STD Risk Research Articles

HIV, STD, and hepatitis risk behaviors of young men before and after incarceration

High rates of HIV, STD and hepatitis and associated risk behaviors have been documented among persons entering correctional facilities. However, there is a paucity of data on risk behaviors after release from custody. This study documents risk behaviors and informs intervention development targeting young men leaving incarcerated settings. We enrolled and interviewed 106 men from five prisons up to 60 days prior to their release from prison and interviewed them again four times after their release (at 1-week, 1-, 3- and 6-months). At enrollment, men were 18–29 years of age. Nearly 54% identified as African American, while 27% identified as White, 10% identified as Hispanic/Latino and 10% identified as “other”. Approximately 83% had been incarcerated multiple times, 37% reported a prior STD diagnosis and their mean lifetime number of sex partners was 36 (median = 20). Many reported multiple sex partners and inconsistent condom use after release. A significant decrease in condom use during vaginal sex with primary committed female partners and in oral sex with both committed and casual female partners after release from prison were reported from 1–6 months. These young men are at sexual risk of HIV, STD and hepatitis infection after release from prison. Interventions are needed to prevent this population from acquiring and transmitting HIV, STD and hepatitis.

Patient–Provider Communication About Sexual Health: The Relationship with Gender, Age, Gender-Stereotypical Beliefs, and Perceptions of Communication Inappropriateness

This investigation examined patient–provider communication about sexual health related to gender and age. Data were collected from 277 individuals, aged 18–60, via convenience and snowball sampling at a large university in southwestern United States. Results indicate women are more proactive about their sexual health than men and tested for STDs more frequently. Women, more than men, initiate discussions with their healthcare provider about sexual health matters and healthcare providers are more likely to initiate communication about such matters with women than men. Men hold stronger gender-stereotypical beliefs than women, are less likely to initiate conversations about sexual issues with their provider, and believe sexual discussions with their partner are inappropriate. Age relates to sexual activity initiation and perceived STD risk.

Changes in Sexual Risk Behavior as Young Men Transition to Adulthood

Understanding how young men's sexual risk behaviors change during the transition from adolescence to early adulthood is important for the design and evaluation of effective strategies to reduce the transmission of HIV and other STDs. Data from three waves of the National Survey of Adolescent Males (1988, 1991 and 1995) were used to categorize 1,880 respondents into clusters according to sexual risk behaviors. Univariate and bivariate analyses were conducted to assess associations between clusters and rates of self-reported STD diagnoses and positive chlamydia tests. Two dimensions of sexual risk-taking defined the clusters: partner characteristics and condom use. More than 50% of men remained in low-risk groups over time. In the first two waves, 24-32% of men reported engaging in high-risk behaviors (risky partners, condom nonuse); these behaviors were associated with elevated levels of STD outcomes. Nearly 40% of men who entered a high-risk group in the first two waves transitioned to a lower risk group by the third wave. Nine percent of men either engaged in increasingly risky behaviors or maintained membership in high-risk groups; elevated STD rates characterized both trajectories. Low condom use combined with having multiple partners during adolescence was associated with elevated STD rates in the year preceding the third wave; high condom use coupled with having risky partners was not. The prominence of low-risk behaviors over time suggests that most young men avoid sexual risk-taking. Effective strategies to reduce HIV and STD risk in young men must simultaneously address multiple dimensions of sexual behavior.

STDs Among Sexually Active Female College Students: Does Sexual Orientation Make a Difference?

Research addressing sexual health or STD risk among lesbian and bisexual college women is scarce. Data on 29,952 sexually active females aged 18-24 who completed the 2006 National College Health Assessment were examined to assess differences in sexual risk factors and recent STD incidence by sexual orientation. Comparisons were analyzed at the bivariate level and through multivariate logistic regression. Bisexual students were the most likely to have had an STD during the past year (9%); lesbians were the least likely (2%). However, lesbians were also the least likely to have had a routine gynecologic examination (46%, compared with 64-73% of others). Among students who had had multiple partners in the past year, those who had had partners of both sexes were more likely to have had an STD (16%) than were students who had had only male partners (9%) or only female partners (6%). Students who had binged on alcohol the last time they partied, had had multiple partners or had had a routine gynecologic examination in the past year, had been tested for HIV or had not used condoms at last vaginal intercourse were at increased odds of having had an STD (odds ratios, 1.3-4.0). Sexual health programs targeting female college students, regardless of sexual orientation, must focus on behavioral risks associated with STDs. In addition, the importance of regular gynecologic exams should be emphasized, especially among lesbians. Further research is needed on risk-taking among female college students who are sexually active with both sexes.

