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Abstract
Objectives Ethnic differences in partnership types and sexual mixing patterns may contribute to elevated STI diagnosis rates among England’s Black Caribbean (BC) population. We examined the differences between BC and White British/Irish (WBI) sexual health clinic (SHC) attendees’ reported partnerships and sexual mixing, and whether these differences could explain ethnic inequalities in STI, focusing on attendees reporting only opposite-sex partners (past year).
Methods We surveyed attendees at 16 SHCs across England (May to September 2016), and linked their survey responses to routinely collected data on diagnoses of bacterial STI or trichomoniasis ±6 weeks of clinic attendance (‘acute STI’). Behaviourally-heterosexual BC and WBI attendees (n=1790) reported details about their ≤3 most recent opposite-sex partners (past 3 months, n=2503). We compared BC and WBI attendees’ reported partnerships and mixing, in gender-stratified analyses, and used multivariable logistic regression to examine whether they independently explained differences in acute STI.
Results We observed differences by ethnic group. BC women’s partnerships were more likely than WBI women’s partnerships to involve age-mixing (≥5 years age difference; 31.6% vs 25.5% partnerships, p=0.013); BC men’s partnerships were more often ‘uncommitted regular’ (35.4% vs 20.7%) and less often casual (38.5% vs 53.1%) than WBI men’s partnerships (p<0.001). Acute STI was higher among BC women than WBI women (OR: 2.29, 95% CI 1.24 to 4.21), with no difference among men. This difference was unaffected by partnerships and mixing: BC women compared with WBI women adjusted OR: 2.31 (95% CI 1.30 to 4.09) after adjusting for age and partner numbers; 2.15 (95% CI 1.07 to 4.31) after additionally adjusting for age-mixing, ethnic-mixing and recent partnership type(s).
Conclusion We found that differences in sexual partnerships and mixing do not appear to explain elevated risk of acute STI diagnosis among behaviourally-heterosexual BC women SHC attendees, but this may reflect the measures used. Better characterisation of ‘high transmission networks’ is needed, to improve our understanding of influences beyond the individual level, as part of endeavours to reduce population-level STI transmission.
- ethnicity
- sexual behaviour
- epidemiology (general)
- infectious diseases
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Footnotes
Handling editor Katy M E Turner
Contributors CHM and GH secured funding for the National Institute for Health Research for the Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England (PHE), in collaboration with London School of Hygiene and Tropical Medicine. SW and PB set up the study and oversaw the implementation of the patient survey in GUM clinics, and SW secured ethical approval and R&D permissions, managed by GH and CHM. PB linked the patient survey data to GUMCAD. CRHA wrote the first draft of the paper, and performed the final data analysis, with the statistical expertise of SF and CHM. MG, CRHA, SW, GH and CHM advised upon the paper’s scope and the comparisons presented. All authors contributed to the drafting of the paper and approved the final version.
Funding The NIHR Health Protection Research Units (HPRU) funding programme funded the NIHR HPRU in Blood Borne and Sexually Transmitted Infections, including this study.
Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethical approval was received from South Central–Oxford C Research Ethics Committee, ref: 15/SC/0223.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement The data that support the findings of this study are available from University College London (UCL) but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Public Health England.