Rural Center for AIDS/STD Prevention

RAP Time

(Volume 2, No. 7, July 3, 1998)

Issue Contents

Heterosexual HIV Transmission Increasing Among Young Adults in the United States

Analysis of AIDS cases for U.S. men and women born between 1960 and 1974 indicates specific trends in the HIV epidemic between 1983 and 1993. Prevalence of HIV infection for persons 18-27 declined by 14 percent between 1988 and 1993.

Increased prevalence rates did occur for heterosexuals as compared to a slowing of HIV incidence among men who have sex with (MSM) and injection drug users (IDUs). Increases were particularly likely among women and minorities.

Description of the Sample and Methodology
Subgroups of adolescent and adult AIDS cases reported to the Centers for Disease Control and Prevention (CDC) were analyzed by years of birth. Cases attributed to perinatal transmission or blood transfusion were excluded.

AIDS was defined according to the 1987 CDC definition. Persons were classified as heterosexually infected if they reported heterosexual contact with a person with AIDS or HIV infection or a person belonging to an established HIV risk group. All estimates were inflated by 18 percent to adjust for AIDS cases that are never reported to CDC.

Outcomes of the Study
In 1992, about 22,000 men and women born between 1965 and 1974 became infected with HIV. Of these, about 43 percent were MSM, about 20 percent were IUDs, and about 34 percent were infected through heterosexual contact. Seventy-three percent were black or Hispanic and 28 percent were women.

In contrast, HIV incidence attributed to heterosexual contact was stable or increased in persons of successively younger age groups. Increases were reported by gender, race, and ethnicity. For example:

  • Black women had the highest incidence of HIV infection from heterosexual contact. Fifteen black women and three Hispanic women were infected for each white women.
  • For females born between 1970 and 1974, heterosexual transmission of HIV accounted for about 52 percent of the HIV prevalence in 1988 and about 72 percent in 1993. Similar findings occured for persons born between 1965 and 1969.
  • For males born between 1970 and 1974, heterosexual transmission of HIV accounted for about three percent of the HIV prevalence in 1988 and about 10 percent in 1993. Similar findings occured for persons born between 1965 and 1969.

A higher proportion of HIV-infected youth (about 1 in 3) had acquired HIV heterosexually than all HIV-infected persons in the U.S. (about 1 in 7).

Implications for Prevention
Despite some prevention success, the rate of heterosexual transmission in young minority persons is a particular concern. Prevention can be strikingly effective in young persons, as demonstrated by the marked decline in HIV prevalence in young white men. Special efforts should be made to prevent heterosexually acquired HIV infection among young women and minorities.

SOURCE: Rosenberg, P. S., & Biggar, R. J. (1998). Trends in HIV incidence among young adults in the United States. Journal of the American Medical Association, 279, 1894-1899.

Teen Males Have Lower Risk of HIV/STD Infection

Results from the National Survey of Adolescent Males indicate that those 15-19 years old were less likely to be sexually experienced in 1995 as contrasted to similar subjects in 1988. Of 1710 males interviewed in 1995, 55 percent had ever had sexual intercourse versus 60 percent in 1988.

Consistency of condom use increased between 1988 and 1995. The average percentage of times a condom was used in the last year was 69 percent in 1995 as compared to 56 percent in 1988. The increase was signficant for whites and blacks but not Hispanics.

The proportion always using condoms increased from 33 percent in 1988 to 45 percent in 1995.

The trends suggest that youth can both reduce sexual activity and increase use of condoms. These findings are meaningful in light of criticism that efforts to promote condom use might lead to more sexual activity.

SOURCE: Sonenstein, F. L., et al.(1998). Changes in sexual behavior and condom use among teenage males: 1988 to 1995. American Journal of Public Health, 88, 956-959.

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Sexual Coercion and Harrasment Related to Greater HIV Risk

Results from a national probability sample of 2000 U.S. men and women indicated a relationship between ever being sexually coereced/harrased and risky behavior for HIV infection.

Sexual harrasment was related to greater HIV risk behavior for men and sexual coercion was related to greater HIV risk behavior for women. For each gender who was harrased, about two-thirds never used condoms.

Twenty-six percent of those sexually coerced reported HIV risk in contrast to 13 percent never coerced. For each gender who was coerced, about two thirds never used condoms. Study results suggest that men who have been sexually harrassed and women who have been sexually coerced are likely to be at risk for HIV infection, and should be considered in prevention efforts. Persons sexually harrased or coerced may have difficulty with long-term relationsihps or may be prone to having sexual relationships with a non-monagamous partner.

SOURCE: Choi, K-H, et al. (1998). Sexual harrasment, sexual coercion, and HIV risk among U. S. adults 18-49 years. AIDS and Behaivor, 2, 33-40.

Rural Residence Increases Risk of Congenital Syphilis

A study shows that fewer prenatal visits, rural residence, and previoius pregnancy loss each increased the odds of congenital syphilis. Rural residence doubled the risk of congenital syphilis.

SOURCE: Mobley, J. A., et al. (1998). Risk factors for congenital syphilis in infants of women with syphilis in South Carolina. American Journal of Public Health, 88, 597-602.

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Timing of First Coitus Differs

The sampled teenagers had a median age of first sexual intercourse of 16.9 years (15.0 for black males and 18.1 for Asian American males). White and Hispanic males and white and black females reported similar ages (16.5 years). The median age for Hispanic females was 17.3 years. No age was reported for Asian American females.

SOURCE: Upchurch, D. M., et al. (1998). Gender and ethnic differences in the timing of first sexual intercourse. Family Planning Perspectives, 30, 121-127.