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.     

Behavioral Changes Associated With Testing HIV-Positive Among Sexually Transmitted Infection Clinic Patients In Cape Town, South Africa

Objectives. We sought to examine behavioral risks and behavior changes associated with testing HIV-positive among sexually transmitted infection (STI) patients, in order to inform HIV- and STI-prevention interventions.Methods. We performed a cohort study of 29 STI patients who seroconverted from HIV-negative to HIV-positive during 1 year of observation and 77 STI patients who persistently tested HIV-negative. Computerized behavioral interviews were collected at baseline and at 1 year, and STI clinic charts were abstracted over the same 1-year period.Results. The STI patients who reported genital bleeding during sexual activity at baseline were significantly more likely to test HIV-positive. Reductions in number of sexual partners and rates of unprotected intercourse occurred for all STI clinic patients regardless of whether they tested HIV-positive.Conclusions. Although risk reductions occurred, 5% of HIV-negative STI clinic patients subsequently tested HIV-positive over 1 year. Behavioral risk-reduction interventions are urgently needed for male and female STI clinic patients.People who are newly diagnosed with HIV infection are a critical population for prevention interventions, particularly individuals with co-occurring sexually transmitted infections (STIs). Although HIV is transmissible at any time during the course of HIV disease, infectiousness is greatest just after HIV seroconversion and during episodes of co-occurring STIs.¹ Research in the United States, Europe, and Australia shows that a significant minority of newly diagnosed HIV-positive persons continues to engage in HIV-transmission risk practices immediately after learning their HIV status.² In one study of recently seroconverted men who have sex with men, Colfax et al.³ found that HIV transmission risk behaviors persisted for a substantial number of infected men. Most concerning was the continued practice of unprotected anal intercourse with HIV-negative or unknown-HIV-status partners. Case–control and prospective cohort studies report that men who seroconvert for HIV are distinguishable from men who remain HIV-negative by their use of psychoactive drugs, sensation-seeking personality characteristics, and intentional risk taking.^4–6Although the majority of HIV infections occur in southern Africa, there is little research available on the behavioral characteristics of people who seroconvert for HIV in this region. One study of Kenyan commercial sex workers showed that women who seroconverted for HIV demonstrated significant reductions in risk practices, with further risk behaviors diminishing over advancing HIV disease.⁷ The HIV epidemic in southern Africa is amplified by co-occurring STIs for several reasons. HIV transmission is facilitated by other STIs degrading naturally protective mucosal and epithelial barriers, creating a portal of entry to the bloodstream and increased access to HIV-susceptible cells. Studies of STI clinic patients show that the median time to HIV seroconversion is 1.5 years from initial STI clinic visit, and that substance use and sexual partners with STIs are major contributing factors to HIV seroconversion.⁸ Sexually transmitted infection clinic patients who seroconvert are at considerable risk for transmitting the virus to others because they are likely to be highly infectious.⁹ A meta-analysis of factors that influence per-act HIV-transmission risks showed that a history of ulcerative STI in either couple member increases the risk for HIV transmission more than 5-fold.¹⁰ Importantly, it is estimated that infectivity in the early stages of HIV infection is 9 times greater than during asymptomatic stages.¹⁰ Therefore, people diagnosed with an STI who also contract HIV represent a critical population for prevention interventions.The purpose of our study was to examine the behavioral characteristics of STI clinic patients who seroconvert for HIV. We were particularly interested in identifying behavioral risk factors as well as subsequent behavior changes among STI clinic patients who test HIV-positive following an STI infection. To achieve these goals we conducted risk behavior assessments in a cohort of STI clinic patients who had tested HIV-negative and then subsequently tested HIV-positive compared with their persistently HIV-negative counterparts.     

