Understanding the Dynamics of Concurrent Sexual Partnerships in Malawi and Tanzania

"In Malawi and Tanzania, concurrent partnerships are complex sexual behaviors embedded within larger social and economic systems that intersect with cultural and gender norms to influence individual behaviors. Interventions aiming to reduce rates of concurrency must understand these dynamics and work within these larger social and structural systems to enact change."

The goal of this study is to develop an in-depth understanding of the relational dynamics and social context of concurrent sexual partnerships and their implications for HIV prevention in Tanzania and Malawi. The study is a product of Research to Prevention (R2P), a 5-year HIV prevention project (2008-2013) that is funded by the United States Agency for International Development (USAID), led by the Johns Hopkins Center for Global Health, and managed by Center for Communication Programs (CCP).

A qualitative design was used to explore community perspectives and individual experiences with concurrent sexual partnerships. In total, 72 focus group discussions and 36 in-depth interviews were conducted with community members in Blantyre, Machinga, Mchinji, Kasungu, and Mzimba districts in Malawi and Dar es Salaam, Shinyanga, Iringa, and Mbeya regions in Tanzania. An additional 18 key informant interviews were conducted with community leaders.

Findings from this qualitative study suggest several avenues for interventions:

"Address environmental-structural factors that create an enabling context

Concurrent sexual relationships occur in a particular environmental, social, and economic context. Environmental-structural factors such as economic vulnerability, labor migration and the social context of alcohol use facilitate sexual concurrency and should be considered in intervention development.

• Poverty and economic vulnerability, particularly among women, facilitate concurrent partnerships; interventions such as microfinance and job training might reduce this risk.
• Separation of couples due to migration may be mitigated by interventions that make separation from loved ones easier or reduce the time spent apart from family...
• To address the intersections between alcohol and concurrency, programs should consider both interventions that target the general population with messages on the risk of alcohol as well as interventions based in alcohol venues that are designed to address the specific social and structural context of sexual risk in these venues.

Address unequal gender norms and strengthen injunctive norms against concurrent partnerships

Many respondents disapprove of concurrency, but believe it is widely practiced. This appears to be a case where injunctive norms (what people believe should be done) conflict with descriptive norms (what people believe others are doing). Strengthening injunctive norms against concurrent partnerships for both men and women through positive role modeling and re-characterizing masculinity may help to discourage such behavior.

Strengthening injunctive norms, however, is unlikely to be successful without also addressing larger gender norms that support gender inequalities. Efforts to reduce transactional sex must consider the complexity of the beliefs underlying the practice and the intersections between power, gender, and poverty that shape it. Interventions to change norms should engage men and address structural factors that shape unequal gender norms. Further research is needed...

Promote partner communication and conflict resolution strategies

Motivating couples to maintain and improve the quality of their primary relationships is key to intervention activities addressing concurrency. Promoting conflict resolution strategies and partner communication around sexual health and sexual pleasure in general and HIV prevention in particular should be part of comprehensive efforts to reduce concurrent partnerships. Social networks can be used to provide relevant information and build partner communication skills about the risks of concurrency....Appropriate interventions could build on the traditional role of community elders and the extended family in conjugal conflict resolution and encourage HIV prevention interventions that target couples as a unit.

Develop parenting skills to discourage concurrency

Parents should be provided with training to develop their skills for having open discussions with their children around relationships, sexuality, and the risks of concurrent sexual partnerships. Programs should focus on developing parenting skills across a variety of dimensions of parental influence, including connectedness, behavioral control, respect for individuality, modeling appropriate behavior, and provision and protection. These efforts should be implemented in conjunction with interventions to engage communities and shift cultural norms around the acceptability of parent-child conversations about sexuality as well as interventions to address other social and economic vulnerabilities of young people."