Computer‐Assisted Surveys May Expand Understanding of STD Risks and Incidence

Perspectives on Sexual and Reproductive HealthVolume 40, Issue 3 p. 183-184 Computer-Assisted Surveys May Expand Understanding of STD Risks and Incidence D. Hollander, D. HollanderSearch for more papers by this author D. Hollander, D. HollanderSearch for more papers by this author First published: 02 September 2008 https://doi.org/10.1363/4018308Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume40, Issue3September 2008Pages 183-184 RelatedInformation

Internet Sex Partnering Could Reduce STD Risk

Internet Sex Partnering Could Reduce STD Risk

Internet Sex Partnering Could Reduce STD Risk

Internet Sex Partnering Could Reduce STD Risk

Despite Published Recommendations, Adults’ Routine Health Care Often Lacks Attention to STD Prevention

Despite Published Recommendations, Adults’ Routine Health Care Often Lacks Attention to STD Prevention

HIV, STD, and Sexual Risk Reduction for Individuals with a Severe Mental Illness: Review of the Intervention Literature.

Seroprevalence studies indicate that HIV infection rates are elevated among individuals with a severe mental illness (SMI) compared to the general population. The higher prevalence of HIV among individuals with SMI has prompted the development and evaluation of tailored sexual risk reduction programs for these individuals. In this paper, we review the literature on sexual risk-reduction interventions for individuals with SMI, including interventions for both uninfected and infected individuals. We discuss components of successful interventions, identify limitations in the current literature, and highlight directions for future research. Finally, we conclude with implications for clinical practice, including a discussion of the challenges and advantages to implementing sexual risk reduction interventions for individuals with SMI.

Older Sexual Partners During Adolescence: Links to Reproductive Health Outcomes in Young Adulthood

Sex at a young age with an older partner has been linked to poor reproductive health outcomes during adolescence, but minimal research has examined the influence of teenagers' having an older sexual partner on reproductive health outcomes during the transition to young adulthood. Logistic regression and contrast analyses of three waves of data from the National Longitudinal Study of Adolescent Health were used to examine whether individuals who had had sex before age 16 with a partner at least three years their senior were at increased risk of becoming teenage or unmarried parents or of contracting an STD by young adulthood. Ten percent of females and 2% of males had had early sex with an older partner. These females were more likely to acquire an STD as young adults than were those whose riskiest relationship was before age 16 with a similar-aged partner (odds ratio, 2.1) or at age 16 or later with a similar-aged or older partner (2.4 and 2.6, respectively). For males, having sex before 16, regardless of partner age, was associated with an elevated STD risk (odds ratio, 1.9), although controlling for relationship history characteristics attenuated the association. Adolescents, particularly young adolescents, should be made aware of the potential risks associated with having older sexual partners. In particular, program providers should be alerted that females who engage in early sexual activity with older partners are at especially high risk of experiencing adverse reproductive health consequences.

Female and Male Condoms Offer Similar Protection Against Exposure to Semen

Breakage slippage and other mechanical problems occur more frequently with female than with male condoms but the two devices are about equally effective barriers to semen exposure according to findings from a randomized crossover trial conducted among women attending a reproductive health clinic in the southern United States in 2000-2001. Prostate-specific antigen (PSA) an indicator of exposure to semen was detected in similar proportions of vaginal fluid samples collected after use of male and female condoms during the study-14% and 17% respectively. PSA was present in high enough levels to potentially affect STD risk in 4-5% of samples associated with each type of device. Exposure to semen was more common if women reported mechanical problems with condoms than if they reported incorrect use. (excerpt)

Delayed Intensification (DI) Enhances Event-Free Survival (EFS) of Children with B-Precursor Acute Lymphoblastic Leukemia (ALL) Who Received Intensification Therapy with Six Courses of Intravenous Methotrexate (MTX): POG 9904/9905: A Childrens Oncology Group Study (COG).

