Prevalence and correlates of sexual concurrency among urban crack-using men

Background: A high number of concurrent sexual relationships within a sexual network increases the number of people with whom each is connected, increasing HIV and STD reinfection risk. Owing to the sizable "shortage" of African-American males in many urban centers, such partnerships may be relatively common among this group, as well as among crack users--who frequently report numerous sexual partners--but little is known about factors discriminating those with concurrent partnerships. Methods: 152 male African American crack users ages ≥18 recruited in Miami and Washington, D.C. were queried on drug use, sexual history, condom use, likely future use with each partner, network condom attitudes, and self-administered a TCU Self-Rating Form (SRF). Results: Sample mean age=39.2 years; 23% lived as married; 7.2% had HIV/AIDS; 51.3% reported injection history; 50 median lifetime female partners; 29.8% reported history of male partner. 49.3% reported concurrent partners. Few differences emerged between men who did/did not report concurrent partnerships in sociodemographics, drug/injection practices, STD history, sexual behaviors, condom use and anticipated use, and network attitudes toward condoms. Those with concurrent partners were significantly less likely to be in higher income categories and to be HIV+ (2.7% vs. 11.8%) and scored significantly higher on SRF Decision Making, marginally higher on Self-Esteem, and significantly lower on Depression. Conclusions: HIV prevention interventions must be built on recognition that 1) concurrent sexual partnerships are common among high-risk male African-American crack users, and 2) such men are relatively indistinguishable, on most sociodemographic, behavioral and attitudinal measures, from other crack users.