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January 2008

Prevalence, Correlates, and Efficacy of Selective Avoidance as a Sexually Transmitted Disease Prevention Strategy Among African American Adolescent Females

Author Affiliations

Author Affiliations: Division of Infectious Diseases, Epidemiology, and Immunology, Department of pediatrics (Dr DiClemente) and Division of Infectious Diseases, Department of Medicine (Drs DiClemente and Caliendo), School of Medicine, and Emory Center for AIDS Research, Rollins School of Public Health (Drs DiClemente, Wingood, Salazar, Sales, and Caliendo and Ms Rose), Emory University, Atlanta, Georgia; and College of Public Health, University of Kentucky, Lexington, and Rural Center for AIDS/STD Prevention, Indiana University, Bloomington (Dr Crosby).

Arch Pediatr Adolesc Med. 2008;162(1):60-65. doi:10.1001/archpediatrics.2007.5

Objectives  To identify the prevalence and correlates of selective avoidance (SA) of sexual intercourse among African American adolescent females at risk for sexually transmitted disease (STD) acquisition and transmission.

Design  Cross-sectional study.

Setting  Health clinics.

Participants  African American females (N = 715) between the ages of 15 and 21 years.

Main Outcome Measures  Self-reported sexual behaviors and laboratory-confirmed STDs.

Results  Among the participants, 35.4% used SA as a strategy to prevent STD acquisition; 25.7% used SA to prevent STD transmission. Use of SA was not associated with current STD status. In multivariable analyses, adolescents who had sexual intercourse with 2 or more partners in the past 60 days, those who had high fear related to condom use negotiation, and those who discussed STD prevention with their sexual partners were 2.05 times more likely (95% confidence interval [CI], 1.31-3.20), 1.55 times more likely (95% CI, 1.09-2.19), and 2.00 times more likely (95% CI, 1.38-2.90), respectively, to use SA to prevent STD acquisition, and the same groups were 2.62 times more likely (95% CI, 1.62-4.24), 1.60 times more likely (95% CI, 1.10-2.32), and 2.13 times more likely (95% CI, 1.39-3.26), respectively, to use SA to prevent STD transmission.

Conclusions  This study provides initial evidence suggesting that SA as a risk-reduction strategy specifically used to prevent STD acquisition and/or transmission may be common among African American adolescent females. Based on a lack of differences in STD prevalence, we recommend that clinicians and prevention programs discourage the use of SA as an STD prevention strategy and encourage adolescent females to use condoms consistently and correctly with all male sexual partners.