Original article
The Impact of Community-Based Sexually Transmitted Infection Screening Results on Sexual Risk Behaviors of African American Adolescents

https://doi.org/10.1016/j.jadohealth.2009.12.024Get rights and content

Abstract

Purpose

To examine the effect of a community-based sexually transmitted infection (STI) screening program on sexual risk behavior among African American adolescents. We hypothesized that adolescents testing positive for an STI and receiving post-test counseling would reduce risky sexual practices, whereas STI-negative adolescents would show little or no change in protective sexual behavior after screening.

Methods

From August 2006 to January 2008, we recruited 636 sexually active African American adolescents (age, 14–17) from community-based organizations in two mid-sized U.S. cities with high STI prevalence. Participants were screened for three STIs (gonorrhea, chlamydia, and trichomoniasis) and completed an audio computer-assisted self-interview. Youth who tested positive for an STI (6.6%) received treatment and counseling. Youth testing negative received no further intervention. Approximately 85% of participants completed 3- and 6-month follow-up assessments. Generalized estimating equations determined the effects of STI screening on adolescents' number of sexual partners and occurrence of unprotected sex.

Results

Adolescents who tested positive for an STI reduced their number of vaginal and oral sex partners and the probability of unprotected sex. STI-negative adolescents demonstrated no change for numbers of partners or unprotected sex.

Conclusions

Community-based STI screening can help to reduce sexual risk behavior in youth who test positive for STIs. Alternative approaches will be needed to reduce risk behavior in youth who test negative but who are nevertheless at risk for acquiring an STI.

Section snippets

Study design

Data analyzed in this study are part of project iMPPACS (iMPPACS is the acronym developed for the multi-site project “in Macon, Providence, Philadelphia, Atlanta, Columbia, and Syracuse), a multisite intervention that combined two levels of HIV/STI prevention programming targeted to African American adolescents: face-to-face small group counseling sessions and a community-wide mass media campaign. As part of the assessment plan, all participants were also tested for three STIs at the baseline

Results

Participants' ages ranged from 14 to 17 (M = 15.6, standard deviation = 1.16; 52% female). At baseline, 42 (6.6%) tested positive for at least one STI. Table 1 shows that females were more likely than males to test STI-positive and that the entire sample exhibited ample risk behavior: 20% of the adolescents reported multiple vaginal sex partners and 25% reported unprotected vaginal and/or anal sex in the last 3 months. Those testing STI-positive were more likely (p < .01) to report multiple vaginal

Discussion

The STI/HIV epidemic affects African American adolescents disproportionately and requires intervention efforts at the community and individual level. Community-based STI screening and counseling has the potential to address structural barriers that African Americans confront and might also serve to detect and avert the spread of asymptomatic STIs [13]. From an individual's perspective, an STI-positive diagnosis with subsequent medical care and counseling has the potential to be a powerful

Conclusions

Testing positive for an STI through community-based screening and receiving standard of care treatment and counseling can lead to a reduction in number of sex partners and reduction in unprotected sex. Screening is, however, less likely to benefit STI-negative adolescents. This is problematic because receiving a negative test result is not an indication of reduced risk for infection. Indeed, STI-negative adolescents in this study reported substantial unprotected sex and multiple partners at

Acknowledgments

The data stem from a project funded by the US National Institute of Mental Health (NIMH), Office on AIDS. This study was conducted through the iMPPACS network supported by the National Institutes of Mental Health (Pim Brouwers, Project Officer) at the following sites and local contributors: Columbia, SC (MH66802, Robert Valois (PI), Naomi Farber, Andure Walker); Macon, GA (MH66807, Ralph DiClemente (PI), Gina Wingood, Laura Salazar, Rachel Joseph, Delia Lang; Angela Caliendo); Philadelphia, PA

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    There are no financial conflicts of interest in relation to this study.

    The data in this study stem from a project funded by the US National Institute of Mental Health (NIMH), Office on AIDS. The content of this article is solely the responsibility of the authors and do not necessarily represent the official views of the NIMH.

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