EFFECT OF HIV COUNSELING AND TESTING ON SEXUALLY-TRANSMITTED DISEASESAND CONDOM USE IN AN URBAN ADOLESCENT POPULATION

Objectives: To determine whether human immunodeficiency virus (HIV) co unseling and testing has an effect on reducing subsequent risk behavio rs in those tested, to evaluate stability in condom use over time, and to determine whether self-reported frequency of condom use relates to the incidence of sexually transmitted diseases (STDs) Design: Cohort study with 2-year follow-up. Setting: An urban adolescent-medicine cli nic. Participants: A random sample of 149 patients (118 female and 31 male adolescents) with a mean (+/-SD) age of 16.4 +/- 1.51 years were selected from a cohort of 500 patients at high risk for HIV infection. The patients had received a risk behavior questionnaire during pretes t counseling for HIV testing. They were divided into 3 groups, identif ied by the letter F, S, or R, based on their self-report of frequency of condom use at enrollment: 24% used condoms frequently/always (F);40 %, sometimes (S); and 36%, rarely/never (R). One hundred twenty-six pa tients (85%) made return visits. Intervention: HIV counseling and test ing. Main Outcome Measures: Medical record documentation of STDs befor e and after HIV testing, and self-reported condom use frequency. Resul ts: Before HIV testing, all 3 condom use groups had a similar frequenc y of STD visits per month. The number of STD visits per month did not decrease significantly in the posttest period for either the total gro up or each of the 3 subgroups. Also, most patients (F, 67%; S, 44%; R, 53%) in each of the 3 subgroups had shifted unfavorably to rarely/nev er (R) condom use within the month before their follow-up visit. Only 24% (8 patients) of those in the initial frequently/always (F) group r eported continued frequent condom use. Conclusions: As has been found in adult studies, single-dose interventions such as HIV counseling and testing did not seem to reduce HIV risk behaviors in our sample of hi ghrisk adolescent patients. None of the 3 groups showed a significant decrease in STDs after HIV testing and counseling. Also, our adolescen t patients reported widely varying condom use frequency over time, yet the incidence of STDs did not correlate with self-reported condom use .