Objective: To estimate parameters of concurrent sexual partnerships in five urban populations in sub-Saharan Africa and to assess their association with levels of HIV infection and other sexually transmitted infections (STI).
Methods: Data were obtained from a multicentre study of factors which determine the differences in rate of spread of HIV in five African cities. Consenting participants were interviewed on sexual behaviour and at four of the five sites also provided a blood and a urine sample for testing for HIV and other STI. Data on sexual behaviour included the number of partnerships in the 12 months preceding the interview as well as the dates of the start and end of each partnership. Summary indices of concurrent sexual partnerships – some of which were taken from the literature, while others were newly developed – were computed for each city and compared to HIV and STI prevalence rates.
Results: A total of 1819 adults aged 15–49 years were interviewed in Dakar (Senegal), 2116 in Cotonou (Benin), 2089 in Yaoundé (Cameroon), 1889 in Kisumu (Kenya) and 1730 in Ndola (Zambia). Prevalence rates of HIV infection were 3.4% for Cotonou, 5.9% for Yaoundé, 25.9% for Kisumu and 28.4% for Ndola, and around 1% for Dakar. The estimated fraction of sexual partnerships that were concurrent at the time of interview (index k) was relatively high in Yaoundé (0.98), intermediate in Kisumu (0.44) and Cotonou (0.33) and low in Ndola (0.26) and in Dakar (0.18). An individual indicator of concurrency (iic) was developed which depends neither on the number of partners nor on the length of the partnerships and estimates the individual propensity to keep (positive values) or to dissolve (negative values) on-going partnership before engaging in another one. This measure iic did not discriminate between cities with high HIV infection levels and cities with low HIV infection levels. In addition, iic did not differ significantly between HIV-infected and uninfected people in the four cities where data on HIV status were collected.
Conclusion: We could not find evidence that concurrent sexual partnerships were a major determinant of the rate of spread of HIV in five cities in sub-Saharan Africa. HIV epidemics are the result of many factors, behavioural as well as biological, of which concurrent sexual partnerships are only one.
From the Institut National de la Santé et de la Recherche Médicale, Unité 88, Saint-Maurice, France, aUNAIDS, Geneva, Switzerland, the bInstitut National de Statistiques et d'Analyses Economiques, Cotonou, Benin, the cCentre Français pour la population et le développement/Institut de Recherche pour le développement, Paris, France, the dInstitut de Formation et de Recherche Démographique, Yaoundé, Cameroon, the eTropical Diseases Research Centre, Ndola, Zambia, the fLondon School of Hygiene and Tropical Medicine, London, UK, the gLaboratoire d'Analyse Numérique, Université Paris VI, France, hThe Population Council, Nairobi, Kenya, the iComité National de Lutte contre le Sida, Dakar, Senegal, and the jDepartment of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium. *See Appendix 2.
Requests for reprints to: E. Lagarde, INSERM U88, Hôpital National de Saint-Maurice, 14 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France
Received: 2 June 2000;
revised: 21 December 2000; accepted: 1 February 2001.
Sponsorship: The study was supported by the following organizations: UNAIDS, Geneva, Switzerland; European Commission, Directorate General XII, Brussels, Belgium; Agence Nationale de Recherches sur le SIDA/Ministère français de la coopération, Paris, France; DFID, London, UK; The Rockefeller Foundation, New York, USA; SIDACTION, Paris, France; Fonds voor Wetenschappelijk Onderzoek, Brussels, Belgium; Glaxo Wellcome, London, UK; BADC, Belgium Development Cooperation, Nairobi, Kenya.