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Opara I, Gabriel C, Duran-Becerra B, Bond K, Hill AV, Hussett-Richardson S, Alves C, Kershaw T. Sexual Health and Drug Use Prevention for Black Girls (The Dreamer Girls Project): Protocol for an Intervention Development. JMIR Res Protoc 2023; 12:e45007. [PMID: 37556188 PMCID: PMC10448282 DOI: 10.2196/45007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Substance use among adolescent girls is associated with numerous risk characteristics, including engaging in sexual risk behaviors, which can lead to HIV and sexually transmitted infection (STI) diagnoses. This is an important phenomenon to target as there is a significant race-gendered paradox that occurs when Black girls use and misuse drugs. When misuse occurs among this group, they are more likely to face harsher consequences and worse health outcomes than boys and other ethnic-minority girls. Therefore, there is a need to understand the risk and protective factors of drug use and sexual risk behaviors among Black girls and develop a robust intervention that can cater for this group. OBJECTIVE We propose the development of a strengths-based prevention education intervention for Black girls between the ages of 13 and 18 years to promote protective factors. METHODS A sequential, mixed methods study will be conducted, and we will use the first 3 steps of the ADAPT-ITT (assessment, decision, adaptation, production, topical experts, integration, training, testing) framework to begin the development of the intervention. Three aims will be described in this protocol. First, aim 1 is to explore sociocultural risk and protective factors among Black girls between the ages 13 and 18 years in drug use and HIV/STI prevention using focus group methodology and surveys. We will conduct at least 10 focus groups to include up to 75 Black girls or until we reach saturation. Our target sample size for the quantitative portion of the study will be 200 participants. Aim 2 will focus on deciding upon an intervention based on findings from aim 1 and forming a youth advisory board to guide intervention development. Aim 3 will be to conduct a pretest of the intervention with the youth advisory board to determine if the intervention is feasible and will be accepted by Black girls. RESULTS The study is part of a 2-year research pilot study award from the National Institutes of Mental Health. Data collection for this study began in October 2021. For aim 1, data collection is 95% complete. We expect to complete all data collection for aim 1 on or before May 30, 2023. Study activities for aim 2 are occurring simultaneously as data are being collected and analyzed and will be completed in the summer of 2023. Study activities for aim 3 will begin in the fall of 2023. CONCLUSIONS This study will be one of the few interventions that address both sexual health and drug use together and cater to Black girls. We anticipate that the intervention will be beneficial for Black girls across the nation to work on building culturally appropriate prevention education and building peer social supports, resulting in reduction or delayed substance use and improved sexual health. TRIAL REGISTRATION ClinicalTrials.gov NCT05014074; https://clinicaltrials.gov/ct2/show/NCT05014074. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45007.
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Affiliation(s)
- Ijeoma Opara
- Yale School of Public Health, New Haven, CT, United States
| | - Cora Gabriel
- Yale School of Public Health, New Haven, CT, United States
| | | | - Keosha Bond
- City University of New York School of Medicine, New York, NY, United States
| | - Ashley V Hill
- University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Courtnae Alves
- Columbia University School of Public Health, New York, NY, United States
| | - Trace Kershaw
- Yale School of Public Health, New Haven, CT, United States
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Zareie B, Rasouli MA, Gouya MM, Akbarpour S, Hadavandsiri F, Rezaei E, Moradi Y, Soltani A, Moradi G. Drug use patterns and related factors among female sex workers in Iran in 2019-2020: results from Integrated Bio-Behavioral Surveillance-III (IBBS-III). Arch Public Health 2023; 81:120. [PMID: 37391840 DOI: 10.1186/s13690-023-01143-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/23/2023] [Indexed: 07/02/2023] Open
Abstract
