Sexual Partner Concurrency of Urban Male and Female STD Clinic Patients: A Qualitative Study

Abstract

Partner concurrency (i.e., overlapping sexual partnerships) facilitates the spread of STDs, including HIV. The present study explored the context of and motivations for partner concurrency among patients recruited from an urban STD clinic. Eight focus groups were conducted with 59 patients (47% women; 77% African American). Qualitative analyses revealed five motivational themes related to the occurrence of concurrent partnerships for men and women. Participants reported these partnerships tend to occur: when people believe that sexual partners are unfaithful or cannot be trusted; when sexual satisfaction is low; when patients report the need for different partners to fulfill multiple needs; in retaliation for a partner’s concurrency; and when people wish to maintain a sexual relationship with an ex-partner who is the parent of a shared child. Four additional themes unique to men were identified. Men reported that they had multiple partners because this practice supports their sense of masculinity and is consistent with familial modeling and community norms, and because having multiple partners is “in a man’s nature.” Men also mentioned that the imbalance in the number of women-to-men in their sexual network facilitates partner concurrency. These findings can help prevention practitioners and researchers to develop interventions to reduce risk associated with partner concurrency.

INTRODUCTION

Partner concurrency, or having multiple sexual partnerships that overlap in time, is believed to be an important factor in the spread of STDs, including HIV (Mah & Halperin, 2010). Having multiple partners increases an individual’s risk of acquiring an STD, and concurrency increases the risk of infection among an individual’s partners and in the larger sexual network (Morris, 2001). The dynamics of HIV transmission further increase risk for individuals whose partners have concurrent partners. HIV transmission is more likely to occur in the first few months after initial infection (Pilcher et al., 2004); partner concurrency increases the risk of HIV during this acute phase of HIV infection. An individual with serially monogamous sexual relationships may have only one sexual partner during the acute phase of HIV infection; however, an individual with concurrent sexual partners would have multiple partners during the acute phase and, therefore, would be much more likely to transmit HIV to these partners (Epstein, 2010).

Both mathematical modeling and empirical research underscore the risk of partner concurrency in STD/HIV infection. Mathematical models have demonstrated that partner concurrency can lead to faster spread of infection and larger epidemics (Morris & Kretzschmar, 1995; Watts & May, 1992). Mathematical models have demonstrated that concurrency could, at least in part, explain the racial disparities in STD and HIV rates that persist despite few racial differences in individual-level sexual behaviors (Morris, Kurth, Hamilton, Moody, & Wakefield, 2009). These findings are supported by field studies demonstrating that concurrency is associated with STD transmission (Koumans et al., 2001; Potterat et al., 1999).

Several researchers have proposed that social and contextual factors may lead to the initiation and maintenance of sexual partner concurrency. These factors include poverty (and drug dependence), which may lead to the exchange sex to meet survival (or drug use) needs, and occupational relocation (migration) or incarceration, which often decreases the male-to-female ratio in a community (Kraut-Becher et al., 2008; Adimora & Schoenbach, 2005). Thus, for example, in low-income, urban communities, there are fewer available African American men than women, due to the large number of African American men who die at a young age or who are incarcerated. The relative shortage of men may reduce women’s power in relationships, and thus reduce their ability to insist on monogamy (Kraut-Becher et al., 2008; Adimora & Schoenbach, 2005).

Researchers have suggested that partner concurrency should be targeted in STD/HIV prevention interventions (Mah & Halperin, 2010; Morris et al., 2009). To effectively target concurrency, researchers must first understand motivations associated with the behavior. Although several qualitative studies of partner concurrency have been conducted in Africa (Harrison, Cleland, & Frohlich, 2008; Leclerc-Madlala, 2003; Selikow, Zulu, & Cedras, 2002), norms for sexual behavior, as well as the social, economic, and interpersonal reasons for engaging in concurrency, are likely to differ by culture and country. Few qualitative studies in the United States have investigated reasons for partner concurrency. Studies in the U.S. have investigated reasons why people have sex, but these studies have focused on sex in committed relationships (e.g., Hill & Preston, 1996), or sex in general (e.g., Meston & Buss, 2007); few studies have investigated reasons for having sex with more than one partner.

