Concurrent sexual partnerships among African American women in Philadelphia: results from a qualitative study
Amy Nunn A D , Samuel Dickman A , Alexandra Cornwall A , Helena Kwakwa B , Kenneth H. Mayer A , Aadia Rana A and Cynthia Rosengard C
+ Author Affiliations
- Author Affiliations
A Alpert Medical School of Brown University and The Miriam Hospital, Division of Infectious Diseases, Providence 02906 RI, USA.
B Philadelphia Department of Public Health, Philadelphia 19144, PA, USA.
C Alpert Medical School of Brown University, Departments of Medicine and Obstetrics & Gynecology, Providence 02906 RI, USA.
D Corresponding author. Email: Amy_nunn@brown.edu
Sexual Health 9(3) 288-296 https://doi.org/10.1071/SH11099
Submitted: 9 July 2011 Accepted: 30 September 2011 Published: 9 January 2012
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, or the social, structural and behavioural factors influencing concurrency. Methods: We recruited 19 heterosexual African American women engaging in concurrent sexual partnerships from a public clinic in Philadelphia in 2009. We conducted interviews exploring social norms, attitudes and practices about concurrency, and the structural, social and behavioural factors influencing concurrent sexual partnerships, guided by grounded theory. 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 included social normalisation of concurrency, inability to negotiate partners’ concurrent partnerships, being unmarried, and not trusting partners. Lack of trust was the most commonly cited reason that women engaged in concurrent partnerships. Structural factors included economic dependence on partners, partners’ dependence on women for economic support and incarceration that interrupted partnerships. Behavioural factors included alcohol and cocaine use. Conclusions: Social, structural and behavioural factors strongly influenced these African American women’s concurrent sexual partnerships. Many HIV interventions disseminated by the CDC focus largely on behavioural 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 are urgently needed.
Additional keywords: concurrency, HIV/AIDS, incarceration.
References
[1] Hall HI, Song R, Rhodes P, Prejean J, An Q, Lee LM, et al Estimation of HIV incidence in the United States. JAMA 2008; 300 520–9.| Estimation of HIV incidence in the United States.Crossref | GoogleScholarGoogle Scholar | 18677024PubMed |
[2] Hall HI, Hughes D, Dean H, Mermin J, Fenton K. HIV Infection – United States, 2005 and 2008. MMWR Morb Mortal Wkly Rep. 2011; 60 87–9.
[3] Centers for Disease Control and Prevention Disparities in diagnoses of HIV infection between Blacks/African Americans and other racial/ethnic populations – 37 states, 2005–2008. MMWR Morb Mortal Wkly Rep 2011; 60 93–8.
| 21293323PubMed |
[4] Centers for Disease Control and Prevention (CDC). HIV/AIDS among women., Atlanta: CDC; 2008.
[5] Harrison KM, Song R, Zhang X. Life expectancy after HIV diagnosis based on national HIV surveillance data from 25 states, United States. J Acquir Immune Defic Syndr 2010; 53 124–30.
| Life expectancy after HIV diagnosis based on national HIV surveillance data from 25 states, United States.Crossref | GoogleScholarGoogle Scholar | 19730109PubMed |
[6] Meditz AL, Meditz AL, Mawhinney S, Allshouse A, Feser W, Markowitz M, Little S, et al Sex, race, and geographic region influence clinical outcomes following primary HIV-1 infection. J Infect Dis 2011; 203 442–51.
| Sex, race, and geographic region influence clinical outcomes following primary HIV-1 infection.Crossref | GoogleScholarGoogle Scholar | 21245157PubMed |
[7] Hallfors DD, Iritani BJ, Miller WC, Bauer DJ. Sexual and drug behavior patterns and HIV and STD racial disparities: the need for new directions. Am J Public Health 2007; 97 125–32.
| Sexual and drug behavior patterns and HIV and STD racial disparities: the need for new directions.Crossref | GoogleScholarGoogle Scholar | 17138921PubMed |
[8] Aral SO, Adimora AA, Fenton KA. Understanding and responding to disparities in HIV and other sexually transmitted infections in African Americans. Lancet 2008; 372 337–40.
| Understanding and responding to disparities in HIV and other sexually transmitted infections in African Americans.Crossref | GoogleScholarGoogle Scholar | 18657713PubMed |
[9] World Health Organization (WHO). Closing the gap in a generation: health equity through action on the social determinants of health. Geneva: WHO; 2008.