Post-induction (ind) intensification with non-anti-metabolite based blocks of therapy, improved EFS on BFM 76/79, CCG 105 and UKALL X. The DI phase of reinduction-reconsolidation (BFM protocol II) was a major component of these strategies. An anti-metabolite based (MTX/mercaptopurine [MP]) intensification also improved EFS (POG 9005/9006). COG 9904 and 9905 addressed whether addition of DI improved EFS for a subset of lower, standard (std) and a subset of NCI high risk (HR) pts who all received 6 courses (cs) of IV MTX (1 gm/m2/24 hrs vs 2 gm/m2/4 hrs) plus oral MP as intensification. The results of the MTX randomization (4 vs 24 hrs) are still blinded. Ind was a dexamethasone (dex)-based 3-drug (NCI std risk) or prednisone-based 4-drug (NCI HR or std with extramedullary disease) regimen. The 3-drug ind was modified because of excessive mortality with the intrathecal (IT) MTX on day 1 changed to IT Ara-C and 6 doses of native asparaginase (asp) (10,000 IU/m2) replaced with 1 dose of PEG asp. 1124 pts were treated pre-; 477 post-amendment. Post-ind, NCI std risk pts with trisomies of chromosomes 4 and 10 or a TELAML1 (TEL) translocation were classified as lower risk and enrolled on 9904. Only the TEL pts participated in the DI randomization. Std risk pts without and HR pts with favorable blast cytogenetics, or pts who did not meet refined NCI high risk age and WBC criteria were eligible for 9905. Pts with CNS3 disease, t(9;22), t(4;11), or hypodiploidy were excluded from both studies. Consolidation on 9904/9905 included 6 cs of IV MTX with leucovorin rescue for all pts. DI began at wk 16 after the 3rd course of IV MTX and was delivered over 8 wks: 1.5 mg/m2 vincristine and 30 mg/m2 daunomycin (wks 1, 2 and 3), daily dex (6 mg/m2 × 21 days), 2500 IU/m2 PEG asp (wk 1), age adjusted IT MTX (wks 1, 5, 6), 75 mg/m2 Ara-C (IV /SC) daily × 4 days (wks 5 and 6), 1 gm/m2 cyclophosphamide (wk 5) and 60 mg/m2 6-thioguanine daily × 14 doses (wks 6–7). A total of 1403 patients were randomized to +/− DI between April 7, 2000 and April 15, 2005. There were only 2 remission deaths; 1 each in +/− DI arms. There was a statistically significant improvement in EFS for all pts receiving the DI, with no statistically significant interaction (size of treatment differences in 4 yr EFS) between any pair of subsets. The difference, though not significant (study not powered to look at subsets), for the 9905 NCI HR pts with and without favorable cytogenetics, was in the same direction as the overall results, but still suboptimal with EFS below 80%. This may reflect differences between the dex and anthracycline used during the DI phase in this study versus BFM 76/69 and CCG 105 and/or the need for an intervention other than this DI in NCI HR patients.No DIDICohort4 yr EFSN4 yr EFSN1 sided p-value*Overall (9904/9905 NCI Std & High Risk)81.6±2.0%71086.5±1.7%6930.00499904/9905 NCI Standard Risk84.5±2.1%51790.3±1.7%5120.00129904 NCI Std Risk with TELAML191.1±2.6%21793.6±2.2%2160.09009905 NCI Std Risk79.8±3.2%30087.9±2.5%2960.00279905 NCI HR74.3±4.3%9376.2±4.5%1810.3839*p-values are by the logrank test

Delinquent Youths’ Risky Behavior Presents Public Health Challenge for Their Communities

Delinquent Youths’ Risky Behavior Presents Public Health Challenge for Their Communities

Anogenital Warts Knowledge and Counseling Practices of US Clinicians: Results From a National Survey

