Secretive females or swaggering males?: An assessment of the quality of sexual partnership reporting in rural Tanzania

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Abstract

In population-based surveys on sexual behaviour, men consistently report higher numbers of sexual partners than women, which may be associated with male exaggeration or female under-reporting or with issues related to sampling, such as exclusion of female sex workers. This paper presents an analysis of data collected in the context of a longitudinal study in rural Tanzania, where a sexual partnership module was applied to all participating men and women in the study population. Since the study design included all men and women of reproductive ages and did not involve sampling, these data provide a unique opportunity to compare the consistency of aggregate measures of sexual behaviour between men and women living in the same villages.

The analysis shows that non-marital partnerships were common amongst single people of both sexes—around 70% of unmarried men and women report at least one sexual partner in the last year. However, 40% of married men also report having non-marital partners, but only 3% of married women did so. Single women reported about half as many multiple partnerships in the last year as men. Under-reporting of non-marital partnerships was much more common among single women than among married women and men. Furthermore, women were more likely to report longer duration partnerships and partnership with urban men or more educated men than with others. If a woman reports multiple partners, biological data indicate that she is at high risk of contracting HIV. For men, however, there is only a weak association between number of partnerships and the risk of HIV, and it cannot be excluded that men, especially single men, exaggerate the number of sexual partners.

Introduction

Surveys have been the primary mode of collection of data on sexual behaviour in the era of AIDS. Initially, the focus of international standardized surveys, such as WHO/GPA surveys and Demographic and Health Surveys, was on initiation of sex, numbers of sexual partners and condom use, with little detailed information on types and characteristics of partnerships (Cleland & Ferry, 1995). In such surveys, men consistently report higher numbers of sexual partners than women, which may be associated with male exaggeration or female under-reporting or with issues related to sampling, such as exclusion of female sex workers (Dare & Cleland, 1994).

Empirical data and epidemiological models have shown the importance of sexual partnership patterns for the spread of HIV and other sexually transmitted infections (STIs). Patterns of interest include behavioural heterogeneity (the extent to which the rate of new partner acquisition varies within the population), partner concurrency (the extent to which partnerships overlap or are sequential) and sexual mixing (the extent to which partner selection is not random) (Morris & Kretzschmar, 1997; Anderson, 1999, pp. 25–37). Therefore, the emphasis in survey data collection has shifted to obtaining better data on types and characteristics of partnerships. UNAIDS (1998) developed a sexual partnership questionnaire, which was used in a four city study in sub-Saharan Africa (Carael & Holmes, 2001; Buve et al., 2001).

This paper presents an analysis of data collected in a longitudinal study in rural Tanzania, where sexual partnership questions were asked of all participating men and women in the study population. Since the study design included all men and women of reproductive ages and did not involve sampling, these data provide a unique opportunity to compare the consistency of aggregate measures of sexual behaviour between men and women. By focusing on the subset of reports about recent partners in the age range eligible for interview and living in the same villages, we deal with those partnerships that should be fully reported by both sides. If reporting is unbiased, we hypothesize that the numbers and characteristics of male partners reported by females should match those of male respondents, and vice versa. By comparing the extent of risky sexual behaviour with biological markers of HIV infection (prevalence and incidence) we can investigate whether the pattern of risk reporting is consistent with disease outcome.

Section snippets

Methods

The study was carried out in Kisesa ward in Mwanza Region, Tanzania. A ward is an administrative entity that falls under a division of a district and is divided into smaller administrative units, such as village, sub-village and ‘balozi’ (10 households). Kisesa ward had a population of 20,000 in 1994 and lies about 20 km east of the regional capital, Mwanza, along the main road to Kenya. It comprises six villages and a trading centre situated on the main road, grouped into trading centre,

Results

A total of 3684 respondents took part in the sexual network survey (1651 men and 2033 women). Based on listings of the household population in the four villages, this represented approximately 84% participation by women and 77% by men. Reports were obtained on a total of 1130 male and 803 female spouses, and 549 male and 1990 female non-marital partners, with whom respondents had sexual relations in the last year. Just over 55% of males and slightly fewer than 30% of females were unmarried, 4%

Discussion

The analysis shows that non-marital partnerships are common amongst single people of both sexes—around 70% of un-married men and women report at least one sexual partner in the last year. However, 40% of married men also report having non-marital partners, whereas only 3% of married women do so. Single women report about half as many multiple partnerships within the year as men, and only one-fifth as many overlapping partnership episodes as are reported by single men.

The overall mean number of

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