Research articleMisconceptions about STD-protective behavior
Introduction
D uring 1997 in the United States, more than 500,000 cases of chlamydia, more than 300,000 cases of gonorrhea, and more than 8000 cases of primary or secondary syphilis were reported to the Centers for Disease Control and Prevention (CDC).1 Estimates of actual numbers of all cases of sexually transmitted diseases (STDs) occurring each year now exceed 15 million.2 In 1995, five of the top ten most commonly reported infectious diseases in the United States were sexually transmitted.3
Past studies have overwhelmingly supported the value of behavioral interventions for reducing frequency of risky sexual behaviors, in contrast to knowledge-only interventions.4, 5, 6, 7, 8, 9 However, correct knowledge about methods of preventing STDs is an essential starting point in the behavior-change process for individuals who have misconceptions about behaviors that prevent STD infection. Such misconceptions may lead to the use of ineffective STD-protective strategies in place of effective, but less acceptable strategies (e.g., douching instead of condom use).
A recent study of more than 1500 low-income women in Missouri showed that nearly 10% had douched at some time as a method of preventing HIV infection; nearly 20% reported using oral or injectable hormonal contraceptives as a method of HIV prevention.10 In another recent study, 68% of 650 female adolescents reported believing that douching prevents STD infection and 60% of the sample reported believing that oral contraceptives prevent STD infection.11 High prevalence of general misconceptions about methods of preventing STDs has been documented in other studies.12, 13
Misconceptions about STD prevention can be traced back to a time when a variety of incorrect prevention strategies were advocated. For example, the U.S. Navy once advocated the use of a post-exposure prophylactic soap applied to the penis as a means of preventing syphilis and gonorrhea (The Sanitube Company, Radio Circle, Mt. Kisco, NY, Sanitube venereal prophylactic technical data, unpublished observations, date unknown). In 1933, the American Medical Association published a pamphlet that included advice to wash “exposed parts” if exposure to venereal disease (VD) were suspected.14 In 1937, the Alabama State Board of Health published a pamphlet emphasizing the STD-protective value of urinating and washing after “exposure.”15 In 1945, the U.S. Public Health Service published a VD case-finding manual for use in training programs. A section of this manual provided VD-prophylactic guidelines from the American Social Hygiene Association. These guidelines instructed that washing the genitals with soap and hot water after sex should be performed as a method of VD protection if a condom is not used.16 More recently, the Internet is a source of misinformation about STD prevention, with at least one website advocating thorough washing of the genitals and urinating after sex to prevent STDs.17 Although soap may have some protective value against sexually transmitted agents, including enveloped viruses,18 scant evidence exists that simply washing the genitals provides much protection after exposure to an STD.
To our knowledge, misconceptions about STD-protective behaviors have not been studied before and after STD counseling. In addition, the relationship of these misconceptions to condom use and STD incidence has not previously been described in published reports.
The purpose of this study was to assess the prevalence of selected misconceptions about STD prevention among a sample of people attending STD clinics in five large metropolitan areas. In addition, the study tested the hypothesis that prevalence of these misconceptions would decrease following STD diagnosis and counseling. We also identified variables that predicted having misconceptions at baseline interview and at the end of a 1-year period. The hypothesis that having misconceptions is related to unprotected vaginal sex and to increased STD incidence was also tested.
Section snippets
Procedures
Data for the present analyses derived from Project RESPECT, a multi-center, randomized controlled trial evaluating the efficacy of three HIV/STD counseling approaches in reducing risky behaviors and new STDs and HIV. Project RESPECT demonstrated that two brief, interactive counseling sessions aimed at personal risk reduction were significantly more effective than two informational sessions. Informational “counseling” is the approach that has typically been used in the context of HIV testing.
Prevalence and declines in misconceptions
Table 2 displays the number and percentage of participants having misconceptions at baseline and the decline in this prevalence at the 3-month follow-up. All declines were significant at p≤0.001. At baseline, misconceptions about douching were common, with about 46% of the sample believing that douching protected from STD infection (more common among men [59%] than women [41%]; p≤0.001). About 39% of the sample believed that urinating after sex protected from STD infection; about 20% believed
Discussion
The most striking finding was the high prevalence of basic misconceptions about behaviors that prevent STD infection. On average, about four of every ten participants initially believed that STD infection could be prevented by urinating after sex. Nearly half of the sample initially believed that douching protects against STDs and about one fifth of the sample initially believed that use of oral contraceptives protects against STDs. About one of every six participants initially believed that
Acknowledgements
We are grateful to the study participants who volunteered for Project RESPECT and to our counselors and research clinical staff in Baltimore, Denver, Long Beach, Newark, and San Francisco. The members of the Project RESPECT study team are as follows: Baltimore— Carolyn Erwin-Johnson, MA, Andrew L. Lentz, MPA, Mary A. Staat, MD, MPH, Dawn Sweet, PhD, and Jonathon M. Zenilman, MD (principal investigator, PI); Denver—John M. Douglas, Jr., MD (PI), Tamara Hoxworth, PhD, Ken Miller, MPH, and William
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