A consistent, comparable series of surveys of adults similar to those collected among adolescents does not exist in the US, making it more difficult to assess whether sexual behaviors of older American adults have changed in the post-World War II era. Catania and colleagues analyzed three national-level behavioral data sets collected at different points and found that sexual behaviors among heterosexual adults aged 18 to 49 were relatively constant from 1988 to 1996, whereas condom use increased significantly in the same time period (Catania et al., 2001). A study of sexual behaviors of a representative sample of Seattle residents comparing sexual behaviors in 1995 and 2004 also found little difference between time periods. At both measurement periods, the median number of lifetime sex partners and the proportion of participants having concurrent partnerships had changed little (Aral et al., 2005). Similarly, however, this study population also reported an increase in use of condoms. Increases in condom use among women aged 18-44 years between 1988 and 1995 were also reported by the National Survey of Family Growth (Anderson et al., 2003).
Recent evidence suggests that this pattern of increasing condom use has not continued. In 2000, adult condom use with primary partners was low even among those at highest risk of sexually transmitted disease (Anderson et al., 2003). Data suggest, however, that adults may be practicing more protective behavior with non-primary partners. The General Social Survey (GSS) found, among adults sampled between 1996 and 2002, a statistically significant trend toward greater condom use with non-regular partners (Anderson et al., 2003).
Trends in STI have generally corresponded to trends in sexual behaviors and condom use. As condom use has increased over the past several decades, rates of STI have generally decreased (CDC, 2005a, 2005b). The HIV/AIDS epidemic and the response of heterosexuals to the epidemic has been more complex. While the epidemic has generally stabilized within the United States, it continues to expand within certain segments of the heterosexual population. The proportion of AIDS cases among females increased from 18 percent in 1985 to 27 percent in 2004, and while the number of AIDS cases among men and women has dropped since its peak in the mid 1990s, the decrease has been less pronounced for women (13 percent for women compared to 35 percent for men) (CDC, 2006b). As with other STI, racial and ethnic minority populations have been disproportionately affected by the HIV epidemic. Among women, rates among Blacks are now 21 times higher than for Whites (CDC, 2006c). These statistics suggest that this evolving epidemic may demand an ever more comprehensive understanding of the interplay of social trends and sexual behaviors.
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