensitive to gender issues because they mistakenly assume that sex workers are autonomous subjects. In the sexual health project for female sex workers implemented in the Kottayam municipal area some gender issues were tackled with modest success. This paper makes a strong plea for more gender sensitivity in sexual health projects and for men to take their fair share of responsibility for HIV transmission.

Decreasing STD incidence and increasing condom use among Chinese sex workers following a short term intervention: a prospective cohort study

Objective: To describe the impact of a repeating behavioural intervention focused on preventive education and provision of STD testing and treatment services to female sex workers. Methods: A prospective cohort...

Narratives, Culture and Sexual Health: Personal Life Experiences of Salvadorean and Chilean Women Living in Melbourne, Australia

This article examines narratives about culture, gender, identity and sexual health amongst Chilean and Salvadorean women living in Melbourne, Australia. We compare women’s narratives about gender roles in their home country to make sense of their experiences of migration, the tensions that arise in renegotiating their gender identities and roles in a new country and the ways these changes are experienced in terms of sexual health and well being. In comparing these past and present narratives of Chilean and Salvadorean born women, we raise a number of questions about the assumptions underpinning many of the sexual health promotion and STD prevention programmes targeted at women in migrant communities in Australia. Many of these programmes have targeted specific ‘language groups’ or ‘geographical regions’ with little attention paid to variations of cultural or socio-economic contexts within people’s home countries or the specific ways in which these impact on gender roles. Additionally, very few sexual health policies and strategies in Australia take into account the impact of the‘migration and settlement process’ and the ways these experiences influence cultural and gender identity of migrants in Australia. We propose that there is a need to build effective and flexible sexual health promotion and STDs, including HIV/AIDS, prevention strategies that build upon a dual strategy which includes men and women.

When is sex safe? Insiders' views on sexually transmitted disease prevention and treatment.

STD prevention programs promote practices and messages that are presumed to fit with most conditions of U.S. communities. Yet, the social and cultural contexts for low-income ethnic communities may frame STD prevention differently, so that people calculate their risk and take actions based on what they have learned through their own observations and life experiences. To understand how people at high risk for STDs make decisions and take actions to protect themselves from these diseases, the authors conducted 38 ethnographic interviews with individuals living in arural community in the South. Practices they reported include selecting "safe" partners on the basis of appearance, familiarity, or church attendance; washing before and after sex to prevent infection; self-treatment with antibiotics obtained without a prescription; and visiting the clinic frequently for checkups for asymptomatic infections. The authors compare and contrast their worldview with the public health concepts of primary and secondary STD prevention.

Health care seeking behaviour for sexually transmitted diseases among commercial sex workers in Morogoro, Tanzania

A qualitative study was conducted in a community of 100 female, self-employed commercial sex workers (CSWs), in Morogoro township, Tanzania. Data was gathered through key informant interviews and open-ended questionnaires. Respondents had extensive experiential knowledge of STDs and HIV/AIDS. They pursued several different avenues in attempting to prevent STDs including eating nutritiously to enhance immunologic status, using condoms, and vaginal washing after each act of intercourse. When they acquired a symptomatic STD, they pursued different avenues of treatment including self-treatment with known herbs, traditional healers (herbalists), injectionists, pharmacies, government hospitals, and private clinics. Almost all CSWs explored all options. Many of the key elements for an effective STD prevention and control program are in place and will be made more effective by training medical personnel, traditional healers, and sex workers themselves. Nous avons effectuéune étude qualitative auprès d'une communautéde 100 femmes travaillant comme prostituées indépendantes dans le township de Morogoro, en Tanzanie. Nous avons rassembléces données au cours d'entretiens avec des informatrices cl es et à l'aide de questionnaires ouverts. Les personnes interrogées ont de vastes connaissances, dérivées de l'expérience, sur les maladies sexuellement transmissibles (MST) et le Sida. Elles utilisent différents types de stratégie pour essayer d'éviter les MST, y compris une alimentation destinée à augmenter la résistance immunologique, l'utilisation de préservatifs et le lavage du vagin après chaque acte sexuel. Lorsque ces femmes attrapent une MST symptomatique, elles essaient différents types de traitement, y compris l'automédication par les plantes médicinales connues, les guérisseurs traditionnels (herboristes), les injections, les pharmacies, les hôpitaux publics et les cliniques privées. Presque toutes les prostituées explorent la totalitédes options disponibles. La plupart des éléments indispensables à la création d'un programme de prévention et de contrôle des MST efficace est déjà en place, et l'effcacitéde ce programme sera encore accrue par la formation du personnel médical, des guérisseurs traditionnels et des prostituées elles-mêmes. En un estudio cualitativo llevado a cabo en una comunidad de 100 trabajadoras sexuales independientes en la ciudad de Morogoro, Tanzania, se obtuvieron datos a través de entrevistas informantes claves, y cuestionarios abiertos. Las entrevistadas mostraron tener amplios conocimientos prácticos sobre enfermedades de transmisión sexual, HIV y sida. Seguían varios métodos diferentes para intentar impedir las enfermedades de transmisión sexual, por ejemplo, comer alimentos nutritivos para aumentar su sistema inmunológico, y utilizar condones y lavados vaginales después de cada relación sexual. Si notaban síntomas de alguna enfermedad de transmisión sexual, seguían tratamientos variados como automedicarse con infusiones conocidas, pedir ayuda a curanderos tradicionales (herbolarios), con inyecciones, en farmacias, hospitales estatales y clínicas privadas. Casi todas las entrevistadas exploraban todas las opciones posibles. Muchos de los elementos clave para lograr una prevención adecuada ya están funcionando, además de un programa de control contra las enfermedades de transmisión sexual que seráz más efica si se educa adecuadamente al personal médico, a los curanderos tradicionales y a las mismas trabajadoras sexuales.

