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2002 National STD Conference - Poster Abstracts 27-50

P27

Douching Behavior in Three Different Samples of Women

PR Brown1, MK Oh1, J Merchant1, E Funkhouser1, E Beatty2, Mary Boschulte2, J Frederick1, T Simpson1, S Howard3

1Univ of Alabama at Birmingham, Birmingham, AL; 2Columbus Health Dept, Columbus, OH; 3Howard University, Washington, DC

Background: Vaginal douching, practiced by many women in the U.S., has been linked to a variety of adverse health consequences.

Objectives: To determine the prevalence of douching practices in diverse geographical locations and to gain insight into women’s perceived benefits of douching.

Methods: A confidential survey was self-administered to convenience samples of women (14–64 years of age) attending public health clinics in rural Alabama (r-AL), urban Alabama (u-AL), and urban Ohio (u-OH). The questionnaire included beliefs about douching and history of douching practices, including age at first douching, frequency, timing, and reasons for douching.

Results: 571 participants (39% r-AL, 42% u-AL, 19% u-OH) completed the survey. The median age was 25 yrs (range 14-63). 77% (440) have “ever used” douching products (78% in r-AL, 75% u-AL, 78% u-OH) and 70% of those under 30 yrs old and 90% >30 yrs. Reasons for douching included to feel good and fresh in 60%, to get rid of odor 38%, to get rid of menstrual blood 36%, to please a partner 5%, to prevent pregnancy and to avoid going to a doctor ( 1% each). Timing of douche included: 60% after menses, 44% when they had vaginal symptoms, 39% after sex, 18% before sex, and 11% before going to a doctor. Mean first douche age was 17.5 ± 3.3 yrs, 18% began before sexual debut, and 66% douched monthly or more often. 97% saw douche advertisements on TV, 67% knew someone who douches regularly, 22% believed douching kills germs, and 29% thought “some women believe douching prevents pregnancy”. Correlates of douching were: history of pregnancy, “knowing someone who douches regularly”, believing “douche kills germs” (p<.0001 respectively), and believing “douche prevents pregnancy” (p=.002). R-AL participants douched more often (p=.01) and were more likely to believe douching prevents infections (p=.01) than others did. No other regional differences were identified.

Conclusion: Douching practices were common in all three samples. Most started in their teens and continued into their twenties and beyond.

Implications for Programs/Policy: In the absence of proven health benefits, potential health consequences of vaginal douching must be addressed in reproductive health programs and public health policy.

Implications for Research: Reasons for douching appear complex and include false beliefs. These findings must be considered in the development of douching intervention strategies.

Measurable Learning Objectives: Participants will be able to describe the widespread practice of douching behavior and the myths associated with it.

Contact Information:

PR Brown / Phone 205-934-8770 / Pebrown@peds.uab.edu.

P28

Initiating Efforts to Change Sexual Health Norms in National Organizations: Project of the STD Prevention Partnership

M Revels1, JA Lipshutz2, M Anderson3, A Alexander4, V Harrison5, C Lewis6 and the STD Prevention Partnership

1ORC Macro, Atlanta, GA; 2Centers for Disease Control and Prevention, Atlanta, GA; 3Academy for Educational Development, Washington, DC; 4Young Women’s Christian Association of the USA, Washington, DC; 5National Education Association’s Health Information Network (NEA–HIN), Washington, DC; 6National Association for the Advancement of Colored People, Baltimore, MD

Background: In 1996, the Institute of Medicine’s (IOM) report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases, identified widespread inability or unwillingness to frankly discuss sexual health issues as a barrier to “adoption of healthy sexual behaviors.” The IOM recommended promoting “a new social norm of healthy sexual behavior [as] the basis for long-term [STD] prevention.” To address this challenge, the STD Prevention Partnership (Partnership) created the National Organization Sexual Health Conversation Project (NOSHCP).

Objectives: To increase salience of sexual health-related issues in national organizations; to initiate organizational norm change related to sexual health; and to assess the Partnership’s ability to promote these norms changes.

Methods: Three Partnership members received financial and technical assistance to design and implement organizationally appropriate interventions reflective of NOSHCP’s goals. Baseline and midpoint site visits were conducted to describe and assess each organization’s activities and identify preliminary lessons learned. Structured interviews were conducted with various respondents in each organization. One year after funding ended, site visits were conducted to determine if organizations were able to sustain interest in sexual health.

Results: Tangible products (e.g., focus groups, staff trainings, brochures, web pages) were developed. However, time and resources needed to design and implement the project, build trusting relationships, and convince different parts of the organizations of the importance of this effort were underestimated. Staffing changes also affected the project’s support and continuity.

Conclusions: Though NOSHCP stimulated tangible products that may initiate norm changes, the project’s full impact may have been compromised by unexpected barriers. Project outcomes will be better understood with findings of the final evaluation (completed December 2001).

Implications for Programs/Policy: Based on lessons learned, organizations not traditionally involved in STD prevention may consider adopting a similar strategy.

Implications for Research: Additional studies on similar organizational strategies would be useful to better understand efficacy and cost-effectiveness of this strategy.

Measurable Learning Objectives: By the end of the session, participants will be able to demonstrate an understanding of the complexity of the issues faced by organizations that decide to raise the level of conversation about sexual health as a strategy to reduce the emotional and economic toll of STDs.

Contact Information:

Michelle Revels / Phone 404-321-3211 / mrevels@macroint.com

P29

Concurrency and STD in New Sexual Partnerships

PM Gorbach1, L Drumright2, KK Holmes3

1University of California–Los Angeles, Los Angeles, CA; 2University of California, San Diego, School of Medicine, San Diego, CA; 3University of Washington, Center for AIDS and STD Research, Seattle, WA

Background: Having more than one sexual partnership (concurrency) contributes to STD transmission among individuals but has not been assessed in new partnerships.

Objective: Assess factors associated with STD among young heterosexuals in new partnerships recruited from STD and family planning (FP) clinics.

Methods: Ninety-six individuals presenting for care at STD and FP clinics in San Diego and their new sexual partners (n = 192) underwent audio, computer-assisted interviews, were tested for gonorrhea and chlamydial infection by ligase chain reaction, for trichomoniasis by culture (InPouch), and had medical records reviewed. First sex in these partnerships occurred in the past 3 months. Recent STD infection and individual characteristics were analyzed using logistic regression for all individuals.

