STIs risk factors for black and ethnic young people in London explored

Multiple sexual partners, inconsistent condom use and different perceptions and expectations of sexual relationships between males and females are the leading risk factors for sexually transmitted infections (STIs) amongst Black and minority ethnic young people in North West London. This is according to the findings in a report published in the online edition of Sexually Transmitted Infections.

The researchers also found that the young people faced a risk of sexually transmitted infections because they did not think they were at risk of such infections and also because they expected infections to cause symptoms.

Existing evidence shows that young women from Black ethnic backgrounds aged under 25 are disproportionately affected by sexually transmitted infections in the UK. Surveillance information from 2006 shows that almost 75% of all chlamydia diagnoses and two-thirds of diagnosed cases of genital warts were in young women. Furthermore, evidence from genitourinary medicine (GUM) clinics showed that younger females of Caribbean ethnicity were the group most likely to be reinfected with an STI within twelve months after their initial diagnosis.

Researchers wanted to establish a better understanding of sexual risk taking and to develop strategies that would overcome barriers to interventions aimed at improving the sexual health of young Black and minority ethnic females in the UK. The investigators also wanted to see if an intervention used to reduce rates of reinfection from STIs amongst minority ethnic females developed in the US (Project SAFE , Texas) could be adapted to a UK setting.

Conducted in Brent, in north-west London, the study used one-to-one in-depth interviews and focus group discussions to collect information from men and women aged 15 to 27 years from a variety of ethnic backgrounds. Brent was chosen because it has high teenage pregnancy rates, a large Black Caribbean population and levels of social deprivation that mirror those in Texas.

Three broad reinfection risk factors were identified by the researchers. These also hampered the success of risk-reduction interventions.

The first factor was concurrent relationships. These were reported by individuals despite their expressed aspirations to have monogamous relationships. The researchers categorised the risk from concurrent relationships into either active or passive depending on relationship status of the individual.

There were two kinds of active concurrent partnerships. The first involved individuals who were single with multiple casual sexual partners. The findings demonstrated a gender difference in these kinds of relationships. Whereas men described little emotional attachment and did not expect monogamy from casual partners, women reported emotional vulnerability. The other type occurred when both men and women had relationships outside their regular relationships for various reasons. Women said they were involved in such relationships because of boredom with current partners or the inability to end unwanted relationships. The men, on the other hand, said this approach was to get sex in the absence of a regular partner or to obtain more varied sex.

Passive concurrent relationships were also indentified by the investigators, and gender differences were also present in these. Women, for example, agreed not to use condoms in what they thought were mutually monogamous relationships. They were unaware of their partner’s other relationships or mistakenly hoped the relationships were permanent rather than casual. Men generally believed their girlfriends were not having other relationships, a possibility they described as unacceptable.

The second risk factor demonstrated by the findings was a mismatch between perceptions and expectations of men and women regarding regular and casual partners. For example, women hoped that casual relationships would develop into committed ones, whereas the men treated such relationships as purely casual.

Lastly, the study found that while individuals acknowledged that condoms provided effective protection against sexually transmitted infection, condoms were not used consistently. Reasons for this included the type of relationship in question, perceptions around reduced pleasure, interrupted sex, lack of trust, and limited knowledge about condoms and the prevention of STIs. Condoms were thought to be necessary for sex with non-regular partners, but not within the contexts of trusted relationships or after sexual health check-ups.

A number of possible limitations with the research are noted by the investigators. These include sampling techniques. The researchers caution that their results may not be applicable to other settings with a different ethnic mix in the population.

Interventions should be developed to address power imbalances in relationships, recommend the investigators. Such interventions should also aim to improve self-esteem and negotiating skills amongst young women.

Sexual health interventions would be better delivered by skilled facilitators, rather than in the form of written information, they recommend.

The researchers conclude that their study demonstrates the relevance of a Project SAFE-style intervention to the UK, and also highlights the need to address barriers to risk reduction, which should extend beyond knowledge of sexually transmitted infections and condom negotiation/use to bridge the gap between knowledge, intentions and behaviour by young people in the UK.