Abstract
Background: Sexual partner concurrency has been implicated in the genesis of generalized HIV epidemic in South Africa. Most South Africans, however, disapprove of concurrency in surveys. These surveys test individuals' explicit attitudes which are susceptible to a number of important biases such as the social desirability bias. Assessment of implicit cognitions have been found to be better predictors of behaviour in socially sensitive domains. We hypothesized that South Africans may have implicit attitudes more tolerant of concurrency than lower concurrency prevalence populations. Methods: To test this hypothesis, we developed a concurrency-implicit association test (C-IAT) and compared the C-IATs of samples of South African and Belgian university students. Results: We found a large and statistically significant difference in the C-IAT between the South Africans (D600-score = -0.009, indicating absence of preference for concurrency or monogamy) and Belgians (D600-score = 0.783, indicating a strong preference for monogamy; t-test = 13.3; P < 0.0001). The effect size measure, Cohen's d, was found to be 0.88, which is considered a large effect size in this field. Conclusions: Our results are compatible with the thesis that differences in implicit attitudes to concurrency play a role in the genesis of generalised HIV epidemics.
Highlights
A higher prevalence of sexual partner concurrency, were an individual has a series of overlapping sexual partners at once, is one of the factors implicated in the genesis of generalized HIV epidemics in Southern and Eastern Africa1–3
The Implicit Association Tests (IATs) results for the study populations in South Africa and Belgium were both normally distributed with a similar variance
We found that 20.0% of South Africans versus 1.4% of Belgians agreed with this statement (P < 0.001)
Summary
A higher prevalence of sexual partner concurrency, were an individual has a series of overlapping sexual partners at once, is one of the factors implicated in the genesis of generalized HIV epidemics in Southern and Eastern Africa. A quantitative analysis of South African survey data, found that most men and women disapproved of concurrency9 This discrepancy may be partly explained by the way that the social desirability bias may affect the accuracy of self-reported data pertaining to socially sensitive topics such as sexual norms. 1. On page 3, the authors state: “(ii) if the variation between these two populations involves a difference in behavior of ‘core-groups’ or general population shifts (iii) the correlation between implicit and explicit attitudes to concurrency and reporting that one has engaged in concurrency at both individual and population levels”. Conclusions: Our results are compatible with the thesis that differences in implicit attitudes to concurrency play a role in the genesis of generalised HIV epidemics
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