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Nguyen N, Powers KA, Miller WC, Howard AG, Halpern CT, Hughes JP, Wang J, Twine R, Gomez-Olive X, MacPhail C, Kahn K, Pettifor AE. Sexual Partner Types and Incident HIV Infection Among Rural South African Adolescent Girls and Young Women Enrolled in HPTN 068: A Latent Class Analysis. J Acquir Immune Defic Syndr 2019; 82:24-33. [PMID: 31169772 PMCID: PMC6692200 DOI: 10.1097/qai.0000000000002096] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sexual partners are the primary source of incident HIV infection among adolescent girls and young women (AGYW) in sub-Saharan Africa. Identifying partner types at greatest risk of HIV transmission could guide the design of tailored HIV prevention interventions. METHODS We conducted a secondary analysis of data from AGYW (aged 13-23 years) enrolled in a randomized controlled trial of cash transfers for HIV prevention in South Africa. Annually, AGYW reported behavioral and demographic characteristics of their 3 most recent sexual partners, categorized each partner using prespecified labels, and received HIV testing. We used latent class analysis (LCA) to identify partner types from reported characteristics, and generalized estimating equations to estimate the relationship between both LCA-identified and prespecified partner types and incident HIV infection. RESULTS Across 2140 AGYW visits, 1034 AGYW made 2968 partner reports and 63 AGYW acquired HIV infection. We identified 5 LCA partner types, which we named monogamous HIV-negative peer partner; one-time protected in-school peer partner; out-of-school older partner; anonymous out-of-school peer partner; and cohabiting with children in-school peer partner. Compared to AGYW with only monogamous HIV-negative peer partners, AGYW with out-of-school older partners had 2.56 times the annual risk of HIV infection (95% confidence interval: 1.23 to 5.33), whereas AGYW with anonymous out-of-school peer partners had 1.72 times the risk (95% confidence interval: 0.82 to 3.59). Prespecified partner types were not associated with incident HIV. CONCLUSION By identifying meaningful combinations of partner characteristics and predicting the corresponding risk of HIV acquisition among AGYW, LCA-identified partner types may provide new insights for the design of tailored HIV prevention interventions.
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Affiliation(s)
- Nadia Nguyen
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Kimberly A. Powers
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Annie Green Howard
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Carolyn T. Halpern
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Maternal and Child Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - James P. Hughes
- Department of Biostatistics, University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jing Wang
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Rhian Twine
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of the Health Sciences, University of the Witwatersrand, South Africa
| | - Xavier Gomez-Olive
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of the Health Sciences, University of the Witwatersrand, South Africa
- INDEPTH Network, Accra, Ghana
| | - Catherine MacPhail
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of the Health Sciences, University of the Witwatersrand, South Africa
- Wits Reproductive Health and HIV Research Institute, University of the Witwatersrand, South Africa
- School of Health and Society, University of Wollongong, NSW, Australia
| | - Kathleen Kahn
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of the Health Sciences, University of the Witwatersrand, South Africa
- INDEPTH Network, Accra, Ghana
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Audrey E. Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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Saw TN, Yasuoko J, Saw YM, Than TM, Win EM, Aung ZZ, Cho SM, Shibanuma A, Poudel KC, Win HH, Iriyama S, Jimba M. Factors associated with concurrent sexual partnerships among men who have sex with men in Yangon, Myanmar. NAGOYA JOURNAL OF MEDICAL SCIENCE 2019; 80:505-518. [PMID: 30587865 PMCID: PMC6295436 DOI: 10.18999/nagjms.80.4.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Men who have sex with men (MSM) are considered to be one of the groups most at risk of contracting HIV. However, to date, information regarding MSM's sexual behaviors and the risk factors for their concurrent sexual partnerships (CSP) have not been known in Myanmar. This study aimed to identify factors associated with CSP among MSM.A cross-sectional study was conducted from September to October 2011 in Yangon, Myanmar. In total, 353 males who had self-reported sex with men were recruited using respondent-driven sampling method. Descriptive statistics and multivariate logistic regression analysis were performed. In total, 61.0% of the MSM reported having CSP. MSM who practiced sex trading in the past six months (adjusted odds ratio8.32; 95% confidence interval [CI]: 2.30-30.10), MSM who had diagnosed with STIs/HIV (AOR 6.71; 95% CI: 4.78-9.28), and MSM who engaged in unprotected insertive anal sex (AOR 1.27; 95% CI: 1.02-1.45) were more likely to have CSP. In contrast, MSM who used condoms consistently during the past six months (AOR = 0.27; 95% CI: 0.08-0.94), MSM who had a regular job (AOR = 0.21; 95% CI: 0.06-0.74), and MSM who initiated sexual activities later in their lives (AOR = 0.08; 95% CI: 0.03-0.25) were less likely to have CSP. Concurrent sexual partnerships are common among MSM in Myanmar. Findings suggest that interventions should focus on MSM who diagnosed with STIs/HIV, do not have regular jobs, and initiated their sexual activities at an early age.