INTRODUCTION Drug use is highly prevalent among female sex workers (FSWs). Some forms of drug use, such as injecting drug users (IDU), put them at greater risks for HIV and blood born disease (BBD). In this study, the pattern of drug use and its related factors among Iranian FSWs were investigated. MATERIALS AND METHODS This cross-sectional study was performed based on the data of the integrated bio-behavioral surveillance-III (IBBS-III) on FSWs in 8 cities of Iran using the respondent-driven sampling (RDS) method conducting in 2019-2020. Of the 1515 FSWs participating in the IBBS-III study, 1,480 answered questions about drug use. To calculate the prevalence of drug use lifetime and in the past month, weighted analysis was used. Univariate and multivariate logistic regression was used to investigate the factors related to drug use. RESULTS The prevalence of lifetime drug use and the prevalence of current drug use (single and poly drug use) among FSWs were estimated to be 29.3% and 18.86%, respectively. According to multivariate regression analysis, the odds ratio (odds) of lifetime drug use showed a statistically significant association with lower education (AOR = 1.18; 95% CI: 1.07-1.3), being a direct sex worker (AOR = 1.77; 95% CI: 1.21-2.61), working in team houses or hangouts (AOR = 1.51; 95% CI: 1.10-2.06), a history of intentional abortion (AOR = 1.41; 95% CI: 1.07-1.87), condom use in the last sex (AOR = 1.61; 95% CI: 1.19-2.17), a history of imprisonment (AOR = 3.05; 95% CI: 2.25-4.14), HIV positive tests (AOR = 8.24; 95% CI: 1.66-40.9), alcohol use (AOR = 1.69; 95% CI: 1.29-2.29), and finding sexual clients in places such as parties, shopping malls, streets, and hotels, or by friends (AOR = 1.46; 95% CI: 1.01-2.12). CONCLUSION Given that drug use among FSWs is about 14 times higher than that of the Iranian general population, it is imperative that drug reduction programs be integrated into service packages. Specifically, prevention programs should be prioritized for occasional drug users within this population as they are at a greater risk of developing drug use issues compared to the general population.
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Affiliation(s)
- Bushra Zareie
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Aziz Rasouli
- Clinical Research Development Unit, Kowsar Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohammad Mehdi Gouya
- Iranian Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Samaneh Akbarpour
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hadavandsiri
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Rezaei
- HIV/ STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Kerman University of Medical Sviences, Kerman, Iran
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ali Soltani
- Department of Restorative Dentistry, Faculty of Dentistry, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ghobad Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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Opara I, Pierre K, Assan MA, Scheinfeld L, Alves C, Cross K, Lizarraga A, Brawner B. A Systematic Review on Sexual Health and Drug Use Prevention Interventions for Black Girls. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3176. [PMID: 35328864 PMCID: PMC8950684 DOI: 10.3390/ijerph19063176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/25/2022] [Accepted: 03/03/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The relationship between drug use and poor sexual health outcomes in Black adolescent females such as diagnoses of sexually transmitted infections, HIV, and early/unwanted pregnancy has been established in the literature. Yet, very few interventions have been successful in reducing the risk of poor sexual health outcomes and drug use for adolescent girls. Even more rare are interventions that are catered to specifically to Black girls in the United States, which is a group that has the highest rates of poorer sexual health outcomes and negative consequences associated with drug use. Therefore, this systematic review sought to identify and organize interventions that are focused on preventing HIV, STIs, early pregnancy and drug use for and include large samples of Black girls. Fifteen interventions were identified that met the review's search criteria. RESULTS A total of 15 interventions that were published between 2005 and 2020 were included in the review. While all but one intervention focused on sexual health outcomes, two interventions infused drug use education for girls. CONCLUSION This review provides recommendations for sexual health and drug use prevention researchers to engage in an intersectional framework and concludes with a summary of next steps to guide future research and policy work to address disparities that impact Black girls.
