Abstract
BackgroundSubstantial concern exists about the high risk of sexually transmitted HIV to adolescent girls and young women (AGYW, ages 15–24) in Eastern and Southern Africa. Yet limited research has been conducted with AGYW’s male sexual partners regarding their perspectives on relationships and strategies for mitigating HIV risk. We sought to fill this gap in order to inform the DREAMS Partnership and similar HIV prevention programs in Uganda.MethodsWe conducted 94 in-depth interviews, from April-June 2017, with male partners of AGYW in three districts: Gulu, Mukono, and Sembabule. Men were recruited at community venues identified as potential transmission areas, and via female partners enrolled in DREAMS. Analyses focused on men’s current and recent partnerships and HIV service use.ResultsMost respondents (80%) were married and 28 years old on average. Men saw partner concurrency as pervasive, and half described their own current multiple partners. Having married in their early 20s, over time most men continued to seek out AGYW as new partners, regardless of their own age. Relationships were highly fluid, with casual short-term partnerships becoming more formalized, and more formalized partnerships characterized by periods of separation and outside partnerships. Nearly all men reported recent HIV testing and described testing at distinct relationship points (e.g., when deciding to continue a relationship/get married, or when reuniting with a partner after a separation). Testing often stemmed from distrust of partner behavior, and an HIV-negative status served to validate respondents’ current relationship practices.ConclusionsAcross the three regions in Uganda, findings with partners of AGYW confirm earlier reports in Uganda of multiple concurrent partnerships, and demonstrate substantial HIV testing. Yet they also unearth the degree to which these partnerships are fluid (switching between casual and/or more long-term partnerships), which complicates potential HIV prevention strategies. Context-specific findings around these partnerships and risk are critical to further tailor HIV prevention programs.
Highlights
Eastern and Southern Africa, with only 6% of the world’s population, is home to half of the world’s people living with HIV, and contributed 46% of all new HIV infections in 2015 [1]
Men were recruited at community venues identified as potential transmission areas, and via female partners enrolled in DREAMS
A prominent example is the PEPFAR-supported DREAMS Partnership [11], which aims to decrease HIV incidence among AGYW across ten countries, including Uganda, by providing a package of evidence-based interventions, and intervening with AGYW but with their sexual partners, parents and communities Regarding men, DREAMS is focused on characterizing male partners of AGYW and engaging them in HIV services including HIV testing, voluntary medical male circumcision (VMMC), and antiretroviral treatment (ART) [11]
Summary
Eastern and Southern Africa, with only 6% of the world’s population, is home to half of the world’s people living with HIV, and contributed 46% of all new HIV infections in 2015 [1]. With about 1.3 million adults aged 15 to 49 living with HIV in the country and a prevalence of 7.3% [3], has recently seen some increases in both HIV prevalence and incidence [3, 4]. There has been recent increased attention on male partners within HIV prevention efforts for AGYW [9, 10]. Men tend to test for HIV and enter ART programs at a more advanced clinical stage than women and, as a consequence, have substantially higher morbidity and mortality [1, 12]. Substantial concern exists about the high risk of sexually transmitted HIV to adolescent girls and young women (AGYW, ages 15–24) in Eastern and Southern Africa.
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