Trends in HIV-Related Risk Behaviors Among High School Students -- United States, 1991-2011

What is already known on this topic?

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). In 2009, young persons aged 15-29 years comprised 21% of the U.S. population but accounted for 39% of all new HIV infections.

What is added by this report?

Overall, decreases in sexual experience and having four or more sex partners did not change significantly beginning in 2001, and increases in condom use did not change significantly beginning in 2003.

What are the implications for public health practice?

To achieve the National HIV/AIDS Strategy for the United States goal of reducing the number of persons who become infected with HIV, renewed educational efforts that reach all students before HIV-related risk behaviors are initiated and that seek to delay the onset of sexual activity, increase condom use among students who are sexually active, and decrease injection drug use are warranted.

Characteristic

Survey Year

Ever Had Sexual Intercourse

Had Sexual Intercourse With Four or More Persons During Their Life

Currently Sexually Active*

Condom Use^†

Ever Injected an Illegal Drug^§

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Total

1991

54.1

(50.5-57.8)

18.7

(16.6-21.0)

37.5

(34.3-40.7)

46.2

(42.8-49.6)

NA

--

1993

53.0

(50.2-55.8)

18.7

(16.8-20.9)

37.5

(35.4-39.7)

52.8

(50.0-55.6)

NA

--

1995

53.1

(48.4-57.7)

17.8

(15.2-20.7)

37.9

(34.4-41.5)

54.4

(50.7-58.0)

2.1

(1.6-2.6)

1997

48.4

(45.2-51.6)

16.0

(14.6-17.5)

34.8

(32.6-37.2)

56.8

(55.2-58.4)

2.1

(1.7-2.7)

1999

49.9

(46.1-53.7)

16.2

(13.7-19.0)

36.3

(32.7-40.0)

58.0

(53.6-62.3)

1.8

(1.4-2.2)

2001

45.6

(43.2-48.1)

14.2

(13.0-15.6)

33.4

(31.3-35.5)

57.9

(55.6-60.1)

2.3

(2.0-2.7)

2003

46.7

(44.0-49.4)

14.4

(12.9-16.1)

34.3

(32.1-36.5)

63.0

(60.5-65.5)

3.2

(2.1-4.7)

2005

46.8

(43.4-50.2)

14.3

(12.8-15.8)

33.9

(31.4-36.6)

62.8

(60.6-64.9)

2.1

(1.8-2.4)

2007

47.8

(45.1-50.6)

14.9

(13.4-16.5)

35.0

(32.8-37.2)

61.5

(59.4-63.6)

2.0

(1.5-2.7)

2009

46.0

(42.9-49.2)

13.8

(12.4-15.4)

34.2

(31.9-36.5)

61.1

(59.0-63.1)

2.1

(1.8-2.5)

2011

47.4

(45.0-49.9)^¶**

15.3

(14.2-16.4)^¶**

33.7

(31.8-35.7)^¶

60.2

(57.5-62.9)^¶**

2.3

(1.9-2.7)

Sex

Male

1991

57.4

(53.1-61.5)

23.4

(20.4-26.7)

36.8

(33.3-40.3)

54.5

(50.5-58.4)

NA

--

1993

55.6

(52.0-59.2)

22.3

(19.6-25.2)

37.5

(34.5-40.7)

59.2

(55.3-63.0)

NA

--

1995

54.0

(49.0-58.8)

20.9

(18.3-23.7)

35.5

(32.0-39.2)

60.5

(56.0-64.9)

3.0

(2.4-3.7)

1997

48.9

(45.4-52.3)

17.6

(16.1-19.2)

33.4

(30.8-36.1)

62.5

(59.6-65.3)

2.6

(2.0-3.3)

1999

52.2

(48.0-56.2)

19.3

(15.8-23.3)

36.2

(32.3-40.2)

65.5

(61.0-69.8)

2.8

(2.1-3.8)

2001

48.5

(45.8-51.3)

17.2

(15.7-18.9)

33.4

(31.0-35.8)

65.1

(62.2-67.9)

3.1

(2.7-3.6)

2003

48.0

(44.6-51.4)

17.5

(15.3-19.9)

33.8

(31.3-36.5)

68.8

(66.0-71.4)

3.8

(2.7-5.4)

2005

47.9

(44.4-51.5)

16.5

(14.8-18.4)

33.3

(30.7-36.0)

70.0

(66.7-73.0)

3.0

(2.6-3.6)

2007

49.8

(46.7-52.9)

17. 9

(16.0-20.0)

34.3

(32.0-36.7)

68.5

(65.4-71.4)

2.6

(2.0-3.4)