Results: Of individuals in new sexual partnerships, 14.6% tested positive for gonorrhea, chlamydial infection, or trichomoniasis at enrollment or according to 6 months’ medical record review; 14.1% reported concurrency (having another partnership) at onset of index partnership, 60% reported condom use at first sex, 25% reported consistent condom use in past month and 64% reported vaginal sex in the past 3 days. In multivariate analysis models using couple as cluster and clinic as strata, concurrency (OR = 2.8, 95% CI 1.07–7.4)) and being Latino (OR = 2.8, 95% CI 1.03–7.8) were significantly associated with STD; gender, schooling, consistent condom use, sexual frequency and cohabitation history were not.

Conclusions: Concurrency at the beginning of new sexual partnerships is a high risk for STD for young adults, possibly because this represents transitions between partnerships when condom use is low. Individual factors and behaviors are less important.

Implications for Programs: STD prevention programs should counsel to reduce concurrency in partnerships, and to increase condom use.

Implications for Research: More research combining data from both partners to assess partnership risk is needed.

Learning Objectives: Ability to describe patterns of risk for STDs in new partnerships.

Contact Information: Pamina M. Gorbach / Phone 310-267-2805 / pgorbach@ucla.edu

P30

Preventive and Risk Behaviors Among Young Black Women Receiving STD Testing Services, Dallas, 1999–2001

KM Sabin1, G Secura1, S Behel1, D Shehan2

1CDC, Atlanta, GA; 2University of Texas Southwestern Medical Center, Dallas, TX

Background: Recent studies suggest that African-American women are among the groups at highest risk for AIDS in the United States.

Objective: To measure preventive and risk behaviors among young minority women receiving STD-related services in family planning clinics.

Methods: We enrolled 306 women between the ages of 15–24 seeking routine or initial family planning services consecutively at three family planning clinics in Dallas between August 1999 and September 2000. Following informed consent, participants responded to a structured questionnaire. Gonorrhea and chlamydia infection were ascertained by Gen-Probe Combo Assay and confirmed with Gen-Probe individual DNA probe. Syphilis was tested for by RPR or VDRL and confirmed by MHATP. All tests were conducted during medical examinations on day of interview.

Results: Overall, 70% of women approached participated in the study. Reactive syphilis tests were returned by 1.6% of respondents; 14.7% were positive for chlamydia, and 5.2% were positive for gonorrhea. Overall, 57 women (18.6%) had at least one infection. Case-patients did not differ from uninfected persons by age, age of partner, condom use, self-reported STD history, or number of partners. HIV testing was accepted by 37.9% of women. Infected women were more likely to have a partner with a history of incarceration. Younger women (1519) were twice as likely to have chlamydia as women 20–24.

Conclusion: Gonorrhea and chlamydia were common among young women receiving family planning services. Younger women were more likely to be infected with chlamydia and to have partners who had been incarcerated.

Implications for Program: Screening young women attending these clinics can reduce disease burden from STD. Ascertainment of incarceration history for sex partners may increase the number of infections identified.

Implications for Research: Prevention research needs to focus on increasing HIV test acceptance by young, urban black women.

Learning Objective: By the end of this session, participants will be able to describe STD related risk behaviors of young, urban black women in Dallas.

Contact: Keith Sabin -

Phone: 404-639-4484 / ksabin@cdc.gov

P31

Substance Abuse Problems Among New York City Sexually Transmitted Disease Clinic Patients, 2000

PW Appel1, R Piculell1, HK Jansky1, K Griffy2,3, L Neylans2,4, S Rubin2,4, S Blank2,4

1New York State Office of Alcoholism and Substance Abuse Services (OASAS), New York and Albany, NY; 2Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA; 3Sexually Transmitted Disease Branch, California Department of Health Services, Sacramento, CA; 4New York City Department of Health (NYCDOH), Sexually Transmitted Disease (STD) Control Program, New York, NY

Background: Alcohol and other drug use (AOD) impact sexual behavior and enhance the risk of sexually transmitted disease (STD) acquisition. STD clinics present opportunities to identify AOD abuse and intervene with services and appropriate referrals.

Objectives: 1) Assess the prevalence of problematic AOD use among New York City (NYC) STD control clinic patients using a brief screening tool, and 2) determine patient demographics, prior AOD treatment, and patient’s desire for an AOD treatment referral.

Methods: Anonymous, quasi-random survey conducted at the seven full-time NYC STD clinics between 15 October and 15 December 2000. The survey instrument included demographics, a screen for AOD problem indicators, AOD treatment history, and desire for an immediate AOD referral. The CAGE-A screen asks four questions about problematic alcohol or drug use behaviors in the past year; two or more “yes” responses is the typical threshold for intervention (e.g., fuller evaluation, education, counseling, or an AOD referral). The modified CAGE-A (mCA) used here asked the questions in terms of lifetime (i.e., “ever”), and “past 30 day” occurrence.

Results: The 702 respondents were 60% male, 85 % ethnic minority, and 67% under 35 years. Thirty-one percent of respondents met the threshold for the lifetime category of the mCA questions and 16.5%, the “past 30 days” category; 13.2% reported prior AOD treatment, 1.4%, current treatment, and 0.7% said they wanted an AOD immediate referral. Eight of the 10 respondents currently in AOD treatment met the threshold for the lifetime mCA questions.

Conclusions: AOD problems are highly prevalent among STD clinic patients and the mCA is a useful means of identifying STD patients for AOD intervention.

Implications for Programs/Policy: AOD screening identifies STD clinic patients needing intervention for AOD problems and may be a useful enhancement of STD prevention services.

Implications for Research: Fuller specification of the nature and severity of AOD problems among STD clinic patients is needed as well as research to evaluate the effectiveness of AOD screening and intervention in STD clinics.

Learning Objective: By the end of the presentation, participants will be more knowledgeable about the prevalence of AOD problems among STD clinic patients and aware of AOD screening and intervention as a means for augmenting STD prevention services.

Contact: Philip W. Appel / Phone / 646-728-4626 / appelp@oasas.state.ny.us

P32

Willingness to Pay for a Contraceptive/Safer Sex Services Health Insurance Benefit

A Kurth, M Weaver, D Lockhart

University of Washington School of Public Health and Community Medicine, Seattle, WA

Background: Contraceptive/safer sex services reduce unintended pregnancies and some STI transmission. Many private health insurance plans do not cover these services.

Objectives: Conduct a population-based survey regarding availability of and willingness to pay (WTP) for insurance coverage of contraceptive/safer sex services.

Methods: Random-digit dial phone survey of 149 men and 182 women >18 years (n = 331) throughout Washington State. Contingent valuation was used to determine maximum WTP, using a bidding game format. WTP response validity was tested for starting point bias, and impact of price unit framing and different contraceptive effectiveness scenarios. Multivariate logistic regression assessed factors associated with support of benefit coverage. Multivariate tobit regression analyzed WTP against income, gender, and age. Heteroscedasticity was handled using a log transformed WTP (results are relative rather than absolute WTP differences).

