Extra-Relational Sex Among Mexican Men and Their Partners' Risk of HIV and Other Sexually Transmitted Diseases

Predominant global AIDS prevention strategies encourage monogamous sexual relationships. However, this strategy has been inadequate for many women. Women's main risk for HIV and other STDs is often their male partners' sexual behavior, and negotiation of safer sex is frequently controlled by men. The current investigation explored the risk of HIV and other STDs among married and cohabiting women in Mexico by estimating the prevalence of men's sexual behavior outside of their primary relationships.

A multistage, stratified probability household survey was conducted in the Mexico City, Mexico, metropolitan area from June 1992 to March 1993 by the National Council for Prevention and Control of AIDS (CONASIDA), at the Mexican Ministry of Health, and the Population Council. Face-to-face interviews were carried out with a 25-minute structured survey. Of 13,713 eligible men, 8,600 men were contacted in person, and only 532 (6 percent) refused to participate, for an overall response rate of 59 percent (n=8,068). Analyses indicated no evidence for bias because of non-response or underreporting. The analysis was restricted to men ages 17 to 60 years who had been married or cohabiting for at least one year and who were sexually active with their wife or cohabiting partner during the year before the survey (n=4,099). Thirty-seven men had been eliminated from the analysis because they reported sex with a secondary partner only. Men who did not supply an answer for the outcome variable extra-relational sex (n=7) or other variables used in the multiple regression analysis (n=102) were removed from the analysis. The final sample size of 3,990 constitutes 97 percent of the originally specified sample. Extra-relational sex was defined as intercourse with more than one female partner during the year before the interview.

Respondents ranged in age from 17 to 60 years (mean=37 years). Eighty-eight percent were married, 31 percent had a primary-school education or less, and 42 percent had at least some university education. Almost half (41 percent) of the respondents were blue-collar workers, and the other half (52 percent) were white-collar workers. Fifteen percent of the married and cohabiting Mexican men reported extra-relational sex. The number of extra-relational partners ranged from 1 to 30. Only three men reported any same-sex sexual behavior during the past year (prevalence=0.1 percent). Of the men who reported extra-relational sex, 28 percent stated that their last sexual partner had been other than their wife or cohabiting partner.

Nine percent of the men who reported extra-relational sex indicated that they used a condom during their last intercourse -- 22 percent if their last sexual partner was a secondary partner and 4 percent if she was the primary partner (P<.001). Condom use rates varied among categories of secondary partners (P<.05). Although few men reported engaging in anal sex during their last sexual activity (n=17), none of these respondents reported using condoms. Condom use was uniformly low across all sociodemographic strata, but a higher education level was associated with condom use with a primary partner, and a white-collar occupation was associated with condom use with a secondary partner.

This investigation explored the degree to which married and cohabiting women in Mexico may be exposed to HIV and other STD risk via the sexual behavior of their male partners. Fifteen percent of the total sample of married and cohabiting men in the Mexico City metropolitan area reported extra-relational sex, so almost 250,000 married and cohabiting men are estimated to have sex with secondary partners over 1 year. If only 5 percent of these men are exposed to an STD, including HIV, and transmit it to their primary partners, more than 10,000 wives and cohabiting partners could be infected each year. It would be possible to protect primary partners, with whom almost no condom use was reported in this study, if condoms were always used with secondary partners. However, findings indicated that condom use rates with secondary partners also were low: less than 25 percent. The combination of substantial amounts of extra-relational sex, minimal condom use, and lack of perceived HIV risk indicates that HIV and other STD prevention efforts that take into account the social context of these risky behaviors are required.

Back to other CDC news for October 16, 2001

Previous Updates