Skip to main content
Top
Published in: AIDS and Behavior 7/2015

01-07-2015 | Original Paper

Sexual Behaviors of US Women at Risk of HIV Acquisition: A Longitudinal Analysis of Findings from HPTN 064

Authors: J. Justman, M. Befus, J. Hughes, J. Wang, C. E. Golin, A. A. Adimora, I. Kuo, D. F. Haley, C. del Rio, W. M. El-Sadr, A. Rompalo, S. Mannheimer, L. Soto-Torres, S. Hodder

Published in: AIDS and Behavior | Issue 7/2015

Login to get access

Abstract

We describe the sexual behaviors of women at elevated risk of HIV acquisition who reside in areas of high HIV prevalence and poverty in the US. Participants in HPTN 064, a prospective HIV incidence study, provided information about individual sexual behaviors and male sexual partners in the past 6 months at baseline, 6- and 12-months. Independent predictors of consistent or increased temporal patterns for three high-risk sexual behaviors were assessed separately: exchange sex, unprotected anal intercourse (UAI) and concurrent partnerships. The baseline prevalence of each behavior was >30 % among the 2,099 participants, 88 % reported partner(s) with >1 HIV risk characteristic and both individual and partner risk characteristics decreased over time. Less than high school education and food insecurity predicted consistent/increased engagement in exchange sex and UAI, and partner’s concurrency predicted participant concurrency. Our results demonstrate how interpersonal and social factors may influence sustained high-risk behavior by individuals and suggest that further study of the economic issues related to HIV risk could inform future prevention interventions.
Literature
1.
go back to reference Centers for Disease Control and Prevention. Estimated HIV incidence in the United States, 2007–2010. HIV Surveillance Supplemental Report. 2012;17(4). Centers for Disease Control and Prevention. Estimated HIV incidence in the United States, 2007–2010. HIV Surveillance Supplemental Report. 2012;17(4).
2.
go back to reference Chen M, Rhodes PH, Hall HI, Kilmarx PH, Branson BM, Valleroy LA. Prevalence of undiagnosed HIV infection among persons aged ≥13 years—National HIV Surveillance System, United States, 2005–2008. MMWR Morb Mortal Wkly Rep. 2012;61(02):57–64.PubMed Chen M, Rhodes PH, Hall HI, Kilmarx PH, Branson BM, Valleroy LA. Prevalence of undiagnosed HIV infection among persons aged ≥13 years—National HIV Surveillance System, United States, 2005–2008. MMWR Morb Mortal Wkly Rep. 2012;61(02):57–64.PubMed
3.
go back to reference Hodder SL, Justman J, Haley DF, Adimora AA, Fogel CI, Golin CE, et al. Challenges of a hidden epidemic: HIV prevention among women in the United States. J Acquir Immune Defic Syndr (1999). 2010;55(2):69.CrossRef Hodder SL, Justman J, Haley DF, Adimora AA, Fogel CI, Golin CE, et al. Challenges of a hidden epidemic: HIV prevention among women in the United States. J Acquir Immune Defic Syndr (1999). 2010;55(2):69.CrossRef
4.
5.
go back to reference HIV Prevalence Estimates—United States. 2006. MMWR Morb Mortal Wkly Rep. 2008;57(39):1073–6. HIV Prevalence Estimates—United States. 2006. MMWR Morb Mortal Wkly Rep. 2008;57(39):1073–6.
6.
go back to reference Characteristics associated with HIV infection among heterosexuals in urban areas with high AIDS prevalence—24 cities, United States, 2006–2007. MMWR Morb Mortal Wkly Rep. 2011;60(31):1045–9. Characteristics associated with HIV infection among heterosexuals in urban areas with high AIDS prevalence—24 cities, United States, 2006–2007. MMWR Morb Mortal Wkly Rep. 2011;60(31):1045–9.
