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Foster care, syndemic health disparities and associations with HIV/STI diagnoses among young adult substance users
  1. Mance E Buttram1,
  2. Maria E Pagano2,
  3. Steven P Kurtz1
  1. 1 Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Fort Lauderdale, Florida, USA
  2. 2 Department of Psychiatry, Division of Child Psychiatry, Case Western Reserve University, Cleveland, Ohio, USA
  1. Correspondence to Dr Mance E Buttram, Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, FL 33138, USA; mance.buttram{at}


Objectives Foster care history is associated with many health and social problems, including sexual risk behaviours, HIV and other sexually transmitted infections (STIs). This cross-sectional study compares sexual risk behaviours among a sample of young adult substance users in Miami (N=602) with and without foster care histories.

Methods Participants completed a comprehensive assessment which included sections on foster care, sexual risk behaviours and related health and social problems. Logistic regression was used to examine the relationship between foster care history, associated syndemic vulnerabilities and increased likelihood of having a prior HIV/STI diagnosis.

Results Bivariate analyses indicated that foster care alumni were more likely to report a prior HIV/STI diagnosis, higher condomless sex frequencies, being high on alcohol or drugs during sex, sexual victimisation and a history of homelessness compared with other participants in the sample (p<0.05). Multivariate analyses revealed that foster care history, sexual victimisation and group sex participation are associated with a prior HIV/STI diagnosis (p<0.05). Group sex participation doubled the odds of a prior HIV/STI diagnosis for foster care alumni, compared with other participants (p<0.5).

Conclusions This exploratory study identifies characteristics that distinguish foster care alumni from non-alumni and signals the need to better serve the sexual and related health needs of individuals with foster care histories. Clinicians and healthcare providers should provide foster care alumni with detailed HIV/STI risk reduction information and resources and services to address related syndemic vulnerabilities (eg, victimisation and homelessness).

  • sexual behaviour
  • substance misuse
  • public health
  • heterosexual behaviour
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  • Handling editor Jackie A Cassell

  • Contributors MEB conceptualised the study, contributed to data analyses and developed a draft of the manuscript. MEP performed statistical analyses and contributed to the interpretation of findings. SPK served as Principal Investigator of the primary study, contributed to study conceptualisation and to the interpretation of findings. All authors participated approved the final version of the manuscript.

  • Funding This research was supported by DHHS Grant Number 5 R01 DA019048 from the National Institute on Drug Abuse.

  • Disclaimer The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Nova Southeastern University IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data are not available.

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