HIV Prevention - Multiple Concurrent Partnerships (MCP)

In recognition of World AIDS Day coming up on December 1, this issue of The Soul Beat looks at HIV Prevention with a specific focus on Multiple Concurrent Partnerships (MCP), which have been identified as one of the key drivers of the HIV epidemic in southern Africa. The newsletter offers strategic thinking documents, programme experiences, and materials related to MCP and the role communication can play in promoting partner reduction, faithfulness, and safer sex within these relationships.

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SOUL BEAT AFRICA IS SEEKING INFORMATION RELATED TO MULTIPLE CONCURRENT PARTNERSHIPS (MCP)

If you are dealing with MCP in your HIV prevention projects, or if you have evaluations, materials, and research documents related to MCP, please send your information to soulbeat@comminit.com

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REPORTS AND ARTICLES DEALING WITH MULTIPLE CONCURRENT PARTNERSHIPS (MCP)

1. Expert Think Tank Meeting on HIV Prevention in High-Prevalence Countries in Southern Africa Report
This report of a meeting convened by the Southern African Development Community (SADC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) in Swaziland in 2006 looks at the drivers of the HIV epidemic in the sub-region and makes proposals to accelerate prevention efforts in the future. Lack of consistent condom usage in long-term multiple and concurrent partnerships, male attitudes and behaviours, intergenerational sex, gender and sexual violence, stigma, lack of openness, and untreated viral STIs were identified as significant contributing drivers of the epidemic. Underlying these drivers are the social and structural factors such as high population mobility, inequalities of wealth, and cultural factors and gender inequality that render young women especially vulnerable to HIV infection.

2. Why is HIV Prevalence so Severe in Southern Africa: The Role of Multiple Concurrent Partnership and Lack of Male Circumcision - Implications for AIDS Prevention
by Daniel Halperin and Helen Epstein
This paper focuses on evidence underlying the 2006 SADC and UNAIDS AIDS Prevention Think Tank Meeting's two main conclusions and priority action areas: to significantly reduce multiple and concurrent partnerships for both men and women and to prepare for the potential national roll out of male circumcision. The paper also outlines conclusions and recommendations from an October 2006 SADC/UNAIDS regional consultation on social change communication for HIV prevention, which included key recommendations on male circumcision and concurrent partner limitation. The paper suggests that differing patterns of sexual behaviour and new findings around male circumcision have important implications for HIV prevention programmes and outcomes.

3. Concurrent Sexual Partnerships Amongst Young Adults in South Africa: Challenges for HIV Prevention Communication
by Warren Parker, Benjamin Makhubele, Pumla Ntlabati, and Cathy Connolly
This report looks at the issue of concurrent sexual relationships amongst heterosexual respondents between the ages of 20 and 30, exploring implications for HIV/AIDS communication and offering recommendations and key message concepts for HIV/AIDS communication. The data shows that awareness of the risks of high sexual partner turnover, casual sex, and sexual partner concurrency are not well recognised. Amongst people with concurrent partners, it was also found that condom use declined rapidly with a "main" partner, and was inconsistent with "other" partners.

4. One Love: Multiple and Concurrent Sexual Partnerships in Southern Africa - A Ten Country Research Report
This report was designed to inform the development of an HIV prevention campaign by the Soul City Regional Programme (SCRP) aimed at reducing new infections in the southern Africa region by focusing on reducing MCPs. The research was conducted in each of the 10 countries which form part of the Soul City Regional Programme: Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Zambia, and Zimbabwe. The primary aim of the research was to gain insight into the audience’s understanding, attitudes, and practices around sexual relationships in the context of HIV prevention. Overall research findings reveal common reasons for multiple concurrent partnerships among people in the 10 countries of this study. Most of these reasons are driven by gender inequality and cultural and social norms that create a context for MCP. Transactional sex and alcohol also play an important role.

5. Sexual Risk Behaviour Among Men with Multiple, Concurrent Female Sexual Partners in an Informal Settlement on the Outskirts of Cape Town
by Mickey Chopra, Loraine Townsend, Cathy Mathews, Mark Tomlinson, Lisa Johnston, Carl Kendall, Najma Shaikh, and Heidi O'Bra
According to this document, 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. This study therefore set out to develop a robust surveillance system to measure key risk behaviours and HIV prevalence among adult men who have multiple, concurrent female sexual partners, and who live in an urban, informal community on the outskirts of Cape Town. Using respondent-driven sampling (RDS) to recruit men, the findings provide evidence that men living in urban, informal communities and who have multiple concurrent female sexual partners use condoms inconsistently, have high levels of transactional sex and intimate partner violence (IPV), and visit shebeens or taverns (where alcohol consumption is high) to acquire new sexual partners.

