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• W1994017816 abstract "THERE ARE CONSIDERABLE RACIAL/ETHNIC disparities in rates of reported sexually transmitted infections (STI) including HIV/AIDS in the United States.1–7 In 2006, reported rates of STIs among blacks as compared to whites were 18 times higher for gonorrhea, 8 times higher for chlamydia, and 6 times higher for syphilis.8 In 2004, estimated HIV/AIDS rates were 8.5 times higher for blacks than whites and 21 times higher for black females as compared to white females.9 These disparities have long existed and the Centers for Disease Control and Prevention (CDC) launched The National Plan to Eliminate Syphilis from the United States to, in part, reduce the tremendous racial disparities in syphilis rates—in 1995, reported syphilis rates for blacks were almost 60 times the rate for whites.10,11 One of the goals of the national plan was enhanced health promotion through appropriate interventions and partner services.11 Moreover, CDC has dedicated substantial resources to HIV and STI prevention12 including efforts to reduce HIV/STI risk, such as decreasing the number of sex partners and increasing condom use among young adults and heterosexual men and women.13 Since the early 1990s, a few studies have focused on the trends in the sexual risk behavior of heterosexual men and women; findings from these studies have been mixed. A survey of adults in Oregon found no significant difference in sexual risk behaviors among the adult men and women surveyed in 1996 and 1998.14 A study of predominantly white 18- to 39-year-old residents of Seattle, WA, found no difference in the number of lifetime and past year sex partners from 1995 to 2003–04, but identified an increase in anal sex and in the sexual repertoire (having vaginal, oral, and anal sex) of heterosexuals during the same time period.15 Similarly, reports of engaging in anal sex and the frequency of anal sex acts among heterosexuals increased from 1993–95 to 1999–2000 in 3 STD clinics.16 Moreover, the number of women who reported having 2 or more sex partners in the 3 months before being interviewed increased significantly over this time period.16 We examined the trends in recent sexual risk behavior among heterosexual women using data from the National Survey of Family Growth (NSFG). The NSFG is a national household survey of the noninstitutionalized population age from 15 to 44 years. The NSFG was most recently conducted in 1995 (Cycle 5) and 2002 (Cycle 6). Both cross-sectional surveys had a response rate of 80%, were conducted in English or Spanish, and included oversamples of black/African American and Hispanic/Latinas. In 1995, the sample included women only; therefore, we limited our analyses to women. Details of the survey and sampling methods have been published previously.17,18 The surveys were approved by the CDC Institutional Review Board. SAS (release 9.1; SAS Institute, Cary, NC) and Sudaan (release 9.0.1; Research Triangle Institute, Research Triangle Park, NC) were used for analyses to account for the complex sampling. Samples were weighted to represent the demographics of the US population at that time and to adjust for nonresponse and other study design features. Our outcome of interest was “having multiple (two or more) vaginal sex partners in the past year” (dummy coded as “yes” or “no”), which was part of the interviewer-administered portion of the survey. We conducted separate χ2 by race/ethnicity for each demographic factor (age, education, marital/cohabitation status, and poverty level income). Briefly, poverty level income is a percentage calculated using family income divided by appropriate US Census poverty thresholds (e.g., for a 1 person household, the poverty threshold was $7710 for Cycle 5 and $9039 for Cycle 6). The poverty level income variable is fully described in the Cycle 5 and Cycle 6 user’s manuals (available at http://www.cdc.gov/nchs/nsfg.htm). There were 10,847 women in the 1995 sample and 7643 women in the 2002 sample (Table 1). In the 2002 sample, there were significantly more Hispanic/Latinas and fewer whites as compared to the 1995 sample. Additionally, in 2002, there were fewer married women and more women who had never been married or were currently cohabiting. Finally, more women were living in poverty in 2002 as compared to 1995.TABLE 1: Demographics by Year (Percentages With Standard Errors)For non-Hispanic black women, there was a significant decrease in 2 or more recent sex partners from 20.4% in 1995 to 16.6% in 2002 (Table 2). For the poorest black women—those with an income less than 150% of the poverty threshold—there was a significant decrease in multiple partners in the past year from 24.1% in 1995 to 17.4% in 2002. Conversely, in non-Hispanic white women whose income was 300% or more of the poverty threshold, there was a significant increase in 2 or more sex partners in the past year from 6.7% in 1995 to 9.2% in 2002. Additionally, in Hispanic/Latina women who were formerly married, there was a significant increase in 2 or more sex partners in the past year from 10.3% in 1995 to 19.0% in 2002. There were no significant differences in reports of multiple partners in the past year for all women (data not shown) and for Hispanic/Latina and white women, separately. For Hispanic/Latina women, reports of multiple partners in the past year were consistent in 1995 and 2002 even when examined by other demographic