Threats of Cross-Contamination on Effects of a Sexual Risk Reduction Intervention: Fact or Fiction

This study sought to empirically evaluate the extent and impact of cross-contamination on the effects of a STI/HIV intervention trial previously shown to be effective in reducing high-risk sexual behaviors among African–American adolescent females. Participants were recruited through community health agencies in the Southeastern United States and comprised 522 sexually active 14- to 18- year-old African–American females who completed self-administered questionnaires and face-to-face interviews at baseline, 6- and 12-month time points. Participants were randomized to a STI/HIV risk reduction group or a general health promotion group. The STI/HIV intervention group participated in four group sessions addressing constructs such as HIV knowledge, communication, condom use self-efficacy and condom use behaviors. The control group participated in four group sessions focused on general health topics. The study setting afforded multiple opportunities for cross-talk between intervention and control group participants. Consistent condom use, defined as condom use during every vaginal sex act, was the primary outcome measure. Other outcome measures included various sexual behaviors, observed condom application skills and psychosocial variables associated with HIV preventive behaviors. Approximately 73% of participants reported some level of cross-talk. Linear and binary GEE models assessing the impact of the STI/HIV intervention on contaminated vs. uncontaminated control group participants indicated no differential effects of the intervention. Furthermore, equivalence tests demonstrated that contaminated and uncontaminated control groups were equivalent. Findings from this study provide empirical evidence suggesting that behavioral and psychosocial outcomes may be resistant to cross-contamination in randomized controlled trials testing safer sex interventions among African–American adolescent females.     

女同性恋人群性行为特征及性传播疾病知识知晓情况调查

目的 了解山东省聊城市女同性恋（LES）人群性行为特征及性传播疾病（STI）知识知晓等情况。方法 于2013-2015年在山东省聊城市通过滚雪球抽样方法,在网络和实地招募调查对象并进行面对面调查。结果 共调查LES 163人,年龄以20~30岁为主,占68.1%（111人）;婚姻状况以未婚为主,占71.8%（117人）;75.5%在<20岁发生性行为,65.6%发生过异性性行为,最近半年至少有2个同性性伴侣的占21.4%,11.6%与同性发生过偶然性行为,13.5%最近1年与异性发生过性行为,13.5%与同性发生过器具交,8.0%发生过商业性行为,20.3%月经期间与同性发生过性行为,与同性交换使用性器具的占8.1%,76.5%交换时不清洗或消毒;STI认识程度较低,仅有41.6%的认为同性性行为会传播STI或容易发生生殖系统感染。结论 LES中存在多性伴现象,缺乏健康知识和防护意识,存在生殖健康危险因素。     

Meta-Analysis of Single-Session Behavioral Interventions to Prevent Sexually Transmitted Infections: Implications for Bundling Prevention Packages

Evidence-based, single-session behavioral interventions are urgently needed for preventing the spread of HIV and other sexually transmitted infections (STIs).To estimate the efficacy of single-session, behavioral interventions for STI prevention, we collected data from 29 single-session interventions (20 studies; n = 52 465) with an STI outcome. Infection with an STI was 35% less likely (odds ratio = 0.65; 95% confidence interval = 0.55–0.77) among intervention group participants than among control group participants. Single-session interventions offer considerable benefits in terms of disease prevention and create minimal burden for both the patient and the provider.Brief and effective STI prevention interventions are a valuable tool and can be readily adapted to bolster the benefits of biomedical technologies focusing on the prevention of HIV and other STIs.INTERVENTIONS TARGETING prevention of HIV and other sexually transmitted infections (STIs) during the course of routine clinical services must be succinct to be effective. Interventions intended to reduce sexual risk behaviors and HIV and other STIs have been tested in a variety of clinical and community settings. Although behavioral interventions have demonstrated significant reductions in risk behaviors and have offered evidence of disease prevention, many consist of multiple steps and sessions,1–5 thus placing a considerable burden on patients and requiring substantial resources.4Of particular concern is the feasibility of implementing multiple-session behavioral interventions in conjunction with currently available health care services. These services continue to face budget reductions that lead to staff shortages and limited means for retaining patients throughout the course of an extended intervention.6 Limited resources can render multiple-session interventions unusable or force service providers to substantially modify these interventions.In addition to the need for brief behavioral interventions in the public health sector, there is a growing demand for feasible behavioral interventions that can be used in combination with biomedical prevention technologies. It is well recognized that no single prevention strategy, including behavioral interventions, male circumcision, preexposure and postexposure prophylaxis, vaccines, and vaginal or anal microbicides, will be completely effective in protecting individuals against infection with HIV and other STIs.7–14 Furthermore, the effectiveness of biomedical prevention technologies can be undermined by changes in risk behaviors, such as risk compensation.15Single-session behavioral interventions can potentially add value to the protective effects of biomedical interventions. There is growing recognition of the need for bundling multiple prevention strategies to gain cumulative effects.16,17 Behavioral risk reduction interventions can play a critical role in comprehensive programs designed to prevent the spread of HIV and other STIs, particularly when they are designed to fit within current health care services.18We conducted a meta-analysis to examine whether single-session risk reduction interventions targeting HIV and other STIs have positive effects on disease outcomes. We focused on STI outcomes because they are clinically meaningful indicators of intervention efficacy. Moreover, we chose single-session interventions because they are most likely to be successfully incorporated into existing services and meta-analyses have not, to date, focused on their effects. There are now sufficient numbers of STI trials with outcome data available to determine whether single-session interventions can lead to disease reductions relative to a standard of care. We also investigated moderators of STI outcomes to identify characteristics of single-session interventions that result in a reduced prevalence of disease. Finally, in a subset of studies that provided behavioral data related to sexual risk taking, we conducted an additional meta-analysis to determine whether single-session interventions improve condom use.     

