Behavioural interventions and abuse: secondary analysis of reinfection in minority women

Sexually transmitted infection (STI), including AIDS disproportionately affects minority women with a history of physical or sexual abuse. The objective of this study was to evaluate the efficacy of gender- and culture-specific behavioural interventions and interactive STI counselling for high-risk minority women with a history of physical or sexual abuse over two years. African- and Mexican-American women with a non-viral STI were enrolled in a randomized trial. Follow-up screens and interviews occurred at six months and one and two years. The primary outcome was subsequent infection with chlamydia and/or gonorrhoea. Secondary analysis of primary outcomes was made by self-reported physical or sexual abuse. Logistic regression was utilized on an intention-to-treat basis. Baseline data from 853 women were included; the retention rate was 91%. Infection rates were higher in abused women in Year 1 (29% vs. 23.8%, P=0.12), Year 2 (23.4% vs.17.6%, P=0.03) and cumulatively (43.8% vs. 33.0%, P=0.003). Unadjusted association between abuse and reinfection was stronger for adolescents (<19 years) than adults in Year 1 (42.7% vs. 30.8%, P=0.03), Year 2 (32.7% vs. 22.0%, P=0.03) and cumulatively (59.4% vs. 43.3%, P=0.004). Corresponding rates for adults were Year 1 (17.8% vs. 17.0%, P=0.84), Year 2 (17.4% vs. 12.7%, P=0.23) and cumulatively (30.7% vs. 22.3%, P=0.08). Reinfection rates were further stratified by adolescence and substance use. Abused adolescents had consistently higher reinfection than non-abused adolescents and abused adults. In conclusion, risk-reduction interventions decreased infective episodes with chlamydia and/or gonorrhoea in the two-year study period for non-abused women. Abused women, particularly adolescents and substance users, had increased episodes in these study periods.