factors such as age, education, and poverty level income. For non-Hispanic white women, having multiple recent sex partners did not change between the years by age, education, or marital status.TABLE 2: Trends in Percent of Women Who Had Multiple Sex Partners in the Past Year: by Race/Ethnicity (Percentages With Standard Errors)As previously indicated, for black women, reports of multiple sex partners in the past year decreased significantly. There was a decreasing trend for those with a high school degree or less and those with a bachelor’s degree or higher; but it did not reach statistical significance. For age, there was a decreasing trend for 15 to 19 and 20 to 24-year olds; however, the only statistically significant difference in multiple sex partners in the past year was for black women age 25 to 44 years, a decrease from 15.7% in 1995 to 12.0% in 2002. For marital status, there were decreasing trends for currently unmarried black women, but the differences were not statistically significant. Findings from this study have important implications for STI and HIV prevention and research, particularly around the issue of racial and ethnic disparities. The significant reduction in the number of black women who reported multiple recent sex partners is encouraging and mirrors temporal trends in STI rates for black women. Data from a national survey demonstrated a significant decrease in the seroprevalence of herpes simplex virus type 2 (HSV-2) for non-Hispanic black women.19 In the United States, gonorrhea rates for non-Hispanic black women dropped from 913.1 per 100,000 in 1995 to 687.7 in 2002.10,20 Rates of primary and secondary syphilis for non-Hispanic black women also fell from 41.6 per 100,000 in 1995 to 6.5 in 2002.10,20 However, despite these substantial declines in multiple recent sex partners and in STI rates for black women, significant disparities remain. In 2002, gonorrhea rates for Hispanic/Latina and non-Hispanic white females were 81.7 and 36.8 per 100,000, and rates of syphilis were 0.9 and 0.2 per 100,000, respectively.20 Although we did not directly compare women by race/ethnicity, in 2002, black women did seem to have higher reports of multiple recent sex partners as compared to white and Hispanic/Latina women. Conversely, for never married women, reports of multiple recent sex partners were similar by race/ethnicity and substantially more black women (53%) have never been married as compared to white (31%) and Hispanic/Latina (32%) women (data are not shown and are from 2002). Our analyses have limitations. First, although NSFG used face-to-face interviews and audio computer-assisted self interview (ACASI) in both years, questions on the number of partners in the past 12 months differed in ACASI. Therefore, we had to rely on questions from the face-to-face interview, which are more subject biased; however, any under-reporting of sexual behavior should have been consistent between the 2 surveys and do not compromise our analysis of trends. Moreover, this analysis does not allow an examination of why behavior change has occurred. Although it is possible that prevention efforts focusing on black women, such as CDC’s National Plan to Eliminate Syphilis11 may be related to the decrease in sexual risk, it is not possible to determine the impact of specific prevention efforts using these data. This study identifies encouraging reductions in multiple sex partners among black women. However, we did not examine the behavior of men over the same time period as the NSFG sample did not include men in 1995. Previous research has shown that men tend to engage in more sexual risk behaviors than women,1,21 and, from 2001 to 2005, 80% of black women who were diagnosed with HIV/AIDS acquired it through heterosexual contact.22 In 2002, the median number of lifetime opposite-sex partners was 5.6 for men but only 3.3 for women.21 Additionally, 11% of men age 15 to 44 years in the United States reported having a concurrent sex partner in the past 12 months.21,23 Accordingly, it is important to consider the sexual behavior of men across time. Finally, the social issues such as racism, segregation, and poverty,1–3,6,24 which influence sexual risk behaviors among non-Hispanic blacks still exist. More research is needed to determine the best methods for reducing or eliminating the negative social determinants of STI/HIV. A recent report shows that there is much work left to be done in the United States.13,25 In 2006, 24% of blacks were living in poverty as compared to 8% of whites, and more blacks live in areas that are racially segregated.25 Our findings indicate that black women, particularly those in poverty, have decreased their number of recent sex partners. This change may reflect improvements in the socio-economic status of black women26 or the effects of STI/HIV prevention messages focused on black women. Whatever the cause, the change itself may decrease the risk of acquiring STI/HIV for black women. Future research and prevention efforts may focus on this change, monitor its evolution, attempt to better understand its causes, and try to ensure that it is maintained and enhanced." @default.
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• W1994017816 title "Black Women in the United States Decrease Their Number of Recent Sex Partners: Temporal Trends From the National Survey of Family Growth" @default.
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