HIV-Related Disparities Among Women: Promoting Healthier Sexual Behavior Can Help Close the Gap

Sexual risk behaviors are associated with increased HIV transmission and prevalence, yet women are largely understudied.

Interventions that promote healthier sexual behavior among black women and Latinas may help prevent HIV infection; especially interventions that address the broader social and structural contexts that nurture risk environments, according to a study.

Although HIV has the highest prevalence among black bisexual men and men who have sex with men, approximately 1 of 4 individuals living with HIV are women. Furthermore, significant racial disparities among women remain. In 2014, approximately 62% of all HIV diagnoses among women were in non-Hispanic black women and 17% in Latinas.

Several factors associated with HIV risk behavior are responsible for these disparities, including high-risk sexual networks, assortative partner selection practices, incarceration, low awareness of HIV status or partner’s status, low male-to-female sex ratios, poverty, low education levels, and lack of access to health care.

In a study published in the Journal of Women’s Health, investigators sought to examine HIV-related sexual risk behaviors among women by race/ethnicity.

“Sexual risk behaviors like inconsistent condom use, anal intercourse, and concurrent sex partnerships are associated with increased HIV transmission and prevalence among women,” the authors wrote. “[Furthermore,] being in a high-risk sexual network and engaging in assortative partner selection patterns coupled with low awareness of partners’ status increase the probability of encountering an HIV-infected partner and a higher risk of HIV acquisition even with less risky sexual behavior.”

The investigators used data from the National Survey of Family Growth (NSFG), an in-person health survey of the civilian, noninstitutionalized population of the United States. They examined HIV-related sexual risk behaviors among sexually active women, aged 18 to 44 years, from the 2006-2008, 2008-2010, and 2011-2013 cycles.

Weighted percentages and performed logistic regression were estimated to measure adjusted prevalence ratios and 95% confidence intervals for associations between selected behaviors and sociodemographic covariates, according to the report.

The total study sample was comprised of 13,588 sexually active women. Of whom, 1.1% reported concurrent opposite-sex partners, 10.3% reported male partners they perceived as being non-monogamous, and 21.1% reported using a condom at last vaginal or anal sex.

Compared with non-Hispanic white women, black women and Latinas were more likely to report condom use at either last vaginal or anal sex. Black women were also more likely to report concurrent opposite-sex partnerships and perceived non-monogamous sex partners compared with white women.

Limitations to the study included social desirability biases that may have affected responses to questions regarding concurrent sexual behaviors, perceptions about a partner’s non-monogamous sexual behaviors, and condom use; analyzed data from the NSFG were from 3 different time points and, therefore, did not account for data during the gaps; the analysis did not include adolescent women younger than 18 years nor women older than 44 years; respondents’ perceptions of their male partners’ non-monogamous sexual behaviors may be inaccurate and may cause under- or overestimation of male partner concurrency; the relatively small sample size used of other non-Hispanic women made it challenging to discuss them when compared with other subpopulations in the analysis; and other contraceptive use was not considered in the analysis, which may impact condom use for some women and should be a consideration in future studies.

“The relationships that we observed between demographic and HIV risk factors are important, and heightened efforts for disproportionately affected non-Hispanic black women are warranted as part of HIV prevention strategies,” the authors concluded. “Interventions that promote healthier sexual behaviors among women could help prevent HIV in this population. Moreover, prevention efforts that address the broader social and structural contexts that nurture risk environments might be especially beneficial for non-Hispanic black women and Latinas.

“Better access to culturally acceptable and affordable medical and social services may offer improved solutions for addressing HIV among women, especially in non-Hispanic black women and Latinas. Furthermore, and enhanced understanding of factors that promote women’s sexual risk behaviors, and development of interventions that improve protective behaviors, could help to further decrease HIV among US women.”