National AIDS Behavioral Surveys Research Articles

Psychosocial Profiles of Women with Risky Sexual Partners: The National AIDS Behavioral Surveys (NABS)

Women represent one of the fastest growing groups of U.S. AIDS cases. This study examined women with risky male sexual partners drawn from a national/urban probability telephone sample. Our analyses use a matched control design to profile women with risky sexual partners and their male partners. We used the multifaceted model of HIV risk (MMOHR) as a framework for examining how women with risky partners differed from matched controls. Compared to matched controls, women with risky partners (n = 209) were young, poor, sexually unassertive, in troubled relationships, and were cognizant of their health risks. We found two distinct groups of women: women whose only risk was through their partner (single risk) and women who had additional risks of their own (multiple risk). Single-risk women were more conservative, more guilty about sex, and in traditional relationships. Interventions should build on women's recognition of their risk and focus on the relationships that support risky behavior.

Participation bias in AIDS‐related telephone surveys: Results from the national AIDS behavioral survey (NABS) non‐response study

A study of nonrespondents from the National AIDS Behavioral Survey (NABS) was conducted in 1990 to attempt to identify potential differences in participants and non‐participants that may influence estimates of sexual risk behavior. Nonrespondents were comprised of two groups: people who refused twice to participate in the main study, and people who were extremely difficult to contact (i.e., could not be contacted within 17 call attempts). Demographic and social‐psychological characteristics of these two groups were compared to those of main study participants. Results indicate that refusers are older, attend church more often, are less likely to believe in the confidentiality of surveys, and have lower sexual self disclosure. Respondents who were contacted only after 18 or more calls show a different pattern of characteristics relative to main survey participants—they are overrepresented among men and Blacks, spend less time at home, and have more sexual partners. Correlational analyses suggest that the attributes of refusers tend to be related to lower sexual risk behavior, while the characteristics of difficult‐to‐contact respondents are related to higher risk behavior.

Psychosocial Correlates of Health-Protective Sexual Communication with New Sexual Partners: The National AIDS Behavioral Survey

We examined health-protective sexual communication (HPSC) with new sexual partners, in a national sample of heterosexuals. Psychosocial factors associated with HPSC were examined with the AIDS Risk Reduction Model (ARRM). Higher HPSC was related to high self-efficacy with respect to sexual activity and to condom use, and to being sexually assertive. Greater comfort with condoms, experience with HIV-preventive behaviors, and commitment to use condoms were also associated with higher HPSC, indicating that there is a strong health component in safer sex talk. Significant interactions among gender, ethnicity, and psychosocial variables underscore the importance of the cultural context in shaping HIV-preventive behaviors. Prevention efforts should address general sexual self-efficacy and encourage HPSC by developing group-specific strategies, such as increasing condom self-efficacy for women, increasing sexual comfort for Latinas, as well as emphasizing the empowering and cooperative aspect of HPSC for all.

Respondents' Understanding of the Words Used in Sexual Behavior Questions

The authors assessed the difficulty respondents have in understanding the vocabulary used in sexual behavior questions. They embedded several questions related to respondents' self-reported difficulty in understanding the terms vaginal intercourse and anal intercourse in a telephone survey of the general population (National AIDS Behavioral Survey II, N = 4,790). Most respondents (95 percent) reported that these terms were easy to understand. However, men were more likely than women to report difficulty, and minority respondents were more likely than white respondents to indicate that vaginal intercourse and anal intercourse were difficult to understand. Most striking was the finding that 25 percent of those with less than 12 years of education reported comprehension difficulty with these terms. In addition, in the High Risk Cities (HRC) sample, respondents who found the terms difficult to understand were more likely to report zero when asked the number of people they had vaginal or anal intercourse with. This has implications for STD/HIV prevention policy in that some demographic groups may appear less sexually active than they really are. Hence, they may be ignored as likely candidates for intervention programs. More research is needed to assess the various dimensions to this problem. Especially needed are ways to facilitate understanding of these basic sexual behavior terms for those with low levels of education

