Condom use and concurrent partnering among heterosexually active, African American men: a qualitative report

"The Nurse Told Her to Get Checked More Regularly Because She is Having Sex with Black Men": An Exploration of the Sexual Health Experiences of Black Heterosexual Men in London

Drivers of poor sexual health outcomes among Black heterosexual man are poorly understood. Previous research has identified a need to understand Black men's behavioral experiences and motivators in the UK. This study aimed to address this gap through a phenomenological exploration of the sexual health experiences and motivators of Black heterosexual men with experience of higher-risk sexual behaviors living in London. Semi-structured interviews were conducted with 10 participants (18-58 years) recruited through barbershops. Reflexive thematic analysis was used to analyze the data. Five themes were generated. For relevance, three themes are discussed in this paper: 1) The Black Man's Battle; 2) Sexual Socialization; and 3) Sexual Behaviors, Relationships, and Health. Race and gender combined to shape experience of sexual socialization. Exposure to explicit media content from a young age promoted multiple sexual partners. Racist sexual stereotypes exposed participants to fetishization and created pressure to meet sexual expectations. Condom use motivators were complex and multifaceted. Experience of institutional racism created a lack of trust in services. However, actual experiences with sexual health services were positive and counteracted the mistrust created by racism. Sexual health services should better tailor their work to Black heterosexual men and diversify their offer. Services should collaborate with Black community organizations to deliver services outside clinical settings.

Correlates of Sexual Behavior Across Fatherhood Status: Finding From the National Longitudinal Study of Adolescent to Adult Health (Add Health), 2016-2018

Amid national trends in postponed parenthood and more diverse family structures, the fatherhood identity may be important to men's sexual behaviors. This study examined factors associated with reports of consistent contraceptive use and multiple sexual partners across fatherhood status. Using public data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), Wave V (2016-2018), two sexual behaviors were examined among 1,163 men aged 32 to 42 years. Outcomes were two binary indicators: consistent contraceptive use with partner and having multiple (≥2) sexual partners in the past year. Fatherhood status was categorized as nonfather, resident father, and nonresident father. Demographic (e.g., race/ethnicity, education, income, and relationship type) and health-related (e.g., drinking, perceived stress, depressive symptoms, and insurance status) factors were considered. Logistic regression analysis produced odds ratios and 95% confidence intervals and were stratified by fatherhood categories. In the sample, 72% of men were resident fathers, 10% were nonresident fathers, and 18% were nonfathers; 28% reported consistent contraceptive use and 16% reported multiple sexual partners. For nonfathers, relationship type and race were associated with reporting multiple sexual partners. For resident fathers, relationship type was the crucial factor associated with consistent contraceptive use and reporting multiple sexual partners. In nonresident fathers, relationship type, education, and income were important factors to consistent contraceptive use and reporting multiple sexual partners. Key findings suggest that relationship type, income, and education are crucial factors to men's sexual behavior. Heterogeneous effects were observed across fatherhood status. This study adds to limited research on fatherhood and sexual behavior among men transitioning from young adulthood to middle age.

Knowledge of sexual partner's HIV serostatus and the practice of safer sex among heterosexual men of African descent in London, Ontario

Objective: Poor knowledge of sexual partners' HIV status is a major contributing factor in the heterosexual spread of HIV in Canada. This study examined knowledge of sexual partner's HIV serostatus and the practice of safer sex among self-identified heterosexual African, Caribbean and Black (ACB) men in London, Ontario.Design: A cross-sectional data was collected from 156 heterosexual ACB men in London. The negative log-log link function was fitted to estimate the relationship between knowledge of sexual partner's HIV status and condom use among ACB men.Results: Findings show that ACB men who know their sexual partner's HIV status are less likely to use condoms compared to men who do not know the serostatus of their sexual partner, controlling for other theoretically relevant covariates. In addition, the findings show that sexually active, single ACB men are less likely to use condoms. On the other hand, ACB men with higher education, employed and with income over 60 thousand dollars a year have a higher likelihood of using condoms.Conclusions: Heterosexual ACB men who used condoms even when they did not know their sexual partners' HIV status could be explained as a resilience-building strategy in response to their increasing HIV vulnerabilities. Heterosexual ACB men's use of condoms is further associated with socioeconomic factors including income, employment and education that need to be addressed for an improved safer sex.