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Affiliation(s)
- Thu Nandar Saw
- Myanma Perfect Research, Yangon, The Republic of the Union of Myanmar.,Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Junko Yasuoko
- Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan
| | - Thet Mon Than
- Department of Medical Services, Ministry of Health and Sports, Nay Pyi Taw, The Republic of the Union of Myanmar
| | - Ei Mon Win
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, The Republic of the Union of Myanmar
| | - Zaw Zaw Aung
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, The Republic of the Union of Myanmar
| | - Su Myat Cho
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Krishna C Poudel
- Department of Public Health, School of Public Health and Health Science, University of Massachusetts Amherst, Amherst, MA, USA
| | - Hla Hla Win
- Department of Preventive and Social Medicine, the University of Medicine 1, Yangon, The Republic of the Union of Myanmar
| | - Shigemi Iriyama
- Department of Nursing, School of Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
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Concurrency and other sexual partnership patterns reported in a survey of young people in rural Northern Tanzania. PLoS One 2017; 12:e0182567. [PMID: 28837686 PMCID: PMC5570426 DOI: 10.1371/journal.pone.0182567] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/20/2017] [Indexed: 01/02/2023] Open
Abstract
African adolescents and young adults remain at substantial risk of infection with HIV and other sexually transmitted infections (STIs), and AIDS is the leading cause of death among African adolescents (10–19 years). Sexual partnership patterns influence transmission risk of sexually transmitted infections. We describe patterns reported by youth (15-30y) in a community-based survey in Tanzania. Among participants reporting multiple partners, we investigated factors associated with reported concurrency. Female (N = 6513) and male (N = 7301) participants had median ages of 21 and 22 years, respectively. Most participants (92%) reported having previously been sexually active, of whom 15% of males and <1% of females reported ≥4 partners in the past year. The point prevalence of concurrency was 2.3% (95%CI 1.9–2.9) for females and 10.6% (95%CI 9.3–12.1) for males. High levels of multiple and concurrent partnerships were reported by those previously married. Females were more likely than males to report having spousal/regular partners and longer partnership lengths. Compared to males, the partnerships reported by females were less likely to be new partnerships, and more likely to be defined by the respondent as still ‘ongoing’. Females reporting younger sexual debut were more likely to report concurrent sexual partners. Far fewer young women reported multiple and concurrent partnerships, but we cannot definitively conclude that concurrency was uncommon for women, because stigma towards women’s multiple sexual partnerships might contribute to substantial under-reporting, as was found in extensive qualitative research in the study population. This study provides one of the most comprehensive quantitative descriptions of partnership patterns of young people in an African setting. Interventions addressing sexual risk among youth should involve male partners, empower women to protect themselves within different types of partnerships, and encourage a greater openness about young people’s sexual relationships.
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Swartz A, Colvin C, Harrison A. The Cape Town boyfriend and the Joburg boyfriend: women's sexual partnerships and social networks in Khayelitsha, Cape Town. SOCIAL DYNAMICS 2016; 42:237-252. [PMID: 28366972 PMCID: PMC5371405 DOI: 10.1080/02533952.2016.1194591] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In South Africa, young people's "multiple" or "concurrent" partnerships have been increasingly prominent in public health discourses - as drivers of HIV transmission. Multiple partnerships are typically framed in moralising, negative terms and depicted primarily as male-driven, within a broader framework of women's vulnerability and use of sex for survival and material gain. Based on ethnographic fieldwork with adolescents and young adults in Khayelitsha township near Cape Town, this article investigates young women's partnerships by exploring their complex interpersonal and social dynamics. We unpack women's multiple motivations for, and careful management strategies of, both sexual and social relationships in a broader context of socioeconomic exclusion, threats to health and wellbeing, social obligations and relationships of care. The meanings and practices associated with young people's relationships are more than the sum of individual sexual behaviours, rigid cultural scripts or simply a locus of "risk." The data presented here highlight some of the limitations of "prevention" approaches that do not take into account this nuanced and multilayered view of such relationships. The affective and empathetic dimensions of young peoples' relationships, as well as the socioeconomic contexts in which they occur should also be considered. Without accounting for this context, standard "prevention" approaches are less likely to succeed.
