Subsequent infection among adolescent African- American males attending a sexually transmitted disease clinic

doi:10.1016/S1054-139X(99)00025-7

Journal of Adolescent Health

Volume 25, Issue 3, September 1999, Pages 217-226

https://doi.org/10.1016/S1054-139X(99)00025-7 Get rights and content

Abstract

Purpose: To identify predictors of subsequent infection among a sample of 15- to 19-year-old African-American males attending an urban sexually transmitted disease (STD) clinic in the Midwest.

Methods: During a 14-month period, 562 youth participated in a brief STD prevention intervention designed to promote condom use. They completed self-administered questionnaires (baseline, posttest, 30-day and 6-month) on their sexual and condom use behavior in the past month. Infection data (baseline, 5 years before, and 12 months after baseline) were obtained from clinic and state surveillance records. Logistic regression was used to predict infection within 6 and 12 months of the baseline visit.

Results: Within 12 months of the baseline, 31.3% were treated for an infection, of whom 1.4% returned within 30 days, an additional 17.1% within 6 months, and the remaining 12.8% within the last 6 months. The 12-month rate was 1.6–1.7 times higher than the rates reported for older STD clinic attendees. Subsequent infection was positively associated with age at first intercourse, number of children fathered, infection prior to and at the index visit, exchange of sex for drugs in the past year, and perceived risk of infection within the year; it was negatively associated with frequency of condom use with one’s steady partner.

Conclusions: Sexually transmitted disease clinic staff routinely obtain information from young African-American males that can be used to identify individuals who are most likely to become reinfected. Because repeaters account for a disproportionate number of infections, prevention efforts tailored to their needs would have a corresponding impact on STD rates.

Section snippets

Participants and design

Between September 1992 and October 1993, 562 males were enrolled in a 14-min STD/HIV prevention intervention designed to promote condom use among 15- to 19-year-old African-American males attending an STD clinic in a large Midwestern city. Self-report data were obtained through four self-administered questionnaires completed shortly after the individual entered the clinic (baseline or index visit), prior to leaving the clinic (posttest), and 30 days and 6 months after the index visit. Infection

Baseline characteristics

Table 1 describes selected demographic and sexual behavior characteristics. Most (97%) of the participants (n = 562) were single, five were married, and nine were separated. Seventy-two percent lived with one or both parents; 29 participants lived with their partner, and two of the five married men lived with their spouse. Only 2% lived alone. Based on their baseline age, 28% were one or more years below their expected grade level. Twenty-five percent were employed and worked an average of 27.9

Discussion

Following participation in a brief intervention designed to promote condom use, adolescent African-American males attending a municipal STD clinic were followed for 12 months. Within that period, 31.3% were treated for one or more infections. The 12-month return rate was 1.6–1.7 times higher than the rate reported by researchers studying repeat infection among older STD clinic attendees 21, 25, 26, 27.

The strongest predictor of infection within 30 days of the index visit was a history of

Acknowledgements

The authors thank Sandy Becken, R.N., Mary Joyce Hotelling, R.N., M.S., Harriet Schlichting, R.N., and the staff of the City of Milwaukee Health Department for playing key roles throughout the study; and Cathy Edwards, Public Health Educator, Wisconsin Division of Health, and her staff for assistance with participant tracking. Research team members Jacqueline Sills, Melvin Pugh, and Carlos Grady played critical roles in fielding the intervention that provided the data used for the present

