Concurrent Sexual Partnerships Amongst Young Adults in South Africa: Challenges for HIV Prevention Communication

This report looks at the issue of concurrent sexual relationships amongst heterosexual respondents between the ages of 20 and 30, exploring implications for HIV/AIDS communication and offering recommendations and key message concepts for HIV/AIDS communication. It draws on data collected from two studies conducted in South Africa in 2006: 1) a national HIV/AIDS communication survey conducted by Centre for AIDS Development, Research and Evaluation (CADRE), working in partnership with Johns Hopkins Health and Education in South Africa (JHHESA), Johns Hopkins University Center for Communications Programs, Health Development Africa (HDA)/Khomanani, and Soul City, which looked mainly at the impact of HIV/AIDS communication; and 2) a qualitative study comprising interviews and focus groups which looked at the nature of sexual relationships and sought to identify implications for HIV/AIDS communication.

Having concurrent sexual partners is well established in the scientific literature as an important factor underpinning rapid growth of the HIV epidemic – particularly in Southern Africa. The findings of this study show that having concurrent sexual partners is common amongst young people aged 20-30 in South Africa. According to the study, the term ‘concurrent sexual partnerships’ is used to define a situation where partnerships overlap in time, either where two or more partnerships continue over the same time period, or where one partnership begins before the other terminates. A sexual partnership is considered to be concurrent if a person reports having two or more sexual partners in the past month. Most people in the 20-30 age group are unmarried (82%), and unemployed (48% of males and 59% of females), and these two factors contribute to sexual partner turnover.

Based on an analysis of the data, the report offers some key recommendations for prevention and communication:

The data shows that awareness of the risks of high sexual partner turnover, casual sex, and sexual partner concurrency are not well recognised. The report calls for an urgent and intensified focus and recommends that the following behaviours should be noted as primary risk factors:

• Having many sexual partners in one's lifetime;
• Frequently changing sexual partners and having two or more sexual partners in a year;
• Starting sexual relationships soon after meeting people;
• Having casual sex and ‘one-night stands’;
• Having more than one partner in the same month;
• Having overlapping sexual partnerships; and
• Having a ‘main’ partner as well as having ‘other’ partners.

According to the study, interventions should also avoid the dualities of meaning, uncovered in the research, embedded in the concept of ‘faithfulness’ in favour of more direct and pragmatic guidelines. The following key concepts are thus suggested for primary HIV prevention:

• Manage your risk to HIV by managing your relationships;
• The more sexual partners you have, the higher your risk of becoming infected with HIV;
• Avoid ‘one-night stands’ and get to know someone well before starting a sexual relationship;
• Having more than one sexual partner in the same month puts you at very high risk of becoming infected with HIV; and
• Space your relationships and avoid having overlapping sexual partnerships.

The findings on condom use suggest that although condom use is pervasive, consistent and correct condom use has not necessarily followed, and this has caused continual high HIV infection rates. Amongst people with concurrent partners, it was found that condom use declined rapidly with a "main" partner, and was inconsistent with "other" partners. Whilst condom promotion remains an important cornerstone to HIV prevention, in the present context of high HIV prevalence in conjunction with exposure to concentrated sexual networks, it is necessary to focus on reducing concurrency. In this context, condom promotion should focus on promotion of correct and consistent condom use.

In addition, HIV testing emerges in the qualitative data as a useful complementary strategy for people in established relationships, or for those considering establishing long-term relationships.

The following key concepts/messages related to condoms and voluntary counselling and testing (VCT) are suggested for complementary HIV prevention communication:

• Always insist on condom use during sex;
• Make sure you know how to use condoms correctly;
• Use condoms every time you have sex;
• Know your status. Don’t unknowingly infect others. Always use a condom;
• Go for HIV testing with your main partner. Share your results and plan your future; and
• If you know you are HIV positive, always use condoms.

According to this report, these messages urgently need to be adopted, intensified, and sustained for a period of at least two to three years, including monitoring and evaluation of progress.