Concurrent sexual partnerships help to explain Africa's high HIV prevalence: implications for prevention

What might account for this pervasive discrepancy? The strong association between lack of male circumcision and HIV risk8-10 helps explain the 4-5-fold difference in HIV rates between southern and western Africa discussed by Asamoah-Odei and colleagues. However, that association does not explain why...

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Bibliographic Details
Published in:The Lancet (British edition) 2004-07, Vol.364 (9428), p.4-6
Main Authors: Halperin, Daniel T, Epstein, Helen
Format: Article
Language:English
Subjects:
Africa South of the Sahara - epidemiology
Asia - epidemiology
Comparative studies
Disease control
Disease transmission
Female
Health risks
HIV
HIV Infections - epidemiology
HIV Infections - prevention & control
HIV Infections - transmission
Human immunodeficiency virus
Humans
Male
Prevalence
Risk Factors
Sexual Behavior
Sexual Partners
Sexually transmitted diseases
STD
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Summary:What might account for this pervasive discrepancy? The strong association between lack of male circumcision and HIV risk8-10 helps explain the 4-5-fold difference in HIV rates between southern and western Africa discussed by Asamoah-Odei and colleagues. However, that association does not explain why HIV has spread so much more extensively in southern Africa than in India, or in Europe, where circumcision is similarly uncommon. Although sexual cultures do vary from region to region,11 the differences are not so obvious. Demographic surveys and other studies suggest that, on average, African men typically do not have more sexual partners than men elsewhere. For example, a comparative study of sexual behaviour found that men in Thailand and Rio de Janeiro were more likely to report five or more casual sexual partners in the previous year than were men in Tanzania, Kenya, Lesotho, or Lusaka, Zambia. And very few women in any of these countries reported five or more partners a year.12 Men and women in Africa report roughly similar, if not fewer, numbers of lifetime partners than do heterosexuals in many western countries.13-15 Of increasing interest to epidemiologists is the observation that in Africa men and women often have more than one-typically two or perhaps three-concurrent partnerships that can overlap for months or years (figure). This pattern differs from that of the serial monogamy more common in the west, or the one-off casual and commercial sexual encounters that occur everywhere.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(04)16606-3