Sexually transmitted infection risk exposure among black and minority ethnic youth in northwest London: findings from a study translating a sexually transmitted infection risk-reduction intervention to the UK setting
- M Gerressu1,
- G Elam1,
- R Shain2,
- C Bonell3,
- G Brook4,
- J Dimmitt Champion2,
- R French1,
- J Elford5,
- G Hart1,
- J Stephenson1,
- J Imrie6,7
- 1Centre for Sexual Health and HIV Research, University College London, London, UK
- 2University of Texas Health Science Center, San Antonio, Texas, USA
- 3London School of Hygiene and Tropical Medicine, London, UK
- 4Patrick Clements GUM Clinic, Central Middlesex Hospital, London, UK
- 5Department of Public Health, City University London, London, UK
- 6National Centre in HIV Research, University of New South Wales, Sydney, Australia
- 7Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa
- Ms M Gerressu, Centre for Sexual Health and HIV Research, University College London, Mortimer Market Centre, Off Capper Street, London WC1E 6JB, UK;
- Accepted 19 January 2009
- Published Online First 27 January 2009
Objectives: Young black women are disproportionately affected by sexually transmitted infections (STI) in the UK, but effective interventions to address this are lacking. The Young Brent Project explored the nature and context of sexual risk-taking in young people to inform the translation of an effective clinic-based STI reduction intervention (Project SAFE) from the USA to the UK.
Methods: One-to-one in-depth interviews (n = 37) and group discussions (n = 10) were conducted among men and women aged 15–27 years from different ethnic backgrounds recruited from youth and genitourinary medicine clinic settings in Brent, London. The interviews explored the context within which STI-related risks were assessed, experienced and avoided, the skills needed to recognise risk and the barriers to behaviour change.
Results: Concurrent sexual partnerships, mismatched perceptions and expectations, and barriers to condom use contributed to STI risk exposure and difficulties in implementing risk-reduction strategies. Women attempted to achieve monogamy, but experienced complex and fluid sexual relationships. Low risk awareness, flawed partner risk assessments, negative perceptions of condoms and lack of control hindered condom use. Whereas men made conscious decisions, women experienced persuasion, deceit and difficulty in requesting condom use, particularly with older partners.
Conclusions: Knowledge of STI and condom use skills is not enough to equip young people with the means to reduce STI risk. Interventions with young women need to place greater emphasis on: entering and maintaining healthy relationships; awareness of risks attached to different forms of concurrency and how concurrency arises; skills to redress power imbalances and building self-esteem.
Funding: The Young Brent Project is funded by the Medical Research Council (G0500117). The views expressed are those of the authors and not necessarily those of the MRC or the health departments.
Competing interests: None.
Ethics approval: The study was approved by the Brent Medical Ethics Committee.
Contributors: JI had the original idea for the study and initiated collaboration with RS. JI developed the study design and applied for funding in collaboration with RS, GB, JE, GE, JS and JDC. CB and RF contributed to the study design as members of the steering group. RS made all Project SAFE data available for the study. GH and GE took over as joint chief investigators during the first year of the project. GE supervised all aspects of the study and was responsible for the management of the grant. GE and MG carried out the fieldwork, analysis and data interpretation. MG wrote the first draft of the paper, which was revised by GE. All authors contributed to subsequent drafts. MG and GE are joint guarantors.