Concurrent partnering and condom use among rural heterosexual African-American men
JaNelle M. Ricks A D , Angelica Geter B , Richard A. Crosby B and Emma Brown CA Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
B College of Public Health, University of Kentucky, Lexington, KY 40506, USA.
C CHARM Inc., Lake City, FL 32025, USA.
D Corresponding author. Email: janelle.ricks@emory.edu
Sexual Health 11(1) 81-83 https://doi.org/10.1071/SH13135
Submitted: 30 August 2013 Accepted: 14 October 2013 Published: 29 November 2013
Abstract
Background: Limited research has targeted HIV risk among heterosexual African-American men in the rural south-eastern United States. Methods: A cross-sectional survey was administered to 538 men to assess HIV knowledge, attitudes towards HIV testing and sexual risk behaviour. Results: Fifty-one percent reported consistent condom use in the past 3 months. Monogamous men reported more consistent condom use (t = 3.47, d.f. = 536, P < 0.001). In concurrent partnerships, condom use was inversely related to age (adjusted odds ratio (AOR) = 0.98, 95% confidence interval (CI) = 0.95–0.998, P = 0.03) and increased with the number of female partners (AOR = 1.49, 95% CI = 1.26–1.76, P < 0.001). Conclusions: African-American HIV prevention outreach should include focus on concurrent partnering in rural settings.
Additional keywords: heterosexuality, HIV prevention, safer sex, United States.
Heterosexual transmission is the second leading mode of HIV transmission in the United States.1 African-Americans bear a disproportionate burden of heterosexually acquired HIV cases.2 Concurrent partnering is one sexual factor shown to increase HIV risk.3–5 Compared with white men, African-American men are more likely to report concurrent sexual relationships.6,7 As such, concurrency has been identified as a likely factor accelerating the spread of HIV among heterosexual African-Americans.8,9
In areas of the rural south-eastern United States, the HIV epidemic has impacted African-Americans unequally.10–17 Limited research has examined concurrent partnering and other correlates of HIV risk among heterosexual African-American men in this region. Evidence from the small body of existing empirical literature examining HIV risk among rural African-Americans has shown that men are more likely to engage in concurrent sexual partnerships17–20 and inconsistent condom use15,17,18 than women. The purpose of this study was to identify correlates of consistent condom use by sexual concurrency status among low-income African-American men.
Potential participants were recruited through local door-to-door, street and faith-based outreaches, and recruitment flyers posted throughout the community. Five hundred and thirty-eight African-American men aged 18–64 years who identified as heterosexual and lived in northern Florida participated. Each completed a survey that assessed demographics, attitudes towards HIV testing, HIV testing history and intention to disclose positive test results, HIV-related knowledge and perceptions of AIDS-related stigma. Descriptive statistics were conducted; bivariate analyses determined which variables to include in subsequent multivariate logistic regression analysis models.
The average age of men in this study was 38.7 years (s.d. = 13.9). About one-third (33.8%) had not graduated from high school and more than half (58.4%) reported a monthly income of less than $500. Forty percent reported being in concurrent sexual relationships. Another 40% reported concurrent sexual relationships with female sex partners in the past 3 months. Consistent condom use was reported by 277 men (51.5%).
Multivariate logistic regression analyses indicated that among currently monogamous men, consistent condom use was inversely related to age and positively associated with ever having been tested for HIV. Among men in concurrent sexual partnerships, multivariate logistic regression analyses revealed that consistent condom use was also inversely related to age. Additionally, condom use increased by 50% for each additional female sex partner reported in the past 3 months. Men with less than a high school education were 63% less likely to report consistent condom use (Table 1).
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Empirical evidence suggests a limited degree of HIV risk consciousness and consistent safer sex practice among African-American men.21–23 A study that examined condom use by casual and primary relationship status found that African-American men were less likely to use condoms with primary partners.24 The current study findings that (a) reported consistent condom use was significantly greater among those reporting current monogamy and (b) the odds of consistent condom use increased in proportion to the number of recent female sex partners reported may indicate a positive response to the AIDS epidemic in rural Florida among African-American men. Despite engaging in concurrent partnerships, these men may indeed be aware of HIV risk.
The results of this study should be considered in light of its limitations. First, the findings are limited by the validity of retrospective self-report. Additionally, the sensitive nature of this study topic allowed for vulnerability to systematic over- or under-reporting of sexual attitudes and behaviours. Finally, the results may not be generalisable to other populations of heterosexual African-American men.
The complex nature of HIV transmission among specific populations makes comprehensive assessment of the determinants of HIV risk behaviour necessary for development of effective prevention intervention strategies. The current study warrants further research on correlates of risk behaviour such as partner concurrency among African-Americans in rural settings.
Conflicts of interest
None declared.
Acknowledgements
This study was supported by Centers for Disease Control and Prevention’s Minority HIV/AIDS Research Initiative project # U01PS000677. We thank the study team members who helped with data collection. The findings and conclusions in this report are those of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.
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