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Affiliation(s)
- Alison Swartz
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Christopher Colvin
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Abigail Harrison
- Department of Behavioral and Social Sciences, International Health Institute, School of Public Health, Brown University, Providence, RI, USA
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Meng X, Zou H, Fan S, Zheng B, Zhang L, Dai X, Deng M, Zhang X, Lu B. Relative Risk for HIV Infection Among Men Who Have Sex with Men Engaging in Different Roles in Anal Sex: A Systematic Review and Meta-analysis on Global Data. AIDS Behav 2015; 19:882-9. [PMID: 25319954 DOI: 10.1007/s10461-014-0921-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We systematically reviewed and meta-analyzed global data on the relative risk for HIV infection among men who have sex with men (MSM) engaging in different roles in anal sex. MSM engaging in receptive anal sex only (MRAI) and MSM engaging in both insertive and receptive anal sex (MIRAI) were 6.9 (95 % CI 5.5-8.6) and 4.3 (95 % CI 3.6-5.3) times more likely to have prevalent HIV compared to MSM engaging in insertive anal sex only (MIAI) in 1981-1985. These figures were 1.8 (95 % CI 1.6-2.0) and 2.2 (95 % CI 2.0-2.4) in 1986-2010. Overall, MRAI and MIRAI were 6.2 (95 % CI 3.3-11.8) and 6.6 (95 % CI 3.8-11.7) times more likely to develop incident HIV infection compared to MIAI. MRAI are at higher risk for HIV infection compared to MIAI. HIV prevalence among men engaging in all roles in anal sex is high enough that all MSM should be aware of potential risk.
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Affiliation(s)
- Xiaojun Meng
- Wuxi Center for Disease Control and Prevention, Wuxi, Jiangsu, People's Republic of China
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Concurrent partnerships in Cape Town, South Africa: race and sex differences in prevalence and duration of overlap. J Int AIDS Soc 2015; 18:19372. [PMID: 25697328 PMCID: PMC4334769 DOI: 10.7448/ias.18.1.19372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 11/19/2014] [Accepted: 01/13/2015] [Indexed: 01/02/2023] Open
Abstract
Introduction Concurrent partnerships (CPs) have been suggested as a risk factor for transmitting HIV, but their impact on the epidemic depends upon how prevalent they are in populations, the average number of CPs an individual has and the length of time they overlap. However, estimates of prevalence of CPs in Southern Africa vary widely, and the duration of overlap in these relationships is poorly documented. We aim to characterize concurrency in a more accurate and complete manner, using data from three disadvantaged communities of Cape Town, South Africa. Methods We conducted a sexual behaviour survey (n=878) from June 2011 to February 2012 in Cape Town, using Audio Computer-Assisted Self-Interviewing to collect sexual relationship histories on partners in the past year. Using the beginning and end dates for the partnerships, we calculated the point prevalence, the cumulative prevalence and the incidence rate of CPs, as well as the duration of overlap for relationships begun in the previous year. Linear and binomial regression models were used to quantify race (black vs. coloured) and sex differences in the duration of overlap and relative risk of having CPs in the past year. Results The overall point prevalence of CPs six months before the survey was 8.4%: 13.4% for black men, 1.9% for coloured men, 7.8% black women and 5.6% for coloured women. The median duration of overlap in CPs was 7.5 weeks. Women had less risk of CPs in the previous year than men (RR 0.43; 95% CI: 0.32–0.57) and black participants were more at risk than coloured participants (RR 1.86; 95% CI: 1.17–2.97). Conclusions Our results indicate that in this population the prevalence of CPs is relatively high and is characterized by overlaps of long duration, implying there may be opportunities for HIV to be transmitted to concurrent partners.
