Extensive empirical investigations have been conducted over the past four decades on the biological and demographic characterization of individuals who have acquired sexually transmitted diseases (STDs). The behavioral component of STD acquisition and transmission, however, has received little attention. A review of the extant literature demonstrates that this arena is virtually devoid of data-based research. Recent investigations of the behavioral factors associated with human immunodeficiency syndrome suggest that these issues are the leading areas for research to lead to effective prevention and control programs at both the individual and societal level. In this project, we propose applying these demonstrated research approaches to providing the basis for understanding the behavioral factors underlying how and why individuals contract STDs and whether they are similar or different from those issues important to understanding STD transmission. In this five-year project, we propose a series of relatively small scale studies which should serve to provide an initial empirical basis to answer the following specific aims: (1) to ascertain the social, cultural and behavioral factors associated with the acquisition and transmission of the principal STDs, to determine if they are similar for different types of STDs, to reinfection, to cross-infection, and whether there are specific life stages associated with infection; (2) to investigate the cultural factors in these processes, to understand the processes by which behaviors symptom recognition, and medical care encounters are a function of the meaning of these factors to the person with STDs; and (3) to conduct pilot intervention studies which will ascertain the extent to which increasing provider communication skills can translate into improved patient understanding, adherence and reduced reacquisition of STDs in the future. A cohort of some 1,000 symptomatic STD patients and their contacts will be examined and interviewed at four points in time: baseline, 3-months, 6-months, and 1-year later, to determine the dynamic behavioral factors involved in STD acquisition, transmission, and reinfection.
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