title: Behavioural interventions and abuse: secondary analysis of reinfection in minority women.
abstract: 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.
authors.affiliation: 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
authors.forename: Jane Dimmitt
authors.initials: JD
authors.lastname: Champion
authors.forename: Rochelle N
authors.initials: RN
authors.lastname: Shain
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Korte
authors.forename: Alan E C
authors.initials: AE
authors.lastname: Holden
authors.forename: Jeanna M
authors.initials: JM
authors.lastname: Piper
authors.forename: Sondra T
authors.initials: ST
authors.lastname: Perdue
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Guerra
mesh_terms: 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