Correlates of Trichomonas Prevalence Among Street-Recruited, Drug-Using Women Enrolled in a Randomized Trial

Abstract

Objectives. Substance-using women need prevention technologies and programs to reduce risk of HIV/sexually transmitted infection (STI). We examined STI prevalence and identified risk correlates for female drug users. Methods. We used interviewer-administered and computer-assisted surveys, and tested specimens for four, treatable STIs (trichomonas, early syphilis, gonorrhea, chlamydia) on 198 HIV-seronegative, street-recruited, substance-using women enrolled in a randomized trial to reduce HIV/STI risk. Results. Most women were crack users (88%), reported sex exchange (80%) and were not in drug user treatment (74%). Two-thirds were African-American and nearly all were unemployed. Protection during sex was infrequent. African-American women reported fewer unprotected sex acts and fewer sexual partners, but greater crack use and more sex-for exchange, than whites or Hispanics. Trichomonas prevalence (36.9%) exceeded that for chlamydia (3.5%), syphilis (1.5%), and gonorrhea (0%). In multivariate logistic regression, having a primary and casual partner more than doubled (AOR 2.86) the risk of having trichomonas and being African-American raised the risk by more than 8 times (AOR 8.45). Conclusions. African-American, drug-using women, and women with multiple partner types, are in urgent need of effective STI/HIV prevention interventions.

Keywords: :

• trichomonas infection
• crack cocaine
• substance use
• women
• African-Americans
• sexually transmitted infection

THE AUTHORS

Erica L. Gollub is Assistant Professor at the Robert Stempel College of Public Health and Social Work at Florida International University, Miami. She completed her MPH in Population Studies and DrPH in Epidemiology at Columbia University. Since 1990, Dr. Gollub has developed and tested novel behavioral interventions for diverse, international populations of women at risk for STD/HIV (African-American women, substance users, immigrants) based on original theories of women's empowerment and using small group counseling, intensively trained peer counselors, and a menu of women's barrier methods known to reduce risk of disease, such as the female condom and the contraceptive diaphragm. She has served as Principal Investigator (PI) and co-investigator of several prevention trials funded by NIH and CDC. In 1997, Dr. Gollub was awarded a Fulbright Scholarship for research among immigrant women in southern France, which resulted in a national anti-HIV/STD program for women adopted by the French Ministry of Health. Dr. Gollub publishes widely on women and prevention, and has served on numerous national and international HIV/AIDS advisory boards. Dr. Gollub was PI for the BestBET study during her tenure as faculty at the University of Pennsylvania.

Kay A. Armstrong is currently a public health consultant conducting qualitative and quantitative evaluations of studies such as medical reproductive health education tools, communication between health care providers and patients regarding health risk decisions, HIV prevention among women with risky behaviors, and ethical decisions and experience among street-level research personnel staff. She was the Director of Research at the Family Planning Council in Philadelphia for 17 years and has previous experience in child abuse prevention and intervention research, domestic violence, HIV/STI, and other public health areas. She is a member of several evaluation and public health organizations and is a member on an Institutional Review Board.

Tamara Boney, M.S., CCRC, is presently the Project Manager at the Treatment Research Center, School of Medicine at the University of Pennsylvania. Ms. Boney has worked extensively in the field of addictions research for over 23 years with several at risk/vulnerable populations including at risk youth, HIV/AIDS, probationers/parolees and female substance abusing populations with such institutions as NIDA and Johns Hopkins University. Ms. Boney holds a Master of Science from Morgan State University in Baltimore.

Delinda Mercer completed her PhD in Professional Psychology at the University of Pennsylvania. She is now a licensed psychologist and the Clinical Coordinator of the Behavioral Health Unit at Regional West Medical Center in Scottsbluff, Nebraska. Her interests include addictions and co-occurring disorders, geropsychology, women's health, persistent mental illness, and rural mental health issues. She is on the Nebraska State Advisory Committee on Substance Abuse Services. She was previously on the faculty at the University of Pennsylvania, where she was involved in research on addiction treatment, psychotherapy, dual disorders, prevention, and women's health.

Sumedha Chhatre is a Lecturer in the Department of Psychiatry, University of Pennsylvania. Her primary research interest is in the area of urban health. She is currently involved in health services research and behavioral research related to HIV prevention, cancer, congestive heart failure, Alzheimer's disease, and mental illnesses. Dr. Chhatre is also a collaborative investigator on a variety of successful peer-reviewed research projects at University of Pennsylvania, including several federally funded grants.

Antonella Lavelanet is currently candidate for J.D. at Rutgers University, Camden, New Jersey, and candidate for D.O. at University of Medicine and Dentistry of New Jersey. Ms. Lavelanet's interests include reproductive health, especially STD trends, as well as reproductive rights. She has worked as researcher on several studies at the University of Pennsylvania and Temple University, as a reproductive health counselor for a women's health organization in Philadelphia, as well as legal intern at Bristol-Myers Squibb.

Katina M. Mackey, M.Ed., is currently a third grade facilitator at Khepera Charter School, an Afrikan-centered learning elementary school in Philadelphia, PA. In 2001, she graduated with a BA in Psychology from Temple University. Upon graduation, she began her research career at the University of Pennsylvania working on the BestBET Study for Women until its completion. Her experience in the field of HIV and STD prevention also includes work on several other NIH-funded studies.

Danielle Fiore is currently a programmer and data manager at the Philadelphia HIV Trials Vaccine Unit (HTVU) in Pennsylvania. The Penn HVTU is a site in the HIV Vaccine Trials Network and participates in Phase II Trials of newly developed vaccines for HIV and targets high-risk drug using populations for participation in these clinical trials. Ms. Tobin holds a BS in Computer Science from Temple University. Her past work in research includes working with the Philadelphia HIV Prevention Trial Unit (HPTU) from 2001 to 2006, one of 22 domestic and international sites of the HIV Prevention Trials Network. She also has research experience in the area of HIV sexual risk reduction for Black drug-using women.

Notes

1 Treatment can be briefly and usefully defined as a planned, goal directed, temporally structured change process, of necessary quality, appropriateness and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help based (AA, NA, etc.) and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities—which aren't also used with non-substance users. In the West, with the relatively new ideology of “harm reduction” and the even newer Quality of Life (QOL) treatment-driven model there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence driven models. Treatment is implemented in a range of environments, ambulatory, and within institutions which can include controlled environments for users and non-users alike. Editor's note.