skills. There are also costs and obstacles associated with adopting behaviors that reduce individual risk of STDs. In this section, immediate factors that influence individual risk of STDs are summarized. It is important to note that these factors are influenced by the social, contextual factors described in Chapter 3, such as poverty and substance use.

Sexual and Other Behaviors

Aral (1994) recently reviewed the sexual and other behaviors that place individuals at greater risk of exposure to STDs. These behaviors are:

  1. Initiation of sexual intercourse at an early age. Persons who initiate intercourse at an early age may be at greater risk of STDs because of the longer time they are sexually active and the greater likelihood of risk factors for STDs such as nonvoluntary intercourse, greater number of partners, and less consistent use of condoms. In addition, adolescents are biologically more susceptible to STDs than adults.
  2. Greater number of partners. The greater the number of partners an individual has, the greater is the risk of exposure. This association may be due to the increased risk of exposure to an infected partner with increasing number of partners and the fact that having multiple partners may be associated with other risk factors such as high-risk partners and less consistent use of condoms.
  3. High-risk partners. Having sex with a partner who is likely to have had many partners increases the risk of an STD.
  4. Increased frequency of intercourse and certain sexual practices . The greater is the frequency of intercourse with an infected partner, the greater are the chances of transmission. Risk of HIV infection, hepatitis B virus infection, and other STDs is greater with anal intercourse than with vaginal or oral intercourse.
  5. Lack of circumcision of male partner. As discussed in Chapter 3, men who are not circumcised appear to have a greater risk of acquiring and transmitting certain STDs, such as HIV infection and chancroid, compared to men who are circumcised. Women with male partners who are circumcised are at reduced risk of exposure compared to those with uncircumcised partners.
  6. Use of vaginal douching. Women who douche are at higher risk for later complications of STDs, such as pelvic inflammatory disease, as discussed in Chapter 3.
  7. Lack of barrier contraceptive use. Consistent use of condoms and barrier contraceptives reduces the risk of STDs. As mentioned in Chapter 3 and Table 4-1, hormonal contraceptives may also affect risk of STDs.
Perception of Risk

Americans commonly underestimate their risk for STDs. In a 1993 survey



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