[10] Adimora AA, Schoenbach VJ, Martinson FE, Donaldson KH, Stancil TR, Fullilove RE. Concurrent sexual partnerships among African Americans in the rural south. Ann Epidemiol 2004; 14 155–60.
| Concurrent sexual partnerships among African Americans in the rural south.Crossref | GoogleScholarGoogle Scholar | 15036217PubMed |
[11] Adimora AA, Schoenbach VJ, Doherty IA. HIV and African Americans in the southern United States: sexual networks and social context. Sex Transm Dis 2006; 33 S39–45.
| HIV and African Americans in the southern United States: sexual networks and social context.Crossref | GoogleScholarGoogle Scholar | 16794554PubMed |
[12] Adimora AA, Schoenbach VJ, Martinson FE, Donaldson KH, Stancil TR, Fullilove RE.. Concurrent partnerships among rural African Americans with recently reported heterosexually transmitted HIV infection. J Acquir Immune Defic Syndr 2003; 34 423–9.
| Concurrent partnerships among rural African Americans with recently reported heterosexually transmitted HIV infection.Crossref | GoogleScholarGoogle Scholar | 14615661PubMed |
[13] Kretzschmar M. Sexual network structure and sexually transmitted disease prevention: a modeling perspective. Sex Transm Dis 2000; 27 627–35.
| Sexual network structure and sexually transmitted disease prevention: a modeling perspective.Crossref | GoogleScholarGoogle Scholar | 11099078PubMed |
[14] Morris M, Kretzschmar M. Concurrent partnerships and the spread of HIV. AIDS 1997; 11 641–8.
| Concurrent partnerships and the spread of HIV.Crossref | GoogleScholarGoogle Scholar | 9108946PubMed |
[15] Garnett GP, Johnson AM. Coining a new term in epidemiology: concurrency and HIV. AIDS 1997; 11 681–3.
| Coining a new term in epidemiology: concurrency and HIV.Crossref | GoogleScholarGoogle Scholar | 9108951PubMed |
[16] Morris M, Kretzschmar M. Concurrent partnerships and transmission dynamics in social networks. Soc Networks 1995; 17 299–318.
| Concurrent partnerships and transmission dynamics in social networks.Crossref | GoogleScholarGoogle Scholar |
[17] Centers for Disease Control and Prevention (CDC). Diagnoses of HIV infection and AIDS in the United States and dependent areas, 2008: HIV surveillance report, volume 20. Atlanta: US Department of Health and Human Services; 2010.
[18] Adimora AA, Schoenbach VJ, Bonas DM, Martinson FE, Donaldson KH, Stancil TR. Concurrent sexual partnerships among women in the United States. Epidemiology 2002; 13 320–7.
| Concurrent sexual partnerships among women in the United States.Crossref | GoogleScholarGoogle Scholar | 11964934PubMed |
[19] Adimora AA, Schoenbach VJ, Doherty IA. Concurrent sexual partnerships among men in the United States. Am J Public Health 2007; 97 2230–7.
| Concurrent sexual partnerships among men in the United States.Crossref | GoogleScholarGoogle Scholar | 17971556PubMed |
[20] Adimora AA, Schoenbach VJ, Taylor EM, Khan MR, Schwartz RJ. Concurrent partnerships, nonmonogamous partners, and substance use among women in the United States. Am J Public Health 2011; 101 128–36.
| Concurrent partnerships, nonmonogamous partners, and substance use among women in the United States.Crossref | GoogleScholarGoogle Scholar | 20724694PubMed |
[21] Neblett RC, Davey-Rothwell M, Chander G, Latkin CA. Social network characteristics and HIV sexual risk behavior among urban African American women. J Urban Health 2011;
| Social network characteristics and HIV sexual risk behavior among urban African American women.Crossref | GoogleScholarGoogle Scholar | 21234695PubMed |
[22] AIDS Activities Coordinating Office of the City of Philadelphia (AACO). Philadelphia HIV/AIDS epidemiological update., Philadelphia: AACO; 2008.
[23] US Census Bureau. The Black population 2000, In Census 2000 Brief., Washington DC: US Census Bureau; 2001. p.7
[24] Nunn A, Zaller N, Cornwall A, Mayer KH, Moore E, Dickman S, et al Low perceived risk and high HIV prevalence among a predominantly African American population participating in Philadelphia’s rapid HIV testing program. AIDS Patient Care STDS 2011; 25 229–35.
| Low perceived risk and high HIV prevalence among a predominantly African American population participating in Philadelphia’s rapid HIV testing program.Crossref | GoogleScholarGoogle Scholar | 21406004PubMed |
[25] Khan MR, Wohl DA, Weir SS, Adimora AA, Moseley C, Norcott K, et al Incarceration and risky sexual partnerships in a southern US city. J Urban Health 2008; 85 100–13.
| Incarceration and risky sexual partnerships in a southern US city.Crossref | GoogleScholarGoogle Scholar | 18027088PubMed |
[26] UNAIDS HIV: consensus indicators are needed for concurrency. Lancet 2010; 375 621–2.
| HIV: consensus indicators are needed for concurrency.Crossref | GoogleScholarGoogle Scholar | 19954832PubMed |
[27] Glaser B, Strauss A. The discovery of grounded theory: strategies for qualitative research. Chicago: Aldine; 1967.
[28] Morse JM. Developing grounded theory: the second generation. Developing qualitative inquiry. Walnut Creek, CA: Left Coast Press; 2009.
