Changes in sexual behavior by young urban heterosexual adults in response to the AIDS epidemic.

Young adults residing in four States were enrolled in the period 1985-88 in a multicenter study of cardiovascular disease risk factors. In 1989, 2,729 members of the group were given a self-administered questionnaire that included questions on changes in sexual behavior that subjects had made in response to the epidemic of acquired immunodeficiency syndrome (AIDS). The final sample of 1,601 young, heterosexual, urban respondents included 412 white men, 568 white women, 224 black men, and 397 black women, all ages 21 to 40 years. Overall, nearly 50 percent of the sample reported having made at least one change in their sexual behavior in response to the AIDS epidemic to decrease their risk of becoming infected by the human immunodeficiency virus. The mean number of changes was 0.8 for white men, 1.1 for white women, 1.6 for black men, and 1.5 for black women. Change was reported more frequently by black respondents than white, with no significant sex differences. The categories of respondents reporting behavior changes were more often young, with a history of recreational drug use, with more sex partners, or having had anal intercourse. The most commonly reported behavior changes were reducing the number of sex partners and being more careful in partner selection. Of the 54 percent of respondents who did not report any change in sexual behavior, about 70 percent reported unprotected sex with more than one partner in the previous year. Significant sexual behavior change in response to the AIDS epidemic remains a goal for health education efforts.     

STD and HIV testing behaviors among black and Puerto Rican young adults

CONTEXT: Given the high rates of infection among urban young adults, STD and HIV testing promotion is a public health priority. To inform future testing efforts, lifetime and recent testing behaviors of this population within casual and serious relationships should be better understood. METHODS: Data from a 2007–2008 study conducted in select neighborhoods in Hartford and Philadelphia were used to examine self‐reported STD and HIV testing behaviors and attitudes among 483 sexually active black and Puerto Rican young adults aged 18–25. Multivariate ordered logit regression analyses were conducted to assess characteristics associated with lifetime number of STD tests. RESULTS: More than eight in 10 participants reported having been tested for STDs, and a similar proportion for HIV, most of them multiple times. Nineteen percent had ever had an STD diagnosis. A majority—86%—perceived their risk of STD infection in the next year as “not at all likely.” Sixty‐one percent of those in serious relationships reported that both partners had been tested, compared with 25% of those in casual relationships. Characteristics associated with higher lifetime number of STD tests were being female (odds ratio, 2.2), being from Philadelphia (2.5), being black (1.5), having lived with two or more serious partners (1.7) and having ever received an STD diagnosis (2.3). DISCUSSION: Despite their risks, participants did not perceive themselves to be at risk of STDs. However, they did report testing repeatedly. Testing was highly acceptable, particularly within serious relationships. Questions about the timing of testing initiation and repeat testing merit attention for the benefits of widespread testing to be fully realized.     

STD and HIV risk factors among U.S. young adults: variations by gender, race, ethnicity and sexual orientation

CONTEXT: STDs, including HIV, disproportionately affect individuals who have multiple minority identities. Understanding differences in STD risk factors across racial, ethnic and sexual minority groups, as well as genders, is important for tailoring public health interventions. METHODS: Data from Waves 3 (2001–2002) and 4 (2007–2008) of the National Longitudinal Study of Adolescent Health were used to develop population‐based estimates of STD and HIV risk factors among 11,045 young adults (mean age, 29 at Wave 4), by gender, race and ethnicity, and sexual orientation (heterosexual, mixed‐oriented, gay). Regression analyses were conducted to examine associations between risk factors and young adults’ characteristics. RESULTS: Overall, sexual‐minority women in each racial or ethnic group had a higher prevalence of sexual risk behaviors—including a history of multiple partners, forced sex and incarceration—than their heterosexual counterparts. Mixed‐oriented women in each racial or ethnic group were more likely than heterosexual white women to have received an STD diagnosis (odds ratios, 1.8–6.4). Black men and sexual‐minority men also appeared to be at heightened risk. Gay men in all racial and ethnic groups were significantly more likely than heterosexual white men to report having received an STD diagnosis (2.3–8.3); compared with heterosexual white men, mixed‐oriented black men had the highest odds of having received such a diagnosis (15.2). CONCLUSIONS: Taking account of multiple minority identities should be an important part of future research and intervention efforts for STD and HIV prevention.     

