Longitudinal Patterns of Sexually Transmitted Infection Risk Based on Psychological Characteristics and Sexual Behavior in Heterosexual Sexually Transmitted Infection Clinic Visitors

Population-level predictors of sexually transmitted infection rate changes in Missouri: an ecological study

BACKGROUND

Sexually transmitted infection rates continue to increase across the US, further developing health disparities and economic burdens of disease, especially as migration occurs. In this study, we aim to assess the relationship between STI rates and population-level variables from 2008 to 2017 at the county level in Missouri.

METHODS

Two data sources were used: STI rates of chlamydia, gonorrhea, syphilis, HIV reported to Missouri DHSS and ACS 1-year county population estimates. Linear regression models and ANOVA tests were conducted in SPSS for each STI from year-to-year and 2008-2017. Covariates included in the analyzes were county-level income, employment rate, race, ethnicity, age, and percent poverty. Further, Akaike Information Criterion tests were performed to indicate the best predictor models and averaged standardized beta values.

RESULTS

Significant relationships among STI rates and population growth were identified. Chlamydia, syphilis, and HIV were positively associated with population growth from 2008 to 2017 (β = 0.15; β = 0.01; β = 0.05, respectively). Gonorrhea was negatively associated with population growth (β = - 0.02) but positively associated with unemployment rates (β = 0.01) highlighting the need to address population growth, as well as other variables in a population.

CONCLUSIONS

There seems to be a positive relationship among population change and rates of STIs. As populations change, rates of STIs change. Moving forward, quantitative work should be conducted in various states and the nation to understand this relationship in different contexts. Future studies should be qualitative word focused on county health departments and community health improvement plans. Lastly, public policy should be implemented to buffer the impact of migration on health outcomes.

Patterns of sexual behaviour associated with repeated chlamydia testing and infection in men and women: a latent class analysis

BACKGROUND

Adolescents and young adults are at higher risk of acquiring Chlamydia trachomatis infection (chlamydia), so testing is promoted in these populations. Studies have shown that re-testing for chlamydia is common amongst them. We investigated how sexual risk behaviour profiles are associated with repeated testing for chlamydia.

METHODS

We used baseline data from a cohort of 2814 individuals recruited at an urban STI -clinic. We applied latent class (LC) analysis using 9 manifest variables on sexual behaviour and substance use self-reported by the study participants. We fitted ordered logistic regression to investigate the association of LC membership with the outcomes repeated testing during the past 12 months and lifetime repeated testing for chlamydia. Models were fit separately for men and women.

RESULTS

We identified four LCs for men and three LCs for women with increasing gradient of risky sexual behaviour. The two classes with the highest risk among men were associated with lifetime repeated testing for chlamydia: adjOR = 2.26 (95%CI: 1.50-3.40) and adjOR = 3.03 (95%CI: 1.93-4.74) as compared with the class with lowest risk. In women, the class with the highest risk was associated with increased odds of repeated lifetime testing (adjOR =1.85 (95%CI: 1.24-2.76)) and repeated testing during past 12 months (adjOR = 1.72 (95%CI: 1.16-2.54)). An association with chlamydia positive test at the time of the study and during the participant's lifetime was only found in the male highest risk classes.

CONCLUSION

Prevention messages with regard to testing for chlamydia after unprotected sexual contact with new/casual partners seem to reach individuals in highest risk behaviour classes who are more likely to test repeatedly. Further prevention efforts should involve potentially more tailored sex-specific interventions taking into consideration risk behaviour patterns.

Identifying Sexually Transmitted Infection Risk Groups Based on Behavioral and Psychological Characteristics Among Heterosexuals During the COVID-19 Pandemic

BACKGROUND

Measures to reduce coronavirus disease (COVID-19) transmission may impact sexual health. We aimed to examine the impact of COVID-19 on sexual behavior and sexually transmitted infection (STI) testing and to characterize individuals who were at high STI risk.