Does Audio‐CASI Improve Reports of Risky Behavior? Evidence from a Randomized Field Trial Among Young Urban Men in India

This study compares the effectiveness of audio computer-assisted self-interviewing (Audio-CASI) with face-to-face interviews and self-administered questionnaires in collecting sensitive information on risky sexual and other behaviors among young men in urban India. A randomized study design compared data collected from 900 male college students using the three data-collection approaches and from 600 young men residing in slums using Audio-CASI and face-to-face interviews. Among the college students, the reported prevalence of risky behaviors was generally higher for young men interviewed through the Audio-CASI approach than with face-to-face interviews; self-administered questionnaires failed to yield significantly higher estimates than face-to-face interviews. Among the slum residents, the results were more mixed; the Audio-CASI approach failed to yield consistently higher responses for many risky behaviors compared with the face-to-face interview mode. The results demonstrate that although Audio-CASI appears to yield higher estimates of risky behavior among college-educated, computer-literate populations of young men, the efficacy of this approach among less-educated and less computer-literate populations appears more doubtful.     

The Impact of Delinquency on Young Adult Sexual Risk Behaviors and Sexually Transmitted Infections

PurposeYouth in the juvenile justice system have increased sexual risk behavior and sexually transmitted infections (STI). However, research exploring the effect of self-reported delinquency on sexual risk behavior and STI is limited, and results vary depending on the populations studied. Therefore, we used nationally representative data to examine the longitudinal association between delinquent behavior, sexual risk behavior, and STI among adolescents and young adults.MethodsWe used a sample of 10,828 participants from the National Longitudinal Study of Adolescent and Health. Outcomes included STI and sexual risk behavior from Wave III (17–27-year-olds). Predictors for the generalized linear regression models (stratified by gender) include race, age, education, relationship status at Wave III, and delinquent behavior groups (life-course persistent, adolescence-limited, late-onset and nondelinquency).ResultsNone of the delinquency groups were associated with young adult STI. Only life-course persistent delinquency was associated consistently with sexual risk behavior (except for condom use). The adolescence-limited and late-onset groups had limited effects on sexual risk outcomes.ConclusionsLife-course persistent delinquency influences the expression of young adult sexual risk behavior. However, delinquent behavior does not predict STI in a population-based sample of youth. Programs and interventions that address the sexual health of youth need to consider the role of delinquency in shaping sexual risk behaviors, and future research should explore broader societal and environmental risk factors on STIs.     