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Affiliation(s)
- Ijeoma Opara
- Department of Social & Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT 06520, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT 06520, USA
| | - Kimberly Pierre
- Irvington Department of Health and Senior Services, Irvington, NJ 07111, USA;
| | | | - Laurel Scheinfeld
- Health Sciences Library, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Courtnae Alves
- School of Health Technology and Management Health Science, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Kristina Cross
- School of Social Welfare, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Ashley Lizarraga
- School of Social Welfare, University of Washington, Seattle, WA 98105, USA;
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Banks DE, Hensel DJ, Zapolski TCB. Integrating Individual and Contextual Factors to Explain Disparities in HIV/STI Among Heterosexual African American Youth: A Contemporary Literature Review and Social Ecological Model. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1939-1964. [PMID: 32157486 PMCID: PMC7321914 DOI: 10.1007/s10508-019-01609-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 12/03/2019] [Accepted: 12/10/2019] [Indexed: 05/21/2023]
Abstract
Heterosexual African American youth face substantial disparities in sexual health consequences such as HIV and STI. Based on the social ecological framework, the current paper provides a comprehensive, narrative review of the past 14 years of literature examining HIV/STI risk, including risky sexual behavior, among heterosexual African American youth and a conceptual model of risk among this population. The review found that individual psychological and biological factors are insufficient to explain the sexual health disparities faced by this group; instead, structural disadvantage, interpersonal risk, and community dysfunction contribute to the disparity in HIV/STI outcomes directly and indirectly through individual psychological factors. The conceptual model presented suggests that for African American youth, (1) HIV/STI risk commonly begins at the structural level and trickles down to the community, social, and individual levels, (2) risk works in a positive feedback system such that downstream effects compound the influence of structural risks, and (3) contextual and individual risk factors must be considered within the advanced stage of the epidemic facing this population. Despite advanced HIV and STI epidemics among heterosexual African American youth, multisystemic interventions that target structural risk factors and their downstream effects are posited to reduce the disparity among this high-risk population.
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Affiliation(s)
- Devin E Banks
- Department of Psychology, Indiana University Purdue University-Indianapolis, 402 N. Blackford St., LD 124, Indianapolis, IN, 46202, USA.
| | - Devon J Hensel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tamika C B Zapolski
- Department of Psychology, Indiana University Purdue University-Indianapolis, 402 N. Blackford St., LD 124, Indianapolis, IN, 46202, USA
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Donenberg G, Emerson E, Kendall AD. HIV-risk reduction intervention for juvenile offenders on probation: The PHAT Life group randomized controlled trial. Health Psychol 2018; 37:364-374. [PMID: 29389155 DOI: 10.1037/hea0000582] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Juvenile offenders report high rates of sexual risk taking, increasing the possibility of HIV. This 2-arm group randomized controlled trial tested the efficacy of PHAT Life, a sexual risk reduction program, compared with a time-matched health promotion program for youth on probation. METHOD Male and female 13- to 17-year-olds (M = 16.08; SD = 1.09) recently arrested and placed on probation at an Evening Reporting Center were eligible for the study. Youth were 66% male, and 90% African American. Teens self-reported their sexual behavior (condom use, number of sexual partners) at baseline and 6 months. Retention was 85%. RESULTS Youth were randomized to PHAT Life (n = 163) or a health promotion program (n = 147). Among youth reporting the highest risk at baseline (a composite measure of multiple partners and inconsistent condom use), those who received PHAT Life were over 4 times more likely than the control group to report a lower level of risk (i.e., no sex or one partner plus consistent condom use) by 6 months, OR = 4.28 with 95% CI [1.37, 13.38], SE = 0.58, p = .01. Among sexually active teens who reported sexual debut before 12-years-old, those who received PHAT Life reported significantly fewer sexual partners at 6-months than controls, partial eta squared = .32, p = .002. CONCLUSIONS Findings support PHAT Life's efficacy to reduce sexual risk for juvenile offenders on probation. Future research should examine how best to disseminate PHAT Life to ensure that it is self-sustaining within the juvenile justice system. (PsycINFO Database Record
