Condom use and HIV risk behaviors among U.S. adults: data from a national survey

Abstract

Context: How much condom use among U.S. adults varies by type of partner or by risk behavior is unclear. Knowledge of such differentials would aid in evaluating the progress being made toward goals for levels of condom use as part of the Healthy People 2000 initiative.

Methods: Data were analyzed from the 1996 National Household Survey of Drug Abuse, an annual household-based probability sample of the noninstitutionalized population aged 12 and older that measures the use of illicit drugs, alcohol and tobacco. The personal behaviors module included 25 questions covering sexual activity in the past year, frequency of condom use in the past year, circumstances of the last sexual encounter and HIV testing.

Results: Sixty-two percent of adults reported using a condom at last intercourse outside of an ongoing relationship, while only 19% reported using condoms when the most recent intercourse occurred within a steady relationship. Within ongoing relationships, condom use was highest among respondents who were younger, black, of lower income and from large metropolitan areas. Forty percent of unmarried adults used a condom at last sex, compared with the health objective of 50% for the year 2000. Forty percent of injecting drug users used condoms at last intercourse, compared with the 60% condom use objective for high-risk individuals. Significantly, persons at increased risk for HIV because of their sexual behavior or drug use were not more likely to use condoms than were persons not at increased risk; only 22% used condoms during last intercourse within an ongoing relationship.

Conclusions: Substantial progress has been made toward national goals for increasing condom use. The rates of condom use by individuals at high risk of HIV need to be increased, however, particularly condom use with a steady partner.

PIP: The 1996 US National Household Survey on Drug Abuse obtained information on a comprehensive set of sex- and drug-related HIV risk behaviors. The sample was comprised of 9270 adults 18-59 years of age. A total of 21% of respondents (12.1% of married and 40.4% of unmarried adults) reported condom use in their most recent sexual encounter. Condoms were used by 19% of those whose last sexual intercourse occurred within a relationship compared with 62% of those whose last intercourse occurred outside of a relationship. Condom use in the context of a committed relationship was highest among respondents who were 18-25 years old (36.3%), Black (29.9%), low-income (24.2%), and from large metropolitan areas (21.2%) and among those with 2 or more sexual partners in the past year (35.3%). In contrast, condom use at last intercourse outside of an ongoing relationship was higher among males (65.3%), college graduates (66.2%), residents of the northeastern US (73.9%), those living in large metropolitan areas (68.9%), and those with two or more partners (65.5%). When the type of relationship was controlled, adults with HIV risk factors (homosexual sex, 6 or more partners, sex with HIV-infected persons, exchange of sex for drugs or money, use of illegal injection drugs in the past 3 years, crack cocaine use during the past year) were not significantly more likely to use condoms than those without these risk factors. Among individuals with one or more sex- or drug-related HIV risk factor, 22% used condoms during last intercourse within an ongoing relationship and 59.5% used condoms at last coitus in a casual relationship. Among adults with no such risk factors, these rates were 18.6% and 62.9%, respectively. Adoption of condom use by high-risk individuals must be increased, particularly with steady partners.