Population contextual associations with heterosexual partner numbers: a multilevel analysis

Sex ratio, poverty, and concurrent partnerships among men and women in the United States: a multilevel analysis

PURPOSE

Social and economic contextual factors may promote concurrent sexual partnerships, which can accelerate population HIV transmission and are more common among African Americans than U.S. Whites. We investigated the relationship between contextual factors and concurrency.

METHODS

We analyzed past 12-month concurrency prevalence in the 2002 National Survey of Family Growth and its contextual database in relation to county sex ratio (among respondent's racial and ethnic group), percentage in poverty (among respondent's racial and ethnic group), and violent crime rate. Analyses examined counties with balanced (0.95-1.05 males/female) or low (<0.9) sex ratios.

RESULTS

Concurrency prevalence was greater (odds ratio [OR]; 95% confidence interval [CI]) in counties with low sex ratios (OR, 1.67; 95% CI, 1.17-2.39), more poverty (OR, 1.18; 95% CI, 0.98-1.42 per 10 percentage-point increase), and higher crime rates (OR, 1.04; 95% CI, 1.00-1.09 per 1000 population/year). Notably, 99.5% of Whites and 93.7% of Hispanics, but only 7.85% of Blacks, lived in balanced sex ratio counties; about 5% of Whites, half of Hispanics, and three-fourths of Blacks resided in counties with >20% same-race poverty.

CONCLUSIONS

The dramatic Black-White differences in contextual factors in the United States and their association with sexual concurrency could contribute to the nation's profound racial disparities in HIV infection.

High adult sex ratios and risky sexual behaviors: a systematic review

Background

Thirty-four countries worldwide have abnormally high sex ratios (>102 men per 100 women), resulting in over 100 million missing women. Widespread sex selective abortion, neglect of young girls leading to premature mortality, and gendered migration have contributed to these persistent and increasing distortions. Abnormally high adult sex ratios in communities may drive sexually transmitted disease (STD) spread where women are missing and men cannot find stable partners. We systematically reviewed evidence on the association between high community sex ratios and individual sexual behaviors.

Methods and Findings

Seven databases (PubMed, Web of Science, Embase, Scopus, The Cochrane Database of Systematic Reviews, Sociological Abstracts, and PopLINE) were searched without restrictions on time or location. We followed PRISMA guidelines and evaluated quality according to STROBE criteria. 1093 citations were identified and six studies describing 57,054 individuals were included for review. All six studies showed an association between high community sex ratios and individual sexual risk behaviors. In high sex ratio communities, women were more likely to have multiple sex partners and men were more likely to delay first sexual intercourse and purchase sex. Only two studies included STD outcomes.

Conclusions

High community sex ratios were associated with increased individual sexual risk behavior among both men and women. However, none of the studies examined unprotected sex or appropriately adjusted for gendered migration. Further studies are needed to understand the effect of community sex ratios on sexual health and to inform comprehensive STD control interventions.

Associations of sex ratios and male incarceration rates with multiple opposite-sex partners: potential social determinants of HIV/STI transmission

OBJECTIVES

Racial/ethnic disparities in heterosexual transmission of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) have been hypothesized to be related to the high rate of incarceration and the shortage of men in black communities. This study tested associations of having multiple sex partners with these factors.

METHODS

Racial/ethnic-specific Census data on the sex ratio and the male incarceration rate were categorized into tertiles and matched with individual data from the National Health and Nutrition Examination Survey 1999-2004 by county of residence for non-Hispanic black, non-Hispanic white, and Mexican American participants. We used logistic regression analyses to examine whether these factors were associated with having multiple opposite-sex partners in the past year.

RESULTS

Sex ratios and incarceration rates varied greatly by race/ethnicity; however, we observed significant associations within each racial/ethnic group. Non-Hispanic black men in counties with a greater shortage of males (adjusted odds ratio [AOR] = 1.9; 95% confidence interval [CI] 1.1, 3.5) and a greater number of incarcerated males (AOR = 1.6; 95% CI 1.1, 2.3) in the non-Hispanic black population had significantly greater odds of having two or more partners. Those in two low sex-ratio categories (AOR = 2.4; 95% CI 1.0, 5.8 and AOR = 4.1; 95% CI 1.6, 10.0) and one high incarceration-rate category (AOR = 2.1; 95% CI 1.2, 3.6) had significantly greater odds of having five or more partners.

