Demographic Characteristics of Heterosexuals with Multiple Partners: The National AIDS Behavioral Surveys.(Statistical Data Included)

In a study of risk behavior among heterosexuals, 9% of a national sample and 12% of a sample drawn from high-risk cities report having two or more sexual partners in the year before the survey. In both samples, sex with multiple partners is most common among men, younger people and the unmarried. Multivariate analyses show that racial and ethnic differences in the proportion of respondents with multiple partners vary by marital status. The results indicate that many heterosexuals are failing to protect themselves against sexually transmitted diseases: Among respondents with multiple partners, only 18% of men and 22% of women always use condoms with their primary partner, and 28% of men and 32% of women always use them with secondary partners. These proportions do not increase significantly with the number of partners; in general, almost half of men and women with multiple partners never use condoms.

(Family Planning Perspectives, 25:208-214, 1993)

The percentage of newly diagnosed cases of AIDS attributed to heterosexual contact increased from 1% in 1983 to more than 4% in 1988 (1) and to approximately 6% in 1992. (2) Other sexually transmitted diseases (STDs) also continue to be significant health problems. The incidence of primary and secondary syphilis has been increasing annually since 1986, reaching a 40-year high in 1990, and chlamydial infections are widespread. (3) Moreover, although gonorrhea incidence rates have decreased during the last five years, rates of antibiotic-resistant gonorrhea increased from seven per 100,000 in 1986 to 23 per 100,000 in 1990. (4)

Individuals who have more than one partner are at greater risk of contracting the human immunodeficiency virus (HIV) and other STDs than are those who have a single sexual partner, because the probability of encountering an infected partner increases with the number of partners. Even if individuals with multiple partners always use condoms during vaginal intercourse, condoms may break, slip off or be used incorrectly.

To curtail the spread of HIV and other STDs, we must identify groups of the population that engage in multiple sexual relationships and trace those relationships across social strata. However, there is a paucity of data on the sexual behaviors that place adult heterosexuals at risk of infection.

To date, the best source of information on multiple partners comes from the annual General Social Survey (GSS), a national household probability sample of approximately 1,400 individuals. (5) Studies have also been conducted in U. S. cities with a high prevalence of AIDS. (6) Although the latter studies oversampled ethnic minorities, they represent only a small fraction of the urban areas that have been hit hard by AIDS, and they do not adequately represent older people. The National Survey of Family Growth also provides important data on sexual behavior, but the sample is limited to women of reproductive age.

Thus, the generalizability of findings from previous national studies on sexual behavior has been limited by low cooperation rates, minimal representation of ethnic minorities, sample limitations on age or gender, or lack of random sampling. (7) In addition, extrapolation from the findings of research on the determinants of condom use and anal or vaginal intercourse cannot explain why people have sexual relationships with more than one partner; the factors that lead people to have many sexual partners are probably different from those that influence the expression of specific sexual behaviors with a given partner.