Objective
Men who have sex with men (MSM) have higher rates of HIV and other sexually transmitted infections (STI) than women and heterosexual men. This elevated risk persists across age groups and reflects biological and behavioral factors, yet there have been few direct comparisons of sexual behavior patterns between these populations.

/pdf/a-comparison-of-sexual-behavior-patterns-among-men-who-have-3mqxoatmpl.pdf

A comparison of sexual behavior patterns among men who have sex with men and heterosexual men and women.

Sexual concurrency indicates that an individual is not in a monogamous relationship with one partner. Instead there is a shorter time between sexual acts with varying partners compared to monogamous individuals. In turn this increases the risk of HIV or STI transmission. The rate of transmission varies depending on the infection but the risk is still present. Because transmission varies widely between people it is necessary to conduct further empirical and theoretical research regarding infection transmission.

Neglected issues and hypotheses regarding the impact of sexual concurrency on HIV and sexually transmitted infections.

BACKGROUND: A number of African countries have planned campaigns against concurrency. It will not be possible to separate the effects of a reduction in concurrency from other behavior changes when evaluating these campaigns. This modeling study explores the potential impact of an intervention to reduce partnership concurrency on HIV incidence in contemporary rural Uganda keeping incidence of sex acts and partnerships in the population constant. METHODS: Data on demography sexual behavior and HIV prevalence from Uganda were used to parameterize an individual-based HIV transmission model. Three baseline model scenarios were simulated representing the best estimate of concurrency prevalence in this population and low and high plausible bounds. Interventions that reduced concurrency by 20% and 50% between 2010 and 2020 were simulated and the impact on HIV incidence in 2020 was calculated. RESULTS: Data showed 9.6% (7.9%-11.4%) of men and 0.2% (0.0%-0.4%) of women reported concurrency in 2008. Reducing concurrency had a nonlinear impact on HIV incidence. A 20% reduction in concurrency reduced HIV incidence by 4.1% (0.3%-5.7%) in men and 9.2% (2.1%-16.8%) in women; a 50% reduction in concurrency reduced HIV incidence by 6.0% (1.4%-10.8%) in men and 16.2% (6.3%-23.4%) in women. CONCLUSIONS: Interventions against concurrency have the potential to reduce HIV incidence and may have a higher impact in women than in men. In rural Uganda overall impact was modest and this study does not provide strong support for the prioritization of concurrency as a target for behavior change interventions. However it may be more useful in higher concurrency settings and for reducing HIV incidence in women.

Exploring the potential impact of a reduction in partnership concurrency on HIV incidence in rural Uganda: a modeling study.

Extramarital partnerships exacerbate high HIV prevalence rates in many communities in sub-Saharan Africa. We explored contextual risk factors and suggested interventions to reduce extramarital partnerships among couples in the fishing communities on Lake Victoria, Kenya. We conducted 12 focus group discussions with 9–10 participants each (N = 118) and 16 in-depth interviews (N = 16) with fishermen and their spouses. Couples who participated were consented and separated for simultaneous gender-matched discussions/interviews. Interview topics included courtship and marriage, relationship and sexual satisfaction, extramarital relationships and how to intervene on HIV risks. Coding, analysis, and interpretation of the transcripts followed grounded theory tenets that allow analytical themes to emerge from the participants. Our results showed that extramarital partnerships were perceived to be widespread and were attributed to factors related to sexual satisfaction such as women needing more foreplay before intercourse, discrepancies in sexual desire, and boredom with the current sexual repertoire. Participants also reported that financial and sociophysical factors such as family financial support and physical separation, contributed to the formation of extramarital partnerships. Participants made suggestions for interventions that reduce extramarital partnerships to minimize HIV risks at the community, couple, and individual level. These suggestions emphasized improving community education, spousal communication, and self-evaluation for positive behavior change. Future studies can draw upon these findings as a basis for designing community-owned interventions that seek to reduce community-level HIV risk through a reduction in the number of sexual partners.

Jaboya (“Sex for Fish”): A Qualitative Analysis of Contextual Risk Factors for Extramarital Partnerships in the Fishing Communities in Western Kenya

Stable serodiscordant relationships and sexual concurrency are pathways that contribute to the HIV epidemic in sub-Saharan Africa. However whether polygyny imparts the same risks as informal concurrent relationships remains an open research question. Using data collected at enrolment from a cohort study of sero-discordant couples, this analysis investigates how polygynous relationships differ from those involving only a single female spouse and whether men involved in polygynous partnerships are more likely to report HIV-risk behaviour than those in single spouse partnerships. Of 444 enrolled couples, 111 (25%) were polygynous and 333 (75%) were single-spouse partnerships. We found that polygynous men were more likely to report controlling sexual decision-making and to report any unprotected sex with unknown sero-status partner. After controlling for potential confounders, polygynous men were still more likely to report unprotected sex with an unknown sero-status partner. In this sample of sero-discordant...

Gendered HIV risk patterns among polygynous sero-discordant couples in Uganda

Objective To compare the effects of polygyny (only men can form concurrent partnerships) and gender-symmetric concurrency (both genders can form concurrent partnerships) on prevalence of long-duration sexually transmitted infections (STIs) using a dynamic stochastic network model. Methods We modelled two pairs of scenarios: polygyny and gender symmetry at higher and lower levels of network concurrency (measured by the average number of concurrent partnerships per partnership). The same level of sexual activity was modelled in all scenarios (measured by mean per capita partnership incidence and per capita number of sex acts). Partnership duration and network concurrency were constant within each of the polygyny/symmetry pairs. Infections that mimicked characteristics of herpes simplex virus type 2 (HSV2) and HIV were introduced onto the networks separately. The mean prevalence 100 years after introduction for the HSV2-like infection and 30 years after introduction for the HIV-like infection were calculated over 1000 model iterations. Results Prevalence of both simulated STIs was significantly lower in the polygyny scenarios than in the symmetry scenarios. At lower concurrency, polygyny resulted in a relative reduction in HSV2-like infection prevalence of 19% (95% CI 15 to 23) compared to gender symmetry. At higher concurrency polygyny led to a relative reduction of 20% (16 to 23). The relative reduction in prevalence of the HIV-like infection after 30 years was 14% (10 to 17) at lower concurrency and 8% (5 to 11) at higher concurrency. Conclusions Polygyny can result in lower STI prevalence compared to populations where both genders practise concurrency. Further work is required to explore whether this reduction is observed when modelling more realistic populations and infection characteristics.

/pdf/polygyny-and-symmetric-concurrency-comparing-long-duration-42bwb81k7z.pdf

Polygyny and symmetric concurrency: comparing long-duration sexually transmitted infection prevalence using simulated sexual networks.

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Polygyny and symmetric concurrency: comparing long-duration sexually transmitted infection prevalence using simulated sexual networks.