Reports on HIV/AIDS: 1990

OCTOBER 5, 1990, MMWR, Vol 39, No. 39, pp. 685-689
Heterosexual Behaviors and Factors
that Influence Condom Use among Patients
Attending a Sexually Transmitted Disease Clinic - San Francisco
Because the incidence of human immunodeficiency virus (HIV) infection and other
sexually transmitted diseases (STDs) is lower among persons who use condoms
regularly, the Public Health Service has promoted the consistent and proper use of
condoms by sexually active persons (1). In San Francisco, rates of HIV infection and
other STDs among white homosexual men have decreased dramatically since 1982
(2,3); this decrease has been attributed to the use of condoms and the adoption of
other sex practices that reduce the risk for transmitting and acquiring these infections.
At the same time, however, the incidence of syphilis and other STDs has increased
among heterosexuals, especially among minorities (2). This report summarizes
findings from a study of heterosexual behaviors and factors that influence condom
use among men and women attending an STD clinic in San Francisco.
From October 1 through December 31, 1989, every 10th man and every second
woman entering the clinic for care was asked to participate in the study. After
obtaining informed consent, an interviewer administered a standardized questionnaire. Patients asked to enroll in the study were 18-65 years of age and reported
having had sexual intercourse with a member of the opposite sex within the previous
12 months; 341 were enrolled, including eight men and 11 women who reported
having had sexual intercourse with members of both sexes. Persons who reported
exchanging sex for money or drugs were also included in the survey. To minimize
recall bias, data from those who had not had sexual intercourse with a member of the
opposite sex within the previous 2 months were excluded from the final analysis
(n = 41).
The 341 patients (162 men and 179 women) enrolled in the study ranged in age
from 18 to 64 years (mean: 28 years); 88 (54%) of the men and 90 (50%) of the women
were either black or Hispanic (Table 1). One hundred fifty-six (46%) reported annual
incomes <$5000. Overall, 149 (46%) of 325 patients were newly diagnosed with an
STD on the day of the interview (61 [39%] of 155 men and 88 [52%] of 170 women);
diagnoses for the remaining 16 were unknown.
Of the 341 patients, 133 (82%) men and 142 (79%) women knew that HIV could be
transmitted through vaginal and anal intercourse and by sharing needles during
intravenous (IV)-drug administration; 157 (97%) men and 171 (96%) women knew that
regular condom use could reduce the likelihood of acquiring HIV infection.
In the final analysis, nearly all (292 [97%] of 300) patients reported they had used
a condom sometime in the past (Figure 1): 245 (82%) at least once in the previous 12
months and 180 (60%) at least once during the 2 months before the interview.
Seventy-six (25%) reported they had used a condom when they last had intercourse;
these patients were less likely to be diagnosed with an STD on the day of the
interview (relative risk [RR]=0.6; 95% confidence interval [CI]=0.4-0.9, MantelHaenszel chi-square test). This association did not vary by their reasons for the clinic
visit. Condom use at last intercourse was reported by five (14%) of 36 Hispanics, 20
(16%) of 126 blacks, and 41(37%) of 112 whites (p<0.001, chi-square test).

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