Sexual Concurrency Research Articles

Sexual Networks’ role in high STI Rates among minority populations

The stubbornly high and unequally distributed rates of sexually transmitted infections have confounded sociologists for decades. Why would STIs afflict minority populations at higher rates than majority populations? There was no biological rationale. Only knowledge of causation could hope to mitigate the discrepancy and provide pathways to prevention and cure. Late in the twentieth century, spurred by the AIDS crisis, the scrutiny of sexual behavior met up with the social determinants of health, resulting in the concepts of sexual networks and concurrency. This paper explores how these ideas have helped us understand, explain, and intervene in the unacceptably high and disproportionately distributed STI epidemic.

Concurrent Partnerships Among Black Women in United States

The imbalanced sex ratio in the Black community could contribute to sexual partner concurrency. This study examined the association between perceptions of the availability of heterosexual male partners (sex ratio) and heterosexual Black women's attitudes and experiences with concurrent sexual partnerships. We found that perceptions of a high sex ratio (more men relative to women) were positively associated with attitudes towards concurrent sexual partnerships and prevalence of sexual concurrency. Future research must account for contextual factors influencing sexual networks such as the sex ratio that affect behaviors and attitudes influencing Black women's risk for HIV infection.

Interventional behavioural change communication on HIV and aids related high risk behaviour among fishermen in Homabay and Siaya Counties, Kenya

Background: Risky sexual behaviors such as sexual concurrency, sexual networks (fish for sex exchange) and unprotected sex, have been reported as the main cause of STIs/HIV infections among the fisher folks. Behavioural change mechanisms such as condom use, and abstinence are some of the interventions used in the prevention HIV/AIDS spread in Kenya.Methods: This was a follow up study on a three tie quasi-experimental study involving 246 randomly selected fisher folks in Mbita and Usenge along Lake Victoria. The study had three phases. baseline, intervention and endline. The survey used questionnaires to collect data among respondents. Using a sample frame in the beach management unit offices, fisherfolks were identified and invited to participate. Consent was obtained from participantsResults: Various variables were influenced by behavior change communication strategies used. These includes use of condom every time of sexual encounter p>0.000, risk associated with non-condom use p>0.004, stopping using condom and fear of getting HIV/AIDS p>0.009, Sexual intercourse without condom use is dangerous p>0.000, whether remembering to use condom every time of sex is difficult P.0.000, whether they are keeping many sexual partners p=0.004, receiving fish/money in exchange for sex in last six months p=0.006.Conclusions: Multiple sexual partners, non-condom use, fish for sex, alcohol consumption and circumcision were significantly associated with risky sexual behavior among the Fisherfolks, therefore other existing interventions need to be intensified to supplement behavior change communication to curb sexually transmitted diseases and further spread of HIV and AIDS.

Infidelity, consensual infidelity, and intergenerational sex as risk factors for the transmission of HIV/AIDS in men of a municipality in Cuba

Background: The use of condoms provides substantial protection against HIV. Sexual concurrency, infidelity, sexual relationships with younger partners could be considered as risky practices for sexually transmitted infections (STIs). Methods: The objective was to describe some risky behaviors among men of the municipality of Havana, Cuba. A cross-sectional study was conducted where 500 men aged 40-49 years were included. Results: The 75.2% of the participants did not use a condom and 30.4% of those without a stable partner have been unfaithful, while 12.6% was engaged in consensual infidelity and 18.2% had sexual relations with younger partners. Significant statistical associations were found between condom use, infidelity, consensual infidelity, and intergenerational sex and having or not a stable partner. Conclusions: There is an association between the studied variables and the presence or not of a stable partner.

How Does Migration Affect HIV Sexual Risk Behaviors Among Involuntary Bachelors? The Mediating Roles of Neighborhoods and Social Networks.