7.
go back to reference Brewer RA, Magnus M, Kuo I, Wang L, Liu TY, Mayer KH. The high prevalence of incarceration history among black men who have sex with men in the United States: associations and implications. Am J Public Health. 2014;104(3):448–54.CrossRefPubMedCentralPubMed Brewer RA, Magnus M, Kuo I, Wang L, Liu TY, Mayer KH. The high prevalence of incarceration history among black men who have sex with men in the United States: associations and implications. Am J Public Health. 2014;104(3):448–54.CrossRefPubMedCentralPubMed
8.
go back to reference Carson EA, Sabol W. Prisoners in 2011. Washington, D.C.: Bureau of Justice Statistics, U.S. Department of Justice; 2012. NCJ 239808. Carson EA, Sabol W. Prisoners in 2011. Washington, D.C.: Bureau of Justice Statistics, U.S. Department of Justice; 2012. NCJ 239808.
9.
go back to reference Maruschak LM. HIV in prisons, 2001–2010. AIDS. 2012;20:25. Maruschak LM. HIV in prisons, 2001–2010. AIDS. 2012;20:25.
10.
go back to reference Pouget ER, Kershaw TS, Niccolai LM, Ickovics JR, Blankenship KM. Associations of sex ratios and male incarceration rates with multiple opposite-sex partners: potential social determinants of HIV/STI transmission. Publ Health Rep. 2010;125(Suppl 4):70–80. Pouget ER, Kershaw TS, Niccolai LM, Ickovics JR, Blankenship KM. Associations of sex ratios and male incarceration rates with multiple opposite-sex partners: potential social determinants of HIV/STI transmission. Publ Health Rep. 2010;125(Suppl 4):70–80.
11.
go back to reference Adimora AA, Schoenbach VJ, Taylor EM, Khan MR, Schwartz RJ, Miller WC. Sex ratio, poverty, and concurrent partnerships among men and women in the United States: a multilevel analysis. Ann Epidemiol. 2013;23(11):716–9.CrossRefPubMedCentralPubMed Adimora AA, Schoenbach VJ, Taylor EM, Khan MR, Schwartz RJ, Miller WC. Sex ratio, poverty, and concurrent partnerships among men and women in the United States: a multilevel analysis. Ann Epidemiol. 2013;23(11):716–9.CrossRefPubMedCentralPubMed
12.
go back to reference Doherty IA, Schoenbach VJ, Adimora AA. Sexual mixing patterns and heterosexual HIV transmission among African Americans in the southeastern United States. J Acquir Immune Defic Syndr (1999). 2009;52(1):114.CrossRef Doherty IA, Schoenbach VJ, Adimora AA. Sexual mixing patterns and heterosexual HIV transmission among African Americans in the southeastern United States. J Acquir Immune Defic Syndr (1999). 2009;52(1):114.CrossRef
13.
go back to reference Leichliter JS, Chandra A, Liddon N, Fenton KA, Aral SO. Prevalence and correlates of heterosexual anal and oral sex in adolescents and adults in the United States. J Infect Dis. 2007;196(12):1852–9.CrossRefPubMed Leichliter JS, Chandra A, Liddon N, Fenton KA, Aral SO. Prevalence and correlates of heterosexual anal and oral sex in adolescents and adults in the United States. J Infect Dis. 2007;196(12):1852–9.CrossRefPubMed
14.
go back to reference de Vincenzi I. A longitudinal study of human immunodeficiency virus transmission by heterosexual partners. European Study Group on Heterosexual Transmission of HIV. N Engl J Med. 1994;331(6):341–6.CrossRefPubMed de Vincenzi I. A longitudinal study of human immunodeficiency virus transmission by heterosexual partners. European Study Group on Heterosexual Transmission of HIV. N Engl J Med. 1994;331(6):341–6.CrossRefPubMed
15.
