Concurrent sexual partnerships among young adults in Cape Town, South Africa: how is concurrency changing?
Brendan Maughan-BrownSouthern Africa Labour and Development Research Unit, University of Cape Town, Private Bag, Rondebosch 7701, Cape Town, South Africa. Email: brendan.maughanbrown@gmail.com
Sexual Health 10(3) 246-252 https://doi.org/10.1071/SH12148
Submitted: 21 August 2012 Accepted: 23 January 2013 Published: 17 May 2013
Abstract
Background: The current debate about the role of concurrent sexual partnerships in the spread of HIV is influenced by limited or weak empirical data on concurrency. There is still uncertainty about the most basic statistics and little is known about how concurrency is changing. Methods: Longitudinal data (n = 2958) with repeated concurrency measures were employed to examine the prevalence of individual concurrency (someone has other partners during their most recent sexual partnership) and perceived partner concurrency (someone perceives his or her partner to have other partners) by population group and gender in 2005 and 2009. Individual fixed-effects logit regression models were created to examine factors associated with changes in individual concurrency among Black men and women. Results: The prevalence of individual concurrency increased among Black men who reported having had sex (from 33% in 2005 to 39% in 2009), remained constant among Black women (14%), decreased among Coloured (mixed-race) men (from 16% to 8%) and remained low among Coloured women (2% in 2005 and 1% in 2009). Overall, a small decrease in perceived partner concurrency was observed. Changes in individual concurrency were positively associated with changes in perceived partner concurrency among men and women. Among Black women, decreases in household income and finding employment increased the odds of reporting a positive change in individual concurrency. Conclusions: Race and gender differences in concurrency should be taken into account in future research and HIV prevention initiatives. High and increasing levels of concurrency within most recent partnerships among Black men highlight this group as a potential focus for such efforts.
Additional keywords: longitudinal panel study, prevalence, sexual behaviour, Southern Africa.
References
[1] Potts M, Halperin DT, Kirby D, Swidler A, Marseille E, Klausner JD, et al Reassessing HIV prevention. Science 2008; 320 749–50.| Reassessing HIV prevention.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1cXmtF2ls7s%3D&md5=3ce9b78db9410db38ed94fea8dc8df60CAS | 18467575PubMed |
[2] Halperin D, Epstein H. Why is HIV prevalence so severe in southern Africa? The role of multiple concurrent partnerships and lack of male circumcision: Implications for AIDS prevention. Southern African Journal of HIV Medicine 2007; 8 19–25.
[3] Mah T, Halperin D. Concurrent sexual partnerships and the HIV epidemics in Africa: evidence to move forward. AIDS Behav 2010; 14 11–6.
| Concurrent sexual partnerships and the HIV epidemics in Africa: evidence to move forward.Crossref | GoogleScholarGoogle Scholar | 18648926PubMed |
[4] Mah T, Shelton J. Concurrency revisited: increasing and compelling epidemiological evidence. J Int AIDS Soc 2011; 14 33
| Concurrency revisited: increasing and compelling epidemiological evidence.Crossref | GoogleScholarGoogle Scholar | 21689437PubMed |
[5] Shelton JD. Why multiple sexual partners? Lancet 2009; 374 367–9.
| Why multiple sexual partners?Crossref | GoogleScholarGoogle Scholar | 19647597PubMed |
[6] Lurie MN, Rosenthal S. Concurrent partnerships as a driver of the HIV epidemic in sub-Saharan Africa? The evidence is limited. AIDS Behav 2010; 14 17–24.
| Concurrent partnerships as a driver of the HIV epidemic in sub-Saharan Africa? The evidence is limited.Crossref | GoogleScholarGoogle Scholar | 19488848PubMed |
[7] Sawers L, Stillwaggon E. Concurrent sexual partnerships do not explain the HIV epidemics in Africa: a systematic review of the evidence. J Int AIDS Soc 2010; 13 1–23.
[8] Sawers L, Isaac AG, Stillwaggon E. HIV and concurrent sexual partnerships: modelling the role of coital dilution. J Int AIDS Soc 2011; 14 44
| HIV and concurrent sexual partnerships: modelling the role of coital dilution.Crossref | GoogleScholarGoogle Scholar | 21914208PubMed |
[9] Morris M, Kretzschmar M. Concurrent partnerships and the spread of HIV. AIDS 1997; 11 641–8.
| Concurrent partnerships and the spread of HIV.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2s3mt1KlsA%3D%3D&md5=81784aa00bd4e06d9c00504f9a1ac31aCAS | 9108946PubMed |
[10] Morris M, Kretzschmar M. A microsimulation study of the effect of concurrent partnerships on the spread of HIV in Uganda. Math Popul Stud 2000; 8 109–33.
| A microsimulation study of the effect of concurrent partnerships on the spread of HIV in Uganda.Crossref | GoogleScholarGoogle Scholar |
[11] UNAIDS Reference Group on Estimates, Modelling, and Projections: Working Group on Measuring Concurrent Sexual Partnerships HIV: consensus indicators are needed for concurrency. Lancet 2010; 375 621–2.
| HIV: consensus indicators are needed for concurrency.Crossref | GoogleScholarGoogle Scholar | 19954832PubMed |
[12] Kenyon C, Boulle A, Badri M, Asselman V. “I don’t use a condom (with my regular partner) because I know that I’m faithful, but with everyone else I do”: the cultural and socioeconomic determinants of sexual partner concurrency in young South Africans. SAHARA J 2010; 7 35–43.