Partner concurrency occurs at elevated rates among patients attending STD clinics. In national surveys, 12% of women report concurrent partnerships in the past five years, and 11% of men reported concurrent partnerships in the past year (Adimora et al., 2002; Adimora, Schoenbach, & Doherty, 2007). In contrast, 32% of patients attending an STD clinic report having other partners since they began a sexual relationship with their current partner (Drumright, Gorbach, & Holmes, 2004). In a recent study with a large sample of STD patients who had a steady partner, 64% reported having sex with at least one other person in the past three months (Senn, Carey, Vanable, Coury-Doniger, & Urban, 2009). Thus, STD clinics provide an opportune setting in which to investigate the psychosocial context of partner concurrency.

In a previous qualitative study of African American men attending an STD clinic, we found that men engaged in partner concurrency because they believed that a single partner could not fulfill all of their needs, having multiple partners was in a man’s nature, men enjoyed variety, growing up men saw family members with concurrent partnerships, having multiple partners made them feel like a man, they were trying to find the right woman, and substance use undermined self-restraint and monogamy (Carey, Senn, Seward, & Vanable, 2010). However, our earlier study did not include women and it is likely that men and women may report different reasons for engaging in partner concurrency (Gorbach, Stoner, Aral, Whittington, & Holmes, 2002). Therefore, the present study was conducted to: (1) replicate our previous findings for motivations for engaging in partner concurrency among men attending an STD clinic; (2) investigate motivations for partner concurrency among women attending an STD clinic; and (3) compare men’s and women’s motivations for engaging in partner concurrency.

METHOD

Participants

Participants were 59 patients (31 men, 28 women) between 18 and 60 years of age (M = 28.5; SD = 10.4) recruited from an urban, publicly-funded STD clinic. The majority of participants were African American (n = 43; 77%); 9% of participants were multiracial, 7% were White, 2% were American Indian/Alaska Native, and 5% indicated they were of “other” race. Most participants had a high school education or less (n = 32; 64%), and were unemployed (n = 37; 65%). Approximately one-half of the sample (n = 24; 47%) reported one sexual partner and one-half (n = 25; 49%) reported more than one sexual partner (i.e., sexual partner concurrency) in the past three months. Few participants (n = 6; 13%) reported using a condom every time they had sex.

Procedure

Participants were recruited from a publicly-funded STD clinic in an urban area of upstate New York during October and November, 2009, as part of a study to develop sexual risk reduction DVDs targeting condom use and partner concurrency. The city in which the STD clinic is located has a population of over 200,000. Slightly more than half of the population (52%) is non-Caucasian, and 26% of the population lives below the federally established “poverty line.” The city has high STD rates; the chlamydia rate is four times the national rate, and the gonorrhea rate is five times the national rate.

Patients were called from the waiting room of the STD clinic to a private exam room, greeted by a trained research assistant (RA), and screened for eligibility (age 18 or older; not obviously impaired or otherwise unable to participate meaningfully in research). Eligible patients were invited to attend a focus group discussion about sexual health and other health issues in their community. The RA explained that the purpose of the study was to elicit information to inform the development of risk reduction DVDs that would be shown to clinic patients. Patients were also informed that focus groups would be comprised of all men or all women and would last two hours, refreshments would be provided, and they would be reimbursed $40 for their time. Patients who agreed to participate completed a brief survey and received a printed invitation. Contact information was obtained and reminder calls were made to participants in the two days before the focus group.

Four male and four female focus groups were conducted; the size of the groups ranged from four to 13 participants (women: four to nine participants; men: five to 13 participants). Written, informed consent was obtained from all participants before the focus groups began. Groups were audiotaped using a digital recorder. Focus groups were conducted with two facilitators matched to the gender of the group. Lead facilitators for the groups were African American mental health professionals, with extensive training in sexual health, qualitative research, and issues facing urban and minority populations; both had extensive prior experience conducting focus groups.

Facilitators followed a semi-structured focus group guide that included open-ended questions related to condom use, partner concurrency, and general health concerns. Participants were asked their thoughts about partner concurrency for men and for women, perceptions of community members’ thoughts about partner concurrency, reasons men and women have multiple partners, whether a committed relationship was realistic, motivations for reducing their number of partners, and benefits of a committed relationship. These questions served as an initial stimulus for discussion; facilitators were encouraged to probe responses and ask follow-up questions, based on participant responses to the initial questions. The research team listened to the audio recordings after each focus group, and facilitators and project staff discussed topics that merited additional follow-up in subsequent focus groups. Focus groups were conducted until content saturation was reached (i.e., until no new ideas or themes emerged during the focus groups). All procedures were approved by the IRBs of the participating institutions.

