Ethnic variations in sexual partnerships and mixing, and their association with STI diagnosis: findings from a cross-sectional biobehavioural survey of attendees of sexual health clinics across England

Abstract

ObjectivesEthnic differences in partnership types and sexual mixing patterns may contribute to elevated STI diagnosis rates among England’s Black Caribbean (BC) population. We examined the differences between BC and White British/Irish (WBI) sexual health clinic (SHC) attendees’ reported partnerships and sexual mixing, and whether these differences could explain ethnic inequalities in STI, focusing on attendees reporting only opposite-sex partners (past year).MethodsWe surveyed attendees at 16 SHCs across England (May to September 2016), and linked their survey responses to routinely collected data on diagnoses of bacterial STI or trichomoniasis ±6 weeks of clinic attendance (‘acute STI’). Behaviourally-heterosexual BC and WBI attendees (n=1790) reported details about their ≤3 most recent opposite-sex partners (past 3 months, n=2503). We compared BC and WBI attendees’ reported partnerships and mixing, in gender-stratified analyses, and used multivariable logistic regression to examine whether they independently explained differences in acute STI.ResultsWe observed differences by ethnic group. BC women’s partnerships were more likely than WBI women’s partnerships to involve age-mixing (≥5 years age difference; 31.6% vs 25.5% partnerships, p=0.013); BC men’s partnerships were more often ‘uncommitted regular’ (35.4% vs 20.7%) and less often casual (38.5% vs 53.1%) than WBI men’s partnerships (p<0.001). Acute STI was higher among BC women than WBI women (OR: 2.29, 95% CI 1.24 to 4.21), with no difference among men. This difference was unaffected by partnerships and mixing: BC women compared with WBI women adjusted OR: 2.31 (95% CI 1.30 to 4.09) after adjusting for age and partner numbers; 2.15 (95% CI 1.07 to 4.31) after additionally adjusting for age-mixing, ethnic-mixing and recent partnership type(s).ConclusionWe found that differences in sexual partnerships and mixing do not appear to explain elevated risk of acute STI diagnosis among behaviourally-heterosexual BC women SHC attendees, but this may reflect the measures used. Better characterisation of ‘high transmission networks’ is needed, to improve our understanding of influences beyond the individual level, as part of endeavours to reduce population-level STI transmission.

Improving our understanding of the disproportionate incidence of STIs in heterosexual-identifying people of black Caribbean heritage: findings from a longitudinal study of sexual health clinic attendees in England

“…This suggests that for BC participants, sexual network effects may have a greater influence on STI acquisition than individual-level risk factors (compared with WBI participants), consistent with previous findings. 3 Interestingly, younger age did predict STI risk in BC but not in WBI participants. The National Chlamydia Screening Programme offers opportunistic screening to all sexually active young people in England and, between 2015 and 2019, there was a disproportionate increase in testing among non-white ethnic groups and positivity was highest among those of black ethnicity.…”

“…In England, almost half a million STI diagnoses are made annually, and this number is rising, particularly for gonorrhoea and syphilis. 1 Ethnic inequalities in sexual health are well described in England, [2][3][4][5][6][7][8] with people of certain black minority ethnicities, especially those of black Caribbean (BC) heritage, experiencing the highest STI diagnosis rates. 2 For example, in 2018, the rate of gonorrhoea diagnoses was seven times higher in men of BC ethnicity compared with men of white ethnicity.…”

The association between region of birth and sexually transmitted infections among people of black Caribbean ethnicity attending sexual health services in England, 2015

“…chlamydia, gonorrhoea, genital herpes, while their Caribbean-born counterparts were more likely to be diagnosed with trichomoniasis and NSGI. The reasons for this are unknown but may be associated with differences in patterns of health-seeking behaviours, and/ or differences in their sexual networks [20,21].…”

Correlates of Casual Sex Amidst Vulnerability to HIV Among ACB Heterosexual Men in Ottawa and Windsor, Ontario Canada

“…Risky sexual behaviour (unprotected anal and vaginal sex) is one of the most common means of HIV transmission [ 18 ]. Of concern also are the risky behaviours that include sexual concurrency [ 19 ], non-disclosure of same sex orientation [ 20 ] and sexual mixing [ 21 ]. Yet there is not enough evidence to prove a long-term debate about risky sexual behaviour as the main reason for HIV spread in the Black population.…”