Rural Center for AIDS/STD Prevention

RAP Time

(Volume 3, No. 8, August 6, 1999)

Issue Contents

Rural, Low-Income Women Less Likely to Use Condoms Than Urban Counterparts

AIDS cases among women and adolescent females rose 364% between 1991 and 1997. Heterosexual transmission is the leading cause of HIV infection among women. Despite widespread awareness of the value of latex condoms for HIV prevention, rates of consistent condom use by male partners of women having sex with men remain low.

Because condom use is a negotiated goal for women, reasons for not using condoms to prevent HIV infection should be examined by gender. This study determined the frequency and predictors of condom use and reasons for not always using condoms for HIV prevention among low-income women.

Sample and Methodology
Questionnaires were distributed at 27 Women, Infants, and Children (WIC) program clinics in 21 Missouri counties. To be in the study, the women had to indicate a primary relationship with a male partner.

Outcomes of the Study
Fifty-four percent of the sample (N=2,010) lived in rural counties and the median age was 25 years. Seventy-three percent were White with 23% being Black. Ninety-three percent reported a monthly income of $2,000 or less. The median number of sexual encounters was 8 in the prior 2 months.

Major findings include:

  • Less than 14% reported always using condoms and 67% reported never using condoms during the prior 2 months. Those who were living in rural areas, who were pregnant, and who were either married or cohabiting with a primary male partner were particularly un- likely to use condoms.
  • Seventy-three percent of the rural women reported never using condoms during the past two months, compared to 48% of urban women never using condoms.
  • Ninety-four percent indicated either a very low or no perceived risk of HIV infection.
  • The major reason for not using condoms was a belief that the male partner was not HIV infected, either because she believed he had been tested (46.9%) or because she simply believed that he was HIV negative (26.3%).
  • Other reasons for not using condoms included less sexual pleasure from condom use for both partners, and beliefs that condom use after unprotected sex is not effective.
  • Rural women were more likely than urban women to believe that their male sex partner was HIV negative, despite lack of testing.
  • Being mostly dependent on the male partner's income discriminated between women who always used condoms and those who believed their partner was HIV negative.

Implications for Prevention
The finding that rural women were less likely than their urban counterparts to use condoms suggests that rural women may perceive less threat of HIV infection. HIV education for rural women should emphasize HIV risk in rural areas and work with communities to enhance self-esteem.

SOURCE: Crosby, R. A., et al. (1999). Frequency and predictors of condom use and reasons for not using condoms among low-income women. Journal of Sex Education and Therapy, 24, 63-70.

Free Condom Provision Increases Use Among Those at Risk

A statewide social marketing program in Louisiana made condoms freely available in public health clinics and businesses in areas with high rates of STDs and HIV. Condom use was assessed yearly.

Between 1994 and 1996, more than 33 million condoms were distributed without significant opposition. Self-reported condom use at the last sexual encounter increased among African American (AA) women (from 28% in 1994 to 36% in 1996), particularly AA women with 2 or more sex partners (from 30% to 48%).

Condom use at last sex increased among AA men (from 40% in 1994 to 54% in 1996). The number of reported partners did not increase.

Condom social marketing can be successfully implemented, and the widespread availability of free condoms is related to increased condom use especially among persons at high risk for STDs/HIV.

SOURCE: Cohen, D. A., et al. (1999). Implementation of condom social marketing in Louisiana, 1993 to 1996. American Journal of Public Health, 89, 204-208.

Many HIV-Infected Report Unprotected Sex Since Diagnosis

One hundred and six persons living with HIV/AIDS in Minnesota were surveyed to assess their risk behavior at time of infection, prediagnosis, and postdiagnosis, as well as other issues related to their HIV infection.

Since diagnosis, 24% reported unprotected anal or vaginal sex with a non-HIV positive person, 37% reported infecting others prior to being diagnosed, and 13% reported infecting others postdiagnosis. Suicidal thoughts, shutting down sexually, safer sex, and unprotected sex with HIV-positive individuals were common postdiagnosis behaviors.

Persons at high risk for transmitting HIV to others were younger, more sexually active, more sexually compulsive, less disclosing of their HIV serostatus, more self-perceiving as contaminated, and aware that safe sex was problematic for them.

HIV prevention should target HIV-positive persons.

SOURCE: Rosser, B. R. S., et al. (1999). The unsafe sexual behavior of persons living with HIV/AIDS: An empirical approach to developing new HIV prevention interventions targeting HIV-positive individuals. Journal of Sex Education and Therapy, 24, 18-28.

3 Million Chlamydia trachomatis Infections Estimated in U. S.

The annual incidence of chlamydial infections in the United States among persons 15 to 44 years of age is estimated to be about 3 million. Data from ongoing chlamydia screening and treatment programs in the U.S. indicates that chlamydial infections has decreased since 1988.

SOURCE: Groseclose, S. L., et al. (1999). Estimated incidence and prevalence of genital Chlamydia trachomatis infections in the United States. Sexually Transmitted Diseases, 26, 339-344.

Teens with Much Older Sex Partner at Risk

About 7% of 15-17 year old women have a much older male sex partner. Those women have a low rate of contraceptive use and relatively high rates of pregnancy/birth. Research is needed to assess why some young women have relationships with an older men, and how their partners affect their reproductive health behavior.

SOURCE: Darroch, J. E., et al. (1999). Age differences between sexual partners in the United States. Family Planning Perspectives, 31, 160-167.