Academic journal article
By Robinson, Beatrice E.; Scheltema, Karen; Cherry, Tonya
The Journal of Sex Research , Vol. 42, No. 3
Within the United States, African Americans are disproportionately infected with HIV and other sexually transmitted diseases (STDs) (Wohl et al., 1998). For example, in the year 2000, African Americans made up 76% of gonorrhea cases, 71% of syphilis cases, 52% of HIV infection cases, and 38% of individuals diagnosed with AIDS, despite constituting only 12% of the U.S. population (Centers for Disease Control and Prevention, 2001). These epidemiologic data highlight a clear, critical need for research aimed at improving the sexual health of this community.
Measures of Risky Sexual Behavior
Multiple concurrent sexual partnerships. Multiple concurrent relationships are a major heterosexual HIV risk indicator for both men and women. Mathematical models demonstrated that concurrent partnerships can amplify nascent HIV epidemics by as much as tenfold (Morris & Kretzschmar, 1995, 1997; Watts & May, 1992), especially in high-prevalence communities (Finer, Darroch, & Singh, 1999) such as Blacks (Adimora & Schoenbach, 2002). Similar to men who have sex with men, there is evidence that multiple partnerships in African American populations (among men and possibly women) are more common than in other racial/ethnic groups (Adimora & Schoenbach; Adimora, Schoenbach, Bonas, et al., 2002; Bakken & Winter, 2002; Catania et al., 1992; Dolcini, Coates, Catania, Kegeles, & Hauck, 1995; Finer, Darroch, & Singh; Ford, Sohn, & Lepkowski, 2002; Peterson et al., 1992; Smith, 1991; Staples & Johnson, 1993; Weinberg & Williams, 1988). Since studies have shown that multiple partnerships are more likely to occur in unmarried relationships (Catania et al.), the higher rates of multiple partnerships in African American samples may be an artifact of the lower marriage rates among African American than in Caucasian and Hispanic samples (Allen & Olson, 2001; Graves & Hines, 1997; Roempke, Graefe, & Lichter, 2002).
In spite of its importance in the HIV-prevention literature, there appears to be little consensus as to terminology for the concept of multiple concurrent sexual partnerships. We found 12 different terms used to describe this concept: non-monogamy, non-monogamous sexual behavior, relative monogamy, non-exclusive relationships, extramarital sex/coitus, concurrent sexual partnerships, multiple partners, multiple sexual partners, overlapping relationships, non-mutually monogamous unions, concurrency/non-exclusivity, and individual concurrency and partnership concurrency (Adimora & Schoenbach, 2002; Bakken & Winter, 2002; Finer et al., 1999; Hines, Snowden, & Graves, 1998; Klitsch, 2002; Manhart, Aral, Holmes, & Foxman, 2002; Norris & Ford, 1999; Santelli, Lowry, Brener, & Robin, 2000; Shain et al., 2002; Short et al., 2003; Smith, 1991).
Consistent condom use. Evidence from HIV-discordant couples shows consistent condom use to be a highly effective HIV/STD prevention strategy, while inconsistent condom use offers insufficient protection (DeVincenzi, 1994; Feldblum, 1991; Miner, Robinson, Hoffman, Albright, & Bockting, 2002; O'Leary & Wingood, 2000; Pulerwitz, Amaro, DeJong, Gortmaker, & Rudd, 2002). Thus, consistent condom use is regarded as the primary outcome measure for HIV risk reduction and is recommended as the primary outcome measure for evaluating HIV-prevention program efficacy (O'Leary & Wingood).
The Sexual Health Model
There is a recognized need to address the sexual context of HIV risk in prevention efforts (Abraham & Sheeran, 1994; Boldero, Moore, & Rosenthal, 1992; Ehrhardt, Yingling, Zawadzki, & Martinez-Ramirez, 1992; Kalichman, 1998). A variety of sexuality variables such as acceptance and comfort with sexuality, sex guilt, and sexual self-esteem have been found to be associated with safer sex behaviors (Abraham & Sheeran; Boldero et al). To provide a conceptual framework for future research in this important area of HIV prevention, we recently developed the Sexual Health Model (Robinson, Bockting, Rosser, Miner, & Coleman, 2002). …