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Morbidity and Mortality Weekly Report
Trends in HIV-Related Risk Behaviors Among High School Students — United States, 1991–2011
<p>CDC Staff</p>
July 27, 2012

One of the three primary goals of the National HIV/AIDS Strategy for the United States is to reduce the number of persons who become infected with human immunodeficiency virus (HIV) (1). In 2009, persons aged 15–29 years comprised 21% of the U.S. population but accounted for 39% of all new HIV infections (2). Sexual intercourse, sexual intercourse with multiple partners, sexual intercourse without using a condom, and injection drug use are behaviors that increase risk for HIV infection. To describe trends in the prevalence of HIV-related risk behaviors among high school students, CDC analyzed data from the biennial national Youth Risk Behavior Survey (YRBS) for the period 1991–2011. The results of that analysis indicated that, although the percentage of students overall who had ever had sexual intercourse decreased significantly from 54.1% in 1991 to 47.4% in 2011, the prevalence of ever having had sexual intercourse did not change significantly after reaching 45.6% in 2001. Similarly, although the percentage of students who had four or more sex partners decreased significantly from 18.7% in 1991 to 15.3% in 2011, the prevalence of having four or more sex partners did not change significantly after reaching 14.2% in 2001. Condom use at most recent sexual intercourse among students currently having sexual intercourse increased from 46.2% in 1991 to 60.2% in 2011. However, the prevalence of condom use did not change significantly beginning in 2003 (63.0%). The prevalence of injection drug use among students overall did not change significantly from 1995 (2.1%) to 2011 (2.3%). The results suggest that progress in reducing some HIV-related risk behaviors among high school students overall and in certain populations did not change significantly in the past decade. To reduce the number of young persons who become infected with HIV, renewed educational efforts and other risk reduction interventions are warranted.

The national YRBS, a component of CDC's Youth Risk Behavior Surveillance System, used independent, three-stage cluster samples for the 1991–2011 biennial surveys to obtain cross-sectional data representative of public and private school students in grades 9–12 in all 50 states and the District of Columbia (3). Sample sizes in the surveys ranged from 10,904 to 16,410. School response rates ranged from 70% to 81%, student response rates ranged from 83% to 90%, and overall response rates* ranged from 60% to 71%.

For each survey, students completed anonymous, self-administered questionnaires that included identically worded questions about their sexual experience, number of sexual intercourse partners, current sexual intercourse, condom use, and injection drug use. Sexual experience was defined as ever having had sexual intercourse. Having multiple sex partners was defined as having sexual intercourse with four or more persons during their life. Current sexual activity was defined as having sexual intercourse with at least one person during the 3 months before the survey. Condom use was defined as using a condom during the most recent sexual intercourse among currently sexually active students. Injection drug use was defined as using a needle to inject any illegal drug into their body one or more times during their life. Data by race/ethnicity are presented for black, white, and Hispanic students only. The three populations are mutually exclusive. All black and white students were non-Hispanic; Hispanic students might be of any race. The numbers of students from other racial/ethnic populations were too small for meaningful trend analysis.

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