Hallfors DD, Iritani BJ, Miller WC, et al. Sexual and drug behavior patterns and HIV and STD racial disparities: The need for new directions

Pacific Institute for Research and Evaluation, Chapel Hill, NC, USA.
American Journal of Public Health (Impact Factor: 4.23). 02/2007; 97(1):125-32. DOI: 10.2105/AJPH.2005.075747
Source: PubMed

ABSTRACT We used nationally representative data to examine whether individuals' sexual and drug behavior patterns account for racial disparities in sexually transmitted disease (STD) and HIV prevalence.
Data were derived from wave III of the National Longitudinal Study of Adolescent Health. Participants were aged 18 to 26 years old; analyses were limited to non-Hispanic Blacks and Whites. Theory and cluster analyses yielded 16 unique behavior patterns. Bivariate analyses compared STD and HIV prevalences for each behavior pattern, by race. Logistic regression analyses examined within-pattern race effects before and after control for covariates.
Unadjusted odds of STD and HIV infection were significantly higher among Blacks than among Whites for 11 of the risk behavior patterns assessed. Across behavior patterns, covariates had little effect on reducing race odds ratios.
White young adults in the United States are at elevated STD and HIV risk when they engage in high-risk behaviors. Black young adults, however, are at high risk even when their behaviors are normative. Factors other than individual risk behaviors and covariates appear to account for racial disparities, indicating the need for population-level interventions.

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    • "High-risk sex among African American youth has been found to be more prevalent when compared to other racial and ethnic groups (Centers for Disease Control and Prevention 2012a, b). However, other factors, beyond individual risk behaviors, may explain this high risk behavior among African American youth (Hallfors et al. 2007; Halpern et al. 2004). Among low-income African Americans , high-risk sex may reflect attempts to survive depressed economic conditions. "
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    ABSTRACT: African American women at increased risk of HIV/sexually transmitted infection (STI) may engage in risky sex as a coping mechanism for depressed economic conditions. This study examines the association between high-risk sexual behavior and structural determinants of sexual health among a sample of young African American women. 237 young African American women (16-19 years old) from economically disadvantaged neighborhoods in North Carolina were enrolled into a randomized trial testing the efficacy of an adapted HIV/STI prevention intervention. Logistic regression analyses predicted the likelihood that young women reporting lack of food at home, homelessness and low future prospects would also report sexual risk behaviors. Young women reporting a lack of food at home (22 %), homelessness (27 %), and low perceived education/employment prospects (19 %) had between 2.2 and 4.7 times the odds as those not reporting these risk factors of reporting multiple sex partners, risky sex partners including older men and partners involved in gangs, substance use prior to sex, and exchange sex. Self-reported structural determinants of sexual health were associated with myriad sexual risk behaviors. Diminished economic conditions among these young women may lead to sexual risk due to hopelessness, the need for survival or other factors.
    American Journal of Community Psychology 08/2014; 54(3-4). DOI:10.1007/s10464-014-9668-9 · 1.74 Impact Factor
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    • "• In 2008, 22% of New York City (NYC) new HIV diagnoses (3,809) were attributable to heterosexual transmission (NYC DOHMH, 2009) • Disproportionately affects women ‐ 72% of new HIV diagnoses in women • Sexual risk behaviors and sexually transmitted disease (STD) cofactors alone do not explain the heterosexual spread of HIV (Hallfors, DD et al., 2007) • Sex partner concurrency may help to explain variation in the heterosexual spread of HIV and other STDs, e.g., in sub‐Saharan Africa and US urban areas "
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    ABSTRACT: Inconsistent findings on the relationship of sex partner concurrency to infection with HIV and other sexually transmitted diseases (STDs) may result from differences in how sex partner concurrency is conceptualized. We examine the relationship of reciprocal sex partner concurrency (RSPC) to diagnosed STDs among heterosexuals. Heterosexually active adults (N = 717) were recruited for a cross-sectional study using respondent-driven sampling (RDS) from high-HIV-risk areas in New York City (NYC, 2006-2007) and interviewed about their sexual risk behaviors, number of sex partners, last sex partners, and STD diagnoses (prior 12 months). RSPC was when both the participant and her/his last sex partner had sex with other people during their sexual relationship. Odds ratios (OR), adjusted odds ratios (aOR), and 95 % confidence intervals (95%CI) were estimated by logistic regression. The sample was 52.4 % female, 74.3 % Black; median age was 40 years. RSPC was reported by 40.7 % and any STD diagnoses by 23.4 %. Any STDs was reported by 31.5 % of those reporting RSPC vs. 17.9 % of those who did not (OR = 2.11, 95%CI = 1.49-3.0). Any STDs was independently associated with RSPC (aOR = 1.54, 95%CI = 1.02-2.32), female gender (aOR = 2.15, 95%CI = 1.43-3.23), having more than three sex partners (aOR = 1.72, 95%CI = 1.13-2.63), and unprotected anal sex (aOR = 1.65, 95%CI = 1.12-2.42). Heterosexuals in high-HIV-risk neighborhoods in sexual partnerships that involve RSPC are at greater risk of STDs and, potentially, HIV. RSPC, in addition to sexual risk behaviors and the number of sex partners, may facilitate the heterosexual spread of HIV through STD cofactors and linkage into larger STD/HIV sexual transmission networks.
    Journal of Urban Health 06/2012; 90(5). DOI:10.1007/s11524-012-9727-1 · 1.94 Impact Factor
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    • "Moreover, research in other behavioral domains, such as romantic relationship formation [13], suggests that early sexual patterns may have important implications for promoting sexual health. From a practical standpoint, further delineation of sexual patterns—and sociodemographic differences in these patterns—is therefore critical to identifying interpersonal and behavioral contexts that may contribute to reproductive and sexual health disparities [14] [15]. "
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    ABSTRACT: Although the emergence of sexual expression during adolescence and early adulthood is nearly universal, little is known about patterns of initiation. We used latent class analysis to group 12,194 respondents from waves I and IV of the National Longitudinal Study of Adolescent Health (Add Health) into one of five classes based on variety, timing, spacing, and sequencing of oral-genital, anal, and vaginal sex. Multinomial logistic regression models, stratified by biological sex, examined associations between sociodemographic characteristics and class membership. Approximately half of respondents followed a pattern characterized predominately by initiation of vaginal sex first, average age of initiation of approximately 16 years, and spacing of >1 year between initiation of the first and second behaviors; almost one-third initiated sexual activity slightly later but reported first experiences of oral-genital and vaginal sex within the same year. Classes characterized by postponement of sexual activity, initiation of only one type of behavior, or adolescent initiation of anal sex were substantially less common. Compared with white respondents, black respondents were more likely to appear in classes characterized by initiation of vaginal sex first. Respondents from lower socioeconomic backgrounds were more likely to be in classes distinguished by early/atypical patterns of initiation. A small number of typical and atypical patterns capture the emergence of sexual behavior during adolescence, but these patterns reveal complex associations among different elements of emerging sexuality that should be considered in future research.
    Journal of Adolescent Health 05/2012; 50(5):456-63. DOI:10.1016/j.jadohealth.2011.09.006 · 2.75 Impact Factor
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