go back to reference Nicolosi A, Correa Leite ML, Musicco M, Arici C, Gavazzeni G, Lazzarin A. The efficiency of male-to-female and female-to-male sexual transmission of the human immunodeficiency virus: a study of 730 stable couples. Italian Study Group on HIV Heterosexual Transmission. Epidemiology (Cambridge, Mass). 1994;5(6):570–5. Nicolosi A, Correa Leite ML, Musicco M, Arici C, Gavazzeni G, Lazzarin A. The efficiency of male-to-female and female-to-male sexual transmission of the human immunodeficiency virus: a study of 730 stable couples. Italian Study Group on HIV Heterosexual Transmission. Epidemiology (Cambridge, Mass). 1994;5(6):570–5.
16.
go back to reference Risser JM, Padgett P, Wolverton M, Risser WL. Relationship between heterosexual anal sex, injection drug use and HIV infection among black men and women. Int J STD AIDS. 2009;20(5):310–4.CrossRefPubMed Risser JM, Padgett P, Wolverton M, Risser WL. Relationship between heterosexual anal sex, injection drug use and HIV infection among black men and women. Int J STD AIDS. 2009;20(5):310–4.CrossRefPubMed
17.
go back to reference Baggaley RF, White RG, Boily MC. HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention. Int J Epidemiol. 2010;39(4):1048–63.CrossRefPubMedCentralPubMed Baggaley RF, White RG, Boily MC. HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention. Int J Epidemiol. 2010;39(4):1048–63.CrossRefPubMedCentralPubMed
18.
go back to reference Novak RM, Metch B, Buchbinder S, Cabello R, Donastorg Y, Figoroa JP, et al. Risk behavior among women enrolled in a randomized controlled efficacy trial of an adenoviral vector vaccine to prevent HIV acquisition. AIDS. 2013;27(11):1763–70.CrossRefPubMedCentralPubMed Novak RM, Metch B, Buchbinder S, Cabello R, Donastorg Y, Figoroa JP, et al. Risk behavior among women enrolled in a randomized controlled efficacy trial of an adenoviral vector vaccine to prevent HIV acquisition. AIDS. 2013;27(11):1763–70.CrossRefPubMedCentralPubMed
19.
go back to reference Adimora AA, Schoenbach VJ, Taylor EM, Khan MR, Schwartz RJ. Concurrent partnerships, nonmonogamous partners, and substance use among women in the United States. Am J Public Health. 2011;101(1):128–36.CrossRefPubMedCentralPubMed Adimora AA, Schoenbach VJ, Taylor EM, Khan MR, Schwartz RJ. Concurrent partnerships, nonmonogamous partners, and substance use among women in the United States. Am J Public Health. 2011;101(1):128–36.CrossRefPubMedCentralPubMed
20.
go back to reference Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD. Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection. Soc Sci Med. 2004;59(8):1581–92.CrossRefPubMed Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD. Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection. Soc Sci Med. 2004;59(8):1581–92.CrossRefPubMed
21.
go back to reference Herbenick D, Reece M, Schick V, Sanders SA, Dodge B, Fortenberry JD. Sexual behavior in the United States: results from a national probability sample of men and women ages 14-94. J Sex Med. 2010;7(Suppl 5):255–65.CrossRefPubMed Herbenick D, Reece M, Schick V, Sanders SA, Dodge B, Fortenberry JD. Sexual behavior in the United States: results from a national probability sample of men and women ages 14-94. J Sex Med. 2010;7(Suppl 5):255–65.CrossRefPubMed
22.
go back to reference Jenness SM, Begier EM, Neaigus A, Murrill CS, Wendel T, Hagan H. Unprotected anal intercourse and sexually transmitted diseases in high-risk heterosexual women. Am J Public Health. 2011;101(4):745–50.CrossRefPubMedCentralPubMed Jenness SM, Begier EM, Neaigus A, Murrill CS, Wendel T, Hagan H. Unprotected anal intercourse and sexually transmitted diseases in high-risk heterosexual women. Am J Public Health. 2011;101(4):745–50.CrossRefPubMedCentralPubMed
23.