To examine messages US clinicians use when counseling patients diagnosed with anogenital warts. In mid-2004, we conducted a confidential mail survey of nationally representative samples of physicians practicing internal and adolescent medicine, family/general practice, obstetrics/gynecology, urology, or dermatology; nurse midwives; physician assistants; and nurse practitioners. The survey assessed knowledge and counseling practices of clinicians who had diagnosed anogenital warts. After adjusting for survey eligibility, 81% responded. Most (89%) were aware that human papillomavirus (HPV) causes anogenital warts, but only 48% were aware that oncogenic and wart-related HPV genotypes usually differ. Most (>95%) clinicians reported telling patients with warts that warts are an STD, are caused by a virus, or that their sex partners may have or may acquire warts. Many clinicians (>/=85%) also reported discussing STD prevention or assessing STD risk with such patients. Most reported addressing ways to prevent HPV (89%), including using condoms; limiting sex partners or practicing monogamy; or abstinence. Many also reported recommending prompt (82%) or more frequent (52%) Pap testing to female patients with anogenital warts. Potential barriers to counseling included providing definitive answers on how HPV infection was acquired, dealing with patients' psychosocial issues, and inadequate reimbursement. Most surveyed clinicians appropriately counseled patients about the cause and prevention of anogenital warts. However, many clinicians were unaware that oncogenic and wart-related HPV types usually differ, and this may explain why many reported recommending more aggressive cervical cancer screening for female patients with warts.

Understanding sex partner selection from the perspective of inner-city black adolescents.

Black adolescents in inner-city settings are at increased risk for HIV and other STDs. Sex partner characteristics, as well as individual behavior, influence individuals' STD risk, yet little is known about the process of sex partner selection for adolescents in this setting. Semistructured in-depth interviews were conducted during the summer and fall of 2002 with 50 inner-city black adolescents (26 females and 24 males) who had been purposively recruited from an STD clinic. Content analysis was used to study interview texts. Young women desire a monogamous romantic partner, rather than a casual sex partner; however, to fulfill their desire for emotional intimacy, they often accept a relationship with a nonmonogamous partner. Young men seek both physical and emotional benefits from being in a relationship; having a partner helps them to feel wanted, and they gain social status among their peers when they have multiple partners. For men, these benefits may help compensate for an inability to obtain jobs that would improve their financial and, as a result, social status. Both women and men assess partners' STD risk on the basis of appearance. HIV and other STD prevention initiatives must go beyond the scope of traditional messages aimed at behavior change and address the need for social support and socioeconomic opportunities among at-risk, inner-city adolescents.

Are IUDs OK When STD Risk Is High

Recommendations concerning intrauterine device (IUD) use have changed during recent years, and the American College of Obstetricians and Gynecologists now states that “nulligravid or multiparous women at low risk for sexually transmitted diseases” (STDs) are appropriate candidates. In a study of almost 200 women in an urban university-based clinic population who (based on their STD risk) traditionally might not have been considered good candidates …

HIV, STD, and Hepatitis Risk in the Week Following Release From Prison: An Event-Level Analysis

Event-level analyses present data on sexual and drug-related behaviors of men, ages 18 to 29 years, in the first week after release from prison. A calendar-based recall assessment reports type of s...

