Multiple Concurrent Partnerships Research Articles

Editor's Note: Black and Polyamorous

Editor's NoteBlack and Polyamorous Ruby Bouie Johnson (bio) The dominant culture (cisgender, white, male, middle class, Christian, monogamous, etc.) has created a hegemonic model and philosophy for intimate and/or romantic relationships in U.S society. Monogamy is that model. A definition of monogamy is being in a relationship or married with one person at a time. Some definitions, explicitly identify a dynamic between a man and a woman. As a result of the internet and the rapid exchange of information, there is an exposure to alternative relational dynamics. Polyamory is an alternative. The translation of polyamory is poly is Greek for "many" (or "multiple") and "amor" is Latin for "love." One can define polyamory [poly] as the possibility of having multiple concurrent partnerships that are romantic or platonic with everyone's consent and awareness. There is not an assignment of gender, sexual orientation, or goal to escalate relationships to marriage. The poly relationship's configuration, goals, and duration are determined by the individuals within the relationship versus dominant social norms. The difficulties with transitioning from a monogamy to polyamory is that there are very few studies, books, or social structures (e.g., media, television shows, fairytales, church, families, movies, etc.) devoted to polyamory. The concept of polyamory and the possibility of a myriad of relational configurations is slowly becoming an option that many are choosing. In the article, Updated Estimate of Number of Nonmonogamous People in the US, Sheff (2019) states that approximately 21% of people in the U.S. have participated in a form of consensual nonmonogamy (i.e. swinging, polyamory, open marriage/relationship, etc.). Furthermore, within the study, Sheff (2019) reports that there is very little variation across demographics including race. [End Page vii] Polyamory and Black Partnership: A New Relational Dynamic As a sex therapist, my private practice consists predominantly of clients in polyamorous relationships. I have found that the shared racial and cultural backgrounds are invaluable when navigating the transition from monogamous to polyamorous relationships. A sense of solidarity, common experiences, and shared history create comfort, reliability, and security within Black relationships. Individuals need security and familiarity as they gain the knowledge and develop the relational skills that are necessary to thrive within poly relationships. Communication, negotiation, and boundary development are some of the relational skills that strengthen and secure the connections. Navigating the space of a dyadic relationship lends itself to the comfort of "it's you and me against the world." The comfort of the unspoken "I see you" is a strength of intraracial relationships. Regardless of the relationship structure, the need for belonging and significance to another does not change. For the Black community, there are cultural, historical, and political ties that bind the community together that are unique to the Black experience. In the past, and sometimes in the present, Black people congregating and connecting with others in public has been illegal. The dominant culture (white, cisgender male, middle class, heterosexual, conservative, Christian) uses isolation and alienation as weapons to negatively skew relational ties. Polyamory is about building relationships and connections. To build relationships and connections, there needs to be likeminded people that share the same intentions within relationships. In my experience, I have found kinship (i.e. intentional family) and solidarity (i.e. "We are in this together.") are inherent attributes of Black polyamorous communities. These same attributes create an opportunity for those who are questioning, curious, or experienced with polyamory to find help, guidance, and support from community members who look like them or possibly identify with the culture or experiences of Black history or culture. Black and Polyamorous Community The underrepresentation and invisibility of the Black polyamorist in the media, dearth of popular social networks in the poly community; and absence of large scale polyamorous events offer the impression that there are very few Black people who are poly. This was the experience of Ron Young a few decades ago. In various podcasts and interviews, Mr. Young discusses [End Page viii] the challenges of being the only black person or one of a few at poly social and online spaces. As a result, Ron founded Black and Poly™. Black and Poly™ is one of the...

Factors influencing sexually transmissible infection disclosure to male partners by HIV-positive pregnant women in Pretoria townships, South Africa: a qualitative study.

A qualitative study was nested in a STI-TT intervention to investigate motivating and enabling factors associated with STI test results disclosure to sexual partners. A semi-structured interview protocol covered partner communication, HIV and STI disclosure, financial security and relationships dynamics. Interviews were conducted in participants' preferred language, audio-recorded, transcribed into English and analysed using a constant comparison approach. The study was conducted in two townships in Pretoria, South Africa. Twenty-eight HIV-positive pregnant women were interviewed. Based on the interviews, two disclosure experiences for women were identified - those with vulnerable experiences and those with self-enabling experiences within their partnerships. Vulnerable women discussed intimate partner violence (IPV) and fear of relationship dissolution as factors influencing their test result disclosure. Self-enabled women discussed their ability to talk with their partners about STI and HIV infections and the influence of multiple concurrent partnerships in the acquisition of HIV/STIs. Both groups of women were concerned about men's health behaviours, and all cited the health and development of their unborn child as a key motivator for test result disclosure. Improved counselling and support for pregnant women to disclose their STI test results to their partners may improve the impact of STI diagnostic testing during pregnancy by improving partner treatment uptake and thus reducing the risk of re-infection.

