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Purpose: To characterize sexual behaviors and sociodemographic factors that are associated with douching among geographically diverse adolescent women with and without HIV infection. Methods: HIV infected subjects recruited preferentially and behaviorally comparable high-risk HIV uninfected subjects were enrolled in a prospective HIV study from 15 sites in 13 U.S. cities. Baseline interview data from 1996 to 1999 for females aged 12 to 19 years were analyzed using one-way analysis of variance and multiple logistic regression. Results: Among the 342 females/young women, 74.9% were black (non-Hispanic), 11.1% Hispanic/Latina, and 14.0% white or other race/ethnicity; 63.5% were HIV infected. Young women who had dropped out of high school comprised 23.4% of subjects. In the 3 months before the interview, 179 (52.3%) adolescents had douched at least once. In a multivariable logistic regression model, recent douching was more common among sexually active females (OR = 2.2; 95% CI: 1.2–4.2), Blacks (OR = 2.2; 95% CI: 1.2–4.1 vs. Hispanics/Whites/others), females who dropped out of high school (OR = 2.1; 95% CI: 1.2–3.7), and HIV infected females (OR = 1.7; 95% CI: 1.04–2.7). Conclusions: In this nationwide study, adolescents who are sexually active, African-American, dropped out of high school, and HIV infected were most likely to douche. Interventions to discourage douching should pay special attention to these populations.

Purpose: To describe disclosure of HIV serostatus by infected youth to parents and sexual partners and to examine the association of disclosure with subject characteristics. Methods: Baseline data on 317 HIV infected adolescents in national 15 site study were examined. Data sources included direct and computer-assisted interview, laboratory studies, and chart reviews. Examination of parental disclosure was restricted to subjects without parental permission requirements. Concordance in parental disclosure/support used McNemar's test. Associations between disclosure to parent(s) and subject characteristics were examined using logistic regression analysis. Repeated measure analysis was used for sexual partner disclosure. Results: Subjects of both genders more often disclosed their HIV infection status to mothers than to their fathers (77% vs. 47%, p Conclusions: Although subjects were more likely to reveal their status to their mothers, parental support was perceived as high after disclosure to either parent. Since "time since diagnosis" was associated with parental disclosure, support systems are necessary for youth until such a disclosure can occur.

Purpose: There is limited information regarding the clinical manifestations of human immunodeficiency virus (HIV) infection among adolescents. To better define the clinical presentation and course of HIV disease in this population, a retrospective review of all HIV-infected persons age 13–21 years at entry into a public, inner-city HIV outpatient clinic in New Orleans, Louisiana, was undertaken. Results: A total of 141 adolescents were included in this study. The cohort was predominantly female (65%) and African-American (83%), and acquired HIV infection through sexual contact (89%). As many as 75% of the females and 48% of the males were diagnosed with at least one sexually transmitted disease (STD), respectively, and young African-American females with a CD 4 cell count > 500/mm 3 were at highest risk. The proportions of female adolescents having a gravida ≥ 1 and 2 were 82% and 20%, respectively. A total of 55% of females were diagnosed with squamous intraepithelial lesions (SIL) at least once. Similar to adults, the majority of opportunistic processes occurred in adolescents with a CD 4 cell count 3 . Known HIV-related symptoms (oral hairy leukoplakia, thrush, and zoster) were significantly predictive ( p Conclusions: Although HIV-related symptoms and infections do not appear to be unique in the adolescent population, it is clear that STDs and pregnancies are common among female adolescents. Our results emphasize the need for aggressive STD and contraceptive protection counseling, and surveillance screening for STDs and cervical dysplasia.

Several studies have found HIV infected adult women particularly those immunosuppressed are at higher risk than non-HIV infected women for cervical dysplasia. Although these results can probably be generalized to adolescent women there are few data pertaining to cervical dysplasia in this age group. To better understand the epidemiology of squamous intraepithelial lesions (SIL) in this population a retrospective study of 62 HIV infected adolescent women from 13-21 years of age enrolled in the HIV Outpatient Program at the Medical Center of Louisiana at New Orleans was undertaken. Demographic and clinical data in this cohort have been previously published. This study is a further analysis of the Papinicoulau (Pap) smear data. Subjects were defined as progressors either if they progressed from a Pap smear not demonstrating SIL to SIL or from low grade SIL to high grade SIL. Rapid CD4 cell count loss was defined as a loss of at least 25% of the baseline CD4 cell count in a period of 6 months. SPSS software was utilized for analyses (SSPS Statistical Software Chicago IL). Significant differences between selected characteristics were determined by Chi-square methods. (excerpt)

Human immunodeficiency virus (HIV)-infected adolescents are faced with serious psychosocial problems. It is vital that clinicians be aware of this aspect of management given the increasing rates of infected youths. To describe these problems a retrospective chart review of all HIV-infected persons 13-21 years of age at entry into a public HIV outpatient clinic in New Orleans Louisiana between November 1 1989 and February 1 1994 was conducted. Psychosocial data were collected retrospectively through medical chart review by trained abstractors. Of the 141 adolescents studied 65% were female and 83% were African-American. Median age and CD4 cell count were 18 (range 14-21 years) and 565 (range 5-1469) respectively. Clinical features of this cohort have been previously described. Fifty-two percent acquired HIV through sex 9% through injection drug use and 2% through infected blood products and 37% were unable to identify their risk factor. The majority of females (44%) were recruited into care from prenatal screening and 13% had a subsequent pregnancy during the follow-up period. Median follow-up time for the cohort was 24 months. Broken appointments were frequent averaging 1.9 missed visits/person-year or 24% of scheduled visits. (excerpt)