Evaluation of a cognitive-behavioral, group, randomized controlled intervention trial to prevent sexually transmitted infections and unintended pregnancies in young women

BACKGROUND: Few cognitive-behavioral interventions have focused on preventing sexually transmitted infections (STIs) and unintended pregnancies (UPs) in young, sexually active women in a single study. Military recruit training provides a well-defined, national, nonclinic sample in which to evaluate such an intervention. METHODS: All female Marine recruits (N=2,288) in training were approached. Of these, 2,157 (94.3%) voluntarily agreed and were randomly assigned, by platoons, to participate in cognitive-behavioral interventions to prevent STIs or UPs or to prevent physical training injuries and cancer. Participants completed self-administered questionnaires and were screened for pregnancy, Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis at baseline and, on average, 1 and 14 months postintervention. RESULTS: A higher proportion of the control group had a postintervention STI or UP [odds ratio (OR)=1.41, 95% confidence interval (CI)=1.01-1.98]. Among participants who had no history of STIs or pregnancy, but who engaged in risky sexual behaviors just before recruit training, the control group was more likely to acquire a postintervention STI (OR=3.24, CI=1.74-6.03). Among participants who were not sexually experienced at baseline, the control group was more likely to have casual (OR=2.05, 95% CI=1.04-4.08) and multiple (OR=1.87, 95% CI=1.01-3.47) sexual partners postintervention. CONCLUSIONS: This randomized controlled trial indicates that cognitive-behavioral interventions are effective for reducing behavioral risk and preventing STIs and UPs in young, sexually active women who are not seeking health care.     

Patterns of Sexual Risk Behavior Change Among Sexually Transmitted Infection Clinic Patients

Effective interventions to reduce sexually transmitted infection (STI) risk behaviors are most potent in the short term and are not uniformly effective for all people. The present study examined patterns of sexual behavior change among 238 men and 104 women who received risk reduction counseling in a public STI clinic and were followed for 9 months with a 1-year retrospective clinic chart abstraction for newly diagnosed STI. A two-stage, multivariate cluster analysis was performed on four risk behavior difference scores (follow-up - baseline) for 1-month, 3-month, 6-month, and 9-month follow-up frequencies of unprotected vaginal and anal intercourse. Cluster analysis identified three profile subgroups: Subgroup 1 had lower levels of risk behavior at all time points; Subgroup 2 had significant reductions in risk over time; and Subgroup 3 demonstrated significant increases in risk over time. Analyses on variables external to the cluster analysis found that the three profile subgroups differed on numbers of sex partners, substance use, sensation seeking, indicators of risk reduction motivation and behavioral skills, and contracting new STI. STI clinic patients with varying profiles of sexual behavior change were, therefore, differentiated by factors relevant to STI interventions.This revised article was published online in June 2005 with the book reviews as separate articles     

The feasibility of recruiting young men in rural areas from community football clubs for STI screening

OBJECTIVE: To investigate the feasibility of recruiting young men from rural football clubs for screening for sexually transmitted infections (STIs). METHODS: Young men aged 16 to 29 were recruited from four football clubs outside of metropolitan areas in Victoria, Australia, and completed a questionnaire about sexual activity, knowledge and history of STIs, and alcohol and drug use, and provided a urine sample for STI testing. RESULTS: One hundred and eight participants completed the questionnaire and 92 (85.2%) also provided a urine sample. More than 90% of eligible players present at the clubs on the night of the study participated. Eighty-seven participants (80.6%) had ever had penetrative sex, with 33 (39.3%) reporting a new sexual partner in the past three months. Among those who had ever had sex, the prevalence of chlamydia was 3.9% (95% Cl 0.8-11.0). While the majority of participants visited their doctor in the past year (78.7%) and were comfortable with the idea of an annual STI screen, few had ever discussed sex or STIs with their doctor or had a previous STI test. CONCLUSION:Young men from rural areas may be at considerable risk of STIs and many have not been previously tested. However, most are willing to participate in screening programs and the high participation rate achieved in this pilot project demonstrates the potential for screening to be successfully extended into non-medical settings such as sporting clubs. IMPLICATIONS: Young people at risk of STIs can be successfully recruited for STI screening from community settings.     