6 What Makes an Adolescent Sexually Active? Intra- and Interpersonal Influences.

Purpose: Sexual abstinence, a healthy people 2010 goal, is a period of time in which a person does not have sex. We examined intra- and interpersonal factors associated with the decision to have sex after a period of abstinence among young women at high STD risk. Methods: With IRB approval, we recruited 378 women (ages 14 – 17 at enrollment, >90% African American) from clinics in high STD risk communities. Subjects (ss) completed face-to-face interviews every 3 months, and daily diaries for 3 month periods twice a year. We PCR tested self-collected vaginal swabs for C. Trachomatis, N. Gonorrhea, and T. Vaginalis every 3 months, and weekly swabs during diary collection. On daily diaries, ss provided partner-specific coital behaviors. We defined an abstinence “run” (consecutive days of no sex) as our unit of analysis. Runs ended with a diary report of sex, and were censored with a missing diary day or the start or end of diary collection. We used frailty models to estimate the effect of intrapersonal factors, interpersonal factors, and STI diagnosis on time to ending a run. Frailty models are adaptations of proportional hazards models that control for multiple observations (in this case “runs” of abstinence) from one individual. Intrapersonal factors included daily positive and negative mood (3 items each, range 3-15, α=0.81 and 0.76 respectively), and daily sexual interest (1 item, range 1-5). Partner-specific interpersonal factors included daily partner support (4 items, range 0-4, α=0.85), and overall relationship quality (6 items, range 6-24, α=0.91). Recent STIs were diagnosed in the quarterly (or 3 month) interview immediately before the run. Results: 378 ss contributed 6070 runs of abstinence, with 55.3% ending with sex and 44.7% censored. The median length of an abstinence run was 10 days (95% CI 9, 11 days) and mean 39.1 days (std error = 0.71). Each year increase in age increased the hazard of ending a run by 22% (p<.001). Each unit increase in sexual interest increased the hazard of ending a run by 22% (p<.001); each unit increase in positive mood increased the hazard by 2% (p<.001); negative mood was not a significant predictor. Each unit increase in partner support increased the hazard of ending a run by 25% (p<.001); and each unit increase in relationship quality increased the hazard by 5% (p<.001). A recent STI decreased the hazard of ending a run by 17% (p<0.01). Conclusions: The decision to have sex after a period of abstinence was strongly influenced by relationship characteristics as well as sexual interest and mood. This challenges popular notions of “casual” adolescent sex (e.g. “friends with benefits”). Adolescent STD prevention may be enhanced by tailoring counseling to these intra- and interpersonal circumstances.

Understanding Sex Partner Selection From the Perspective of Inner-City Black Adolescents

CONTEXT: Black adolescents in inner-city settings are at increased risk for HIV and other STDs. Sex partner characteristics, as well as individual behavior, influence individuals' STD risk, yet little is known about the process of sex partner selection for adolescents in this setting. METHODS: Semistructured in-depth interviews were conducted during the summer and fall of 2002 with 50 inner-city black adolescents (26 females and 24 males) who had been purposively recruited from an STD clinic. Content analysis was used to study interview texts. RESULTS: Young women desire a monogamous romantic partner, rather than a casual sex partner; however, to fulfill their desire for emotional intimacy, they often accept a relationship with a nonmonogamous partner. Young men seek both physical and emotional benefits from being in a relationship; having a partner helps them to feel wanted, and they gain social status among their peers when they have multiple partners. For men, these benefits may help compensate for an inability to obtain jobs that would improve their financial and, as a result, social status. Both women and men assess partners’STD risk on the basis of appearance. CONCLUSIONS: HIV and other STD prevention initiatives must go beyond the scope of traditional messages aimed at behavior change and address the need for social support and socioeconomic opportunities among at-risk, inner-city adolescents.

Understanding Sex Partner Selection From the Perspective of Inner‐City Black Adolescents

CONTEXT: Black adolescents in inner‐city settings are at increased risk for HIV and other STDs. Sex partner characteristics, as well as individual behavior, influence individuals' STD risk, yet little is known about the process of sex partner selection for adolescents in this setting.METHODS: Semistructured in‐depth interviews were conducted during the summer and fall of 2002 with 50 inner‐city black adolescents (26 females and 24 males) who had been purposively recruited from an STD clinic. Content analysis was used to study interview texts.RESULTS: Young women desire a monogamous romantic partner, rather than a casual sex partner; however, to fulfill their desire for emotional intimacy, they often accept a relationship with a nonmonogamous partner. Young men seek both physical and emotional benefits from being in a relationship; having a partner helps them to feel wanted, and they gain social status among their peers when they have multiple partners. For men, these benefits may help compensate for an inability to obtain jobs that would improve their financial and, as a result, social status. Both women and men assess partners’STD risk on the basis of appearance.CONCLUSIONS: HIV and other STD prevention initiatives must go beyond the scope of traditional messages aimed at behavior change and address the need for social support and socioeconomic opportunities among at‐risk, inner‐city adolescents.