Prevalence of AIDS-related risk factors and condom use in the United States.

A national probability survey of human immunodeficiency virus (HIV)-related risk factors among the general heterosexual population, the National AIDS (acquired immunodeficiency syndrome) Behavioral Surveys, has obtained data from 10,630 respondents. Data are presented on the prevalence of HIV-related risks in the general heterosexual population, on the distribution of the three largest risk groups across social strata, and on the prevalence and distribution of condom use among heterosexuals reporting a risk factor. Between 15 and 31 percent of heterosexuals nationally and 20 and 41 percent in cities with a high prevalence of AIDS reported an HIV risk factor. Condom use was relatively low. Only 17 percent of those with multiple sexual partners, 12.6 percent of those with risky sexual partners, and 10.8 percent of untested transfusion recipients used condoms all the time. Overall, the results suggest that current HIV prevention programs have, to a very limited extent, reached those heterosexuals with multiple sexual partners but have failed to reach many other groups of the heterosexual population at risk for HIV. New public health strategies may be needed for these specific risk groups.

Bridging barriers to clinic-based HIV testing with new technology: translating self-implemented testing for African American youth.

Numerous barriers to clinic-based HIV testing exist (e.g., stigmatization) for African American youth. These barriers may be addressed by new technology, specifically HIV self-implemented testing (SIT). We conducted a series of formative phase 3 translation studies (49 face-to-face interviews, 9 focus groups, 1 advisory panel review) among low-income African American youth (15-19 years) and providers of adolescent services in two US cities to identify potential translation difficulties of the OraQuick SIT. Based on content analysis, we found that providers and African American youth viewed SITs positively compared to clinic-based testing. Data suggest that SITs may reduce social stigma and privacy concerns and increase convenience and normalization of HIV testing. Challenges with SIT implementation include difficulties accessing confirmatory testing, coping with adverse outcomes, and instructional materials that may be inappropriate for low socioeconomic status (SES) persons. Study results underscore the need for translation studies to identify specific comprehension and implementation problems African American youth may have with oral SITs.

Health-risk behaviors and health concerns among young adolescents.

This study examined the health concerns and behaviors of 563 adolescents (aged 11 through 14) from a variety of social, racial, and ethnic backgrounds. Behaviors associated with adolescent morbidity and mortality were examined, including sexual behavior, substance use, and injury-related behaviors. Although young adolescents are often viewed as unlikely participants in these risk behaviors, the results of this study suggest that greater attention should be paid to this younger group and their health-risk behaviors. A majority of the sample had tried alcohol and tobacco, and almost a third had used marijuana. Twenty-one percent were sexually active. Prevalence rates varied by social class, race-ethnicity, gender, and age. More than 75% of the sample had visited a physician during the prior year, suggesting an important role physicians may serve as sources of information and positive role models for these young adolescents. The results suggest that we stop viewing young adolescents as naive children and begin to view them as observers of and participants in a changing social environment that has important implications for their current and future health status. Without a realistic appraisal of the young adolescent, we can expect to have little overall effect on the status of adolescent health in the United States.

Perceived competencies, peer group affiliation, and risk behavior among early adolescents.

This study examined the role of self-esteem and peer group membership in risk behavior among 183 8th graders in a multiethnic school. The hypothesis was that domain-specific rather than global self-esteem would be associated with "crowd" membership that in turn would be related to risk behavior. Data were gathered through informant interviews and individual surveys. Domain-specific self-esteem was related to crowd affiliation as well as to alcohol and cigarette use; global self-esteem was not related. Crowd affiliation related to alcohol use and sexual behavior after controlling for the effects of demographic and self-esteem variables, but crowd membership did not fully mediate the relationship between self-esteem and risk behavior. Availability of alcohol and cigarettes mediated the relationship between crowd affiliation and use of these substances. Findings support growing evidence that multiple adolescent peer groups exist and that group membership is closely tied to behavior.

Multiple sexual partners and their psychosocial correlates: the population-based AIDS in multiethnic neighborhoods (AMEN) study.

