Sexual partnership patterns as a behavioral risk factor for sexually transmitted diseases

Context: Women's and men's number of sexual partners and protective practic es such as condom use can have a direct effect on their risk of contracting sexually transmitted diseases (STDs), including HIV; Methods: The 1988 and 1995 cycles of the National Survey of Family Growth a nd five rounds of the General Social Survey conducted from 1988 to 1996 are used to examine women's and men's numbers of recent sexual partners. Level s of direct risk for STDs (two or more partners in the past year) and the s ocial and demographic correlates of multiple partnership are analyzed among women and men. In addition, women's indirect risk for STDs (their partners ' involvement with other partners in the past year) is used to estimate the ir overall risk of STDs through multiple partnerships. Results: At least three-quarters of sexually active U.S. women and men in t he late 1980s and mid-1990s had had only one sexual partner in the precedin g 12 months. Moreover, there is no indication that the proportion with more than one partner in the past year changed substantially over that period. Nevertheless, combining women's and men's partnership reports suggests that about 17 million women aged 15-44-34% of those sexually active in the past year-were at risk for STDs because of direct exposure to multiple partners (5.4 million), indirect exposure (6.3 million) or both direct and indirect exposure (5.5 million). In all, 21% of women were at direct risk and 23% w ere at indirect risk. In comparison, among men aged 18-44 24% were at direc t risk for STDs and an unknown proportion were at indirect risk. Multivaria te analyses indicated that unmarried individuals, women younger than 40 and men aged 20-29, blacks and women in the South were all at elevated risk fo r STDs because of multiple partnership. Overall, in 1995 19% of sexually ac tive women aged 15-44 had used condoms to protect against STDs over the pre ceding year, and 19% of those sexually active in the three months before th e survey were current condom users. Condom use specifically for STD prevent ion was more common among women reporting both direct and indirect risk for STDs (58%) and among those at direct risk (46%) than among other women; wo men whose partners put them at indirect risk only were less likely to be cu rrent or recent condom users than women who were not at risk or were only a t direct risk. Conclusions: There is a continuing need to educate people regarding their r isk for STDs, to increase the use of existing barrier methods and to develo p new methods that protect against STD infection. In addition, if we are to develop a better understanding of the extent of STD risk through multiple partnership, the collection of information on number of partners and relati onships between partners must be expanded and improved.