205310 Sexual risk taking behaviors and sexually transmitted infections among HIV positive adolescents

Wednesday, November 11, 2009

John A. Nelson, CPNP, PhD , Harlem Health Promotion Center, Columbia University, New York, NY
Christel Hyden, MS, CHES , Harlem Health Promotion Center, Columbia University, New York, NY
Alwyn T. Cohall, MD , Harlem Health Promotion Center, Columbia University, New York, NY
Natalie Neu, MD , Harlem Health Promotion Center, Columbia University, New York, NY
BACKGROUND

Among people living with HIV/AIDS (PLWHA), sexually transmitted infections ( STIs) represent significant risk as decreased immune function can increase severity of STIs and facilitate acquisition of new STIs. HIV/STI comorbidity also increases likelihood of transmitting HIV. In NYC, 13-24 year olds have the highest STI rate of any PLWHA, yet evidence from the CDC's “Ask, Screen, Intervene” (ASI) curriculum of risk assessment, STI/pregnancy screening, and harm reduction demonstrates that clinicians don't screen for STIs among PLWHA.

METHODOLOGY

Project S.T.A.Y. (Services To Assist Youth) provides comprehensive services to adolescent PLWHA in NYC and routinely Asks, Screens and Intervenes. Through a retrospective chart review the proposed study will describe patients' self-reported sexual behavior, including number of partners, condom use, and HIV status disclosure. Screening results for gonorrhea/Chlamydia, syphilis, trichomoniasis, herpes, HPV, and cervical/anal pap and biopsies will be reported.

RESULTS

A preliminary analysis found 82% of S.T.A.Y. clientele were sexually active and among those, 40% were diagnosed with at least one new STI. Additionally, the majority of new STIs were asymptomatic, diagnosed through aggressive screening, underscoring the importance ASI in this high-risk group.

DISCUSSION

This presentation will describe sexual risk behaviors and STI rates of adolescent PLWHA, identify whether STIs are primarily discovered through routine screening or symptomatic diagnosis, and evaluate what variables predict condom use, HIV status disclosure, and STIs. Preliminary findings support the efficacy of the ASI approach to providing needed services to HIV positive adolescents, however additional attention is needed to reduce risk-taking behaviors in this population.

Learning Objectives:
To describe sexual risk taking behaviors of 55 HIV infected adolescents and young adults, analyze STI infection and reinfection rates over the course of a year, identify whether STIs are primarily discovered through routine screening or symptomatic diagnosis, and evaluate whether behavioral variables such as the number of sexual partners or gender of sexual partners is predictive of decreased likelihood of condom use and HIV status disclosure, and increased STI incidence.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: John A. Nelson, CPNP, PhD is the Project S.T.A.Y. nurse practitioner. John began providing care to HIV+ adolescents in 1989 after completing his MSN at Yale University. John has since provided care to HIV+ and HIV at-risk adolescents and young adults in Brooklyn, Manhattan, Queens, Bronx, and in rural Sullivan County, NY. John completed his Ph.D. in Nursing at NYU in May 2006, and joined the team at Project S.T.A.Y. in September 2006. John has published journal articles on issues including LGBT adolescents, HIV and adolescents, and cervical dysplasia in adolescent women. John¡¯s role with Project S.T.A.Y. includes clinical care to HIV+ and HIV at-risk adolescents and young adults, community-based outreach, research, and program growth and development
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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