Human papillomavirus vaccine-related risk perceptions and subsequent sexual behaviors and sexually transmitted infections among vaccinated adolescent women

ObjectiveTo examine the association between risk perceptions after human papillomavirus (HPV) vaccination and sexual behaviors and sexually transmitted infection (STI) diagnosis over 30 months following vaccination.MethodsParticipants included 112 sexually experienced girls aged 13–21 years who were enrolled at the time of first HPV vaccination and completed ⩾2 of 4 follow-up visits at 2, 6, 18, 30 months and including 30 months. At each visit, participants completed surveys assessing risk perceptions (perceived need for safer sexual behaviors, perceived risk of STIs other than HPV) and sexual behaviors. STI testing was done at 6, 18, and 30 months. Outcomes were condom use at last intercourse with main male partner, number of sexual partners since last study visit, and STI diagnosis. Associations between risk perceptions and sexual behaviors/STIs were examined using generalized linear mixed models.ResultsMean age was 17.9 years; 88% were Black; 49% had a history of STI at baseline. Scale scores for perceived need for safer sexual behaviors did not change significantly over time. Scale scores for perceived risk of STIs other than HPV significantly changed (p = 0.027), indicating that girls perceived themselves to be more at risk of STIs other than HPV over 30 months following vaccination. Multivariable models demonstrated that greater perceived need for safer sexual behaviors following vaccination was associated with condom use (p = 0.002) but not with number of partners or STI diagnosis. Perceived risk of STIs other than HPV was not associated with the three outcomes.ConclusionsThe finding that perceived risk for STIs other than HPV was not associated with subsequent sexual behaviors or STI diagnosis is reassuring. The association between perceived need for safer sexual behaviors and subsequent condom use suggests that the HPV vaccination visit is an important opportunity to reiterate the importance of safer sexual behaviors to sexually experienced girls.     

Application of computer-assisted interviews to sexual behavior research.

Collection of sensitive data with the use of video-enhanced, computer-assisted, self-administered interviews (V-CASI) has the potential to reduce interview bias and improve the validity of the study. The purpose of this study was to compare responses to sensitive questions elicited by V-CASI and by face-to-face interview (FTFI) methods. Women attending a New Orleans, Louisiana, public family planning or sexually transmitted disease clinic from July 1995 to July 1996, diagnosed with a Chlamydia trachomatis infection responded to eight close-ended behavioral questions (four socially undesirable, two socially desirable, and two neutral behaviors) using both FTFI and V-CASI techniques in a randomized crossover design. Of the 280 women included, the mean age was 23 years, 95 percent were African American, and 71 percent felt comfortable using computers. While kappa scores indicated good-to-excellent agreement between interview techniques, women tended to admit to socially undesirable behaviors more often on V-CASI compared with FTFI. Thirty percent of the women gave a discrepant response between V-CASI and FTFI toward social desirability. Women who reported a socially undesirable behavior in V-CASI (i.e., more than two sex partners and infrequent condom usage) were more likely to have a discrepant response. Utilization of the same logistic regression model to predict condom use yielded different results when data from V-CASI were used compared with data from FTFI. The V-CASI technique can reduce social desirability bias and improve validity in research requiring information on sensitive sexual behaviors.     

Randomized clinical trial of brief risk reduction counseling for sexually transmitted infection clinic patients in Cape Town, South Africa

