Moscicki A B, Millstein S G, Broering J, Irwin C E
Department of Pediatrics, University of California, San Francisco.
J Pediatr. 1993 May;122(5 Pt 1):813-20. doi: 10.1016/s0022-3476(06)80035-1.
This study was performed to identify specific high-risk behaviors, such as unprotected oral, anal, and vaginal intercourse and substance abuse, associated with human immunodeficiency virus infection among adolescents attending three diverse clinics located in a localized geographic area: a university-based clinic, a Planned Parenthood clinic, and an inner-city public health clinic (PHC). Six hundred seventy-one female and 207 male adolescents attending one of the three clinics completed a structured questionnaire. Similarities among patients at the clinic sites included high rates of anal intercourse (21%), unprotected vaginal sex (95%), oral sex (73%), and poor communication skills (42%). Some differences appeared as well, including higher rates of homosexual experiences, no birth control use, and having multiple partners among adolescents attending the PHC (p < 0.001). In contrast, adolescents attending either the university-based clinic or the Planned Parenthood Clinic had higher rates of substance abuse around sexual activity than those who attended the PHC (p < 0.001). We conclude that adolescents attending general medical clinics in the San Francisco Bay area engage in high-risk behaviors that place them at risk for transmission of human immunodeficiency virus even though many have had previous education about acquired immunodeficiency syndrome and sexually transmitted disease. Specific risk factors include unprotected receptive anal intercourse, unprotected vaginal intercourse with new and unknown partners, experience in homosexual behavior, high rates of oral sex, multiple partners, poor communication skills, and frequent use of illicit substances in conjunction with sex. The differences found among sites indicate the need for health care providers and prevention programs to provide emphasis on practices specific to the adolescents in their service area.
本研究旨在确定特定的高风险行为，如无保护的口交、肛交和阴道性交以及药物滥用，这些行为与位于某一局部地理区域的三家不同诊所的青少年感染人类免疫缺陷病毒有关：一家大学附属医院诊所、一家计划生育诊所和一家市中心公共卫生诊所（PHC）。在这三家诊所之一就诊的671名女性青少年和207名男性青少年完成了一份结构化问卷。各诊所患者的相似之处包括肛交发生率高（21%）、无保护阴道性交（95%）、口交（73%）以及沟通能力差（42%）。也存在一些差异，包括在PHC就诊的青少年中同性恋经历、未采取避孕措施以及有多个性伴侣的比例较高（p<0.001）。相比之下，在大学附属医院诊所或计划生育诊所就诊的青少年在性活动期间药物滥用的比例高于在PHC就诊的青少年（p<0.001）。我们得出结论，在旧金山湾区综合医疗诊所就诊的青少年从事高风险行为，这使他们面临感染人类免疫缺陷病毒的风险，尽管许多人此前已接受过关于获得性免疫缺陷综合征和性传播疾病的教育。具体风险因素包括无保护的接受性肛交、与新的和不认识的性伴侣进行无保护阴道性交、同性恋行为经历、口交发生率高、多个性伴侣、沟通能力差以及频繁在性行为时使用非法药物。各诊所之间发现的差异表明，医疗服务提供者和预防项目需要针对其服务区域内青少年的特定行为重点开展工作。
