Heterosexual Populations

Direct Measures of Risk Behavior

Among heterosexuals, the following measures of risk behavior are available in Louisiana to provide important information on factors that may affect the risk of acquiring or transmitting HIV infection:

• number of sex partners and frequency of condom use or unprotected sex (Tables 19 and 20 and Figures 29 and 30)
• substance use, including injection drug use (Figure 31)
• exchanging money or drugs for sex

HITS, BRFSS, SOS, and YRBSS provide information on risk behavior related to sexual activity in heterosexual populations. (For a more detailed description of these data sources, including strengths and limitations, see Appendix A.) HITS is an anonymous, cross-sectional survey of populations at high risk for HIV infection, including heterosexuals, that was conducted in 3 cities in Louisiana (New Orleans, Baton Rouge, and Monroe) in 2001. Eligible heterosexual adults, recruited in STD clinics, had to be at least 18 years of age, able to give informed consent, and residents of the state for at least 1 year. To be eligible for the heterosexual risk group, a person had to have come to the clinic because of a suspected STD, not have been treated for an STD during the past 90 days, not have been at the clinic because of referral or follow-up, and not have had homosexual sex within the past 12 months.

BRFSS is a state-based random-digit-dialed telephone survey that monitors behavioral risks among the general adult population. A sexual behavior module was added to this survey in 1994, 1995, 1996, 1998, and 2000. The questions in this module, which was for adults (aged 18–49), concerned number of sex partners, condom use, and treatment for STDs. Because BRFSS respondents were contacted by telephone, the data are not representative of households that do not have telephones. In addition, BRFSS surveys the general noninstitutionalized adult population in an area, not just the persons at highest risk for HIV/AIDS. This means that the extent of HIV behavioral risk information collected by the BRFSS questionnaire is limited and that inferences can be made only at the state level.

SOS is a self-administered survey conducted each year by CBOs at 3 sites where they actively conduct street outreach. These sites include areas with high rates of HIV/STDs, drug use, or other high-risk behavior. Respondents were asked about sex partners, history of condom use, drug use, HIV testing history, and exposure to prevention programs. These data represent persons at particularly high risk for HIV and are not generalizable to the general population in the local community.

The Youth Risk Behavioral Surveillance System (YRBSS) distributes a self-administered questionnaire to a representative sample of students in grades 9 through 12 at the state and local level. In Louisiana, the survey is administered at the state level and in Orleans Parish public schools; however, only the survey administered to Orleans Parish high school students includes questions related to sexual behavior. In 1999, the survey was conducted in the City of New Orleans school system to obtain information on health behavior and risk behaviors, including sexual behavior and drug-use behavior. Students in New Orleans schools were asked whether they had sexual intercourse during the past 3 months and whether they had sexual intercourse with 4 or more partners in their lifetime. Respondents who had sexual intercourse within the past 3 months were asked whether they had used a condom during the most recent intercourse and whether they had drunk alcohol or used drugs before the most recent intercourse. Because this survey is administered in school, students at highest risk may be underrepresented because they may be more likely to be absent from school or to drop out of school, especially those in upper grades.

Number of Sex Partners and Frequency of Condom Use or Unprotected Sex

In the general population surveyed by BRFSS, almost all (96%) persons who reported that they had been sexually active at any time during the past 5 years had been sexually active during the past 12 months. Overall, only 13% of the general population aged 18–49 had had 2 or more sex partners during the past year (Table 19). Larger proportions of males (17%), younger age groups (20% among persons aged 18–24), and blacks (19%) had 2 or more sex partners.

Overall, in BRFSS, 56% of persons with 2 or more partners during the past year had used a condom during their most recent sexual encounter. Condom use was lowest among women (45%) and blacks (52%); however, it did not differ much according to age group. The percentages of condom use by persons with 2 or more sex partners were similar in BRFSS (56%) and SOS (58%) (Tables 19 and 20). However, females and youth in the SOS reported higher rates of condom use.