Results: Most respondents (87%) believed these methods should be covered by insurers. Women (89%) were more likely than men (74%) to support coverage (ORa 5.6, 95% CI 2.4-13.4). Only 24% said their current insurance had such coverage. Unadjusted mean WTP for contraceptive/safer sex benefits was $8.79/month; actuarial cost is ~$1.93/month. The benefit to cost ratio is high at 4.6. Women were willing to pay 27% more per month than men (p=0.001), adjusting for age, income, and bid start point. Nearly 7% of individuals indicated they had changed their method due to cost concerns.

Conclusions: We found strong support among men and women of insurance coverage for contraceptive/safer sex services.

Implications for Programs: Estimates of WTP provide evidence to policy makers of perceived benefits of insurance coverage.

Implications for Research: Out-of-pocket costs may result in individuals shifting to less effective or no method use. Future studies should examine whether lack of insurance coverage is associated with adverse outcomes such as increased unintended pregnancy or STI rates.

Learning Objectives: Participants will become familiar with WTP methodologies for assessing the value of insurance benefits relevant to sexual health.

Contact Information: Ann Kurth /Phone 206-731-3625 / akurth@u.washington.edu

P33

Impact of HIV-Prevention Counseling on Intended Risk-Reduction Behavior

L Brooks1, C Metcalf2, R Francis3, J Douglas1, S Padilla4, B Dillon2, H Cross5

1Denver Department of Public Health; 2Centers for Disease Control & Prevention; 3NOVA Research Company; 4California State University, Long Beach, CA; 5New Jersey Department of Health & Senior Services

Background: HIV-prevention counseling reduces risk of acquiring STDs. It is difficult to determine which behavioral changes are most influenced by prevention counseling, and which would occur after an STD examination without prevention counseling.

Objective: To determine the effect of HIV-prevention counseling on STD clinic clients’ intended risk-reduction behavior.

Methods: Patients attending three STD clinics for an STD examination were enrolled in a randomized trial comparing two HIV-testing and -counseling interventions (rapid and standard HIV testing). Participants were offered two counseling sessions either in one clinic visit or in two visits about one week apart. Counseling focused on risk behavior and developing a risk-reduction plan. Participants completed self-administered questionnaires before and after counseling. This included a set of questions on intention to use specific behaviors to reduce risk of STDs.

Results: Prior to counseling, most of the 2,108 respondents were already practicing, or wanted to start practicing, most risk-reduction behaviors applicable to their situation. Comparing responses before and after counseling, the goals most impacted by counseling include: have fewer partners (67% vs. 73%); talk to partners about risk (86% vs. 91%); break up with a risky partner (62% vs. 67%); and get to know potential partners better before having sex (59% vs. 63%). Of the suggested risk-reduction goals, the least favored initial goal was sexual abstinence (29%). Following counseling a total of 32% chose abstinence as a risk-reduction goal. All these changes were statistically significant (P<0.01).

Conclusions: Prevention counseling influenced risk-reduction goals in multiple ways, and had a beneficial effect on intention to practice less-risky behavior.

Implications for Programs/Policy: Prevention counseling is useful in helping clients to consider additional ways of reducing risky sexual behavior.

Implications for Research: Further research is needed to determine how to sustain the benefits of prevention counseling, by ensuring that intentions are carried out.

Learning Objectives: Participants will be able to describe types of changes in risk-reduction goals that may occur following HIV-prevention counseling, as well as the likely magnitude of increases in intention to adopt different types of risk-reduction behavior.

Contact Information: Lesley Brooks / Phone 303-436-4103 / lbrooks@dhha.org

P34

Gender Differences in Chlamydia Awareness and STD Health Care Seeking: Results From The 2000 California Behavioral Risk Factor Surveillance System

R Gindi1, JM Chow1, J Lifshay1, B Davis2, H Bauer1, MC Samuel1, G Bolan1

1California Department of Health Services, Sexually Transmitted Diseases Control Branch, Berkeley, CA
2Public Health Institute, Survey Research Group, Sacramento, CA

Background: Current chlamydia control efforts focus on women accessing care in a variety of settings. Data on gender differences in chlamydia awareness and STD health care seeking patterns are needed to inform control strategies for men.

Objective: To assess awareness of asymptomatic chlamydia infection and describe patterns in seeking STD care.

Method: The 2000 California BRFSS is a random-digit-dialed population-based survey administered to persons 18 years of age or older. Questions were asked of participants 18-44 years old to assess knowledge about asymptomatic chlamydia infection and a hypothetical question about where they would seek STD care. Data were weighted to the age-, race-, and sex- distribution of the 1990 California population. Logistic regression modeling adjusted for age, gender, race/ethnicity, education, employment, income, and language of survey.

Results: Of 2,515 adults surveyed, 44% answered the question on asymptomatic chlamydia infection correctly; women were more likely to answer correctly than men (54% vs. 35%, p<.0001). Most men (75%) reported that they would seek STD care at a primary care setting, and others reported public clinics (12%), family planning clinics (7%), or urgent care (5%). In contrast, 78% of women reported that they would seek care at a primary care setting, 10% at family planning clinics, 6% at public clinics, and 3% at urgent care. Adults with private insurance were more likely to choose primary care than those with public insurance (58% vs. 7%, adjusted OR = 2.4, 95% CI = 1.7, 3.3, p<.0001).

Conclusions: Chlamydia awareness should be targeted to California men as well as to women. Efforts to increase awareness should target the private sector as well as a variety of care settings.

Implications for Program/Policy: Increase chlamydia awareness efforts. Increase efforts to ensure quality STD care in a variety of care settings.

Implications for Research: Inform larger-scale chlamydia screening projects and evaluations by identifying target groups in need of STD services and education.

Learning Objectives: 1. Assess level of awareness of asymptomatic chlamydia transmission among California adults 2. Identify the settings in which California adults would choose to seek STD Care. 3. Describe the demographics associated with awareness and seeking STD care in specific settings.

