Download Multiple and Concurrent Partnerships: Driving Southern Africa`s HIV

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A Useful Resource In Advocacy
Multiple and Concurrent
Partnerships: Driving
Southern Africa’s HIV
Epidemic
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HIV in Southern Africa
Some important facts to note:
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Southern Africa remains the region most affected by HIV in
the world; approximately 40% of all people living with HIV live
in the SADC region. Eleven percent (11%) of the adult
population in southern Africa is HIV positive.
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Infection rates among adults in Botswana, South Africa and
Swaziland, range from 20% to at least 30%.
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The region has a generalised epidemic, meaning that
transmission is sustained by sexual behavior in the general
population.
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What is driving Southern Africa‘s HIV epidemic?
A Southern African Development Community (SADC) “Think Tank” on HIV prevention
convened in 2006 and identified the following as ‘drivers’ of the HIV epidemic:
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High levels of multiple and concurrent sexual partnerships by
men and women
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Insufficient consistent and correct condom use
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Low levels of male circumcision
Other important drivers of the HIV epidemic are:
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Male attitudes to sex and male sexual behaviour
Intergenerational sex (age-disparate sex)
Gender and sexual violence
Stigma and lack of openness
Untreated Sexually Transmitted Infections (STIs)
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What are multiple concurrent partnerships?
Multiple concurrent partnerships can broadly be described as relationships where
an individual has two or more sexual relationships that overlap in time.
Multiple Concurrent Partnerships (MCP) refer to relationships between men and
women who have more than one sexual relationship at the same time. These
relationships can be long or short term. They vary in nature and meaning, ranging
from a one night stand with a sex worker or even a stranger, to long term relationships.
Reasons for engaging in MCP vary. Some people have multiple sexual partners for
pleasure, while others do it to increase their social status or achieve material gain.
Some have multiple partners for psychological or emotional reasons. Others engage
in this practice because they see it as their cultural or social right to have more than
one sexual partner.
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What are the forms of multiple and concurrent
sexual partnerships?
Multiple and concurrent sexual partnerships take different forms, some of which are:
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Steady partner and other ‘side’ partners (small houses)
Intergenerational sexual relationships
Transactional sexual relationships
Polygamy
What is the connection between MCP and HIV?
The practice is widespread throughout the region and it has been cited as one
of the reasons why HIV prevalence rates are highest in southern Africa, than in
any other region in the world. The Southern African Development Community
(SADC) officially recognises that the practice of MCP is a key contributor to the
spread of HIV in southern Africa.
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When people engage in unprotected sex with many different partners, they
increase their chances of becoming infected with HIV. Unprotected sex is always
a risk, so the more you do it, the greater the risk. Furthermore, each one of those
partners may have their own network of partners with whom they are having
unprotected sex. All it takes is for HIV to enter the network through one individual,
for everybody to be at risk of infection.
When somebody is first infected with HIV, their viral load is very high, making
it very easy to transmit the virus to their partners. Studies have shown that during
the first three weeks of being infected with HIV, a person is highly infectious,
and this increases the chances of passing on the virus to sexual partners through
unprotected sex during this period. In multiple concurrent partnerships, this may
mean that many people become newly infected and spread HIV within the
networks, in a short period of time.
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When somebody is first infected with HIV, their
viral load is very high, making it very easy to
transmit the virus to their partners.
Studies have shown that during the first three
weeks of being infected with HIV, a person is
highly infectious, and this increases the chances
of passing on the virus to sexual partners through
unprotected sex during this period.
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What are the common factors driving Multiple and
Concurrent Partnerships?
There are several common factors that promote multiple and concurrent
partnerships in the sub-region. Some of which are:
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Negative cultural and social norms, including polygamy and
gender inequality which create serious power imbalances and
fuel MCP. Negative social norms have made it ‘normal’ for men
to have more than one sexual partner, while at the same time
condemning women who engage in MCP.
Lack of communication between partners in sexual relationships,
especially among “steady” or long term relationships.
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Why should countries in Southern Africa focus
on MCP?
