STI Testing and Counseling can Reduce Risky Behaviors
Sexually transmitted infections (STIs) affect millions of Americans every year; and minority youth are disproportionately affected. African Americans have higher rates of STIs, including HIV, compared to other races in the United States. Due to the asymptomatic nature of most STIs, they may go undetected and hence untreated until complications arise. Therefore, it is important to screen and test sexually active youth and to counsel them on the dangers of early and risky sexual activity. Community-based STI screening may be a promising strategy to detect and to reduce infection rates in youth. To find evidence supporting this strategy, Sznitman et al recently studied the effect of community-based STI screening and counseling on the sexual behaviors of African American youth.1
The researchers hypothesized that STI-positive youth receiving post-test counseling would reduce “risky sexual behaviors” compared to STI-negative youth. 636 sexually experienced youth aged 14 to 17 years from an HIV/STI prevention intervention program in two U.S. cities participated in the study. Self reported sexual behavior data were collected at baseline as well as 3-month and 6-month follow-up. The number of sex partners and “unprotected” sexual contact in the last three months were recorded. Urine testing for chlamydia, gonorrhea and trichomoniasis was done for the participants at baseline and 6-month follow-up. Participants who tested positive received STI treatment and counseling by a chosen health care provider. STI-negative participants were not given any intervention. Data from 590 participants who completed either the 3-month or 6-month follow-up were included for analysis.
Results showed that, at baseline, 42 (~7%) participants had at least one STI. After 6 months, the number of vaginal sex partners of STI-positive teens reduced by 44%. Additionally, the probability of “unprotected’ vaginal or anal sex reduced by 28%. In contrast, in STI-negative teens (those who had not received the counseling), the number of vaginal sex partners increased by 32% after 6 months. Furthermore, 19% of those with a positive STI test at baseline tested positive again at 6-month follow-up. The study results indicate that testing positive for STIs and receiving counseling may help reduce risky sexual behaviors in youth. However, preventing re-infection may be difficult unless both partners avoid risky sexual behaviors to remain infection-free.
This study is limited in some ways. The participants were only followed for 6 months. Longer follow-up period is needed to examine the long term effects of STI screening and counseling. Another limitation of this study is that the data were based on self report and accuracy of the data is dependent on participant recall. In addition, the participants of this study were recruited from only two U.S. cities. This sample may not be representative of the entire population of African-American youth in the U.S. It is also unknown what other factors may have played a role in changing sexual behaviors of participants.
Regardless of these limitations, the study findings support the hypothesis that community-based STI screening and counseling may help in promoting healthier sexual behaviors. Results in this study are consistent with previous studies in which HIV testing and counseling showed positive impact on sexual behaviors of HIV-positive individuals but not on HIV-negative individuals.2 However, several issues need to be addressed in future studies. Interestingly, from the results, it is apparent that STI detection and treatment are not enough. Increased risky behaviors and re-infection occur even after STI testing. Youth should not have to risk the consequences before realizing what the healthiest sexual behaviors are for them. In fact, risk avoidance (primary prevention) is far better than risk reduction (secondary prevention). Effective interventions need to promote the safest sexual behaviors.
In conclusion, community-based STI testing and counseling may be an effective tool in reducing risky sexual behaviors. However, risk avoidance (postponing sexual activity until teens are in a lifelong committed relationship with an uninfected partner), is clearly the most effective strategy to avoid STIs and other consequences of risky sexual behaviors.
1. Sznitman SR, Carey MP, Vanable PA, et al. The impact of community-based sexually transmitted infection screening results on sexual risk behaviors of African American adolescents. J Adolesc Health. 2010;47(1):12-19.
2. Weinhardt LS, Carey MP, Johnson BT, Bickham NL. Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985-1997. Am J Public Health. 1999 Sep;89(9):1397-1405.
Reviewed: November 2010