Contact Information: Renee Gind / Phone 510-883-6640 / rgindi@dhs.ca.gov

P35

Gender Differentials in the Extent of Knowledge About RTI and STI in India: Evidence from RCH-RHS

RK Sharma and R Ranjan

The annual incidence of Sexual Transmitted Diseases (STDs) is estimated at 5 percent or approximately 40 million new infections every year in India. Associated complications such as infertility in males and females, pregnancy wastages, congenital and neonatal infections, and death play a heavy burden on women. The high incidence of RTI/STDs also indicates the potential for rapid and extensive spread of the HIV epidemic. The reproductive and child health approach emphasizes the healthy sexual life of the couples without fear of contracting disease. With this approach, the RCH program includes the component of identification and management of reproductive tract infection (RTI) and sexual transmitted infection (STI) and motivates people with RTIs and STIs to seek medical help and assists them by referring to seek treatments. The main objectives of our paper are to understand the gender differentials in the extent of knowledge about RTIs and STIs and their correlates and to examine the extent of prevalence of symptoms of RTI/STIs and places of assistance.

In the present study, RCH-RHS survey (1998–99), Phase II data has been used. In the RCH survey, information has been collected from currently married females and males on the awareness of RTIs, STIs, sources of information, mode of transmission, curability, and place of treatment, etc. Bivariate analysis and logistic regression have been used separately for males and females.

The study clearly brought out interesting findings; the awareness of RTIs and STIs among males and female varies by their background characteristics. Electronic media and relatives/friends are the main sources of information for both males and females. Symptoms of RTI/STIs were reported more among females and persons with low standards of living. Nevertheless, more males sought any treatment than females, and private hospitals or practitioners are the main sources of treatment.

Gender differentials in the extent of knowledge of the RTIs and STIs, prevalence and treatment-seeking behavior suggest that ongoing community-based programs on health in India should place more emphasis on females, especially for females with low standards of living.

P36

Oral Sex and Other High-Risk Behaviors

A Pierce1, E Koumans1, M Sawyer2 J Papp1, C Black1, L Markowitz1

1Centers for Disease Control and Prevention, Atlanta, GA; 2Emory University, Atlanta, GA

Background: Oral sex among adolescents has emerged as a possible alternative to vaginal sex, but little is known about this behavior.

Objective: To describe risk behaviors associated with oral sex among female adolescents attending a primary care clinic.

Methods: As part of an ongoing study of risk factors of sexually transmitted infections at an adolescent clinic, face-to-face interviews were conducted upon study enrollment. Topics included sexual history, peer norms, condom use, drug and alcohol use, and other risk behaviors in the prior 90 days. Consistent condom use was defined as using a condom with every sexual act. Oral sex was defined as any oral-genital contact.

Results: Of 376 females who completed an initial interview and had complete laboratory results, 96% were African-American and the mean age was 16 years. All reported sexual activity in the previous 90 days. Vaginal sex was reported by 341 (91%), oral sex by 103 (27%), and anal sex by 16 (4%). Of those who engaged in oral sex, 102 (99%) also had vaginal sex. The number of oral sex acts ranged from 1–90. Compared to women who reported no oral sex acts, those who had oral sex were more likely to have been sexually abused (34% vs. 20%, p=0.004), smoke marijuana in the past 90 days (49% vs. 25%, p=0.001), consume alcohol an hour before sex (41% vs. 15%, p=0.003), and less likely to consistently use condoms for vaginal sex (43% vs. 15%, p=0.001).

Conclusions: The adolescents in this population did not use oral sex as a substitute for vaginal sex. Adolescents who engaged in oral sex were also more like to participate in many other high risk behaviors.

Implications for Programs: Messages and programs that address oral sex in adolescents should address the context in which this practice occurs.

Implications for Research: Additional research to address high risk behaviors in adolescents should include oral sex as well as vaginal sex.

P37

America Online Perpetuates Syphilis and Gonorrhea Transmission in San Francisco

JD Klausner, A Kim, C Kent

STD Prevention and Control Services, San Francisco Department of Public Health (SFDPH), San Francisco, CA

Background: In the mid- and late-1990s, rectal gonorrhea and early syphilis increased significantly in gay men in San Francisco particularly among persons who used the Internet to meet sexual partners.

Objective: To describe which Internet service providers (ISP) were associated with STD transmission in San Francisco.

Methods: We reviewed a prior study among syphilis cases and STD clinic patient controls conducted in 1999 and re-analyzed a cross-sectional study among persons screened for rectal gonorrhea in 2000. We reviewed where recent syphilis cases met sexual partners in 2000 and the first 8 months of 2001.

Results: Persons with early syphilis in the latter half of 1999 were 9 times more likely to meet partners in one America Online (AOL) chat room than elsewhere. In 2000, men with rectal gonorrhea were almost 3 times more likely (OR = 2.8 [95%, CI 1.4–5.7]) than men without rectal gonorrhea to meet sexual partners on the Internet. Of those men (n = 14) with rectal gonorrhea using the Internet to meet partners, 11 (79%) used AOL and only 2 (14%) used Gay.com (P<.05). In 2000 and the first 8 months of 2001, 16 (21%) of 75 early syphilis cases met partners on the Internet, 12 (75%) of these on AOL.

Conclusions: Meeting partners in internet chat rooms was strongly associated with increased risk for syphilis and gonorrhea among gay men in San Francisco. The overwhelming proportion of these cases met partners on AOL. Targeted prevention education and intervention efforts directed towards AOL members using chat rooms to meet sexual partners are urgently needed.

Implications for Program/Policy: Successful collaborations with Internet service providers, particularly with AOL, are necessary for STD programs that identify Internet use as common among STD cases.

Implications for Research: Further studies may address effective interventions to reduce the risk of STDs among AOL chat room users.

Learning Objectives: Participants will be able to describe what Internet service providers are associated with STD risk in gay men in San Francisco.

P38

The Relationship Between Number of Sexual Partners and Receiving an Annual Medical Exam Among Latino Adolescents: Modifying Role of Acculturation

OL Sarmiento1, WC Miller1,2, CA Ford2,3

1Department of Epidemiology, School of Public Health and the 2Departments of Medicine and 3Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC

Background: Efforts to decrease STD prevalence through screening and counseling during routine health care visits depend on adolescents at risk receiving routine care. For Latino adolescents, acculturation may modify the relationship between risky sexual behaviors and use of routine health care.

Purpose: To assess the relationship between number of sexual partners and receiving an annual routine physical exam among adolescents of differing Latino origins, and the potential modifying effect of acculturation.

Methods: A cross-sectional analysis of wave 1 of the National Longitudinal Study of Adolescent Health including 3,099 adolescents of Mexican, Cuban, Puerto-Rican and other (Central/South American and Dominican) Latino origins was conducted. Multivariate logistic regression was used to examine the independent and interaction effects of lifetime number of sexual partners and acculturation (immigrant-generational status or language spoken at home) on receiving a routine exam in the past year after adjusting for socio-demographic characteristics and insurance status.