Application of Core Processes for Understanding Multiple Concurrent Sexual Partnerships Among Adolescents in Uganda.

Introduction: Adolescents in Uganda, as in other sub-Saharan countries, engage in sex with multiple concurrent partners, thus placing them at risk for HIV and unplanned pregnancies, but it is not clear why. This study explored why adolescents in Uganda engage in multiple concurrent sexual partnerships (MCSP).Methods: This study used a Core Processes methodology. We used the processes of brainstorming, and identification of evidence and theoretical support, in various phases/steps of intervention planning, to provide possible explanations for adolescent MCSP.Results: Adolescents were found to have limited knowledge of the risks associated with MCSP and perceived a low risk for HIV. Peer influence to engage in MCSP exacerbated the problem among adolescents. Poor communication with sexual partners and parents and societal indifference to multiple sexual partnerships increased permissive attitudes toward infidelity. The unclear adolescent sexual and reproductive health policies hampered access to services, and transactional sexual relationships with older (polygamous) sexual partners increased the HIV risk. Adolescents were found to be more concerned about unplanned pregnancies than HIV risk.Discussion: From the empirical evidence, adolescent health programs in Uganda should incorporate comprehensive sexual health education on HIV and teenage pregnancy risk-reduction strategies. Programs should strengthen parental and community support through enhanced collaborative training on communication with and for adolescents. Forming strategic partnerships with various stakeholders for concerted efforts to address the MCSP problem among adolescents is critical.

Male partners of young women in Uganda: Understanding their relationships and use of HIV testing.

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.

Adolescents Discussing Sexual Behaviors With Key Influencing Audiences

There is an increasing concern on early initiation of sexual activity among adolescents, increasing sexually transmitted infections, and teenage pregnancy in Uganda. Adolescents perceptions of these sexual behaviors might be the result of discussing sexual and reproductive health issues with key influencing audiences. This study qualitatively explored the effect of sexuality discussions with key influencing audiences by means of in-depth interviews and focus group discussions with adolescents (N=83). Findings indicate that adolescence stage comes with changes of intense sexual desires, often presumed difficult to control thus leading adolescents to engage in sexual activities. Adolescents indicated that they were aware of the sexual behaviors such as condom use, contraception use, and multiple concurrent partnerships, but intertwined with persistent myths and misconceptions. Although discussing sexuality issues with someone was found to be instrumental, adolescent highlighted challenges that hinder discussion with key influencers. Challenges include, parents lack of time to talk to their children; some religious affiliations perceived to discourage use of contraception; limited skills of community health workers to address adolescent information needs; meetings held in groups not followed up with age-focused or one-on-one discussions; negative health workers’ attitudes and use of technical language; and peer pressure. These findings suggest the need to provide adequate and updated information to clear any misconceptions and strengthening of key influencers’ communication skills to gain confidence in addressing adolescent sexual and reproductive health needs.

Extra mouths to feed: The odds of young mothers engaging in transactional sexual relationships in South Africa

Transactional sexual relationships (TSRs) are of concern because of the negative health outcomes associated with the practice. Lack of condom use and multiple concurrent partnerships increase the r...

Partner preferences in the context of concurrency: What Himba want in formal and informal partners

Abstract Research on human mate preferences that distinguishes between short- and long-term partners has been conducted mainly in industrialized societies, where multiple mating and concurrent partnerships are stigmatized. However, cross-culturally, there is significant variation in the frequency and the level of acceptance of such relationships. Furthermore, the dichotomy between short- and long-term partnerships does not fully describe the diversity in actual extra-pair behavior, which ranges from single sexual encounters to multi-year love affairs. Here we present another comparison, between formal (marital) and informal (non-marital) partners, which we feel better captures this diversity. We assess the traits that men and women prefer in each type of partner among Himba pastoralists, where concurrent partnerships are common and accepted for both sexes. We situate our findings in relation to three main explanations for concurrent partnerships: dual-mating, trading-up and multiple investors. We find some similarities with the existing literature in the traits that are listed as important, including physical attractiveness, wealth and intelligence. Our evidence suggest that Himba men follow a dual strategy, preferring hard-working wives and attractive girlfriends. Women's preferences align most strongly with a multiple investors explanation, most clearly articulated through their preferences for wealthy husbands and generous boyfriends. Limited support is also found for a dual-mating strategy in women. These findings suggest that local cultural norms and ecologies modulate mate preferences in important ways.

