HIV This Week

Vissers DCJ, Voeten HACM, Urassa M, Isingo R, Ndege M, Kumogola Y, Mwaluko G, Zaba B, De Vlas SJ and Habbema JDF. Separation of spouses due to travel and living apart raises HIV risk in Tanzanian couples. Sexually Transmitted Diseases, August 2008, Vol. 35, No. 8, p.714–720

Persons with absent partners may be more vulnerable to risky sexual behaviour and therefore HIV. Partner absence can be due to travelling (e.g. family visits or funerals) or to living apart (e.g. work-related or in polygamous marriages). Debby et al investigated to what extent partner absence leads to more risky sexual behaviour in Tanzanian couples. They compared 95 men and 85 women living apart with 283 men and 331 women living together. Only persons who were still married were included, either living apart or cohabiting at the time of the interview. Subjects were classified into 4 groups: coresidents being either nonmobile or mobile, and people living apart either frequently or infrequently seeing each other. Most people living apart were polygamously married. Men living apart did not report more extramarital sex than coresident men. However, among coresident men, extramarital sex was reported by 35% of those being mobile compared with 15% of those nonmobile. Among women, those living apart reported extramarital sex more often than coresidents (14% vs. 7%), and this was mainly due to women living apart who infrequently saw their husbands. Risky sexual behaviour occurs more often in mobile coresident men, and in women living apart infrequently seeing their spouses. These groups are relatively easy to identify and need extra attention in HIV prevention campaigns.

Editors’ note: Concurrent relationships, multiple partners, and mobility are known to be associated with an increased risk of HIV exposure. The results of this study of couples, who were co-resident in 1996 and still married in 2002 according to both partners, emphasise the importance of studying the sexual behaviour of both sexes. Although most couples living apart in this area of north-western Tanzania were in polygamous marriages, living apart was not associated with increased extramarital sex in men but it was in women. Being mobile was a risk factor for unprotected extramarital sex in men but not in women. Promoting condom use for extramarital encounters is an obvious first step but a better understanding of the determinants of sexual risk behaviour in women living apart is needed to inform effective prevention programmes.

Nigeria is home to more people living with HIV than any other country in the world, except South Africa and India - where an estimated 2.9 million [1.7 million - 4.2 million] people were living with the virus in 2005. Women bear the greatest burden of frequent high-risk pregnancies, raising large families, and increasingly, the AIDS epidemic. Thus, there is a need for better understanding of the determinants of high risk sexual behaviour among women. In this study, Uthman et al examined factors associated with extra-marital sex among women in Nigeria and investigated how much variation in reported extra-marital sex can be attributed to individual-, and community-level factors. Uthman et al analyzed data from 6362 sexually active women aged 15 - 49 years who participated in the Nigeria 2003 Demographic and Health Survey using multilevel logistic regression models. Results are presented as odds ratio with 95% confidence interval. Independent of other factors, compared to women aged 15-24 years, those 25 - 34 years (odds ratio [OR] 0.59; 95% CI: 0.44 - 0.79) and 35 years or older (OR 0.36; 95% CI: 0.24 - 0.54) were less likely to have reported multiple concurrent sex partners in the last 12 years. As expected, women currently or formerly married were less likely to have reported multiple concurrent sex partners than women never married. Women who drank alcohol in the last three months were more likely to have reported multiple concurrent sex partners. Compared to women from richest household, women from poorest and middle household were 83% and 51% more likely to have multiple concurrent sex partners in the last 12 month respectively. After individual compositional and contextual factors, community wealth status was statistically significant with sexual behaviour. The study has demonstrated that individual and community wealth status are independent predictors of women's sexual behaviour, and that there is significant neighbourhood variation in odds of multiple concurrent sex partners, even after controlling for effects of both individual- and community-level characteristics. Scholars trying to understand variation individual high risk sexual behaviour should pay attention to the characteristics of both individuals and places of residence.

Editors’ note: Although this study has a large sample size, it suffers from its vague definition of the high-risk sexual behaviour ‘multiple concurrent partners’. This is defined as ‘having two or more sex partners in the last 12 months’. Such a definition lumps together women who became widows or divorced or left a partnership earlier in the year and then entered a new partnership (with no concurrency), women who exchange sex for money at high frequency (possibly with no concurrency, depending on your definition, unless they have regular clients or an ongoing boyfriend/husband), and women with concurrent partnerships. It makes sense that sexually active unmarried women, women who drink alcohol, or women from poor or middle-income households, are more likely to have two or more partners in the previous 12 months but no evidence is presented to suggest that these are concurrent partnerships, let alone ‘multiple’ concurrent partnerships.