Prevalence, correlates, and efficacy of selective avoidance as a sexually transmitted disease prevention strategy among African American adolescent females

Objectives: To identify the prevalence and correlates of selective avoidance (SA) of sexual intercourse among African American adolescent females at risk for sexually transmitted disease (STD) acquisition and transmission. Design: Cross-sectional study. Setting: Health clinics. Participants: African American females (N=715) between the ages of 15 and 21 years. Main Outcome Measures: Self-reported sexual behaviors and laboratory-confirmed STDs. Results: Among the participants, 35.4% used SA as a strategy to prevent STD acquisition; 25.7% used SA to prevent STD transmission. Use of SA was not associated with current STD status. In multivariable analyses, adolescents who had sexual intercourse with 2 or more partners in the past 60 days, those who had high fear related to condom use negotiation, and those who discussed STD prevention with their sexual partners were 2.05 times more likely (95% confidence interval [CI], 1.31-3.20), 1.55 times more likely (95% CI, 1.09-2.19), and 2.00 times more likely (95% CI, 1.38-2.90), respectively, to use SA to prevent STD acquisition, and the same groups were 2.62 times more likely (95% CI, 1.62-4.24), 1.60 times more likely (95% CI, 1.10-2.32), and 2.13 times more likely (95% CI, 1.39-3.26), respectively, to use SA to prevent STD transmission. Conclusions: This study provides initial evidence suggesting that SA as a risk-reduction strategy specifically used to prevent STD acquisition and/or transmission may be common among African American adolescent females. Based on a lack of differences in STD prevalence, we recommend that clinicians and prevention programs discourage the use of SA as an STD prevention strategy and encourage adolescent females to use condoms consistently and correctly with all male sexual partners.