Objectives: Young black women are disproportionately affected by sexually transmitted infections (STIs) 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 US to the UK.
Methods: One-to-one in-depth interviews (n=37) and focus groups (n=10) were conducted among men and women aged 15 to 27 from different ethnic backgrounds recruited from youth and genito-urinary 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. While men made conscious decisions, women experienced persuasion, deceit and difficulty in requesting condom use, particularly with older partners.
Conclusions: Knowledge of STIs and condom use skills are 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.
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