6. Ten Myths and One Truth About Generalised HIV Epidemics
by James D. Shelton
The author explores 10 misconceptions about widespread or generalised HIV epidemics. The author recommends behaviour change techniques - including explicit messages sensitive to local cultures that raise perception of personalised risk, which focus on what people have adopted spontaneously: cessation of concurrent partnerships. He states that "Even modest reductions in concurrent partnerships could substantially dampen the epidemic dynamic."

7. "Know Your Epidemic, Know Your Response”: A Useful Approach, If We Get It Right
by Daniel Halperin and David Wilson
This article expands upon the "rallying cry" "know your epidemic, know your response", stating that the era of standard global prevention is over. The authors discuss the state of global HIV and AIDS as not a single epidemic, but a multitude of diverse epidemics. They distinguish between "concentrated and generalised epidemics, which are fundamentally different - not because of arbitrary prevalence thresholds, but about who gets infected and how." Concentration is described as transmission among defined vulnerable groups, such as sex workers or injecting drug users. Transmission among the general population that persist, due to sustained sexual behaviours, despite effective programmes with vulnerable groups, is considered a generalised epidemic. The paper looks at partner reduction as a way to reduce transmission in generalised epidemics, and states that although little is known about how to effectively promote partner reduction, this should not be an excuse not to immediately increase ones commitment to well-evaluated programmes aimed at reducing multiple and concurrent sexual partnerships.

8. What Every Bride Needs to Know
This article looks at the role that bridal showers can play in educating women about HIV/AIDS and in empowering them to negotiate safe sex within marriage. Since studies show that married couples are at higher risk of HIV infection than unmarried men and women, women who are entering into marriage need to be able to protect themselves. As bridal showers are used as a forum to provide tips to the bride on how to manage domestic arguments and ensure a happy sex life, some organisations are starting to use these occasions to promote issues related to sexual health and HIV/AIDS.

9. UNAIDS Combination Prevention Briefs
This series of briefs, published by UNAIDS, is designed to offer an overview of the key interventions needed as part of a combination prevention approach in the countries of Eastern and Southern Africa with high HIV prevalence. The briefs focus on the following 4 areas: modes of transmission, multiple concurrent partnerships, vulnerabilities of women and girls, and male circumcision. Each brief offers background information, outlines challenges to scaling-up within a combination prevention approach, and offers recommendations for action.

10. Multiple Concurrent Partnerships: The Story of Zimbabwe - Are Small Houses a Key Driver?
This paper looks at the phenomenon of "small houses" in Zimbabwe, and how they are a key driver of the HIV epidemic. According to the author, a "small house" is essentially a longer-term sexual relationship between a married man and another, usually younger, woman. "Small houses" are viewed by Zimbabwean men as a safer alternative to casual sex, which they understand to be high risk, because they see women in "small houses" as being faithful to them. Because of this perception, they are unlikely to use condoms. However, the report states that mutual fidelity is very rare, and that there are many factors that lead women in "small houses", their married male partners, and the men's wives to be unfaithful.

COMMUNICATION PROJECTS DEALING WITH MCP

11. OneLove Campaign - Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Zambia, Zimbabwe
This 4-year regional campaign, which grew out of the Soul City Regional Programme, aims to reduce HIV incidence in 9 Southern African countries by reducing multiple concurrent partnerships (MCP). The OneLove campaign uses mass media (including television drama, radio drama, and print booklets in multiple languages) combined with face to face education, social mobilisation, and advocacy. It aims to stimulate public discourse and debate around culture and gender and challenge harmful practices that promote MCP, whilst promoting protective practices. It is being rolled out across the region in 2008, with Tanzania being the first to launch in October 2008, and will run until 2011.
Contact hope@phela.org.ls OR ssikwese@pakachere.org OR d.namburete@nweti.org.mz OR desertsoul1@redcross.org.na OR fortunate@lusweti.org.sz OR soulcity@soulcity.org.za OR info@feminahip.or.tz OR graces@zccp.org.zm OR caroline@action.co.zw OR action@action.co.zw

12. Sikia Kengele (Listen to the Bell) – Tanzania
Launched in March 2007, Sikia Kengele (Listen to the Bell) is a multi-media communications campaign which seeks to encourage people to change their sexual behaviours through partner reduction and being faithful. The campaign uses multiple reinforcing approaches including interpersonal communication through "Bell Ringers", community mobilisation activities around a "big bell", and a radio-based mass media initiative. The national campaign aims to encourage "zero grazing" and uses the symbol of a bell to represent "a wake up call" for behaviour change.
Contact Diana Kisaka dkisaka@tmarc.or.tz OR Nelson Karanja nkaranja@tmarc.or.tz

