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

Among a sample of 1,334 urban heterosexuals aged 18-25 from the 1990-1991 National AIDS Behavioral Surveys, 24% report having had more than one sexual partner during the past year. Young men are more than twice as likely as young women, and unmarried respondents are eight times as likely as married respondents, to have multiple partners. A multiple regression analysis of the interaction between race or ethnicity and education indicates that among whites, young people with 12 or more years of education are four times as likely to have multiple partners as are those with less than a high school education; among Hispanics and blacks, educational level is not related to having more than one partner. Among those with multiple partners, approximately 40% never use condoms with primary or secondary partners, and condom use decreases with increasing number of partners. (Family Planning Perspectives, 25:268-272,1993)

Young people aged 18-25 are in a unique stage of development, best characterized as a transition period between adolescence and the stages of adulthood involving marriage and parenthood. Today, many young adults delay marriage or a commitment to a long-term monogamous sexual relationship until age 25 or later. In 1987 the median age at first marriage was 23.6 years among women and 25.3 years among men. (For the 1950s through the early 1980s, medians were 20-21 years for women and 22-23 years for men.) (1) Thus, age 25 can be considered a transitional age for many adults in the 1990s.

Although young adults delay making long-term commitments, they have sex more often and have more sex partners during a given year than any other age group. (2) Because the probability of encountering a partner infected with the human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) increases as the number of partners increases, young adults who combine multiple partnerships with inconsistent condom use are highly vulnerable to infection. As of June 1992, more than 90,000 AIDS cases--approximately 40% of all reported cases--had been among persons 25-34 years of age, (3) many of whom were infected during their late teens or early 20s. In addition, almost 70% of the more than 12 million STD infections reported in 1990 occurred among persons younger than 25. (4)

These statistics reflect the high levels of sexual risk-taking behavior in this population. However, comparatively little is known about the sexual behaviors of young adults that place them at risk for HIV and other STDs. Most of the developmental literature related to young people has been devoted to adolescence and young adult marriage; little of it addresses the period between adolescence and marriage. (5) Research that has focused on young adults and dating relationships has been confined mainly to college students. Most research on young adults related to sexual behavior has been limited to the teenage years, or to never-married women in their 20s. However, it is just as important to study young men in their 20s, since they tend to have more sexual partners than men in any other age-group and than women overall. In addition, surveying both married and unmarried men and women is especially critical in this age-group, since many persons would have married only recently and could have had other sexual partn ers until shortly before doing so. Furthermore, marriage is not always a guarantee of monogamy.

While surveys of college students provide important data on the sexual behavior of young adults, they tend to be of predominantly white, middle- and upper-class youth. In addition, such surveys are often based on nonprobability samples, and the generalizability of the results even to all college students is limited.

Even though surveys of adolescents and college-age adults have examined several dimensions of AIDS-related behavior, effective prevention strategies aimed at curbing HIV and STDs among all young adults require a more comprehensive description of the prevalence and distribution of sexual risk behaviors in this age-group. General population studies can begin to fill this gap, but for the most part, studies of the sexual behavior of heterosexual adults, especially of HIV-relevant risk-taking among young heterosexual men and women, have been sorely lacking.

The recently completed National AIDS Behavioral Surveys (NABS) provide an opportunity to address this major gap in our knowledge. The NABS is the largest general population survey of HIV-relevant sexual behavior in the United States. The sample was designed to estimate the prevalence of AIDS nationally and in major urban centers. This article draws on a subsample of 1,334 young adults from the NABS high-risk cities sample to examine heterosexual activity with multiple partners by age, gender, race or ethnicity, educational level and marital status. The high-risk cities sample represents urban areas with high AIDS prevalence and large minority populations, areas where the need for behavioral maps to help target prevention efforts is especially critical.