Data Analyses

Digital audio recordings were transcribed and checked for accuracy. Transcripts were analyzed using the principles of grounded theory (Glaser & Strauss, 1967), to develop hypotheses and theories based on the data. After familiarizing themselves with the recordings and transcripts, coders created broad categories, and each unit of the transcript was assigned to one or more categories. Within each broad category, similar data were grouped together, and subcategories were created based on these data groupings. Coders discussed categories and subcategories; these categories and subcategories were revised as new data were considered, or as researchers came to new understandings and generated new hypotheses.

To optimize the trustworthiness of the results, regular meetings were held to discuss results and to develop new understandings and interpretations of the data. Information obtained in earlier focus groups was investigated further in subsequent focus groups, to ensure emergent themes were accurately understood. In addition, focus groups were conducted until content saturation was reached. Throughout the data analysis process, disconfirming evidence for emerging ideas was sought.

RESULTS

The two primary reasons given by both men and women for having concurrent partnerships were: no one is faithful (with the corollary, I cannot trust anyone); and lack of sexual satisfaction with a main partner. These themes were raised in every focus group that was conducted. Although less common, both men and women reported the following reasons for having multiple partners: different partners fulfill different needs; retaliation for partner having other partners; and continuing sexual relationship with their child’s mother/father. Men also indicated they had multiple partners because: of familial modeling; it feeds their ego (i.e., supports their sense of being a man); it is in a man’s nature to have multiple partners; and there are many available women. Evidence for each of these themes is provided below.

No One is Faithful

The most common theme throughout the focus groups was that participants thought no one was faithful, and that they could not trust anyone. Some comments were specifically directed at the untrustworthiness of the opposite sex; one male participant said, “Everything is poppin’ off now. Every chick. Ain’t no faithful girl no more” (Participant 1, African American male, age 20), while a female participant stated, “…no guy will be very faithful” (Participant 2, African American female, age 22). For the most part, both men and women acknowledged that both sexes were likely to be non-monogamous. Participants commented, “…either she out there doin’ something behind your back, or you doin’ something” (Participant 3, African American male, age 43), and “You can be in a long-term relationship, but still they be cheating. They be cheating. They be sliding off. Not only men. Women do it too.” (Participant 4, African American female, age 26). Thus, most participants believed it was normative for both men and women to have concurrent partners.

Previous relationships with partners who were non-monogamous made it difficult for participants to trust their partners and to be emotionally invested in their relationships. One man said,

Cause it’s crazy, when you been through a lot of relationships, you been through a lot, it’s like you basically push trust off, you push it off, push it off to the back of your head, like, you try to keep like no emotional ties to anybody, something like that, that’s why certain people don’t trust.

(Participant 5, Multiracial male, age 23)

Inability to trust partners was a common theme, with one woman stating, “You wanna trust them, but at the same time you can’t trust, and like, why be with somebody that you can’t trust?” (Participant 6, African American female, age 18).

This inability to trust a partner and to emotionally invest in a relationship may have contributed to a lack of concern for a partner’s happiness or well-being; participants reported that many individuals were concerned only with pleasing themselves, as reflected in the phrase, “I’m doin’ me.” One way in which people pleased themselves was by having multiple partners. “People are not being faithful. People go off and they do them.” (Participant 4, African American female, age 26). Thus, participants seemed to be describing a cycle in which repeated relationships with unfaithful partners led them to be unable to trust and feel emotionally close to subsequent partners. This, in turn, led them to be unfaithful to their current partner; those partners may then find it difficult to trust subsequent partners, and would continue the cycle of distrust.

In contrast, a few participants had been or were currently in monogamous, committed relationships. They spoke about these relationships very positively. One man countered other participants’ assumption that no one could be trusted, stating, “That’s just how it worked with us, because, I don’t know, I guess some relationships are stronger than others, when you can kind of like get that trust and that loyalty and commitment between each other…” (Participant 7, African American male, age 36). A female participant said of her monogamous relationship, “I love it. Mine’s just one partner and I actually love it.” (Participant 8, African American female, age 29). Many participants spoke of their desire to eventually find one partner and be in a mutually monogamous relationship. A male participant said, “It’s all about meeting one woman and getting married to her and having a family.” (Participant 9, African American male, age 34). A female participant said, “You got to pick somebody…you got to have goals…I want a husband, I don’t want husbands…I want one person.” (Participant 10, African American female, age 23). Some participants were not actively looking for the one right partner; rather, this was a goal for them at some point in the future. Nonetheless, many participants, particularly female participants, were actively looking for a committed, faithful partner, and had just not been able to find that person. This desire for a monogamous partner was inconsistent with participants’ beliefs that no one could be trusted and no one would be faithful.