How black heterosexual men's narratives about sexual partner type and condom use disrupt the main and casual partner dichotomy: 'we still get down, but we not together'

Sexual partner types and partnership dynamics have important implications for condom use. Yet most HIV prevention research conceptualises condom use as individual-level rather than dyadic-level behaviour. Evidence of a generalised HIV epidemic in urban predominantly low-income US Black heterosexual communities highlights the need for a culturally and contextually-grounded understanding of partner types, partnership dynamics and condom use from the perspective of Black heterosexual men. We conducted individual interviews with 30 self-identified men between the ages of 18 and 44, 18 (60%) of whom reported at least two partner types in the last 6 months. Key findings include: (1) 'main and casual' partner types per the HIV prevention literature; (2) three casual-partner subtypes: primary, recurrent, and one-time casuals; (3) overlapping partnership dynamics between main partners, primary-casual partners and recurrent-casual partners, but not one-time casual partners; and (4) consistent condom use reported for one-time casual partners only. The study underscores the critical need for more condom promotion messages and interventions that reflect the dyadic and culturally-grounded realities of US Black heterosexual men's sexual partner types and partnership dynamics.

Social, Clinical, and Behavioral Determinants of HIV Infection and HIV Testing among Black Men in Toronto, Ontario: A Classification and Regression Tree Analysis

Black men bear a disproportionate burden of HIV infection. These HIV inequities are influenced by intersecting social, clinical, and behavioral factors. The purpose of this analysis was to determine the combinations of factors that were most predictive of HIV infection and HIV testing among black men in Toronto. Classification and regression tree analysis was applied to secondary data collected from black men (N = 460) in Toronto, 82% of whom only had sex with women and 18% whom had sex with men at least once. For HIV infection, 10 subgroups were identified and characterized by number of lifetime male partners, age, syphilis history, and perceived stigma. Number of lifetime male partners was the best single predictor of HIV infection. For HIV testing, the analysis identified 8 subgroups characterized by age, condom use, number of sex partners and Chlamydia history. Age (>24 years old) was the best single predictor of HIV testing.

HIV-Related Communication and Safe Sex Practices among Heterosexual Black Men: A Qualitative Report

HIV prevention efforts have given limited attention to the influence of social norms on the process of communicating about safer sex practices among heterosexual Black men. To address this and inform the development of an HIV prevention behavioral intervention for heterosexual African American men, we conducted computerized, structured interviews with 61 men living in high HIV prevalence neighborhoods in New York City to participate in either one of the five focus group interviews and/or an in-depth qualitative interview. Participants had a mean age of 33 years, 25% held less than a high school education, 66% earned an annual income of $10,000 or less, and 86% had a history of incarceration Qualitative analysis was used to identify emergent themes within the domains of condom use communication, HIV status disclosure with sexual partners, and general HIV knowledge among peers. Thematic analyses revealed that communication was hindered by (1) low perception of risk of sex partners (2) relationship insecurities and (3) HIV stigma within the community and between sex partners. Most communication related to condom use was based on their perception of their sex partner's HIV risk and fear of contracting HIV and/or a partner's reaction to proposing or using condoms. Discussions related to HIV status elicited concerns of being labeled as HIV-positive or leading to unprotected sex. Communication among peers was rare due in part to the stigma of HIV in the Black community. Effective HIV interventions for heterosexual should include communication strategies that address the cultural norms that influence safe sex practices.

