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Sexual Behavior and Condom Use -- District of Columbia, January-February 1992

From 1980 through 1990, the cumulative incidence of acquired immunodeficiency syndrome (AIDS) in the District of Columbia (DC) (2713 cases per 100,000 persons) was approximately eight times that of the surrounding metropolitan area (340 per 100,000) (1). From 1980 through 1986, the AIDS epidemic primarily involved men who had sex with men; since 1986, the incidence of AIDS has been increasing among injecting-drug users (IDUs) and their sex partners (1). Although AIDS incidence in DC has been projected to increase by 34% from 1990 to 1994 (1), patterns of sexual behavior and condom use are unknown among homosexual/bisexual men, IDUs, and other heterosexuals in DC and other urban areas with a high incidence of AIDS. To obtain current data on human immunodeficiency virus (HIV)-related knowledge and behavior, the DC Commission of Public Health (CPH) conducted a telephone survey of DC residents regarding HIV-related knowledge, number of sex partners, and condom use during the 1-year period preceding the survey. This report summarizes results of the survey.

During January-February 1992, the DC CPH conducted a telephone survey of residents aged 18-45 years who were contacted through randomly selected telephone numbers. Excluded were government/business telephone numbers, numbers not answered after three attempts, and respondents aged greater than 45 years. Of 1300 persons eligible for interview, 795 (61%) responded. The interviews included questions on number of sex partners, relationship to primary sex partner, sex of sex partner, and condom use (2). Results are reported for 578 non-Hispanic sexually active persons (defined as respondents who were married or who reported having a sex partner during the preceding 12 months); the sample size for Hispanics was too small to include in the analysis. To adjust for unequal sampling probabilities and nonresponse, estimates were weighted by race, sex, and age to the 1990 census population of DC. Statistical comparisons of proportions and logistic regression modeling were used to characterize these data.

Overall, 25% of respondents reported having had two or more sex partners during the previous 12 months. The mean number of partners among all respondents was 1.5 (Table 1, page 397); respondents with two or more partners had an average of 3.2 partners during the preceding year. Respondents who were not in a steady relationship (55%) and respondents who self-rated their HIV risk as "high" or "medium" (55%) were most likely to report multiple partners (Table 1). Men were more likely than women (35% versus 15% (p less than 0.001)), and blacks were more likely than whites (28% versus 20% (p less than 0.001)) to report having had two or more partners.

Overall, 40% of respondents reported always using condoms, and 34% reported never using condoms (Table 1). Among sexually active persons not in a steady relationship, 65% reported always using condoms, and 11% reported never using condoms. Of those who reported having had two or more sex partners, 59% reported always using condoms, and 9% reported never using condoms. Seventy percent of men who had two or more sex partners reported always using condoms, compared with 37% of women.

Based on stepwise multiple logistic regression, which removed variables that did not contribute substantially to the model, the number of sex partners was the strongest predictor of always using condoms (odds ratio (OR)=2.5 for two or more versus one sex partner; 95% confidence interval (CI)=1.7-3.0} (3). Men were almost twice as likely as women (OR=1.9; 95% CI=1.3-2.7) and blacks were almost twice as likely as whites (OR=1.9; 95% CI=1.2-2.8) to report always using condoms. Men who had reported two or more sex partners were substantially more likely to always use condoms than were men with one partner (OR=3.5; 95% CI=2.1-5.9), but women who reported two or more partners were not significantly more likely to use condoms than were women with one sex partner (OR=1.3; 95% CI=0.6- 2.5). College graduates (OR=1.6 for college graduates versus all others; 95% CI=1.0-2.4) and 18-29-year-olds (OR=1.5 for 18- 29-year-olds versus 30-45-year-olds; 95% CI=1.0-2.1) were also independent although marginal predictors of reporting always using condoms.

Reported by: V Kofie, MD, Preventive Health Svcs Administration, District of Columbia Commission of Public Health. A Peruga, MD, AIDS Program, Pan American Health Organization. Behavioral Surveillance Br, Office of Surveillance and Analysis, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: When compared with a 1988 nationwide sample of 18- 45-year-old sexually active men (4), a higher percentage of DC men in 1992 reported having had two or more sex partners during the year (25% versus 35%, respectively). The same survey indicated that the percentage of women nationwide who reported having had two or more sex partners differed little from the percentage of DC women (13% versus 15%, respectively). The findings in the DC study indicate that sexually active men in an urban area such as DC may be more likely to report having had sexual contact with two or more sex partners in the recent past.

The findings in this report also indicate that, in DC, the percentage of persons with multiple partners who reported always using condoms was higher than that reported from a national sample (59% versus 17%, respectively) (5). Although the findings reported here and the national sample measured different age ranges and obtained the same information with different questions, the difference between the results of the two surveys may reflect the higher percentage of college graduates among DC residents in this sample compared with persons nationwide. In addition, because findings in this sample were not weighted for education level, this group may overrepresent college graduates in DC.

This survey is subject to at least three limitations. First, with a sample based on randomly selected telephone numbers, households without telephones (i.e., poorer residents) were not included. Second, persons who are often away from home would have been less likely to have been contacted. Third, this survey was not designed to determine condom use of specific partners. However, use of global measures of condom use such as "always" or "never" should offset recall bias for condom use in regard to different sex partners.

The findings in this report can be used to determine target groups for public health education messages encouraging consistent use of condoms. These messages should be appropriate for the target groups with risk behaviors for HIV infection.

References

  1. Rosenberg PS, Levy ME, Brundage JF, et al. Population-based monitoring of an urban HIV/AIDS epidemic. JAMA 1992;268:495-503.

  2. Kanouse D, Berry SH, Gorman EM, et al. AIDS-related knowledge, attitudes, beliefs, and behaviors in Los Angeles County. Santa Monica, California: RAND, 1991.

  3. SAS Institute, Inc. Statistical Analysis System (SAS), version

  4. Cary, North Carolina: SAS Institute, Inc, 1990.

  5. CDC. Number of sex partners and potential risk of sexual exposure to human immunodeficiency virus. MMWR 1988;37:565-8.

  6. Catania JA, Coates TJ, Stall R, et al. Prevalence of AIDS-related risk factors and condom use in the United States. Science 1992;258:1101-6.

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