African American women's risky sexual behavior within main and non-main partnerships: Individual and partnership characteristics

Incidence levels for African American women are markedly higher for HIV and STDs compared to White women. This study incorporated individual and partnership characteristics in the prediction of risky sexual behavior at the partnership-level, with separate examination of main and non-main partnerships. We analyzed cross-sectional survey data from 725 African American women referred from HIV testing sites as part of a larger study, who reported on multiple partnerships. We used mixed model regressions with participant included as a random factor to predict instances of unprotected vaginal sex at the partnership-level, conducting separate analyses for the 795 main partnerships and 329 non-main partnerships reported. For main partnerships, not being married, positive attitudes towards condoms, more condom negotiation behaviors with partner, and lack of partner resistance to condoms remained significantly associated with fewer unprotected sex occasions in multivariate analysis. For non-main partnerships, several risk characteristics of partners were associated at a bivariate level with behavior (e.g. partner having sex with other women and men, abuse), although in multivariate analysis, only positive attitudes, more condom negotiation behaviors, lack of partner resistance, and increased sexual power remained significantly associated with fewer unprotected sex occasions. Condom negotiation skills should remain an important consideration in interventions to decrease risky sexual behavior among this population. However, women still may not be able to overcome partner resistance, especially in non-main partnerships marked by an imbalance in sexual power, and in marriages. In addition to condom negotiation skills, skills to assess partner risks could also be incorporated into interventions.