Aids‐related risk behaviors and safer sex practices of women in midlife and older in the United States: 1990 to 1992

Women in midlife and older represent over 25% of all women with AIDS and 4% of all reported AIDS cases in the United States. We present prevalence estimates and demographic correlates of AIDS‐related risk behavior and safer sex practices among women in midlife and older from the National AIDS Behavioral Surveys (NABS). Data are of women aged 40 to 75 in the (a) NABS 1 national sample (n = 887), (b) NABS 1 urban sample (n = 2,111), and (c) NABS 2 national sample (n = 624). Data from the baseline survey (NABS 1) revealed that approximately 8% or 4.5 million women aged 40 to 75 engaged in behaviors that might expose them to HIV. Data from the follow‐up survey (NABS 2) indicated that the proportion of women who reported a risk factor remained at about 8%. Overall safer sex practices among older women who reported sexual risk behaviors were minimal. Between 90% and 100% had not used condoms in the previous 6 months. Moreover, almost 90% of the women who reported a risk behavior did not perceive themselves to be at risk.

Antibody testing and condom use among heterosexual African Americans at risk for HIV infection: the National AIDS Behavioral Surveys.

This study describes predictions of condom use and human immunodeficiency virus (HIV) antibody testing in a population-based sample of African-American heterosexuals who reported HIV risk behavior. Data were taken from the National AIDS Behavioral Surveys. Of the African-American respondents, 22% reported some risk for HIV infection; of those, 24% had been tested for HIV. Prevention messages encouraging HIV testing and condom use have not resulted in high rates of self-protective behavior among African Americans. Future prevention interventions must focus on specific motivations and barriers with regard to engaging in preventive behavior among specific age, gender, and educational-level groups within the population of African Americans at risk for HIV infection.

Predictors of Follow-Through on Plans to be Tested for HIV

Fewer than 40% of people in the United States with HIV risk factors have been tested. However, almost 40% of untested individuals with HIV risk factors in high AIDS prevalence cities stated in the 1991 National AIDS Behavioral Surveys (NABS) that they (1) "planned to be tested" or (2) "would get tested if no one could find out." We used longitudinal data from the 1991 and 1992 NABS (n = 5,543), which are nationally representative telephone surveys. We assessed whether untested individuals were tested one year later, and we used logistic regressions to address two research questions: What are the predictors of testing among untested individuals? What are the predictors of testing among untested individuals who "planned to be tested" or "would get tested if no one could find out?" We found that 30% of individuals who "planned to be tested," 16% of individuals who "would get tested if no one could find out," and 11% of persons with no intentions to be tested had been tested one year later (P < .001). In regression analyses, risk factors and higher education were key predictors of testing. It is encouraging that 30% of individuals who plan to be tested did get tested within one year. Further research, however, needs to examine testing barriers for the 70% of individuals who do not follow through on testing plans. The results provide important information for targeting testing programs, developing effective public policies, and addressing the debate over issues such as name reporting and the availability of home HIV tests.

The association between magic Johnson's HIV serostatus disclosure and condom use in at‐risk respondents

Two waves of data from the National AIDS Behavioral Surveys, one collected prior to Magic Johnson's disclosure that he was HIV positive and one collected after, were used to address whether the disclosure was related to increases in condom use in a representative sample of respondents with a risk factor for HIV. Results indicated that Blacks, Hispanics, those with fewer than 12 years of education, and unmarried respondents were more likely to report being influenced by Magic Johnson's announcement. In addition, even when sociodemographic variables related to change in condom use were controlled, those respondents who reported being influenced by Magic Johnson's announcement were more likely to increase their condom use.

HIV risk factors, condom use, and HIV antibody testing among heterosexual Hispanics: the National AIDS Behavioral Surveys (NABS).