| “I don’t use a condom (with my regular partner) because I know that I’m faithful, but with everyone else I do”: the cultural and socioeconomic determinants of sexual partner concurrency in young South Africans.Crossref | GoogleScholarGoogle Scholar | 21409303PubMed |
[13] Halperin DT, Mugurungi O, Hallett TB, Muchini B, Campbell B, Magure T, Benedikt C, Gregsonet S. A surprising prevention success: why did the HIV epidemic decline in Zimbabwe? PLoS Medicine 2011; 8 e1000414
| A surprising prevention success: why did the HIV epidemic decline in Zimbabwe?Crossref | GoogleScholarGoogle Scholar | 21346807PubMed |
[14] Stoneburner RL, Low-Beer D. Population-level HIV declines and behavioral risk avoidance in Uganda. Science 2004; 304 714–8.
| Population-level HIV declines and behavioral risk avoidance in Uganda.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2cXjsV2gt7k%3D&md5=fff4c4042b72f24569d2ef4fa6ba69b9CAS | 15118157PubMed |
[15] Sandøy IF, Dzekedzeke K, Fylkesnes K. Prevalence and correlates of concurrent sexual partnerships in Zambia. AIDS Behav 2010; 14 59–71.
| Prevalence and correlates of concurrent sexual partnerships in Zambia.Crossref | GoogleScholarGoogle Scholar | 18841461PubMed |
[16] Hunter M. The materiality of everyday sex: thinking beyond “prostitution” Afr Stud 2002; 61 99–120.
| The materiality of everyday sex: thinking beyond “prostitution”Crossref | GoogleScholarGoogle Scholar |
[17] Kaufman CE, Stavrou SE. “Bus fare please”: the economics of sex and gifts among young people in urban South Africa. Cult Health Sex 2004; 6 377–91.
| “Bus fare please”: the economics of sex and gifts among young people in urban South Africa.Crossref | GoogleScholarGoogle Scholar |
[18] Leclerc-Madlala S. Transactional sex and the pursuit of modernity. Social Dynamics 2003; 29 213–33.
| Transactional sex and the pursuit of modernity.Crossref | GoogleScholarGoogle Scholar |
[19] Mah T. Prevalence and correlates of concurrent sexual partnerships among young people in South Africa. Sex Transm Dis 2010; 37 105–8.
| Prevalence and correlates of concurrent sexual partnerships among young people in South Africa.Crossref | GoogleScholarGoogle Scholar | 19823109PubMed |
[20] Adimora A, Schoenbach V, Doherty I. Concurrent sexual partnerships among men in the United States. Am J Public Health 2007; 97 2230–7.
| Concurrent sexual partnerships among men in the United States.Crossref | GoogleScholarGoogle Scholar | 17971556PubMed |
[21] Dunkle K, Jewkes R, Brown H, Gray G. Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet 2004; 363 1415–21.
| Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa.Crossref | GoogleScholarGoogle Scholar | 15121402PubMed |
[22] Allison P. Fixed effects regression models. Thousand Oaks: SAGE Publications; 2009.
[23] Mah T, Maughan-Brown B. Social and cultural contexts of concurrency in a township in Cape Town, South Africa. Cult Health Sex 2013; 15 135–147.
| Social and cultural contexts of concurrency in a township in Cape Town, South Africa.Crossref | GoogleScholarGoogle Scholar | 23181362PubMed |
[24] Harrison A, Cleland J, Frohlich J. Young people’s sexual partnerships in KwaZulu-Natal, South Africa: patterns, contextual influences, and HIV risk. Stud Fam Plann 2008; 39 295–308.
| Young people’s sexual partnerships in KwaZulu-Natal, South Africa: patterns, contextual influences, and HIV risk.Crossref | GoogleScholarGoogle Scholar | 19248716PubMed |
[25] Gorbach P, Stoner B, Aral S, Whittington W, Holmes K. “It takes a village”: understanding concurrent sexual partnerships in Seattle, Washington. Sex Transm Dis 2002; 29 453–62.
| “It takes a village”: understanding concurrent sexual partnerships in Seattle, Washington.Crossref | GoogleScholarGoogle Scholar | 12172529PubMed |
[26] Morris M, Kurth A, Hamilton D, Moody J. Concurrent partnerships and HIV prevalence disparities by race: linking science and public health practice. Am J Public Health 2009; 99 1023–31.
| Concurrent partnerships and HIV prevalence disparities by race: linking science and public health practice.Crossref | GoogleScholarGoogle Scholar | 19372508PubMed |
[27] Soul City Institute Regional Programme. Multiple and concurrent sexual partnerships in Southern Africa: a ten country research report. Johannesburg: Soul City Institute for Health & Development Communication; 2008.
[28] Stephenson R. Community influences on young people’s sexual behavior in 3 African countries. Am J Public Health 2009; 99 102–9.
| Community influences on young people’s sexual behavior in 3 African countries.Crossref | GoogleScholarGoogle Scholar | 19008517PubMed |
[29] Adimora A, Schoenbach V. Social context, sexual networks, and racial disparities in rates of sexually transmitted infections. J Infect Dis 2005; 191 S115–22.
| Social context, sexual networks, and racial disparities in rates of sexually transmitted infections.Crossref | GoogleScholarGoogle Scholar | 15627221PubMed |