IDSA Report: Coverage of 2004 IDSA Meeting

Condom use inconsistent for high-risk heterosexuals

Survey conducted in 10 states

Researchers at the Centers for Disease Control and Prevention (CDC) have concluded that safe sex messages continue to be ignored by many high-risk individuals.

"We know that correct and consistent use of condoms can prevent HIV and sexually transmitted diseases (STDs), and there are a lot of people who are not getting that message or who are choosing not to use that information," says Kathleen M. Gallagher, DSC, MPH, CDC epidemiologist. The study was presented at the recent 2004 annual meeting of the Infectious Diseases Society of America, held Sept. 30 to Oct. 3, 2004, in Boston.

And the people who are not consistently engaging in safe sex include those who visit STD clinics, where the message should be readily available, she says.

CDC investigators analyzed 2002 data from the HIV Testing Survey, an anonymous, cross-sectional study in 10 different states of three different at-risk populations: injection drug users, men who have sex with men (MSM), and high-risk heterosexuals, Gallagher explains.

"For this study, we focused on high-risk heterosexuals, who were recruited at STD clinics," she says. "Then we collected patient information about sexual and drug-use behaviors that could ultimately result in HIV transmission."

In all, 1,225 heterosexuals were included in the study, and of this population, 54% were male, 61% were black, 12% were white, and 17% were Hispanic. Also, 61% were between the ages of 18 and 24, although the age ranged up to 50, adds Gallagher.

"We looked at the respondents and saw how many had sex with their primary partner and how many with nonprimary partners," she says.

About 61% reported sex with primary partners within the past 12 months, and most of these people reported inconsistent condom use with those partners. Another 51% reported having sex with a nonprimary partner during the same 12 months prior to the interview, and 64% of those patients reported inconsistent condom use, Gallagher points out.

"So the message is there’s a lot of inconsistent condom use, and this obviously could increase the risk for HIV transmission, especially among heterosexuals," she says.

"Some of the data are consistent with other studies," Gallagher adds. "For example, other studies have shown that people are usually better at using condoms with nonprimary partners, and these findings were consistent with that."

Investigators did not ask about the HIV status of partners or their knowledge of HIV status, and this information might offer an explanation for the finding of inconsistent condom use among primary partners, she notes.

"If they’re negative and their partner is negative, maybe they don’t feel it’s necessary," she says.

"This has come up in many other studies." However, the study found that 35% of respondents reported having sex both with a primary partner and with a nonprimary partner, adds Gallagher.

"These are people who are having more than one sex partner during a 12 month period, and we don’t know if they are serial partners," she explains. "At least for some of those people, it’s likely they have both a primary and a nonprimary partner at the same time, but we haven’t been able to quantify that."

More consistent use with younger people

Another interesting finding was that people who were younger tended to use condoms more consistently, Gallagher notes. "We saw a statistically significant increase in inconsistent condom use with age."

Investigators did include questions about HIV prevention messages, but haven’t analyzed those data, she adds.

"I think we realize that this is a significant population for prevention messages for a couple of reasons," Gallagher says. "One is that if you look at HIV and AIDS statistics that the CDC publishes annually, you’ll see over time there’s been a steady increase in cases attributed to heterosexual transmission, and this particularly is true of female cases."

CDC scientists know that trend is something that needs to be followed and the CDC has given out funding to community-based organizations (CBOs) to target heterosexuals at risk for HIV, she says.

"Of the 141 directly funded CBOs, 63 receive money for targeting heterosexuals, so there are prevention programs out there," Gallagher adds.