The rate of HIV infection and AIDS cases among heterosexual Hispanics is increasing. Data from a national probability survey of HIV-related risk factors among 4,390 heterosexual Hispanics in the 1990-1991 National AIDS Behavioral Surveys reveal that 164% of respondents reported an HIV risk factor; of these, 35.3% had been tested for HIVl Multiple sex partners and risky main sexual partner were the major risk factors. Men and middle-income Hispanics reported a higher prevalence of HIV testing. Half of those at highest riskfor HIV infection had neither been tested for HlV antibody nor had used condoms to protect themselves. The results suggest that HIV infection poses a great threat, particularly among certain heterosexual Hispanic subgroups where condom use and HIV testing is relatively low, illustrating the extreme need for developing new HIV prevention strategies among specific Hispanic risk groups.

In Early 1990s, U.S. Men and Women Were Just as Likely to Initiate Risky Behavior as to Halt it

National AIDS Behavioral Survey data indicate that heterosexual men and women seem to have done little between 1991 and 1992 to reduce their risk of contracting AIDS and other sexually transmitted diseases (STD). The National AIDS Behavioral Surveys consisted of two surveys each conducted in two waves. The baseline survey was conducted from June 1990 to February 1991 with follow-up interviews conducted one year later from January to August 1992. Among respondents aged 18-49 1553 men and women were interviewed at baseline and 1062 of them could be reinterviewed. The majority sampled were not at risk of HIV or STD infection either at wave one or wave two. Both nationally and in cities where the risk of AIDS is believed to be high 6-8% of respondents aged 18-49 reported that they had discontinued risky behavior between the 1991 baseline and the 1992 follow-up surveys. Over the same period 7-11% of those who had not engaged in risky behavior previously began to do so.

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

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. A longitudinal survey was conducted. 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. 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.

Who Plans to Be Tested for HIV or Would Get Tested if No One Could Find Out the Results?

We analyzed the characteristics of individuals at risk for HIV who have not been tested but who (1) planned to be tested, or (2) would get tested "if no one other than you (the respondent) could find out your results." Data were from the 1991 National AIDS Behavioral Surveys, a probability sample of the U.S. population. Logistic regression was used to analyze the correlates of testing behavior among the 41% of individuals in high-prevalence cities who had HIV risk factors (n = 3,175). Of this group, 7% planned to be tested and 30% would get tested "if no one other than you could find out the results." Minorities and individuals with less education and without insurance were more likely to plan to be tested (versus previously tested), and individuals with less education and lower incomes were more likely to be willing to be tested "if no one other than you could find out the results" (versus previously tested). We conclude that a variety of options to increase testing rates should be explored, including accessible testing services, policies and procedures to increase perceptions of testing privacy, and home testing.

Prevalence and social distribution of men who have sex with men: United states and its urban centers

Prevalence data on the social distribution and AIDS‐related risk behavior of men who have sex with men are presented from two national probability surveys [General Social Survey (GSS) and National Health and Social Life Survey (NHSLS)] and a probability survey of urban centers in the U.S. [National AIDS Behavioral Surveys (NABS)]. Men residing in large cities, the highly educated, and Whites were more likely to report sex with men. In the urban sample (NABS), one third reported sex with women. In addition, minority men were more likely to report sex with men and women. More than half of the men with an HIV risk factor reported consistent condom use. The surveys were based on two different modes of interviewing (self‐administered and telephone), conducted independently of each other and by different organizations. The prevalence estimates from these surveys are consistent with each other and with other population‐based surveys in the United States and Europe. We discuss these data in light of the ongoing d...

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).

AIDS risk behaviors among late middle-aged and elderly Americans. The National AIDS Behavioral Surveys

AIDS risk behaviors among late middle-aged and elderly Americans. 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%).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.

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.

HIV antibody testing among those at risk for infection. The National AIDS Behavioral Surveys

HIV antibody testing among those at risk for infection. The National AIDS Behavioral Surveys

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.