Accounts for Unprotected Sex with Partners Met Online from Heterosexual Men and Women from Large US Metropolitan Areas

For about 30 years, soon after the onset of the AIDS epidemic, sexual-health messaging has emphasized personal responsibility for using condoms to protect from acquiring or transmitting HIV or other sexually transmitted infections. Those who did not use condoms during casual sexual encounters may therefore feel compelled to offer to others aware of their behavior what sociologists have called "accounts," an impression-management strategy to avoid unfavorable judgment. We analyzed accounts-excuses and justifications-from qualitative interviews with 150 adults who had unprotected sex in the past 3 months with at least two different partners met online (ages 18-50, mean: 33.7, equally divided among black, Hispanic, and white men and women, over half were college educated and the median yearly household income range was $50-$75,000). Many participants made excuses that aimed to defer responsibility for unprotected sex: they claimed that consistently practicing safer sex was impossible, that they got carried away by sexual passion, that they were inebriated, that they were influenced by emotional or psychological problems, or they put fault on their partners. Participants also provided justifications, claiming that unsafe sex had been acceptable because the risks taken were likely minimal or negotiated with their partner. Understanding the accounts heterosexual adults offer to excuse and justify condomless sex with partners met online can be helpful in developing prevention messages that debunk these explanations for their behavior.

Intersectional Epistemologies of Ignorance: How Behavioral and Social Science Research Shapes What We Know, Think We Know, and Don't Know About U.S. Black Men's Sexualities

Epistemologies of ignorance describe how ignorance influences the production of knowledge. Advancing an intersectional epistemologies of ignorance approach that examines how conscious (or unconscious) ignorance about racism, heterosexism, and classism shapes empirical knowledge about Black men's sexualities, we conducted a critical review of the behavioral and social science research on U.S. Black men, ages 18 and older, for two time frames: pre-1981 and the most recent decade, 2006-2016. Our search yielded 668 articles, which we classified into five categories: sexual violence, sexual experiences and expressions, sexual identities, cultural and social-structural influences, and sexual health and sexual risk. We found that most of the research, particularly pre-1981, centered the experiences of White heterosexual men as normative and implicitly constructed Black men as hypersexual or deviant. Most of the research also color-blinded White privilege and ignored how racism, heterosexism, and classism structured Black men's inequities. We also found notable exceptions to these trends. Black men who are gay, bisexual, or who have sex with men, and research on HIV risk were prominent in the past decade, as was research that emphasized the social-structural (e.g., poverty, heterosexism, racism) and cultural (e.g., masculinity, religion) contexts of Black men's lives and sexualities. We provide 10 recommendations to avoid intersectional epistemic ignorance in future research.

Condom Use in the Context of Main and Casual Partner Concurrency: Individual and Relationship Predictors in a Sample of Heterosexual African American Men

Researchers have identified engagement in sexual concurrency, particularly when condom use is inconsistent, as a risk factor for HIV and other sexually transmitted infections. This risk is particularly salient in rural communities in which dense interconnection of sexual networks can promote the spread of sexually transmitted infections. The authors investigated individual and relationship factors that predict inconsistent condom use in the context of main and casual partner sexual concurrency among 176 rural African American men. The individual psychosocial factors investigated included impulsivity and anger/hostility. Relationship variables included fidelity expectations, criticism from partners, and relationship control in both main and casual relationships. No individual risk factors were associated with main partner inconsistent condom use; however, impulsivity and anger/hostility positively predicted inconsistent condom use with a casual partner. Relationship control in the main partnership predicted inconsistent condom use with the main partner. Criticism from the main partner positively predicted inconsistent condom use with a casual partner. Finally, expectations for a casual partner's fidelity positively predicted inconsistent condom use with that partner. These findings underscore the importance of considering the influence of one sexual partnership on behavior in another and of taking this complexity into account in the development of preventive interventions.

Characteristics of African American Women and Their Partners With Perceived Concurrent Partnerships in 4 Rural Counties in the Southeastern U.S

BACKGROUND

To the individual with concurrent partners, it is thought that having concurrent partnerships confers no greater risk of acquiring HIV than having multiple consecutive partnerships. However, an individual whose partner has concurrent partnerships (partner's concurrency) is at increased risk for incident HIV infection. We sought to better understand relationships characterized by partner's concurrency among African American women.