In this study we examined multiple partners in a household probability sample of heterosexuals. Thirty-seven percent reported 2 or more partners in the past year, and 6% reported 5 or more partners. Significant interactions among gender, ethnicity, and relationship status revealed complex relations. African American men without a primary partner were the most likely to have multiple partners; ethnic minority women with primary partners were the least likely. Psychosocial factors associated with multiple partners were examined with the AIDS Risk Reduction Model (ARRM). Situational factors influenced how ARRM variables related to multiple partners. Perceived risk, commitment to monogamy, and communication were all important correlates. Prevention efforts must focus on increasing awareness of the risks of heterosexual transmission of HIV for people in dating relationships and on strengthening sexual communication skills with new partners.

Cognitive and emotional assessments of perceived risk for HIV among unmarried heterosexuals.

We examined perceived risk of contracting HIV using assessments of likelihood and worry in a probability sample of unmarried heterosexuals. Perceptions of the likelihood of contracting HIV and worry about HIV were only modestly correlated (r = .23), suggesting that they are different constructs. Far more respondents expressed worry (43%) than expressed the belief that they were at risk for HIV (9%). A significant proportion of the sample reported experiences that may have placed them at risk for HIV transmission. Demographic and psychosocial correlates of perceived likelihood and worry were examined in separate multivariate logistic analyses. Misconceptions about HIV transmission, a history of injection-drug-using sexual partners, and less education were associated with higher perceived likelihood of contracting HIV. Misconceptions, having multiple sexual partners in the past year, and a history of sexually transmitted diseases (STDs) were associated with high worry about HIV. Implications of the findings for correcting HIV-related misconceptions are discussed.

Correlates of condom use among black, Hispanic, and white heterosexuals in San Francisco: the AMEN longitudinal survey. AIDS in Multi-Ethnic Neighborhoods survey.

We examined correlates of condom use among heterosexual whites, blacks, and Hispanics (ages 20-45 years) with an human immunodeficiency virus (HIV) risk factor in a community-based longitudinal sample (San Francisco; n = 716). Lag models were used to examine hypothesized antecedents of condom use at wave 2. High levels of condom use were associated with labeling one's sexual behavior as risky for HIV infection, high levels of condom enjoyment and commitment to use condoms, good sexual communication practices, gender (trend), and marital status. The results support the need for wide-ranging intervention programs that stimulate people to make personal risk assessments, teach basic sexual skills, and direct those in need of intensive help to appropriate agencies.

Extramarital sex and HIV risk behavior among US adults: results from the National AIDS Behavioral Survey.

Data from the National AIDS Behavioral Survey were used to examine the social distribution of extramarital sex and risk for human immunodeficiency virus (HIV) infection among married individuals in the United States. Of 1686 married respondents living across the United States, 2.2% reported extramarital sex; of 3827 married respondents living in 23 urban areas with large Hispanic or African-American populations, 2.5% reported having sexual partners outside marriage. The data indicate that the correlates of extramarital sex varied by race/ethnicity. Low levels of condom use were found among people reporting extramarital sex (8% to 19% consistent users).

Data from the National AIDS Behavioral Surveys. III. Multiple sexual partners among blacks in high-risk cities.

The National AIDS Behavioral Surveys collected data between June 1990 and February 1991 on the prevalence of multiple sex partners and condom use among 2, 166 blacks living in cities with a high prevalence of AIDS cases. Almost one-fifth (19%) of respondents report having had two or more partners in the year preceding the survey. More men (30%) than women (10%), and more single (25%) than married or cohabiting adults (8%), report that they have had multiple sexual partners in the previous year. Although respondents are more likely to use condoms with secondary than main sexual partners, substantial proportions of blacks with multiple sex partners used no condoms in the previous year with either their main (47%) or their secondary partners (35%).