CONCLUSION

Sex ratios and incarceration rates were associated with the number of opposite-sex partners in some groups. Because the risk of HIV/ STI transmission depends, in part, on the number of partners, it is important to determine the causal relationships among these associations to help better understand racial/ethnic HIV/STI disparities and improve prevention programs and interventions.

The male-to-female ratio and multiple sexual partners: multilevel analysis with patients from an STD clinic

Sexual partner concurrency plays an important role in HIV and STD transmission. The shortage of African-American men may facilitate partner concurrency. This study evaluated whether the male-to-female ratio was associated with African-American participants' number of recent sexual partners, and whether this association differed by gender. Multilevel modeling was used to determine the influence of individual (i.e., gender) and population-level (i.e., sex ratio) variables on the number of recent sexual partners. African-American patients (N = 915; 52% male) were recruited from an STD clinic. Patients reported their number of sexual partners; the male-to-female ratio per census tract was obtained from the U.S. Census Bureau. There were fewer men than women in nearly all census tracts. The interaction between gender and the male-to-female ratio was significant. For men, there was no association between the sex ratio and their number of sexual partners. For women, as the sex ratio increased, their number of sexual partners increased; however, this association was driven by participants who reported trading sex. We found no evidence that fewer African-American men in a census tract was associated with men having more sexual partners.

Violence in adolescents: social and behavioural factors

OBJECTIVE

To estimate the prevalence of young people's involvement in violence measured as participation in physical fights or being physically, sexually or emotionally abused. We also aimed to understand the role of social, demographic and other behavioural characteristics in violence.

METHODS

We evaluated 7511 adolescents (4243 girls and 3268 boys) aged 15 to 19 years old, enrolled in public schools. Information was obtained using an anonymous, self-administrated questionnaire.

RESULTS

The most frequently reported type of violence was emotional abuse (15.6%). Boys reported greater involvement in fights (3.6 vs. 13.6%, p<0.001) and physical abuse (7.5 vs. 19.5%, p<0.001). The prevalence of emotional abuse (16.2 vs. 14.8%, p=0.082) and sexual abuse (2.0 vs. 1.8%, p=0.435) was similar in girls and boys. After adjustment, increasing age decreased the odds of being involved in fights in both genders but increased the odds of emotional abuse. Living in a rented home was associated with physical abuse in girls (odds ratio [OR]: 1.4; 95% confidence interval [95%CI]: 1.0-1.9) and boys (OR: 1.6; 95%CI: 1.2-2.0). In girls the odds of being emotionally abused increased with greater parental education. Smoking and cannabis use were associated with all types of violence in both genders.

CONCLUSIONS

The most frequently reported form of violence was emotional abuse. We found differences by gender, with boys reporting more physical abuse and involvement in fights. Adolescents whose parents had a higher educational level reported more physical and emotional abuse, which may be related to differences in the perception of abuse.

Characteristics of sexual abuse in childhood and adolescence influence sexual risk behavior in adulthood

Childhood and adolescent sexual abuse has been associated with subsequent (adult) sexual risk behavior, but the effects of force and type of sexual abuse on sexual behavior outcomes have been less well-studied. The present study investigated the associations between sexual abuse characteristics and later sexual risk behavior, and explored whether gender of the child/adolescent moderated these relations. Patients attending an STD clinic completed a computerized survey that assessed history of sexual abuse as well as lifetime and current sexual behavior. Participants were considered sexually abused if they reported a sexual experience (1) before age 13 with someone 5 or more years older, (2) between the ages of 13 and 16 with someone 10 or more years older, or (3) before the age of 17 involving force or coercion. Participants who were sexually abused were further categorized based on two abuse characteristics, namely, use of penetration and force. Analyses included 1177 participants (n=534 women; n=643 men). Those who reported sexual abuse involving penetration and/or force reported more adult sexual risk behavior, including the number of lifetime partners and number of previous STD diagnoses, than those who were not sexually abused and those who were abused without force or penetration. There were no significant differences in sexual risk behavior between nonabused participants and those who reported sexual abuse without force and without penetration. Gender of the child/adolescent moderated the association between sexual abuse characteristics and adult sexual risk behavior; for men, sexual abuse with force and penetration was associated with the greatest number of episodes of sex trading, whereas for women, those who were abused with penetration, regardless of whether the abuse involved force, reported the most episodes of sex trading. These findings indicate that more severe sexual abuse is associated with riskier adult sexual behavior.