# Presentation: 016073

## Changes in Sex Networks and Repeat STDs among Male Adolescentsand Young Adults

**Jonathan M Ellen****1****, Charlotte Gaydos****1****,**
**Michelle Chung****1****, Nancy Willard****1****,**
**Cornelius A Rietmeijer****2**
**1****Johns Hopkins School of Medicine **
**2****Denver Public Health Department**

## Background

- Individuals with repeat infection are believed to play a greater role in maintaining endemic rates STIs
- Identification of individuals at increased risk for repeat infection could trigger specific interventions
- Studies have failed to identify predictors of repeat GC and CT beyond race/ethnicity, age, and geography

## Initial vs. Repeat Infection

- Correlates of initial GC/CT
- Condom use
- Rate of sex partner turnover
- Sex partners’ networks (local networks)
- Correlates of repeat GC/CT
- Changes in correlates of initial STI _after_ initial STI
- Little evidence that there are changes condom use
- If current sex partners treated, having a new partner may be protective or risky depending on their network

## Sex Networks

- Prevalence of STI in local sex networks correlated with risk of STI of members
- Local sex networks vary in their prevalence of STI
- Individuals may migrate in and out of sex networks
- Sex networks are closely linked to social networks
- Could target social networks along with sex networks for control activties

## Objectives

- To determine whether decrease in the percentage of sex partners who are within the index’s social network is associated with decrease risk for repeat GC and/or CT among those with new partners.

## Methods

- Longitudinal research study
- Asymptomatic CT- and GC-infected boys 13-25 years old from the non-detention venues in Baltimore City and Denver, CO
- Participants interviewed and sex contacts notified
- Re-interviewed and tested for GC/CT at 1 month and 4 months

## Participant Interview

- Asked about each partner including
- New partners since last interview
- Old partners mentioned at other interviews
- Queried about their perceptions of their partners drug and sex behaviors and their link to social networks
- Egocentric data

## Social and Sex Network Overlap

- Each sex partner was coded as within participants’ social network or not within social network
- Defined as within network if any:
- Met through close friends
- More than 1⁄2 of friends knew
- Friends had sex with partner
- Partner knew any of other sex partners
- Percentage of sex partners within social network

## Analysis

- Independent variables
- New partner since last interview
- Change in percentage overlap since last interview
- Between baseline and 1 month interview
- Between 1 month and 4 month interview
- Dependent variable
- GC/CT diagnosis at end of interval
- Logistic regression and GEE
- Analysis stratified by city

## Participants

|  | Baltimore
N=51 | Denver
N=100 |
| --- | --- | --- |
| Mean age | 18.0 years | 20.4 years |
| Race/Ethnicity   
   AA
   Latino
   White
   Asian | 
98%
0%
0%
2% | 
23%
48%
27%
2% |
| Follow-up visits
   1
   2 | 
31
20 | 
55
45 |

## Recruitment Venues

|  | Baltimore
(N=51) | Denver
(N=100) |
| --- | --- | --- |
| SBHC | 51% | 4% |
| Teen Clinic | 49% | 10% |
| STD Clinic | Not Applicable | 38% |
| Drug Treatment | Not Applicable | 2% |
| Street Outreach | Not Applicable | 9% |
| DHD Outreach | Not Applicable | 21% |
| CBO | Not Applicable | 15% |

## Overall:STD by New Partner (N=209 visits)

|  | No STD | STD |
| --- | --- | --- |
| No New partner | 125 (66%) | 8 (42%) |
| New Partner | 65 (34%) | 11 (58%) |
| Odds Ratio = 2.83 (1.03,7.80) |  |  |

## Baltimore:STD by New Partner (71 visits)

|  | No STD | STD |
| --- | --- | --- |
| No New partner | 39 (95%) | 2 (5%) |
| New Partner | 25 (83%) | 5 (17%) |
| Odds Ratio = 3.90 (0.70,21.70) |  |  |

## Denver:STD by New Partner (138 visits)

|  | No STD | STD |
| --- | --- | --- |
| No New partner | 86 (93%) | 6 (7%) |
| New Partner | 40 (87%) | 6 (13%) |
| Odds Ratio = 2.15 (0.65,7.08) |  |  |

## Baltimore:STD by Change in Overlap (30 visits)*

|  | No STD | STD |
| --- | --- | --- |
| No decrease in overlap | 12 (71%) | 5 (29%) |
| Decrease in overlap | 13 (100%) | 0 (0%) |
| Odds Ratio = 0.084 (0.17,0.34) |  |  |

- * Among those with a new partner

## Denver:STD by Change in Overlap (38 visits)*

|  | No STD | STD |
| --- | --- | --- |
| No decrease in overlap | 21 (87%) | 3 (13%) |
| Decrease in overlap | 12 (86%) | 2 (14%) |
| Odds Ratio = 1.17 (0.17,7.99) |  |  |

- * Among those with a new partner

## Limitations

- Lack of validated definition of social and sex network overlap
- Relies on perceptions of partners behaviors
- Small sample size

## Conclusion

- Failure to replicate Baltimore findings in Denver may be due to differences in populations, extent of DIS activity, or limitations of study
- To the extent that future studied replicate Baltimore findings, preventive treatment of social networks may reduce repeat infection among adolescents and young adults

## Funding

- Centers for Disease Control and Prevention, Division of STD Prevention