Authors: Kamb M¹, Lindsey C¹, Metcalf CA¹, Douglas JM Jr², Malotte CK³, Paul S, Rhodes F, Rogers J, Peterman T¹.

¹CDC, Atlanta; ²Denver Publ Hlth, Denver, CO; ³Long Beach Dept Hlth, Long Beach, CA; ⁴New Jersey Health Dept., Trenton, NJ.

Background: Five years apart, two trials of HIV/STD counseling efficacy (Project RESPECT, 1993-95 and RESPECT-2, 1999-2000) enrolled STD patients at three urban STD clinics across the U.S. (Newark, Denver, Long Beach). The two trials collected similar behavioral, clinical and laboratory data. Methods: We compared participating men (M) and women (W) on their baseline demographic, behavioral, and STD data. Demographic factors and behaviors were based on questionnaires, and STDs on nucleic acid test or culture for N. gonorrhoeae [GC] and nucleic acid test for chlamydia [CT]. The trials had similar eligibility criteria except RESPECT enrolled only heterosexual men; thus we excluded RESPECT-2 M who reported sex with a man during the past 3 months.

Results: We had baseline data for 1467 M and 1260 W from RESPECT [R1], and 1478 M and 1325 W from RESPECT-2 [R2]. For both studies, enrollment varied numbers by site, but similar numbers of M and W enrolled in the two studies at each site. Participants in both studies were similar by site in gender, race/ethnicity, and age. Among W in Denver, Long Beach, and Newark, CT prevalence was 12%, 20%, and 17% respectively in R1 and 8%, 13%, and 15% in R2. Among M at those sites, CT prevalence was 16%, 21% and 19% in R1 and 11%, 16%, and 15% in R2. Among W, GC prevalence was 8%, 9%, and 15% in R1 and 5%, 4%, and 16% in R2. Among M, GC prevalence was 11%, 15%, and 32% in R1 and 7%, 6%, and 25% in R2. Thus, in M and W, CT and GC decreased in Denver and Long Beach. In Newark, both STDs decreased in M but prevalences remained high, while in W both STDs remained stable and high. The proportion of subjects who reported always (9% W, 14% M) or never (40% W, 37% M) using condoms was similar across sites and did not change over time. However, in R2 at each site more M and W reported > 1 sex partner (R1 v R2: M: 40% v 54%; W 20% v 35%) and more reported anal sex in the past 3 months (M:9% v 21%; W: 9% v 22%).

Conclusions: The general decrease in STD prevalence with stable or increasing risk behaviors among patients attending these US STD clinics suggests the declining STD prevalences may be due to enhanced STD detection and treatment through improved screening rather than large scale behavior change. Alternatively, condom use and number of partners may be insensitive measures of STD risk.