Objectives. We examined the effects of a brief counseling intervention designed to reduce HIV risk behaviors and sexually transmitted infections (STIs) among patients receiving STI services in Cape Town, South Africa.Methods. After randomization to either a 60-minute risk reduction counseling session or a 20-minute HIV–STI educational session, patients completed computerized sexual behavior assessments. More than 85% of the participants were retained at the 12-month follow-up.Results. There were 24% fewer incident STIs and significant reductions in unprotected vaginal and anal intercourse among participants who received risk reduction counseling relative to members of the control condition. Moderator analyses showed shorter lived outcomes for heavy alcohol drinkers than for lighter drinkers. The results were not moderated by gender.Conclusions. Brief single-session HIV prevention counseling delivered to STI clinic patients has the potential to reduce HIV infections. Counseling should be enhanced for heavier drinkers, and sustained outcomes will require relapse prevention techniques. Disseminating effective, brief, and feasible behavioral interventions to those at highest risk for HIV infection should remain a public health priority.Although South Africa has less than 1% of the world''s population, it accounts for nearly 10% of the global burden of AIDS. It is estimated that currently 5.5 million South Africans (12.3% of the country''s total population of 44.8 million) are infected with HIV.¹ A number of different factors probably account for the high incidence of HIV in South Africa, including sexual mixing patterns, social migration, high rates of alcohol abuse, sexual coercion in relationships characterized by gender power imbalances, and delayed rollout of HIV prevention programs.^2–5Perhaps most critical in driving HIV infections are other co-occurring sexually transmitted infections (STIs), which increase susceptibility to HIV by degrading naturally protective mucosal immunological mechanisms, migrating vulnerable cells to the genital tract, and affording HIV a portal of entry into the bloodstream. STIs also facilitate transmission of the virus from HIV-infected partners by increasing their HIV infectiousness.⁶ As a result of these factors, in combination with high HIV prevalence rates, South Africans who contract STIs are among the highest-risk populations for HIV infection in the world.²Although behavioral interventions have been shown to be effective in reducing sexual risks among STI clinic patients,⁷ several of these interventions have relied on multiple group sessions that have proven difficult to implement.^8,9 In response to the urgent need for effective, feasible, and affordable interventions designed to prevent HIV among STI clinic patients, researchers have developed brief single-session HIV risk reduction counseling interventions intended for use in both resource-rich^10–13 and resource-poor STI clinics.¹⁴ When performed in conjunction with HIV testing, brief prevention counseling has shown promise in reducing sexual risk behaviors and decreasing STIs.^15,16Brief risk reduction counseling has also demonstrated promising outcomes when delivered outside of HIV testing. For example, Crosby et al.¹⁷ examined a single-session personalized counseling intervention for men receiving STI clinic services in the United States. The intervention led to increases in condom use, reductions in unprotected sex, reductions in sexual partners, and 38% fewer new STI diagnoses relative to a standard of care control group. Overall, single-session sexual risk reduction counseling can be as effective as interventions that require multiple sessions and consume far greater resources.^7,18The brief risk reduction counseling intervention reported here is grounded in cognitive–behavioral theories of health behavior change and is designed for use with all STI patients, including those who refuse HIV testing. We previously tested this intervention in a small trial conducted in Cape Town, South Africa. We observed a 63% reduction in unprotected vaginal and anal intercourse over a 6-month follow-up period, compared with the 30% reduction observed in an HIV education control condition.¹⁹ In addition, condom use among participants increased from 65% to 88%. The overall findings were promising and suggested that a brief single-session counseling intervention may be effective in reducing the risk of HIV and other STIs in South Africa.We report the outcomes of a randomized clinical trial designed to test the effects of a brief single-session risk reduction counseling session intended for use in resource-poor STI clinics. We hypothesized that brief theory-based risk reduction counseling sessions would reduce unprotected vaginal and anal intercourse and prevent STIs during 12 months of observation. We also examined potential moderators of the intervention effects. We included participant gender as a factor in the analyses because there are differences in STI risks between men and women, especially given the gender dynamics in sexual relationships and that men ultimately control the use of condoms. We also tested alcohol use and use of other drugs as moderators of risk reduction outcomes because they are known cofactors for HIV transmission risk behaviors in South Africa.^20,21     

Sexual, Behavioral, and Social Characteristics of Female Sex Workers and Their Risk of Sexually Transmitted Infections: In South Korea

