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Measuring Prevalence and Correlates of Concurrent Sexual Partnerships Among Young Sexually Active Men in Kisumu, Kenya

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Abstract

Our objectives were to: (1) compare multiple measures of partnership concurrency, including the UNAIDS-recommended definition and (2) describe the prevalence and correlates of concurrent sexual partnerships among young Kenyan men. We analyzed 10,907 lifetime partnerships of 1,368 men ages 18–24 years enrolled in a randomized trial of male circumcision to reduce HIV-1 incidence in Kisumu. Partnership concurrency was determined by overlapping dates and examined over varying recall periods and assumptions. The lifetime prevalence of concurrency was 77 %. Sixty-one percent of all partnerships were concurrent and factors associated with concurrency differed by partner type. Point prevalence of concurrency at the time of the interview was consistently the highest and UNAIDS-recommended definition was the most conservative (25 vs. 18 % at baseline, respectively). Estimates of concurrency were influenced by methods for definition and measurement. Regardless of definition, concurrent partnerships are frequent in this population of young, sexually active men in high HIV prevalence Kisumu, Kenya.

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References

  1. Epstein H, Morris M. Concurrent partnerships and HIV: an inconvenient truth. J Int AIDS Soc. 2011;14(13):13.

    Article  PubMed  Google Scholar 

  2. Lurie M, Rosenthal S, Williams B. Concurrency driving the African HIV epidemics: where is the evidence? Lancet. 2009;374(9699):1420. author reply-1.

    Article  PubMed  Google Scholar 

  3. Lurie MN, Rosenthal S. The concurrency hypothesis in Sub-Saharan Africa: convincing empirical evidence is still lacking. Response to Mah and Halperin, Epstein, and Morris. AIDS Behav. 2010;14(1):34.

    Article  PubMed  Google Scholar 

  4. Lurie MN, Rosenthal S. Concurrent partnerships as a driver of the HIV Epidemic in Sub-Saharan Africa? The evidence is limited. AIDS Behav. 2010;14(1):17–24. discussion 5–8.

    Article  PubMed  Google Scholar 

  5. Epstein H. The mathematics of concurrent partnerships and HIV: a commentary on Lurie and Rosenthal, 2009. AIDS Behav. 2010;14(1):29–30. discussion 4–7.

    Article  PubMed  Google Scholar 

  6. Morris M. Barking up the wrong evidence tree. Comment on Lurie & Rosenthal, “Concurrent partnerships as a driver of the HIV epidemic in Sub-Saharan Africa? The evidence is limited”. AIDS Behav. 2010;14(1):31–3. discussion 4–7.

    Article  PubMed  Google Scholar 

  7. Mah TL, Halperin DT. Concurrent sexual partnerships and the HIV epidemics in Africa: evidence to move forward. AIDS Behav. 2010;14(1):11–6. discussion 34–7.

    Article  PubMed  Google Scholar 

  8. Kalichman SC, Grebler T. Reducing numbers of sex partners: do we really need special interventions for sexual concurrency? AIDS Behav. 2010;14(5):987–90.

    Article  PubMed  Google Scholar 

  9. Watts CH, May RM. The influence of concurrent partnerships on the dynamics of HIV/AIDS. Math Biosci. 1992;108(1):89–104.

    Article  PubMed  CAS  Google Scholar 

  10. Kretzschmar M, Morris M. Measures of concurrency in networks and the spread of infectious disease. Math Biosci. 1996;133(2):165–95.

    Article  PubMed  CAS  Google Scholar 

  11. Morris M, Kretzschmar M. Concurrent partnerships and the spread of HIV. AIDS. 1997;11(5):641–8.

    Article  PubMed  CAS  Google Scholar 

  12. Eaton JW, Hallett TB, Garnett GP. Concurrent sexual partnerships and primary HIV infection: a critical interaction. AIDS Behav. 2011;15(4):687–92.

    Article  PubMed  Google Scholar 

  13. Powers KA, Ghani AC, Miller WC, et al. The role of acute and early HIV infection in the spread of HIV and implications for transmission prevention strategies in Lilongwe, Malawi: a modelling study. Lancet. 2011;378(9787):256–68.

    Article  PubMed  Google Scholar 

  14. Mermin J, Musinguzi J, Opio A, et al. Risk factors for recent HIV infection in Uganda. JAMA. 2008;300(5):540–9.

    Article  PubMed  CAS  Google Scholar 

  15. Koumans EH, Farley TA, Gibson JJ, et al. Characteristics of persons with syphilis in areas of persisting syphilis in the United States: sustained transmission associated with concurrent partnerships. Sex Transm Dis. 2001;28(9):497–503.