Age-Related Differences in Socio-demographic and Behavioral Determinants of HIV Testing and Counseling in HPTN 043/NIMH Project Accept

Youth represent a large proportion of new HIV infections worldwide, yet their utilization of HIV testing and counseling (HTC) remains low. Using the post-intervention, cross-sectional, population-based household survey done in 2011 as part of HPTN 043/NIMH Project Accept, a cluster-randomized trial of community mobilization and mobile HTC in South Africa (Soweto and KwaZulu Natal), Zimbabwe, Tanzania and Thailand, we evaluated age-related differences among socio-demographic and behavioral determinants of HTC in study participants by study arm, site, and gender. A multivariate logistic regression model was developed using complete individual data from 13,755 participants with recent HIV testing (prior 12 months) as the outcome. Youth (18–24 years) was not predictive of recent HTC, except for high-risk youth with multiple concurrent partners, who were less likely (aOR 0.75; 95% CI 0.61–0.92) to have recently been tested than youth reporting a single partner. Importantly, the intervention was successful in reaching men with site specific success ranging from aOR 1.27 (95% CI 1.05–1.53) in South Africa to aOR 2.30 in Thailand (95% CI 1.85–2.84). Finally, across a diverse range of settings, higher education (aOR 1.67; 95% CI 1.42, 1.96), higher socio-economic status (aOR 1.21; 95% CI 1.08–1.36), and marriage (aOR 1.55; 95% CI 1.37–1.75) were all predictive of recent HTC, which did not significantly vary across study arm, site, gender or age category (18–24 vs. 25–32 years).

Changing Understandings of Gender and Parenthood in a North-Central Namibian Village

Gender and sexual behaviour have been in the spotlight when discussing reasons for the HIV/AIDS pandemic in sub-Saharan Africa and means of preventing further infections. Although many manifestations of these problems, in terms of gendered power balance, bedroom negotiation power, or multiple concurrent partnerships have been listed in various studies, the interaction between construction of gendered identity and gender aspects of AIDS awareness work needs more analysis. This article takes one northern Namibian village as a case study and looks more closely at how gendered identity construction is changing, and how AIDS educational campaigns interact with the discussion of gender at the local level. I argue that the status of parenthood is changing, in that supporting structures, such as marriage, the home and the joint responsibility of both parents for their children, are fading, although this does not yet show in the definitions of meme and tate – words used to describe women/mothers and men/fathers. This should be explored in educational material instead of concentrating on what are considered to be the negative sides of sexual behaviour.

Approaches to Sampling Gay, Bisexual, and Other Men Who Have Sex with Men from Geosocial-Networking Smartphone Applications: A Methodological Note

Geosocial-networking smartphone applications utilize global positioning system (GPS) technologies to connect users based on their physical proximity. Many gay, bisexual, and other men who have sex with men (MSM) have smartphones, and these new mobile technologies have generated quicker and easier modes for MSM to meet potential partners. In doing so, these technologies may facilitate a user’s ability to have multiple concurrent partners, thereby increasing their risk for acquiring HIV or other sexually transmitted infections. Researchers have sought to recruit users of these applications (e.g., Grindr, Jack’d, Scruff) into HIV prevention studies, primarily through advertising on the application. Given that these advertisements often broadly targeted large urban areas, these approaches have generated samples that are not representative of the population of users of the given application in a given area. As such, we propose a method to generate a spatially representative sample of MSM via direct messaging on a given application using New York City and its geography as an example of this sampling and recruitment method. These methods can increase geographic representativeness and wider access to MSM who use geosocial-networking smartphone applications.

Predictors of multiple concurrent and multiple sexual partnerships among male and female youth aged 18–24 in South Africa

This study aimed to determine predictors of multiple concurrent and multiple sexual partnerships among South African male and female youth. Data were from a cross-sectional population-based household survey of 3 123 youths aged 18 to 24 years from four South African provinces (males = 53.6%, blacks = 97.8%). Results from a sub-sample of being sexually active in the past 12 months (n = 1787) indicate that 5.3% (7.1% in males and 3.1% in females) youth participants had multiple concurrent sexual partners, and 38.8% (50.1% in males and 25.8% in females) had had two or more sexual partners in the past 12 months. Among females, multiple concurrent partnerships were only predicted by lower social network resources. Predictors of multiple sexual partnerships (two or more sexual partners in the past 12 months) among males included high HIV risk perception, never been tested for HIV and hazardous or harmful alcohol use. By contrast, among females, high peer pressure, lower education and ever having taken drugs predicted involvement with multiple sexual partners. Multi-level health promotion interventions are indicated for sexual behaviour change among South African youth.

