Concurrent sexual partnerships among African American women in Philadelphia: results from a qualitative study

Abstract

Background African American women are disproportionately affected by HIV/AIDS. Concurrent sexual partnerships may contribute to racial disparities in HIV infection. Little is known about attitudes and practices related to concurrency among African American women and the social, structural and behavioral factors that influence concurrency. Methods We recruited 19 heterosexual African American women engaging in concurrent sexual partnerships from a public health clinic in Philadelphia in 2009. We conducted in-depth interviews exploring social norms, attitudes and practices about concurrency, and the structural, social and behavioral factors influencing concurrent sexual partnerships. Grounded theory guided interview protocols and data analysis. Results Seventeen women reported one main and one or more non-main partners; two reported no main partners. Many women used condoms more frequently with non-main than main partners, noting they trust main partners more than non-main partners. Social factors influencing concurrency included social normalization of concurrency, inability to negotiate partners’ other concurrent partnerships, being unmarried, and not trusting main and non-main partners. Not trusting partners and the community at large were the most commonly cited reasons that women engaged in concurrent partnerships. Structural factors included economic dependence on partners, partners’ dependence on women for economic support and housing, and incarceration that interrupted partnerships. Behavioral factors including alcohol and cocaine use influenced concurrency. Conclusions Social, structural, and behavioral factors strongly influenced these African American women’s concurrent sexual partnerships. Many evidence-based interventions (EBIs) disseminated by the US Centers for Disease Control and Prevention (CDC) focus largely on behavioral factors and may fail to address the social and structural factors influencing African American women’s sexual networks. Novel HIV prevention interventions that address the social determinants of African American women’s HIV risks in addition to conventional HIV risk- taking behaviors are urgently needed.

Women’s decision-making about self-protection during sexual activity in the deep south of the USA: a grounded theory study

“…It was anticipated that an important aspect of these women’s experiences that would influence their self-protection decisions would be their financial situation and lack of economic support (Nunn et al 2012), yet, this was not discussed by any of the participants in this study. Instead, the emotional aspects of the relationship appeared to be more important to them.…”

“…Research related to HIV acquisition among women, particularly minority women living in Southern states, has primarily focused on gaining an understanding of the individual and sociocultural factors that influence the practice of risky sexual behaviours (Mallory 2008; Mullinax et al 2016; Nunn et al 2012; Paranjape et al 2006; Smith 2015; Teitelman et al 2015; Villar-Loubet et al 2016). Trust, the imbalance of power and an unequal gender ratio have been found to be important factors that influenced women’s use of condoms when engaging in risky sexual activity, especially in the case of long-term relationships.…”

Factors Associated with African American Women’s Sexual Health and Risk Behavior: A Mixed Methods Study

“…The consistency of AAW's condom usage has often been described as low or sporadic (Perkins et al, 2014;Pfileger et al, 2013). Additionally, research studies examining AAW's sexual behavior often explore women's condom use in conjunction with having multiple or concurrent sexual partners (Grieb, Davey-Rothwell, & Latkin, 2012a;McLellan-Lemal et al, 2012;Nunn et al, 2012). Concurrent sexual partnerships involve having sexual encounters with multiple partners that overlap or occur over the same span of time (Nunn et al, 2012).…”

“…Additionally, research studies examining AAW's sexual behavior often explore women's condom use in conjunction with having multiple or concurrent sexual partners (Grieb, Davey-Rothwell, & Latkin, 2012a;McLellan-Lemal et al, 2012;Nunn et al, 2012). Concurrent sexual partnerships involve having sexual encounters with multiple partners that overlap or occur over the same span of time (Nunn et al, 2012). AAW have frequently been identified as being more likely than women of other groups to engage in concurrent partnerships (Adimora, Schoenbach, Taylor, Khan, & Schwartz, 2011;Nunn et al, 2012).…”

“…Concurrent sexual partnerships involve having sexual encounters with multiple partners that overlap or occur over the same span of time (Nunn et al, 2012). AAW have frequently been identified as being more likely than women of other groups to engage in concurrent partnerships (Adimora, Schoenbach, Taylor, Khan, & Schwartz, 2011;Nunn et al, 2012). Both inconsistent condom use and concurrent sexual partnerships have been identified as high-risk behaviors engaged in more frequently by AAW and are commonly used to measure AAW's sexual risk (McLellan-Lemal et al, 2012;Neblett et al, 2011;Perkins et al, 2014).…”