Objective: Our previous findings indicate that approximately 64% of Mexican-American and African-American women with STD have been involved in a physically or sexually abusive relationship. Abused women report higher sexual risk behavior and have higher STD re-infection rates than non-abused women. Of abused women, adolescent women with a history of physical or sexual abuse are at greatest risk for STD re-infection. Abused versus nonabused adolescent women have more partners, younger age at first coitus and higher STD re-infection rates. These results identified the need for interventions specifically designed for abused adolescent women to realize a reduction in both interpersonal violence and STD re-infection rates. Adolescent women who have experienced abuse were identified and offered individualized and group psychotherapeutic interventions to help them overcome psychological sequelae of abuse and avoid future abusive relationships. Because abused adolescent women are in special need of social support, the combination of counseling with supplemental support groups focusing on abuse should be particularly effective. However, clinical cases that are complicated by the existence of sexual abuse and STD often involve ethical issues concerning patient privacy and legitimate breaches of confidentiality etc., that can potentially harm the individual. These issues underscored the need to incorporate ethical analysis into group and individual psychotherapeutic interventions addressing sexual abuse and STD. This project applied a methodological tool for characterizing personal and collective risk profiles of sexually abused minority adolescents with STD for the development of evidence-based processes for psychotherapeutic interventions. Design: Qualitative Population, Sample, Setting, Years: Participants in this research included a convenience sample of 60 Mexican-and African-American adolescent women, aged 14-18 years with a history of STD and physical or sexual abuse. Variables: Sexual risk behaviors, sexual relationships, physical or sexual abuse, DSM-IV diagnoses, STD history Methods: This study applied an ethical framework to cases involving sexual abuse and STD, by utilizing the concepts of casuistry, or case-based reasoning. The concepts of casuistry were applied to cases involving individual and group psychotherapeutic interventions for sexually abused Mexican-and African-American adolescent women with STD. The process for deductive application of the concepts of casuistry for ethical analysis of these actual cases involved a format developed by Jonsen, Siegler and Winslade (1992). Findings: Themes identified from individual and group intervention data provided the context for identification of clinical dilemmas and subsequent application of the concepts of casuistry for ethical analysis. Themes identified related to conflict resolution, confidentiality, substance use, interpersonal relationships, STD, physical or sexual abuse and DSM-IV diagnoses. Conclusions: These results identified a need for interventions specifically designed for minority adolescent women to realize a reduction in sexual risk behaviors, abuse, and STD. Identification of sexual or physical abuse and assessment for DSM-IV diagnoses is recommended to expand risk-reduction interventions for modifying sexual behavior patterns and health-seeking behaviors of Mexican- and African-American women that are related to STD. However, there is also a need for incorporation of an ethical framework for analysis of clinical dilemmas associated with implementation of these interventions. Implications for Practice/Policy: Inclusion of an ethical framework for analysis of clinical dilemmas encountered in community health programs concerning sexual or physical abuse and STD is a necessary component of these prevention programs. Implications for Research: There is a need for further development of the research methodology for application of ethical frameworks for analysis of clinical dilemmas encountered in community-based clinical research programs.
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