Survey: most adults don't notify sex partners of STDs

A telephone survey of 1,000 men and 500 women shows that while most people with sexually transmitted diseases (STDs) have a responsibility to inform their sexual partners, only about one-third of men and women with STDs revealed the existence of the STD to their partner before having sex. For American adults, there is a 1 in 4 chance of contracting an STD during their lifetime compared to a 1 in 250 chance of getting HIV. However, most men and women have not been tested for any STDs besides HIV. American adults seriously underestimate their risk of contracting STDs, and very few are aware of the different types of STDs that exist.     

Lesbians' Sexual Activities and Efforts to Reduce Risks for Sexually Transmitted Diseases

Introduction: Little information is available regarding the specific sexual practices of lesbians, and whether these activities may carry an associated health risk. Methods: Self-identified lesbians from all U.S. states (N = 6935) responded to a questionnaire that was printed in a national biweekly gay, lesbian and bisexual news magazine. Items included sexual practices engaged in with women during the past 1 and 5 years, past history of a sexually transmitted disease (STD), number and gender of lifetime and recent sexual partners, concerns regarding STDs, and risk reduction behaviors. Results: Lesbians engaged in a variety of sexual activities with female partners including orogenital sex, use of a dildo, and anilingus. Seventeen percent reported a lifetime diagnosis of an STD. Women with a history of an STD were more likely to be concerned about STDs, to ask questions of their new female sexual partners, and to have had an HIV test. Conclusions: Lesbians participate in a variety of sexual activities with their female partners that involve the exchange of body fluids, potential exposure to blood, and genital and anal stimulation that may put them at risk for STDs.     

Pilot study of AIDS risk in the general population.

This study evaluated a methodology for obtaining information on the prevalence of risk behaviors for human immunodeficiency virus infection (HIV) in the general population. From two census tracts in an upper midwestern urban community, 334 households were identified at random. One adult between the ages of 18 and 55 years in each household was asked to complete a confidential questionnaire about knowledge and attitudes toward acquired immunodeficiency syndrome (AIDS) and risk behaviors for HIV infection. Half the responders were also asked to provide a blood sample for HIV serotesting. Response rates to the behavior questionnaire were high (85 to 90 percent). However, only 72 percent of those asked to provide a blood sample agreed to do so. Survey results showed low rates of HIV risk behavior in this population sample. The median number of lifetime sexual partners was five for men and three for women, and most reported contacts exclusively with persons of the opposite sex. Eleven percent of the men and 5 percent of the women reported having had sexual partners of the same sex during their lifetime. Seven percent of men and 3 percent of women reported same sex partners in the last 12 months. Very few reported extremely high-risk behaviors (that is, only one man reported multiple sexual partners with anal intercourse in the previous year). About one in five survey respondents reported having changed his or her behavior because of the AIDS epidemic, usually by being more selective about and reducing the number of sexual partners.(ABSTRACT TRUNCATED AT 250 WORDS)     

Use of the Internet to Meet Sexual Partners,Sexual Risk Behavior,and Mental Health in Transgender Adults

The purpose of this study was to examine the use of the internet to meet sexual partners among transgender individuals and examine correlates of this use, including sexual risk behavior, discrimination experiences, and mental health. A sample of 166 transgender adults (112 male-to-female transgender women and 54 female-to-male transgender men) were recruited in community venues and anonymously completed measures assessing these variables. Most participants (64.5 %) were HIV-negative, 25.2 % were HIV-positive, and 10.3 % did not know their HIV status. Overall, 33.7 % of participants reported having met a sexual partner over the internet, which did not differ significantly between transgender women and men. Among these individuals, transgender women reported significantly more lifetime internet sexual partners (median = 3) than transgender men (median = 1). Use of the internet to meet sexual partners was associated with lower self-esteem but not with depression, anxiety, somatic distress or discrimination experiences. Among transgender women, use of the internet to meet sexual partners was associated with each of the 11 sexual risk behaviors examined, including having multiple partners, sex under the influence of drugs, number of unprotected anal or vaginal sex acts, and history of commercial sex work. The use of the internet to meet partners was not associated with sexual risk behavior among transgender men (0/11 variables assessed). Although the internet is a common mode of meeting sexual partners among some transgender adults, it may also be a potential venue for prevention interventions targeting transgender individuals at particularly high risk for HIV acquisition.     