2009

46.1

(41.5-50.9)

16.2

(13.7-19.1)

32.6

(29.4-36.0)

68.6

(66.0-71.2)

2.7

(2.1-3.4)

2011

49.2

(46.6-51.8)^¶**

17.8

(16.2-19.4)^¶**

33.3

(31.1-35.6)^¶

67.0

(63.5-70.3)^¶**

2.9

(2.4-3.4)

Female

1991

50.8

(46.7-54.9)

13.8

(12.1-15.7)

38.2

(34.7-41.8)

38.0

(33.7-42.5)

NA

--

1993

50.2

(47.5-52.8)

15.0

(13.2-17.0)

37.5

(35.7-39.3)

46.0

(43.2-49.0)

NA

--

1995

52.1

(46.9-57.2)

14.4

(11.1-18.5)

40.4

(36.1-44.8)

48.6

(43.3-53.9)

1.0

(0.6-1.7)

1997

47.7

(43.9-51.5)

14.1

(12.3-16.3)

36.5

(33.8-39.3)

50.8

(47.7-53.8)

1.5

(0.9-2.5)

1999

47.7

(43.5-51.9)

13.1

(11.0-15.5)

36.3

(32.2-40.7)

50.7

(44.8-56.6)

0.7

(0.5-1.1)

2001

42.9

(401.-45.8)

11.4

(10.0-13.0)

33.4

(30.9-35.9)

51.3

(47.8-54.9)

1.6

(1.2-2.1)

2003

45.3

(42.6-48.0)

11.2

(9.8-12.7)

34.6

(32.5-36.8)

57.4

(54.2-60.5)

2.5

(1.4-4.2)

2005

45.7

(42.0-49.4)

12.0

(10.4-13.7)

34.6

(31.5-37.7)

55.9

(53.0-58.8)

1.1

(0.8-1.6)

2007

45.9

(43.1-48.6)

11.8

(10.5-13.1)

35.6

(332.-38.1)

54.9

(51.8-58.1)

1.3

(0.8-2.2)

2009

45.7

(43.0-48.5)

11.2

(10.1-12.4)

35.6

(33.4-38.0)

53.9

(51.4-56.4)

1.4

(1.2-1.8)

2011

45.6

(43.0-48.3)^¶

12.6

(11.4-14.0)^¶

34.2

(32.1-36.4)^¶

53.6

(50.6-56.4)^¶**

1.6

(1.3-2.0)

Characteristic

Survey Year

Ever Had Sexual Intercourse

Had Sexual Intercourse with Four or More Persons During Their Life

Currently Sexually Active*

Condom Use^†

Ever Injected an Illegal Drug^§

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Race/Ethnicity^††

Black

1991

81.5

(78.0-84.5)

43.1

(39.5-46.7)

59.3

(55.3-63.1)

48.0

(44.1-51.9)

NA

--

1993

79.7

(76.2-82.7)

42.7

(38.8-46.7)

59.1

(54.6-63.5)

56.5

(52.6-60.3)

NA

--

1995

73.4

(68.4-77.8)

35.6

(31.2-40.3)

54.2

(49.4-59.0)

66.1

(61.0-70.9)

1.1

(0.6-2.0)

1997

72.7

(69.7-75.4)

38.5

(34.9-42.3)

53.6

(50.3-56.9)

64.0

(61.0-66.8)

1.0

(0.5-2.0)

1999

71.2

(62.2-78.8)

34.4

(24.7-45.7)

53.0

(43.8-62.0)

70.0

(64.1-75.2)

0.9

(0.5-1.6)

2001

60.8

(53.9-67.4)

26.6

(22.9-30.6)

45.6

(40.1-51.2)

67.1

(63.4-70.6)

1.6

(1.0-2.5)

2003

67.3

(63.7-70.6)

28.8

(26.3-31.5)

49.0

(46.0-52.0)

72.8

(68.8-76.4)

2.4

(1.5-3.9)

2005

67.6

(64.4-70.7)

28.2

(25.6-30.9)

47.4

(44.7-50.1)

68.9

(65.0-72.5)

1.7

(0.9-3.0)

2007

66.5

(63.0-69.9)

27.6

(24.8-30.6)

46.0

(42.3-49.7)

67.3

(62.6-71.6)

1.8

(1.2-2.6)

2009

65.2

(62.0-68.3)

28.6

(25.5-32.0)

47.7

(44.2-51.2)

62.4

(57.9-66.8)

2.4

(1.7-3.4)

