267400 Social, structural and behavioral correlates of Trichomonas vaginalis infection among homeless and unstably housed women

Tuesday, October 30, 2012 : 2:45 PM - 3:00 PM

Elise Riley, PhD , School of Medicine, University of California, San Francisco, San Francisco, CA
Jennifer Cohen, MPA , School of Medicine, University of California, San Francisco, San Francisco, CA
Barbara Grimes, PhD , School of Medicine, University of California, San Francisco, San Francisco, CA
Carina Marquez, MD , School of Medicine, University of California, San Francisco, San Francisco, CA
Peter Chin-Hong, MD , School of Medicine, University of California, San Francisco, San Francisco, CA
Susan Philip, MD , STD Prevention and Control Services, San Francisco Department of Public Health, San Francisco, CA
OBJECTIVE: To determine correlates of Trichomonas vaginalis (T. vaginalis) infection in homeless and unstably housed women, a population in which few STI studies have been conducted. METHODS: A probability sample of community-recruited women with a history of homelessness underwent T. vaginalis screening and behavioral interviews between April and October of 2010. Data were analyzed using multivariable logistic regression to establish independent correlates of T. vaginalis. RESULTS: Among 245 women (126 HIV+ and 118 HIV-), the median age was 47, 72% were of non-white race/ethnicity and 65% had completed high school. T. vaginalis prevalence was 14% compared to 3% in the general population. Significant adjusted correlates (p<0.05) of T. vaginalis included younger age (OR [age>48]=0.10), short-term homeless shelter stays (OR=6.08), and use of marijuana (OR=2.99). Correlates from previous studies that were not significant here included race/ethnicity, HIV infection (on or off antiretroviral therapy), income and education. Depression, PTSD and the use of cocaine were also not significant correlates of T. vaginalis in this population. CONCLUSION: The prevalence of T. vaginalis is exceptionally high among homeless and unstably housed women, and the strongest correlates differ from those reported in the general population. These findings build on a growing body of literature suggesting that structural factors like housing instability are among the strongest predictors of infection and poor health. Results shown here further suggest that broad categories like poverty and race have likely acted as surrogates for specific situations like homelessness, which limit options and put women at greater risk for infection.

Learning Areas:
Clinical medicine applied in public health
Diversity and culture
Epidemiology
Public health or related research

Learning Objectives:
1. Describe the epidemiology of Trichomonas vaginalis in homeless and unstably housed women compared to women from the general US population. 2. Discuss implications of study results for targeted STI interventions among younger homeless women. 3. Differentiate between broad categories such as poverty and specific components of poverty such as housing instability in both research as well as policy.

Keywords: STD, Homelessness

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have overseen research programs regarding infectious diseases in homeless women for 11 years, provide mentoring and consultation on this topic, and continue to publish in related topics.
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.