Correlates of Sexually Transmitted Infection Screening Among Binge Substance Using American Indian Adults

Introduction: Sexually Transmitted Infections (STIs) including HIV are a serious public health threat. STIs are often asymptomatic resulting in the infected person being unaware of their need for treatment. The Centers for Disease Control and Prevention (CDC) recommend all sexually active women younger than 25, or those having new or multiple sex partners be tested annually. For men, CDC recommends those who have sex with men be tested annually.

Native American (Native) adults have higher rates of STIs than other racial/ethnic groups in the United States. Further, people with substance use disorders are at higher risk for STIs as drug and alcohol use can lead to sexual risk taking. While Native substance using adults are at high risk for STIs, little is known about their testing behaviors or predictors of testing. This analysis explores predictors of STI and HIV testing behaviors among Native adults enrolled in a Randomized Control Trial (RCT) of a brief risk reduction intervention.

Methods: Participants are N=252 Native adults ages 18 to 55 from a Native community. All participants enrolled have recently engaged in binge substance use. The RCT is evaluating EMPWR, a 2-session, personalized counseling program. EMPWR focuses on helping participants recognize and reduce their sexual risk behaviors and motivate STI testing. Data are collected at baseline through 6-months post-intervention and include demographics, mental health and sexual risk behaviors. Bivariate analyses examined associations between factors and being tested for STIs in the past 12 months. Regression models examined which factors significantly predicted STI testing behavior.

Results: Less than half of participants been tested for STIs in the past year (38.1%) and 28.5% had ever been tested for HIV. Most participants stated they were usually tested at the local Indian Health Service clinic while about 9% were usually tested at the local jail. Among females, using a condom at last sex and having sex with more than one person in the same day was associated with lower odds of STI testing. Among males, drug use and binge drinking were associated with higher odds of STI testing.

Discussion: Regular testing among high risk adults is a primary prevention strategy for reducing STIs and HIV. Understanding who does and does not comply with CDC testing recommendations can provide direction for STI testing promotion efforts. In this study, males, potentially with lower substance use, should be targeted. Among women, messaging should promote STI testing, especially for those who have multiple partners, in addition to condom use. We will discuss recommendations for prevention messaging and tailoring of programs such as EMPWR based on the findings from this analysis.