Sexual and drug-use risk factors for HIV and STDs: a comparison of women with and without bisexual experiences

OBJECTIVES: This study was done to compare risk factors for HIV/STDs in women who reported having had sex with both men and women and women who reported having had sex with men only. METHODS: Female participants in a multisite, randomized HIV/STD prevention study in the Seattle area reported both having had sex with a man in the 3 months before and having at least 1 risk factor for HIV/STDs during the year before the study. Of these women, 38% who reported ever having had sex with a woman were compared with those who reported having had sex with men only. RESULTS: Women who had had sex with both men and women were more likely than women who had had sex with men only to report drug use in the 3 months before the study, a greater lifetime number of male partners, a sex partner who had had sex with a prostitute, an earlier age at sexual debut, and forced sexual contact (P < .01 for all comparisons). Women who had had sex with both men and women had a mean of 3.2 of these 5 risk factors, vs 2.1 among women who had had sex with men only (P < .001). CONCLUSION: Women who had had sex with both men and women were more likely than women who had had sex with men only to engage in multiple risk behaviors. Health workers should be aware of bisexual experience among women, since this may be a marker for multiple risk behaviors for HIV/STDs.     

Early Sexual Risk Among Black and Minority Ethnicity Teenagers: A Mixed Methods Study

PurposeTo determine how ethnic background influences early sexual activity among young adults.MethodsQuantitative data were collected during the Research with East London Adolescents Community Health Survey study, a population-based survey of young adults belonging to white and black and minority ethnic groups and residing in east London in 2001 (n = 2,689) and 2003 (n = 2,675). Qualitative data were obtained from 146 young adults between January and September 2003.ResultsBlack Caribbean, black African, white other, and mixed ethnicity young men were most likely to report high-risk sexual behaviors, that is, sexual debut at the age of ≤13 years, having unprotected sex, and having multiple sexual partners. There were marked variations within groups commonly collapsed as “black” or as “Muslim.” Black Caribbean and black African young adults reported high rates of protective behaviors in addition to risk behaviors. Qualitative data confirmed variations in sexual behavior within ethnic groups. Longitudinally, risk of engaging in two or more high-risk sexual behaviors was predicted by low family support (OR: 2.8, 95% CI: 1.6–4.9), regular smoking (OR: 4.5, 95% CI: 1.7–12.0), and usage of illicit drugs (OR: 2.9, 95% CI: 1.5–5.8), with lower risk predicted by low peer support (OR: .3, 95% CI: .2–.6).ConclusionsYoung adults belonging to black and minority ethnic groups reported a wide variation in sexual risk behaviors. High levels of high-risk behaviors were reported in ethnic groups known to have high rates of sexually transmitted infections. Effective sexual health interventions should be started early and they must focus on sexual debut and partner choices as well as messages regarding safe sex.     

Gynecological Infections and Sexual Practices of Massachusetts Lesbian and Bisexual Women

Objective: The assumption that self-identified lesbians are at low risk for sexually transmitted diseases (STDs) and other gynecological infections may be premised upon infrequent screening, ignorance of lesbian sexual practices, and the discomfort that lesbians may feel concerning the disclosure of their sexual identity and behavior. We hypothesize that transmission between women may occur, and actual risk may depend upon the sexual behaviors as well as the number and gender of partners. Methods: In 1994, the Family Planning Council of Western Massachusetts developed a Lesbian Health Needs Assessment Survey. The Fenway Community Health Center (FCHC) supplemented the survey with a one-page STD questionnaire aimed at evaluating STD testing, diagnoses, and sexual practices among self-identified lesbian and bisexual women. Circulated only in eastern Massachusetts, 421 of the 1523 surveys, including the one-page STD supplement, that were distributed were returned. The prevalence of specific STDs among women with and without recent male sexual partners was compared and analyzed in relation to self-reported sexual behavior. Results: Among lesbians who denied having prior male sexual partners, the following gynecological infections were reported: trichomoniasis, anogenital warts, and abnormal Pap smears. The most commonly reported sexual practices were digital–vaginal penetration, oral–oral, oral–genital, and genital–genital contact. Conclusions: Probable woman-to-woman transmission of STDs and vaginitis was frequently reported. Although the true incidence of specific infections among lesbians is unknown, routine screening should be offered to sexually active lesbians.     

Misunderstanding of 'safer sex' by heterosexually active adults.

