Sexual attitudes, knowledge and behaviour

What is known about the sexual attitudes, knowledge and behaviour of black African people in the UK has come from a small number of studies. The BASS Line 2007¹ and 2008-09² research findings have significantly added to this body of information, while notable previous studies include PADARE³, Mayisha I⁴ and Mayisha II.⁵ The BASS Line surveys collected quantitive data, via self-completion questionnaires, from black African people of all HIV statuses. These surveys provide the most recent data from a national sample (local data reports organised by Strategic Health Authority are available on the ‘local reports’ page at www.sigmaresearch.org.uk).

BASS Line 2007 received 4172 valid responses.

Almost a fifth of respondents (19%) had no sexual partners in the past year, and 46% had one partner only. A total of 28% had between two and five partners, and 6% had six or more partners.

However this varied markedly by gender – women were more likely to have no partners (24%) or one partner only (52%), and less likely to have six or more partners (3%). Men who had sex with men (either sometimes or always) reported higher numbers of partners.

Over half of both men and women (55%) reported having a regular sexual partner (7% of whom live in Africa). Concurrent regular partnerships were uncommon: a further 7% of men and 2% of women reported having more than one partner.

Moreover, 57% of men and 81% of women who had a primary relationship reported that they had been monogamous in the relationship. The majority of those who had not been monogamous had had one or two other partners (26% of men, 14% of women).

BASS Line found substantial differences in sexual behaviour in relationships between people of different genders and between those who had different types of sexual relationships.

Women were more likely to report monogamy than men, with 17% of men reporting that they had one other regular sexual partner outside their main relationship (compared to 8% of women).

Similar to the findings of previous studies, those with regular partners and those who were in monogamous relationships were more likely to report not using male or female condoms at all in the last year. Yet more women in current regular sexual relationships reported that they had definitely had unprotected sex with someone of a different HIV status in the previous year than women not in a relationship (6 versus 1.2%).

Complex factors are at play: people who find it difficult to negotiate condom use because they are in a relationship are not necessarily unaware of their risk of infection or transmission. Prevention still needs to tackle culturally informed attitudes about the acceptability of condom use in relationships.

Those with multiple sexual partners also have complex prevention needs. BASS Line found that, although the use of condoms increases with the number of sexual partners a person has, so does the likelihood of having unprotected sex with someone of a different HIV status.

Although the respondents were largely recruited by health organisations that distribute condoms, 25% of respondents did not know that condoms are freely available from sexual health clinics, family planning clinics and community organisations. A similar number (23%) said that they sometimes had problems getting hold of condoms.

Moreover, just under a third of respondents (29%) agreed with this statement: “If I carried a condom I would worry what people thought of me.” Those who agreed also tended to say that they had a problem getting hold of condoms, confirming that getting and using condoms can be difficult in a context of social disapproval.

As a measure of the respondent’s confidence in his or her ability to discuss safer sex with a new partner (self-efficacy), they were asked to agree or disagree with this statement: “I would find it easy to talk about safer sex and HIV with new sexual partners.” Whilst 63% agreed; 37% either disagreed or chose “don’t know”.

Similarly, in response to the statement “I can use a condom with a sexual partner if I want to”, 29% either disagreed or chose “don’t know”.

Furthermore 30% of respondents who had used condoms in the past year said that a condom had broken or come off during that period of time. Those respondents were more likely to report behaviours that are likely to lead to condom failure, especially using a condom for more than half an hour and not using water-based lubricant.

BASS Line has found that there are significant knowledge gaps about HIV within the African population. Amongst all respondents who wanted to know more about subjects related to HIV, over a quarter (26%) wanted to know more about safer sex and how to prevent HIV. In the 2008-2009 survey, 68% of respondents had never heard of post-exposure prophylaxis (PEP) and 37% wanted to know more about it.

Among people who did not think they were HIV-positive, 92% said that they did not want to get HIV. However in response to the statement “I am in control of whether or not I get HIV”, 38% either disagreed or chose “don’t know”. Moreover, 25% of those with diagnosed HIV did not agree with a similar statement about control over HIV transmission.

Comparing people with diagnosed HIV to others in the sample, those with HIV had fewer sexual partners and were less likely to have had unprotected intercourse in the preceding year (32%, compared to 60% of those who had tested negative and 48% of those who had never tested). Generally they were more knowledgeable about HIV than people who had never tested or whose last test was negative.

On the other hand, people with HIV were the group most likely to report problems with interpersonal needs related to HIV prevention, such as influencing their partners or discussing safer sex and HIV.

The researchers noted that a key aim of health promotion is that people have control over HIV in their everyday lives, but that these findings suggest that a significant proportion of respondents lack the knowledge, skills and resources to exercise that control. They suggest that increased knowledge alone will not be sufficient: interventions to increase confidence and skills to avoid risky sex are therefore required.