Top

Published in:

01-02-2010 | Original Paper

Prevalence and Correlates of Concurrent Sexual Partnerships in Zambia

Authors: Ingvild F. Sandøy, Kumbutso Dzekedzeke, Knut Fylkesnes

Published in: AIDS and Behavior | Issue 1/2010

Abstract

Concurrent partnerships may cause more rapid spread of HIV in a population. We examined how the prevalence of parallel relationships changed among men and women aged 15–49 in Zambia from 1998 to 2003 using data collected during the Sexual Behavior Surveys 1998, 2000, and 2003. Predictors of concurrent partnerships among men were studied by univariate and multivariate regression analyses. Thirteen percent of rural and 8% of urban men reported more than one ongoing relationship in 1998, and these proportions declined to 8% and 6%, respectively in 2003. The proportion of women reporting concurrent relationships was 0–2%. The most important predictors of concurrency were early sexual debut, being married, early marriage and absence from home. The reduction in concurrent sexual partnerships is consistent with reductions in other sexual risk behaviors found in other studies and may have contributed to the recently observed decline in HIV prevalence in Zambia.

Adimora, A. A., Schoenbach, V. J., Bonas, D. M., Martinson, F. E., Donaldson, K. H., & Stancil, T. R. (2002). Concurrent sexual partnerships among women in the United States. Epidemiology (Cambridge, Mass.), 13, 320–327. doi:10.1097/00001648-200205000-00013.

Adimora, A. A., Schoenbach, V. J., Martinson, F., Donaldson, K. H., Stancil, T. R., & Fullilove, R. E. (2004). Concurrent sexual partnerships among African Americans in the rural south. Annals of Epidemiology, 14, 155–160. doi:10.1016/S1047-2797(03)00129-7.CrossRefPubMed

Agha, S. (2002). Declines in casual sex in Lusaka, Zambia: 1996–1999. AIDS (London, England), 16, 291–293. doi:10.1097/00002030-200201250-00021.

Anderson, R. R. M., May, R. R. M., Boily, M. M. C., Garnett, G. G. P., & Rowley, J. J. T. (1991). The spread of HIV-1 in Africa: Sexual contact patterns and the predicted demographic impact of AIDS. Nature, 352, 581–589. doi:10.1038/352581a0.CrossRefPubMed

Boerma, J. T., Urassa, M., Nnko, S., Ng’weshemi, J., Isingo, R., Zaba, B., et al. (2002). Sociodemographic context of the AIDS epidemic in a rural area in Tanzania with a focus on people’s mobility and marriage. Sexually Transmitted Infections, 78(Suppl 1), i97–i105.CrossRefPubMed

Buve, A., Lagarde, E., Carael, M., Rutenberg, N., Ferry, B., Glynn, J. R., et al. (2001). Interpreting sexual behaviour data: Validity issues in the multicentre study on factors determining the differential spread of HIV in four African cities. AIDS (London, England), 15(Suppl 4), S117–S126. doi:10.1097/00002030-200108004-00013.

Carter, M. W., Kraft, J. M., Koppenhaver, T., Galavotti, C., Roels, T. H., Kilmarx, P. H., et al. (2007). “A bull cannot be contained in a single kraal”: Concurrent sexual partnerships in Botswana. AIDS and Behavior, 11, 822–830. doi:10.1007/s10461-006-9203-6.CrossRefPubMed

Central Statistical Office (2008). HIV prevalence declines [Electronic Version]. The Monthly, 62, 16–17. Retrieved 05.08.2008.

Coffee, M., Lurie, M. N., & Garnett, G. P. (2007). Modelling the impact of migration on the HIV epidemic in South Africa. AIDS (London, England), 21, 343–350. doi:10.1097/QAD.0b013e328011dac9.