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Affiliation(s)
- Geri Donenberg
- Department of Medicine, College of Medicine, University of Illinois at Chicago
| | - Erin Emerson
- Center for Dissemination and Implementation Science, Healthy Youths Program, Community Outreach Intervention Projects, University of Illinois at Chicago
| | - Ashley D Kendall
- Center for Dissemination and Implementation Science, Healthy Youths Program, Community Outreach Intervention Projects, University of Illinois at Chicago
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Sanchez D, Hamilton ER, Gilbert DJ, Vandewater EA. Examining Africentric Cultural Values, Ethnic Identity, and Substance Use Abstinence in Low-Income, Early Adolescent, African American Girls. JOURNAL OF BLACK PSYCHOLOGY 2018; 44:74-100. [PMID: 37503449 PMCID: PMC10372843 DOI: 10.1177/0095798417746265] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
An examination of cultural protective factors that foster substance use abstinence among low-income, early adolescent, African American girls may be helpful in understanding how to promote resilience and reduce negative health outcomes. This study examined the relations between Africentric cultural values, ethnic identity, and substance use abstinence among 196 low-income African American early adolescent girls (age 11-14 years). Results of logistic regressions revealed that Africentric values were negatively linked to cigarette and alcohol abstinence. Results also showed a significant positive interaction between Africentric cultural values and ethnic identity exploration that contributed to increased cigarette and alcohol abstinence. Implications for research and practice with African American early adolescent girls are discussed.
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Cunningham K, Martinez DA, Scott-Sheldon LAJ, Carey KB, Carey MP. Alcohol Use and Sexual Risk Behaviors among Adolescents with Psychiatric Disorders: A Systematic Review and Meta-Analysis. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2017; 26:353-366. [PMID: 29204066 DOI: 10.1080/1067828x.2017.1305934] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Adolescents with psychiatric disorders appear to be at increased risk for acquiring HIV and other sexually transmitted infections; however, little is known about the prevalence of behavioral risk factors in this population. This meta-analysis aimed to assess the prevalence of alcohol use and sexual risk behaviors among adolescents with psychiatric disorders. Electronic database searches identified studies sampling adolescents diagnosed with psychiatric disorders and assessing both alcohol and sexual risk behaviors. Fourteen studies sampling 3,029 adolescents with psychiatric disorders were included. The majority of adolescents with psychiatric disorders report alcohol use and sexual risk behaviors. Risk reduction interventions targeting these two behaviors are needed.
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Affiliation(s)
- Karlene Cunningham
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.,Bradley/Hasbro Children's Research Center, Rhode Island Hospital, Providence, RI, USA
| | - David A Martinez
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.,Bradley/Hasbro Children's Research Center, Rhode Island Hospital, Providence, RI, USA
| | - Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA
| | - Kate B Carey
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA.,Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA
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Brawner BM, Fannin EF, Reason JL, Weissinger G. Addressing Unmet Sexual Health Needs among Black Adolescents with Mental Illnesses. JOURNAL OF BLACK SEXUALITY AND RELATIONSHIPS 2016; 3:75-91. [PMID: 29119132 PMCID: PMC5672943 DOI: 10.1353/bsr.2016.0007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite advances in HIV epidemiologic and prevention research, adolescents with mental illnesses remain a historically underserved group with respect to human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention resources. Black adolescents with mental illnesses in particular are a relatively underserved, hidden population in the field of sexual health. Strategies and guidelines are needed to account for underlying psychopathology among Black adolescents with mental illnesses in ways that current models have yet to address. In this paper, we propose several actionable mechanisms to better integrate HIV/STI and mental health related services and activities for sexual health promotion.