Sexual Satisfaction

Both men and women reported having multiple partners because their main partner did not satisfy them sexually. Lack of sexual satisfaction was more common for men, with both men and women acknowledging that men had multiple partners because they were not sexually satisfied with their main partner. A male participant stated, “A lot of the guys are runnin’ back and forth to the clinic because they’re messin’ around with girls because their women won’t do what they want … Therefore, the guys are going elsewhere to get what they want.” (Participant 11, African American male, age 24). When talking about why men have other partners, one female participant stated these other partners are “willin’ to do what you don’t do” (Participant 6, African American female, age 18). Although less common, women also reported that they had multiple partners because they were not sexually satisfied. One woman reported that her partner did not want to have sex as frequently as she did, so she sometimes had sex with another man: “I do wander off outside the relationship. See, he’s not a very sexual person.” (Participant 12, Puerto Rican female, age 29).

Both men and women also said that some women allow their partners to have other partners because the woman is unwilling to do what the man wants sexually. A male participant said of his female partner, “but she wasn’t going to do what I really wanted…[said to] go get it your damn self.” (Participant 13, African American male, age 57). Women also acknowledged that this happened in relationships.

Maybe, okay, you don’t like all the stuff that he likes and that’s just going to make him go and cheat because you don’t like what he likes [sexually], he don’t like what you like so, basically, you tell him to do whatever.

(Participant 14, American Indian/Alaskan Native female, age 21)

A female participant commented that women sometimes withhold sex when they are mad, which could lead to their partner seeking sexual satisfaction elsewhere. She cautioned the other participants in the group,

When you get mad at your man…don’t stop giving it to him, because if you do, he’s gonna go get it from somewhere else…when you get mad, you need to stop cutting him off. You need to stop using sex as an emotional weapon.

(Participant 15, African American female, age 48)

Sometimes people sought sexual satisfaction elsewhere because their partner would not participate in a specific sexual act. For example, when one woman confronted a partner about his affair, she reported that he said, “Well, I only did that because she gives me head [fellatio] and you don’t” (Participant 15, African American female, age 48). Other times, people sought sexual satisfaction elsewhere because one partner wanted more frequent sexual activity than the other partner. One female participant said, “A lot of people get together and they’re at different sexual levels…and that’s where the cheating starts.” (Participant 16, Caucasian female, age 23).

Both men and women reported having multiple partners because they liked variety, and having sex with different people was exciting. A female participant said, “It was the thrill of having sex with this person, having sex with that person” (Participant 17, African American female, age 29). Both male and female participants agreed that sex with one person could be boring. One male participant said, “It’s true. You will get tired of that person. You will get tired of the same sex…it becomes stale.” (Participant 18, African American male, age 40).

In contrast, several women acknowledged that it could be sexually pleasurable, sometimes even more pleasurable, to be with only one partner, because of the love both partners have for each other. One female participant spoke of, “that feeling…that you have, with one person, that you was with” (Participant 19, African American female, age 26). For several women, the key to maintaining sexual pleasure with a single partner was open communication. Women said, “If they’re with one person, then you have time to get open with [him]” (Participant 16, Caucasian female, age 23) and “I’m going to tell my partner I’m very sexually active so I don’t [go] out and sleep with other different men to get satisfaction guaranteed…I’m going to tell my partner [what I need].” (Participant 8, African American female, age 29). Women also spoke of the need to “spice things up” sexually, to keep sex with a single partner interesting and exciting. One male participant, who had been in a monogamous relationship but wanted the excitement of having multiple partners, acknowledged the experience was not as pleasing as he expected. “I wanted multiples…I ain’t missing out…I should have stayed … at home.” (Participant 13, African American male, age 57).

