ORIGINAL RESEARCH ARTICLE Behavioural interventions and abuse: secondary analysis of reinfection in minority women Jane Dimmitt Champion PhD FAAN*, Rochelle N Shain PhD - , Jeffrey E Korte PhD , Alan E C Holden PhD - , Jeanna M Piper MD - , Sondra T Perdue Dr PH § and Fernando A Guerra MD MPH** *Department of Family Nursing Care, School of Nursing; - Department of Obstetrics & Gynecology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78230-3900; Department of Biostatistics, Bioinformatics and Epidemiology, Medical University of South Carolina, Charleston, SC; § Department of Microbiology, The University of Texas Health Science Center at San Antonio; **San Antonio Metropolitan Health District, San Antonio, TX, USA Summary: Sexually transmitted infection (STI), including AIDS disproportionately affects minority women with a history of physical or sexual abuse. The objective of this study was to evaluate the efficacy of gender- and culture-specific behavioural interventions and interactive STI counselling for high-risk minority women with a history of physical or sexual abuse over two years. African- and Mexican-American women with a non-viral STI were enrolled in a randomized trial. Follow-up screens and interviews occurred at six months and one and two years. The primary outcome was subsequent infection with chlamydia and/or gonorrhoea. Secondary analysis of primary outcomes was made by self-reported physical or sexual abuse. Logistic regression was utilized on an intention-to-treat basis. Baseline data from 853 women were included; the retention rate was 91%. Infection rates were higher in abused women in Year 1 (29% vs. 23.8%, P ¼ 0.12), Year 2 (23.4% vs. 17.6%, P ¼ 0.03) and cumulatively (43.8% vs. 33.0%, P ¼ 0.003). Unadjusted association between abuse and reinfection was stronger for adolescents (o19 years) than adults in Year 1 (42.7% vs. 30.8%, P ¼ 0.03), Year 2 (32.7% vs. 22.0%, P ¼ 0.03) and cumulatively (59.4% vs. 43.3%, P ¼ 0.004). Corresponding rates for adults were Year 1 (17.8% vs. 17.0%, P ¼ 0.84), Year 2 (17.4% vs. 12.7%, P ¼ 0.23) and cumulatively (30.7% vs. 22.3%, P ¼ 0.08). Reinfection rates were further stratified by adolescence and substance use. Abused adolescents had consistently higher reinfection than non-abused adolescents and abused adults. In conclusion, risk-reduction interventions decreased infective episodes with chlamydia and/or gonorrhoea in the two-year study period for non-abused women. Abused women, particularly adolescents and substance users, had increased episodes in these study periods. Keywords: STI prevention, HIV prevention, interpersonal violence, behavioural intervention, minority women INTRODUCTION There is a need for community-based, culturally sensitive, cognitive-behavioural interventions to reduce sexual risk behaviour among minority women for prevention of sexually transmitted infection (STI)/HIV and abuse (phy- sical, sexual, psychological). 1 Behavioural intervention to reduce high-risk behaviour and ensuing infection is critical, particularly for young minority women. African- and Mexican-American women aged 15–24 years are most dramatically impacted by STI. 2 Our prior trials showed that a theory-based, behavioural, risk-reduction interven- tion (Project SAFE), designed specifically for low-income African- and Mexican-American women, helped reduce infection with chlamydia and/or gonorrhoea by approxi- mately 38% during one- and two-year follow-ups. 3,4 These studies are unique in that they designed and evaluated culturally relevant, minority-women-specific interventions based upon the AIDS Risk Reduction Model, and were shown to be effective through controlled randomized trials. Although the intervention was successful with the sample as a whole, we found women with a history of sexual or physical abuse reported more sexual risk behaviours and genitourinary symptomatology and health-seeking beha- viours that placed them at higher risk for STI reinfection, pelvic inflammatory disease (PID) and infertility. 5–9 This paper presents a secondary analysis of primary outcomes (chlamydia and/or gonorrhoea) by self-reports of physical or sexual abuse for African- and Mexican-American women aged 14–45 years enrolled in a control-randomized trial of a Correspondence to: Dr Jane Dimmitt Champion Email: dimmitt@uthscsa.edu International Journal of STD & AIDS 2007; 18: 748–753 748