Leveraging changing gender norms to address concurrency: focus group findings from South African university students
Stephanie R. Psaki A E , Nono Ayivi-Guedehoussou B and Daniel T. Halperin C D
+ Author Affiliations
- Author Affiliations
A Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
B The Pardee RAND Graduate School, RAND Corporation, Santa Monica, CA 90401, USA.
C Public Health Program, Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico.
D Department of Health Behavior, Gillings School of Global Public Health, Chapel Hill, NC 27599-7400, USA.
E Corresponding author. Email: spsaki@jhsph.edu
Sexual Health 10(4) 369-376 https://doi.org/10.1071/SH12209
Submitted: 8 December 2012 Accepted: 25 April 2013 Published: 1 July 2013
Abstract
Background: This study aims to complement recent research on sexual concurrency in South Africa by providing a deeper understanding of women’s roles and motivations for engaging in and accepting their partners’ concurrency. Our goal is to inform the implementation of more effective interventions that embrace the powerful role that women can play in healthy sexual decision-making in consensual relationships. Methods: We conducted 12 focus groups with male and female students at the University of KwaZulu-Natal. Drawing on a subset of those focus groups, we examined the gender norms underpinning the apparently widespread acceptance of concurrent sexual partnerships. Our analysis focusses on women’s attitudes and behaviours towards concurrency – from both men’s and women’s perspectives – with a goal of identifying opportunities to engage women as agents of change in sexual partnership patterns in their communities. Results: Our findings indicate that: (1) concurrent sexual partnerships were the norm among male students and increasingly common among female students; (2) material gain and changes in women’s perceptions of their roles and power in relationships were the primary female motives for concurrency; (3) peer pressure, a perceived innate need and a fear of being alone were the primary male motives for concurrency; (4) women often know that their partners are cheating and stay with them because they believe they are the most important partner, for financial reasons, or because they worry they will not find another partner. Conclusions: HIV prevention interventions in populations where concurrency is common would benefit from emphasising women’s role and power in taking greater control of their own sexual decision-making in consensual and nonviolent relationships.
Additional keywords: femininity, HIV, masculinity, sexual scripts.
References
[1] 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 |
[2] Mah TL. 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 |
[3] 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.
| 21409303PubMed |
[4] Shisana O, Rehle T, Simbayi L, Parker W, Zuma K, Bhana A. South African National HIV Prevalence, HIV Incidence, Behaviour and Communications Survey. Cape Town: HSRC Press; 2009.
[5] Hudson CP. Concurrent partnerships could cause AIDS epidemics. Int J STD AIDS 1993; 4 249–53.
| 1:STN:280:DyaK2c%2Fjt1Kluw%3D%3D&md5=c54ebdd28faba276e9dd95adaea4db8dCAS | 8218510PubMed |
[6] Morris M, Kretzschmar M. Concurrent partnerships and transmission dynamics in networks. Soc Networks 1995; 17 299–318.
| Concurrent partnerships and transmission dynamics in networks.Crossref | GoogleScholarGoogle Scholar |
[7] Mah TL, Halperin DT. Concurrent sexual partnerships and the HIV epidemics in Africa: evidence to move forward. AIDS Behav 2010; 14 11–6.
| 18648926PubMed |
[8] Pilcher CD, Tien HC, Eron JJ, Vernazza PL, Leu SY, Stewart PW, et al Brief but efficient: acute HIV infection and the sexual transmission of HIV. J Infect Dis 2004; 189 1785–92.
| Brief but efficient: acute HIV infection and the sexual transmission of HIV.Crossref | GoogleScholarGoogle Scholar | 15122514PubMed |
[9] Wawer MJ, Gray RH, Sewankambo NK, Serwadda D, Li X, Laeyendecker O, et al Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda. J Infect Dis 2005; 191 1403–9.
| Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda.Crossref | GoogleScholarGoogle Scholar | 15809897PubMed |
[10] Epstein H, Swidler A, Gray R, Reniers G, Parker W, Parkhurst J, et al Measuring concurrent partnerships. Lancet 2010; 375 1869
| 20511007PubMed |
[11] 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 |
[12] Van Rossem R, Meekers D, Akinyemi Z. Consistent condom use with different types of partners: evidence from two Nigerian surveys. AIDS Educ Prev 2001; 13 252–67.
| Consistent condom use with different types of partners: evidence from two Nigerian surveys.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38%2Fit1Klsw%3D%3D&md5=c7477253a46ec199334525b9a3463b34CAS | 11459361PubMed |
[13] Epstein H, Halperin D. 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 19–24.
