Unprotected anal intercourse among women in low-income areas — United States, 2006-2007

Background: The risk of women contracting HIV through unprotected anal intercourse (UAI) is estimated to be 18 times that of unprotected vaginal intercourse. We assessed the prevalence and correlates of UAI among women in low-income areas participating in the National HIV Behavioral Surveillance System (NHBS).

Methods: Interviews and HIV tests were conducted among heterosexuals in 24 U.S. cities during 2006-2007. Women residing in low income areas, aged 18-50 who reported ≥1 opposite sex partner in the past 12 months were recruited by peers or in venues. We restricted our analysis to those without other HIV risk factors such as injection drug use, sex work, or a previous positive HIV test, to assess factors associated with UAI.

Results: Of 7304 women who met our analysis criteria, 1573 (22%) reported AI with a male partner in the past 12 months and 1312 (18%) reported UAI (83% of those who had AI had UAI). AI was more prevalent among Hispanic (29%) and white (27%) women than black women (19%). In a multivariate logistic regression model, the odds of UAI were higher among Hispanic (adjusted odds ratio [aOR]=2.08, 95% confidence interval [CI]=1.79-2.42) or white (aOR=1.58, CI=1.23-2.05) than black women; women with 2-3 (aOR=1.87, CI=1.61-2.16) or ≥ 4 (aOR=3.91, CI=3.31-4.63) sex partners in the past 12 months than those with 1 sex partner; and those aged ≥ 25 (aOR=1.41, CI= 1.23- 1.62).

Conclusions: AI and UAI were common among heterosexual women in low-income areas and must be addressed through improved prevention messages to heterosexuals.