METHODS

Dutch heterosexual males and females who participated in a cohort study in 2016 to 2018 were invited to fill out 2 questionnaires again in 2020 (age, 21-28 years). We used behavioral and psychological data from: prelockdown (September 2019 to February 2020), lockdown (March to May 2020), and postlockdown (June to August 2020). Behavior change was compared between subgroups identified with latent class analysis.

RESULTS

Four latent classes were identified (n = 238). Individuals in class 1 (48% of study population) and class 2 (36%) were at low STI risk and reported mostly steady partnerships. Individuals in class 3 (9%) and class 4 (7%) reported multiple casual partners prelockdown. Class 4 was characterized by lower condom use and health goals, negative infection prevention attitudes, and higher impulsiveness compared with class 3. Furthermore, same/increased partner numbers during lockdown (class 3, 18%; class 4, 56%) and postlockdown (class 3, 36%; class 4, 42%) compared with prelockdown was often reported. Of individuals who wanted an STI test during the pandemic, 62% in class 3 and 56% in class 4 did not get tested, mainly because they were unable to get an appointment.

CONCLUSIONS

A subgroup of individuals, characterized by low health goals, negative infection prevention attitudes, and high impulsiveness, engaged in high-risk behavior during the pandemic. Identifying these individuals may help provide appropriate health care during strict lockdowns and after relaxation of measures.

Modelling the impact of tailored behavioural interventions on chlamydia transmission

Behavioural interventions tailored to psychological characteristics of an individual can effectively achieve risk-reducing behaviour. The impact of tailored interventions on population-level chlamydia prevalence is unknown. We aimed to assess the impact on overall chlamydia prevalence five years after the introduction of an intervention aimed at increasing self-efficacy, social norms, attitudes and intentions towards condom use (i.e., condom intervention), and an intervention aimed at increasing health goals and decreasing impulsiveness (i.e., impulsiveness intervention). A pair model, informed by longitudinal psychological and behavioural data of young heterosexuals visiting sexual health centers, with susceptible-infected-susceptible structure was developed. The intervention effect was defined as an increased proportion of each subgroup moving to the desired subgroup (i.e., lower risk subgroup). Interventions tailored to subgroup-specific characteristics, assuming differential intervention effects in each subgroup, more effectively reduced overall chlamydia prevalence compared to non-tailored interventions. The most effective intervention was the tailored condom intervention, which was assumed to result in a relative reduction in chlamydia prevalence of 18% versus 12% in the non-tailored scenario. Thus, it is important to assess multiple psychological and behavioural characteristics of individuals. Tailored interventions may be more successful in achieving risk-reducing behaviour, and consequently, reduce chlamydia prevalence more effectively.

The impact of STI test results and face-to-face consultations on subsequent behavior and psychological characteristics

Sexually transmitted infection (STI) testing without face-to-face counselling is increasingly offered at sexual health centers (SHC), and ordering self-sampling tests online is becoming more popular. However, the impact of testing without counselling on behavior is unknown. We examine the impact of STI testing with and without consultation and the combined effect of a positive test result and treatment consultation, on behavioral and psychological characteristics over time. Data from a longitudinal study among heterosexual SHC visitors aged 18-24 years was used. The impact of a test consultation (participants who tested chlamydia negative with vs. without consultation) and treatment consultation/positive test result (participants who tested chlamydia positive vs. negative), was assessed by comparing behavioral and psychological characteristics before testing (baseline), and at three-week and six-month follow-up, using generalized estimating equation models. Changes after testing were similar between participants who tested chlamydia negative with and without test consultation, namely decreased risk perception, shame, number of partners, and increased knowledge. However, participants who tested chlamydia positive reported stronger increases in health goals and intentions towards condom use, and stronger decreases in the number of partners and stigma, compared to participants who tested negative. Furthermore, condom use increased in chlamydia positive, and decreased in chlamydia negative participants. A treatment consultation/positive test result had a risk-reducing impact on behavioral and psychological characteristics, whereas the impact of a test consultation was limited. Since the majority of young heterosexuals test chlamydia negative, alternative interventions (e.g., online) achieving risk-reducing behavior change targeted to individuals who tested negative are needed.