[14] Epstein H, Morris M. Concurrent partnerships and HIV: an inconvenient truth. J Int AIDS Soc 2011; 14 13–24.
| Concurrent partnerships and HIV: an inconvenient truth.Crossref | GoogleScholarGoogle Scholar | 21406080PubMed |
[15] Jewkes R, Morrell R. Gender and sexuality: emerging perspectives from the heterosexual epidemic in South Africa and implications for HIV risk and prevention. J Int AIDS Soc 2010; 13 6–17.
| 20181124PubMed |
[16] 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 |
[17] Steffenson AE, Pettifor AE, Seage GR, Rees HV, Cleary PD. Concurrent sexual partnerships and human immunodeficiency virus risk among South African youth. Sex Transm Dis 2011; 38 459–66.
| Concurrent sexual partnerships and human immunodeficiency virus risk among South African youth.Crossref | GoogleScholarGoogle Scholar | 21258268PubMed |
[18] Lagarde E, Auvert B, Carael M, Laourou M, Ferry B, Akam E, et al Concurrent sexual partnerships and HIV prevalence in five urban communities of sub-Saharan Africa. AIDS 2001; 15 877–84.
| Concurrent sexual partnerships and HIV prevalence in five urban communities of sub-Saharan Africa.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3Mzls1WgsQ%3D%3D&md5=2f82122ddcfffc01ba92640aa4537d87CAS | 11399960PubMed |
[19] Simon W, Gagnon JH. Sexual scripts: permanence and change. Arch Sex Behav 1986; 15 97–120.
| Sexual scripts: permanence and change.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL283ktFertQ%3D%3D&md5=8458c1f3725e4225f0b018f3c322cb34CAS | 3718206PubMed |
[20] Leclerc-Madlala S. Cultural scripts for multiple and concurrent partnerships in southern Africa: why HIV prevention needs anthropology. Sex Health 2009; 6 103–10.
| Cultural scripts for multiple and concurrent partnerships in southern Africa: why HIV prevention needs anthropology.Crossref | GoogleScholarGoogle Scholar | 19457288PubMed |
[21] Connell RW. Change among the gatekeepers: men, masculinities, and gender equality in the global arena. Journal of Women in Culture and Society 2005; 30 1801–25.
| Change among the gatekeepers: men, masculinities, and gender equality in the global arena.Crossref | GoogleScholarGoogle Scholar |
[22] Devries KM, Free C. ‘I told him not to use condoms’: masculinities, femininities and sexual health of Aboriginal Canadian young people. Sociol Health Illn 2010; 32 827–42.
| ‘I told him not to use condoms’: masculinities, femininities and sexual health of Aboriginal Canadian young people.Crossref | GoogleScholarGoogle Scholar | 20456685PubMed |
[23] Dunkle KL, Jewkes R. Effective HIV prevention requires gender-transformative work with men. Sex Transm Infect 2007; 83 173–4.
| Effective HIV prevention requires gender-transformative work with men.Crossref | GoogleScholarGoogle Scholar | 17569718PubMed |
[24] Seal DW, Erhardt AA. Masculinity and urban men: perceived scripts for courtship, romantic and sexual interactions with women. Cult Health Sex 2003; 5 295–319.
| Masculinity and urban men: perceived scripts for courtship, romantic and sexual interactions with women.Crossref | GoogleScholarGoogle Scholar |
[25] Harrison A, O’Sullivan LF, Hoffman S, Dolezal C, Morrell R. Gender role and relationship norms among young adults in South Africa: measuring the context of masculinity and HIV risk. J Urban Health 2006; 83 709–22.
| Gender role and relationship norms among young adults in South Africa: measuring the context of masculinity and HIV risk.Crossref | GoogleScholarGoogle Scholar | 16758334PubMed |
[26] 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 |
[27] MacPhail C, Campbell C. ‘I think condoms are good but, aai, I hate those things’: condom use among adolescents and young people in a Southern African township. Soc Sci Med 2001; 52 1613–27.
| ‘I think condoms are good but, aai, I hate those things’: condom use among adolescents and young people in a Southern African township.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3Mris1Gnsw%3D%3D&md5=6867bdca01dcf457b7d267f131f144aeCAS | 11327136PubMed |
[28] Sathiparsad R. ‘It is better to beat her’: male youth in rural KwaZulu-Natal speak on violence in relationships. Agenda 2005; 66 49–62.
