Background Modelling and empirical evidence suggest that population differences in the practice of concurrent sexual partnership could be the most important explanation of the observed heterogeneity in HIV epidemic in sub-Saharan Africa. Biomedical and some behavioural evidence have not sufficiently explained the variation. This study aimed at comparing the rate of concurrent sexual partnerships among adolescents in Arusha, Tanzania and Polokwane, South Africa, two areas with contrasting level of HIV magnitude.
Methods A baseline cross-sectional study involving junior secondary school adolescents in Arusha, Tanzania and Polokwane South Africa was conducted in 2010 as part of the school-based Health Intervention project (LASH). Adolescents from 12 randomly selected schools from each country were interviewed regarding their socio-demographic characteristics, sexual behaviours and substance use. Data were entered and analysed using SPSS statistical package.
Results A total of 2408 adolescents from Arusha and 1649 from Polokwane participated in the study. Adolescent interviewed in Arusha were significantly older than their Polokwane counterpart (Mean age (SD) 19.3(0.5) and 15.5(0.7), respectively, p<0.001). The overall prevalence's of reported multiple concurrent sexual partnerships were 9.2% in Arusha and 25.2% in Polokwane (OR, 3.7, 95% CI 3.0 to 4.7. Both males and Females adolescents from Polokwane were significantly more likely to report concurrent sexual partnerships than those from Arusha (p<0.001). Moreover, adolescents from Polokwane reported practice of other HIV risk behaviours as compared to those in Arusha (p<0.001). History of sexual experience (vaginal, oral, anal), ever use of condom and substance use were independent predictors of multiple concurrent sexual partnerships in both sites.
Conclusions High practice of multiple concurrent sexual partnerships among adolescent living in high HIV prevalent area as compared to those in low prevalence area indicate that concurrent partnership could be the most important explanation of the observed heterogenic HIV transmission in sub-Saharan Africa. Being sexually active and substance use predict practice of concurrent sexual partnerships among adolescents. Delaying sexual debut and addressing substance use among adolescents may have a significant impact on HIV epidemic.
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