The sex ratio imbalance in China since the 1980s has resulted in a large number of involuntary bachelors in rural China. Previous studies have found an association between migration and HIV sexual risk behaviors among involuntary bachelors, but how migration affects these bachelors' HIV sexual risk behaviors remain poorly understood. Using data from a cross-sectional survey in 2017 (a sample of 740 male respondents who had rural household registration, had never been married, and were aged 28-49 years), we investigated the relationship between migration and HIV sexual risk behaviors. Logistic regressions show that migration, neighborhood characteristics, and social networks were significantly associated with commercial sex and multiple sex partners, whereas only neighborhood characteristics and social networks were positively correlated with sexual partnership concurrency. Neighborhood characteristics and social networks mediated the relationships of migration with commercial sex and migration with multiple sex partners. Social networks mediated the association between neighborhood characteristics and concurrency. Multiple-step mediation analysis showed that the indirect effect of migration on commercial sex and multiple sexual partners through neighborhood characteristics and social networks was significant. Our findings suggest that further interventions should address neighborhood characteristics and social networks together.

Effects of behavioural change communication on HIV and AIDS related high risk behaviour among fishermen in Homabay and Siaya Counties, Kenya

Background: Risky sexual behaviors such as sexual concurrency, sexual networks (fish for sex exchange) and unprotected sex, have been reported as the main cause of sexually transmitted diseases (STIs) /HIV infections among fisher folks. Behavioral change mechanisms as condom use and abstinence are some of interventions used in prevention HIV/AIDS spread in Kenya. Risky sexual behaviors increase risk of contracting STIs including HIV/AIDSMethods: This was a cross-sectional descriptive study involving 246 randomly selected fisher folks in Mbita- and Usenge along Lake Victoria. The survey used questionnaires to collect data among respondents. Using a sample frame in the beach management unit offices, fisherfolks were identified and invited to participate. Consent was obtained from participantsResults: The mean age of respondents was 31 years old. The 72% of the participants were directly involved in fishing. Participants who had extra marital relationship though married were 56.1% in Mbita and 47% in Usenge. Respondents who took alcohol with friends were 94.1% in Mbita and 96.2% in Usenge. Respondents who indicated that they had unprotected sex under influence of alcohol were 48.3% in Mbita and 77.1% in Usenge. Those who were sexually taken advantage of while under the influence of alcohol were 23.8% in Mbita and 38.3% in Usenge while those had sexually taken advantage of under the influence of alcohol were 18.3% in Mbita and 37.8% in Usenge.Conclusions: Targeted behaviour change communication (BCC) strategies designed specifically for fisherfolks is needed to curb high incidences of risky sexual behaviours noted among the fishermen.

Sexual partnership concurrency and age disparities associated with sexually transmitted infection and risk behavior in rural communities in Kenya and Uganda

We examined sex-specific associations of partner age disparity and relationship concurrency with Neisseria gonorrhoeae and/or Chlamydia trachomatis (NG/CT) infection, higher-risk relationships, and condom use as proxies for HIV risk. Data were collected in 2016 from 2179 adults in 12 communities in Uganda and Kenya. Logistic regression models examined associations of age disparity and relationship concurrency with NG/CT infection, condom use, and higher-risk (commercial sex and other higher-risk) relationships in the past 6 months, controlling for covariates. Partner age and relationship concurrency were associated with NG/CT infection in women but not men. Relative to women in age-disparate relationships, women in both age-disparate and age-homogeneous relationships had higher odds of NG/CT infection (adjusted odds ratio [aOR]=3.82, 95% confidence interval [CI]: 1.46-9.98). Among men and women, partnership concurrency was associated with higher-risk partnerships. In addition, relative to those with a single age-homogeneous partner, those with concurrent age-homogeneous partners had higher odds of condom use (men: aOR=2.85, 95% CI: 1.89-4.31; women: aOR=2.99, 95% CI: 1.52-5.89). Concurrent age-disparate partnerships were associated with condom use among men only (aOR=4.02, 95% CI: 2.54-6.37). Findings underscore the importance of targeted HIV prevention efforts for couples in age-disparate and concurrent relationships.