go back to reference Sales JM, Brown JL, Diclemente RJ, Rose E. Exploring factors associated with nonchange in condom use behavior following participation in an STI/HIV prevention intervention for African-American adolescent females. AIDS Res Treat. 2012;2012:231417.PubMedCentralPubMed Sales JM, Brown JL, Diclemente RJ, Rose E. Exploring factors associated with nonchange in condom use behavior following participation in an STI/HIV prevention intervention for African-American adolescent females. AIDS Res Treat. 2012;2012:231417.PubMedCentralPubMed
24.
go back to reference Kalichman SC, Cain D, Knetch J, Hill J. Patterns of sexual risk behavior change among sexually transmitted infection clinic patients. Arch Sex Behav. 2005;34(3):307–19.CrossRefPubMed Kalichman SC, Cain D, Knetch J, Hill J. Patterns of sexual risk behavior change among sexually transmitted infection clinic patients. Arch Sex Behav. 2005;34(3):307–19.CrossRefPubMed
25.
go back to reference Hodder SL, Justman J, Hughes JP, Wang J, Haley DF, Adimora AA, et al. HIV acquisition among women from selected areas of the United States: a cohort study. Ann Intern Med. 2013;158(1):10–8.CrossRefPubMedCentralPubMed Hodder SL, Justman J, Hughes JP, Wang J, Haley DF, Adimora AA, et al. HIV acquisition among women from selected areas of the United States: a cohort study. Ann Intern Med. 2013;158(1):10–8.CrossRefPubMedCentralPubMed
26.
go back to reference McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Behav. 1988;15(4):351–77.CrossRef McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Behav. 1988;15(4):351–77.CrossRef
27.
go back to reference DiClemente RJ, Salazar LF, Crosby RA, Rosenthal SL. Prevention and control of sexually transmitted infections among adolescents: the importance of a socio-ecological perspective—a commentary. Public Health. 2005;119(9):825–36.CrossRefPubMed DiClemente RJ, Salazar LF, Crosby RA, Rosenthal SL. Prevention and control of sexually transmitted infections among adolescents: the importance of a socio-ecological perspective—a commentary. Public Health. 2005;119(9):825–36.CrossRefPubMed
28.
29.
go back to reference Eshleman SH, Hughes JP, Laeyendecker O, Wang J, Brookmeyer R, Johnson-Lewis L, et al. Use of a multifaceted approach to analyze HIV incidence in a cohort study of women in the United States: HIV prevention trials network 064 study. J Infect Dis. 2013;207(2):223–31.CrossRefPubMedCentralPubMed Eshleman SH, Hughes JP, Laeyendecker O, Wang J, Brookmeyer R, Johnson-Lewis L, et al. Use of a multifaceted approach to analyze HIV incidence in a cohort study of women in the United States: HIV prevention trials network 064 study. J Infect Dis. 2013;207(2):223–31.CrossRefPubMedCentralPubMed
30.
go back to reference Gallagher KM, Sullivan PS, Lansky A, Onorato IM. Behavioral surveillance among people at risk for HIV infection in the U.S.: the National HIV Behavioral Surveillance System. Publ Health Rep (Washington: 1974). 2007;122 Suppl 1:32–8. Gallagher KM, Sullivan PS, Lansky A, Onorato IM. Behavioral surveillance among people at risk for HIV infection in the U.S.: the National HIV Behavioral Surveillance System. Publ Health Rep (Washington: 1974). 2007;122 Suppl 1:32–8.