    Article  PubMed  CAS  Google Scholar 

  16. Potterat JJ, Zimmerman-Rogers H, Muth SQ, et al. Chlamydia transmission: concurrency, reproduction number, and the epidemic trajectory. Am J Epidemiol. 1999;150(12):1331–9.

    Article  PubMed  CAS  Google Scholar 

  17. Morris M, Epstein H, Wawer M. Timing is everything: international variations in historical sexual partnership concurrency and HIV prevalence. PLoS ONE. 2010;5(11):e14092.

    Article  PubMed  Google Scholar 

  18. Tanser F, Bärnighausen T, Hund L, et al. Effect of concurrent sexual partnerships on rate of new HIV infections in a high-prevalence, rural South African population: a cohort study. Lancet. 2011;378(9787):247–55.

    Article  PubMed  Google Scholar 

  19. Ferry B, Carael M, Buve A, et al. Comparison of key parameters of sexual behaviour in four African urban populations with different levels of HIV infection. AIDS. 2001;15(Suppl 4):S41–50.

    Article  PubMed  Google Scholar 

  20. Kwena ZA, Bukusi EA, Ng’ayo MO, et al. Prevalence and risk factors for sexually transmitted infections in a high-risk occupational group: the case of fishermen along Lake Victoria in Kisumu, Kenya. Int J STD AIDS. 2010;21(10):708–13.

    Article  PubMed  CAS  Google Scholar 

  21. Kenyon C, Boulle A, Badri M, Asselman V. “I don’t use a condom (with my regular partner) because I know that I’m faithful, but with everyone else I do”: the cultural and socioeconomic determinants of sexual partner concurrency in young South Africans. SAHARA J. 2010;7(3):35–43.

    Article  PubMed  Google Scholar 

  22. Carter MW, Kraft JM, Koppenhaver T, et al. “A bull cannot be contained in a single kraal”: concurrent sexual partnerships in Botswana. AIDS Behav. 2007;11(6):822–30.

    Article  PubMed  Google Scholar 

  23. Xu H, Luke N, Msiyaphazi Zulu E. Concurrent sexual partnerships among youth in urban Kenya: prevalence and partnership effects. Popul Stud (Camb). 2010;64(3):247–61.

    Article  Google Scholar 

  24. Sandoy IF, Dzekedzeke K, Fylkesnes K. Prevalence and correlates of concurrent sexual partnerships in Zambia. AIDS Behav. 2010;14(1):59–71.

    Article  PubMed  Google Scholar 

  25. Voeten HA, Egesah OB, Habbema JD. Sexual behavior is more risky in rural than in urban areas among young women in Nyanza province, Kenya. Sex Transm Dis. 2004;31(8):481–7.

    Article  PubMed  Google Scholar 

  26. Kajubi P, Green EC, Hudes ES, et al. Multiple sexual partnerships among poor urban dwellers in Kampala, Uganda. J Acquir Immune Defic Syndr. 2011;57(2):153–6.

    Article  PubMed  Google Scholar 

  27. Steffenson AE, Pettifor AE, Seage GR 3rd, Rees HV, Cleary PD. Concurrent sexual partnerships and human immunodeficiency virus risk among South African youth. Sex Transm Dis. 2011;20:20.

    Google Scholar 

  28. Harrison A, Cleland J, Frohlich J. Young people’s sexual partnerships in KwaZulu-Natal, South Africa: patterns, contextual influences, and HIV risk. Stud Fam Plann. 2008;39(4):295–308.

    Article  PubMed  Google Scholar 

  29. Lagarde E, Auvert B, Carael M, et al. Concurrent sexual partnerships and HIV prevalence in five urban communities of Sub-Saharan Africa. AIDS. 2001;15(7):877–84.

    Article  PubMed  CAS  Google Scholar 

  30. Clark S, Kabiru C, Mathur R. Relationship transitions among youth in urban Kenya. J Marriage Fam. 2010;72(1):73–88.

    Article  PubMed  Google Scholar 

  31. UNAIDS. HIV: consensus indicators are needed for concurrency. Lancet. 2010;375(9715):621–2.

    Article  Google Scholar 

  32. Glynn JR, Dube A, Kayuni N, et al. Measuring concurrency: an empirical study of different methods in a large population-based survey and evaluation of the UNAIDS guidelines. AIDS. 2012;26(8):977–85.

