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.
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.
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.
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.