Results: Cubans and Puerto-Ricans reporting multiple partners were less likely to receive routine health care than those with one partner [adjusted odds ratios (aOR) for Cubans, and Puerto Ricans: 0.32 and 0.29]. For Cubans, this association was modified by immigrant-generational status. First-generation Cuban immigrants reporting multiple partners were more likely to receive routine care than those reporting single partners (aOR = 3.95). However, second and third generation Cuban immigrants reporting multiple partners were less likely to report receiving routine care (aOR = 0.23) than those reporting single partners.

Conclusions: The relationship between number of sexual partners and routine health care differed by country of origin and immigrant-generational status.

Implications for Programs/Policy: Efforts to increase the use of routine health care among Latino adolescents at higher risk for STDs should consider immigrant-generational status and differences between subpopulations.

Implications for Research: Further research should explore mechanisms by which immigrant-generational status influences risky sexual behaviors and routine health care utilization.

Contact Information:

OlgaSarmiento / sarmient@email.unc.edu

P39

Stage of Change for Sexual Risk Reduction in HIV-Infected Clients at a Sexually Transmitted Diseases Clinic

M Urban1, K McMahon2, R Polito1, M Scahill1, K Berkhoudt1, P McGrath1, P Coury-Doniger1

1University of Rochester School of Medicine, Rochester, NY; 2Monroe County Department of Health

Background: Stage of Change (SOC/TTM) theory defines five stages of readiness for behavior change and has been applied to sexual target behaviors for risk reduction.

Objectives: To determine the distribution of the SOC among HIV-infected clients attending an STD Clinic.

Methods: Clients were characterized as Newly Diagnosed (ND) with HIV infection (new positive test) or Previously Known Positive (PKP). SOC for sexual target behaviors was assessed for all HIV-infected clients attending the Clinic from 19982000. The stages are: (1) Precontemplation (sees no need for target behavior); (2) Contemplation (sees need, but has barriers); (3) Ready for Action (about to do target behavior); (4) Action (doing target behavior <120 days); and (5) Maintenance (doing target behavior >120 days).

Results: One hundred sixty-six clients with HIV infection were seen; 57 ND and 109 PKP. Fifty-eight percent of ND and 70% PKP clients reported multiple partners and yet of these, 81% ND and 54% PKP clients saw no need to use condoms consistently (Precontemplation) or had significant barriers (Contemplation). PKP clients were 2.5 times (44% vs 17%) more likely in Action or Maintenance stage (already using safe behaviors) than ND clients.

Conclusions: The majority of clients with HIV infection had multiple partners. Clients with PKP infection were more likely to be practicing safer sexual behaviors.

Implications for Programs: Effective prevention interventions for newly diagnosed and those living with HIV/AIDS need to be developed. STD clinics seeing large numbers of ND and PKP clients are a high priority for these interventions.

Implications for Research: Further research into ongoing risk behaviors and targeted behavioral interventions for persons with HIV infection is essential to HIV prevention efforts.

Learning Objectives: To describe the readiness of those living with HIV/AIDS for sexual risk reduction.

Contact Information: Marguerite Urban / Phone 716-464-5928 / Fax 716-464-6510 / marguerite_urban@urmc.rochester.edu

P40

Assessment Instruments Affect Sexually Transmitted Disease Knowledge Levels

J Lambert, SD Barger

Northern Arizona University, Department of Psychology, Flagstaff, AZ

Background: The bulk of sexually transmitted disease (STD) prevention and education has revolved around HIV, but STDs other than HIV account for substantial morbidity and mortality. Public awareness of such STDs is low, and education efforts are limited in part by inadequate knowledge assessment instruments. The present study explored the effects of questionnaire format on assessed disease knowledge among young adults at risk for STDs.

Objective: To create two STD knowledge instruments and compare knowledge levels across questionnaire formats. The relations among knowledge, risk perceptions and risk behaviors were also explored.

Methods: College student volunteers (N = 172) were randomly assigned to complete either an open- or closed-ended questionnaire assessing knowledge about seven STDs (chlamydia, gonorrhea, syphilis, herpes, genital warts, hepatitis B, and HIV). For each disease, items were created to assess a variety of knowledge domains, including cause, symptoms, long-term consequences, treatment, prevalence, and modes of transmission.

Results: Participants’ knowledge scores were higher on the closed- versus open-ended version (65% vs. 49% correct). In contrast to generally high knowledge about HIV, participants knew much less about common STDs regardless of instrument format. Disease knowledge was inconsistently related to risk perceptions and risk behaviors.

Conclusions: Questionnaire format significantly affects assessed knowledge levels. Young adults know little about STDs other than HIV.

Implications for Programs: Health professionals should emphasize non-HIV STDs in prevention and education efforts.

Implications for Research: STD assessment instruments require greater development and evaluation. Links among domain-specific knowledge and preventative behaviors should also be explored.

Learning Objectives: Participants will learn about artifacts in STD knowledge assessment.

Contact Information: Jennifer Lambert/ Phone 858-467-4990 / jelambert@ucsd.edu

P41

Three Year Follow-Up of Documentation and Self-Report of STD History Among Minority Women with STD

JD Champion, RN Shain, JM Piper, S Perdue

The University of Texas Health Science Center at San Antonio, San Antonio, TX

Objective: A limitation in determining STD history and re-infection among women with STD concerns the nature of STD self-report data. Often no confirmation of information concerning STD history is available and the validity of the participants’ responses is unknown. Previous studies have found that patient reports of medical events are valid data sources. This study examines documentation and self-reporting of STD history among women with STD.

Methods: Mexican- and African-American women (n = 827) with active STD entered a study of behavioral interventions to reduce STD recurrence. Each underwent questioning at entry regarding STD history. Full exams and interviews including STD history were conducted at 6-, 12-, 24- and 36-month follow-up and problem visits. Medical records concerning any gynecological examination, STD testing, or treatment reported were obtained and reviewed for documentation and self-reports of STD history. Comparisons were made with our clinical medical records and on-going documentation of STD history and re-infection over 36 months.

Results: Medical records from 835 offsite visits were obtained. STD history was documented at 56% of visits (STD clinic, 91%; abortion clinics, 11%); 42% of documented STD histories were consistent with our clinic records. Inaccurate responses were highest at private doctor and community clinics (67%), and lowest at STD clinics (50%). More STD testing occurred at visits with documented STD histories (56% vs 44%, P=.05). STD treatment occurred with STD testing more often at visits with versus without recorded STD histories (61% vs 39%, P<.001).

Conclusions: Documentation and self-reporting of STD history as part of medical records is inconsistent and often inaccurate.