Sexual Concurrency Among Adolescent Women With Multiple Partners: A Daily Diary Study

PurposeSexual partnerships that overlap in some period of time (i.e., concurrent) are a key factor in sexually transmitted infection (STI) transmission. Research examining concurrency among adolescents typically uses person-level, cross-sectional, and/or retrospective data, obscuring factors that manifest on any given occasion of concurrency. We used sexual diaries to examine: (1) daily prevalence of vaginal sex concurrency when two partners are reported by adolescent women; and (2) individual, relational, and behavioral attributes that impact the likelihood of sex with neither partner, with one partner or the other, or with both partners on any given day. MethodsDaily diaries were drawn from a large longitudinal cohort study examining sexual relationships, behaviors, and STIs among adolescent women. Participants contributed 280,844 partner-associated diary entries, of which (27.9%; n = 78,356) indicated multiple partners. All two-partner diary entries were retained for analysis (N = 323; Mage = 17.55; 90% African American). Random intercept mixed-effects multinomial logistic regression was used to evaluate the impact of predictor variables on odds of having sex with one or the other, both, or neither partner. ResultsMost two-partner days (93.5%) involved no sex with either partner. Few reports (.2%) indicated same-day sexual concurrency. Older age, greater partner support, and higher sexual interest increased the likelihood of sex with both partners on the same day. ConclusionsIndividual, relational, and behavioral factors predict concurrency in ways that challenge assumptions that secondary partnerships constitute negligible relationships. Programs targeting partner concurrency in adolescents may find success tailoring messaging around these findings.

Sexual partner concurrency: is it a useful concept for HIV prevention? A systematic review of the evidence for intervention effectiveness in low- and middle-income countries

ABSTRACT If sexual partner concurrency drives HIV transmission dynamics, shouldn’t HIV prevention efforts be addressing this behavior? We systematically reviewed studies evaluating interventions to reduce sexual partner concurrency in low- and middle-income countries using pre/post or multi-arm designs. Only two studies met our inclusion criteria; neither found significant differences by intervention exposure on self-reported concurrency. Overall, very few interventions have specifically targeted concurrency, and those that did have not been rigorously evaluated. In practice, concurrency may be difficult to separate from multiple partnerships more generally.

1539. Pilot Study of Sexual Networks and Sexually Transmitted Infection Risk in a Military Population

BackgroundIn the U.S., military members experience a higher incidence of sexually transmitted infections (STIs) than the age and gender-adjusted general population, placing a costly and preventable burden on the military health system (MHS). These increased rates are likely due to differences in both individual and network level risk factors. To assess the feasibility of a survey examining the impact of sexual network risk factors on risk, a survey assessing STI individual and network level risk factors to include a 90-day sexual partnership inventory was piloted at a single military medical center.MethodsA sample of 50 military beneficiaries completed a computer-assisted self-interview (CASI) cross-sectional egocentric survey administered on a tablet. Demographical and clinical data were captured from the electronic medical record. Non-parametric statistics were used to analyze the data.Results45 of 50 subjects (90%) completed the survey. 40 (88%) subjects completed at least one partnership survey and reported 1 to 20 partners per subject. Respondents were mostly active duty (91.8%) and had been active duty for less than five years (68.2%). Common risk behaviors were explored and included meeting partners online (68.75%) and having partners who use drugs (48.94%) or are heavy drinkers (44.68%). Partnership inventories suggest sexual concurrency and disassortative mixing on age, racial and ethnic groups, and military service.ConclusionWhile previous studies demonstrate that service members will complete sexual risk behavior surveys, this pilot egocentric partnership study demonstrates their willingness to provide detailed information on risk behaviors as well as detailed information on sexual partnerships. While we report on statistically significant associations, these may be subject to bias due to the underlying characteristics of the source population. As a result, these data will not likely be reflected in the full study population. 80% of pilot subjects completed the questionnaire and submitted at least one partnership survey, indicating the possibility of gathering more diverse individual sexual risk questionnaires from active duty service members. Based on these data, a multisite study of sexual networks was implemented in the MHS and is currently under analysis.Disclosures All Authors: No reported disclosures

Migration, Social Networks, and HIV Sexual Risk Behaviors Among Involuntary Bachelors in Rural China.

