Is polygamy really benign?

'Good culture, bad culture': polygyny, cultural change and structural drivers of HIV in Papua New Guinea

Culture is often problematised as a key structural driver of HIV transmission in Papua New Guinea. Official HIV programmes, as well as church teachings, tend to focus on customary marital practices of polygyny and bride price payments as 'harmful traditions'. This focus can oversimplify the effects of current and historical nuances of cultural, political and economic change on sexual concurrency and gender inequality. Community-based healthcare workers in Southern Highlands Province explain that customary marital practices are now highly reconfigured from their traditional forms. A recent mining boom has financially advantaged local and travelling men, who are driving an increase of sexual concurrency, transactional sex and inflation of bride price payments. Healthcare workers suggest that the erosion of important social relationships and kinship obligations by the expanding cash economy has caused an intensification of individual male power while enhancing the vulnerability of women. Yet without the means to challenge the effects of uneven economic development, healthcare workers are left to target 'culture' as the central influence on individual behaviours. A commitment to address structural inequality by political leadership and in HIV prevention programmes and a careful contextualisation of cultural change is needed.

Trends in concurrency, polygyny, and multiple sex partnerships during a decade of declining HIV prevalence in eastern Zimbabwe

Background. Observed declines in the prevalence of human immunodeficiency virus (HIV) infection in Zimbabwe have been attributed to population-level reductions in sexual partnership numbers. However, it remains unknown whether certain types of sex partnerships were more important to this decline. Particular debate surrounds the epidemiologic importance of polygyny (the practice of having multiple wives).

Methods. We analyze changes in reported multiple partnerships, nonmarital concurrency, and polygyny in eastern Zimbabwe during a period of declining HIV prevalence, from 1998 to 2011. Trends are reported for adult men (age, 17–54 years) and women (age, 15–49 years) from 5 survey rounds of the Manicaland HIV/STD Prevention Project, a general-population open cohort study.

Results. At baseline, 34.2% of men reported multiple partnerships, 11.9% reported nonmarital concurrency, and 4.6% reported polygyny. Among women, 4.6% and 1.8% reported multiple partnerships and concurrency, respectively. All 3 partnership indicators declined by similar relative amounts (around 60%–70%) over the period. Polygyny accounted for around 25% of male concurrency. Compared with monogamously married men, polygynous men reported higher levels of subsequent divorce/separation (adjusted relative risk [RR], 2.92; 95% confidence interval [CI], 1.87–4.55) and casual sex partnerships (adjusted RR, 1.63; 95% CI, 1.41–1.88).

Conclusions. No indicator clearly dominated declines in partnerships. Polygyny was surprisingly unstable and, in this population, should not be considered a safe form of concurrency.

Marital concurrency and HIV risk in 16 African countries

Research has identified sexual concurrency as a potential underlying driver of high HIV infection levels in sub-Saharan Africa, though few studies have explicitly examined the contribution of marital concurrency. Utilizing a multi-level model of Demographic and Health Surveys with HIV-biomarkers for sixteen African countries, this study assessed the relationship between an individual's HIV serostatus and rates of formal and informal marital concurrency (% polygamous unions, % extramarital partner past year) among married men and women. Mutually exclusive regional-level variables were constructed and modeled to test the contextual risk posed by living in a region with higher levels of formal and informal marital concurrency controlling for individual sexual partnerships and other covariates. Compared with regions where monogamous unions were more prevalent, the odds of having HIV were higher among individuals living in regions with more informal marital concurrency, but lower in regions with more polygamy, even accounting for individual-level sexual behavior. These results can help inform prevention policy and practice in sub-Saharan Africa.

The changing cultural and economic dynamics of polygyny and concurrent sexual partnerships in Iringa, Tanzania

Polygyny has been identified both as a 'benign' form of concurrency and as the cultural basis of concurrent partnerships that are considered important drivers of the HIV epidemic in sub-Saharan Africa. This paper investigates the changing cultural and economic dynamics of polygyny in concurrency in Iringa, Tanzania, a region with traditions of polygyny and high prevalence of HIV. Our analysis of focus group discussions, in-depth interviews and key informant interviews indicate that contemporary concurrent partnerships differ from regional traditions of polygyny. Whereas in the past, polygyny reflected men's and their kin group's wealth and garnered additional prestige, polygyny today is increasingly seen as a threat to health, and as leading to poverty. Nevertheless, participants evoked the social prestige of polygyny to explain men's present-day concurrency, even outside the bounds of marriage, and despite continued social prohibitions against extramarital affairs. Difficult economic conditions, combined with this prestige, made it easier for men to engage in concurrency without the considerable obligations to wives and children in polygyny. Local economic conditions also compelled women to seek concurrent partners to meet basic needs and to access consumer goods, but risked greater moral judgement than men, especially if deemed to have excessive 'desire' for money.

Gendered HIV risk patterns among polygynous sero-discordant couples in Uganda

Stable serodiscordant relationships and sexual concurrency are pathways that contribute to the HIV epidemic in sub-Saharan Africa. However whether polygyny imparts the same risks as informal concurrent relationships remains an open research question. Using data collected at enrollment from a cohort study of sero-discordant couples, this analysis investigates how polygynous relationships differ from those involving only a single female spouse and whether men involved in polygynous partnerships are more likely to report HIV-risk behaviour than those in single spouse partnerships. Of 444 enrolled couples, 111 (25%) were polygynous and 333 (75%) were single-spouse partnerships. We found that polygynous men were more likely to report controlling sexual decision-making and to report any unprotected sex with unknown sero-status partner. After controlling for potential confounders, polygynous men were still more likely to report unprotected sex with an unknown sero-status partner. In this sample of sero-discordant couples we found indication of excess HIV-risk behaviour among men involved in polygynous relationships.