Predictors of Sexually Transmitted Infection Positivity Among Substance-Using Native American Adults

Abstract

Background Sexually transmitted infections (STIs) are a public health crisis with Native Americans suffering a high burden of disease. Studies across gender and racial/ethnic groups have found varying risk factors associated with STI positivity. Understanding how risk factors are associated with STI positivity can help design interventions for those most at risk. Methods Participants were Native American binge substance using adults enrolled in a randomized controlled trial evaluating a brief intervention to increase STI screening and reduce sexual risk-taking behaviors. Participants completed a self-report assessment at baseline that included questions about sexual risk factors and STI testing behaviors and diagnosis. This analysis includes those who had ever completed an STI test at baseline. Bivariate and multivariate analyses using logistical regression were utilized to identify associations between risk factors and past STI diagnosis. Results A total of 193 people were included in the analysis. Over half (50.6%) of the participants had ever been diagnosed with an STI. Risk behaviors varied by gender. More women with a self-reported history of STI reported having sex with someone they thought had an STI, past experience of physical/sexual violence, and having passed out from drinking. Men with a self-reported history of STI were more likely to report past marijuana and other drug use. Among women with a self-reported history of STI, having sex with someone they thought had an STI was associated with STI positivity, whereas other drug use was associated with STI positivity among men with a self-reported history of STI. Conclusions Findings provide information for those working to reduce STIs in Native Communities to better identify and design programs for those at highest risk for STIs. Additional studies examining gender dynamics and sexual risk taking among native adults are warranted.

Factors associated with the involvement of women drug users in risky sexual behaviors: A narrative review

“… Level of education: The results of some studies showed that there was a significant relationship between educational status and awareness about HIV, concerns about the risk of contracting HIV through unprotected sex, and the lack of sustained use of condoms. [ 22 23 ] Jones et al . [ 10 ] showed that there was a significant relationship between a low level of education and involvement in exchange sex (the exchange of monetary or non-monetary items for sex).…”

Predictors of STD Screening From the Indigenist Stress-Coping Model Among Native Adults With Binge Substance Use

“…Similarly, traumatic life events and stress have been associated with sexual risk behaviors in AI youth and adults. This was especially the case among young women in a study conducted with a Northern Plains tribe (43) and in a study with a Southwestern tribe (7,25).…”

“…Alternatively, in Native communities it is important to consider the importance of communal risk; literature specific to Native communities underscores Native cultural practices and values about the importance of family and community for promoting health and wellness (23,24). Thus, we suggest taking a more holistic view of behavior change when working with Native communities which includes utilizing Native-centered theories and including measures such as household size as a proxy measure for social support and family engagement (25). Furthermore, treatment approaches that are congruent with AI/AN cultural values, traditions, and customs enhance treatment engagement (26)(27)(28).…”

“…Data for this paper were gathered in 2015 at the baseline assessment as part of a randomized controlled trial (RCT) evaluating the EMPWR (Educate, Motivate, Protect, Wellness and Respect) intervention for impacts on several sexual health risks, including completion of STD screening (25,28,55,56). EMPWR was culturally adapted from an evidence-based intervention "Project RESPECT" (28).…”

“…The study was conducted from July 2015 to June 2019, and the study aims were evaluated at three time points (baseline, 3-, and 6-months post-intervention). Details about the RCT design, protocol and intervention outcomes are reported elsewhere (25,27,28,55). This paper utilizes the cross-sectional baseline data collected prior to participants receiving EMPWR intervention sessions.…”