Clark L R, Brasseux C, Richmond D, Getson P, D'Angelo L J
Department of Adolescent and Young Adult Medicine, Children's National Medical Center, Washington, DC, USA.
Arch Pediatr Adolesc Med. 1998 Mar;152(3):269-73. doi: 10.1001/archpedi.152.3.269.
To determine whether human immunodeficiency virus (HIV) counseling and testing has an effect on reducing subsequent risk behaviors 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).
Cohort study with 2-year follow-up.
An urban adolescent-medicine clinic.
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 pretest counseling for HIV testing. They were divided into 3 groups, identified 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 patients (85%) made return visits.
HIV counseling and testing.
Medical record documentation of STDs before and after HIV testing, and self-reported condom use frequency.
Before HIV testing, all 3 condom use groups had a similar frequency of STD visits per month. The number of STD visits per month did not decrease significantly in the posttest period for either the total group 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/never (R) condom use within the month before their follow-up visit. Only 24% (8 patients) of those in the initial frequently/always (F) group reported continued frequent condom use.
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 high-risk adolescent patients. None of the 3 groups showed a significant decrease in STDs after HIV testing and counseling. Also, our adolescent patients reported widely varying condom use frequency over time, yet the incidence of STDs did not correlate with self-reported condom use.
确定人类免疫缺陷病毒（HIV）咨询与检测对降低受检者后续危险行为是否有效果，评估避孕套使用随时间的稳定性，并确定自我报告的避孕套使用频率与性传播疾病（STD）发病率之间是否存在关联。
为期2年随访的队列研究。
一家城市青少年医学诊所。
从500名HIV感染高危患者队列中随机抽取149名患者（118名女性和31名男性青少年），平均（±标准差）年龄为16.4±1.51岁。这些患者在HIV检测的检测前咨询期间接受了危险行为问卷调查。根据他们在入组时自我报告的避孕套使用频率，将他们分为3组，分别用字母F、S或R表示：24%的人经常/总是使用避孕套（F）；40%的人有时使用（S）；36%的人很少/从不使用（R）。126名患者（85%）进行了回访。
HIV咨询与检测。
HIV检测前后性传播疾病的病历记录以及自我报告的避孕套使用频率。
在HIV检测前，所有3个避孕套使用组每月性传播疾病就诊频率相似。在检测后期间，无论是总组还是3个亚组中的每一组，每月性传播疾病就诊次数均未显著减少。此外，3个亚组中的大多数患者（F组为67%；S组为44%；R组为53%）在随访就诊前一个月内不利地转变为很少/从不（R）使用避孕套。最初经常/总是（F）组中只有24%（8名患者）报告继续经常使用避孕套。
正如在成人研究中所发现的那样，像HIV咨询与检测这样的单剂量干预措施似乎并未降低我们高危青少年患者样本中的HIV危险行为。在HIV检测和咨询后，3组中均未出现性传播疾病显著减少的情况。此外，我们的青少年患者报告随着时间推移避孕套使用频率差异很大，但性传播疾病的发病率与自我报告的避孕套使用情况并无关联。
