Concurrent Sexual Partnerships and the HIV Epidemics in Africa: Evidence to Move Forward

Mah, Timothy L.; Halperin, Daniel T.

doi:10.1007/s10461-008-9433-x

Cited by 308 publications

(335 citation statements)

References 35 publications

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“…Young married women are more likely to be sexually active, engage in frequent unprotected sex, and have infected partners, relative to their unmarried counterparts (Clark 2004). The role of concurrent sexual partnerships in married men is increasingly recognized as an important component of HIV transmission to their spouses (Mah and Halperin 2010). 57 As a result, married women are overwhelmingly at risk not because of their own behavior but because of their husband's.…”

Section: Discussionmentioning

confidence: 99%

Legal Origins and Female HIV

Anderson¹

2018

American Economic Review

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More than one-half of all people living with HIV are women and 80 percent of all HIV-positive women in the world live in sub-Saharan Africa. This paper demonstrates that the legal origins of these formerly colonized countries significantly determine current-day female HIV rates. In particular, female HIV rates are significantly higher in common law sub-Saharan African countries compared to civil law ones. This paper explains this relationship by focusing on differences in female property rights under the two codes of law. In sub-Saharan Africa, common law is associated with weaker female marital property laws. As a result, women in these common law countries have lower bargaining power within the household and are less able to negotiate safe sex practices and are thus more vulnerable to HIV, compared to their civil law counterparts. Exploiting the fact that some ethnic groups in sub-Saharan Africa cross country borders with different legal systems, we are able to include ethnicity fixed effects into a regression discontinuity approach. This allows us to control for a large set of cultural, geographical, and environmental factors that could be confounding the estimates. The results of this paper are consistent with gender inequality (the “feminization” of AIDS), explaining much of its prevalence in sub-Saharan Africa. (JEL I12, J15, J16, K11, K15, O15, O17)

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Section: Discussionmentioning

confidence: 99%

Legal Origins and Female HIV

Anderson¹

2018

American Economic Review

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“…At least in the United States, heterosexual populations tend to report concurrency at prevalence rates of around 10% or less [26,28]. There has also been some debate over the extent to which concurrency drives HIV infections in these populations, particularly in sub-Saharan Africa where HIV is more prevalent among heterosexual men and women [4,[29][30][31][32].…”

Section: Discussionmentioning

confidence: 99%

“…Mathematical models of HIV/STI epidemics consistently predict more numerous infections in populations that have a high number of concurrent sexual partnerships and a low number of serially monogamous partnerships [1][2][3][4]. This is largely due to individuals serving as possible links for viral transmission between their concurrent partners, particularly if safer sex is not always practiced.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Correlates of Sexual Partner Concurrency Among Australian Gay Men Aged 18–39 Years

Lyons

Hosking

2013

AIDS Behav

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Mathematical models predict higher rates of HIV and sexually transmitted infections (STIs) in populations with higher rates of concurrent sexual partnerships. Although gay men and other men who have sex with men (MSM) have disproportionately high rates of HIV/STIs, little is known about the prevalence and correlates of sexual concurrency in these populations. This paper reports findings from a national community-based survey of 1,034Australian gay-identified men aged 18-39 years, who gave detailed information about their sexual partners over the past 12 months. In all, 237 (23%) reported two or more concurrent sexual partners. For their most recent period of concurrency, 44% reported three or more partners and 66% reported unprotected sex with one or more of their partners. A multivariate logistic regression found sexual concurrency was significantly more likely among men on higher incomes (P=0.02), who first had anal sex at a relatively young age (P=0.03), and who reported a large number of partners in the past 12 months (P<0.001). Age, education, HIV status, and other sociodemographic and sexual behavior variables were not significant correlates. However, men who reported sexual concurrency were significantly more likely to have been diagnosed with an STI in the past 12 months (P=0.04). Findings from this study suggest sexual concurrency is common among younger Australian gay men. With many of these men not always using condoms, health agencies should consider the potential impact of concurrency on HIV/STI epidemics among gay men and other MSM. KeywordsSexual concurrency; concurrent sexual partnerships; gay men; men who have sex with men;HIV; sexually transmitted infections 3

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“…However, individual risk behaviors, such as condom use and the number of sex partners, and sexually transmitted disease (STD) cofactors do not by themselves explain the heterosexual spread of HIV. 3,4 In addition to these risk factors, the characteristics of sexual networks among heterosexuals, 5 specifically the pattern of sex partner concurrency (overlapping sex partnerships in the same time interval), may help to explain the heterosexual spread of HIV and other STDs in sub-Saharan Africa [6][7][8] and in high-risk urban and rural areas in the United States. [9][10][11] A high prevalence of sex partner concurrency in a population has been hypothesized to increase the number of direct or indirect sexual connections and thereby to influence the extent, rapidity, and persistence of HIV and other STD epidemics.…”

Section: Introductionmentioning

confidence: 99%

Reciprocal Sex Partner Concurrency and STDs among Heterosexuals at High-Risk of HIV Infection

et al. 2012

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Inconsistent findings on the relationship of sex partner concurrency to infection with HIV and other sexually transmitted diseases (STDs) may result from differences in how sex partner concurrency is conceptualized. We examine the relationship of reciprocal sex partner concurrency (RSPC) to diagnosed STDs among heterosexuals. Heterosexually active adults (N=717) were recruited for a cross-sectional study using respondent-driven sampling (RDS) from high-HIV-risk areas in New York City (NYC, 2006(NYC, -2007 and interviewed about their sexual risk behaviors, number of sex partners, last sex partners, and STD diagnoses (prior 12 months). RSPC was when both the participant and her/his last sex partner had sex with other people during their sexual relationship. Odds ratios (OR), adjusted odds ratios (aOR), and 95 % confidence intervals (95%CI) were estimated by logistic regression. The sample was 52.4 % female, 74.3 % Black; median age was 40 years. RSPC was reported by 40.7 % and any STD diagnoses by 23.4 %. Any STDs was reported by 31.5 % of those reporting RSPC vs. 17.9 % of those who did not (OR=2.11, 95%CI=1.49-3.0). Any STDs was independently associated with RSPC (aOR=1.54, 95%CI=1.02-2.32), female gender (aOR=2.15, 95%CI=1.43-3.23), having more than three sex partners (aOR=1.72, 95%CI=1.13-2.63), and unprotected anal sex (aOR=1.65, 95%CI=1.12-2.42). Heterosexuals in high-HIV-risk neighborhoods in sexual partnerships that involve RSPC are at greater risk of STDs and, potentially, HIV. RSPC, in addition to sexual risk behaviors and the number of sex partners, may facilitate the heterosexual spread of HIV through STD cofactors and linkage into larger STD/HIV sexual transmission networks.

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Concurrent Sexual Partnerships and the HIV Epidemics in Africa: Evidence to Move Forward

Cited by 308 publications

References 35 publications

Legal Origins and Female HIV

Legal Origins and Female HIV

Prevalence and Correlates of Sexual Partner Concurrency Among Australian Gay Men Aged 18–39 Years

Reciprocal Sex Partner Concurrency and STDs among Heterosexuals at High-Risk of HIV Infection

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