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Kenyon C, Buyze J, Colebunders R. Classification of incidence and prevalence of certain sexually transmitted infections by world regions. Int J Infect Dis 2013; 18:73-80. [PMID: 24211229 DOI: 10.1016/j.ijid.2013.09.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/11/2013] [Accepted: 09/15/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES This study sought to assess if there is a meaningful way in which variations in sexually transmitted infection (STI) prevalence can be classified at the level of world regions. METHODS Linear regression was performed to assess if the incidence and prevalence of six STIs (HIV, herpes simplex virus type 2, chlamydia, gonorrhea, syphilis, and trichomoniasis) by world region was positively correlated. Partitioning around medoids (PAM) was then used to assess if the regions of the world can be classified according to the incidence and prevalence of these STIs. RESULTS We found evidence that STI incidence/prevalence varies considerably in different regions around the world. Linear regression revealed that the incidence and prevalence of certain STIs by world region was positively correlated (Pearson's correlation coefficient varied from 0.664 to 0.985). PAM provided support for dividing the world regions into two, three, or four STI incidence/prevalence categories, but it provided most support for the two-category system. In each of these systems the East Asia/Pacific and North Africa/Middle East regions were in the lowest STI category and Sub-Saharan Africa was the only region in the high STI category. CONCLUSIONS The incidence and prevalence of certain STIs by world region are positively correlated. The world regions can be meaningfully classified according to STI incidence/prevalence.
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Affiliation(s)
- C Kenyon
- Clinical HIV/STD Unit, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium; Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, Observatory, South Africa.
| | - J Buyze
- Clinical HIV/STD Unit, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - R Colebunders
- Clinical HIV/STD Unit, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
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The implications of respondent concurrency on sex partner risk in a national, web-based study of men who have sex with men in the United States. J Acquir Immune Defic Syndr 2013; 63:514-21. [PMID: 23591633 DOI: 10.1097/qai.0b013e318294bcce] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) represent the largest HIV risk group in the United States. Sexual concurrency catalyzes HIV transmission in populations by increasing the indirect exposure of one's sex partners to one another. Although individual-level (egocentric) designs have demonstrated a high prevalence of concurrency among MSM respondents, methods are lacking for understanding the exposure implications for partners (dyads) reported in such studies. METHODS A new technique for manipulating egocentrically collected partnership timing data to measure the degree to which respondents' patterns of concurrency and serial monogamy resulted in the indirect exposure of respondents' partners to other partners was developed. Two outcomes were constructed for each partner: any concurrent or serially monogamous exposure to another partner (any exposure) and any concurrent exposure to another partner, irrespective of serial monogamy (any concurrent exposure). Reports of unprotected anal intercourse (UAI) were incorporated to construct the outcomes of 'any UAI exposure' and 'any concurrent UAI exposure.' This method was applied to an online study of MSM aged ≥18 years, with comparisons made by partner's race-ethnicity, age, type, and meeting location. RESULTS Among 4060 repeat partners of 2449 MSM, 73% had any exposure in the previous 6 months; 58% had any concurrent exposure. Among UAI partners, 37% had concurrent UAI exposure. Black UAI partners were more likely than whites to have any concurrent UAI exposure [unadjusted odds ratio (95% confidence interval) = 1.34 (1.05 to 1.70)], as were casual UAI partners relative to main partners [unadjusted odds ratio (95% confidence interval) = 4.37 (3.58 to 5.35)]. In adjusted models, black UAI partners were significantly more likely to have any UAI exposure, but not concurrent UAI exposure. Casual UAI partners remained more exposed by both outcomes. CONCLUSIONS Sex partners of MSM, particularly casual and black non-Hispanic partners, face a high degree of exposure to other partners.
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The contribution of emotional partners to sexual risk taking and violence among female sex workers in Mombasa, Kenya: a cohort study. PLoS One 2013; 8:e68855. [PMID: 23950879 PMCID: PMC3737234 DOI: 10.1371/journal.pone.0068855] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 06/06/2013] [Indexed: 11/19/2022] Open
Abstract
Objectives To assess sexual risk-taking of female sex workers (FSWs) with emotional partners (boyfriends and husbands), compared to regular and casual clients. Experiences of violence and the degree of relationship control that FSWs have with emotional partners are also described. Design Cohort study with quarterly follow-up visit over 12-months. Methods Four hundred HIV-uninfected FSWs older than 16 years were recruited from their homes and guesthouses in Mombasa, Kenya. A structured questionnaire assessed participant characteristics and study outcomes at each visit, and women received risk-reduction counselling, male and female condoms, and HIV testing. Results Four or more unprotected sex acts in the past week were reported by 21.3% of women during sex with emotional partners, compared to 5.8% with regular and 4.8% with casual clients (P<0.001). Total number of unprotected sex acts per week was 5–6-fold higher with emotional partners (603 acts with 259 partners) than with regular or casual clients (125 acts with 456, and 98 acts with 632 clients, respectively; P<0.001). Mostly, perceptions of “trust” underscored unprotected sex with emotional partners. Low control over these relationships, common to many women (36.9%), was linked with higher partner numbers, inconsistent condom use, and being physically forced to have sex by their emotional partners. Half experienced sexual or physical violence in the past year, similarly associated with partner numbers and inconsistent condom use. Conclusions High-risk sexual behaviour, low control and frequent violence in relationships with emotional partners heighten FSWs' vulnerability and high HIV risk, requiring targeted interventions that also encompass emotional partners.
