Sociodemographic, behavioral, and clinical correlates of inconsistent condom use in HIV-serodiscordant heterosexual couples

We examined sociodemographic, behavioral, and clinical characteristics asso ciated with inconsistent condom use in a cross-sectional analysis of 145 se xually active HIV-serodiscordant heterosexual couples who participated in t he California Partners Study II. All couples were aware of their HIV-serodi scordant status. Forty-five percent of couples reported having had unprotec ted vaginal or anal sex in the previous 6 months. In the multivariate coupl e-level analyses, factors independently associated with inconsistent (i.e., < 100%) condom use in the previous 6 months included lower educational lev el, unemployment, African-American ethnicity, and practice of anal sex by t he couple. Injection drug use was associated with inconsistent condom use a mong couples with younger HIV-infected partners. In addition, couples with HIV-infected partners who had higher CD4 cell counts and couples in which t he HIV-infected male partner ever had sex with a man were more likely to us e condoms inconsistently. Consistency of condom use did not depend on the g ender of the HIV-infected partner or duration of sexual relationship. The f indings suggest that many HIV-serodiscordant heterosexual couples remain at high risk of HIV transmission and may benefit not only from behavioral int erventions but also from structural interventions aimed at improving their social and economic conditions.