    Article  PubMed  Google Scholar 

  33. Helleringer S, Kohler HP, Kalilani-Phiri L, Mkandawire J, Armbruster B. The reliability of sexual partnership histories: implications for the measurement of partnership concurrency during surveys. AIDS. 2011;25(4):503–11.

    Article  PubMed  Google Scholar 

  34. Maughan-Brown B, Venkataramani AS. Measuring concurrent partnerships: potential for underestimation in UNAIDS recommended method. AIDS. 2011;25(12):1549–51.

    Article  PubMed  Google Scholar 

  35. Nelson SJ, Manhart LE, Gorbach PM, et al. Measuring sex partner concurrency: it’s what’s missing that counts. Sex Transm Dis. 2007;34(10):801–7.

    PubMed  Google Scholar 

  36. Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007;369(9562):643–56.

    Article  PubMed  Google Scholar 

  37. Mattson CL, Bailey RC, Agot K, Ndinya-Achola JO, Moses S. A nested case-control study of sexual practices and risk factors for prevalent HIV-1 infection among young men in Kisumu, Kenya. Sex Transm Dis. 2007;34(10):731–6.

    PubMed  Google Scholar 

  38. Mattson CL, Campbell RT, Bailey RC, et al. Risk compensation is not associated with male circumcision in Kisumu, Kenya: a multi-faceted assessment of men enrolled in a randomized controlled trial. PLoS ONE. 2008;3(6):e2443.

    Article  PubMed  Google Scholar 

  39. Mattson CL, Campbell RT, Karabatsos G, et al. Scaling sexual behavior or “sexual risk propensity” among men at risk for HIV in Kisumu, Kenya. AIDS Behav. 2010;14(1):162–72.

    Article  PubMed  CAS  Google Scholar 

  40. Westercamp N, Mattson CL, Madonia M, et al. Determinants of consistent condom use vary by partner type among young men in Kisumu, Kenya: a multi-level data analysis. AIDS Behav. 2010;14(4):949–59.

    Article  PubMed  Google Scholar 

  41. Carey MP, Carey KB, Maisto SA, Gordon CM, Weinhardt LS. Assessing sexual risk behaviour with the Timeline Followback (TLFB) approach: continued development and psychometric evaluation with psychiatric outpatients. Int J STD AIDS. 2001;12(6):365–75.

    Article  PubMed  CAS  Google Scholar 

  42. Hu FB, Goldberg J, Hedeker D, Flay BR, Pentz MA. Comparison of population-averaged and subject-specific approaches for analyzing repeated binary outcomes. Am J Epidemiol. 1998;147(7):694–703.

    Article  PubMed  CAS  Google Scholar 

  43. Eaton JW, McGrath N, Newell ML. Unpacking the recommended indicator for concurrent sexual partnerships. AIDS. 2012;26(8):1037–9.

    Article  PubMed  Google Scholar 

  44. Manhart LE, Aral SO, Holmes KK, Foxman B. Sex partner concurrency: measurement, prevalence, and correlates among urban 18–39-year-olds. Sex Transm Dis. 2002;29(3):133–43.

    Article  PubMed  Google Scholar 

  45. Adimora AA, Schoenbach VJ, Martinson F, et al. Concurrent sexual partnerships among African-Americans in the rural south. Ann Epidemiol. 2004;14(3):155–60.

    Article  PubMed  Google Scholar 

  46. NACC, NASCOP. Kenya AIDS Epidemic update 2011. Nairobi, Kenya. 2012.

  47. Kenya National Bureau of Statistics (KNBS), ICF Macro. Kenya Demographic and Health Survey 2008–09. 2010.

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Acknowledgments

This work was funded by the Division of AIDS, NIAID, NIH. R. C. Bailey was supported by the NIH funded Chicago Developmental Center for Aids Research. We thank all of the participants, without whom this work would not have been possible. We are grateful to Nicholas Ouma, Evans Otieno, Bob Ogollah, Kevine Amolloh, and the entire UNIM Project staff for their assistance in data collection and recruitment. C. L. Mattson and R. C. Bailey designed the study; C. L. Mattson carried out the study; N. Westercamp analyzed the data and drafted the paper; all authors reviewed and edited the final manuscript.

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Correspondence to Nelli Westercamp.

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Westercamp, N., Mattson, C.L. & Bailey, R.C. Measuring Prevalence and Correlates of Concurrent Sexual Partnerships Among Young Sexually Active Men in Kisumu, Kenya. AIDS Behav 17, 3124–3132 (2013). https://doi.org/10.1007/s10461-013-0457-5

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