Rural Center for AIDS/STD Prevention

RAP Time

(Volume 3, No. 9, September 3, 1999)

Issue Contents

High-Risk Sexual Behavior Found Among Rural and Small Town HIV-Infected Persons

Possibly some individuals in rural areas and small towns who are aware of their HIV infections continue high-risk behaviors that place their partners at risk for HIV infection. This study examined rates and predictors of high-risk sexual behavior among 79 persons living with HIV/AIDS in nonmetropolitan areas of a Midwestern state.

In late 1995, an anonymous self-report survey assessing health-related variables including sexual behavior was distributed to persons living with HIV/AIDS in communities with populations under 50,000 in Wisconsin.

Outcomes of the Study
Seventy-nine respondents (54 men, 25 women) lived in towns with populations of 50,000 or fewer. Forty-eight respondents (61%) lived in communities with 5000 or less persons. The average age was 36.5 years with most respondents (67%) being White. Forty-four percent were HIV positive but asymptomatic, 27% had HIV illnesses but not AIDS, and 30% had been diagnosed with AIDS. The average participant lived 29.8 miles from a large urban center.

Major findings include:

  • HIV-positive men reported an average of 2.9 different male sexual partners in the preceding 6 months. Sixty-one percent reported no male sexual partners, 18% reported one male sexual partner, and 7% reported three or more male sexual partners during this time. Only 13% reported any female sexual partners in the prior 6 months.
  • Among the sexually active men (n=27), 19% never used condoms, 11% rarely used condoms, 30% used condoms some or most of the time, and 41% always used condoms.
  • Two-thirds of the men were infected by a male sex partner, and 11% did not know how they were infected.
  • HIV-positive female respondents reported an average of 0.84 male sexual partners during the prior 6 months. Forty-eight percent reported no male sexual partners, 40% reported one male sexual partner, and 12% reported two or more male sexual partners during this time.
  • Among sexually active women (n=12), 50% reported that theirintercourse occasions were never or rarely protected by condoms, 33% reported that condoms were used some or most of the time, and 17% reported that condoms were always used.
  • Sixty-eight percent of women said they were infected by a male sex partner, and 12% did not know who infected them.
  • Individuals who were more likely to have unprotected sex lived with their partners, reported higher physical well-being, had poor relationships with their physicians, and more frequently used alcohol and illegal drugs.

Implications for Prevention
As AIDS increases in rural areas and as HIV-infected rural residents live longer, interventions are needed to assist HIV-infected rural individuals who have difficulty avoiding high-risk sexual behaviors.

SOURCE: Heckman, T. G., et al. (1999). High-risk sexual behavior among persons living with HIV disease in small towns and rural areas. Journal of Sex Education and Therapy, 24, 29-36.

Abstinence Has User-Failure Rates of 26% to 86%

Existing research on condom and abstinence method and user-failure rates and the use of this research on determining sexuality education curricula was reviewed.

Latex condoms effectively prevent pregnancies and most sexually transmitted diseases or infections, with method-failure rates between 0.5% and 7%, but with user-failure rates between 12% and 70%.

Total abstinence presumably has a method-failure rate of zero, but research on periodic abstinence indicates user-failure rates between 26% and 86%. No researchers have attempted to establish total abstinence user-failure rates.

Abstinence-only curricula evaluations have demonstrated changes in adolescents' attitudes but little changes in sexual behaviors. Comprehensive sexuality education curricula have demonstrated attitudinal changes and delays in adolescents' sexual activity.

SOURCE: Haignere, C. S., et al. (1999). Adolescent abstinence and condom use: Are we sure we are really teaching what is safe? Health Education and Behavior, 26, 43-54.

Condom Use Teaching in Schools Supported in Rural State

This study assessed public opinion about the promotion, use, and effectiveness of condoms for HIV prevention. Indiana adults were randomly surveyed by telephone in 1998 (n=521) and 1993 (n=688). A stability of opinion from 1993 to 1998 was found.

About three-fourths agreed that Indiana public high schools should educate teenagers about how to use condoms to prevent HIV infection. A strong majority supported the federal government and the three major TV networks promoting condoms.

About one-half agreed that condoms should be made available to teenagers in the Indiana public high schools without parental permission. Nearly all believed that condoms are effective in preventing HIV transmission. About 65% believed that promoting condom use is not the same as promoting sex. Younger and unmarried subjects and condom users were more positive about condom use and promtion.

SOURCE: Yarber, W. L., & Torabi, M. R. (1999). Public opinion from a rural state about condoms for HIV prevention: 1993 and 1998. Journal of Sex Education and Therapy, 24, 56-62.

Adolescents with Alcohol Disorders Have More Risky Sex

This study of 371 adolescent drinkers found that those with alcohol disorders were more likely than other drinkers to be sexually active, to have greater number of sexual partners, and to initiate sexual activity at slighter younger ages. Independent of alcohol group, females were more likely than males to have unprotected sexual encounters.

SOURCE: Bailey. S. L., et al. (1999). Risky sexual behaviors among adolescents with alcohol use disorders. Journal of Adolescent Health, 25, 179-181.

Older Women Knowledgeable about AIDS

This sample of older, predominately White women were quite knowledgeable of transmission factors, but were less knowledgeable about early interventions and their own risk status. Even though they were generally at low risk, they might have been at higher risk than they perceived.

SOURCE: Yates, M. E., (1999). The importance of AIDS-related knowledge for mid-life and older women. AIDS Education and Prevention, 11, 224-231.