Multiple Needs

Both men and women reported that it was difficult to find one partner who fulfilled all their needs (not including the sexual needs discussed above), so they sought out other partners to fill these different needs. One male participant stated, “I think [a man] got four extra chicks, and chicks got four extra [men]. Like they do different jobs.” (Participant 20, African American male, age 22). Similarly, a female participant said women “want to grab…different people ‘cause…you’re just looking for different things.” (Participant 19, African American female, age 26).

When participants spoke specifically of the needs that different partners fill, they often spoke of material needs. One man said, “If one chick got a house with no car, you get a chick that got a car with no house. That way you got both now. You got a car and a house.” (Participant 1, African American male, age 20). In addition to material needs, some participants mentioned emotional needs. One woman stated,

It’s that you can be in love with this person, like I love him, that’s my dude, right here, I love him. But maybe he can’t provide for you like he want, like you need him to do or whatever, or do other things you need him to do. So you go over here and he can do this for you. He can provide…. You be goin’ back and forth.

(Participant 4, African American female, age 26)

Retaliation

Men and women also reported having concurrent partnerships when they suspected or found out that their partner had sex with someone else. Some participants thought the same standards should apply to both partners, so if one partner had sex with other people, both partners should be able to have sex with other people. One male participant said,

You be doin’ some old faithful shit, tryin’ not to mess with no other shorties, but you think your shorty out there doin’ her[self], you gonna be like, damn! … I’m puttin’ in all this effort. I’m puttin’ in 100% and it’s a possibility she out here fuckin’ other [men]. So you gonna do you.

(Participant 20, male)

A female participant similarly said,

You can’t go out and do whatever you want to do and still expect for me to be waitin’ for you. I’m not gonna sit around and wait for nobody. So when you off doin’ you, I’m off doin’ somethin’ else too.

(Participant 4, African American female, age 26)

Some participants might have been struggling for equality or fairness in their relationships, while other participants protected themselves by trying not to be more emotionally invested in the relationship than their partners.

Finding out your partner had other partners could be emotionally painful. One participant said, “I’ve seen my homeboys get cheated on and stuff like that and I’ve been with girls that are cheatin’ on their husbands and boyfriends and stuff like that, so I know it’s a hurtful and painful thing.” (Participant 18, African American male, age 40). Another participant said if his main partner found out about his other partners, “She gonna be real sad. She gonna be sick…So that’ll hurt her feelings.” (Participant 21, African American male, age 23). This hurt and distress led some individuals to have sex with someone outside of their main partnership, to try to hurt their partner the way they were hurt. One participant said, “She just gonna do her fuckin’, then ask you about it [cheating], that way if you lie and she think you lie or know, she gonna throw all the shit she did in your face.” (Participant 22, African American male, age 19).

Child’s Mother/Father

Some men and women continued to have sex with their child’s mother/father, even if they were no longer each other’s primary partner. For some participants, it was expected that they would continue to have a sexual relationship with their child’s mother/father. One male participant said,

My baby’s mom…she’s married, and I mean it’s like almost every single day, she expect me to hit it [i.e., have sex with her] …to this day she expects that, because you my baby’s daddy, you supposed to be givin’ it up to me, if I’m not satisfied over here.

(Participant 7, African American male, age 36)

Another male participant said,

A lot of people, once they have a kid, well, they feel like there ain’t even no reason to be with her no more, because I’m gonna always be able to hit it…I don’t give a damn who you with, you gonna give me some of them buns.

(Participant 23, African American male, age 24)

Although none of the women personally acknowledged that they continued to have sex with their child’s father, one woman said that she knew other women who continued to have sex with their child’s fathers. “So I know ‘cause I got friends and stuff and most of them still do deal with their baby fathers regardless if they in a different relationship.” (Participant 4, African American female, age 26). Many of the women were judgmental about other women who continued to have sex with their child’s father, with one participant saying, “You know you got low self-esteem when you stoop that low.” (Participant 2, African American female, age 22). One participant elaborated on the complex relationship between herself, her daughter, and her daughter’s father, stating that because her child’s father did not provide anything for their daughter, she felt like she would be betraying her daughter if she had sex with him.

He think because he my baby father he’s supposed to be able to have sex with me whenever he want to or whatever, but he don’t provide so you know…you don’t get any. To me it feel like if I would, I’d be like betraying my daughter or something, like, how you got him up here, he can’t even go get us some milk or something.

