Rural Center for AIDS/STD Prevention

RAP Time

(Volume 2, No. 6, June 5, 1998)

Issue Contents

Greater Distance from HIV Health Care Predicts Continued Sexual Risk Behavior

A survey of females and males throughout Wisconsin showed that greater geographic distance from health care providers predicted unprotected sexual intercourse in the past six months. Given that rural residents are typically isolated from HIV care specialists, this finding implies that rural HIV positive persons may continue to have unprotected sex after an HIV/AIDS diagnosis.

Description of the Sample
Study participants were 277 HIV positive females and males in Wisconsin, with 29 percent indicating rural residence. Eighty percent of the sample was male. Seventy-one percent were white and 19 percent were black, with the remainder being other race/ethnicity. Forty-one percent were HIV positive without symptoms, 23 percent were HIV positive with symptoms, and 36 percent had an AIDS diagnosis.

Collection of Data
AIDS Service Organizations throughout Wisconsin agreed to distribute anonymous questionnaires to their clients either by mail or during in-home visits.

Outcomes of the Study
Forty-eight percent of the male respondents reported no male sex partners in the past six months, with 25 percent, 7 percent, and 20 percent reporting one male partner, two male partners, or at least three male partners, respectively. Eight percent of the men reported sex with a female partner in the past six months.

Forty-six percent of the females reported no male sex partners in the past six months, with 41 percent and 13 percent reporting one male partner and at least two male partners, respectively. Of those having sex in the past six months, about one-half of both females and males always used condoms. About one-quarter of both genders reported rarely or never using condoms.

Seventy-two percent were high risk (self-report of one or more unprotected sexual encounters in the past six months). Younger age, less education, and lack of HIV-related symptoms predicted continued high-risk sexual behavior. Three other factors contributed to predicting high or low risk behavior:

  • Living with the sex partner increased the odds of risky sex by more than three times.
  • Persons not having negative symptoms from treatment were more likely, by 70 percent, to practice risky sex.
  • Living a greater distance from the health care provider increased the odds of risky sex by nearly 60 percent.

Implications for Prevention
Prevention efforts aimed at HIV positive persons should be an important component of HIV prevention programs. Reducing high-risk behavior among those HIV-infected would greatly contribute to reducing HIV incidence. Minimizing barriers to care, such as geographic distance, is one possible method of lowering the odds of risky sexual behavior among HIV positive persons in rural areas. Further, HIV and AIDS health care should be extended into rural areas.

SOURCE: Heckman, T. G., Kelly, J. A., & Somlai, A. M. (1998). Predictors of continued high-risk sexual behavior in a community sample of persons living with HIV/AIDS. AIDS and Behavior, 2, 127-135.

CDC Issues HIV/AIDS Surveillance Report for 1997

About 60,000 cases of AIDS were diagnosed in the United States in 1997, a decline of more than 8,000 cases compared to 1996. However, the proportion of AIDS cases among blacks and Hispanics continue to rise.

The new data indicate that black and Hispanic males are 7.3 and 3.5 times more likely, respectively, to be diagnosed with AIDS than white males. Further, black and Hispanic females are 19.6 and 7.2 times more likely, respectively, to be diagnosed with AIDS than white males.

Cases of AIDS diagnosed in 1997 bring the cumulative number of U. S. AIDS cases to more than 641,000. Heterosexual contact was the leading cause of HIV infection in women diagnosed with AIDS (38%) and only a minor cause of HIV infection in men diagnosed with AIDS (7%). Injection drug use continues to be a significant source of HIV infection in both sexes (32% for females and 22-27% for males). Sex between men remains the leading cause of HIV infection among men diagnosed with AIDS (45-50%).

SOURCE: CDC. (1997). HIV/AIDS surveillance report, 9 (2).

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Heterosexual Repertoire is Related to Same-Sex Experience

Telephone interviews with 356 white-Americans (WA) and 140 black-Americans (AA) were conducted to assess relationships between heterosexual behaviors and history of same-sex partners.

WA were more likely than AA to report engaging in both vaginal and oral sex and AA were more likely than WA to report only vaginal sex. About five percent of both WA and AA reported anal, oral, and vaginal sex.

Those having anal, oral, and vaginal sex with their most recent partner were more than eight times as likely to also report a history of same-sex relationships. Those having anal, oral, and vaginal sex were nearly three times more likely to also report that their current relationship was not monogamous.

Persons in same-sex relationships were likely to have more frequent vaginal sex. Among WA, increased condom use was related to vaginal and oral sex and decreasing use was related to vaginal sex only.

SOURCE: Foxman, B., Aral, S. O., & Holmes, K. K. (1998). Heterosexual repertoire is associated with same-sex experience. Sexually Transmitted Diseases, 25, 232-242.

Study Measures Prevalence of Chlamydia in United States

A national probability sample of 1144 persons 12 to 39 years of age indicated that prevalence of Chlamydia was 7 percent for non-Hispanic blacks, 3 percent for Mexican-Americans and 2 percent for non-Hispanic whites. In all three groups, prevalence was higher for women than men. Prevalence rates were highest for those 15 to 24 years of age.

SOURCE: Mertz, K. J. et al. (1998). A pilot study of the prevalence of Chlamydial infection in a national household survey. Sexually Transmitted Diseases, 25, 225-228.

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Oral HIV Testing Acceptable to Gay Men

A survey of 118 gay men in bars indicated that 64 were willing to take the Orasure test for HIV. Ninety-two percent of those who were tested indicated comfort using the Orasure test.

SOURCE: Sy, F. (1998). The acceptability of oral fluid testing for HIV antibodies: A pilot study in gay bars in a predominantly rural state. Sexually Transmitted Diseases, 25, 211-215.