AJPH
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (17)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Anderson, J. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Anderson, J. E.
Related Collections
Right arrow Other Birth Control
Right arrow HIV/AIDS
Right arrow Prevention
Right arrow Sexual Health
Right arrow Surveys
June 2003, Vol 93, No. 6 | American Journal of Public Health 912-914
© 2003 American Public Health Association

RESEARCH AND PRACTICE

Condom Use and HIV Risk Among US Adults

John E. Anderson, PhD

John E. Anderson is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Ga.

Correspondence: Requests for reprints should be sent to John E. Anderson, PhD, Division of HIV/AIDS Prevention, Mail Stop E-46, Centers for Disease Control and Prevention, Atlanta, GA 30333 (e-mail: jea1{at}cdc.gov).


   INTRODUCTION
TOP
 INTRODUCTION
METHODS
 RESULTS
 DISCUSSION
 References
 
HIV prevention programs seek to increase the use of condoms among persons at risk for acquiring HIV.1 In recent years, the importance of condoms for prevention has remained high as the epidemic has shifted to have more impact on women and persons subject to infection through heterosexual contact.2 Data from surveys indicate increasing condom use among adolescents3–6 and adults7–8 since the 1980s.

I present data on condom use from a nationally representative survey of adults living in the United States—the General Social Survey—for 1996, 1998, and 2000, the first national data, available since the mid-1990s, on condom use among adults; the goal is to measure trends in condom use and to estimate the extent to which persons at increased risk for HIV report using condoms to protect their sexual partners and themselves.


   METHODS
TOP
 INTRODUCTION
 METHODS
RESULTS
 DISCUSSION
 References
 
The General Social Survey has collected information on a variety of topics of social importance annually or semiannually since 1972 from a national household-based probability sample of US adults aged 18 and older.9 Questions on sexual behavior and condom use were asked in 1996, 1998, and 2000 as part of a self-administered questionnaire, and drug use questions were added in 2000. The overall response rates for the main interview of the General Social Surveys have averaged 77%, and since 1996, an estimated 13.7% of the respondents did not complete the selfadministered questionnaire. The data presented here are for 5743 sexually active respondents aged 18 and older interviewed in 1996, 1998, and 2000; the more detailed analysis is for 1786 respondents from the 2000 General Social Survey.

The condom use measure is based on a question on condom use at last sexual intercourse (Table 1Go), similar to questions used on several national surveys.3,5,10,11 Condom use is assessed separately by relationship to last sexual partner, contrasting regular, ongoing partners with other partners, and is presented for major population subgroups defined by demographic and socioeconomic factors as well as by sex- and drug-related HIV risk. Percentages have been computed for population groups, with t tests of differences between categories. Estimates based on survey weighting factors9 have been adjusted with an assumed design effect of 1.3.


View this table:
[in this window]
[in a new window]
  		TABLE 1— Condom Use at Last Sexual Intercourse,a by Partner Type and Year, in Adults Aged 18 and Older Who Were Sexually Active in the Past Year: 1996, 1998, 2000 General Social Surveys
 

   RESULTS
TOP
 INTRODUCTION
 METHODS
 RESULTS
DISCUSSION
 References
 
Condom use during last sexual intercourse was reported by 19.5% of the adults in the 1996, 1998, and 2000 General Social Surveys (Table 1Go). No increase in condom use from 1996 to 2000 was found. As noted in other studies,10–16 condom use was much higher with nonregular sexual partners: 42.9% versus 17.5% for sexual intercourse within ongoing relationships. Among persons whose last sexual intercourse was within a regular relationship, condom use was higher among those who were unmarried, were younger, were Black, had 2 or more sexual partners or not-well-known partners in the past year, or had some degree of HIV risk, whether from sexual or drug use behavior (Table 2Go). Condom use outside of regular relationships was higher among those with some degree of sex risk.