Correlates of safer sex communication among college students

Correlates of safer sex communication among college students The purpose of this study was to examine factors that are thought to promote communication about safer sex and HIV among college students in the United States of America and to determine the extent to which communication about safer sex is important in the use of condoms. A better understanding of factors associated with safer sex communication can be helpful in developing HIV and STD prevention programmes for college students. Following approval from the institutional review boards of the six participating colleges and universities, researchers collected data from a random sample of students. The study included participant responses if participants were 18-25 years of age, single and sexually active. For the sample of 1349 participants, the mean age was 20.6 years. Sixty-three per cent of the sample was female, 50.5% white, 42.3% African-American, and the remainder of other ethnic groups. Over 50% of respondents reported frequent condom use, with 28% noting that they used a condom every time and 30.6% reporting condom use almost every time they had sex. Only 9.6% indicated that they never used a condom. The results of hierarchical multiple regression analysis revealed that the perception of quality of general communication with parents, the perception of a partner's attitude towards communication, communication self-efficacy, and communication outcome expectancies, were associated with safer sex communication. However, the association between safer sex communication and condom use was weak, suggesting that other factors excluded from this study are important in determining condom use for this sample of respondents. The findings provide some implications for HIV interventions. Interventions that enhance self-efficacy and positive outcome expectancies related to communication about safer sex are likely to foster discussion with a sexual partner. However, they might not lead to actual condom use.

Developing an interactive STD-prevention program for youth: lessons from a north Indian slum.

An intervention developed to teach young men in the urban slums of Lucknow, India, about sexually transmitted diseases is described in detail. This community-based intervention was designed to impart core educational messages and to address preexisting ideas about sexual health and STD-prevention practices among participants. Indicators of knowledge recorded before and after the intervention are presented and evaluated against the scores of a control group. Levels of sexual activity and factors associated with risky sex are discussed. The intervention was successful in raising the young men's awareness of STDs significantly in all areas except for the length of time that symptoms take to manifest following risky sex and the ineffectiveness of washing one's genitals after sex to avoid acquiring STDs. Lessons learned during the intervention are described as a means of informing future STD-education programs, and issues requiring prompt attention are identified.

High prevalence of asymptomatic STDs in incarcerated minority male youth: a case for screening.

To assess STD prevalence among a sample of incarcerated minority male youth in a southern US city. A consecutive entrant, cross-sectional study of 284 minority males 14 to 18 years was performed. All adolescents were screened for gonorrhea and chlamydia using ligase chain reaction tests. Eighteen percent of youth were identified as having either gonorrhea, chlamydia, or both. Approximately 84% of those with sexually transmitted diseases (STDs) self-reported having no symptoms. Failure to use condoms in the past month was significantly associated with a positive test result for STDs (odds ratio = 1.9, 95% CI = 1.1-3.3). The findings indicate an urgent need for routine STD screening and STD-prevention programs for adolescent males in detention facilities. A study of 284 detained black male adolescents revealed 18% prevalence of gonorrhea, chlamydia, or both. Approximately 84% of those with sexually transmitted diseases self-reported not having symptoms.