Addressing Multiple and Concurrent Partnerships in Southern Africa
A Think Tank meeting on HIV prevention in the high HIV prevalence countries in southern Africa, convened by SADC and UNAIDS in 2006, concluded that 'high levels of multiple and concurrent sexual partnerships by men and women with insufficient consistent, correct condom use, combined with low levels of male circumcision are the key drivers of the epidemic in the sub-region.' One of two 'key priority interventions' the meeting recommended was the need to "significantly reduce multiple and concurrent partnerships for both men and women."
Studies show that men and women in the region often have more than one sexual partner at the same time. These concurrent partnerships can overlap for months or years. The pattern of concurrent partnerships is different to the pattern of serial monogamy more common in the West and can result in much higher rates of HIV transmission across communities. Viral load and 'infectivity' is much higher during the three to four week 'acute infection' window period that initially follows HIV infection. The combined effects of sexual networking and the acute infection spike in viral load means that as soon as one person in a network of concurrent relationships contracts HIV everyone else in the network is placed at risk. Conversely, modeling suggests that a relatively small reduction in multiple concurrent partnerships in the population will have a disproportionate effect in reducing the extent to which individuals are linked in one sexual network.
In Southern Africa male and female motivations for seeking more than one partner include long absences away from home in the migrant labour system, female vulnerability, ease of opportunity and social, cultural and economic factors. Women are often not passive victims but active agents in pursuing concurrent partnerships, particularly with men older than themselves, in order to meet a range of needs. These include cash, various material resources and social status as well as sexual satisfaction, love and security.
Addressing multiple concurrent partnerships in HIV prevention requires targeted locally informed and culturally relevant messages to raise personal awareness of risk and change socio-cultural norms around sexual partnering. Increased effort and resources are also needed to directly engage young and older men.
Key resources
In September 2008, UNAIDS and Soul City Institute co-convened a meeting of HIV prevention communications practitioners working on addressing multiple and concurrent partnerships within HIV prevention efforts in Eastern and Southern Africa. The meeting focused on exploring and sharing experiences, to date, as well as on shaping the plans
for HIV prevention communications in the region. A key recommendation of the meeting was the establishment of an active community of practice of HIV prevention communications practitioners to promote a more coordinated regional response to HIV prevention communications.
UNAIDS
Multiple Concurrent Partnerships - Fact Sheet
SAFAIDS
How to card series - Multiple Concurrent Partnerships: Driving Southern Africa's HIV Epidemic
UNAIDS and Soul City Institute
Community of Practice on HIV prevention communications meeting - Johannesburg, 14-15 May 2009
On 14 and 15 May 2009, UNAIDS and Soul City Institute co-convened the second of a series of meeting of HIV prevention communications practitioners working on discussing comprehensive HIV prevention efforts with a particular focus on addressing multiple and concurrent partnerships in Eastern and Southern Africa.
Download the meeting presentations:
- Definitions and Measures of Multiple and Concurrent Partnerships
- HIV Prevention Response and Modes of Transmission. Analysis in Eastern & Southern Africa
- National HIV Prevention Strategies: Implementation, Progress and Challenges (Swaziland)
- Using research, monitoring and evaluation to improve our ability to address MCP at country level (Botswana)
- Learning gained from male circumcision communications (South Africa)
- Culture and social norms and HIV prevention (Malawi)
- Dr. B.U.Chirwa's prsentation: 1) SADC as a Hyper endemic area; 2) Regional Strategy, commitments; 3) 3 Ones Principles for the National response; 4) Complementarity
- Breakout session - group work 1
- Breakout seesion - gropu work 2
UNAIDS and Soul City Institute
Multiple Concurrent Partnerships Campaigns and Communications Towards a Coordinated Regional Response. Meeting Report, September 2008
In September 2008 UNAIDS and Soul City brought together communications practitioners to take stock and discuss practice and progress in the region in addressing the risk of multiple concurrent partnerships. The meeting focussed on ensuring commitment to greater sharing and coordination in communications addressing not only multiple concurrent partnerships but also broader combination prevention efforts.
