An unmatched retrospective case control study was conducted to test the feasibility of investigating social and behavioural factors which may have contributed to recent HIV seroconversion in a group of homosexual men. Participants, recruited from a London sexually transmitted disease (STD) clinic, were sexually active and had had a negative HIV test with a subsequent test (positive (cases) or negative (controls)) within three to 15 months. Twenty cases and 22 controls were recruited between February and October 1995. There was no difference between cases and controls in: the number of regular or casual sexual partners, the proportion who were unaware of their regular partners' serostatus (cases 60%, controls 59%), or the proportion who had known HIV-positive regular partners (cases 20%, controls 23%). A significant difference in sexual behaviour was found only when the HIV status of partners, if known, was taken into account: cases were more likely than controls to have had unprotected receptive anal intercourse with a partner not known to be HIV-negative (OR = 5.5, CI = 1.15-29.50). Fifty per cent of the cases and 27% of the controls acquired acute STDs between the two HIV tests. All participants achieved high self-efficacy scores, but the controls believed their peers placed a greater value on safer sex. Cases cited emotional issues and the use of drugs and alcohol as contributing to their seroconversion, whereas controls cited a commitment to safer sex and the avoidance of high-risk situations as contributing to their remaining HIV-negative. The results illustrate the importance of acknowledging the concept of 'negotiated safety' in studies of sexual behaviour; seroconversion was only associated with unprotected sex with a partner not known to be HIV-negative. Despite high self-efficacy scores, indicating the skills to negotiate safer sex, high levels of unsafe anal intercourse were reported. Differences between cases and controls included the importance of safer sex, periods of emotional vulnerability, influence of peers and the appropriate use of condoms. There is a need for these results to be confirmed in a larger and more powerful study.

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IntroductionIn Britain, STI diagnoses rates are highest among black Caribbeans compared to other ethnic groups. The prevalence of concurrency is also high in this population. Concurrent partnerships, (i.e. having sexual partners overlapping in time), can enhance the rate and speed of STI transmission. We explored typologies and drivers of concurrency in black Caribbeans in England and considered their implications for STI prevention.MethodsUsing purposive sampling, we recruited people of black Caribbean ethnicity aged ≥15 years from community settings and STI clinics. Audio-recorded 4 focus group discussions (n=28 participants) and 24 in-depth interviews were conducted between June 2014-Dec 2015 using topic guides. Data was transcribed, managed using NVivo software and analysed using thematic framework to identify patterns of concurrent partnerships and condom use, and reasons for concurrency.Results32 women and 20 men (age range: 15–70 years) identifying as heterosexual participated. Open, situational, and experimental concurrent partnerships were commonly reported. Open concurrent partnerships involved a person having a main sexual partner and, in the case of men, additionally having sex with other “side chicks” or “thots”, and in the case of women, “side dicks”. Situational partnerships involved having a sexual relationship with an ex-partner, especially with someone with whom they had had a child, while having another main sexual partner. These types of partnerships were usually long-term, and condoms were less likely to be used due to emotional attachment, if a co-parent was single and then condomless sex was perceived as a way to “entice” the partner back, or due to the relationship being founded on sexual pleasure. Usuallypeople were aware of the concurrent nature of these partnerships. Experimental concurrent partnerships, commonly reported by single participants, were usually short term, and mostly involved condom use. These were fuelled by lack of readiness to settle with a single partner, or trying to figure out the type of partner they may want to settle with. Other commonly reported reasons for concurrency were low self-esteem at an individual level. At a socio-cultural level, although concurrency was frowned upon, it was perceived as “a Black Caribbean thing” with references being commonly made in certain types of popular music and dance among black Caribbeans, changing norms of relationships in an era where you can “order sex via app”, peer pressure, and a normalisation of concurrency on social media, especially among men.ConclusionAmong black Caribbeans, the different types and contexts of concurrent partnerships can have implications for STI prevention. Awareness of being in a concurrent partnership could potentially facilitate uptake of interventions including condom use, partner notification, and reduce the risk of re-infection. In addition, such interventions should address broader sociocultural factors influencing risk behaviour including the impact of media.