[29] Magnus M, et al Magnus M, et al Risk factors driving the emergence of a generalized heterosexual HIV epidemic in Washington, District of Columbia networks at risk. AIDS 2009; 23 1277–84.
| Risk factors driving the emergence of a generalized heterosexual HIV epidemic in Washington, District of Columbia networks at risk.Crossref | GoogleScholarGoogle Scholar |
[30] Khan MR, Doherty IA, Schoenbach VJ, Taylor E, Epperson M, Adimora AA. Incarceration and high-risk sex partnerships among men in the united states. J Urban Health 2009; 86 584–601.
| Incarceration and high-risk sex partnerships among men in the united states.Crossref | GoogleScholarGoogle Scholar |
[31] Manhart LE, Aral SO, Holmes KK, Foxman B. Sex partner concurrency: measurement, prevalence, and correlates among urban 18–39-year-olds. Sex Transm Dis 2002; 29 133–43.
| Sex partner concurrency: measurement, prevalence, and correlates among urban 18–39-year-olds.Crossref | GoogleScholarGoogle Scholar |
[32] Schwartz D, Feyler N, Baker J, Brady K. HIV and AIDS in the City of Philadelphia. Philadelphia: AIDS Activities Coordinating Office, Philadelphia Department of Public Health; 2009.
[33] Schwartz D, Schwartz D, Feyler N, Baker J, Brady K. HIV and AIDS in the City Of Philadelphia. Philadelphia: AIDS Activities Coordinating Office of the Philadelphia Department of Public Health; 2010.
[34] Weiss R. Learning from strangers: the art and method of qualitative interview studies. New York: Simon and Schuster; 1994.
[35] Seidman I. Interviewing as qualitative research: a guide for researchers in education and the social sciences. New York: Teachers College Press of Columbia University; 1998.
[36] Merriam S. Qualitative research and case study applications in education. San Francisco: Jossey-Bass; 2001.
[37] Rice P, Ezzy D. Qualitative research methods: a health focus. New York: Oxford University Press; 2001.
[38] Adimora AA, Schoenbach VJ. Social context, sexual networks, and racial disparities in rates of sexually transmitted infections. J Infect Dis 2005; 191 S115–22.
| Social context, sexual networks, and racial disparities in rates of sexually transmitted infections.Crossref | GoogleScholarGoogle Scholar |
[39] Taylor EM, Behets FM, Schoenbach VJ, Miller WC, Doherty IA, Adimora AA. Coparenting and sexual partner concurrency among White, Black, and Hispanic men in the United States. Sex Transm Dis 2010; 38 293–8.
[40] Gorbach PM, Stoner BP, Aral SO, Whittington W, Holmes KK. “It takes a village”: understanding concurrent sexual partnerships in Seattle, Washington. Sex Transm Dis 2002; 29 453–62.
| “It takes a village”: understanding concurrent sexual partnerships in Seattle, Washington.Crossref | GoogleScholarGoogle Scholar |
[41] Nunn A, Dickman S, Cornwall A, Rosengard C, Kwakwa H, Kim D, et al Social, structural and behavioral drivers of concurrent partnerships among African American men in Philadelphia. AIDS Care 2011; [In press]
| Social, structural and behavioral drivers of concurrent partnerships among African American men in Philadelphia.Crossref | GoogleScholarGoogle Scholar |
[42] Senn TE, Scott-Sheldon LA, Seward DX, Wright EM, Carey MP. Sexual partner concurrency of urban male and female STD clinic patients: a qualitative study. Arch Sex Behav 2011; 38 293–8.
[43] Bowleg L, Teti M, Massie JS, Patel A, Malebranche DJ, Tschann JM. ‘What does it take to be a man? What is a real man?’: ideologies of masculinity and HIV sexual risk among Black heterosexual men. Cult Health Sex 2011; 13 545–59.
| ‘What does it take to be a man? What is a real man?’: ideologies of masculinity and HIV sexual risk among Black heterosexual men.Crossref | GoogleScholarGoogle Scholar |
[44] Khan MR, Behrend L, Adimora AA, Weir SS, Tisdale C, Wohl DA. Dissolution of primary intimate relationships during incarceration and associations with post-release STI/HIV risk behavior in a southeastern city. Sex Transm Dis 2011; 38 43–7.
[45] Butkovitz A. Economic report of Philadelphia: financial forecast and snapshot. Philadelphia: Office of the Controller, City of Philadelphia; 2010.
[46] Eichel L. Philadelphia’s crowded, costly jails: the search for safe solutions. Philadelphia: Pew Charitable Trusts; 2010.
[47] Putnam R. Making democracy work: civic traditions on modern Italy. Princeton, NJ: Princeton University Press; 1993.
[48] Putnam R. Bowling alone. New York: Simon and Schuster; 2000.
[49] Adimora AA, Auerbach JD. Structural interventions for HIV prevention in the United States. J Acquir Immune Defic Syndr 2010; 55 S132–5.
| Structural interventions for HIV prevention in the United States.Crossref | GoogleScholarGoogle Scholar |
[50] Diffusion of Evidence-Based Interventions (DEBI). DANYA International, Inc. Available at: www.effectiveinterventions.org. [Accessed 21 October 2011.]