This study calculated the sexually transmitted infection (STI) prevalence rates among female sex workers (FSWs) in South Korea and elucidated the social and behavioral risk factors that affect FSW??s infection with STIs. FSWs were recruited using a multistage cluster probability sampling method (N?=?1,073). STI prevalence rates were 9.8?% for Treponema pallidum, 2.6?% for gonorrhea, and 12.5?% for Chlamydia. The risk probability of STI infection was higher for participants with fewer social relationships (OR?=?0.99), more suicide attempt experiences (OR?=?1.36), lower frequency of condom use (OR?=?0.81), lower self-efficacy (OR?=?0.78), and more irregular STI examination experiences (OR?=?0.69). The STI prevalence rates of FSWs in South Korea were lower than those of FSWs in other Southeast Asian nations. While the direct factors for STI prevalence among this population were related to safe sex, indirect factors such as social support were also significant. Because this affects the self-efficacy of isolated individuals among sex workers, preventive interventions in STIs among FSWs must be expanded to the promotion of social support and mental health programs.     

A randomized comparison of A-CASI and phone interviews to assess STD/HIV-related risk behaviors in teens.

PURPOSE: To compare response bias associated with a telephone survey of sexually transmitted disease/human immunodeficiency virus (STD/HIV)-related risk behaviors and an in-home self-administered audio computer assisted self interview (A-CASI). METHODS: We randomly assigned an urban household sample of 223 African-American adolescents to a telephone interview or an A-CASI in their home. The sample was previously recruited by telephone for an earlier study regarding STDs and sexual behavior. We queried participants about their STD/HIV-related risk behaviors. We also assessed their perceived comfort, honesty, and accuracy in answering questions in the different modes through a telephone computer-assisted self-interview (T-CASI). RESULTS: There were no significant differences by mode in percentages of participants reporting STD/HIV-related risk behaviors, except more A-CASI participants reported having engaged in sexual intercourse in past 3 months (43.8% vs. 33.3%). There were no differences in perceived comfort, honesty, and accuracy in answering questions in the different modes. These results also did not change after we adjusted for age, household structure, and current school enrollment. CONCLUSIONS: Telephone interviews, a more economical mode, can be employed without much risk of increasing the response bias in the data assessing crude measures of risk.     

Knowledge,perceived stigma,and care-seeking experiences for sexually transmitted infections: a qualitative study from the perspective of public clinic attendees in Rio de Janeiro,Brazil

Background  

An estimated 12 million sexually transmitted infections (STIs) are documented in Brazil per year. Given the scope of this public health challenge and the importance of prompt treatment and follow-up counseling to reduce future STI/HIV-related risk behavior, we sought to qualitatively explore STI clinic experiences among individuals diagnosed with STIs via public clinics in Rio de Janeiro, Brazil. The study focused on eliciting the perspective of clinic users with regard to those factors influencing their STI care-seeking decisions and the health education and counseling which they received during their clinic visit.     

Sexual Behavior and STI/HIV Status Among Adolescents in Rural Malawi: An Evaluation of the Effect of Interview Mode on Reporting

This study investigates the reporting of premarital sex in rural southern Malawi. It summarizes the results of an interview‐mode experiment conducted with unmarried young women aged 15–21 in which respondents were randomly assigned to either an audio computer‐assisted self‐interview (ACASI) or a conventional face‐to‐face (FTF) interview. In addition, biomarkers were collected for HIV and three STIs: gonorrhea, chlamydia, and trichomoniasis. Prior to collecting the biomarkers, nurses conducted a short face‐to‐face interview in which they repeated questions about sexual behavior. The study builds on earlier research among adolescents in Kenya where we first investigated the feasibility and effectiveness of ACASI. In both Malawi and Kenya, the mode of interviewing and questions about types of sexual partners affect the reporting of sexual activity. Yet the results are not always in accordance with expectations. Reporting for “ever had sex” and “sex with a boyfriend” is higher in the FTF mode. When we ask about other partners as well as multiple lifetime partners, however, the reporting is consistently higher with ACASI, in many cases significantly so. The FTF mode produced more consistent reporting of sexual activity between the main interview and a subsequent interview. The association between infection status and reporting of sexual behavior is stronger in the FTF mode, although in both modes a number of young women who denied ever having sex test positive for STIs/HIV.     