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Several studies with small and “high risk” samples have demonstrated that a history of childhood or adolescent sexual abuse (CASA) is associated with sexual risk behaviors (SRBs). However, few studies with large random samples from the general population have specifically examined the relationship between CASA and SRBs with a comprehensive set of measures.
The study was a cross-sectional retrospective survey of past and current sexual health and behavior.
A random sample of 4781 persons from the Swedish Post Address Register was obtained, which included 6,119,000 Swedish citizens in 1996. Of those persons, 2810 participants agreed to participate in the study. Participants were interviewed as well as administered a questionnaire regarding their sexual health and behavior.
Using Mann-Whitney U tests, a history of CASA was found to be associated with younger age at first intercourse; younger age at diagnosis of first sexually transmitted infection (STI); greater frequency of unintended pregnancy; greater likelihood of participation in group sex; higher likelihood of not interrupting sexual intercourse despite the risk of pregnancy or risk of an STI; greater likelihood of exchanging sex for money or other necessities/drugs; more frequent substance use in the last 48 hours; and higher likelihood of adult sexual and physical assault.
The findings of this study confirm previous research, which has reported an association between CASA and SRBs in smaller and high-risk samples. Clinicians working with adults with a history of CASA should be aware of the relationship between CASA and SRBs and be prepared to address such issues during therapy.
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Les tests de Mann-Whitney U ont montré qu’un passé de ASIA était en relation avec un âge plus précoce de premier rapport sexuel, à un plus jeune âge de diagnostic de première infection sexuellement transmissible (IST), à une plus grande fréquence de grossesse non désirée, à une plus grande probabilité de sexualité de groupe, à une plus grande probabilité de non-interruption d’un rapport sexuel en dépit du risque de grossesse ou de IST, à une plus grande probabilité de rapport pour de l’argent ou pour d’autres besoins/drogue, à un usage de drogue dans les dernières 48 heures, à une plus grande probabilité d’agression physique ou sexuelle adulte.
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Varios estudios realizados con muestras pequeñas y de “alto-riesgo” han demostrado que una historia de abuso sexual en la infancia o en la adolescencia está asociada con conductas sexuales de riesgo. Sin embargo, pocos estudios con amplias muestras aleatorias y de la población general han examinado específicamente la relación entre ambas variables con un bloque de medidas completas.
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A past sexually transmitted disease (STD) diagnosis is an important predictor for risk of a subsequent infection (1–4).
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^☆: This research was supported by National Institute of Mental Health Grant R01-MH48630. The first author was also supported by National Institute of Drug Abuse Grant P50-DA10075.

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Original ArticlesSubsequent infection among adolescent African- American males attending a sexually transmitted disease clinic☆

Abstract

Section snippets

Participants and design

Baseline characteristics

Discussion

Acknowledgements

J Adolesc Health

J Adolesc Health

J Adolesc Health

Sexually transmitted disease surveillance, 1996

Diagnosis and reporting of HIV and AIDS in states with integrated HIV and AIDS surveillance—United States, January 1994–June 1997

MMWR

The sexual behavior of men in the United States

Fam Plann Perspect

Factors influencing first intercourse for teenage men

Public Health Rep

The determinants of first sex by age 14 in a high-risk adolescent population

Fam Plann Perspect

Heterosexual experiences and partnerships of urban, low-income African-American and Hispanic youth

J Acquir Immune Defic Syndr Hum Retrovirol

Young men’s risk behaviors for HIV infection and sexually transmitted diseases, 1988 through 1991

Am J Public Health

Social influences on the sexual behavior of youth at risk for HIV exposure

Am J Public Health

Antibody testing and condom use among African-Americans at risk for HIV infectionThe National AIDS Behavioral Surveys

Am J Public Health

Sexual knowledge, attitudes, and risky sexual behavior among inner-city Black male adolescents

J Adolesc Res

The social organization of sexualitySexual practices in the United States

Youth Risk Behavior Surveillance—United States, 1995

MMWR

Sexual practices and intentions among preadolescent and early adolescent low-income urban African-Americans

Pediatrics

Does condom availability make a difference?

An evaluation of Philadelphia’s health resource centers. Fam Plann Perspect

Factors associated with condom use by sexually active male adolescents at risk for sexually transmitted diseases

Pediatrics

Original Articles
Subsequent infection among adolescent African- American males attending a sexually transmitted disease clinic☆