Rural Center for AIDS/STD Prevention

RAP Time

(Volume 3, No. 3, March 5, 1999)

Issue Contents

Rates of Condom Use At Last Sex by U.S. Adults Lower in Rural Communities

The assessment of condom use and its correlates is necessary for designing and evaluating effective HIV prevention programs. Results from a recent national study indicated the percent of persons using condoms during last sex. Several demographic and behavioral factors were correlated with condom use.

Sample and Methodology
Data were analyzed from the National Household Survey of Drug Abuse, an annual household probability sample of non-institutionalized persons 12 years of age or older that measures the use of illicit drugs, alcohol and tobacco. A personal behaviors module included questions concerning sexual activity in the past year, including condom use. This analysis involved 10,025 adults aged 18-59. The analysis was conducted to describe the frequency of condom use among United States adults and to determine how this varies by type of sex partner and by respondent traits.

Outcomes of the Study
Ninety-five percent of the sample reported they last had sex in the context of an ongoing relationship, with about 19% reporting condom use during most recent intercourse. Among respondents reporting last sex within a casual relationship, about 62% reporting using a condom.

Other major findings were:

  • Of those reporting last sex in an ongoing relationship, 21.2% residing in a large metropolitan area, 17.5% residing in a small metropolitan area, and 15.5% residing in a nonmetropolitan area used a condom at last sex.
  • Of those reporting last sex in a casual relationship, 68.9% residing in a large metropolitan area, 58.5% residing in a small metropolitan area, and 51.4% residing in a nonmetropolitan area used a condom at last sex.
  • About 10% of respondents reporting last sex in an ongoing relationship indicated that condoms were used for disease prevention as opposed to pregnancy prevention or for other reasons.
  • More than 20% of those reporting last sex in a casual relationship indicated that condoms were used for disease prevention instead of pregnancy prevention or for other reasons.
  • Among persons in ongoing relationships, condom use was higher for respondents who were younger, black, and of lower income.
  • Forty percent of unmarried adults used a condom at last sex, compared with the health goal of 50% for year 2000.
  • Forty percent of injecting drug users used condoms at last intercourse, compared with the 60% condom use objective for high-risk individuals.

Persons at increased risk for HIV from their sexual behavior or drug use were not more likely to use condoms than were persons not at increased risk. Rates of condom use in rural areas were lower than in metropolitan areas. Rural HIV/STD prevention education programs should promote condom use for persons in both ongoing and casual relationships.

SOURCE: Anderson, J. E., et al. (1999). Condom use and HIV risk behaviors among U.S. adults: Data from a national survey. Family Planning Perspectives, 31, 24-28.

Greater Coital History Related to Bacterial STDs in Women

Data from 9,882 sexually active women who participated in the 1995 National Survey of Family Growth describe the characteristics of women who report a history of infection with a bacterial STD or of treatment for PID. The sample was 80% white and 14% black, with 55% currently married.

Overall, 6% and 8% of sexually active women reported a history of bacterial STD and PID, respectively. Women who first had sexual intercourse before age 15 were nearly four times as likely to report a bacterial STD, and more than twice as likely to report PID, as were women who first had sex after age 18.

Having more than five lifetime sexual partners also was associated with both having an STD and having PID. PID was more common among women reporting a history of a bacterial STD (23%) than among women who reported no such history (7%).

SOURCE: Miller, H. G., et al. (1999). Correlates of sexually transmitted bacterial infections among U.S. women in 1995, Family Planning Perspectives, 31, 4-10, 23.

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Having Sex While High Related to Substance Abuse and STD History

In a study of 366 persons in a program for those convicted of driving under the influence, those with a substance abuse problem were more likely to have sex while high on alcohol or drugs. Subjects were mostly white (93%) and male (80%), with nearly 10% reporting a prior STD.

The likelihood of having sex while high without condoms always being used was more than 70% greater among those with an established substance abuse problem, nearly 80% greater among those who reported regular use of alcohol or drugs before age 18, and about 2.6 times greater among those who reported trying two or more different drugs in their lifetime.

Having sex while high without condoms always being used was significantly associated with increased likelihood of reporting a history of STD infection. Having sex while high may be an important behavior to address to prevent STDs in the DUI population.

SOURCE: Siegal, H. A., et al. (1999). Under the influence: Risky sexual behavior and substance abuse among driving under the influence offenders. Sexually Transmited Diseases, 26, 87-92.

School Condom Distribution Did Not Increase Use or Coitus

A recent study conducted at 10 Seattle high schools found that making condoms available through vending machines and school clinics did not increase sexual activity, but also did not increase reported frequency of condom use during last sex.

SOURCE: Kirby, D., et al. (1999). The impact of condom distribution in Seattle schools on sexual behavior and condom use. American Journal of Public Health, 89, 182-187.

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Factors Related to Maintaining Safe Sex Identified

Habitual behavior patterns, in particular sexual practices and use of drugs or alcohol, may more effectively identify those heterosexual HIV serodiscordant couples likely to have difficulty avoiding unsafe sex. Factors related to adopting safe sex may not be relevant to maintaining safe sex.

SOURCE: Shurnick, J. H., et al. (1998). Maintenance of safe sex behavior by HIV-serodiscordant heterosexual couples. AIDS Education and Prevention, 10, 493-505.