The San Francisco Chronicle - Thursday, October 7, 1999
Carl T. Hall, Chronicle Science Writer

Results highlighted the growing problem of indirect spread of disease, particularly among female partners of HIV-positive men.

"A fair number of these people are underestimating their risk," said Lawrence Finer, senior research associate at the New York-based Alan Guttmacher Institute and co-author of the new study, published in the latest issue of the institute's Family Planning Perspectives journal.

He noted that couples in which the man has multiple partners are no more likely to use condoms than are strictly monogamous couples. Few men, he added, are apt to suggest using protection with their main partners after beginning a secret liaison.

Based on surveys taken between 1988 and 1996, Finer and his colleagues estimated that at least 17 million U.S. women -- or a third of all sexually active females between the ages of 18 and 44 -- are at risk of contracting a sexually transmitted disease (STD), through multiple partners.

The estimate includes 5.4 million women who had more than one sexual partner within the past year, 6.3 million who slept with a man who had multiple partners, and 5.5 million who had both direct and indirect risk.

The study looked at the risks of disease spreading in heterosexual relationships, and it focused mostly on male-to-female indirect exposure because of insufficient survey data for risks to men.

Results showed no evidence of any recent increase in the proportion of sexually active adults, male or female, with multiple partners.

Surveys in the late 1990s showed about 14 percent of men ages 18 to 44 said they had at least three partners within the prior year, down from 18 percent in comparable surveys a decade earlier. For women, the proportion held constant at about 5 percent.

"There's a public perception of increasing promiscuity, but the data don't show that at all," Finer said.

The survey found a substantial discrepancy between what men say about their promiscuity and what women say about their male partner's activities.

Surveyors found that 24 percent of the men reported having had more than one partner during the past year, far higher than the 15 percent estimate from women asked about their partner.

The difference between the two findings led to the new estimate of 3.5 million sexually active women unknowingly at risk of being exposed to a sexually transmitted disease.

Whether this risk actually leads to infection was left unanswered in the Guttmacher study. Finer also conceded that some men may simply have overstated their number of partners, although it's also possible that some may have kept their dalliances hidden even from the researchers.

Despite the unknowns, the survey clearly showed that indirect risks tend to be highest for younger, lower-income minority women, particularly divorced women or women who have never been married.

Formerly married women had odds seven times higher than married women of being at risk, while the potential for indirect exposure was nearly twice as high among women in their late teens than among women in their 40s. All told, about two-thirds of sexually active, unmarried women and teens are at risk of exposure through multiple sex partners.

Specialists in prevention of sexually transmitted diseases said it behooves women to seek regular testing and weigh both their own and their partner's risk factors. Another possibility is to use birth control methods that provide some protection against dangerous microbes.

"This is the first time we've had a national examination of this issue," said Linda Alexander, president of the American Social Health Association, a nonprofit based in Research Triangle, N.C. "We make all sorts of assumptions when we enter into sexual relationships, and often the assumptions are not true. This is how these epidemics continue to rage."

Close to 1 million people are thought to be carriers of the AIDS virus, including about 300,000 unaware of their HIV-positive status. New HIV infections are estimated at 40,000 a year.

"The epidemic is increasingly female," said Daniel Zingale, executive director of AIDS Action, a Washington, D.C. advocacy and research group. Relationships with men who have multiple sexual partners or who inject drugs make women "increasingly vulnerable," he added, calling for more research into vaginal microbicides as "a last-ditch defense."

Another obvious solution might be expanded HIV testing, although the costs and benefits of a national education effort remain controversial.

CHART:

SEX PARTNERS

A study estimates 17 million women in the United States are at risk of a sexually transmitted disease because they or their partners have had sex with someone else -- in many cases, the women don't know they are at risk because they believe their partners are monogamous.

Table 1: Here's a summary for adults ages 18-44 who have had sex at least once within the past year

Partner(s)	Women	Men
One partner	86.3%	75.8%
Two partners	8.8%	10.3%
Three or more partners	4.9%	13.9%

Source: Alan Guttmacher Institute Chronicle Graphic
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