Program Implications: STD testing occurred more often in clinics when STD history was recorded; proportionately fewer STD treatments were given when STD testing occurred.

Research Implications: Further study is recommended to determine factors associated with inconsistent documentation and inaccurate self-report of STD history.

Learning Objectives: Participants will be able to discuss the relationship between documentation, testing, treatment, and accuracy of self-report history of STD among minority women with STD.

P42

Relative Impact of Increased Condom Use Versus Increased Abstinence on STD and HIV Prevalence

JR Mann, CC Stine

The Medical Institute for Sexual Health, Austin, TX

Background: Reducing STD and HIV risk in adolescents is vitally important. Unfortunately, the expected impact of various interventions on STD/HIV prevalence is seldom estimated prior to choosing an intervention approach.

Objective: To compare the relative theoretical impact of increases in sexual abstinence and consistent condom use on STD and HIV prevalence.

Methods: The theoretical impacts of increases in consistent condom use and sexual abstinence on STD/HIV prevalence were calculated using S-I-R (S-I-S) mathematical modeling and evidence-based assumptions about STD/HIV prevalence and adolescent sexual behaviors.

Results: The relative impact of increased consistent condom use and increased sexual abstinence on STD/HIV prevalence differs based on disease characteristics and sexual behavior patterns. The relative impact of consistent condom use generally increases as STD infectivity and prevalence decrease. Increased sexual abstinence can decrease STD/HIV prevalence to a greater extent than increased consistent condom use, but to do so abstinence must increase in both infected as well as uninfected individuals.

Conclusions: The impact of a successful prevention program on health outcomes depends on the behavior change(s) being promoted, the health outcome(s) of interest and the behavioral characteristics of the targeted population. The same intervention approach should not be expected to have the same impact in every situation.

Implications for Programs/Policy: The health outcome(s) of interest and expected behavioral outcome(s) of an intervention must be clearly articulated prior to beginning any intervention, and used in selecting the particular program to be implemented. Abstinence promotion efforts must include high-risk individuals to be optimally effective.

Implications for Research: Research should aim to identify interventions that will most significantly improve health outcomes—not just behavioral proxies—in various circumstances. Effective methods for delivering abstinence messages to high-risk individuals must be developed.

P43

A Sexual Risk Reduction Intervention for Incarcerated Women

N Liddon, JS St Lawrence, M Hogben

Centers for Disease Control and Prevention, Atlanta, GA

Background: Incarcerated women represent an at-risk group for STD. However, a paucity of data exists on interventions for this at-risk population. A sexual risk reduction intervention based on Social Cognitive Theory and Theory of Gender and Power aimed to increase self-efficacy and attitudes toward prevention and condom use, and decrease unprotected sex both during incarceration and following release into the community.

Objectives: To investigate the baseline sexual risk behaviors and STD background of the study sample.

Methods: Women in a Mississippi prison nearing release were interviewed at baseline, in preparation for an 8-session sexual risk reduction condition. A parallel intervention condition targeted drug use, and a non-intervention group assessed intervention diffusion. Women were recruited from a Tennessee prison for a control group. In all, 472 women completed measures at baseline and post intervention.

Results: Women were predominantly African-American (61.4%) and under the age of 40 (82.4%). Self-reported lifetime STD prevalence was 38.9% (2.1% in the past 30 days). One-third of women reporting sex with a male in the past 30 days also reported using a condom. Average number of male partners was higher among women who reported a lifetime STD, (t = 3.62, P<.001). Last-time condom use was associated with reported STD in the last 30 days (t = 2.25, P<.05).

Conclusions: Associations between sexually risky behaviors and lifetime and recent STD diagnosis reinforce the overall need for behavioral change strategies. These data further highlight that incarcerated women are excellent candidates for effective risk reduction interventions.

Implications for Program/Policy: Correction facility screening programs could help identify women in need of medical treatment as well as behavioral intervention to reduce sexual risk.

Implications for Research: Further investigation will focus on both the immediate and post-release effects of a theory-based intervention for incarcerated women.

P44

Screening for Sexually Transmitted Diseases (STD) in the Correctional Setting: Targeting Men Who Have Sex with Men (MSM)

D Carr, D Kodagoda, M Campos Bovee, A Lawrence, P Kerndt

Los Angeles County, Sexually Transmitted Disease Program, Los Angeles, CA

Background: In March of 2000 The Los Angeles County (LAC) Sexually Transmitted Disease (STD) Program in collaboration with the Los Angeles County Sheriff’s Department (LASD) began testing men who have sex with men (MSM) for syphilis and other STDs, including HIV, in the nation’s largest county jail.

Objective: To describe implementation of STD screening in a high risk incarcerated population. To describe plans to reduce risk of STD transmission among inmates while incarcerated.

Content: There will be an opening presentation describing the background of why and how the screening of MSM in LAC jail began. Following will be a description of the current delivery of services that are being provided, including the follow-up and case management of those testing positive and examples of working with such a diverse group. There will be a discussion about how the project has expanded to include a select group of general population inmates. An epidemiological presentation will provide information regarding the significance of testing of MSM in the jail versus the general population. The final presentation will include a discussion of the rational and proposed plans to distribute condoms into the correctional setting.

Implications for Programs: Testing those in the MSM unit is a unique opportunity to detect, treat and educate many high-risk individuals. This testing project can be used to assist public health authorities with the syphilis elimination initiative and control of other STDs.

Implications for Research: Continued evaluation and research of behavioral data being collected on the MSM population will reveal a clearer picture of the importance of educating and offering testing to incarcerated individuals.

Learning Objectives: By the end of this session, participants will be able to:

1. Outline and discuss one way to implement STD screening in a high-risk population within a correctional setting.

2. Explain the importance of STD education and testing of those who are incarcerated, targeting high-risk activities inside and outside of jail, whether they be MSM or general population inmates.

Contact Information: Deborah Carr / Phone 213-744-3343 / dcarr@dhs.co.la.ca.us

P45

STD Interventions in Large County Jail Facilities: Phoenix, Arizona

P Powers, G Steinhauser, J Weisbuch

Background: The Maricopa County jail facilities incarcerate over 120,000 arrestees each year. Over 60% are housed for less than 48 hours. This is a high-risk population for STD screening. New screening projects have been implemented to facilitate effective STD interventions.

Objective: To illustrate new screening approaches enhancing STD interventions.

Methods: Jail screening strategies were discussed with the Medical Director of the Maricopa County Correctional Health Services and the Health Director of Maricopa County. Activities were implemented after conducting problem-solving meetings and through the pursuit of some outside financial support.