2011

60.0

(56.6-63.4)^¶

24.8

(22.4-27.3)^¶

41.3

(38.4-44.3)^¶

65.3

(60.4-69.9)^¶**

2.4

(1.7-3.5)^¶

White

1991

50.0

(46.7-53.4)

14.7

(13.0-16.7)

33.9

(31.1-36.9)

46.5

(41.8-51.2)

NA

--

1993

48.4

(45.6-51.3)

14.3

(12.3-16.6)

34.0

(31.9-36.2)

52.3

(48.2-56.3)

NA

--

1995

48.9

(43.8-54.1)

14.2

(11.8-16.8)

34.8

(30.8-39.0)

52.5

(48.4-56.6)

2.0

(1.5-2.7)

1997

43.6

(39.4-48.0)

11.6

(10.2-13.2)

32.0

(29.0-35.3)

55.8

(53.8-57.8)

1.8

(1.4-2.4)

1999

45.1

(41.1-49.2)

12.4

(10.4-14.7)

33.0

(29.6-36.5)

55.0

(49.8-60.2)

1.6

(1.2-2.1)

2001

43.2

(40.7-45.8)

12.0

(10.6-13.5)

31.3

(29.0-33.6)

56.8

(53.7-59.9)

2.4

(2.0-2.9)

2003

41.8

(39.0-44.5)

10.8

(9.4-12.4)

30.8

(28.7-32.9)

62.5

(59.2-65.6)

2.5

(1.5-4.3)

2005

43.0

(38.8-47.3)

11.4

(9.7-13.3)

32.0

(28.7-35.5)

62.6

(60.0-65.2)

1.9

(1.6-2.3)

2007

43.7

(40.5-47.0)

11.5

(9.6-13.7)

32.9

(30.3-35.5)

59.7

(56.8-62.5)

1.5

(1.0-2.3)

2009

42.0

(37.9-46.3)

10.5

(9.0-12.3)

32.0

(28.8-35.3)

63.3

(60.4-66.1)

1.6

(1.2-2.1)

2011

44.3

(41.1-47.4)^¶**

13.1

(11.7-14.5)^¶**

32.4

(29.7-35.3)

59.5

(55.4-63.5)^¶**

1.9

(1.6-2.3)

Hispanic

1991

53.1

(49.4-56.7)

16.8

(14.3-19.7)

37.0

(33.4-40.8)

37.4

(31.3-44.0)

NA

--

1993

56.0

(51.8-60.2)

18.6

(15.7-22.0)

39.4

(35.6-43.3)

46.1

(41.6-50.6)

NA

--

1995

57.6

(48.6-66.1)

17.6

(14.1-21.7)

39.3

(32.3-46.8)

44.4

(33.4-56.0)

2.2

(1.4-3.4)

1997

52.2

(48.4-55.8)

15.5

(13.2-18.1)

35.4

(31.5-39.5)

48.3

(42.6-54.0)

2.2

(1.6-2.9)

1999

54.1

(49.0-59.0)

16.6

(13.2-20.7)

36.3

(32.2-40.5)

55.2

(48.1-62.0)

1.8

(1.1-2.8)

2001

48.4

(43.8-53.0)

14.9

(13.2-16.7)

35.9

(32.7-39.4)

53.5

(48.2-58.7)

2.5

(1.8-3.4)

2003

51.4

(48.1-54.8)

15.7

(13.5-18.1)

37.1

(34.4-40.0)

57.4

(51.9-62.8)

3.9

(2.2-6.8)

2005

51.0

(46.5-55.4)

15.9

(13.6-18.5)

35.0

(31.1-39.1)

57.7

(53.4-61.8)

3.0

(2.1-4.2)

2007

52.0

(48.3-55.6)

17.3

(15.2-19.5)

37.4

(33.8-41.1)

61.4

(56.7-65.9)

3.1

(2.2-4.3)

2009

49.1

(46.0-52.2)

14.2

(12.7-15.9)

34.6

(32.2-37.0)

54.9

(51.7-58.0)

3.1

(2.4-4.0)

2011

48.6

(46.1-51.0)

14.8

(13.6-16.0)

33.5

(31.6-35.4)

58.4

(54.0-62.7)^¶**

2.9

(2.2-3.8)^¶

Abbreviations: HIV = human immunodeficiency virus; CI = confidence interval; NA = not available.

* Had sexual intercourse with at least one person during the 3 months before the survey.

† During most recent sexual intercourse among students who were currently sexually active.

§ Used a needle to inject any illegal drug into their body one or more times during their life. Wording of this question changed substantially after the 1993 survey, so 1991 and 1993 data are not included.

¶ Significant linear effect (p<0.05).

** Significant quadratic effect (p<0.05).

†† 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.