CONTEXT: How much condom use among U.S. adults varies by type of partner or by risk behavior is unclear. Knowledge of such differentials would aid in evaluating the progress being made toward goals for levels of condom use as part of the Healthy People 2000 initiative. METHODS: Data were analyzed from the 1996 National Household Survey of Drug Abuse, an annual household-based probability sample of the noninstitutionalized population aged 12 and older that measures the use of illicit drugs, alcohol and tobacco. The personal behaviors module included 25 questions covering sexual activity in the past year, frequency of condom use in the past year, circumstances of the last sexual encounter and HIV testing. RESULTS: Sixty-two percent of adults reported using a condom at last intercourse outside of an ongoing relationship, while only 19% reported using condoms when the most recent intercourse occurred within a steady relationship. Within ongoing relationships, condom use was highest among respondents who were younger, black, of lower income and from large metropolitan areas. Forty percent of unmarried adults used a condom at last sex, compared with the health objective of 50% for the year 2000. Forty percent of injecting drug users used condoms at last intercourse, compared with the 60% condom use objective for high-risk individuals. Significantly, persons at increased risk for HIV because of their sexual behavior or drug use were not more likely to use condoms than were persons not at increased risk; only 22% used condoms during last intercourse within an ongoing relationship. CONCLUSIONS: Substantial progress has been made toward national goals for increasing condom use. The rates of condom use by individuals at high risk of HIV need to be increased, however, particularly condom use with a steady partner.

Adult↗

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HIV seroprevalence surveys in drug treatment centers.

Sharing of equipment used to inject illicit drugs intravenously is a risk factor for human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). Systematic surveillance of HIV infection among intravenous drug users (IVDUs) in the United States is essential to monitor the HIV epidemic and to target and evaluate prevention programs for IVDUs and their partners. The most accessible segment of the largely covert population of IVDUs are those in drug treatment programs. In collaboration with State and local health departments and drug abuse treatment agencies, the Centers for Disease Control is conducting blinded (serologic test results not linked to identifiable persons) and nonblinded (in which clients voluntarily agree to participate) surveys of IVDUs entering drug treatment in 39 U.S. metropolitan areas. The same protocol is used in all participating drug treatment centers. Blinded surveys will be carried out annually to determine HIV seroprevalence rates in eligible IVDUs entering drug treatment and to monitor trends over time. Each year, nonblinded surveys of IVDUs entering drug treatment will assess self-reported drug use and sexual behaviors to help design educational interventions and to detect changes in behavior over time. This sentinel surveillance system, using a standardized methodology, will provide the best national and regional data available on the seroprevalence of HIV among IVDUs and the relationships of drug use, sexual behaviors, and HIV serologic status of IVDUs.

AIDS Serodiagnosis↗

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Using seroprevalence data in managing public health programs.

An objective of the Centers for Disease Control (CDC) family of HIV seroprevalence surveys, conducted by State and local health departments, is the collection of seroprevalence data that may be useful in managing public health programs. In prevention programs, seroprevalence data may be used in allocating resources, in determining the types and amount of education, counseling, and testing services offered, and in identifying access points for HIV-infected persons for medical followup and care. Over time, data will be useful in detecting and following trends in HIV infection and in evaluating the impact of program activities to prevent HIV infection. No single seroprevalence survey is representative of the entire population of a metropolitan area. Each type of survey has strengths and limitations that must be considered when interpreting seroprevalence data. However, results from the family of surveys are the best available data because they are relatively unaffected by self-selection bias, they are standardized, and the information is collected over time. Characterization of the population surveyed and adherence to standard CDC protocols improve the quality of the data. Consultants in health departments and at CDC form a network for providing technical support and disseminating data to health care providers and program managers.

AIDS Serodiagnosis↗

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Where injecting drug users receive HIV counseling and testing.

In 1990, nearly 1.5 million human immunodeficiency virus (HIV) antibody tests were performed at publicly funded sites. Eight percent of those tests were performed for self-identified illegal injecting drug users (IDU). The authors examined data from 28 project areas using a client record data base that permitted an analysis of self-reported risk behavior by type of service delivery site. Among self-identified IDUs, 68 percent of those tested and 82 percent of those found to be seropositive had obtained HIV counseling and testing services in settings other than drug treatment centers. The findings indicate that HIV-prevention programs for IDUs need to be available in various service delivery settings, not just in drug treatment programs. Strong links and cooperation between sites offering HIV counseling and testing and sites providing drug treatment programs are important to preventing HIV transmission to and from IDUs.

Counseling↗