Why is HIV Prevalence so Severe in Southern Africa: The Role of Multiple Concurrent Partnership and Lack of Male Circumcision - Implications for AIDS Prevention

This 12-page paper focuses on evidence underlying the 2006 Southern African Development Community (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.

The paper discusses concurrent partnerships and lack of circumcision as key to the rapid spread of HIV in the Southern African region. The authors compare the sexual practices in many parts of sub-Saharan Africa with those of other regions in the world, noting that although the number of sexual partners is similar for Africa and elsewhere, the nature of the sexual partnerships differs widely. In most other regions, the tendency is toward serial monogamy or once-off casual encounters, whereas in Southern Africa, the tendency is towards concurrent longer-term partnerships. According to the report, these concurrent relationships put partners at increased risk, as risk of infection increases with the number of sexual encounters with an HIV infected person, and new infections can spread rapidly from one partner to others in the sexual network during the highly infectious period that occurs directly after an initial HIV infection.

The authors argue that encouraging men and women to have fewer concurrent sexual partners can lead to a drop in HIV prevalence, and cite examples from Uganda's "Zero Grazing" campaign of the late 1980s and early 1990s. According to the report, surveys conducted during that time indicated that between 1989 and 1995 there was a 60% decline in the percentage of people reporting two or more sexual partners in the previous 12 months. The authors further state that behavioural changes are believed to explain much of the decline in HIV prevalence that occurred in Uganda in the 1990s. Reductions in HIV prevalence in other countries such as Kenya, Zimbabwe, and Swaziland have similarly been associated with a decrease in the incidence of concurrent or multiple partners.

The paper concludes that although partner reduction/faithfulness approaches have received relatively little attention in most of Africa, they appear to be feasible and epidemiologically crucial. The authors state that the experiences of Uganda and some other places suggest there is empirical validity to the common-sense notion of emphasising partner limitation. However, they also state that this must be done in addition to other approaches, such as the promotion of consistent condom use and increased access to safe and affordable male circumcision.