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Background: The southeastern
Objectives: Explore STI prevalence and risk factors in rural and urban areas of
Methods: Between 2005 and 2008, 1985 drug users, men who have sex with men and their sex partners participated in a study examining the potential for the sexual diffusion of HIV from high risk groups to lower risk groups. The study was conducted in two rural and two urban counties in North Carolina. Participants were recruited using respondent driven sampling (RDS) and interviewed using audio computer assisted self-interview (ACASI) technology. Participants were tested for HIV, syphilis, gonorrhea and Chlamydia. Bivariate analyses were used to identify variables associated with gonorrhea, Chlamydia and syphilis. Variables significant at p < 0.2 in bivariate analyses were included in multiple logistic regression analyses to identify variables that were independently associated with each infection.
Results: The sample was 40% female, 76% African-American, 22% non-Hispanic white and 2% Hispanic with a median age of 41. Almost two-thirds (65%) reported use of a hard drug (i.e. cocaine, crack, heroin, or methamphetamine) and 12% reported injecting in the previous 30 days. Approximately 30% of participants were recruited in a rural county. HIV prevalence was 8.2%, Chlamydia prevalence was 3.6%, gonorrhea prevalence was 2.5% and prevalence of syphilis was 2.6% and prevalence of any STI (excluding HIV) was 7.8%. In multiple logistic regression models that adjusted for gender, race and drug use, being recruited in a rural area was consistently associated with increased STI infection with odds ratios ranging from 1.86 for syphilis to 4.63 for gonorrhea.
Conclusions: STIs are a serious problem North Carolina, particularly in rural areas.
Implications for Programs, Policy, and/or Research: Increased efforts are needed to reduce STIs in rural