(Participant 4, African American female, age 26)

Familial Modeling

Men reported that they had multiple partners because when they were growing up, their male relatives had multiple female partners. Because of this familial modeling, some participants viewed multiple partners as normative and never considered monogamy as an option. One participant said, “I wasn’t raised like that, you’re only supposed to have one woman, ain’t nobody ever put that in my head…so I grown up watching my older brother slam all these shorties, I’m gonna do the same thing.” (Participant 24, African American male, age 19). Because participants saw their male relatives with multiple partners, they thought it was acceptable to have multiple partners. One female participant said, “It’s what you see growing up. Like men probably just see the stuff, so they think it’s okay. Like they see their dad or their uncles cheating and they think it’s okay if the women see it too.” (Participant 10, African American female, age 23). One participant acknowledged that he did not like it when his stepdad cheated on his mom, but when he grew up he had multiple partners anyway. “You see your stepdad got four and five women…this was indirect. So I’m growin’ up doin’ the same thing they doin’ even though I hated what they were doin.” (Participant 25, male).

Familial modeling was a less common reason for women to have multiple partners; one male participant further added to the discussion about familial modeling by noting,

If the daughter grows up in a household where her momma bear got different men in and out all the time, she’s gonna think that’s okay because she sees momma bear doin that…that’s what she’s used to….the only reason I could see why girls have a whole bunch of different partners.

(Participant 23, African American male, age 24)

A few participants expressed a desire to change their behavior in order to be a role model for their own children. They did not want their children to have multiple partners. One man said,

Now if my daughter was to come home with four or five different dudes on different nights I’d look at her like she crazy. So how is she lookin’ at me?…I’m gonna be a role model….I don’t need four or five different broads. I just need one broad to be faithful to.

(Participant 26, African American male, age 45)

Similarly, another male participant said about his son,

When he came to me one day and was like, ‘Dad, how many girlfriends you got?’…I can’t also teach him to do that ‘cause he’s young. He gonna grow up and think, ‘My daddy had all them girls. I’ll have me a bunch of girls.’ He can end up in a situation where he can’t get himself out of in the future.

(Participant 27, Multiracial male, age 28)

Men’s “Ego” and Sense of Masculinity

Having multiple partners enhanced men’s sense of masculinity, and made them feel like a man. One male participant said, “It’s like a cockiness…I can get all these women, I can get anyone I want…I got a whole phone full of women…it’s like an ego trip.” (Participant 9, African American male, age 34). Another participant said of men who have multiple partners, “You the dude, you know what I’m sayin’, you that dude…you gonna get that slappin’ back.” (Participant 23, African American male, age 24). Several men talked about competing for women. Sometimes men competed with each other to have more partners. One participant said, “And also it’s an ego thing…he got four girls, he got five girls…now I feel I gotta keep up with the Jones with him, because he got four girls.” (Participant 28, Multiracial male, age 25). Other times there was a competition to have sex with one particular woman.

It’s hard to stay with one shorty…we all go out to the club, then we see like one shorty, like who tough, we all goin’ to be aimin’ at her, everybody’s going to be like, whoever get her, that dude, if you don’t get her that sucks for you.

(Participant 29, African American male, age 19)_

In a Man’s Nature

Some participants reported that it is perfectly natural (“in a man’s nature”) to have multiple partners. One participant thought that for some, but not all, men, it was in their nature to really enjoy sex; thus, these men needed multiple partners.

It all depends on what type of quilt you’re cut from. Like me, I’m cut from that horny quilt, like I need ‘em, I’ve gotta smack buns. I’m not even gonna say I’m addicted to it, it’s just, I just like women.

(Participant 23, African American male, age 24)

Other participants thought that having multiple partners was a part of all men’s genetic make-up. “They call it the cheat gene, ‘cause, you know, it basically means you got a girl that you wanna step out on that person…it’s something that’s part of us and it’s always probably gonna be part of us.” (Participant 18, African American male, age 40). These men had a fatalistic sense about having multiple partners; because it was in their nature to have multiple partners, they were unable to fight against this strong natural urge. However, one participant challenged the other group members’ assertion that it was in a man’s nature to have multiple partners, saying, “On the Discovery Channel too, they also have animals that are monogamous.” (Participant 26, African American male, age 45)

Many Available Women

A few men reported that it was difficult to be with only one woman when there were so many available women. One participant said, “But then man, it’s temptation. So many [women] around. So many girls around.” (Participant 30, male). Another male participant said, “It’s hard to be with just one person when there’s so many other people.” (Participant 22, African American male, age 19).