METHODS

A total of 1013 African American women participated in a cross-sectional survey from 4 rural Southeastern counties.

RESULTS

Older age at first sex was associated with lower prevalence of partner's concurrency (prevalence ratio, 0.70; 95% confidence interval, 0.57-0.87), but the participant's age was not associated with partner's concurrency. After adjusting for covariates, ever having experienced intimate partner violence (IPV) and forced sex were most strongly associated with partner's concurrency (prevalence ratios, 1.61 [95% confidence intervals, 1.23-2.11] and 1.65 [1.20-2.26], respectively). Women in mutually monogamous partnerships were the most likely to receive economic support from their partners; women whose partners had concurrent partnerships did not report more economic benefit than did those whose partners were monogamous.

CONCLUSIONS

Associations between history of IPV and forced sex with partner's concurrency suggest that women with these experiences may particularly benefit from interventions to reduce partner's concurrency in addition to support for reducing IPV and other sexual risks. To inform these interventions, further research to understand partnerships characterized by partner's concurrency is warranted.

Race/Sex Interactions and HIV Testing Among College Students

OBJECTIVES

The primary aim of the study was to examine race/sex interactions and other behavioral and demographic covariates of past-year HIV testing among college students attending a racially diverse historically black university. The relationship between race/sex interactions and engaging with multiple sex partners during the past year was also examined.

PARTICIPANTS

The sample included 566 students who identified as Black or White and engaged in vaginal, oral, or anal sex during the past 12 months.

METHODS

A total of 113 undergraduate classes were randomly selected, stratified by time of day. Surveys were administered by project team members who were assisted by peer health educators to increase the cultural competency of the study. The response rate was 94 %.

RESULTS

The sample of 566 participants included Black women (54 %), Black men (26 %), White women (13 %), and White men (7 %). The mean age was 25 (median = 22 years), and 42 % resided on campus. Nearly half (46 %) reported two or more sex partners in the past year, and 9 % of participants were diagnosed with STD in the past year. Sixty-nine percent reported being tested for HIV, 58 % had been tested in the past year, and 18 % had been tested for HIV on two or more occasions during the past year. In multivariable analysis, Black men (AOR = 0.43; 95 % CI = 0.27, 0.69), White women (AOR = 0.25; 95 % CI = 0.14, 0.47), and White men (AOR = 0.22; 95 % CI = 0.10, 0.49) were significantly less likely than Black women to be tested for HIV in the past year. Residing off campus (AOR = 1.88; 95 % CI = 1.18, 2.99) and engaging with two or more sex partners in the past year (AOR = 2.59; 95 % CI = 1.70, 3.95) significantly increased the likelihood of HIV testing in the past year. Students who engaged only with heterosexual partners (AOR = .25; 95 % CI = 0.09, 0.76) or were female and bisexual (AOR = 0.17; 95 % CI = 0.04, 0.69) were less likely to be tested for HIV in the past year compared to men who have sex with men/men and women. In a separate model, Black men (AOR = 1.87; 95 % CI = 1.18, 2.97) were significantly more likely than Black women to engage with two or more sex partners during the previous year. Compared to Black women, White women (AOR = 0.51; 95 % CI = 0.26, 0.98) were less likely to report two or more sex partners in the past year. Students involved in a relationship during the past 30 days (AOR = 0.33; 95 % CI = 0.22, 0.49) were less likely than other students to engage with two or more sex partners in the past year.

CONCLUSIONS

Over half (58 %) of the students had been tested for HIV in the past year-a promising outcome. However, 42 % of sexually active students had not been tested. Campus prevention initiatives need to reinforce the importance of frequent HIV testing. In particular, targeted prevention efforts need to be focused on heterosexual Black male college students.

Careful Conversations and Careful Sex: HIV Posttesting Experiences Among African American Men in Rural Florida

PURPOSE

In the United States, black/African American (black) men bear the greatest burden of human immunodeficiency virus (HIV), accounting for 42% of new HIV infections in 2012 despite being 6% of the population. In Florida, heterosexual HIV transmission has increased among black men. Few studies have examined HIV testing experiences for black heterosexual men (BHM) in the rural South. This study describes the post-HIV-testing trial experiences of BHM in rural Florida.

