Sexual partnership patterns as a behavioral risk factor for sexually transmitted diseases.

CONTEXT: Women's and men's number of sexual partners and protective practices such as condom use can have a direct effect on their risk of contracting sexually transmitted diseases (STDs), including HIV. METHODS: The 1988 and 1995 cycles of the National Survey of Family Growth and five rounds of the General Social Survey conducted from 1988 to 1996 are used to examine women's and men's numbers of recent sexual partners. Levels of direct risk for STDs (two or more partners in the past year) and the social and demographic correlates of multiple partnership are analyzed among women and men. In addition, women's indirect risk for STDs (their partners' involvement with other partners in the past year) is used to estimate their overall risk of STDs through multiple partnerships. RESULTS: At least three-quarters of sexually active U.S. women and men in the late 1980s and mid-1990s had had only one sexual partner in the preceding 12 months. Moreover, there is no indication that the proportion with more than one partner in the past year changed substantially over that period. Nevertheless, combining women's and men's partnership reports suggests that about 17 million women aged 15-44--34% of those sexually active in the past year--were at risk for STDs because of direct exposure to multiple partners (5.4 million), indirect exposure (6.3 million) or both direct and indirect exposure (5.5 million). In all, 21% of women were at direct risk and 23% were at indirect risk. In comparison, among men aged 18-44, 24% were at direct risk for STDs and an unknown proportion were at indirect risk. Multivariate analyses indicated that unmarried individuals, women younger than 40 and men aged 20-29, blacks and women in the South were all at elevated risk for STDs because of multiple partnership. Overall, in 1995, 19% of sexually active women aged 15-44 had used condoms to protect against STDs over the preceding year, and 19% of those sexually active in the three months before the survey were current condom users. Condom use specifically for STD prevention was more common among women reporting both direct and indirect risk for STDs (58%) and among those at direct risk (46%) than among other women; women whose partners put them at indirect risk only were less likely to be current or recent condom users than women who were not at risk or were only at direct risk. CONCLUSIONS: There is a continuing need to educate people regarding their risk for STDs, to increase the use of existing barrier methods and to develop new methods that protect against STD infection. In addition, if we are to develop a better understanding of the extent of STD risk through multiple partnership, the collection of information on number of partners and relationships between partners must be expanded and improved.

PIP: This study examines the effects of sexual partnership patterns and protective practices on the risk of contracting sexually transmitted diseases (STDs), including HIV in the US. Data from the 1988 and 1995 cycles of the National Survey of Family Growth and five rounds of the General Social Survey conducted from 1988 to 1996 were used to examine women's and men's number of recent sexual partners. Included in the analysis are the levels of direct risks for STDs and the social and demographic correlates of multiple partnership among women and men. The results of the analysis revealed that having multiple sexual partners or having a partner who has multiple partners over a relatively short period of time are key behavioral factors that contribute to an individual's risk for STDs. Combining women's and men's partnership reports suggested that about 17 million women aged 15-44 were at risk for STDs because of direct exposure to multiple partners (5.4 million), indirect exposure (6.3 million), or both direct and indirect exposure (5.5 million). Meanwhile, among men aged 18-44, about 24% were at direct risk for STDs and an unknown proportion were at indirect risk. Condom use for STD prevention was more common among women reporting both direct and indirect risk for STDs (58%) and among those at direct risk. The findings in this study indicated that there is a need for continued and increased emphasis on public education concerning the risk factors in STDs, as well as the methods to prevent and control STD infection.

Does the timing of the first family planning visit still matter?

CONTEXT: The timing of a first family planning visit relative to first intercourse can affect the likelihood of an early unintended pregnancy. METHODS: Nationally representative data from the 1982, 1988 and 1995 cycles of the National Survey of Family Growth were used to examine changes in the timing of first family planning visits and to explore the degree to which young women are now more likely than in the past to practice contraception independently of making a visit to a provider. Cox proportional hazards models were used to estimate how background variables, visit status and the initiation of contraceptive use affected risks of unintended pregnancy in the four years preceding each survey. RESULTS: The proportion of women who waited a month or more after their first intercourse to see a provider grew slightly between 1978 and 1995, from 76% to 79%; women waited a median of 22 months after first intercourse in 1991-1995. Any contraceptive use at first intercourse increased among both women who delayed a first visit (from 51% to 75%) and among those whose first visit occurred before their first intercourse or within the same month (from 61% to 91%). Cox proportional hazards analysis suggests that the protective effect of a first family planning visit decreased over the period studied, due in part to the increase in early contraceptive use. CONCLUSIONS: The importance of the first family planning visit appears to be declining, as sexually active young women who delay their first visit increasingly do so because they are already using a provider-independent method (primarily the condom). Thus, a multifaceted approach to providing family planning may now be needed, in which independent method use and visits to providers both play a role.

PIP: The timing of a first family planning visit relative to first intercourse can affect the likelihood of an early unintended pregnancy. Nationally representative data from the 1982, 1988, and 1995 cycles of the National Survey of Family Growth were studied to identify changes in the timing of first family planning visits and to investigate the degree to which young women are now more likely than in the past to practice contraception independently of visiting a provider. The proportion of women who waited a month or more after their first intercourse to see a provider grew from 76% to 79% between 1978 and 1995, with women waiting for a median of 22 months after first intercourse in 1991-95. Any contraceptive use at first intercourse increased among women who delayed a first visit from 51% to 75%, and among those whose first visit occurred before their first intercourse or within the same month from 61% to 91%. The importance of the first family planning visit seems to be declining, as sexually active young women who delay their first visit increasingly do so because they are already using a provider-independent method, mainly the condom. This greater use of the condom is related to the advent of the HIV/AIDS pandemic and the associated broader awareness of condoms' ability to block the transmission of HIV and other STDs.