Rural and Nonrural African American High School Students and STD/HIV Sexual-Risk Behaviors

Compared to adults, adolescents in the United States are disproportionately infected with STDs, including HIV. Among adolescents, African Americans are particularly at risk. Despite widespread recognition that African-American adolescents represent a priority for interventions designed to reduce the risk of STD/HIV, studies have not assessed differences in STD/HIV sexual-risk behaviors between rural and nonrural African-American adolescents. The purpose of this analysis is to examine differences in STD/HIV sexual-risk behaviors and selected antecedent factors among a nationally representative sample of rural and nonrural African-American high school students in the United States.

Data from CDC's 1999 Youth Risk Behavior Survey were used for this analysis. The YRBS biannually measures the prevalence of 6 categories of priority health-risk behaviors among youth through representative national, state and local surveys. The 1999 YRBS is a school-based survey employing a 3-stage cluster design yielding a nationally representative sample of students in grades 9 through 12 in private and public schools. In the first stage, counties were selected. The second and third stages consisted of selecting schools and intact classes of students, respectively. All students in the selected classes were eligible to participate in the survey. To enable separate analysis of data, African-American and Hispanic adolescents were purposefully oversampled. Randomly selected classrooms of students completed an 88-item questionnaire, administered by trained data collectors. Parental consent was obtained prior to survey administration. The student participation rate was 86 percent.

Approximately 16 percent of the sample attended rural high schools, with the remaining participants attending urban and suburban high schools. The sample was 2,083 African-American female high school students (359 rural and 1,724 nonrural), and 1,893 African-American male high school students (304 rural and 1,589 nonrural). The mean age for males was 16.29. The mean age for females was 16.6. The sample was equally distributed across each of the 4 high schools.

Among those who reported ever having sex, the median age of first intercourse was 13 years old for males and 14 years old for females. Females reported a median of 2 lifetime partners, whereas males reported a median of 4. The median number of partners over the past 3 months was 1 for both genders. Compared to their nonrural counterparts, rural African-American adolescent females were 46 percent more likely to report ever having sexual intercourse, 44 percent more likely to initiate sex before age 15, 38 percent more likely to have a lifetime number of at least 3 sexual intercourse partners, 80 percent more likely to have more than one sexual partner in the past 3 months, and 34 percent more likely to report they had not used a condom during their last intercourse experience. Compared to their nonrural counterparts, rural African-American adolescent males were 65 percent more likely to report ever having sexual intercourse and 96 percent more likely to report they had not used a condom during their last intercourse experience.

The findings indicate that, overall, the rural African-American female students engaged in greater level of sexual-risk behaviors than did their nonrural counterparts. Fewer differences in sexual-risk behaviors between rural and nonrural males were found. However, in analyses of females and of males, all of the significant differences observed suggested greater risk for the rural adolescents. Thus, the findings indicate rural high school students, particularly females, may experience an increased risk of STD/HIV infection in comparison to their nonrural peers. The findings of this analysis suggest that rural African-American adolescent females and males would benefit from behavioral intervention programs designed to reduce their risk of potential infection with STDs, including HIV.

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