title: Effect of relationship factors on safer sex decisions in older inner-city women.
abstract: OBJECTIVE
  Heterosexual transmission of the human immunodeficiency virus (HIV) in older women is on the rise, yet little is known about safer sex practices in these women. We sought to determine the prevalence of and effect of relationship factors on safer sex practices among older women living in a high HIV incidence region.
  
  
  METHODS
  In a cross-sectional study at an ambulatory medicine clinic of a large inner-city hospital, participants were women over age 50 seeking medical services at the study site. Measurements included (1) partner trust, (2) dependence on partner, (3) personally obtaining condoms, (4) safer sex (frequent condom use or abstinence), (5) knowledge of condom efficacy, and (6) perceived HIV risk.
  
  
  RESULTS
  Of 155 participants in a current relationship, 81% were sexually active; however, only 13% of these women used condoms frequently. No significant differences were found between participants who did and did not practice safer sex with respect to their age, race, employment, marital status, knowledge of condom efficacy, or perceived HIV risk. Trust in partner was independently associated with lower odds of safer sex (OR 0.3, 95% CI 0.08-1.06). Personally obtaining condoms (OR 9.2, 95% CI 1.9-44.2) and dependence on partner for condoms (OR 12.3, 95% CI 3.0-50.3) were independently associated with higher odds of safer sex. CONCLUSIONS. Few older women in high HIV incidence areas practice safer sex. Relationship factors impact the risk of acquiring HIV through safer sex decisions. HIV prevention messages geared to older women should incorporate references to the role these factors can play in reducing their HIV risk.
authors.affiliation: Division of General Medicine, Emory University School of Medicine, Atlanta, Georgia, USA. aparanj@emory.edu
authors.forename: Anuradha
authors.initials: A
authors.lastname: Paranjape
authors.forename: Lisa
authors.initials: L
authors.lastname: Bernstein
authors.forename: Diane Marie
authors.initials: DM
authors.lastname: St George
authors.forename: Joyce
authors.initials: J
authors.lastname: Doyle
authors.forename: Susan
authors.initials: S
authors.lastname: Henderson
authors.forename: Giselle
authors.initials: G
authors.lastname: Corbie-Smith
mesh_terms: D000368:Aged; D017280:Condoms / Q000706:statistics & numerical data; D016001:Confidence Intervals; D003268:Contraception Behavior; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007398:Interpersonal Relations; D008875:Middle Aged; D016017:Odds Ratio; D021841:Safe Sex / Q000706:statistics & numerical data*; D012736:Sex Education / Q000379:methods; D012747:Sexual Partners; D011795:Surveys and Questionnaires; D035502:Trust; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data*; D016387:Women's Health