31.
go back to reference Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.CrossRef Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.CrossRef
32.
go back to reference Prins A, Ouimette P, Kimerling R, Camerond RP, Hugelshofer DS, Shaw-Hegwer J, et al. The primary care PTSD screen (PC-PTSD): development and operating characteristics. Int J Psychiatry Clin Pract. 2004;9(1):9–14. Prins A, Ouimette P, Kimerling R, Camerond RP, Hugelshofer DS, Shaw-Hegwer J, et al. The primary care PTSD screen (PC-PTSD): development and operating characteristics. Int J Psychiatry Clin Pract. 2004;9(1):9–14.
33.
go back to reference Heagerty P, Liang K-Y, Zeger S. Analysis of longitudinal data. Oxford: Oxford University Press; 2013. Heagerty P, Liang K-Y, Zeger S. Analysis of longitudinal data. Oxford: Oxford University Press; 2013.
34.
go back to reference Adimora AA, Hughes JP, Wang J, Haley DF, Golin CE, Magnus M, et al. Characteristics of multiple and concurrent partnerships among women at high risk for HIV infection. J Acquir Immune Defic Syndr. 2014;65(1):99–106. Adimora AA, Hughes JP, Wang J, Haley DF, Golin CE, Magnus M, et al. Characteristics of multiple and concurrent partnerships among women at high risk for HIV infection. J Acquir Immune Defic Syndr. 2014;65(1):99–106.
35.
go back to reference Bartholow BN, Buchbinder S, Celum C, Goli V, Koblin B, Para M, et al. HIV sexual risk behavior over 36 months of follow-up in the world’s first HIV vaccine efficacy trial. J Acquir Immune Defic Syndr. 2005;39(1):90–101.CrossRefPubMed Bartholow BN, Buchbinder S, Celum C, Goli V, Koblin B, Para M, et al. HIV sexual risk behavior over 36 months of follow-up in the world’s first HIV vaccine efficacy trial. J Acquir Immune Defic Syndr. 2005;39(1):90–101.CrossRefPubMed
36.
go back to reference Metsch LR, Feaster DJ, Gooden L, Schackman BR, Matheson T, Das M, et al. Effect of risk-reduction counseling with rapid HIV testing on risk of acquiring sexually transmitted infections: the AWARE randomized clinical trial. JAMA. 2013;310(16):1701–10.CrossRefPubMedCentralPubMed Metsch LR, Feaster DJ, Gooden L, Schackman BR, Matheson T, Das M, et al. Effect of risk-reduction counseling with rapid HIV testing on risk of acquiring sexually transmitted infections: the AWARE randomized clinical trial. JAMA. 2013;310(16):1701–10.CrossRefPubMedCentralPubMed
37.
go back to reference Aral SO, Adimora AA, Fenton KA. Understanding and responding to disparities in HIV and other sexually transmitted infections in African Americans. Lancet. 2008;372(9635):337–40.CrossRefPubMed Aral SO, Adimora AA, Fenton KA. Understanding and responding to disparities in HIV and other sexually transmitted infections in African Americans. Lancet. 2008;372(9635):337–40.CrossRefPubMed
38.
go back to reference Guest G, Shattuck D, Johnson L, Akumatey B, Clarke EE, Chen PL, et al. Changes in sexual risk behavior among participants in a PrEP HIV prevention trial. Sex Transm Dis. 2008;35(12):1002–8.PubMed Guest G, Shattuck D, Johnson L, Akumatey B, Clarke EE, Chen PL, et al. Changes in sexual risk behavior among participants in a PrEP HIV prevention trial. Sex Transm Dis. 2008;35(12):1002–8.PubMed
39.
go back to reference Kaul R, Kimani J, Nagelkerke NJ, Fonck K, Keli F, MacDonald KS, et al. Reduced HIV risk-taking and low HIV incidence after enrollment and risk-reduction counseling in a sexually transmitted disease prevention trial in Nairobi, Kenya. J Acquir Immune Defic Syndr. 2002;30(1):69–72.CrossRefPubMed Kaul R, Kimani J, Nagelkerke NJ, Fonck K, Keli F, MacDonald KS, et al. Reduced HIV risk-taking and low HIV incidence after enrollment and risk-reduction counseling in a sexually transmitted disease prevention trial in Nairobi, Kenya. J Acquir Immune Defic Syndr. 2002;30(1):69–72.CrossRefPubMed
40.
