Concurrent sexual partnerships and HIV prevalence in five urban communities of sub-Saharan Africa

Objective: To estimate parameters of concurrent sexual partnerships in five urban populations in sub-Saharan Africa and to assess their association wi th levels of HIV infection and other sexually transmitted infections (STI). Methods: Data were obtained from a multicentre study of factors which deter mine the differences in rate of spread of HIV in five African cities. Conse nting participants were interviewed on sexual behaviour and at four of the five sites also provided a blood and a urine sample for testing for HIV and other STI. Data on sexual behaviour included the number of partnerships in the 12 months preceding the interview as well as the dates of the start an d end of each partnership. Summary indices of concurrent sexual partnership s - some of which were taken from the literature, while others were newly d eveloped - were computed for each city and compared to HIV and STI prevalen ce rates. Results: A total of 1819 adults aged 15-49 years were interviewed in Dakar (Senegal), 2116 in Cotonou (Benin), 2089 in Yaounde (Cameroon), 1889 in Kis umu (Kenya) and 1730 in Ndola (Zambia). Prevalence rates of HIV infection w ere 3.4% for Cotonou, 5.9% for Yaounde, 25.9% for Kisumu and 28.4% for Ndol a, and around 1% for Dakar. The estimated fraction of sexual partnerships t hat were concurrent at the time of interview (index k) was relatively high in Yaounde (0.98), intermediate in Kisumu (0.44) and Cotonou (0.33) and low in Ndola (0.26) and in Dakar (0.18). An individual indicator of concurrenc y (iic) was developed which depends neither on the number of partners nor o n the length of the partnerships and estimates the individual propensity to keep (positive values) or to dissolve (negative values) on-going partnersh ip before engaging in another one. This measure iic did not discriminate be tween cities with high HIV infection levels and cities with law HIV infecti on levels. In addition, iic did not differ significantly between HIV-infect ed and uninfected people in the four cities where data on HIV status were c ollected. Conclusion: We could not find evidence that concurrent sexual partnerships were a major determinant of the rate of spread of HIV in five cities in sub -Saharan Africa. HIV epidemics are the result of many factors, behavioural as well as biological, of which concurrent sexual partnerships are only one . (C) 2001 Lippincott Williams & Wilkins.