To assess the understanding of safer sex among heterosexual adults, people enrolled in human immunodeficiency virus (HIV) education trials at a sexually transmitted disease (STD) clinic and a university student health service were surveyed concerning sexual behavior with their latest reported partner. Of 646 sexually active persons enrolled in the trials, 233 (36 percent) reported having had safer sex with their latest partner; 124 of them (53 percent) also reported having vaginal or anal intercourse without a condom during that sexual encounter. Among the 124 who reported safer sex despite having intercourse without a condom, only 23 percent reported asking partners about their HIV status, 46 percent had asked about intravenous drug use, and 47 percent had asked about the number of prior sexual partners. For 34 percent of those surveyed, the length of the sexual relationship with their latest partner was 1 month or less, and 18 percent estimated that this partner had had 11 or more prior sexual partners. STD clinic participants characterized intercourse without a condom as safer sex more often than student health service enrollees (76 percent versus 39 percent, P < 0.001). The concept of safer sex is often misunderstood by persons engaging in behavior at risk for HIV transmission, and the level of misunderstanding differs among samples. Interventions to reduce transmission of HIV must confront misconceptions about the risk of sexual intercourse without condoms and include specific instructions understood by the targeted group.     

Change Trajectories in Women's STD/HIV Risk Behaviors Following Intervention

Three 16-month sexual risk-taking trajectories were identified in 287 women in an STD/HIV intervention study. The Risk Eliminator group reported no sex risk following intervention while the Risk Reducer group reported continuous drops over time. The High Risk group reported higher initial risk than the other two and no subsequent changes. The trajectory groups showed no between- or within-group effects of intervention exposure. Trajectory groups were compared on baseline characteristics. No differences were seen in demographics or STD/HIV knowledge. Compared to one or both of the other groups, the High Risk women reported more lifetime partners, recent paying partners, adult rape, and recent substance use. Their steady partners were more likely to be abusive, intoxicated during sex (as were the women themselves), and believed to be non-monogamous. The Risk Eliminator group differed from the other two by being less likely to report a history of childhood sexual abuse.     

中国大陆男男性接触者艾滋病性病高危险行为情况调查

目的 调查中国大陆男男性接触者（men who have sex with men,MSM)的艾滋病（acpuired immunodeficiency syndrome,AIDS）和性病（sexually transmitted diseases,STD）高危险行为及相关情况。方法 采用不同记名邮寄问卷形式调查。结果 发放调查问卷1800份,回收有效问卷729份,应答率40.5%。调查对象平均31.0岁。首次男男性交平均18.6岁。累计男性伴平均数39.2人,75.7%有过肛交行为。近一年内,63.6%有过陌生男性伴,39.8%曾群交,9.3%“买”过性,３.8％“卖”过性。约半数与女性性交过。　133人自述患过性病（18.2%）。62人检测过人类免疫缺陷病毒（human immune deficiency virus,HIV）抗体,11人阳性（17.7%）。约2/3使用过避孕套。结论 被调查的MSM在性方面相当活跃,HIV感染率在这一人群中巳达较高水平,而且流行全直接蔓延到异性恋人群。     

Testing for sexually transmitted diseases among women of reproductive age: United States, 1988.

Approximately 13.3 million women aged 15-44--about 26 percent of all women of reproductive age who had ever had intercourse--were tested for sexually transmitted diseases (STDs) in the 12 months before the 1988 National Survey of Family Growth. Slightly over half of the women tested received the test as part of a family planning visit. Women who used clinics for family planning services were most likely to be tested--54 percent compared with 34 percent of women who used a private doctor for family planning and 16 percent of women who did not receive family planning services that year. The findings suggest that access to medical care, especially access to family planning clinics, has strong effects on a woman's chances of being screened for STDs, independent of her individual characteristics. The most important individual characteristic affecting the chance of being tested for an STD was race: About 47 percent of black, 27 percent of Hispanic, and 23 percent of white and other women were tested in the 12 months before the survey. Among groups with high-risk behaviors, only 34 percent of sexually experienced teenagers were screened for STDs in the past year, as were only 43 percent of women with a positive STD history and 32 percent of women with 10 or more lifetime partners.     