go back to reference Nunn A, Dickman S, Cornwall A, Kwakwa H, Mayer KH, Rana A, et al. Concurrent sexual partnerships among African American women in Philadelphia: results from a qualitative study. Sex Health. 2012;9(3):288–96.CrossRefPubMedCentralPubMed Nunn A, Dickman S, Cornwall A, Kwakwa H, Mayer KH, Rana A, et al. Concurrent sexual partnerships among African American women in Philadelphia: results from a qualitative study. Sex Health. 2012;9(3):288–96.CrossRefPubMedCentralPubMed
41.
go back to reference Grieb SM, Davey-Rothwell M, Latkin CA. Concurrent sexual partnerships among urban African American high-risk women with main sex partners. AIDS Behav. 2012;16(2):323–33.CrossRefPubMedCentralPubMed Grieb SM, Davey-Rothwell M, Latkin CA. Concurrent sexual partnerships among urban African American high-risk women with main sex partners. AIDS Behav. 2012;16(2):323–33.CrossRefPubMedCentralPubMed
42.
go back to reference Poundstone KE, Strathdee SA, Celentano DD. The social epidemiology of human immunodeficiency virus/acquired immunodeficiency syndrome. Epidemiol Rev. 2004;26:22–35.CrossRefPubMed Poundstone KE, Strathdee SA, Celentano DD. The social epidemiology of human immunodeficiency virus/acquired immunodeficiency syndrome. Epidemiol Rev. 2004;26:22–35.CrossRefPubMed
43.
go back to reference Satterwhite CL, Kamb ML, Metcalf C, Douglas JM Jr, Malotte CK, Paul S, et al. Changes in sexual behavior and STD prevalence among heterosexual STD clinic attendees: 1993-1995 versus 1999-2000. Sex Transm Dis. 2007;34(10):815–9.PubMed Satterwhite CL, Kamb ML, Metcalf C, Douglas JM Jr, Malotte CK, Paul S, et al. Changes in sexual behavior and STD prevalence among heterosexual STD clinic attendees: 1993-1995 versus 1999-2000. Sex Transm Dis. 2007;34(10):815–9.PubMed
44.
go back to reference Cooper HL, Linton S, Haley DF, Kelley ME, Dauria EF, Karnes CC, et al. Changes in exposure to neighborhood characteristics are associated with sexual network characteristics in a cohort of adults relocating from public housing. AIDS Behav. 2014. doi:10.1007/s10461-014-0883-z. Cooper HL, Linton S, Haley DF, Kelley ME, Dauria EF, Karnes CC, et al. Changes in exposure to neighborhood characteristics are associated with sexual network characteristics in a cohort of adults relocating from public housing. AIDS Behav. 2014. doi:10.​1007/​s10461-014-0883-z.
45.
go back to reference Fisher RJ. Social desirability bias and the validity of indirect questioning. J Consum Res. 1993:303–15. Fisher RJ. Social desirability bias and the validity of indirect questioning. J Consum Res. 1993:303–15.
Metadata
Title
Sexual Behaviors of US Women at Risk of HIV Acquisition: A Longitudinal Analysis of Findings from HPTN 064
Authors
J. Justman
M. Befus
J. Hughes
J. Wang
C. E. Golin
A. A. Adimora
I. Kuo
D. F. Haley
C. del Rio
W. M. El-Sadr
A. Rompalo
S. Mannheimer
L. Soto-Torres
S. Hodder
Publication date
01-07-2015
Publisher
Springer US
Published in
AIDS and Behavior / Issue 7/2015
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-014-0992-8

Other articles of this Issue 7/2015

AIDS and Behavior 7/2015 Go to the issue