View this table:
[in this window]
[in a new window]
  		TABLE 2— Used Condom at Last Sexual Intercourse, by Relationship Type and Selected Characteristics, in Adults Aged 18 and Older Who Were Sexually Active in the Past Year: 2000 General Social Survey
 
An estimated 4.6% (95% confidence interval = 3.4%, 5.8%) of the 2000 General Social Survey respondents were at increased risk through either sexual or drug-use behavior. As Table 2Go indicates, these at-risk persons were more likely to use condoms with their regular partners (35.8% vs 16.2% for those not at increased risk). This implies that most of the persons at risk (i.e., 64.2%) were not using condoms with their ongoing sexual partners and therefore were placing their partners or themselves at risk for acquiring or transmitting HIV.


   DISCUSSION
TOP
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
References
 
The 1996, 1998, and 2000 General Social Surveys provide the first national data on condom use for adults since the mid-1990s. The 2000 General Social Survey estimate of 35.1% condom use at last sexual intercourse by unmarried adults (95% confidence interval = 30.2%, 40.0%) suggests that Objective 18.4 of Healthy People 2000: National Health Promotion and Disease Prevention Objectives17—to increase this indicator to 50%—was not achieved.

The General Social Survey’s use-at-lastsexual-intercourse approach cannot answer all questions about condom use behavior, but it has some advantages over other techniques: it requires fewer questions, has been found to yield similar results to alternative methods,18 places fewer cognitive demands on respondents,19 and has been used by several national surveys.3,5,10,11 Sensitive behaviors are subject to underreporting on surveys, but the use of a self-administered questionnaire has been found to yield higher reporting than interviewer-administered interviews.20

The General Social Survey provides national estimates at frequent intervals data that is unavailable elsewhere. The picture regarding condom use among adults in the United States is clear. No trend toward greater condom use is apparent in the 1996 to 2000 period. Persons at increased behavioral risk for HIV are more likely than others to use condoms, but most of them are not using condoms with their regular partners. The General Social Survey estimates that 7 to 12 million adults are at increased risk for acquiring or transmitting HIV through risk behavior.21 Increasing safe-sex behavior for these individuals is a priority for prevention programs.1


   Acknowledgments
 
The data presented here are from the public use files of the General Social Survey, which are available from the National Opinion Research Center.

The author would like to acknowledge the contributions of Ronald W. Wilson and Tom Smith in developing the data on which this brief is based.

Human Participant Protection

The data were collected with the informed consent of the respondents following procedures approved by the institutional review board of the National Opinion Research Center.


   Footnotes
 
Peer Reviewed

Accepted for publication July 2, 2002.


   References
TOP
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 References
 
1. HIV Prevention Strategic Plan Through 2005. Atlanta, Ga: Centers for Disease Control and Prevention; January 2001.

2. Karon J, Fleming P, Steketee R, De Cock K. HIV in the United States at the turn of the century: an epidemic in transition. Am J Public Health. 2001;91:1060–1068.[Abstract]

3. Kann L, Kinchen SA, Williams BI, et al. Youth risk behavior surveillance—United States, 1999. MMWR CDC Surveill Summ. 2000;49(5):1–32.[Medline]

4. Everett S, Warren C, Santelli J, Kann L, Collins. JL, Kolbe LJ. Use of birth control pills, condoms, and withdrawal among US high school students. J Adolesc Health. 2000;27:112–118.[ISI][Medline]

5. Sonenstein FL, Ku L, Lindberg LD, Turner CF, Pleck JH. Changes in sexual behavior and condom use among teenaged males: 1988 to 1995. Am J Public Health. 1998;88:956–959.[Abstract/Free Full Text]

6. Santelli J, Lindberg L, Abma J, McNeely C, Resnick M. Adolescent sexual behavior: estimates and trends from four nationally representative surveys. Fam Plann Perspect. 2000;32:156–165, 194.[ISI][Medline]

7. Piccinino L, Mosher W. Trends in contraceptive use in the United States. Fam Plann Perspect. 1998;30:4–10, 46.[ISI][Medline]

8. Catania J, Canchola J, Binson D, et al. National trends in condom use among at-risk heterosexuals in the United States. J Acquir Immune Defic Syndr Hum Retrovirol. 2001;27:176–182.

