III. Multiple Sexual Partners Among Blacks in High-Risk Cities. (Data from the National AIDS Behavioral Surveys).(Statistical Data Included)

The National AIDS Behavioral Surveys collected data between June 1990 and February 1991 on the prevalence of multiple sex partners and condom use among 2, 166 blacks living in cities with a high pre valence of AIDS cases. Almost one-fifth (19%) of respondents report having had two or more partners in the year preceding the survey More men (30%) than women (10%), and more single (25%) than married or cohabiting adults (8%), report that they have had multiple sexual partners in the previous year. Although respondents are more likely to use condoms with secondary than main sexual partners, substantial proportions of blacks with multiple sex partners used no condoms in the previous year with either their main (47%) or their secondary partners (35%).

(Family Planning Perspectives, 25:263-267,1993)

Black heterosexual men and women are 10 times more likely to be diagnosed with AIDS than are white men and women. (1) This racial disparity in AIDS cases has been largely attributed to a higher prevalence and incidence of the human immunodeficiency virus (HIV) infection among black injection drug users than among white users, (2) and a higher relative risk of AIDS among blacks than among whites who are sexual partners of injection drug users. (3) The potential risk of black adults' contracting AIDS through heterosexual transmission raises the need for large, systematic, random probability surveys to identify high-risk sexual behaviors within this population.

However, few data on the extent of sex with multiple partners and on condom use are available from population-based surveys with adequate samples of blacks. Data from the national General Social Surveys (4) and the National Survey of Men (5) indicated that blacks were more likely than whites or Hispanics to report having had multiple partners in the past year. Data from the National Survey of Family Growth revealed that differences in marital status between white and black women were associated with differences in numbers of sex partners. Divorced and separated black women were the most likely to have had multiple sexual partners within the previous three months (11% had done so), followed by unmarried white women (9%) and never-married black women (6%). (6)

Several local or state surveys in the United States provide data on the prevalence of sex with multiple partners among blacks. Generally, these studies have found that black and white heterosexuals reported similar reductions in their numbers of sexual partners in recent years; (7) that higher proportions of blacks than of whites reported unprotected sex with multiple partners during the previous six months; (8) that regardless of race, respondents who were unmarried or not in a sexually exclusive relationship reported they did not regularly use condoms; (9) and that black women were less likely than white women to have sexual partners who always used condoms. (10)

Methodological concerns, however, limit the extent to which these studies adequately describe HIV risks associated with multiple sexual partners. Although the studies point out important demographic differences in risk between white and nonwhite populations, most lack large enough samples to examine these risks separately for each racial or ethnic group. Also, most of these studies neglect to consider condom use in addition to number of sexual partners. Lastly, not all of these studies include AIDS epicenters, where the prevalence of HIV infection in the "partner pool" is high, and the risk of acquiring HIV infection from having multiple partners is elevated.

The National AIDS Behavioral Surveys (NABS) oversampled blacks specifically to assess HIV-related risk factors in the general heterosexual population of the United States and in high-risk cities, defined as those with a high prevalence of AIDS cases. Previously published results indicate that between 15% and 31% of heterosexual adults nationally and between 20% and 41% in high-risk cities reported an HlV risk factor, and only 17% of those with multiple sexual partners reported condom use all the time. Respondents who reported multiple sexual partners were more likely to be black or white than