Results:

New jail screening projects:

Holding Tank syphilis screening – prior to the 09/2000 start date fewer than 40 inmates screened in the Holding Tank per month. During the first six months of CY 2001, a monthly average of 2,494 males and 268 females were screened for syphilis in the Holding Tank.

Court ordered syphilis screening for prostitutes – prior to start date no data available for prostitute screening. After the May 2001 start date, an additional 178 females and 10 males were screened during its first two months of operation.

Juvenile Detention Center chlamydia screening (males and females) – male inmates have a 9% rate of positive test findings and females have a 21% rate of positive test findings. Prior to start date, 2/1998, only diagnostic tests were used to test symptomatic inmates.

Female chlamydia and gonorrhea screening for adult and teenage inmates – screening will start in January 2002. Update will be listed on poster display.

STAT syphilis testing at the Holding Tank – targeted STAT testing will be initiated in January 2002. STAT testing will promote prompt administration of syphilis treatment prior to the inmate’s release.

Conclusions / Implications for Program/Policy: STDs are detected when aggressive, innovative screening projects are implemented in the county jail. Syphilis screening at the Maricopa County jails accounts for 27% of the syphilis morbidity in Maricopa County.

P46

Modeling the STD Risk Behaviors of Imprisoned U.S. Women

M Hogben1, JS St. Lawrence1, G Eldridge2, MH Hennessy3

1Centers for Disease Control and Prevention, Atlanta, GA; 2Jackson State University, Jackson, MS; 3University of Pennsylvania, Philadelphia, PA

Background: Incarcerated women have typically been sexually active, and had multiple sex partners. Using the Theory of Planned Behavior (TPB) as a template, we tested psychosocial models of incarcerated women’s risk behaviors prior to and during incarceration.

Objective: To generate and test a theoretically-based STD risk behavior model.

Methods: We drew data from 427 women (61% African American, 35% white) at two prisons in the southern United States. We estimated relations via path analyses, using TPB-based frameworks of questionnaire responses as indicators of underlying constructs. Constructs included beliefs about HIV/STD prevention, perceived barriers to condom use, beliefs about condom use, perceived norms, perceived behavioral control, intentions to use condoms, and favorable condom attitudes.

Results: Lifetime history of STD was 39%, and condom use during last incidence of sex was 30%. As predicted, prevention beliefs, perceptions of barriers, condom use beliefs, condom attitudes, perceived behavioral control, and perceived norms were associated with condom use intentions (p<.001 except for prevention beliefs, p<.05). Condom attitudes mediated at least some of the associations between intentions and prevention beliefs, condom use beliefs, and perceived barriers. Prison-based norms were most closely related to intentions.

Conclusions: Empirically validated models mean incarcerated women’s mental processes can be related to those of other women, and risk reduction interventions can be evaluated.

Implications for Program/Policy: A prison-based intervention program might either work upon changing general norms, or in diminishing their relative influence. Prison-based norms may be less important post-release, so pre-release programs should also consider the impact of other TPB constructs.

Implications for Research: The demonstration of actual mediating effects strengthens the links among the constructs of TPB as applied to incarcerated women. Also, this demonstration of a coherent and stable baseline model provides a platform for evaluating the effects of interventions.

Learning Objectives: Participants will see how theoretical guidance in examining how incarcerated women’s behaviors group together is useful as a basis for practical risk reduction interventions.

Contact Information: Matthew Hogben / Phone 404-639-1833 / mhogben@cdc.gov

P47

Urine-Based Chlamydia Screening of Young Men in State and Local Juvenile Detention Facilities—Prevalence Variations in Oregon and Washington, 1998–2000

DS LaMontagne, LE Patrick

Region X Infertility Prevention Project, Center for Health Training, Seattle, WA

Background: Urine-based testing for chlamydia (CT) has improved public health access to hard-to-reach populations. Since 1998, young men incarcerated in some state and local detention facilities in Washington and Oregon have received urine-based testing by EIA or LCR for chlamydial infection as a part of the Region X Infertility Prevention Projects’ expansion efforts.

Objectives: To estimate the prevalence of CT among incarcerated adolescent males tested with urine-based enzyme immunoassay (EIA) and ligase chain reaction (LCR).

Methods: Urine CT test records from 1998–2000 for 7,666 incarcerated males from nine state and seven local juvenile detention facilities in Oregon and Washington were analyzed. Prevalence, chi-square tests for trend, and univariate predictors of infection were calculated using SPSS 8.0.

Results: Overall prevalence was low—3.3% (253/7,666); 98% of males tested were asymptomatic. Chlamydia prevalence varied by facility type and test: 5.2% among males tested at local juvenile detention using LCR; 4.0% among males tested at state facilities using LCR; 2.8% among males tested at local detention centers using EIA; and 2.1% at state facilities using EIA. Prevalence also varied by age.

Conclusions: Chlamydia prevalence among incarcerated males is generally low, especially at state facilities, reflecting the difference in the likelihood of exposure between long-term and short-term detention. Higher positivity was found at sites using LCR, in part because of increased sensitivity.

Implications for Programs: Given the lack of opportunity for sexual contact with an infected female population, the low prevalence of infection among males in state juvenile detention should be expected. Further efforts at reducing CT among males should focus on local detention centers where there is rapid population turnover.

Implications for Research: Given the low prevalence of CT infection among younger incarcerated males (less than 15 years of age) and those housed in state facilities, research evaluating selective screening approaches might be beneficial.

Measurable Learning Objectives: Participants will be able to describe the correlates of and differences in CT prevalence among young males incarcerated in state and local juvenile detention centers in Oregon and Washington and assess the role of facility type in these differences.

Presenting Author Contact Information: D. Scott LaMontagne / Research Associate, Center for Health Training, 1809 7th Avenue, Suite 400, Seattle, WA 98144. / Phone 206-447-9538 / slamontagne@jba-cht.com

P48

Monitoring STD, HIV, and TB Prevalence in Persons Entering Corrections Facilities

RH Kahn1, SP Danner1, T Raziano1, K Hutchins1, J Ford2, K Middleton1, M Fobbs3, A Spalding4, P Powers5, T Outlin6, C Hyer7, CK Kent8, SJN McNabb1

1Centers for Disease Control and Prevention, Atlanta, GA; 2Massachusetts Department of Health, Boston, MA; 3Missouri Department of Health, Jefferson City, MO; 4Rhode Island Department of Corrections, Cranston, RI; 5Arizona Department of Health, Phoenix, AZ; 6Alabama Department of Health, Birmingham, AL; 7Oregon Department of Health, Portland, OR; 8San Francisco Department of Health, San Francisco, CA

Background: Many local STD, TB, and corrections programs routinely screen for STDs, HIV, and TB in correctional facilities. Systematic data collection of STD, HIV, and TB prevalence in this population is limited. Knowledge of disease and infection status among persons entering jails may allow for better STD, HIV, and TB prevention activities.