In general, high-risk heterosexual behavior (i.e., having 2 or more sex partners during the past 12 months) was nearly 5 times higher in SOS than in BRFSS (60% vs. 13%) (Tables 19 and 20).

The differences between BRFSS and SOS in the proportions of groups that reported high-risk heterosexual behavior were greatest among whites (10% in BRFSS vs. 67% in SOS) and females (10% in BRFSS vs. 49% in SOS). Having multiple sex partners was only about 3 times more common among blacks surveyed in SOS than among blacks surveyed in BRFSS. These results indicate that in street outreach programs, specific groups would probably benefit more from specifically focused interventions.

In SOS, condom use among persons with 2 or more sex partners remained stable during 1997–2001 (data not shown).

The women interviewed in HITS (≥ 18 years of age, at STD clinics) seemed to be at greater risk of having had 2 or more sex partners during the past 12 months (67%), compared with those surveyed in SOS (49%). Similar proportions of men in both surveys reported having had 2 or more sex partners (HITS, 69%; SOS, 69%). Of persons in HITS, 17% of the women and 40% of the men had had 4 or more sex partners during the past 12 months. (Data for these HITS results are not shown.)

Of the heterosexuals surveyed in HITS, 67% of the men and 43% of the women reported having had at least 1 casual sex partner during the past 12 months (data not shown). Of those with at least 1 casual sex partner, 20% of the men and 31% of the women reported not knowing the HIV status of their most recent sex partner (data not shown). Moreover, most of the persons interviewed indicated that they did not always use condoms with their casual sex partners (69% of men sometimes/never vs. 59% of women sometimes/never) (Figure 28). Of the STD clinic patients, 14% of men and 17% of women never used condoms during sex with their casual partners.

Figure 28: Condom Use with Casual Sex Partners Among Heterosexuals at STD Clinics
Louisiana HIV Testing Survey, 2001

Of New Orleans high school students, 24% reported in 1999 that they had had sexual intercourse with 4 or more persons in their lifetime, compared with 15% of high school students nationwide. Reports of 4 or more lifetime partners were 3.4 times higher among male students than among female students (Figure 29). The proportion who had had sexual intercourse with 4 or more partners increased with age, as shown in the linear increase by grade.

Figure 29: Percentage of High School Students with 4 or More Lifetime Sex Partners
Youth Risk Behavior Surveillance Survey, 1999

Although a higher proportion of New Orleans students (43%), compared with students nationwide (36%), reported having had sexual intercourse during the past 3 months (data not shown) more New Orleans students reported condom use during most recent intercourse (Figure 30). In 1999, more than 60% of female students and 75% of male students said they had used a condom during their most recent sexual intercourse. The largest proportion of condom users was 9th graders (81%); by 12th grade, the proportion declined to 59%. This decline was observed nationally as well.

Figure 30: Condom Use During Most Recent Sex Among High School Students Having Sex During Past 3 Months
Youth Risk Behavior Surveillance Survey, 1999

Substance Use

Of New Orleans students who had had sexual intercourse during the past 3 months, 20% reported having drunk alcohol or used drugs before their most recent sexual intercourse. A higher proportion of male students, compared with female students, said that they had drunk alcohol or used drugs before intercourse (26% vs. 14%); however, the proportions of male and female students who reported substance use were 5% lower than the proportions nationwide (Figure 31). The use of substances before sexual intercourse increased from 15% among 9th graders to 26.3% among 12th graders, but the increase did not follow a linear pattern. In addition, although alcohol and drug use were less common among New Orleans students in grades 9–11 compared with national percentages, the proportion of New Orleans 12th graders who reported substance use was larger compared with 12th graders nationwide.

Figure 31: Alcohol or Drug Use Before Most Recent Sex Among High School Students Having Sex During the Past 3 Months
Youth Risk Behavior Surveillance Survey, 1999

In the HITS study, 43% of respondents reported having ever used drugs to get high; nearly all (97%) also reported that they had used drugs during the past year. A small proportion (4%) reported having injected drugs. Of those with a history of injection drug use, only two thirds were considered current IDUs (i.e., persons who had injected drugs during the past year). Overall, 5% of the respondents reported having exchanged money or drugs for sex during the past 12 months.

