Background Concurrent sexual relationships increase the likelihood of exposure to HIV/STDs. Sexual patterns among poor urban African-American (AA) women may help to explain the disproportionate incidence of HIV/STDs seen in this population. Single women with children by multiple fathers may engage in unprotected sex with the fathers of their children; these men are called Baby Daddies. Baby Daddy sex as a risk factor is complicated and based in a sexual reality grounded in poverty and power. This analysis focused on women who have continued sexual relationships with the father of their children in addition to other sexual relationships. We explored the psychosocial factors surrounding women who engage in unprotected Baby Daddy sex.

Methods We conducted in-depth interviews with AA women living in low-income housing projects in Houston, TX. Study participants were at least 18 years old and involved in multiple sexual relationships. Interviews were conducted in participants' homes and lasted 1½ h. Each interview was digitally-recorded and transcribed verbatim. Participants were paid $20 US for their time. Qualitative analysis was conducted using MAXQDA10 software. We identified and organised codes, categories, and themes to form a comprehensive picture of the behaviours of our sample.

Results Our sample included 26 AA women aged 21 to 40 years. Themes that emerged illustrated the contextual environment of women's sexual decisions and included: financial insecurity, parenting, relationship ideals, loneliness, and baby daddy sex. Participants characterised their choice to have unprotected baby daddy sex through the following categories: trust/bond based on shared child, love, compensation for financial support of children, pleasure, and longing for past relationship. These findings identified the importance and implied intimacy of the baby daddy relationships and suggested reasons for unprotected sex.

Conclusions These findings indicate risk implications because they add concurrent sexual relationships with unprotected sex, thus increasing the potential for exposure and transmission of HIV/STDs. More importantly, this study reflects the lasting importance of a relationship resulting in children and how that relationship influences sexual health. Interventions that focus on poor urban AA women in Houston should acknowledge the cultural constructions of both sexuality and relationships in this population, both related to socioeconomic and power inequalities.