In rural China there is an abnormally high male-biased sex ratio. The result is a large number of involuntary bachelors. This study examines how migration and social networks relate to bachelors' sexual risk behaviors. Data are from a cross-sectional questionnaire survey in which 740 male respondents who had rural household registration, had never married, and were aged 28 or older were interviewed in 2017. Logistic regression reveals that both migration and social networks place the bachelors at an especially high risk of HIV transmission by increasing the chance that they engage in commercial sex, whereas only social networks are significantly associated with sexual partnership concurrency. Additionally, social networks mediate the association between migration and commercial sex. This suggests that social networks play an important role in bachelors' risk of HIV transmission and that further intervention should address their social networks.

Addressing sexually transmitted infections in the sociocultural context of black heterosexual relationships in the United States.

Black girls and women are disproportionately affected by sexually transmitted infections (STIs) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Research shows sexual networks, sexual concurrency, and assortative mixing impacting racial disparities in STI/HIV. However, the underlying sociocultural conditions of these phenomenon have yet to be fully explored within a framework of Black girls' and women's sexual development. This grounded theory study investigated the sociocultural conditions and processes of becoming a sexual Black woman in order to understand the sociocultural drivers of STI/HIV rates among this group. We used theoretical sampling to select and interview 20 Black women aged 19-62 years old from a Midwestern community. This study revealed sociocultural conditions related to Black heterosexual relationships and STI/HIV risk. Protecting Black men, silencing Black girls and women, cultural norms and messaging about sexuality, and gendered societal expectations and sexual stereotypes contribute to STI/HIV risk in Black girls and women. Our findings demonstrate how the intersection of social and systemic structures (i.e.,history, incarceration, unemployment) shape the context of Black heterosexual relationships. We suggest STI/HIV prevention efforts address these systemic, cultural, and societal factors in order to effectively reduce racial disparities in STI/HIV risk.

The Prevalence, Frequency and Social Ecology of Sexual Concurrency Among Young Adult Women.

Sexual concurrency among women is associated with increased risks of STD transmission, unintended pregnancy and sexual health disparities. Understanding the prevalence of concurrency-overlapping sexual partnerships-is imperative to reducing these disparities. Weekly, population-representative panel data from 757 women aged 18-22, collected from 2008 to 2012 in Michigan, were drawn from the Relationship Dynamics and Social Life study. Univariate analyses assessed the prevalence of two forms of sexual concurrency. Multivariate logistic regression models investigated associations between women's social-ecological characteristics and concurrency. Twenty percent of women had vaginal intercourse with two partners in one week; 14% had intercourse with a second partner during an ongoing relationship. In both cases, the majority of individuals had intercourse with the second partner in one to three weeks in total. The likelihood of both types of concurrency was elevated among women who believed they should have sex with men after seeing them for a while (log-odds, 0.27 and 0.23, respectively) and among those who were Black (0.58 and 1.02, respectively); the likelihood was reduced among women who were more willing to refuse unwanted sex (-0.10 and -0.13, respectively) and who were in exclusive, cohabiting, or married or engaged relationships (-1.82 to -2.64). Having intercourse with multiple partners in one week was also associated with receiving sex education from parents, the degree that parents and friends approved of sex, and having had early intercourse without contraception. Sexual concurrency among young women is prevalent but intermittent, and interventions that address individuals' social-ecological contexts are needed to reduce negative health outcomes.