UNAIDS
Strategic Considerations for Communications on Multiple and Concurrent Partnerships within broader HIV Prevention in Southern Africa. 2009
This guidance document results from interactions with civil society in the region and collaboration between UNAIDS, the Harvard AIDS Prevention Research Project and the World Bank, including an expert meeting on MCP held on 28-29 January 2009 in Gabarone, Botswana. It arose from recognition of the need for regional guidance on the principles and good practice for MCP campaigning to assist national programmes, in particular, to strengthen HIV prevention efforts for MCP reduction.
This meeting built on two previous meetings to discuss MCP in the region: one held by UNAIDS RST ESA and Soul City in Johannesburg in September 2008, bringing together MCP practitioners to share experiences and ideas; and a second held by PEPFAR in Washington in October 2008 to share programmatic experiences from the region and to deepen understanding of the contribution of MCP to the hyper-endemic epidemics in southern Africa.
UNAIDS
Multiple and Concurrent Partnerships. Strategic Considerations. April 2009 (Powerpoint presentation)
Michael Carael, Mohamed Ali, John Cleland
Nuptiality and Risk Behaviour in Lusaka and Kampala - African Journal of Reproductive Health, Vol. 5, No. 1, Aug. 2001
This analysis assesses the link between partnership status and the probability of having one or more casual or non-regular sexual relationships in the past 12 months, using data from sample surveys conducted in Kampala and Lusaka in 1989/90 under the auspices of the Global Programme on AIDS. Non-regular sexual relationship was found to be much more common among individuals in relatively informal primary partnerships than among married individuals, and also more common among those with multiple primary partners.
James D Shelton, Daniel T Halperin, David Wilson
Has global HIV incidence peaked? (Comment published in Lancet online, March 30 2006)
Article considering the decline in HIV prevalence in a number of African settings and elsewhere.
Christine L. Mattson, Robert C. Bailey, Kawango Agot, J. O. Ndinya-Achola and Stephen Moses
Nested Case-Control Study of Sexual Practices and Risk Factors for Prevalent HIV-1 Infection Among Young Men in Kisumu, Kenya - Sexually Transmitted Diseases, May 2007, Vol. 34, No. 5
To evaluate risk factors for prevalent HIV-1 infection, reserachers analyzed crosssectional data from a nested sample of 1337 uncircumcised men aged 18-24 years participating in the context of a randomized controlled trial (RCT) of male circumcision (MC) to reduce HIV-1 incidence in Kisumu, Kenya.
He' Le' Ne A. C. M Voeten, Omar B. Egesah and J. Dik. F Habbema
Sexual Behavior Is More Risky in Rural Than in Urban Areas Among Young Women in Nyanza Province, Kenya
The goal of this study was to measure sexual risk behavior among young adults in Nyanza province in Kenya and to compare rural and urban areas. The study found that for women, sexual behavior was more risky in rural than in urban areas, also after adjusting for sociodemographic differences. Rural women reported less frequently being a virgin at marriage, a higher number of lifetime partners, and less consistent condom use with nonspousal partners. For men, sexual risk behavior was equally high in urban and rural areas.
The present report explores both quantitative and qualitative data related to the 20-30 year age group with a focus on concurrent sexual relationships amongst heterosexual respondents. Much HIV prevention focus has emphasised risk amongst youth, with youth variously defined in terms of age range, including teenagers and post-teenage groups, but predominantly focusing on young people under 20. This focus on younger 'youth' has resulted in lesser emphasis being placed on understanding of young adults in the 20-30 year age group, as well as other older age groups vulnerable to HIV.
CADRE
Shifting sands. Knowledge, risk and gender in South Africa (Powerpoint presentation). 2007
UNAIDS
Multiple and Concurrent Partnerships. Strategic Considerations (Powerpoint presentation)