Sociodemographic, Behavioral, and Clinical Correlates of Inconsistent Condom Use in HIV-Serodiscordant Heterosexual Couples

As HIV transmission through heterosexual sex increases, HIV-serodiscordant heterosexual couples are likely to become a significant risk group. Although the per-contact probability of HIV transmission for heterosexual vaginal intercourse is fairly low, the overall risk of transmission compounded over a large number of unprotected sex acts in HIV-serodiscordant couples with long-term relationships may be quite high. Consistent condom use, however, may reduce the risk of sexual HIV transmission in serodiscordant heterosexual couples by as much as 87 percent, as suggested by a published meta-analysis of couples studies.

Obstacles to consistent condom use in heterosexual couples who are aware of their HIV-serodiscordant status have rarely been examined and may be different from barriers to condom use in other populations. The authors examined not only the condom use outcome but also risk factors for inconsistent condom use for the couple as a unit rather than for the individual partners. The present analysis focused on the demographic, clinical, and behavioral risk characteristics of couples associated with inconsistent condom use in the previous six months. The authors investigated whether the consistency of condom use may differ across racial/ethnic, income, education and age groups because of the factors such as different access to and acceptability of condoms and different levels of related knowledge about HIV and other STDs.

Analyses were conducted for a baseline sample of 145 HIV-serodiscordant couples who participated in the California Partners Study II (CPSII) and who had complete information on the key variables of interest. The CPS II was a randomized behavioral risk-reduction intervention trial for heterosexual HIV-serodiscordant couples living in the greater San Francisco Bay area. Sexually active heterosexual HIV-serodiscordant couples were recruited between November 1996 and July 1999 through the commercial media, outreach, and advertising at HIV-related agencies, departments of public health, hospitals, clinics, drug treatment centers, and through related research studies, in an attempt to identify and enroll as many eligible couples as possible. Of 628 individuals who contacted the study to participate, 488 were eligible based on eligibility screening, and 290 individuals completed the CPS II baseline and were confirmed by HIV serology to be in an HIV-serodiscordant relationship with their study partners. All participants received an HIV-antibody test, standard pre- and post-test counseling, and if needed, referrals to HIV/AIDS services.

The median duration of sexual relationship among the 145 couples was 44 months, or approximately 3.5 years. Nineteen couples reported being sexually active together for less than 6 months. Couples reported a median of 30 vaginal sexual contacts and a median of 0 anal sexual contacts with each other within the previous 6 months. In 23 percent of couples, one or both partners reported having had anal sex with each other in the past 6 months. The demographic composition of the baseline sample of 290 individuals was 39 percent African-American, 35 percent white, and 11 percent Hispanic. Of the 145 couples, 46 percent were multiracial (partners of different race/ethnicity) and 29 percent had both African-American partners. The median age of participants was 40 and was similar for HIV-infected, HIV-uninfected, male, and female partners. Of these couples, 32 percent were married, and most (80%) were mutually monogamous in the past 6 months. Substance use was very common; in a third (36%) of couples one or both partners reported injection drug use in the past 6 months.

The author's findings indicate that, despite awareness of their HIV-serodiscordant status, many sexually active heterosexual HIV-serodiscordant couples in the San Francisco area fail to use condoms consistently. In 45 percent of couples in the study, both partners reported having had unprotected sex within the previous 6 months, demonstrating a clear need for risk- reduction interventions in this population. In the present analysis, the independent sociodemographic predictors of inconsistent condom use among HIV-serodiscordant heterosexual couples were a couple's having lower educational status, unemployment, and African-American ethnicity. Couple-level interventions are the natural choice for counseling steady partners to prevent HIV transmission within the couple. Implementation of outreach and targeted HIV prevention and education programs for HIV-serodiscordant couples may contribute to reducing heterosexual HIV transmission in other urban centers.

Back to other CDC news for December 6, 2001

Previous Updates