Analysis of the impact of cash transfer programs on HIV risk behaviors in Kenya

Background This paper investigates the impact of Kenyan unconditional cash transfer programs on a range of HIV risk indicators, including transactional sex, sexual concurrency, knowledge of HIV, and HIV testing. Previous research on cash transfers in similar contexts suggests that the provision of cash transfers can be a potent method to bolster HIV prevention efforts. We hypothesized that as a result of receiving cash transfers from the government, individuals will have increased contact with social services, which can provide them with critical health education that will motivate them to modify their HIV risk behaviors. Methods We used data from the latest Kenya Demographic and Health Survey (KDHS), which contained 12,800 unique responses from individuals between the ages of 15 and 54. We compared the prevalence of various HIV risk indicators and demographic covariates between those who received cash transfers and those who did not using unequal variances t-tests and chi-square tests. We estimated the average treatment effect on the treated (ATT) using propensity score matching. Results Notably, individuals who received any cash transfer were less likely to have paid for sex in the past 12 months (ATT: -0.024, P=0.023), more likely to know of a place to get tested for HIV (ATT: 0.022, P=0.030), and more likely to have used a condom during sex with their most recent partner (ATT: 0.045, P=0.038). However, cash transfer recipients were more likely to have a sexual partner 10 or more years older than themselves (ATT: 0.102, P<0.001), less likely to have comprehensive HIV knowledge (ATT: -0.118, P<0.001), and more likely to have been tested for HIV two or more years ago (ATT: 0.052, P=0.028). Conclusions Based on our analysis of nationally representative data, we conclude that the receipt of unconditional cash transfers is associated with the reduction of some HIV risk indicators in Kenya.

Social Capital and Risk of Concurrent Sexual Partners Among African Americans in Jackson, Mississippi

Concurrent sexual partnerships (i.e., relationships that overlap in time) contribute to higher HIV acquisition risk. Social capital, defined as resources and connections available to individuals is hypothesized to reduce sexual HIV risk behavior, including sexual concurrency. Additionally, we do not know whether any association between social capital and sexual concurrency is moderated by gender. Multivariable logistic regression tested the association between social capital and sexual concurrency and effect modification by gender. Among 1445 African Americans presenting for care at an urban STI clinic in Jackson, Mississippi, mean social capital was 2.85 (range 1–5), mean age was 25 (SD = 6), and 62% were women. Sexual concurrency in the current year was lower for women compared to men (45% vs. 55%, χ2(df = 1) = 11.07, p = .001). Higher social capital was associated with lower adjusted odds of sexual concurrency for women compared to men (adjusted Odds Ratio [aOR] = 0.62 (95% CI 0.39–0.97), p = 0.034), controlling for sociodemographic and psychosocial covariates. Interventions that add social capital components may be important for lowering sexual risk among African Americans in Mississippi.

Individual and Relationship Predictors of Couple-Level Sexual Concurrency in Heterosexual South African Couples.

One of the major goals of couple-based HIV prevention programs in sub-Saharan Africa is to reduce outside sex partners, known as sexual concurrency. This cross-sectional study examined sexual concurrency at the couple-level and differentiated couples based on whether neither, one, or both partners engaged in sexual concurrency over the past 6months. Individual predictors (alcohol use and lifetime history of physical or sexual trauma) and relationship predictors (mistrust, relationship inequity, relationship satisfaction, and sexual satisfaction) were used as predictors of couple-level sexual concurrency. A quantitative investigation using path analysis was carried out with data collected from 286 South African heterosexual couples. Results showed that alcohol use for both sexes, relationship dissatisfaction for women, and mistrust among women were predictive of different types of sexual concurrency. Findings suggest that consideration of the experiences and behavior of both partners may be useful in understanding different reasons for engagement in sexual concurrency.

Correlates of concurrent partnerships and patterns of condom use among men who have sex with men and transgender women in Peru.

