Concurrent Partnerships, Nonmonogamous Partners, and Substance Use Among Women in the United States

摘要

Objectives. We determined the prevalence, distribution, and correlates of US women's involvement in concurrent sexual partnerships, a sexual-network pattern that speeds population-wide HIV dissemination. Methods. We used sexual partnership dates reported by 7643 women in the 2002 National Survey of Family Growth to determine prevalence of concurrent sexual partnerships during the preceding 12 months. We examined associations between concurrency and sociodemographic characteristics and risk behaviors. Results. Prevalence of concurrent partnerships was 5.7% based on reported partnerships and 8.3% after adjustment for possible underreporting. Concurrency was associated with younger age (22 to 24 years: prevalence odds ratio [POR] = 2.44) versus older age (40 to 44 years); marital status (formerly married: POR = 6.56; never married: POR = 3.81; vs married); Black race/ethnicity (POR = 1.78); younger age at first sexual intercourse (12 to 13 years: POR = 2.89) versus 18 years or older); having a nonmonogamous sexual partner (POR = 6.96); having intercourse while “high” on drugs or alcohol (POR = 1.61); binge drinking (POR = 1.70); and crack or cocaine use (POR = 2.72). Conclusions. The association of concurrency with nonmonogamous sexual partners and substance use suggests the existence of extensive sexual networks that link people at higher risk for HIV infection with increased opportunities for disseminating infection. Population-level parameters of sexual behavior are critical determinants of the spread of sexually transmitted infections (STIs), including HIV. 1 Concurrent sexual partnerships (partnerships that overlap in time) have emerged as potentially important determinants of STI dissemination throughout the population. Concurrent partnerships can spread infection through a sexual network faster than the same number of sequential partnerships. 2 – 4 Thus, the extent of concurrency contributes to the distribution of STIs among the population. 1 Our analysis of cycle 5 (1995) of the National Survey of Family Growth (NSFG) reported a 5-year concurrency prevalence of 12% for US women during 1991 through 1995. Women with concurrent partnerships were younger, began having sexual intercourse earlier, and were less likely to be married than were women who did not have concurrent partnerships. 5 That analysis was restricted to the public use data file, however, and therefore did not examine drug use behaviors and other sexual risk behaviors that are key factors in the US epidemic of heterosexual HIV transmission. We recently analyzed the NSFG cycle 6 (2002) public use data file and “omitted items” file, which contains questions concerning drug use and sensitive sexual risk behaviors, to investigate demographic, socioeconomic, and behavioral risk correlates of concurrency among US men. 6 We now present a parallel analysis of concurrent sexual partnerships during the past year for US women interviewed in the NSFG cycle 6. By examining the relationship between concurrency, other sexual and drug use behaviors, and social and demographic characteristics, we aimed to further characterize aspects of sexual networks among US women that promote the spread of HIV and other STIs.