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Kenyon C, Buyze J, Colebunders R. HIV prevalence by race co-varies closely with concurrency and number of sex partners in South Africa. PLoS One 2013; 8:e64080. [PMID: 23704973 PMCID: PMC3660381 DOI: 10.1371/journal.pone.0064080] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 04/08/2013] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND HIV prevalence differs by more than an order of magnitude between South Africa's racial groups. Comparing the sexual behaviors and other risk factors for HIV transmission between the different races may shed light on the determinants of South Africa's generalized HIV epidemic. METHODS Five nationally representative and one city-representative population-based surveys of sexual behavior were used to assess the extent to which various risk factors co-varied with HIV prevalence by race in South Africa. RESULTS In 2004, the prevalence of HIV was 0.5%, 1%, 3.2% and 19.9% in 15-49 year old whites, Indians, coloureds and blacks respectively. The risk factors which co-varied with HIV prevalence by race in the six surveys were age of sexual debut (in five out of five surveys for men and three out of six surveys for women), age gap (zero surveys in men and three in women), mean number of sex partners in the previous year (five surveys in men and three in women) and concurrent partnerships (five surveys in men and one in women). Condom usage and circumcision were both more prevalent in the high HIV prevalence groups. The reported prevalence of concurrency was 6 to 17 times higher in the black as opposed to the white men in the five surveys. CONCLUSIONS The differences in sexual behavior in general, and the prevalence of concurrency and the number of sexual partners in particular, offer a plausible and parsimonious cause to explain a part of the differing prevalences of HIV between South Africa's racial groups.
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Affiliation(s)
- Chris Kenyon
- HIV/STD Unit, Institute of Tropical Medicine, Antwerp, Belgium.
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Coital frequency and condom use in monogamous and concurrent sexual relationships in Cape Town, South Africa. J Int AIDS Soc 2013; 16:18034. [PMID: 23618365 PMCID: PMC3636421 DOI: 10.7448/ias.16.1.18034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 02/01/2013] [Accepted: 02/27/2013] [Indexed: 01/11/2023] Open
Abstract
Introduction A decreased frequency of unprotected sex during episodes of concurrent relationships may dramatically reduce the role of concurrency in accelerating the spread of HIV. Such a decrease could be the result of coital dilution – the reduction in per-partner coital frequency from additional partners – and/or increased condom use during concurrency. To study the effect of concurrency on the frequency of unprotected sex, we examined sexual behaviour data from three communities with high HIV prevalence around Cape Town, South Africa. Methods We conducted a cross-sectional survey from June 2011 to February 2012 using audio computer-assisted self-interviewing to reconstruct one-year sexual histories, with a focus on coital frequency and condom use. Participants were randomly sampled from a previous TB and HIV prevalence survey. Mixed effects logistic and Poisson regression models were fitted to data from 527 sexually active adults reporting on 1210 relationship episodes to evaluate the effect of concurrency status on consistent condom use and coital frequency. Results The median of the per-partner weekly average coital frequency was 2 (IQR: 1–3), and consistent condom use was reported for 36% of the relationship episodes. Neither per-partner coital frequency nor consistent condom use changed significantly during episodes of concurrency (aIRR=1.05; 95% confidence interval (CI): 0.99–1.24 and aOR=1.01; 95% CI: 0.38–2.68, respectively). Being male, coloured, having a tertiary education, and having a relationship between 2 weeks and 9 months were associated with higher coital frequencies. Being coloured, and having a relationship lasting for more than 9 months, was associated with inconsistent condom use. Conclusions We found no evidence for coital dilution or for increased condom use during concurrent relationship episodes in three communities around Cape Town with high HIV prevalence. Given the low levels of self-reported consistent condom use, our findings suggest that if the frequency of unprotected sex with each of the sexual partners is sustained during concurrent relationships, HIV-positive individuals with concurrent partners may disproportionately contribute to onward HIV transmission.
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