Concurrent Sexual Partnerships and HIV Transmission in Khayelitsha, South Africa

This 43-page working paper, published by the Centre for Social Science Research (CSSR), looks at the role that concurrent sexual partnerships play as a risk factor for HIV infection. The study argues that by better understanding the epidemiological and socio-cultural role of concurrency, primary behaviour change approaches to HIV prevention can be more effective and appropriately targeted, especially in sexually-transmitted, generalised epidemics such as in South Africa.

The study comprises a literature review on concurrent partnerships, followed by data on the frequency of concurrency using a representative sample of adults in Khayelitsha, South Africa. The study found that 17% of adults in married or regular partnerships reported concurrency, with men reporting significantly higher levels. However, the study notes that this may be a very conservative estimate, as qualitative research has found much higher frequency of concurrency. Engaging in concurrency was correlated with being less religious, and with knowledge that one's primary partner also had other partners. According to the report, these findings are generally consistent with findings from other quantitative studies in Southern Africa.

The report recommends that the promotion of sexual exclusivity or serial partnerships be an important prevention message because of its effects at the individual level (i.e. lower personal risk), as well as at the population level (fewer connections in a sexual network). Religion and religiosity play a secondary role to sexual risk behavior, but should be considered in HIV prevention efforts.

The study concludes that concurrent sexual partnerships are a critical element of sexual risk behaviours associated with HIV transmission, and that given the moderate frequency of concurrency and the social norms that support such behaviours, HIV interventions should begin to address them. Future research can start the task of understanding how to best modify this and other high risk behaviours that will potentially require widespread changes in social norms.