Large numbers of drug-involved adolescents enter the juvenile justice system at risk for the sexually transmitted infections (STIs) chlamydia and gonorrhea, treatable and often asymptomatic bacterial infections that increase HIV risk. However, current STI surveillance for juvenile offenders is symptom-based and typically limited to correctional facilities (although most juvenile offenders are not incarcerated), resulting in many undetected cases that increase public health risk. Designing and expanding more effective STI health interventions require data on how STI infection among all delinquents (not just those incarcerated) is related to drug use and risk behaviors. Moreover, few STI/HIV risk reduction interventions have been implemented for adolescent offenders in the community. Thus, there is a need to further our understanding of drug use and sex risk behaviors among youth at the """"""""front end"""""""" of the juvenile justice system, to develop new screening methods that identify infections early in the juvenile justice process, and to provide more effective prevention and treatment services to a broader segment of this population. This grant proposes to implement an STI assessment and urine screening (for chlamydia and gonorrhea) protocol in the Hillsborough County (FL) Juvenile Assessment Center (JAC); analyze relations among drug use, sex risk behaviors and STI infection rates; and identify STI-related service needs and impediments to expanding STI testing and services for this underserved high-risk population. Future planned research will further explore the STI-related service needs of delinquent youth, and develop, pilot, and implement an STI risk reduction program in a controlled clinical trial. Data from an Intake Assessment and STI urine tests will be collected from a sample of 900 eligible delinquent youth consecutively admitted to the JAC (stratified to yield 450 females (an important but understudied subpopulation). Organizational data will be drawn from juvenile justice and service provider records, geocoded data on infections and health service locations, and 40 staff interviews. Follow-up data on STI treatment and retesting will be collected from the Hillsborough County Health Department for STI-positive participants. JAC and State/County health officials are committed to collaborating with the research team on this and future projects. There are four study aims:
AIM 1 : To assess STI/HIV risk profiles in high-risk juvenile offenders (i.e. active drug users and those at risk for drug use) and compare them to low-risk offenders.
AIM 2 : To identify STI and HIV prevention service needs among juvenile offenders and the organizational and individual barriers to delivering these services.
AIM 3 : To determine STI (chlamydia and gonorrhea) and self-reported HIV prevalence rates among juvenile offenders entering the juvenile justice system.
AIM 4 : To determine the percentage of STI-positive youth who return for medical treatment, and analyze the factors associated with provision and receipt of treatment.
