Concurrent Sexual Partnerships Among Individuals on HAART in South Africa: An Opportunity for HIV Prevention

This 14-page working paper shares findings of a study to measure the prevalence of multiple concurrent partnerships (MCP) and condom use among individuals on highly active antiretroviral therapy (HAART) in the South African township of Khayelitsha in Cape Town. Comparisons are made between individuals on HAART and the general population from the same geographic area. According to the study, the prevalence of reported concurrency was relatively high among a sample of HAART patients and in the general population (24% and 18% respectively) and reported consistent condom use was significantly higher among HAART patients compared to the general population (58% versus 20%).

As stated in the report, given the large numbers of people living with HIV (PLHIV), particularly in southern Africa, secondary prevention has increasingly become a component of a comprehensive approach to the HIV epidemic. This suggests that there is a possible need for specific efforts to promote partner and concurrency reduction among PLHIV.

The data used in the analysis comes from two surveys collected by the AIDS and Society Research Unit at the University of Cape Town, one with people on HAART, and one with the general population. The authors say that a majority of respondents in both surveys were women. Similar percentages of individuals on HAART and in the general population reported being sexually active in the past year. Nearly a quarter of the HAART population reported having engaged in concurrency, with slightly less reporting concurrency in the general population. 35% of HAART respondents reported a belief that their sexual partner had other partners, and this figure was driven predominantly by women. 21% of respondents in the general population reported believing their partners were involved in concurrency. The majority of HAART respondents (58%) reported using a condom consistently, while 11% indicated they never used a condom. More men than women reported consistent condom use. Among the general population, 67% reported never using a condom, while 20% reported consistent condom use. In this case, more women than men report always using a condom.

According to the study, these findings indicate that many individuals in both study populations engage in concurrent sexual partnerships, and there are concerns that concurrency among individuals on HAART may have adverse public health effects. Concurrent partnerships have negative implications for HIV prevention, treatment, and care efforts through the transmission of HIV to sero-negative partners or through HIV reinfection between sero-positive partners. The public health significance of these reported concurrent partnerships was underscored by the fact that almost one in five of those on HAART who engaged in concurrency also reported inconsistent condom use. The report states that this underscores the importance of further investigating concurrency among individuals on HAART and in the general population to gain a better understanding of the social and individual factors which shape MCP prevalence.

The authors say that comparisons across the two studies provide interesting insights into public health efforts to reduce risky behaviours. For example, retrospective data on condom usage among the HAART sample prior to treatment reflects the potential efficacy of condom use messages: 12%, 57%, and 70% reported always using condoms before counselling and testing (CT), after CT but before receiving anti-retroviral treatment, and after starting HAART, respectively.

The authors recommend that partner and concurrency reduction interventions be included in prevention packages designed for the general population, including PLHIV and those on HAART. Reducing concurrent partnerships may be challenging, given the extent of concurrency in the general population and hence the evident social-rootedness of such practices. However, condom use has increased over time among the HAART sample and is significantly greater compared to the general population. This indicates that many individuals on HAART are receptive to safer sex counselling. There is thus potential for counselling and HAART services to be used to promote concurrency reduction as a component of HIV prevention. While increasing the risk perception of concurrency is important in the short term, research needs to evaluate structural factors, such as economic and gender inequalities, which play a role in engaging in concurrent sexual partnerships. Further research is also necessary to better understand the role of concurrency and sexual networks in onward transmission of HIV or reinfection among PLHIV, including those on HAART.