Ebook Concurrent Sexual Partnerships and HIV Infection: Evidence from National Population-Based Surveys
Knowing the prevalence and correlates of multiple and concurrent sexual partnerships is important for understanding the dynamics of HIV transmission, and thus for developing effective prevention interventions. Although at least a few theoretical models of multiple and concurrent partnerships have been developed, there is little agreement about how to derive empirical measures and how to assess the relationship of multiple and concurrent sexual partnerships with HIV infection.
This study takes advantage of self-reported data on sexual partnerships and biomarker data on HIV serostatus that have been collected in recent years from adult women and men (age 15-49) by nationally representative Demographic and Health Surveys (DHS) and AIDS Indicator Surveys (AIS). Using information on up to three of the respondents’ most recent sexual partners, we evaluate and compare the prevalence of concurrent sexual partnerships across countries defining concurrent partnerships as having two or more sexual partners that overlapped in time in the year preceding the survey. We also examine key characteristics of respondents reporting concurrent partnerships in pooled samples for sub-Saharan Africa, and we evaluate the association between concurrency and HIV serostatus at the individual level, after controlling for educational level, wealth status, condom use, male circumcision, and other factors. Finally, we assess the relationship between prevalence of concurrency and HIV prevalence at the community and country levels.
We find that men are much more likely than women to have concurrent partners. Our analysis also shows that many reported multiple partnerships in the 12 months preceding the survey interview were not concurrent ones. Finally, very few men had overlapping partners for one year or longer.
In the pooled samples for sub-Saharan Africa, we find that urban, more-educated, and wealthier women and men are more likely to have concurrent partnerships than their rural, less-educated, and poorer counterparts. Circumcised men are also more likely to have concurrent partners than uncircumcised men. Those who had concurrent partners are more likely to report using condoms than those who did not have concurrent partners; yet only one-fifth of women and less than one-tenth of men with concurrent partners reported using condoms at last sex.
In most countries, at the individual level women and men who had concurrent sexual partners in the previous 12 months were more likely to be HIV-positive than those who had only one lifetime partner, or those who had multiple lifetime partners but no overlapping partners in the previous 12 months. Yet the duration of overlap in concurrent sexual relationships does not seem correlated with the likelihood of HIV infection. At the individual level, in the pooled samples for sub-Saharan Africa, a positive and significant relationship between concurrent sexual partnerships and HIV-positive status is observed for both women (aOR=3.32; 95%CI: 2.22-4.97) and men (aOR=2.87; 95%CI: 1.85-4.45), after adjusting for other factors such as educational level, wealth status, urban/rural residence, and condom use. Among men, controlling for male circumcision has virtually no effect on the adjusted association between sexual concurrency and HIV serostatus (aOR=2.85; 95%CI: 1.84-4.42).
CONTENTS
TABLES
FIGURES
APPENDIX TABLES
SUMMARY
1. INTRODUCTION
- Study Aims
Background
2. DATA
3. METHODS
- Measurement of Concurrent Sexual Partnerships
Analytical Approach
Study Limitations
4. PREVALENCE OF MULTIPLE SEXUAL PARTNERSHIPS
- Multiple Marriages and Polygamy
Multiple Sexual Partnerships
5. PREVALENCE AND CORRELATES OF CONCURRENT SEXUAL PARTNERSHIPS
- Prevalence of Sexual Concurrency
Prevalence of Sexual Concurrency by Duration of Overlap
Correlates of Sexual Concurrency
Condom Use with Concurrent Sexual Partners
6. THE ASSOCIATION BETWEEN SEXUAL CONCURRENCY AND HIV
- The Association between Sexual Concurrency and HIV Serostatus at the Individual Level
The Association between Sexual Concurrency and HIV Serostatus at the Individual Level in the Pooled Sub-Saharan Africa Sample
The Association between the Duration of Overlapping Sexual Partnerships and HIV Serostatus at the Individual Level
The Association between the Prevalence of Sexual Concurrency and HIV Prevalence at the Community Level
The Association between the Prevalence of Sexual Concurrency and HIV Prevalence at the Country Level
7. CONCLUSIONS
REFERENCES
APPENDIX TABLES
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