Comparison of key parameters of sexual behaviour in four African urban populations with different levels of HIV infection

Objective: To explore whether differences in sexual behaviour could explain differences in the rate of spread of HIV in four urban populations in Afri ca. Methods: A cross-sectional, population-based study was conducted in two cit ies where the prevalence of HIV among adults exceeded 20% (Kisumu, Kenya an d Ndola, Zambia) and two cities with a much lower HIV prevalence among adul ts (Cotonou, Benin and Yaounde, Cameroon). In each of these cities, approxi mately 1000 men and 1000 women, aged 15-49 years, were randomly selected fr om the general population. Consenting men and women were interviewed about their sociodemographic characteristics and sexual behaviour, including char acteristics of spouses and of non-spousal partners. Key parameters of sexua l behaviour were compared between the four cities. Results: On average, women in the high HIV prevalence cities had their sexu al debut earlier than in the other cities. Men and women in Kisumu and Ndol a got married earlier than men and women in Cotonou and Yaounde. High rates of partner change, contacts with sex workers, concurrent partnerships and large age differences between partners were no more common in the two high HIV prevalence cities than in the two low HIV prevalence cities. Conclusions: In these four African populations, differences in reported sex ual behaviour could not explain the differences in rate of spread of HIV. I n all four cities, highrisk sexual behaviour patterns were identified. (C) 2001 Lippincott Williams & Wilkins.