Beliefs about gender equality are strongly predictive of multiple concurrent partnerships and HIV risk behaviours in South Africa, suggesting that better prevention of HIV could be achieved with education campaigns that promote ideas of gender equality to men, and more frequent condom use to women, according to findings presented at the Fourth South African AIDS conference in Durban.
Multiple partnering, often described as concurrency, is a strong risk factor for HIV and is believed by some scientists to be the key factor in explaining why HIV prevalence in southern Africa is so high compared to other regions of the continent. However, despite some evidence of the dangers of the practice, little is known about it, particularly with regards to its interplay with condom use.
In order to better understand the role of concurrent partners and HIV risk, scientists at the Aurum Institute For Health Research examined the 2001 census and randomly sampled 16 of 154 areas in Rustenburg, South Africa. Fieldworkers then superimposed the population distribution onto a satellite map and performed interviews with people from 512 randomly chosen houses.
Residents in each dwelling were numbered and one of them randomly subjected to an interview geared towards obtaining demographic information, beliefs about HIV vulnerability, condom use and perceptions of gender equality. The survey captured sexual acts that occurred three months previous to the interview. Multivariate logistic models were then used to statistically analyse the data.
Of the 351 people sampled, 59.8% were female and 84.9% black. Seventy three percent were sexually active and, of these, 9.7% admitted to having more than one sexual partner. Furthermore, only 56.1% of those surveyed reported using condoms (the definition of condom use included all those who had used a condom once or more during the three months).
Men believing in greater gender equality were more likely [OR 95%, CI: 0.30 (0.13 to 0.68)] to be monogamous while, paradoxically, women of the same belief were more likely to have multiple concurrent partners. [OR 95%, CI: 0.30 (0.13 to 0.68)].
The results suggest that beliefs about gender relations play a strong role in determining multiple concurrent partnering and HIV risk. Men are protected by believing in equality but women are at heightened risk.
The researchers call for more resources to be directed at gender equality campaigns and for women to be more actively encouraged to use condoms.
Latka M et al. Factors associated with concurrent sexual partnering & condom use are not the same: Results from a Representative Household Survey in Rustenburg, South Africa. (abstract 477). Fourth South African AIDS Conference, Durban, South Africa, abstract 477, 2009.