Sexual and Drug Behavior Patterns and HIV and STD Racial Disparities: The Need for New Directions
Denise Dion Hallfors, PhD,
Bonita J. Iritani, MA,
William C. Miller, MD, PhD, MPH and
Daniel J. Bauer, PhD
Denise Dion Hallfors and Bonita J. Iritani are with the Pacific Institute for Research and Evaluation, Chapel Hill, NC. William C. Miller is with the Departments of Epidemiology and Medicine, University of North Carolina, Chapel Hill. Daniel J. Bauer is with the Department of Psychology, University of North Carolina, Chapel Hill.
Correspondence: Requests for reprints should be sent to Denise Dion Hallfors, PhD, 1516 E Franklin St, Suite 200, Chapel Hill, NC 27514 (e-mail: hallfors{at}pire.org).
Objectives. We used nationally representative data to examinewhether individuals sexual and drug behavior patternsaccount for racial disparities in sexually transmitted disease(STD) and HIV prevalence.
Methods. Data were derived from wave III of the National LongitudinalStudy of Adolescent Health. Participants were aged 18 to 26years old; analyses were limited to non-Hispanic Blacks andWhites. Theory and cluster analyses yielded 16 unique behaviorpatterns. Bivariate analyses compared STD and HIV prevalencesfor each behavior pattern, by race. Logistic regression analysesexamined within-pattern race effects before and after controlfor covariates.
Results. Unadjusted odds of STD and HIV infection were significantlyhigher among Blacks than among Whites for 11 of the risk behaviorpatterns assessed. Across behavior patterns, covariates hadlittle effect on reducing race odds ratios.
Conclusions. White young adults in the United States are atelevated STD and HIV risk when they engage in high-risk behaviors.Black young adults, however, are at high risk even when theirbehaviors are normative. Factors other than individual riskbehaviors and covariates appear to account for racial disparities,indicating the need for population-level interventions.
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