Coffee, M. P., Garnett, G. P., Mlilo, M., Voeten, H. A., Chandiwana, S., & Gregson, S. (2005). Patterns of movement and risk of HIV infection in rural Zimbabwe. The Journal of Infectious Diseases, 191(Suppl 1), S159–S167. doi:10.1086/425270.CrossRefPubMed

Drumright, L. N., Gorbach, P. M., & Holmes, K. K. (2004). Do people really know their sex partners? Concurrency, knowledge of partner behavior, and sexually transmitted infections within partnerships. Sexually Transmitted Diseases, 31, 437–442. doi:10.1097/01.OLQ.0000129949.30114.37.CrossRefPubMed

Fylkesnes, K., Musonda, R. M., Kasumba, K., Ndhlovu, Z., Mluanda, F., Kaetano, L., et al. (1997). The HIV epidemic in Zambia: Socio-demographic prevalence patterns and indications of trends among childbearing women. AIDS (London, England), 11, 339–345. doi:10.1097/00002030-199703110-00012.

Fylkesnes, K., Musonda, R. M., Sichone, M., Ndhlovu, Z., Tembo, F., & Monze, M. (2001). Declining HIV prevalence and risk behaviours in Zambia: Evidence from surveillance and population-based surveys. AIDS (London, England), 15, 907–916. doi:10.1097/00002030-200105040-00011.

Glynn, J. R., Carael, M., Auvert, B., Kahindo, M., Chege, J., Musonda, R., et al. (2001). Why do young women have a much higher prevalence of HIV than young men? A study in Kisumu, Kenya and Ndola, Zambia. AIDS (London, England), 15(Suppl 4), S51–S60. doi:10.1097/00002030-200108004-00006.

Gorbach, P. M., Drumright, L. N., & Holmes, K. K. (2005). Discord, discordance, and concurrency: Comparing individual and partnership-level analyses of new partnerships of young adults at risk of sexually transmitted infections. Sexually Transmitted Diseases, 32, 7–12. doi:10.1097/01.olq.0000148302.81575.fc.CrossRefPubMed

Gregson, S., Nyamukapa, C. A., Garnett, G. P., Mason, P. R., Zhuwau, T., Carael, M., et al. (2002). Sexual mixing patterns and sex-differentials in teenage exposure to HIV infection in rural Zimbabwe. Lancet, 359, 1896–1903. doi:10.1016/S0140-6736(02)08780-9.CrossRefPubMed

Hargreaves, J. R., Bonell, C. P., Boler, T., Boccia, D., Birdthistle, I., Fletcher, A., et al. (2008). Systematic review exploring time trends in the association between educational attainment and risk of HIV infection in sub-Saharan Africa. AIDS (London, England), 22, 403–414.

Hargreaves, J. R., & Glynn, J. R. (2002). Educational attainment and HIV-1 infection in developing countries: A systematic review. Tropical Medicine and International Health, 7, 489–498. doi:10.1046/j.1365-3156.2002.00889.x.CrossRefPubMed

Hattori, M. K., & Dodoo, F. N. A. (2007). Cohabitation, marriage, and ‘sexual monogamy’ in Nairobi’s slums. Social Science and Medicine, 64, 1067–1078. doi:10.1016/j.socscimed.2006.10.005.CrossRefPubMed

Jochelson, K., Mothibeli, M., & Leger, J. (1991). Human immunodeficiency virus and migrant labor in South Africa. International Journal of Health Services, 21, 157–173. doi:10.2190/11UE-L88J-46HN-HR0K.PubMed

Kelly, J. (1995). Changing HIV risk behavior: Practical strategies. New York: The Guildford Press.

Kilian, A. H., Gregson, S., Ndyanabangi, B., Walusaga, K., Kipp, W., Sahlmuller, G., et al. (1999). Reductions in risk behaviour provide the most consistent explanation for declining HIV-1 prevalence in Uganda. AIDS (London, England), 13, 391–398. doi:10.1097/00002030-199902250-00012.

Kishamawe, C., Vissers, D. C., Urassa, M., Isingo, R., Mwaluko, G., Borsboom, G. J., et al. (2006). Mobility and HIV in Tanzanian couples: Both mobile persons and their partners show increased risk. AIDS (London, England), 20, 601–608. doi:10.1097/01.aids.0000210615.83330.b2.

