Gender and Multiple and Concurrent Sexual Partnerships in Lesotho

This 79-page study was conducted to fill an information gap in Lesotho around multiple concurrent partnerships (MCP) and HIV. In particular, the goal of the study was to produce strategic information on determinants of sexual behaviour, focusing particularly on social, economic, and cultural factors that promote MCP, with the purpose to inform national gender interventions aimed at HIV prevention. The study found that MCP is not uncommon among Basotho men and women and is a likely contributor to high rates of HIV transmission in the country. The study was conducted as a collaborative partnership between the National AIDS Commission Lesotho (NAC), The Joint United Nations Programme on HIV/AIDS (UNAIDS) and Family Health International (FHI), and was conceptualised and implemented in collaboration with the President's Emergency Plan for AIDS Response (PEPFAR) Lesotho.

The study focused on men (aged 18-44 years) and women (aged 15-34 years) and was conducted at five sites in Lesotho including the urban capital of Maseru, a foothills urban site, a lowlands rural site, a border town, and a rural mountain site. Research methods included focus group discussions and individual in-depth interviews to describe community perceptions, values, norms and experience, and individual behaviours and experience with regard to sexual relationships and practices. In total, 30 focus groups and 92 interviews were conducted among people from a wide range of backgrounds. These included gender-specific focus groups.

The results suggest that concurrency is not reflective of an increased rate of sexual activity. Rather, multiple weeks with no sexual activity and multiple months with only one sexual partner were the norm for many people with concurrent partners. According to the authors, understanding the way in which 'being faithful' is translated and defined within Basotho culture is important for understanding MCP. Few people described sexual monogamy as an indicator of faithfulness. Most equated faithfulness with actions that protect a person from the hurt that may result from knowing about other relations. Discretion and secrecy figured prominently in people's ideas of faithfulness. Given this, the authors suggest that intervention messages about "being faithful" need to be carefully nuanced or they run the risk of promoting secrecy and contributing to higher risk rather than lower risk for the partners involved.

The study also found that the tension between the desirability of stable relationships and the negative reactions towards couples who seem to have such relations is closely intertwined with gender power relations. Men who are monogamous are seen as soft or weak. Women who are monogamous are either seen as afraid of their partners and lacking power, or as strong and able to withstand men's efforts at seduction. Economic factors were a constant theme - i.e., the need for basic necessities or wanting small luxuries. According to the study, the distinction between a "need" and a "want" as motivation for MCP is extremely important as a consideration for developing effective interventions.

The study showed a general perception that age-discrepant relationships are characteristic of MCP, although very few people who were interviewed in-depth reported having such a relationship. A number of myths around condoms were also reported by both men and women, as was a dislike of condoms. Nonetheless, condom use was commonly reported by people with multiple partners, though such use was generally inconsistent. Alcohol consumption was another common theme, although it was referenced as part of the background or story.

According to the authors, messages about HIV transmission need to be developed with greater attention to the way the concept is translated into and interpreted within Sesotho to ensure that people understand that the virus remains in a person's body and continues to replicate even when it is 'passed on' to another person. There is also a need for dialogue about the meaning of respect for partners at national, district, and community levels.

The study also recommends making visible and promoting positive aspects of Basotho culture - using the stories from those who are monogamous as the basis for alternative cultural models. It also highlights the need for long-standing commitment of all organisations partnering to address MCP and a standardisation of messaging across them. The authors stress that behaviour change will not come overnight, but rather it requires a consensus of stakeholders on key issues and a unified front from implementing partners, along with long-term investment.