Context of Risk for HIV and Sexually Transmitted Infections Among Incarcerated Women in the South: Individual,Interpersonal, and Societal Factors

Incarcerated women are disproportionately affected by HIV and sexually transmitted infections (STIs) due to risk factors before, during, and after imprisonment. This study assessed the behavioral, social, and contextual conditions that contribute to continuing sexual risk behaviors among incarcerated women to inform the adaptation of an evidenced-based behavioral intervention for this population. Individual, in-depth interviews were conducted with 25 current and 28 former women prisoners to assess HIV/STI knowledge, perceptions of risk, intimate relationships, and life circumstances. Interviews were independently coded using an iterative process and analyzed using established qualitative analytic methods. Major themes identified in the interviews involved three focal points: individual risk (substance abuse, emotional need, self-worth, perceptions of risk, and safer sex practices); interpersonal risk (partner pressure, betrayal, and violence); and risk environment (economic self-sufficiency and preparation for reentry). These findings highlight the critical components of HIV/STI prevention interventions for incarcerated women.     

What Girls Won't Do for Love: Human Immunodeficiency Virus/Sexually Transmitted Infections Risk Among Young African-American Women Driven by a Relationship Imperative

PurposeRates of Human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) continue to increase among African-American youth. Adolescents who have a stronger identity in relation to others (relational identity) rather than to themselves (self-identity) may view intimate relationships as imperative to a positive self-concept, which may lead to risky sexual behavior and abuse. Therefore, the present study assessed the associations among a relationship imperative and HIV/STI-related risk factors and behaviors.MethodsParticipants were 715 African-American adolescent females, aged 15 to 21 years. They completed measures that assessed how important a relationship was to them and HIV-related risk factors and behaviors. Participants also provided vaginal swab specimens for STI testing.ResultsMultivariate logistic regression analyses, controlling for covariates, were conducted. Females who endorsed a relationship imperative (29%), compared to those who did not, were more likely to report: unprotected sex, less power in their relationships, perceived inability to refuse sex, anal sex, sex while their partner was high on alcohol/drugs, and partner abuse. Furthermore, participants with less power, recent partner abuse, and a perceived ability to refuse sex were more likely to test STI positive.ConclusionThese results indicate that if African-American adolescent females believe a relationship is imperative, they are more likely to engage in riskier sexual behaviors. Additionally, less perceived power and partner abuse increases their risk for STIs. HIV/STI prevention programs should target males and females and address healthy relationships, sense of self-worth, self-esteem and the gender power imbalance that may persist in the community along with HIV/STI risk.     

Young people's use of condoms and their perceived vulnerability to sexually transmitted infections

OBJECTIVE: Although sexually transmitted infections (STIs) are most prevalent among young people, they do not use condoms consistently to prevent infection. This study examined young people's perceptions of vulnerability to STIs and pregnancy. METHOD: A cross-sectional survey on sexual behaviour was carried out on a stratified random sample of school-going Year 12 and Year 13 young people aged 16-18 years in Christchurch, New Zealand. RESULTS: 1,136 students participated in the study, half of whom were sexually active. Fewer than half of the sexually active participants (44.6%) used condoms on every occasion of sexual intercourse. Only 23% of participants reported that they felt vulnerable to acquiring an STI, with a quarter of respondents reporting not using condoms because they did not think that either they or their partner had an infection, and a quarter reported not using condoms because they used other contraceptive measures. CONCLUSIONS: The results of this study support the premise that young people are more concerned about preventing unwanted pregnancy than STIs. Their perception of low risk of acquiring STIs is not without substance, however, as it was established that there was a low prevalence of Chlamydia trachomatis among this school-going population. The key to achieving more consistent condom use for STI prevention for young people may be through finding ways to get them to accept that they are vulnerable to STIs, despite the low prevalence among their peers, because the consequences of infection are far-reaching.