Koumans, E. H., Farley, T. A., Gibson, J. J., Langley, C., Ross, M. W., McFarlane, M., et al. (2001). Characteristics of persons with syphilis in areas of persisting syphilis in the United States: Sustained transmission associated with concurrent partnerships. Sexually Transmitted Diseases, 28, 497–503. doi:10.1097/00007435-200109000-00004.CrossRefPubMed

Lagarde, E., Carael, M., Glynn, J. R., Kanhonou, L., Abega, S. C., Kahindo, M., et al. (2001). Educational level is associated with condom use within non-spousal partnerships in four cities of sub-Saharan Africa. AIDS (London, England), 15, 1399–1408. doi:10.1097/00002030-200107270-00009.

Lagarde, E., Schim van der Loeff, M., Enel, C., Holmgren, B., Dray-Spira, R., Pison, G., et al. (2003). Mobility and the spread of human immunodeficiency virus into rural areas of West Africa. International Journal of Epidemiology, 32, 744–752. doi:10.1093/ije/dyg111.CrossRefPubMed

Lurie, M. N., Williams, B. G., Zuma, K., Mkaya-Mwamburi, D., Garnett, G., Sturm, A. W., et al. (2003a). The impact of migration on HIV-1 transmission in South Africa: A study of migrant and nonmigrant men and their partners. Sexually Transmitted Diseases, 30, 149–156. doi:10.1097/00007435-200302000-00011.CrossRefPubMed

Lurie, M. N., Williams, B. G., Zuma, K., Mkaya-Mwamburi, D., Garnett, G. P., Sweat, M. D., et al. (2003b). Who infects whom? HIV-1 concordance and discordance among migrant and non-migrant couples in South Africa. AIDS (London, England), 17, 2245–2252. doi:10.1097/00002030-200310170-00013.

Manhart, L. E., Aral, S. O., Holmes, K. K., & Foxman, B. (2002). Sex partner concurrency: Measurement, prevalence, and correlates among urban 18–39-year-olds. Sexually Transmitted Diseases, 29, 133–143. doi:10.1097/00007435-200203000-00003.CrossRefPubMed

Mbizvo, M. T., Machekano, R., McFarland, W., Ray, S., Bassett, M., Latif, A., et al. (1996). HIV seroincidence and correlates of seroconversion in a cohort of male factory workers in Harare, Zimbabwe. AIDS (London, England), 10, 895–901. doi:10.1097/00002030-199607000-00013.

Michelo, C., Sandøy, I. F., Dzekedzeke, K., Siziya, S., & Fylkesnes, K. (2006a). Steep HIV prevalence declines among young people in selected Zambian communities: Population-based observations (1995–2003). BMC Public Health, 6, 279. doi:10.1186/1471-2458-6-279.CrossRefPubMed

Michelo, C., Sandøy, I. F., & Fylkesnes, K. (2006b). Marked HIV prevalence declines in higher educated young people: Evidence from population-based surveys (1995–2003) in Zambia. AIDS (London, England), 20, 1031–1038. doi:10.1097/01.aids.0000222076.91114.95.

Michelo, C., Sandøy, I. F., & Fylkesnes, K. (2008). Antenatal clinic HIV data found to underestimate actual prevalence declines: Evidence from Zambia. Tropical Medicine and International Health, 13, 171–179.PubMed

Ministry of Health, Central Board of Health, and Government of Republic of Zambia (2005). Zambia antenatal clinic sentinel surveillance report, 1994–2004. Lusaka.

Mnyika, K. S., Klepp, K. I., Kvale, G., & Ole-Kingori, N. (1997). Determinants of high-risk sexual behaviour and condom use among adults in the Arusha region, Tanzania. International Journal of STD and AIDS, 8, 176–183. doi:10.1258/0956462971919840.CrossRefPubMed

Morris, M. (1993). Telling tails explain the discrepancy in sexual partner reports. Nature, 365, 437–440. doi:10.1038/365437a0.CrossRefPubMed

Morris, M., & Kretzschmar, M. (1997). Concurrent partnerships and the spread of HIV. AIDS (London, England), 11, 641–648. doi:10.1097/00002030-199705000-00012.

Nelson, S. J., Manhart, L. E., Gorbach, P., Martin, D. H., Stoner, B. P., Aral, S. O., et al. (2007). Measuring sex partner concurrency: It’s what’s missing that counts. Sexually Transmitted Diseases, 34, 801–807.PubMed

Pettifor, A. E., van der Straten, A., Dunbar, M. S., Shiboski, S. C., & Padian, N. S. (2004). Early age of first sex: A risk factor for HIV infection among women in Zimbabwe. AIDS (London, England), 18, 1435–1442. doi:10.1097/01.aids.0000131338.61042.b8.

