Background:
Latino patients have increasingly presented to the Baltimore City Health Department (BCHD) STD clinics over the last decade.

Objective:
Identify factors associated with condom use and STD acquisition among Latino patients in Baltimore.

Method:
We examined medical records from Latino patients at the BCHD STD clinics between 2002-2007, selecting records from the first visit when an STD test was performed. Ethnicity was self-reported. We used Chi-square analysis to examine differences in STD risk factors between male and female patients. We used logistic regression to examine risk factor associations with condom use and STD diagnosis. IRB approval was obtained from the participating agencies.

Result:
There were 538 Latino and 366 Latina patients tested for an STD at the BCHD STD clinics. Females were less likely to report condom use at last sex than males (22% vs. 37%, p<.0001). After adjustment for behavioral risk factors, females remained less likely to report condom use than males, though the difference was slightly more pronounced among those who used alcohol or drugs. (aORdrugs: 1.6, 95% CI: 1.3-1.9; aORno drugs: 1.3, 95% CI: 1.1-1.5). Females and males had similar prevalence of gonorrhea (5% and 8%, respectively), syphilis (7% and 11%), and HIV (1% and 2%). Independent risk factors for diagnosis of gonorrhea, syphilis or HIV included: English-proficient as compared to Spanish-speaking only (aOR 1.8, 95% CI: 1.2-2.6), being older than 25 years of age (aOR 1.6, 95% CI: 1.1-2.5), and reporting cocaine use by a sex partner (aOR 2.2, 95% CI: 1.4-3.5).

Conclusion:
Substance use plays an important role in condom use and STD acquisition in this population. Further research on Latino linguistic assimilation and STD risk will be necessary to improve prevention efforts.

Implications:
Condom use and STD prevention interventions for Latino patients should take both acculturation and patient/partner substance use into account.