BackgroundIn Peru, there is an ongoing high-incidence HIV epidemic among men who have sex with men (MSM) and transgender women (TW). Sexual concurrency, or having sex with a partner in between two acts of sex with another partner, may be a key factor in onward HIV transmission. In this study, we quantify concurrency, evaluate factors associated with concurrency, and assess condom use with concurrent partners among MSM and TW in Peru.MethodsWe conducted a secondary analysis of data from the 2011 Peruvian Biobehavioral Survey. Pearson’s Chi-squared test was used to identify individual-level characteristics associated with concurrency. We estimated the association between participant characteristics, concurrent partnerships, partnership type (stable vs. non-stable), and CLAI within the context of concurrent partnerships using multivariate and repeated-measure Poisson regression.Results3-month cumulative prevalence of concurrency was higher among TW compared to MSM (30.7% vs 25.2%, p = 0.014). Among those with concurrent stable and non-stable partners, 45% used condoms with both partners (95% CI: 40%-50%) and 30% preferentially had CLAI with the stable partner only (95%CI: 26%-35%). Factors associated with CLAI within the context of concurrent partnerships varied between MSM and TW.ConclusionsAlthough concurrency is common among TW and MSM in Peru, patterns of concurrency and differential condom use may vary between TW and MSM. Future research may explore differential condom use with stable and non-stable partners to better understand behavioral factors that may alter vulnerability to HIV in TW compared to MSM.

Characterizing Men Who Have Sex with Transgender Women in Lima, Peru: Sexual Behavior and Partnership Profiles.

HIV prevalence is high among transgender women (TW), but how HIV is transmitted to this population is not well understood. This analysis aims to characterize sexual partners of TW (PTW) to understand how their behavior contributes to HIV risk among TW. We examined baseline data from TW, PTW, and men who have sex with men (MSM) from a treatment-as-prevention study in Lima, Peru. Individual and partnership characteristics were compared across groups, and Poisson regression was used to calculate prevalence ratios for associations between sexual concurrency and potential correlates. We found that 81% of PTW had no cisgender male partners. Prevalence of alcohol dependency, concurrency, and condomless anal intercourse was high and HIV testing was low compared to the other groups. Our results suggest that PTW are a distinct population from MSM and TW, engage in behavior associated with HIV transmission, and are likely not well reached by HIV prevention interventions.

Sexual Risk and Criminal Justice Involvement Among Women Who Use Drugs.

Criminal justice system involvement among US women is associated with increased risk for HIV/sexually transmitted infections, yet effects of different forms of criminal justice involvement on intimate relationships are not well understood. This study examined associations between arrest, probation, and jail incarceration on the number of sexual partners, sexual concurrency, and consistent condom use for drug-using women (n = 631) in Oakland, California. We used logistic and negative binomial regression and adjusted for demographics, sex exchange and drug use. Probation was associated with higher rates of sexual partnership and concurrency (IRR 1.87, 95% CI [1.11, 3.15]; OR 3.64, 95% CI [1.08, 12.20]). Incarceration lasting over 12weeks was associated with higher rates of sexual partnership (IRR 2.23, 95% CI [1.41, 3.51]). Women incarcerated once in the past year had higher odds of concurrency (OR 2.15, 95% CI [1.01, 4.57]). Our results reinforce the need for risk-reduction interventions and criminal justice diversion for women who use drugs.

Examining sexual concurrency and number of partners among African, Caribbean, and Black women using the social ecological model: Results from the ACBY study

HIV/AIDS disproportionately affects African, Caribbean, and Black (ACB) communities in Canada. ACB women are overrepresented in new HIV infections compared with Canada’s general population. Sexual concurrent relationships and multiple sex partners are factors that may spread HIV and other sexually transmitted infections more rapidly among this group. The purpose of this study was to understand factors related to sexual concurrency and number of partners among ACB women ages 16–25 living in Canada. Participants were recruited through respondent driven sampling. We surveyed 274 ACB women living in Canada and 153 participants reporting sexual intercourse were retained in analysis. Descriptive statistics were used to determine distribution of sexual concurrency behaviour by variables of interest. Analysis of variance and linear regression were used to examine differences in number of partners by individual, family, and community factors. Approximately 45% of participants were of African origin, 35% were Caribbean and 11% were Black. The majority of participants lived in Canada for ten years or more (68%). Sexual concurrency was not prevalent among ACB women living in Canada ages 16–25, but ethnicity, nativity, interactions with the criminal justice system, and perceived neighborhood quality were associated with number of sex partners. Various individual and structural factors impact sexual risk behaviour. Efforts to reduce HIV/STI risk should consider of factors outside of individual behaviour.