Characteristics of Sexual Abuse in Childhood and Adolescence Influence Sexual Risk Behavior in Adulthood

Childhood and adolescent sexual abuse has been associated with subsequent (adult) sexual risk behavior, but the effects of force and type of sexual abuse on sexual behavior outcomes have been less well-studied. The present study investigated the associations between sexual abuse characteristics and later sexual risk behavior, and explored whether gender of the child/adolescent moderated these relations. Patients attending an STD clinic completed a computerized survey that assessed history of sexual abuse as well as lifetime and current sexual behavior. Participants were considered sexually abused if they reported a sexual experience (1) before age 13 with someone 5 or more years older, (2) between the ages of 13 and 16 with someone 10 or more years older, or (3) before the age of 17 involving force or coercion. Participants who were sexually abused were further categorized based on two abuse characteristics, namely, use of penetration and force. Analyses included 1177 participants (n=534 women; n=643 men). Those who reported sexual abuse involving penetration and/or force reported more adult sexual risk behavior, including the number of lifetime partners and number of previous STD diagnoses, than those who were not sexually abused and those who were abused without force or penetration. There were no significant differences in sexual risk behavior between nonabused participants and those who reported sexual abuse without force and without penetration. Gender of the child/adolescent moderated the association between sexual abuse characteristics and adult sexual risk behavior; for men, sexual abuse with force and penetration was associated with the greatest number of episodes of sex trading, whereas for women, those who were abused with penetration, regardless of whether the abuse involved force, reported the most episodes of sex trading. These findings indicate that more severe sexual abuse is associated with riskier adult sexual behavior.     

Extrarelational sex among Mexican men and their partners' risk of HIV and other sexually transmitted diseases

OBJECTIVES: This study explored the risk of HIV and other sexually transmitted diseases (STDs) among married and cohabiting women in Mexico City, Mexico, derived from their partners' sexual behaviors. METHODS: Results were derived from the first population-based household survey in Mexico that investigated male sexual behavior. Analyses were restricted to sexually active married or cohabiting men (n = 3990). RESULTS: Fifteen percent of the men reported extrarelational sex during the past year, 9% reported condom use during last intercourse, and 80% perceived no HIV risk. Most secondary partners were coworkers, mistresses, or friends. CONCLUSIONS: Targeted HIV and STD prevention efforts appear necessary because a substantial number of women may be at risk.     

Interactions between persons at risk for AIDS and the general population in Denmark.

A nationwide study of sexual behavior was undertaken among 4,680 randomly selected Danes aged 18-59 years. The median number of sexual partners (lifetime) was highest for men aged 30-34 years (eight partners) and for women aged 25-29 years (seven partners). After adjustment for age and sex, having had greater than or equal to 5 sexual partners in the past year was strongly associated with living in larger cities, intravenous drug use, and having sex with a prostitute, a bisexual man, an intravenous drug user, or a resident of sub-Saharan Africa. The frequency of ever having had anal intercourse was highest among women aged 20-34 years (range, 27%-36%) and was independently associated only with increasing number of sexual partners (lifetime). Overall, 2.7% of men reported any homosexual experience, among whom most (88%) had also had heterosexual intercourse. Prostitute contact (ever) was reported by 13% of all men and was associated with a high educational level, a history of travel, a greater number of sexual partners, and intravenous drug use. Overall, sexual contact with someone considered at high risk of human immunodeficiency virus (HIV) infection (a homosexual/bisexual man, intravenous drug user, prostitute, or sub-Saharan African resident) was reported by 15.9% of men and 4.8% of women. Among active blood donors (past year), 12.5% of men and 4.0% of women had engaged in potentially risky behavior. HIV testing was deliberately sought more often by respondents exposed to someone at increased risk of HIV infection (10.6%) than by those unexposed (6.5%, p less than 0.01). Exposure to persons at risk of HIV infection is considerable in Denmark. The majority of persons who have had potential exposure to HIV have not yet been tested for HIV.     

Adult sexual behavior in 1989: number of partners, frequency of intercourse and risk of AIDS

Questions on sexual behavior that were added to the National Opinion Research Center's 1988 and 1989 General Social Surveys reveal that 97 percent of adult Americans have had intercourse since age 18. Respondents report having an average of about 1.2 sexual partners during the year preceding the survey and nearly 7.2 partners since age 18; men claimed to have had considerably more partners than did women. About one-fifth of adult Americans had no partners during the previous year. Moreover, over a year's time, only 1.5 percent of married people reported having had a sexual partner other than their spouse. On average, adults report engaging in intercourse 57 times per year. About two percent of sexually active adults reported being exclusively homosexual or bisexual during the year preceding the survey, and 5-6 percent have been exclusively homosexual or bisexual since age 18. Seven percent of adults are at relatively high current risk of contracting AIDS--three percent because they have had multiple partners, three percent because they have had unfamiliar partners and one percent because of their sexual orientation. However, 33 percent have engaged in relatively risky behavior at some time since age 18.