Questions for Casey Copen, Ph.D., M.P.H., Statistician and Author of “Receipt of a Sexual Risk Assessment From a Doctor or Medical Care Provider in the Past Year Among Women and Men Aged 15–44 With Recent Sexual Activity.”
Q: Why did you decide to examine the percentage of women and men aged 15-44 in the U.S. who received a sexual risk assessment?
CC: Sexually transmitted infections (STIs) including chlamydia and gonorrhea are among the most common reportable infections nationwide. If left untreated, STIs can result in serious health consequences, including infertility. The first step in the prevention of HIV and other STIs is to identify the people who may be at risk. Health care providers who talk to their patients about aspects of their sexual experience may make them aware of behaviors that may increase their risk, such as not using condoms and having multiple sexual partners. In 2011 (for men) and 2013 (for women), four questions were added to the audio computer-assisted self-interview portion of the National Survey of Family Growth (NSFG) that asked whether a doctor or other medical care provider had questioned them in the past year about 1) their sexual orientation or the sex of their sexual partners; 2) their number of sexual partners; 3) their use of condoms; 4) the types of sex they have, whether vaginal, oral or anal. Taken together, these questions comprise what is referred to in this report as a sexual risk assessment. I conducted these analyses because it is important to have a general sense for whether doctors or other medical care providers ask their patients these types of questions.
Q: What are we seeing with the overall percentage of U.S. adults with recent sexual activity who received a sexual risk assessment?
CC: Overall, 47% of women and 23% of men aged 15-44 with recent sexual activity (i.e., sex with an opposite-sex or same-sex partner in the past year) received a sexual risk assessment from a doctor or other medical care provider in the past year.
Q: What differences did you see in the receipt of a sexual risk assessment by selected social, demographic and behavioral characteristics in this analysis?
CC: Receipt of a sexual risk assessment was higher among women and men aged 15-24, those who were Hispanic and Non-Hispanic black, those who had income below 300% of the poverty level, or who had public health insurance. Additionally, receipt of a sexual risk assessment was higher among men who identified as gay or bisexual, lived in urban areas , or who had a usual place to go for medical care. Higher receipt of a sexual risk assessment was also seen for women and men who had two or more opposite-sex partners in the past compared with those who had only 1 opposite-sex sexual partner and for men who had a same-sex sexual partner in the past year or who had any HIV-related sexual risk behaviors in the past year.
Q: Were there any findings that surprised you?
CC: It is not surprising that studies on the prevalence of sexual risk assessment are generally concerned with clinic populations (i.e., those who may be most at risk for HIV/STI infection). However, I do find it interesting that, to my knowledge, this is the first time a nationally representative household survey has provided estimates of sexual risk assessment receipt in the general reproductive-aged population.
Q: What overall message do you hope to leave with the general public when it comes to sexual risk assessment?
CC: A sexual risk assessment is a primary prevention tool that can help identify persons at risk of HIV/STIs. While about half of women aged 15-44 received a sexual risk assessment in the past year, for men, receipt was more focused among those who engaged in HIV risk-related behaviors in the past year. In addition, both women and men who received a sexual risk assessment were more likely to have been tested for HIV/STI in the past year. This positive relationship suggests that where clinical conversations about sexual behavior occur, HIV/STI testing may follow.