Perceived financial need and sexual risk behavior among urban, minority patients following sexually transmitted infection diagnosis.

BACKGROUND: Previous studies have shown that racial/ethnic and gender disparities in human immunodeficiency virus (HIV)/sexually transmitted infections (STI) may be due in part to factors such as poverty and income-inequality. Little has been published in the HIV/STI literature on the effect of the perception of having unmet basic needs on sexual risk behavior. METHODS: Data on perceived financial need and sexual risk were collected as part of a behavioral intervention aimed at promoting STI partner notification and reducing sexual behavior among minority patients presenting for care at 1 of 2 STI treatment centers in Brooklyn, NY, between January 2002 and December 2004. Data from 528 participants collected at the 6-month follow-up visit were used for the current study. RESULTS: Forty-three percent of participants were categorized as having unmet needs. Those with unmet needs were more likely to report unprotected anal or vaginal sex (unprotected anal or vaginal intercourse [UAVI]; 62%) versus those who had met needs (53%). This association was significant (adjusted odds ratio=1.28; 95% confidence interval=1.04-1.53), after controlling for age, sex, site of recruitment, intervention group membership, and country of origin. Stratified analyses indicated that, in the group that did not receive the intervention, there was a statistically significant interaction between sex and basic needs such that women with unmet needs were more likely to report any UAVI (78%) than those with met needs (54%) (adjusted odds ratio=1.18; 95% confidence interval=1.07-1.24). No such relationship was detected for men in this sample. CONCLUSIONS: The significant association between perceived unmet needs and UAVI appears to be particularly relevant for women. These findings provide preliminary evidence that HIV/STI intervention components that seek to directly deal with issues of reduction in partner conflict might be beneficial to women with high perceived unmet basic needs, and for whom a potential dissolution of a relationship may represent a further loss in ability to meet basic needs.

A randomized controlled trial for reducing risks for sexually transmitted infections through enhanced patient-based partner notification.

OBJECTIVES: We sought to assess the effectiveness of approaches targeting improved sexually transmitted infection (STI) sexual partner notification through patient referral. METHODS: From January 2002 through December 2004, 600 patients with Neisseria gonorrhoeae or Chlamydia trachomatis were recruited from STI clinics and randomly assigned to either a standard-of-care group or a group that was counseled at the time of diagnosis and given additional follow-up contact. Participants completed an interview at baseline, 1 month, and 6 months and were checked at 6 months for gonorrhea or chlamydial infection via nucleic acid amplification testing of urine. RESULTS: Program participants were more likely to report sexual partner notification at 1 month (86% control, 92% intervention; adjusted odds ratio [AOR] = 1.8; 95% confidence interval [CI] = 1.02, 3.0) and were more likely to report no unprotected sexual intercourse at 6 months (38% control, 48% intervention; AOR = 1.5; 95% CI = 1.1, 2.1). Gonorrhea or chlamydial infection was detected in 6% of intervention and 11% of control participants at follow-up (AOR = 2.2; 95% CI = 1.1, 4.1), with greatest benefits seen among men (for gender interaction, P = .03). CONCLUSIONS: This patient-based sexual partner notification program can help reduce risks for subsequent STIs among urban, minority patients presenting for care at STI clinics.