Behavioural interventions and abuse: secondary analysis of reinfection in minority women.
Sexually transmitted infection (STI), including AIDS disproportionately affects minority women with a history of physical or sexual abuse. The objective of this study was to evaluate the efficacy of gender- and culture-specific behavioural interventions and interactive STI counselling for high-risk minority women with a history of physical or sexual abuse over two years. African- and Mexican-American women with a non-viral STI were enrolled in a randomized trial. Follow-up screens and interviews occurred at six months and one and two years. The primary outcome was subsequent infection with chlamydia and/or gonorrhoea. Secondary analysis of primary outcomes was made by self-reported physical or sexual abuse. Logistic regression was utilized on an intention-to-treat basis. Baseline data from 853 women were included; the retention rate was 91%. Infection rates were higher in abused women in Year 1 (29% vs. 23.8%, P=0.12), Year 2 (23.4% vs.17.6%, P=0.03) and cumulatively (43.8% vs. 33.0%, P=0.003). Unadjusted association between abuse and reinfection was stronger for adolescents (<19 years) than adults in Year 1 (42.7% vs. 30.8%, P=0.03), Year 2 (32.7% vs. 22.0%, P=0.03) and cumulatively (59.4% vs. 43.3%, P=0.004). Corresponding rates for adults were Year 1 (17.8% vs. 17.0%, P=0.84), Year 2 (17.4% vs. 12.7%, P=0.23) and cumulatively (30.7% vs. 22.3%, P=0.08). Reinfection rates were further stratified by adolescence and substance use. Abused adolescents had consistently higher reinfection than non-abused adolescents and abused adults. In conclusion, risk-reduction interventions decreased infective episodes with chlamydia and/or gonorrhoea in the two-year study period for non-abused women. Abused women, particularly adolescents and substance users, had increased episodes in these study periods.
Champion
Jane Dimmitt
JD
Department of Family Nursing Care, School of Nursing, The University of Texas Health Science Center at San Antonio, 7703 Floyd C Drive, San Antonio, TX 78230-3900, USA. dimmitt@uthscsa.edu
Shain
Rochelle N
RN
Korte
Jeffrey E
JE
Holden
Alan E C
AE
Piper
Jeanna M
JM
Perdue
Sondra T
ST
Guerra
Fernando A
FA
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000367:Age Factors; D002690:Chlamydia Infections / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control*; D003376:Counseling; D005260:Female; D005500:Follow-Up Studies; D006069:Gonorrhea / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D017058:Mexican Americans; D008875:Middle Aged; D008913:Minority Groups; D012742:Sex Offenses; D016896:Treatment Outcome