Trends in concurrency, polygyny, and multiple sex partnerships during a decade of declining HIV prevalence in eastern Zimbabwe

Jeffrey W. Eaton, Felicia R. Takavarasha, Christina Schumacher, Owen Mugurungi, Geoffrey P. Garnett, Constance Nyamukapa, Simon Gregson

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Observed declines in the prevalence of human immunodeficiency virus (HIV) infection in Zimbabwe have been attributed to population-level reductions in sexual partnership numbers. However, it remains unknown whether certain types of sex partnerships were more important to this decline. Particular debate surrounds the epidemiologic importance of polygyny (the practice of having multiple wives).

METHODS: We analyze changes in reported multiple partnerships, nonmarital concurrency, and polygyny in eastern Zimbabwe during a period of declining HIV prevalence, from 1998 to 2011. Trends are reported for adult men (age, 17-54 years) and women (age, 15-49 years) from 5 survey rounds of the Manicaland HIV/STD Prevention Project, a general-population open cohort study.

RESULTS: At baseline, 34.2% of men reported multiple partnerships, 11.9% reported nonmarital concurrency, and 4.6% reported polygyny. Among women, 4.6% and 1.8% reported multiple partnerships and concurrency, respectively. All 3 partnership indicators declined by similar relative amounts (around 60%-70%) over the period. Polygyny accounted for around 25% of male concurrency. Compared with monogamously married men, polygynous men reported higher levels of subsequent divorce/separation (adjusted relative risk [RR], 2.92; 95% confidence interval [CI], 1.87-4.55) and casual sex partnerships (adjusted RR, 1.63; 95% CI, 1.41-1.88).

CONCLUSIONS: No indicator clearly dominated declines in partnerships. Polygyny was surprisingly unstable and, in this population, should not be considered a safe form of concurrency.

Original languageEnglish (US)
Pages (from-to)S562-S568
JournalJournal of Infectious Diseases
Volume210
DOIs
StatePublished - Dec 1 2014

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Zimbabwe
Marriage
HIV
Confidence Intervals
Population
Divorce
Virus Diseases
Sexually Transmitted Diseases
Spouses
Cohort Studies

Keywords

  • behavior change
  • concurrency
  • divorce
  • HIV
  • multiple partnerships
  • polygyny
  • Zimbabwe

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Trends in concurrency, polygyny, and multiple sex partnerships during a decade of declining HIV prevalence in eastern Zimbabwe. / Eaton, Jeffrey W.; Takavarasha, Felicia R.; Schumacher, Christina; Mugurungi, Owen; Garnett, Geoffrey P.; Nyamukapa, Constance; Gregson, Simon.

In: Journal of Infectious Diseases, Vol. 210, 01.12.2014, p. S562-S568.