The role of concurrent sexual partnerships is increasingly recognised as
important for the transmission of sexually transmitted infections, particularly
of heterosexual HIV transmission in southern Africa. Evidence suggests
that concurrent partnerships compared to serial partnerships:
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Can increase the size of an HIV epidemic
Can increase the speed at which it infects a population
Can increase the HIV epidemic’s persistence within a population
Identifying and understanding sub-groups of people
who are more vulnerable to, and more likely to, transmit
HIV is essential for improving the effectiveness of HIV
prevention efforts.
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Policy makers need to:
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Demonstrate role-model leadership and protect themselves from HIV.
Mobilise governments and its stakeholders to invest in in-depth of
analysis of the national HIV epidemic in order to appropriately target
interventions. Without an in-depth analysis of the epidemic, countries
cannot have adequate understanding of the epidemic – who is affected,
by how much, why and where are they. Without an accurate
characterisation of local epidemics countries cannot target interventions
and resources effectively.
Allocate more resources towards programmes that deliberately
engage men, both young and old, on issues of multiple concurrent
sexual partnerships.
Invest in intensive programmes targeted at raising awareness of the
HIV risks of multiple concurrent partnerships.
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Increase access to women controlled prevention methods that will
put the power of safe sex in women’s hands.
Examine the inter-linkages between gender, HIV and culture in order
to create a supportive environment for HIV prevention at both country
and regional levels.
Address negative cultural norms and beliefs and encourage positive
cultural practices, recognising both the key role they may play in
supporting prevention efforts and the potential they have to fuel HIV
transmission.
Promote gender equality and address gender norms and relations to
reduce the vulnerability of women and girls, and involving men and
boys in this effort.
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.
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Strong leadership for
prevention will ensure
better coordination,
accountability and sound
technical direction for
prevention.
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What is the OneLove Campaign?
The campaign aims to shift social norms and reinforces positive behaviours without
blaming those who are behaving in risky ways. It role models safer sexual behaviour
and challenges women and men to change their behaviour to live a safer and
happier life. It is responding to mounting evidence of MCP being a key driver of
the HIV Epidemic in southern Africa.
OneLove is the largest multi-country campaign in Southern Africa to address MCP.
For more information visit www.onelovesouthernafrica.org
OneLove is for all of us!
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Further Reading
1.
UNAIDS, 2008, Report on the global HIV/AIDS epidemic 2008
2.
The Lancet, 2008, Putting prevention at the forefront of HIV/AIDS
3.
UNAIDS Regional Support Team for Eastern and Southern Africa and the Soul City Institute Meeting Report:
Multiple Concurrent Partnerships Campaigns and Communications, Towards a Coordinated Regional
Response, 17-18 September 2008, www.unaidsrstesa.org/thema
4.
5.
UNAIDS, 2007, Practical Guidelines for Intensifying HIV Prevention
Soul City Institute, 2008 Multiple and Concurrent Sexual Partnerships in Southern Africa, A Ten Country
Research
6.
Timothy L. Mah & Daniel. T Halperin ,2008, Concurrent Sexual Partnerships and the HIV Epidemics in
Africa: Evidence to Move Forward
7.
Cadre, 2007, Concurrent Sexual Partnerships Amongst Young Adults in South Africa Challenges for HIV
prevention communication
8.
Daniel Halperin and Helen Epstein, 2007, Why is HIV Prevalence so Severe in Southern Africa: The Role
of Multiple Concurrent Partnerships and Lack of Male Circumcision-Implications for AIDS Prevention
9.
Dr.Datius Rweyemamu, 2008, Feminahip, Multiple and Concurrent Sexual Partnerships among Youths
in Tanzania
10.
Medical Research Council, South Africa, Policy Brief, April 2008, Sexual Risk Behaviour Among Men with
Multiple, Concurrent Female Sexual Partners in An Informal Settlement On the outskirts of Cape Town.
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Produced by the SAfAIDS Policy Desk
For more information contact SAfAIDS Regional Policy Desk:
479 Sappers Contour, Lynnwood, Pretoria 0081, South Africa.
Tel: +27-12-361-0889 Fax: +27-12-361-0899
E-mail: [email protected], Website: www.safaids.net
ISBN: 978-0-7974-3973-3
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