STD prevention and the challenge of gender and cultural diversity: knowledge, attitudes, and risk behaviors among black and Hispanic inner-city STD clinic patients.

BACKGROUND AND OBJECTIVES: This study describes gender and cultural differences in sex-related risk behaviors, knowledge, and attitudes among black and Hispanic men and women seeking services at an STD clinic in the South Bronx. STUDY DESIGN: Survey instruments were administered to 3,348 men and women selected as a proportionate random sample of clinic patients registered from January through December 1992. RESULTS: There were significant differences in risk behaviors, knowledge about AIDS and STDs, and attitudes related to condom use among men and women who sought services at this large inner-city clinic. Across groups, the majority of subjects had a history of prior STDs and previously had been treated at a STD clinic. Overall levels of knowledge were high, with the exception of specific issues related to condom use and STD symptoms. Gender and cultural differences were most apparent in sex practices, experience with condoms, and attitudes concerning the use of condoms in relationships. CONCLUSIONS: These data indicate the need to design clinic prevention programs that reflect the diversity of gender and culturally based attitudes, knowledge, and behaviors within inner-city populations. Minority men and women who seek services at STD clinics are known to be at high risk of HIV infection and other sexually transmitted diseases. Yet providing all members of this patient population with the same prevention messages is not sufficient; differences in sex practices, educational needs, and concerns about adopting safer sex behaviors must be taken into account. This study underscores how important it is for clinics to develop the multiple interventions necessary to provide patients with the specific information and skills they need--beyond admonishments to avoid risky sex and use condoms--and for clinic staff to be trained in providing education that is gender and culturally appropriate.