Social pathways of sexual risk and protection among West Indian immigrant STD clinic attendees

Background. We explored how the West Indian (WI) migration experience in New York City (NYC) influences sexual risk and protection. English-speaking black WI immigrants constitute over 20% of the foreign-born population of NYC and more than one-quarter of its black population, yet remain under-studied. Method. Quantitative and in-depth assessments were conducted with WI immigrant men (N = 20) and women (N = 36) who had been diagnosed in the past year with an STI in the clinic of a large public hospital. Results. Migration influenced sexual risk and protection through multiple pathways: Many participants had experienced challenging immigration experiences that directly or indirectly shaped sexual risk. These included homelessness, lack of job opportunities, and, for some, involvement in illegal activities. Although male-dominant relationships were common in both NYC and home countries, men and women noted that intimate partner violence is greater in the WI because there are more severe consequences in NYC. Participants highlighted the greater visibility of HIV/STI prevention messages and condoms in NYC, yet believed that the “anonymity” of the city compared with close-knit communities at “home” fostered multiple partnerships, especially for women. Only 12.5% had traveled to the WI in the past year, but of these, 28.6% had unprotected sex with someone from that country during their stay. Conclusion. Migration fosters contexts of both greater risk and protection for WI immigrants. Better understanding of these processes can assist in developing more successful HIV/STI prevention interventions for this populous NYC group.