West Indian–born black men attending two New York City STD clinics were less likely than U.S.-born black men to report a number of behaviors that potentially increase the risk of acquiring STDs, including having casual and onetime partners.1 Among black women, by contrast, West Indian immigrants appeared more vulnerable to STD risk than those born in the United States, because they were less confident that they could persuade regular partners to use condoms or undergo STD screening. These findings, and others from the same study, shed light on the risk profile of an immigrant group that represents a substantial proportion of black New Yorkers.
The study used baseline data from an assessment of an intervention aimed at improving partner STD notification. Participants were sexually active men and women aged 18 and older who had had chlamydia or gonorrhea diagnosed at one of the clinics in 2002–2004. In face-to-face interviews, they provided information on their participation in a wide range of risk-related behaviors during the past 90 days, as well as attitudes toward and beliefs about condom use and notifying partners of STD infection. Researchers conducted bivariate and multivariate analyses to examine overall and gender-specific comparisons between immigrant and native-born participants.
A total of 587 men and women were included in the analyses. In both the immigrant and the U.S.-born subgroups, women were about 25 years old, on average, and men were 28; roughly three-quarters of women and half of men in each group reported an income of less than $18,000. West Indians had less schooling than U.S.-born blacks; the majority of immigrants had lived in the United States for more than four years.
Bivariate gender-specific comparisons revealed no differences by place of birth in participants' STD histories. In each subgroup, approximately one-half of participants had ever had an STD, nine in 10 had been tested for HIV and no more than 4% were HIV-positive. Immigrants' and U.S.-born participants' reports of risky sexual behaviors in the past 90 days were largely similar, but a few significant differences emerged. U.S.-born women were more likely than West Indians to have had five or more partners (4% vs. 0%) and to have had a onetime partner—someone they had had sex with once and did not plan to have sex with again (18% vs. 9%). Among the small numbers who had had anal sex, native-born women were more likely than immigrants to say that they had never used condoms on these occasions (75% vs. 14%). Among men, participants born in the United States were more likely than immigrants to have had a casual partner (56% vs. 43%), to have had a onetime partner (43% vs. 33%), to have had anal sex (26% vs. 15%) and to have used drugs other than marijuana (6% vs. 1%). However, native-born black men also were more likely than their West Indian counterparts to report one protective behavior: Forty percent and 26%, respectively, had declined to have sex because they did not have a condom or their partner did not agree to use one.
Although most measures of condom use did not vary by participants' place of birth, adjusted analyses suggested that differences in condom-related beliefs and intentions may leave U.S.-born blacks less vulnerable to risk than West Indian immigrants. Overall, the former were more likely than the latter to view consistent condom use with regular partners extremely favorably (odds ratio, 1.6). Furthermore, women born in the United States had higher odds than immigrant women of feeling extremely confident that they could convince a regular partner to use condoms (2.4), but they had lower odds of saying that they were extremely likely to use condoms consistently with casual partners (0.2). Men's responses were not related to their place of birth.
U.S.-born and West Indian participants overall did not differ in their beliefs about STD screening and notification with regard to regular and casual partners. However, U.S.-born women were more likely than West Indian women to feel extremely confident that they could convince regular partners to undergo screening (odds ratio, 1.9) and less likely to feel extremely favorably toward discussing screening with casual partners (0.1). Native-born men had lower odds than immigrant men of feeling extremely confident that they could discuss STD screening with a regular partner (0.5). Although the numbers were small, it appeared that participants who were born in the United States had reduced odds of feeling that they could probably convince a onetime partner to undergo STD screening and of feeling extremely favorably toward discussing screening with such a partner.
The researchers conclude that the use of traditional, broad racial and ethnic categories in public health research obscures "significant heterogeneity" among black subgroups living in the United States and that place of birth is an important characteristic to include in studies of STD-related risk among black immigrants. Moreover, given their findings of West Indian women's relative reluctance to discuss condom use and STD screening with regular partners, the investigators stress the need "for interventions that target gender norms and behaviors among West Indian immigrants."
1. Hoffman et al., HIV and sexually transmitted infection risk behaviors and beliefs among black West Indian immigrants and US-born blacks, American Journal of Public Health, 2008, 98(11):2042–2050.