DISCUSSION

A primary finding of the present study was that both women and men believed that having multiple partners was normative, corroborating findings obtained previously with men attending an STD clinic (Carey et al., 2010). Because concurrency is associated with the spread of STDs through a population (Koumans et al., 2001; Potterat et al., 1999), it may be an important factor in the STD epidemic in some urban areas.

In this study, men and women gave very similar reasons for having concurrent partners: no one is faithful/you cannot trust anyone; your partner is not sexually satisfying; different partners fill different needs; retaliation for your partner being non-monogamous; and ongoing sexual relationship with child’s mother or father. In addition, men reported familial modeling, ego enhancement, man’s nature, and opportunity (i.e., many available women) as reasons for concurrency. These findings are consistent with previous research findings that although there is substantial overlap between men and women in their reasons for having sex, men more frequently report engaging in sex to boost social status and self-esteem, and because the opportunity presented itself (Meston & Buss, 2007).

The most common reason for partner concurrency in the present study was that no one is faithful and no partner could be trusted. This finding corroborates results from other studies that have found that, in groups where concurrency is common, many relationships are characterized by a lack of trust and a feeling that it would be risky to become too emotionally involved with a partner (Singer et al., 2006). However, this finding is inconsistent with previous research findings that people have sex to express their love and commitment to a partner (Hill & Preston, 1996; Meston & Buss, 2007). Much previous research on sex motivations was conducted with college students (e.g., Hill & Preston, 1996; Meston & Buss, 2007) whose relationship patterns may be different from the relationship patterns reported by this urban, adult sample. There are many historical and political reasons for marginalized groups to be distrustful of institutions and people in power (Whaley, 2001). However, it is disheartening that participants in this study were distrustful of their own intimate partners. As concurrency becomes common, and individuals find out their partner has other partners, people may find it difficult to trust subsequent partners.

Concurrency would be less of a risk factor for STD/HIV transmission if condoms were used correctly and consistently, with every partner. In the current study, most participants did not use a condom with their main partner, even though they did not trust their partner to be monogamous. Participants were generally unable to articulate why they engaged in unprotected sex with a partner they suspected was non-monogamous. Most participants reported that a condom was used at the beginning of a relationship but, at some point, condom use was discontinued; after one sexual event without a condom, it was difficult to resume condom use in that relationship. Many participants expressed a desire to find a trusted and monogamous partner; perhaps this desire to be in a committed relationship led participants to discontinue condom use, a sign of commitment and trust, even if their relationship did not involve commitment and trust.

There is evidence that having a satisfying and supportive relationship with a partner has positive physical and mental health benefits, whereas individuals in a low-quality or unsupportive relationship may actually experience negative physical and mental health consequences (Holt-Lunstad, Birmingham, & Jones, 2008; Kiecolt-Glaser & Newton, 2001). Not only were most participants’ relationships characterized by a lack of trust, they were characterized by a pronounced self-interest, as evidenced by the oft-heard phrase, “I’m doin’ me.” In addition to trust and commitment, having both partners equally committed to the relationship is an important predictor of healthy functioning in relationships (Drigotas & Rusbult, 1999); in an environment where partner concurrency is perceived to be normative and trust in relationships is rare, participants may have tried to ensure that they were as committed to the relationship as their partners, which is to say, not very committed. Thus, researchers may need to consider not only the STD/HIV risks of partner concurrency, but also the mental and physical health risks associated with having relationships characterized by lack of trust and support.

Many of the reasons for partner concurrency reported in the present study were similar to reasons reported by urban men in an earlier study, that is, man’s nature, filling different needs, variety/sexual satisfaction, familial modeling, and ego building (Carey et al., 2010), and are also similar to reasons for having sex reported in other studies (Meston & Buss, 2007). Several additional reasons for partner concurrency emerged in the present study, including retaliation and sex with child’s mother/father.

In this study, participants reported having sex with another partner after finding out their partner was not monogamous. Gorbach et al. (2002) termed this “reactive concurrency.” This was reported more frequently by women than by men, perhaps explaining why it did not emerge as a prominent theme in the previous study with men (Carey et al., 2010). This has been reported in previous studies as a reason for engaging in sex, although it was not commonly reported (Meston & Buss, 2007).

