High-risk Cities Research Articles

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%).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.

I. Sexual Risk for Human Immunodeficiency Virus Infection Among Women in High-Risk Cities

Data from 3,482 women aged 18-49 living in 23 urban areas of the United States who participated in the 1990-1991 National AIDS Behavioral Surveys show that in the preceding year, approximately 15% engaged in sexual behavior that might expose them to the human immunodeficiency virus (HIV). Risk behaviors include having multiple sexual partners, having a risky main sexual partner or having both multiple partners and a risky main partner. An additional 17% of women with no other risk factor report that they do not know their main partner's HIV risk status. Predictors of risk factors vary by ethnicity, and having multiple partners and having a risky main partner appear to have distinct sets of predictors. Single women are more likely than others to have multiple partners, and among white women, those with more than 12 years of education are more likely to have multiple partners. Among blacks and Hispanics, younger women are more likely than older women to have multiple partners. Among Hispanic women, married respondents and those with more than 12 years of education are more likely than others to have a risky main sexual partner; the latter pattern is reversed among white women, however, with those having less than 12 years of education being more likely to have a risky main sexual partner. In general, women with a risky main partner are the least likely to use condoms consistently.

IV. Multiple Sexual Partners Among Young Adults in High-Risk Cities

IV. Multiple Sexual Partners Among Young Adults in High-Risk Cities

II. Multiple Sexual Partners among Hispanics in High-Risk Cities

Data from a random sample of 4,658 heterosexual Hispanics from 23 high-risk cities in the 1990-1991 National AIDS Behavioral Surveys reveal that 11% of Hispanics have had multiple partners in the past year-17% of men and 4% of women. The study shows a higher proportion of multiple sexual partners in the past year among Hispanic men who are unmarried (31%), Cuban (28%), aged 18-29 (25%), better educated (21%), of lower income (23%) and highly acculturated (20%). Among Hispanic women, marital status, age, Hispanic subgroup and level of acculturation are significant predictors of having multiple partners. Among highly acculturated Hispanic men, income, Hispanic subgroup and marital status are significant predictors of having multiple partners; among less acculturated Hispanic men, marital status is the only significant predictor. Only 20% of Hispanics with multiple partners report using a condom regularly with their primary partner, and 29% report regular condom use with their secondary partner. Among men, condom use tends to decrease as the number of partners increases.

The epidemiology of AIDS-related malignancies

Immunosuppression resulting from HIV infection does not explain the unique distribution of Kaposi's sarcoma across risk groups. A majority of cases occur among homosexual men, particularly those with oral-anal contact, those with sexual contacts in high-risk cities, and those frequently use nitrite inhalants, suggesting a currently unidentified etiologic cofactor. Risk of non-Hodgkin's lymphoma among HIV-infected persons continues to increase over time. Because all HIV-infected groups are at high risk of non-Hodgkin's lymphoma, environmental cofactors may be less important in the disease's etiology. Because data on risk factors for AIDS-related non-Hodgkin's lymphoma are limited, further studies are needed. Cohort studies suggested that the risk of Hodgkin's disease is greater among HIV-infected persons; however, the number of cases reported has been small. Hodgkin's disease occurring among HIV-infected persons is more aggressive than and differs in presentation from that among noninfected persons. The addition of invasive cervical cancer to the US Centers for Disease Control definition of AIDS is based on data showing that HIV-infected women have a high prevalence of cervical disease. Although no conclusions can yet be drawn regarding the temporal relationship of cervical disease and HIV infection, there is evidence of a direct relationship between the degree of HIV-induced immunosuppression and the extent of cervical disease. Other cancers are being diagnosed among AIDS patients, and monitoring of the risk of solid tumors among various cohorts of high-risk and HIV-infected persons continues.

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.

Condom Use is Low Among U.S. Heterosexuals at Risk of HIV Infection; 15% of Population Has at Least One Risk Factor

2673 individuals randomly sampled nationwide and 8263 individuals randomly sampled in urban populations considered to be at high risk for HIV infection responded to National AIDS Behavioral Surveys measuring risk factors for HIV infection among heterosexuals from the general population over the period June 1990 - February 1991. High-risk cities were those with large numbers of AIDS cases and large Hispanic or African-American populations. These latter 2 ethnic groups were oversampled as were individuals aged 50-75. Individuals reporting 2 or more sex partners in the previous 12 months were broadly categorized as being at risk for HIV infection. Under the authors most conservative definitions for quantitatively estimating respondent risk individuals were at risk if they has 1 or more of the following factors: 2 or more sex partners over the previous year a risky sex partner being a transfusion recipient a hemophiliac of IV drug user over the previous 5 years. At least 15% of respondents reported a risk factor for HIV infection under these condition while 20% did so of those sampled in high-risk cities. Only 17% of those with multiple partners and 13% of those with risky sex partners used condoms all the time. Those educated beyond high school unmarried or non-cohabiting men African-American and Whites and older age groups were most likely to report having multiple partners. Those with income under $10000 were 90% more likely to have risky primary sex partners than respondents with income over $40000 and women were 50% more likely than men to have a risky primary partner. 38% of respondents with multiple partners and from high risk cities reported never using a condom; 70% of those with risky partners reported never using condoms; and 71% of those in high-risk cities with a risk factor reporting anal intercourse over the previous 6 months reported never using condoms. Among high-risk city respondents however those generally more likely to report having multiple partners such as individuals educated beyond high school unmarried and non-cohabiting male and youths in their 20s were more likely to report using condoms. Those categorized at risk for HIV infection may therefore not necessarily be at high risk for exposure to HIV or other sexually transmitted diseases. Nonetheless survey results suggest that HIV prevention messages have not reached certain population groups at potential risk of infection.