MedicalResearch.com Interview with:
Dr. Tiffany Aholou
Division of HIV/AIDS Prevention
MedicalResearch.com: What is the background for this study?
Response: Women accounted for 24% of people living with HIV in the United States at the end of 2013 and 19% of HIV diagnoses in 2014. Of these diagnoses, 78% were among black women and Latinas. HIV diagnoses among women are overwhelmingly attributed to heterosexual contact with a person known to have, or to be at high risk for, HIV infection. Of note, new HIV diagnoses among US women declined 40% over a 10 year period (2005-2014), yet we continue to see significant racial/ethnic disparities due largely to a complex web of demographic, individual, social and contextual factors with the environment that enables HIV risk behaviors to occur.
While the decline in new HIV diagnoses among US women is noteworthy, in our review of the literature, we found research studies that specifically focus on women and HIV from a domestic perspective were scarce. To fill this gap and sharpen our understanding about sexual behaviors that are associated with heterosexual transmission of HIV, this study used data from three cycles of the National Survey of Family Growth (2006-2008, 2008-2010, and 2011-2013) to examine HIV-related sexual risk and protective behaviors – concurrent sex partnerships, non-monogamous sex partners, and condom use at either last vaginal sex or anal sex – among sexually active women aged 18-44 years by race/ethnicity and over time.
MedicalResearch.com: What are the main findings?
- Our sample consisted of 13,588 sexually active women aged 18-44 years, representing 48.1 million women in the US.
- Findings show that 1.1% reported concurrent sex partnerships, 10.3% reported male partners whom they perceived were non-monogamous, and 21.1% reported using a condom at either last vaginal or anal sex.
- Concurrent sex partnerships were significantly more likely to be reported by women who were non-Hispanic black, unmarried/single, self-identified as bisexual and who had ≥ 3 opposite-sex partners than women who were married, heterosexuals, and who had one or two partners, respectively; Latinas were significantly less likely to report having concurrent opposite-sex partners.
- Sex with a perceived non-monogamous sex partner was significantly more likely to be reported by non-Hispanic black, unmarried/single and bisexuals when compared to women who were non-Hispanic white, married, and heterosexuals.
- Condom use at either last vaginal or anal sex was significantly higher among Latinas, non-Hispanic black and non-Hispanic other women, unmarried/single, resided in central and other metropolitan/suburban areas when compared to their other female counterparts.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Risk factors such as concurrent sex partnerships and sex with perceived non-monogamous sex partners in the past 12 months were fairly uncommon among our sample of reproductive-aged sexually active women. However, these behaviors were more prevalent among some demographics, namely among non-Hispanic black women. These findings are consistent with other studies that have shown these behaviors to be fueled by social and contextual factors that drive non-Hispanic black women’s risk for HIV, for example mass incarceration of non-Hispanic black men and low male to female sex ratio. To counter concurrent sex partnerships and, and sex with perceived non-monogamous sex partners and the associated risks we recommend engaging women along with male partners early on in prevention efforts.
In terms of protective behaviors, while condom use rates were low among women in our sample, there were some demographics where condom use were more likely to be reported. Primary care physicians and other healthcare clinicians can play a pivotal role in educating women about the importance of ongoing sexual health, such as consistent and correct condom use as protection against pregnancy, HIV and other sexually transmitted infections. They can also consider offering pre-exposure prophylaxis (PrEP) as another prevention option coupled with condoms for women who may have bisexual partners or are in serodiscordant relationships.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: To better understand and explain racial/ethnic HIV diagnosis disparities, we recommend that future studies obtain risk and protective behavior information from women as part of routine surveillance. Furthermore, better access to culturally acceptable and affordable medical and social services may offer improved solutions for addressing HIV among women, especially in non-Hispanic black women and Latinas.
MedicalResearch.com: Is there anything else you would like to add?
Response: It is also important to note that a condom-use goal for all sexually active, unmarried women aged 15-44 has been archived in Healthy People 2020. In light of the low condom use rates, as with men who have sex with men, reinstating a condom-use target goal for women may be a public health priority that merits further consideration.
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Sexual Risk and Protective Behaviors Among Reproductive-Aged Women in the United States.
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