Young Women With STDs at Triple Risk for HIV Infection

Emma Hitt, PhD

September 04, 2009

September 4, 2009 (Atlanta, Georgia) — Young women between the ages of 13 and 24 years who have been diagnosed with a sexually transmitted disease (STD) are approximately 3 times more likely to be diagnosed with HIV in the next 10 years compared with the general age-matched population of women, new research findings suggest.

Karin Bosh, PhD, from the Missouri Department of Health and Senior Services, in Jefferson City, presented the findings here at the 2009 National HIV Prevention Conference.

"Since HIV is associated with men who have sex with men and injection drug users, showing an increased risk of HIV within a fairly short time period might make the topic a little more relevant to younger women who may not perceive themselves as being at risk," Dr. Bosh told Medscape HIV/AIDS.

The researchers collected information about the first chlamydia, gonorrhea, or syphilis diagnosis between 1992 and 1997 among women 13 to 24 years of age, followed up with additional STD diagnoses during 3 years.

A total of 48,579 women who were diagnosed with an STD between the ages of 13 and 24 years between 1992 and 1997 and who were without a previous or concurrent diagnosis with HIV were included in the analysis.

The incidence of HIV diagnosis was significantly higher in women with an STD compared with those without (0.31% vs 0.09%; P < .0001). In addition, women diagnosed with a second STD in the 3 years following the first diagnosis were more likely to be diagnosed with HIV within 10 years compared with women with a single STD diagnosis within the first 3 years (0.58% vs 0.18%; P < .0001).

The researchers also found that women first diagnosed with gonorrhea or syphilis were significantly more likely to be diagnosed with HIV than women first diagnosed with chlamydia (0.61% vs 0.20%; P < .0001).

"This information can be used by STD providers to educate female youth on how behavioral risk, measured through STD diagnoses, influences their likelihood of becoming infected with HIV," the researchers noted.

"We wanted to provide an estimate that health care providers and prevention workers could use when talking with young females," Dr. Bosh told Medscape HIV/AIDS. "The findings also highlight the fact that it is important to also routinely test for HIV, especially in young females diagnosed with an STD," she said.

Dr. Bosh added that although the study was conducted in the state of Missouri, the results are probably generalizable to the rest of the United States.

Kenneth Mayer, MD, director of the Fenway Community Health Center in Boston, Massachusetts, noted that he thinks this is an important study, indicating that when "young women are diagnosed with an STD, intensive education and prevention efforts are needed to decrease their risk of subsequently becoming HIV-infected," and that a "subset of young women is in greatest need of HIV-prevention intervention."

According to Dr. Mayer, from this type of study, it is impossible to know if the STD was related to the subsequent HIV through a biological mechanism (e.g., residual genital tract inflammation). "It is more likely that the STD is a marker of a young person's social network, and partners who could transmit an STD could also transmit HIV," he told Medscape HIV/AIDS.

The study did not receive commercial support. Dr. Bosh and Dr. Mayer have disclosed no relevant financial relationships.

2009 National HIV Prevention Conference: Abstract CCT2B-4. Presented August 26, 2009.

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