Bringing it home: community survey of HIV risks to primary sex partners of men and women in alcohol-serving establishments in Cape Town, South Africa

Abstract

BackgroundConcurrent sexual relationships facilitate the spread of HIV infection, and sex with non-primary partners may pose particularly high risks for HIV transmission to primary partners.ObjectiveWe examined the sexual and alcohol-related risks associated with sex partners outside of primary relationships among South African men and women in informal drinking establishments.MethodsMen (n=4959) and women (n=2367) with primary sex partners residing in a Xhosa-speaking South African township completed anonymous surveys. Logistic regressions tested associations between having outside partners and risks for sexually transmitted infections (STI)/HIV.ResultsForty-four percent of men and 26% women with primary sex partners reported also having outside sex partners in the previous month. Condom use with outside partners was inconsistent for men and women; only 19% of men and 12% of women used condoms consistently with outside sex partners. Multivariable regressions for men and women showed that having outside partners was significantly associated with having been diagnosed with an STI, consuming alcohol in greater frequency and quantity, alcohol use during sex, meeting sex partners in alcohol-serving venues, and higher rates of unprotected sex.ConclusionsHaving outside sex partners was associated with multiple risk factors for HIV infection among South African shebeen patrons. Social and structural interventions that encourage condom use are needed for men and women with outside partners who patronise alcohol-serving venues.

Protective Factors and HIV Risk Behavior Among South African Men

“…Consistent with a study in Cape Town, older age was associated with lower odds of having multiple partners. 22 However, contrary to a study in Free State Province, 21 younger participants were not more likely to report using condoms.…”

“…Other surveys conducted in sub-Saharan Africa have reported lower rates of condom use with steady partners as opposed to casual partners. 22,38 We found that only 52.7% of men with casual partners reported always using condoms with their casual partners in the past three months. Similarly, a study in Cape Town found that only 58.5% of men who had both primary and outside partners reported always using condoms with their outside partners in the past 30 days.…”

“…Similarly, a study in Cape Town found that only 58.5% of men who had both primary and outside partners reported always using condoms with their outside partners in the past 30 days. 22 …”

“…21 However, older age was a protective factor for multiple partnerships in a community survey of people age 18 years and older in alcohol-serving establishments in Cape Town, South Africa. 22 Older men were less likely to report having both primary and outside partners than were younger men. This pattern of higher rates of condom use and multiple partnerships in younger men compared with older men has been consistently observed in the South Africa National HIV Prevalence Surveys.…”

Highlights from this issue

“…A study of customers in alcohol serving venues in South Africa demonstrates very high rates of concurrency, and low rates of condom use outside primary partnerships, in both men and women 6. In China, a study of adolescent female sex workers reaches similar conclusions,7 with high rates of unprotected non-commercial partnerships.…”