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Affiliation(s)
- Bridgette M Brawner
- Assistant Professor of Nursing, Center for Health Equity Research, Center for Global Women's Health, University of Pennsylvania School of Nursing, 418 Curie Blvd., Room 419, Philadelphia, PA 19104
| | - Ehriel F Fannin
- Ruth L. Kirschstein NRSA Predoctoral Fellow (T32NR007100), Center for Health Equity Research, Center for Global Women's Health, University of Pennsylvania School of Nursing
| | - Janaiya L Reason
- Research Coordinator, Center for Health Equity Research, Center for Global Women's Health, University of Pennsylvania School of Nursing
| | - Guy Weissinger
- BSN-to-PhD Hillman Scholar, Center for Health Equity Research, University of Pennsylvania School of Nursing
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Kim S, Lee C. Factors Affecting Sexually Transmitted Infections in South Korean High School Students. Public Health Nurs 2015; 33:179-88. [PMID: 26073128 DOI: 10.1111/phn.12211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study identified factors affecting sexually transmitted infections (STIs) among high school students in South Korea. DESIGN AND SAMPLE This study was a secondary data analysis using data from the eighth annual Korea Youth Risk Behavior Web-based Survey conducted in 2012. Data from 2,387 high school students who reported having sexual intercourse were analyzed using descriptive statistics, chi-square tests, and logistic regression by gender. MEASURES The survey questionnaire measured drug experience, Internet pornography preference, age at first intercourse, and method of contraception. RESULTS Overall, 7.2% of participants had experienced STIs. The common significant predictors of STIs in male and female students were drug experience, Internet pornography preference, and age at first intercourse. Contraceptive methods were statistically significant only for males; living arrangements and Internet usage were significant only for females. CONCLUSIONS Drug experiences, Internet pornography preference, and age at first intercourse were strong factors that affected both male and female students, suggesting the necessity to reinforce laws and regulations prohibiting drug use and pornography. Moreover, precise and detailed information on intercourse, sexual behaviors, and STIs offered by public health nurses should be officially provided starting in elementary school. For male students, the practice of condom use should be emphasized.
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Affiliation(s)
- Suhee Kim
- Department of Nursing, Graduate School of Yonsei University, Seoul, Korea
| | - Chungyul Lee
- Nursing Policy Research Institute, College of Nursing, Yonsei University, Seoul, Korea
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Hwang LY, Ma Y, Moscicki AB. Biological and behavioral risks for incident Chlamydia trachomatis infection in a prospective cohort. Obstet Gynecol 2014; 124:954-960. [PMID: 25437724 PMCID: PMC4251549 DOI: 10.1097/aog.0000000000000429] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To identify biological and behavioral risks for incident Chlamydia trachomatis among a prospective cohort of young women followed frequently. METHODS Our cohort of 629 women from two outpatient sites was seen every 4 months (October 2000 through April 2012) for behavioral interviews and infection testing. C trachomatis was tested annually and any time patients reported symptoms or possible exposure using commercial nucleic acid amplification tests. Analyses excluded baseline prevalent C trachomatis infections. Risk factors for incident C trachomatis were assessed using Cox proportional hazards models. Significant risks (P<.10) from bivariate models were entered in a multivariate model adjusted for four covariates chosen a priori (age, race or ethnicity, condom use, study site). Backward stepwise elimination produced a final parsimonious model retaining significant variables (P<.05) and the four adjustment variables. RESULTS The 629 women attended 9,594 total visits. Median follow-up time was 6.9 years (interquartile range 3.2-9.8), during which 97 (15%) women had incident C trachomatis. In the final multivariate model, incident C trachomatis was independently associated with human papillomavirus at the preceding visit (P<.01), smoking (P=.02), and weekly use of substances besides alcohol and marijuana (P<.01) since the prior visit. Among 207 women with available colpophotographs (1,742 visits), cervical ectopy was not a significant risk factor (P range=.16-.39 for ectopy as continuous and ordinal variables). CONCLUSION Novel risks for C trachomatis include preceding human papillomavirus, smoking, and substance use, which may reflect both biological and behavioral mechanisms of risk such as immune modulation, higher-risk sexual networks, or both. Improved understanding of the biological bases for C trachomatis risk would inform our strategies for C trachomatis control.
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Affiliation(s)
- Loris Y Hwang
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
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