How many HIV infections cross the bisexual bridge? An estimate from the United States.

OBJECTIVE: Most heterosexual women with AIDS have been infected by male sex partners who acquired HIV via injecting drug use or sex with men. The contribution of bisexuality to heterosexual HIV however, has been poorly quantified. In this paper, we estimate the number of HIV infections that spread from the homosexual community to women who have sex with bisexual men. METHODS: We developed an HIV transmission model and assigned values to the model's parameters using data from a probability survey of US cities with a high risk of HIV. RESULTS: We estimated that these are about 400 HIV infections transmitted annually from HIV-infected bisexual men in high-risk cities to their female sex partners; two-thirds of these infections are transmitted to main female partners and one-third to casual partners. Uncertainties in the value of model parameters lead to variation in expected HIV infections mostly within the range 200 to 600, and for one parameter up to nearly 800. CONCLUSION: We conclude that transmission via bisexuality is a relatively minor component of the estimated 40,000 annual HIV infections in the USA.

Protective role of health values in adolescents' future intentions to use condoms.

PURPOSE: To examine the protective role of health values in adolescents' intentions to use condoms. METHODS: Two hundred thirty-six sexually active adolescents who were attending a municipal sexually transmitted diseases clinic were interviewed, using standardized and constructed instruments, regarding their previous condom use, health values, condom attitudes, social norms regarding condoms, self-efficacy regarding condoms, and intentions to use condoms in the future. Correlations and hierarchical multiple regression analyses were conducted to examine the direct and indirect effects of health values on intentions to use condoms. RESULTS: Health values were significantly correlated with intentions to use condoms with main and casual sexual partners, and accounted for a significant amount of variance in intentions to use condoms with casual sexual partners, after controlling for demographic variables, past condom use, and constructs from the Theory of Planned Behavior. Health values were also found to moderate the relationship between condom attitudes and intentions to use condoms with casual partners. CONCLUSIONS: Efforts to include health values as a protective factor in health behavior theory and risk-reduction interventions are warranted.

Attitudes about sexual disclosure and perceptions of stigma and shame.

OBJECTIVES: To determine the association between stigma and shame about having a sexually transmitted disease and adolescents' past STD related care seeking; between stigma, shame, and perceptions about disclosure of sexual behaviours to a doctor or nurse; and whether the association of stigma, shame, and care seeking was moderated by perceptions about disclosure. METHODS: A household sample of 142 sexually active African-American youths, 13-19 years old, was questioned about STD related stigma (alpha = 0.89), STD related shame (alpha = 0.90), and perceptions about disclosure of sexual behaviours to a doctor or nurse (alpha = 0.81). RESULTS: Among females, stigma was associated with increased anticipation of negative reactions to disclosure of sexual behaviours to a doctor or nurse (odds ratio (OR) = 0.319; 95% confidence interval (CI) =0.12 to 0.85) while shame was not. Stigma was also independently associated with STD related care seeking in the past year (OR = 0.296; 95% CI = 0.09 to 0.94) while shame was not. There was no association between stigma and shame with perceptions about disclosure or past care seeking in males. Perceived outcomes of disclosing sexual behaviours did not moderate the association of stigma, shame, and past STD related care seeking. CONCLUSIONS: Stigma about STDs may influence how female adolescents perceive reactions to disclosure of their sexual behaviour to healthcare providers. It may also be an important factor in their decision seek to STD related care. Perceptions about disclosure of sexual behaviour to a doctor or nurse do not change the relation of stigma or shame to past STD related care seeking.

Perceived STD risk, relationship, and health values in adolescents' delaying sexual intercourse with new partners.

OBJECTIVES: To examine the amount of time adolescents waited to have intercourse with past partners (main and casual), and intentions to delay with future partners. To determine psychosocial factors which predict delay intentions among adolescent males and females with future partners (main and casual). METHODS: Adolescent STD clinic attendees were approached before clinical appointments to participate in an interview. Data from 205 participants who had previous experience with both main and casual partners were used in the current study. RESULTS: Adolescents waited less time to have intercourse with most recent casual than with most recent main partners (chi2 = 31.97, p<0.0001). The amount of time waited with past partners was shorter than intended time to wait in future relationships (medians of 1 month v 2 months (main) (t = 3.47, p<0.0010; medians of 2 weeks v 1 month (casual) (t = 6.14, p<0.0001)). Factors influencing intentions to delay intercourse with future main partners differed by sex; males were negatively influenced by importance of sex in relationships, while females were positively influenced by importance of intimacy in relationships, perceived risk of STDs, and health values. CONCLUSIONS: Implications for designing interventions for adolescent males and females are discussed.

Concurrent sex partners and risk for sexually transmitted diseases among adolescents.

BACKGROUND/OBJECTIVES: A large percentage of sexually active adolescents have multiple sex partners and are at high risk of acquiring sexually transmitted diseases (STDs). Little is known about adolescents' patterns of sexual partnerships (e.g., concurrent versus serial) and how these patterns influence STD risk. GOAL OF THE STUDY: To determine the frequency with which adolescents have concurrent partners during a main relationship and the association between having concurrent partners and STD risk. STUDY DESIGN: Adolescents seeking care at a public STD clinic were recruited from March, 1996, to May, 1998. Demographic and behavioral data were obtained during an interviewer-administered questionnaire. Sexually transmitted disease testing and physical exams were performed by clinicians. RESULTS: Of those adolescents who reported having at least one main partner during the previous 6 months (n = 245), 110 (44.9%) had multiple partners, and 76 (31%) had at least one concurrent partner during a main relationship. Greater number of concurrent partners was associated with STD diagnosis/exposure after controlling for number of sex partners (OR = 1.6; 95% CI, 1.1-2.4). CONCLUSIONS: A significant percentage of adolescents have concurrent partners during a main relationship, and having concurrent partners increases STD risk.