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Sexually Transmitted Infections Among Urban Shelter Clients

Grimley, Diane M. PhD*; Annang, Lucy PhD*; Lewis, Ivey MAEd*; Smith, Rev William*; Aban, Immaculada PhD†; Hooks, Terry BA*; Williams, Samantha PhD‡; Hook, Edward W. III MD§; Lawrence, Janet St PhD‡

doi: 10.1097/01.olq.0000223285.18331.4d

Background: Sexually transmitted infections (STIs) remain common in the United States. One contributor to this persistent problem is pockets of infection among persons who may not have regular access to health care, a group that includes those who seek services at shelters.

Objective: The goals of the study were to: 1) determine the acceptability of STI testing among individuals seeking services at shelters in 2 midsized southeastern cities; 2) evaluate the prevalence of chlamydia, gonorrhea, syphilis, and HIV among these individuals; and 3) assess the proportion that subsequently learned their test results and received timely and appropriate treatment if warranted.

Study Design: Using a cross-sectional design, 430 individuals between the ages of 19 and 45 seen at 3 shelters in 2 cities were approached for participation. After completing a brief behavioral assessment, each participant provided a urine specimen for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) testing, blood for syphilis serologic testing, and an oral sample for HIV testing.

Results: The overall recruitment rate was 97% (96% in city A and 98% in city B). Seventy-eight percent were black with a mean age of 35.1 years. STI prevalence among those reporting sexual activity in the past 2 months was 12.9% in city A and 19.9% in city B (P = 0.04). The rate of CT in city B was significantly higher than city A (15.0% vs. 6.4%, P = 0.02); however, similar rates were found for GC (5.0% vs. 3.2%), primary and secondary syphilis (0.08% vs. 1.4%), and HIV (0.07% vs. 0.06%). Overall, 91.5% of the positive cases (89.0% in city A and 94.0% in city B) learned their test results and were successfully treated.

Conclusion: We found that shelter clients were receptive to STI testing, even for HIV, with most positive cases notified and successfully treated.

We found that shelter clients were receptive to sexually transmitted infection testing, even for HIV, with most positive cases notified and successfully treated.

From the Departments of *Health Behavior and †Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; the ‡Division of STD Prevention, Centers for Disease and Control, Atlanta, Georgia; and the §Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama

The authors thank the shelters, the CBOs, the state and local health departments, and the study participants.

This study was funded by the Centers of Disease Control and Prevention through the Cooperative Agreement No. U65/CCU422269-02.

Correspondence: Diane M. Grimley, PhD, Department of Health Behavior, University of Alabama at Birmingham, RPHB 227, 1530 3rd Ave. S, Birmingham, AL 35294-0022. E-mail:

Received for publication October 22, 2005, and accepted February 21, 2006.

© Copyright 2006 American Sexually Transmitted Diseases Association