Participants in the current study also reported having a continuing sexual relationship with their child’s mother/father. A continuing sexual relationship with a co-parent has been reported in other studies (Gorbach et al., 2002; Singer et al., 2006) but little research has explored the context of these relationships (Nelson & Morrison-Beedy, 2008). In the present study, while acknowledging that other women had continuing sexual relationships with their child’s father, most women personally denied having a sexual relationship with their child’s father; some women were judgmental about other women who continued to have sex with their child’s father. Thus, this behavior, particularly among women, was stigmatized; focus groups, therefore, may not have been the best method by which to explore sexual relationships among individuals who have a child together. Further work is necessary to understand the reasons why men and women continue to have sex with their child’s mother/father. One hypothesis worthy of investigation is whether such behavior reflects a latent desire to reconstitute a sense of family.

Reported reasons for partner concurrency were remarkably similar for men and women, with a few exceptions. Unlike women, men reported that having multiple partners was in a man’s nature, and that having many partners was important for their ego. Beliefs that multiple partners are “in a man’s nature” or that men require or are predisposed toward multiple partnerships find support in evolutionary perspectives in which men optimize the likelihood of passing on their genes with multiple partners (Buss, 2003). Social or cultural perspectives would explain such beliefs differently; that is, these reasons likely arise from social constructions of masculinity (Kerrigan et al., 2007; Whitehead, 1997), and from the double standard whereby men who have many sex partners are viewed positively, whereas women with many sex partners are viewed negatively (Crawford & Popp, 2003). Social modeling may also explain gender differences in partnering behavior. Men, but not women, reported having multiple partners because, when they were young, they saw their male relatives with multiple partners. Because it is more accepted by society for men to have multiple partners (Crawford & Popp, 2003), women were unlikely to see their female relatives with multiple partners.

Men also reported having multiple partners because there were many available women. This reflects the gender ratio imbalance among African Americans, due in part to the disproportionate incarceration of Black men, and the disproportionate number of Black men dying at young ages due to illness and violence (Adimora & Schoenbach, 2005; Aral, Adimora, & Fenton, 2008; Lane et al., 2004).

Three methodological factors may limit the generalizability of the results obtained. First, the research was conducted with a relatively small sample of men and women, and the sample may not be representative of all clinic patients. Second, all participants were recruited from an STD clinic; results may not generalize to other populations of men and women. Finally, sexual relationships in general, and partner concurrency in particular, is a socially sensitive topic; participants may not have been comfortable revealing their personal situations and behaviors to other members of the focus group or to the focus group moderators.

Several issues that arose in the current focus groups deserve greater exploration in future research. For example, research might explore the dissonance between having multiple partners but desiring one, ideal partner, as well as the meaning and structure of “family” in this population subgroup. Understanding the reasons and context for partner concurrency can help researchers develop interventions to reduce risk of STDs and HIV. The two main reasons for partner concurrency provided by participants in the present study, that no one is faithful/cannot trust anyone and partner is not sexually satisfying, are two areas that could be targeted in a couple’s intervention focused on building a healthy and trusting relationship and communicating openly with a partner. Media campaigns could challenge some of the assumptions underlying the reasons for partner concurrency, including the assumptions that no one can be faithful, one partner cannot be sexually satisfying, and it is a sign of masculinity to have multiple partners. Interventions will need to be conducted in a clinically skilled and sensitive way, as many participants thought it would be offensive to tell someone they should reduce their number of partners. Such campaigns have been implemented in other countries; for example, reductions in the prevalence of HIV in Uganda has been attributed, at least in part, to the “zero grazing” campaign that was implemented there (Epstein, 2007). Alternatively, interventions could focus on condom use every time with every partner, for people who have concurrent partnerships. Given the difficulties participants reported with re-introducing condoms into a relationship after having sex without a condom, it may be difficult for individuals in established relationships to resume (or initiate) condom use. Perhaps the best approach to reduce the risk associated with concurrency is to give people a menu of options to eliminate or reduce risk, and allow them to decide which option would work best for them, consistent with motivational principles (Miller & Rollnick, 2002) and self-determination theory (Ryan & Deci, 2000). Further research is needed to determine the optimal approach to reducing the STD and HIV risk associated with partner concurrency.