Potterat, J. J., Zimmerman-Rogers, H., Muth, S. Q., Rothenberg, R. B., Green, D. L., Taylor, J. E., et al. (1999). Chlamydia transmission: Concurrency, reproduction number, and the epidemic trajectory. American Journal of Epidemiology, 150, 1331–1339.PubMed

Rogers, E. M. (1983). Diffusion of Innovations. New York: The Free Press.

Sandøy, I. F., Kvåle, G., Michelo, C., & Fylkesnes, K. (2006). Antenatal clinic-based HIV prevalence in Zambia: Declining trends but sharp local contrasts in young women. Tropical Medicine and International Health, 11, 917–928. doi:10.1111/j.1365-3156.2006.01629.x.CrossRefPubMed

Sandøy, I. F., Michelo, C., Siziya, S., & Fylkesnes, K. (2007). Associations between sexual behaviour change in young people and decline in HIV prevalence in Zambia. BMC Public Health, 7, 60. doi:10.1186/1471-2458-7-60.CrossRefPubMed

Slaymaker, E., & Buckner, B. (2004). Monitoring trends in sexual behaviour in Zambia, 1996–2003. Sexually Transmitted Infections, 80(Suppl 2), ii85–ii90. doi:10.1136/sti.2004.012054.CrossRefPubMed

Sopheab, H., Fylkesnes, K., Vun, M. C., & O’Farrell, N. (2006). HIV-related risk behaviors in Cambodia and effects of mobility. Journal of Acquired Immune Deficiency Syndromes, 41, 81–86. doi:10.1097/01.qai.0000174654.25535.f7.CrossRefPubMed

Traeen, B., & Stigum, H. (1998). Parallel sexual relationships in the Norwegian context. Journal of Community and Applied Social Psychology, 8, 41–56. doi:10.1002/(SICI)1099-1298(199801/02)8:1<41::AID-CASP440>3.0.CO;2-3.CrossRef

UNAIDS. (2000). National AIDS programmes: A guide to monitoring and evaluation. Geneva: UNAIDS.

Watts, C. H., & May, R. M. (1992). The influence of concurrent partnerships on the dynamics of HIV/AIDS. Mathematical Biosciences, 108, 89–104. doi:10.1016/0025-5564(92)90006-I.CrossRefPubMed

White, R., Cleland, J., & Carael, M. (2000). Links between premarital sexual behaviour and extramarital intercourse: A multi-site analysis. AIDS (London, England), 14, 2323–2331. doi:10.1097/00002030-200010200-00013.

Wolffers, I., & Fernandez, I. (1995). Migration and AIDS. Lancet, 346, 1303. doi:10.1016/S0140-6736(95)91908-2.CrossRefPubMed

Title: Prevalence and Correlates of Concurrent Sexual Partnerships in Zambia
Authors: Ingvild F. Sandøy
Kumbutso Dzekedzeke
Knut Fylkesnes
Publication date: 01-02-2010
Publisher: Springer US
Published in: AIDS and Behavior / Issue 1/2010
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI: https://doi.org/10.1007/s10461-008-9472-3

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Prevalence and Correlates of Concurrent Sexual Partnerships in Zambia

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2010

Urban African-American Men Speak Out on Sexual Partner Concurrency: Findings from a Qualitative Study

Injecting Equipment Sharing in Russian Drug Injecting Dyads

Couples-Focused Behavioral Interventions for Prevention of HIV: Systematic Review of the State of Evidence

HIV Risk Behaviors in Heterosexual Partnerships: Female Knowledge and Male Behavior

Barking up the Wrong Evidence Tree. Comment on Lurie & Rosenthal, “Concurrent Partnerships as a Driver of the HIV Epidemic in Sub-Saharan Africa? The Evidence is Limited”

Scaling Sexual Behavior or “Sexual Risk Propensity” Among Men at Risk for HIV in Kisumu, Kenya

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page