METHODS

We conducted 12 focus groups (4-7 participants per group) in 3 rural Florida counties with BHM who participated in a larger randomized HIV testing trial. Interviews were professionally transcribed and data were analyzed using NVivo 10. The qualitative analysis was informed by the strengths perspective (ie, emphasis on abilities rather than risks) and used a thematic analytical approach.

RESULTS

Sixty-seven men participated (median age 41.5 years); 39 (58%) earned a monthly income of less than $500, 38 (57%) attained education through high school or higher, 37 (55%) were unmarried, and 40 (60%) reported practicing monogamy; all who tested for HIV were negative for HIV. We identified 3 main themes based on self-reported actions: (1) risk reduction (eg, more consistent condom use, fewer sex partners), (2) sexual health communications with sex partners (eg, negotiating HIV testing with sex partners, getting to know partners better), and (3) health communications with peers and family (eg, disclosing test results, encouraging others to get tested).

CONCLUSIONS

Among BHM, being in this HIV testing study facilitated increased protective behaviors and communications for HIV prevention. Interventions for BHM in rural areas warrant incorporating these strategies to encourage routine HIV testing.

The Role of Relationship Type, Risk Perception, and Condom Use in Middle Socioeconomic Status Black Women's HIV-prevention Strategies

This research analyzes qualitative focus group and interview data from the Sister Circle Study- a pilot study that explored HIV risk among middle SES Black women ages 25- 45 in North Carolina. Findings reveal that gendered relationship dynamics, perceptions of a sex ratio imbalance, and levels of trust in relationships may reduce some women's ability to negotiate monogamy and condom use with their male partners. The research suggests that higher socioeconomic status does not fully buffer some middle SES Black women from HIV risk and highlights the role interpersonal and structural factors play in shaping HIV risk for this group.

Black Women with Multiple Sex Partners: The Role of Sexual Agency

Motivations of low-income substance using heterosexual Black women in New York City for having multiple sexual partners are explored in this paper. Analysis of in-depth interviews with 50 study participants demonstrates that their relationships consisted of those who had: (1) a main sex partner and a secondary sex partner; or (2) two or more "casual" partners. Individual-level motivations for extra relational sex fell into four dominant themes: sexual pleasure, partner infidelity, sex exchange and past main partners. Using a Black feminist framework, we describe how participants displayed considerable autonomy by actively forming and withdrawing from sexual relationships with men. However, women described low rates of condom use with main partners and inconsistent use of condoms with more casual sexual partners. This contradiction becomes an important area for sexual health interventions. Women who had sexual relations with only one current mate in the past two years were recruited as a monogamous comparison group.

Knowing is not enough: a qualitative report on HIV testing among heterosexual African-American men

Despite having higher rates of HIV testing than all other racial groups, African-Americans continue to be disproportionately affected by the HIV epidemic in the United States. Knowing one's status is the key step to maintaining behavioral changes that could stop the spread of the virus, yet little is known about the individual- and socio-structural-level barriers associated with HIV testing and communication among heterosexual African-American men. To address this and inform the development of an HIV prevention behavioral intervention for heterosexual African-American men, we conducted computerized, structured interviews with 61 men, focus group interviews with 25 men in 5 different groups, and in-depth qualitative interviews with 30 men living in high HIV prevalence neighborhoods in New York City. Results revealed that HIV testing was frequent among the participants. Even with high rates of testing, the men in the study had low levels of HIV knowledge; perceived little risk of HIV; and misused HIV testing as a prevention method. Factors affecting HIV testing, included stigma, relationship dynamics and communication, and societal influences, suggesting that fear, low perception of risk, and HIV stigma may be the biggest barriers to HIV testing. These results also suggest that interventions directed toward African-American heterosexual men must address the use of "testing as prevention" as well as correct misunderstandings of the window period and the meaning of HIV test results, and interventions should focus on communicating about HIV.