Trends in human immunodeficiency virus- and sexually transmitted disease-related risk behaviors among U.S. high school students, 1991-2009.

Background: People who engage in unprotected sexual intercourse or use injection drugs are at increased risk for HIV infection and sexually transmitted diseases (STDs). Monitoring changes in behaviors over time can provide information about the effectiveness of new policies and programs.

Purpose: To measure trends in HIV- and STD-related risk behaviors among high school students in the U.S. during 1991-2009.

Methods: Nationally representative data from the 1991-2009 biennial national Youth Risk Behavior Surveys were analyzed to describe trends in HIV- and STD-related risk behaviors. For each cross-sectional national survey, students completed anonymous, self-administered questionnaires assessing risk behavior participation. This study was approved by the CDC IRB, and parental permission was obtained. To assess the significance of time trends for each behavior, logistic regression analyses were conducted that controlled for gender, grade, and race/ethnicity and simultaneously assessed linear and quadratic effects. Data were analyzed in 2010.

Results: During 1991-2009, decreases were observed in the percentage of U.S. high school students who ever had sexual intercourse, had multiple sex partners, and who were currently sexually active. The prevalence of condom use increased during 1991-2003 and then leveled off during 2003-2009. However, these changes in risk behaviors were not observed in some gender and racial/ethnic subgroups.

Conclusions: Additional efforts to reduce HIV- and STD-related risk behaviors, particularly among black and Hispanic students, must be implemented to decrease rates of HIV infection and STDs.