Prevalence and correlates of “selective avoidance” among African American adolescent females at risk of acquiring and transmitting STDs

Background: To identify the prevalence and correlates of “selective avoidance” of sexual intercourse among African American adolescent females. Methods: Cross-sectional study of 715 African American adolescent females (15-21 years old) was conducted at health clinics. Data collection included a) an audio-computer assisted self-interview (ACASI) and self-collected vaginal swabs assayed using nucleic acid amplification tests for Trichomonas vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae. The use of selective avoidance as a risk-reduction strategy was assessed relative to: 1) preventing STD acquisition, 2) preventing STD transmission, or 3) preventing both acquisition and transmission. Results: Approximately 35% used selective avoidance to prevent acquisition, 25.7% to prevent transmission, and 19.3% to prevent both. Selective avoidance was not associated with unprotected vaginal sex or STD status. With two exceptions, each reason for using selective avoidance was significantly associated, at the bivariate level, with each of four correlates representing potential motives, and each of three potential relational dynamics. In multivariable analyses, two correlates were significantly associated with all three reasons for selective avoidance: having sex with 2 or more partners in the past 60 days and recently discussing STD prevention with boyfriends/sex partners. Conclusion: This study provides initial evidence suggesting that selective avoidance as a risk-reduction strategy, specifically used to prevent STD acquisition and/or transmission, may be common among African American adolescent females. Unfortunately, the use of selective avoidance alone appears insufficient to achieve risk reduction. In light of the relational and motivational correlates identified, interventions that help African American adolescents supplement these avoidance-oriented efforts are warranted.