13. Scrutinize Campaign - South Africa
This campaign, created in partnership with United States Agency for International Development (USAID), the Johns Hopkins Health Education in South Africa (JHHESA), and designer jeans label Levi's, aims to encourage and equip young people to take responsibility to reduce their risk of HIV infection. The campaign, which was launched in 2008, involves a series of short animated commercials known as animerts. It uses animated township characters who illustrate daily life encounters that place young people at risk of HIV infection. The animerts, which are intended for 18-32 year-olds in South Africa, aim to equip viewers with a new HIV fact or insight to help them examine (or scrutinize) their own risky behaviours and beliefs. The main topics addressed by the series are perceptions of risk, multiple and concurrent partnerships, faithfulness, condom use and safety, transactional intergenerational sex, and alcohol and sex.
Contact Richard Delate Richard@jhuccp.co.za

14. Be a Man Campaign - Uganda
Young Empowered and Healthy (Y.E.A.H.), a communication initiative of the Uganda AIDS Commission, launched the "Be a Man" campaign during the June 2006 World Cup football broadcasts on national television. The goal of the campaign was to reduce the number of young men with multiple sexual partners, improve communication between sexual partners, and encourage mutual disclosure of HIV status, respect, faithfulness, non-violent means of resolving conflicts, active parenting, and responsible alcohol use. Along with television spots, the campaign included the production of posters and billboards, as well as discussion groups and training sessions.
Contact Vincent Kiwanuka kalimire@yahoo.co.uk AND info@yeahuganda.org OR Cheryl Lettenmaier cherylL@hcpuganda.org

15. Likusasa ngelami (The Future is Mine) – Swaziland
This campaign, run by the National Emergency Response Council on HIV and AIDS (NERCHA) in Swaziland, aimed to motivate members of the public to choose not to engage in risky sexual behaviour. More specifically, it was designed to encourage delayed sexual debut, keeping to one partner, and faithfulness within marriage. The campaign, named "likusasa ngelami" which means "the future is mine", aimed to do this by encouraging audiences to value their futures and therefore adopt positive behaviours. The campaign used posters, radio, print, and public service announcements on television.
http://www.comminit.com/en/node/280466/38
Contact info@nercha.org.sz

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MCP PROJECT EVALUATION

16. Evaluating the Trusted Partner Campaign in Four Sub-Saharan African Countries
This document summarises the findings of an evaluation of the Trusted Partner Campaign, a regional project implemented by Population Services International (PSI). The campaign was developed to alter misconceptions that resulted in a heightened sense of trust between partners leading to subsequent lower consistent condom use. The evaluation, which was conducted in Lesotho, Mozambique, Uganda, and Zambia, found that the campaign has not had any impact on elevating the level of caution that individuals use before having sex with regular partners. Exposure to this campaign was only associated with consistent condom use in Mozambique, and the impact was only felt among those with the highest levels of exposure to the campaign.

MCP RESOURCE MATERIALS

17. Tsha Tsha DVD Discussion Guide
This guide and the accompanying DVD form part of a strategy to broaden the reach of Tsha Tsha, a South African youth-oriented television series that focuses on young people living in a world affected by HIV/AIDS. The guide aims to encourage conversation and debate around 4 key themes: HIV risk in relation to having multiple sexual partnerships, as well as multiple, concurrent (overlapping) sexual partnerships; care and support for orphans and vulnerable children; minimising the risk of mother-to-child transmission of HIV; and antiretroviral treatment.

18. HIV Peer Education Picture Codes
Produced in Botswana for Pact, a United States-based international non-governmental organisation, this set of picture codes was developed as material to be used in group outreach sessions to stimulate discussion around behaviours which put people at risk of HIV infection. The situations and related behaviours include sexual violence, alcohol abuse, concurrent sexual partners, and sex for money or gifts.

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To view previous newsletters related to this topic see:

The Soul Beat 112 - Materials - HIV/AIDS, Reproductive Health, and Lifeskills

The Soul Beat 94 - HIV/AIDS Communication

The Soul Beat 75 - Action for Orphans and Vulnerable Children

The Soul Beat 62 - MDG # 6 - Combatting HIV/AIDS, malaria and other diseases

Click here to view archived editions of The Soul Beat Newsletter.