STD surveillance data and vital statistics data on pregnancy rates among teenagers provide information that may help to identify the potential occurrence of high-risk heterosexual behavior. Although increases in STD or teen pregnancy rates do not directly indicate that HIV exposure is increasing, these measures may indicate an increase in unprotected sex.

Gonorrhea

During 1997–2001, gonorrhea rates for males were consistently higher than those for females (Figure 32). Rates for both males and females increased during that period. Although gonorrhea rates for blacks were approximately 25 times greater than those for whites, rates for both groups increased from 1997 through 2001 (Figure 33).

Figure 32: Trends in Gonorrhea Rates, by Sex
Louisiana, 1997-2001

Figure 33: Trends in Gonorrhea Rates, by Ethnicity
Louisiana, 1997-2001

Gonorrhea rates were highest for persons aged 20–29 years, followed by persons aged 13–19 (Figure 34). In 2001, gonorrhea rates were highest in Region 7 (Shreveport), followed closely by Region 1 (New Orleans). Although gonorrhea rates in all regions generally decreased from 2000 to 2001, rates in the New Orleans region seem to be increasing (Figure 35).

Figure 34: Trends in Gonorrhea Rates, by Age Group
Louisiana, 1997-2001

Figure 35: Trends in Gonorrhea Rates, by Public Health Region
Louisiana, 1997-2001

In 2001, new cases of gonorrhea were diagnosed in every parish in the state: 16 parishes had more than 250 new gonorrhea cases per 100,000 persons in the parish (Figure 36).

Figure 36: Gonorrhea Rates by Parish, Louisiana 2001

The Shreveport region had the highest concentration of new gonorrhea cases: 5 of the 9 parishes had more than 250 new cases. Caddo Parish had the highest gonorrhea case rate of all parishes in the state (753 cases/100,000 persons), followed closely by Orleans Parish (715 cases/100,000 persons).

Syphilis

In 2001, a total of 367 persons statewide were reported with early syphilis (primary, secondary, or early latent), which represented a 17% decrease from the number of cases reported in 2000. Cases were reported in 33 of the 64 parishes and were concentrated in the southeastern part of the state. Seven parishes reported more than 20 cases of early syphilis per 100,000 residents (Figure 37).

Figure 37: Early Syphilis Rates by Parish, Louisiana 2001

During 1998–2001, the rates of primary and secondary syphilis were higher for males than for females (Figure 38). However, syphilis rates for males and females have decreased significantly since 1998. This decrease may be due in part to enhanced outreach, screening, and partner notification, which are part of Louisiana's CDC-funded Syphilis Elimination Project.

Figure 38: Trends in Syphilis Rates, by Sex
Louisiana, 1997-2001

Historically, the rates of syphilis in Louisiana have been much higher for blacks than for whites; however, the disparity in rates has narrowed in recent years (Figure 39). In 1997, rates were 31 times higher for blacks than for whites. In 2001, rates were 17 times higher for blacks. Rates in both groups decreased during 1999–2001.

Figure 39: Trends in Syphilis Rates, by Ethnicity
Louisiana, 1997-2001

Syphilis rates were highest for persons aged 20–29 years and lowest for persons aged 40 or more. Rates for persons in all age groups decreased from 1998 through 2001 (Figure 40).

Figure 40 Trends in Syphilis Rates, by Age Group
Louisiana, 1997-2001

Pregnancy Rates for Teenagers

During 1996–2000, overall pregnancy rates for teenagers decreased 6% (data were not available for 2001). However, in 2000, the pregnancy rate of 62.5 per 1,000 in Louisiana was still well above the national rate of 48.5 per 1,000. The pregnancy rate has decreased more for white teenagers (8%) than for black teenagers (5%). Pregnancy rates for black teenagers continue to be twice as high as rates for white teenagers.

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