Changes in Sexual Behavior and STD Prevalence Among Heterosexual STD Clinic Attendees: 1993-1995 Versus 1999-2000

The researchers examined trends in sex behaviors and STD prevalence over time among heterosexual STD clinic populations from three urban US clinics.

Using a cross-sectional analysis comparing baseline data on risk (self-reported) and STDs (laboratory defined) from two randomized controlled trials, the researchers evaluated counseling efficacy conducted about five years apart: Project RESPECT (1993-95) and RESPECT-2 (1999-2000.)

Although the 2,457 participants from RESPECT and the 3,080 participants from RESPECT-2 were demographically similar, the proportion of participants reporting any unprotected anal sex was much higher in RESPECT-2. Seven percent of women in RESPECT vs. 18 percent in RESPECT-2 reported unprotected anal sex as did 7 percent of men in RESPECT vs. 17 percent in RESPECT-2.

Additionally, a larger percentage of participants reported a new sex partner in RESPECT-2 (women: 43 percent vs. 61 percent; men: 54 percent vs. 72 percent.)

More women reported two or more partners (37 percent vs. 48 percent) and a partner with another concurrent sex partner (19 percent vs. 32 percent).

Slightly more women and men in RESPECT-2 reported two protective behaviors: having an HIV test and any condom use. However, consistent condom use did not differ.

Conversely, the proportion of participants with bacterial STDs (chlamydia, gonorrhea or syphilis) was much lower in RESPECT-2 (women: 24 percent vs. 18 percent; men: 38 percent vs. 24 percent).

The researchers concluded that despite substantial promotion of safer sex behaviors over the past decade, many risk behaviors remained stable over time. Furthermore, some behaviors, such as unprotected anal sex, appeared considerably higher. Finally, even in the absence of widespread behavior change, the prevalence of common bacterial STDs appeared to have decreased significantly.

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