Concurrent Partners and HIV Risk: Applying Lessons Learned in African Countries

By Tracy Leong, SIECUS Program Research Intern

Source:

Michele Peake Adrasik, et al., “Developing Concurrency Messages for the Black Community in Seattle, Washington,” AIDS Education and Prevention (December 2012).

Description:

Recent studies show that having sexually concurrent partnerships (that is, having more than one sexual relationship at a given time) increases risk for transmission of HIV. Africa is the only continent with extensive experience including this information in messaging for HIV prevention campaigns. Drawing from the African experience, researchers developed a project in Seattle, Washington to generate an HIV prevention campaign that educated the community about the risks of concurrent sexual partnerships.[1] The campaign specifically targeted both African American MSM (men who have sex with men) and African-born heterosexually identified individuals, two populations who are infected at disproportionate rates when compared to others. The Seattle researchers formed a Disparities Working Group (DWG), convening HIV service providers and other members of the community, to conduct interviews and focus groups and discovered that many people see concurrency as a part of their culture. With their findings, the DWG developed a “Zero-Grazing” campaign to increase communication and discussion in Seattle’s black communities about HIV and concurrency, in hope of reducing stigma and increasing awareness. 

Key Findings:

  • Concurrency is seen as normative and a part of the culture and traditions of many in the community that was studied.
     
  • Communication about sexual activity and safer sex is lacking. There is a stigma attached to openly discussing sexual topics, as well as a fear of judgment despite the norm of concurrency. 
     
  • Many people believe they aren’t really at risk for HIV or believe they are at an “affordable” risk because HIV prevention messages are less prominent in North America (as compared to Africa), and improved treatments have allowed HIV-positive individuals to live longer lives. 
     
  • Although there are comparatively high levels of concurrency among African Americans and African-born populations throughout the United States, few if any HIV prevention efforts in the U.S. have attempted to educate about the connection between concurrency and HIV infection.

Analysis:

Recent studies in Zimbabwe[2],[3] indicate that the HIV epidemic cannot be sustained without sexual concurrency. According to this study’s authors, sexual concurrency seems to be normative in some communities in the United States, and may be a specific HIV risk factor in some African American communities. According to research, concurrency can be explained by numerous social and structural forces including: limited educational and employment opportunities, economic injustice and racial discrimination which affect family and marriage dynamics, and sex ratios. In communities where concurrency is normative, even when individuals do not participate in riskier sexual behaviors or drug use, these other disparities place them at higher risk for HIV infection.[4]

“Zero-grazing” was a phrase used in campaigns to reduce partner concurrency launched in Uganda in 1986,[5] using community-based, face-to-face communication to encourage sexually active people to choose monogamy. This effort seems to have been effective: in 2003, prevalence (existing cases) of HIV in Uganda dropped to about 5% from 15% in the early 1990s. Critics of campaigns to promote monogamy argue that the decrease in HIV rates is more likely due to increased use of condoms and the cumulative effect of earlier AIDS deaths (which removed infected people from the population). 

In the Seattle study, concurrency, while more common among heterosexual men, was also found among women. For the MSM population, it was so customary that monogamous individuals were a minority. The researchers also found that many in the study overall did not perceive  HIV/AIDS as a considerable threat. Most people in the study were unaware of the high rates of infection within their local community (with the exception of the MSM population); many said they knew people who were infected, but didn’t think they could personally be affected. According to the authors, this lack of awareness and concern can be attributed to several factors: minimal media attention about HIV/AIDS in the United States in comparison to Africa (according to the African-born respondents) made some believe they were “safe;” a clear lack of open discussion regarding sexual topics, making it taboo to talk about sex and especially about concurrency; and study participants observing improved treatment for those diagnosed with HIV, allowing them to live many decades following a diagnosis, and therefore making HIV infection seem like more of an affordable risk.  

The African experience indicates that serial monogamy can greatly reduce the risk of HIV transmission; however, studies also show that HIV prevention needs to include education and encourage open communication about safer sex for those who continue in concurrent sexual relationships. According to the Seattle study, many people were unaware about their risk because of stigma associated with talking openly about concurrency; although concurrency is a norm for many in these Seattle communities, it is a norm with stigma. 

The research process demonstrated a need to include messaging about using protection every time an individual participates in sexual activity; it also demonstrated the need to dispel still-widely-held perceptions that HIV/AIDS remains only a “homosexual” issue. Given the difficulty many people had discussing sex, and especially concurrency, it is clear that sexuality educators need to find a universally recognized term to replace the scientific vocabulary of “concurrency.”


[1]Peake Andrasik M, Hughes Chapman C, Clad R, Murray K, Foster J, Morris M, Parks MR, Kurth AE (2012). Developing concurrency messages for the Black community in Seattle, Washington. AIDS Educ Prev, 24(6): 527-548.

[2]Eaton JW, Hallett TB, Garnett GP (2011). Concurrent sexual partnerships and primary HIV infection: a critical interaction. J AIDS and Behavior. May; doi: 10.1007/s10461-010-9787-8, <http://www.ncbi.nlm.nih.gov/pubmed/20890654>.

[3]Goodreau SM, Cassels S, Kasprzyk D, Montaño DE, Greek A, Morris M (2012). Concurrent partnerships, acute infection and HIV epidemic dynamics among young adults in Zimbabwe. J AIDS and Behavior. February; doi: 10.1007/s10461-010-9858-x, <http://www.ncbi.nlm.nih.gov/pubmed/21190074>.

[4]Nunn A, Dickman S, Cornwall A, Rosengard C, Kwakwa H, Kim D, James G, Mayer KH (2011). Social, structural and behavioral drivers of concurrent partnerships among African American men in Philadelphia. AIDS Care. November; doi: 10.1080/09540121.2011.565030.

[5]Green EC, Halperin DT, Nantulya V, Hoggle JA (2006). Uganda’s HIV prevention success: therole of sexual behavior change and national response. J AIDS and Behavior. July; doi:  10.1007/s10461-006-9073-y, <http://link.springer.com/article/10.1007%2Fs10461-006-9073-y>.  

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