PIP: Data from several studies suggest that Black heterosexual men and women in the U.S. are ten times more likely to be diagnosed with AIDS than are White men and women. U.S. National AIDS Behavioral Surveys data collected June 1990 - February 1991 offer insight into the prevalence of multiple sex partners and condom use among Blacks in cities with high prevalence of AIDS cases. The authors present findings from telephone interviews with 2166 self-described Black heterosexuals aged 18-49 years. 63% of the sample was female and 37% was male. 56% had more than 12 years of formal education. 19% of respondents reported having had two or more partners in the year before the survey. Of those reporting having multiple sex partners in the previous year, 30% of men did so compared to 10% of women, along with 25% of single individuals compared to 8% of married or cohabiting adults. Respondents were more likely to use condoms with secondary than main sex partners. More precisely and respectively, 47% and 35% of Blacks with multiple sex partners used no condoms in the previous year with their main and secondary partners. Efforts are therefore urgently needed to increase the prevalence of condom use in the interest of reducing the incidence of HIV infection in such communities.

Data from the National AIDS Behavioral Surveys. IV. Multiple sexual partners among young adults in high-risk cities.

Among a sample of 1,334 urban heterosexuals aged 18-25 from the 1990-1991 National AIDS Behavioral Surveys, 24% report having had more than one sexual partner during the past year. Young men are more than twice as likely as young women, and unmarried respondents are eight times as likely as married respondents, to have multiple partners. A multiple regression analysis of the interaction between race or ethnicity and education indicates that among whites, young people with 12 or more years of education are four times as likely to have multiple partners as are those with less than a high school education; among Hispanics and blacks, educational level is not related to having more than one partner. Among those with multiple partners, approximately 40% never use condoms with primary or secondary partners, and condom use decreases with increasing number of partners.

Demographic characteristics of heterosexuals with multiple partners: the National AIDS Behavioral Surveys.

In a study of risk behavior among heterosexuals, 9% of a national sample and 12% of a sample drawn from high-risk cities report having two or more sexual partners in the year before the survey. In both samples, sex with multiple partners is most common among men, younger people and the unmarried. Multivariate analyses show that racial and ethnic differences in the proportion of respondents with multiple partners vary by marital status. The results indicate that many heterosexuals are failing to protect themselves against sexually transmitted diseases: Among respondents with multiple partners, only 18% of men and 22% of women always use condoms with their primary partner, and 28% of men and 32% of women always use them with secondary partners. These proportions do not increase significantly with the number of partners; in general, almost half of men and women with multiple partners never use condoms.

Risk factors for HIV and other sexually transmitted diseases and prevention practices among US heterosexual adults: changes from 1990 to 1992.

OBJECTIVES: The National AIDS Behavioral Survey (1990-1992) of heterosexual adults (18-49 years) measured human immunodeficiency virus (HIV) risk factors, condom use, and HIV antibody testing, with a focus on major "high-risk" cities. METHODS: A longitudinal survey was conducted. RESULTS: There was little reduction in the overall prevalence of HIV risk factors in the national or high-risk cities cohorts over time. Despite this picture of stability, approximately 39% of the population at risk for HIV because of multiple sexual partners turns over annually. There was little change in HIV test-seeking or in consistent condom use with primary sexual partners. Although the majority of at-risk respondents used condoms sporadically or not at all (65%), a significant increase in condom use was found among those reporting multiple sexual partners in both waves, particularly among Black heterosexuals. Data from other surveys and condom sales nationally support the findings. CONCLUSIONS: There is a need for a series of surveys in this area to assess the reliability of the present findings and to monitor the general US population's response to prevention programs.

National trends in condom use among at-risk heterosexuals in the united states.

Based on national level surveys, we examined data relevant to the United States' overall effort to prevent the spread of HIV among heterosexual adults. We examined changes in condom use among at-risk heterosexuals over the past decade. The observed increases over time in condom use across all heterosexual at-risk population segments are consistent with the observed (declines) trends in HIV and syphilis in the 1990s. These results and findings from prior studies suggest that U.S. efforts to facilitate condom use and contain HIV and related sexually transmitted disease (STD)-cofactors among adult at risk heterosexuals was succeeding over most of the 1990s. The absence of national level behavioral trend data after 1996, and the ambiguities of HIV spread suggest some caution in projecting trends into this century. National and local efforts need to be directed at sustaining behavioral change and conducting more rigorous studies on population trends in HIV/STD-related behaviors/pathogens.