Research output: Contribution to journalArticle

Eaton, Jeffrey W. ; Takavarasha, Felicia R. ; Schumacher, Christina ; Mugurungi, Owen ; Garnett, Geoffrey P. ; Nyamukapa, Constance ; Gregson, Simon. / Trends in concurrency, polygyny, and multiple sex partnerships during a decade of declining HIV prevalence in eastern Zimbabwe. In: Journal of Infectious Diseases. 2014 ; Vol. 210. pp. S562-S568.
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abstract = "BACKGROUND: Observed declines in the prevalence of human immunodeficiency virus (HIV) infection in Zimbabwe have been attributed to population-level reductions in sexual partnership numbers. However, it remains unknown whether certain types of sex partnerships were more important to this decline. Particular debate surrounds the epidemiologic importance of polygyny (the practice of having multiple wives).METHODS: We analyze changes in reported multiple partnerships, nonmarital concurrency, and polygyny in eastern Zimbabwe during a period of declining HIV prevalence, from 1998 to 2011. Trends are reported for adult men (age, 17-54 years) and women (age, 15-49 years) from 5 survey rounds of the Manicaland HIV/STD Prevention Project, a general-population open cohort study.RESULTS: At baseline, 34.2{\%} of men reported multiple partnerships, 11.9{\%} reported nonmarital concurrency, and 4.6{\%} reported polygyny. Among women, 4.6{\%} and 1.8{\%} reported multiple partnerships and concurrency, respectively. All 3 partnership indicators declined by similar relative amounts (around 60{\%}-70{\%}) over the period. Polygyny accounted for around 25{\%} of male concurrency. Compared with monogamously married men, polygynous men reported higher levels of subsequent divorce/separation (adjusted relative risk [RR], 2.92; 95{\%} confidence interval [CI], 1.87-4.55) and casual sex partnerships (adjusted RR, 1.63; 95{\%} CI, 1.41-1.88).CONCLUSIONS: No indicator clearly dominated declines in partnerships. Polygyny was surprisingly unstable and, in this population, should not be considered a safe form of concurrency.",
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N2 - BACKGROUND: Observed declines in the prevalence of human immunodeficiency virus (HIV) infection in Zimbabwe have been attributed to population-level reductions in sexual partnership numbers. However, it remains unknown whether certain types of sex partnerships were more important to this decline. Particular debate surrounds the epidemiologic importance of polygyny (the practice of having multiple wives).METHODS: We analyze changes in reported multiple partnerships, nonmarital concurrency, and polygyny in eastern Zimbabwe during a period of declining HIV prevalence, from 1998 to 2011. Trends are reported for adult men (age, 17-54 years) and women (age, 15-49 years) from 5 survey rounds of the Manicaland HIV/STD Prevention Project, a general-population open cohort study.RESULTS: At baseline, 34.2% of men reported multiple partnerships, 11.9% reported nonmarital concurrency, and 4.6% reported polygyny. Among women, 4.6% and 1.8% reported multiple partnerships and concurrency, respectively. All 3 partnership indicators declined by similar relative amounts (around 60%-70%) over the period. Polygyny accounted for around 25% of male concurrency. Compared with monogamously married men, polygynous men reported higher levels of subsequent divorce/separation (adjusted relative risk [RR], 2.92; 95% confidence interval [CI], 1.87-4.55) and casual sex partnerships (adjusted RR, 1.63; 95% CI, 1.41-1.88).CONCLUSIONS: No indicator clearly dominated declines in partnerships. Polygyny was surprisingly unstable and, in this population, should not be considered a safe form of concurrency.

AB - BACKGROUND: Observed declines in the prevalence of human immunodeficiency virus (HIV) infection in Zimbabwe have been attributed to population-level reductions in sexual partnership numbers. However, it remains unknown whether certain types of sex partnerships were more important to this decline. Particular debate surrounds the epidemiologic importance of polygyny (the practice of having multiple wives).METHODS: We analyze changes in reported multiple partnerships, nonmarital concurrency, and polygyny in eastern Zimbabwe during a period of declining HIV prevalence, from 1998 to 2011. Trends are reported for adult men (age, 17-54 years) and women (age, 15-49 years) from 5 survey rounds of the Manicaland HIV/STD Prevention Project, a general-population open cohort study.RESULTS: At baseline, 34.2% of men reported multiple partnerships, 11.9% reported nonmarital concurrency, and 4.6% reported polygyny. Among women, 4.6% and 1.8% reported multiple partnerships and concurrency, respectively. All 3 partnership indicators declined by similar relative amounts (around 60%-70%) over the period. Polygyny accounted for around 25% of male concurrency. Compared with monogamously married men, polygynous men reported higher levels of subsequent divorce/separation (adjusted relative risk [RR], 2.92; 95% confidence interval [CI], 1.87-4.55) and casual sex partnerships (adjusted RR, 1.63; 95% CI, 1.41-1.88).CONCLUSIONS: No indicator clearly dominated declines in partnerships. Polygyny was surprisingly unstable and, in this population, should not be considered a safe form of concurrency.

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