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Association of adolescents' history of sexually transmitted disease (STD) and their current high-risk behavior and STD status: a case for intensifying clinic-based prevention efforts.
Sexually Transmitted Diseases 2002;29(9):503-509.
DiClemente RJ, Wingood GM, Sionean C, Crosby RA, Harrington K, Davies
S, Hook III EW, Oh MK.
Abstract
BACKGROUND: Adolescents are at high risk of sexually transmitted disease (STD)/HIV
infection, and one vulnerable subgroup is African American females. The association
between adolescents' previous experience of STD and recent sexual risk behaviors
has been ill-defined. GOAL: The goal was to examine the associations between
adolescents' self-reported history of STD diagnosis and current sexual risk
behaviors, prevention knowledge and attitudes, and STD infection status.
STUDY DESIGN: This was a cross-sectional survey. Recruitment sites were in
low-income neighborhoods of Birmingham, Alabama, characterized by high rates
of unemployment, substance abuse, violence, and STDs. Participants were sexually
active adolescent females (N = 522) 14 to 18 years of age. Information on
STD history and current sexual behaviors (within the 30 days before assessment)
was collected in face-to-face interviews. Less sensitive topics, such as
STD prevention knowledge, attitudes about condom use, and perceived barriers
to condom use, were addressed via self-administered survey. DNA amplification
of vaginal swab specimens provided by the adolescents was performed to determine
current STD status. Outcomes associated with past STD diagnosis were determined
by means of logistic regression to calculate adjusted odds ratios (AORs)
in the presence of observed covariates. RESULTS: Twenty-six percent of adolescents
reported ever having an STD diagnosed. Although past STD diagnosis was associated
with increased STD prevention knowledge, it was not associated with increased
motivation to use condoms. Compared with adolescents who had never had an
STD, adolescents with a history of diagnosed STD were more likely to report
not using a condom at most recent intercourse (AOR = 2.54; 95% CI = 1.64-3.93;
= 0.0001), recent unprotected vaginal intercourse (AOR = 1.79; 95% CI = 1.15-2.79;
= 0.010), inconsistent condom use (AOR = 2.27; 95% CI = 1.46-3.51; < .0001),
sexual intercourse while drinking alcohol (AOR = 2.09; 95% CI = 1.33-3.28;
= 0.001), and unprotected intercourse with multiple partners (AOR = 3.29;
95% CI = 1.09-9.89; = 0.034). Past STD diagnosis was associated with increased
risk for current biologically confirmed gonorrhea and trichomoniasis (AOR
= 2.48; 95% CI = 1.09-5.23; = 0.030; and AOR = 2.05; 95% CI = 1.18-3.59;
= 0.011, respectively). Past STD diagnosis was not significantly associated
with increased risk of current biologically confirmed chlamydia (AOR = 0.78;
95% CI = 0.45-1.37; = 0.38). CONCLUSION: Among this sample of female adolescents,
past STD diagnosis was an indicator of current high-risk sexual activity
and increased risk for two common STDs: gonorrhea and trichomoniasis. Although
adolescents may gain factual knowledge from the experience of having an STD
diagnosed, they are not applying that knowledge to their current sexual behaviors.
Thus, these adolescents remain at risk for subsequent STD infection. Therefore,
the findings suggest that there is a need to intensify clinic-based prevention
efforts directed toward adolescents with a history of STDs, as a strategy
for reducing STD-associated risk behaviors and, consequently, the likelihood
of new STD infections.