Objectives: To develop a surveillance system for monitoring STDs, HIV, and TB prevalence among persons entering correction facilities and determine the prevalence of STDs, HIV, and TB in this population group.

Methods: From 2000 to 2001, eight health departments collaborated with CDC to develop an integrated surveillance system addressing STD, HIV, and TB prevalence among adult jail inmates. As of September 2001, results from 97,616 STD, HIV, and TB evaluations have been reported from eight cities, including tuberculin skin tests (TST) (eight cities), serologic tests for syphilis (STS) (seven cities), urine ligase chain reaction for chlamydia and gonorrhea (three cities), and HIV (two cities).

Results: In facilities screening women, STS positivity ranged from 2.1–11.5%; chlamydia, 3.8– 8.5%; gonorrhea, 3.5– 5.2%; HIV, 0.6–1.2%; and latent tuberculosis infection (LTBI), 0.0–3.5%. In facilities screening men, STS positivity ranged from 1.1–2.3%; chlamydia, 4.6–5.5%; gonorrhea, 1.0–5.2%; HIV, 1.1–1.1%; and LTBI, 0.3–6.1%. STS positivity was 2.6% in black arrestees, 1.5% in American Indians, 0.65% in whites, and 1.8% in arrestees with race identified as “other.” Of 351 arrestees with LTBI, 187 (53%) were foreign born and 164 (46%) were U.S. born.

Conclusions: This project demonstrates that integrated surveillance of STD, HIV, and TB prevalence among persons entering jails is feasible and that STD, HIV, and TB prevalence is high in some facilities. Integrating STD, HIV, and TB prevalence monitoring in jail settings facilitates clinical management and provides insights in to the epidemiologic characteristics of person at high risk.

Learning Objectives:

1. Participants will be able to describe the feasibility and utility of monitoring STD and TB prevalence in persons entering correctional facilities.

2. Participants will be able to identify groups with the highest prevalence of STD and TB infection among incarcerated persons.

P49

Incarceration and Community-Level Sexually-Transmitted Diseases Rates in North Carolina Counties

LA Sampson, JC Thomas

Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC

Background: During the past decade, local and national-level policy changes have resulted in a dramatic increase in the number of Americans in prison. These policies should be examined from the perspective of the direct and indirect effects they may have on the health of communities. High rates of incarceration may contribute to high rates of STDs by disrupting sexual networks and gender balance in affected communities. This study builds on previous individual-level work by specifically addressing the question of community-level associations.

Objectives: To determine whether community-level incarceration rates are associated with community-level STD rates.

Methods: STD cases (AIDS, chlamydia, gonorrhea, syphilis) and prison admissions were obtained for all North Carolina Counties (n = 100) for years 1992–1999. Age-adjusted STD and incarceration rates were calculated and same-year and one-year lagged correlations were then computed and mapped.

Results: Incarceration rates increased dramatically across the time period from a county average of 16/100,000 in 1992 to 103/100,000 in 1999. Gonorrhea rates decreased by nearly 50% during the same period but same-year correlation of rates across counties remained consistent (ranging from r2 = 0.44 to r2 = 0.58 for the 8-year period). Average county chlamydia rates increased from 62/100,000 in 1992 to 84/100,000 in 1999 and the same-year correlations continually increased from r2 = 0.31 to r2 = 0.58. AIDS and Syphilis were less strongly and consistently associated (nearly all r2<0.4) but all correlations were positive. One-year lagged correlations exhibited similar patterns.

Conclusions: Incarceration rates are associated with STD rates at the county level, and are strongest for chlamydia and gonorrhea.

Implications for Programs/Policy: This study provides new information for those assessing the costs and benefits of new incarceration policies—that the health of communities from which the inmates come warrants consideration.

Implications for Research: This study establishes a rationale for further work examining the health effects of incarceration on communities.

Measurable Learning Objectives: By the end of the session, participants will be able to describe the association between STDs and incarceration in this setting and discuss the need for increased evaluation of incarceration policy and community health.

P50

Sentinel STD Surveillance Among Incarcerated MSM

M Campos Bovee, D Kodagoda, J Chen, D Carr, P Kerndt

Los Angeles County Department of Health Services STD Program, Los Angeles, CA

Background: A Los Angeles County jail maintains a unique segregated unit for men who self-identify and are confirmed as men who have sex with men (MSM). Voluntary and confidential testing for syphilis, HIV, chlamydia and gonorrhea began in March 2000.

Objective: To describe the STD morbidity among incarcerated MSM.

Methods: Inmates provided urine for chlamydia and gonorrhea LCR testing. Blood was collected for RPR/FTA-ABS syphilis and ELISA/Western Blot HIV testing. Lab-confirmed results with inmate demographic data were analyzed using descriptive statistics.

Results: From March 2000 to October 2001, 2,082 inmates were tested for at least one STD (N = 2079 syphilis, 1727 HIV, 1688 chlamydia and gonorrhea tests). African Americans, whites, and Hispanics account for one third each of the population. The median age was 34, with 25–44 year olds accounting for 76%. Testing detected 23 (1%) syphilis (8 early syphilis), 177 (12 %) HIV, 48 (3%) chlamydia, and 23 (1%) gonorrhea cases. Twenty one individuals (1%) were found to be co-infected with HIV and at least one other STD (chlamydia, gonorrhea, or syphilis). Early syphilis cases identified in this population accounted for 3.5% of the total number of reported syphilis cases among MSM in Los Angeles County (N = 231) during the same time period.

Conclusions: STD morbidity among incarcerated MSM is high and warrants routine screening and treatment programs. The high HIV infection rate creates concerns about unknowing transmission in jail and after release, thereby providing an opportunity to offer preventive case management and timely and appropriate treatment referrals.

Implications for programs: Testing at this unit is a unique opportunity to detect and treat many high-risk individuals for STD morbidity. This setting should be considered as a sentinel site in any local syphilis elimination initiative.

Implications for Research: Analysis of behavioral data, currently being collected, will reveal a more complete STD client profile of this sentinel population.

Learning Objectives: By the end of this session participants will be able to discuss the STD testing presently conducted at a segregated MSM unit in Men’s Central Jail.

Contact information: Maria Campos Bovee / Phone 213-744-5972 / mbovee@dhs.co.la.ca.us

 

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  • Page last reviewed: June 1, 2003
  • Page last updated: June 1, 2003
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