[29] 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 |
[30] Leclerc-Madlala S. Age-disparate and intergenerational sex in southern Africa: the dynamics of hypervulnerability. AIDS 2008; 22 S17–25.
| Age-disparate and intergenerational sex in southern Africa: the dynamics of hypervulnerability.Crossref | GoogleScholarGoogle Scholar | 19033752PubMed |
[31] Pettifor AE, Rees HV, Kleinschmidt I, Steffenson AE, MacPhail C, Hlongwa-Madikizela L, et al Young people’s sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey. AIDS 2005; 19 1525–34.
| Young people’s sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey.Crossref | GoogleScholarGoogle Scholar | 16135907PubMed |
[32] Varga CA. How gender roles influence sexual and reproductive health among South African adolescents. Stud Fam Plann 2003; 34 160–72.
| How gender roles influence sexual and reproductive health among South African adolescents.Crossref | GoogleScholarGoogle Scholar | 14558319PubMed |
[33] Kitzinger J. Qualitative research. Introducing focus groups. BMJ 1995; 311 299–302.
| Qualitative research. Introducing focus groups.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2MzlvFOrug%3D%3D&md5=b9bbf652480ad6c05d6832adf76241c6CAS | 7633241PubMed |
[34] Kitzinger J. Focus groups with users and providers of health care. In Pope C, Mays N, editors. Qualitative research in health care. London: BMJ Publishing Group; 1997.
[35] Madriz E. Focus groups in feminist research. In Denzin NK, Lincoln YS, editors. Collecting and interpreting qualitative materials, 2nd edn. Newbury Park: Sage Publications; 2003.
[36] Corbin J, Strauss A. Basics of qualitative research: techniques and procedures for developing grounded theory, 3rd edn. Thousand Oaks: Sage Publications; 2007.
[37] Charmaz K. Constructing grounded theory: a practical guide through qualitative research. London: Sage Publications Inc; 2006.
[38] Morgan DL. Focus groups as qualitative research, 2nd edn. Thousand Oaks: Sage Publications; 1997.
[39] Campbell C, MacPhail C. Peer education, gender and the development of critical consciousness: participatory HIV prevention by South African youth. Soc Sci Med 2002; 55 331–45.
| Peer education, gender and the development of critical consciousness: participatory HIV prevention by South African youth.Crossref | GoogleScholarGoogle Scholar | 12144146PubMed |
[40] O’Sullivan LF, Harrison A, Morrell R, Monroe-Wise A, Kubeka M. Gender dynamics in the primary sexual relationships of young rural South African women and men. Cult Health Sex 2006; 8 99–113.
| Gender dynamics in the primary sexual relationships of young rural South African women and men.Crossref | GoogleScholarGoogle Scholar | 16641060PubMed |
[41] Spronk R. Female sexuality in Nairobi: flawed or favoured? Cult Health Sex 2005; 7 267–77.
| Female sexuality in Nairobi: flawed or favoured?Crossref | GoogleScholarGoogle Scholar | 16864202PubMed |
[42] Jones R. Sex scripts and power: a framework to explain urban women’s HIV sexual risk with male partners. Nurs Clin North Am 2006; 41 425–36.
| Sex scripts and power: a framework to explain urban women’s HIV sexual risk with male partners.Crossref | GoogleScholarGoogle Scholar | 16908234PubMed |
[43] Jones R, Oliver M. Young urban women’s patterns of unprotected sex with men engaging in HIV risk behaviors. AIDS Behav 2007; 11 812–21.
| Young urban women’s patterns of unprotected sex with men engaging in HIV risk behaviors.Crossref | GoogleScholarGoogle Scholar | 17160484PubMed |
[44] Creswell JW. Qualitative inquiry & research design: choosing among five approaches, 2nd edn. Thousand Oaks: Sage Publications; 2007.