9. Davis JA, Smith TW. General Social Surveys, 1972–2000: Cumulative Codebook. Chicago, Ill: National Opinion Research Center; 2001.

10. Anderson J, Wilson R, Doll L, Jones T, Barker P. Condom use and HIV risk behaviors among U.S. adults: data from a national survey. Fam Plann Perspect. 1999;31:24–29.[ISI][Medline]

11. Laumann E, Gagnon J, Michael R, Michaels S. The Social Organization of Sexuality. Chicago, Ill: University of Chicago Press; 1994.

12. Tanfer K, Grady WR, Klepinger DH, Billy JOB. Condom use among men. Fam Plann Perspect. 1993;25:61–66.[ISI][Medline]

13. Leigh B, Temple M, Trocki K. The sexual behavior of U.S. adults: results of a national survey. Am J Public Health. 1993;83:1400–1407.[Abstract/Free Full Text]

14. Anderson JE, Brackbill R, Mosher WD. Condom use for disease prevention among unmarried U.S. women. Fam Plann Perspect. 1996;28:25–28.[ISI][Medline]

15. Kost K, Forrest JD. American women’s sexual behavior and exposure to risk of sexually transmitted diseases. Fam Plann Perspect. 1992;24:244–254.[ISI][Medline]

16. Macaluso M, Demand M, Artz L, Hook E. Partner type and condom use. AIDS. 2000;14:537–546.[ISI][Medline]

17. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Washington, DC: US Dept of Health and Human Services; 1991. DHHS publication PHS 91-50212.

18. Anderson J, Rietmeijer C, Wilson R, Barker P. Asking about condom use: is there a standard approach that should be adopted across surveys? In: 1998 Proceedings, American Statistical Association, Section on Survey Research Methods. Alexandria, Va: American Statistical Association; 1998:873–877.

19. Sudman S, Bradburn N, Schwarz N. Thinking About Answers. San Francisco, Calif: Jossey-Bass; 1996:195–196.

20. Turner CF, Lessler J, Devore J. Effects of mode of administration and wording on reporting of drug use. In: Turner C, Lessler J, Gfroerer J, eds. Survey Measurement of Drug Use: Methodological Studies. Washington, DC: Government Printing Office; 1992:177–220. DHHS publication ADM-92-1929.

21. Anderson JE, Stall R. How many people are at risk for HIV in the United States? The need for behavioral surveys of at-risk populations. J Acquir Immune Defic Syndr Hum Retrovirol. 2002;29:104.




This article has been cited by other articles:


Home page
 Sex. Transm. Infect.Home page
S D Mehta, S Moses, K Agot, W Agingu, C Parker, J O Ndinya-Achola, and R C Bailey
Herpes simplex virus type 2 infection among young uncircumcised men in Kisumu, Kenya
Sex. Transm. Inf., February 1, 2008; 84(1): 42 - 48.
[Abstract] [Full Text] [PDF]

Home page
 Eur J Public HealthHome page
C. Signorelli, C. Pasquarella, R. M. Limina, E. Colzani, M. Fanti, A. Cielo, M. Greco, C. P. de' Somenzi, M. Chironna, and M. Quarto
Third Italian national survey on knowledge, attitudes, and sexual behaviour in relation to HIV/AIDS risk and the role of health education campaigns
Eur J Public Health, October 1, 2006; 16(5): 498 - 504.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (17)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Anderson, J. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Anderson, J. E.
Related Collections
Right arrow Other Birth Control
Right arrow HIV/AIDS
Right arrow Prevention
Right arrow Sexual Health
Right arrow Surveys

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2003 by the American Public Health Association