Heavy Sexual Content Versus Safer Sex Content: A Content Analysis of the Entertainment Education Drama Shuga

ABSTRACTExtremely popular with Kenyan youth, the entertainment-education drama Shuga was designed with specific goals of promoting condom use, single versus multiple sexual partners, and destigmatization of HIV. Almost as soon as it aired, however, it generated controversy due to its extensive sexual themes and relatively explicit portrayal of sexual issues. To determine how safer sex, antistigma messages, and overall sexual content were integrated into Shuga, we conducted a content analysis. Results indicated that condom use and HIV destigmatization messages were frequently and clearly communicated. Negative consequences for risky sexual behavior were communicated over the course of the entire series. Messages about multiple concurrent partnerships were not evident. In addition, in terms of scenes per hour of programming, Shuga had 10.3 times the amount of sexual content overall, 8.2 times the amount of sexual talk, 17.8 times the amount of sexual behavior, and 9.4 times the amount of sexual intercourse as found in previous analysis of U.S. entertainment programming. Research is needed to determine how these factors may interact to influence adolescent viewers of entertainment education dramas.

“Once you join the streets you will have to do it”: sexual practices of street children and youth in Uasin Gishu County, Kenya

BackgroundAdolescents living in HIV endemic settings face unique sexual health risks, and in the context of abject poverty, orphanhood, social marginalization, and discrimination, adolescents may be particularly at-risk of horizontal HIV transmission. Street-connected children and youth are a particularly vulnerable and marginalized population and therefore may be a key population at-risk.MethodsWe sought to describe the sexual behaviours of street-connected children and youth in order to comprehend their sexual practices and elucidate circumstances that put them at increased risk of contracting HIV utilizing qualitative methods from a sample of street-connected children and youth in Eldoret, Kenya. We recruited participants aged 11–24 years who had lived on the street for ≥ 3 months to participate in 25 in-depth interviews and 5 focus group discussions stratified by age and sex.ResultsIn total we interviewed 65 street-connected children and youth; 69 % were male with a median age of 18 years (IQR: 14–20.5 years). Participants identified both acceptable and unacceptable sexual acts that occur on the streets between males and females, between males, and between females. We grouped reasons for having sex into four categories based on common themes: pleasure, procreation, transactional, and forced. Transactional sex and multiple concurrent partnerships were frequently described by participants. Rape was endemic to street life for girls.ConclusionThese findings have important policy and programming implications, specifically for the government of Kenya’s adolescent reproductive health policy, and highlight the need to target out-of-school youth. There is an urgent need for social protection to reduce transactional sex and interventions addressing the epidemic of sexual and gender-based violence.

Cross-sectional study assessing HIV-related knowledge, attitudes and behavior in the Namibian truck transport sector: Readjusting HIV prevention programs in the workplace.

The objectives of this study were to assess the current status of HIV-related knowledge, attitudes, and behavior (KAB) of employees in the private transport sector in Namibia and to compare companies with established HIV workplace program (WPPs) with those that have recently initiated the implementation of such programs. The study was designed as a cross-sectional questionnaire-based survey. Between January and March 2011, the survey was conducted in the Namibian truck transport sector in six companies of different sizes. The participants were selected randomly from the workforce. Data collection was based on a KAB questionnaire. The range of correct answers to the survey concerning the knowledge of HIV transmission was 67-95%. Twenty percent of the employees had never been tested for HIV. Additionally, risky sexual behaviors were quite prevalent and included having multiple concurrent partners and the use of sex for incentives. This study revealed that drivers and laborers were especially at risk for such behaviors. The employees of companies with established WPPs were tested for HIV more often than those of companies with new WPPs; however, aside from this difference, only minor differences were observed between the two groups. The findings of this study highlight the need for on-going HIV information and prevention campaigns that focus on the special needs of mobile and low-income workers. WPPs should be tailored accordingly and shift their focus to more practical approaches, such as voluntary counseling and testing (VCT), to increase their effectiveness.

The role of relationship types on condom use among urban men with concurrent partners in Ghana and Tanzania

Multiple concurrent partnerships are hypothesized to be important drivers of HIV transmission. Despite the demonstrated importance of relationship type (i.e., wife, girlfriend, casual partner, sex worker) on condom use, research on concurrency has not examined how different combinations of relationship types might affect condom use. We address this gap, using survey data from a sample of men from Ghana (GH: n = 807) and Tanzania (TZ: n = 800) who have at least three sexual partners in the past three months. We found that approximately two-thirds of men's reported relationships were classified as a girlfriend. Men were more likely to use a condom with a girlfriend if their other partner was a wife compared to if their other partner was a sex worker (GH: OR 3.10, 95% CI, 1.40, 6.86; TZ: OR 2.34, 95% CI 1.35, 4.06). These findings underscore the importance of considering relationship type when designing HIV prevention strategies in these settings.

Sexual and reproductive health and HIV in border districts affected by migration and poverty in Tanzania

Objectives To assess HIV knowledge, attitudes, sexual practices and sexual and reproductive health (SRH) service delivery in border areas of Tanzania, with a view to support the prioritisation of SRH interventions in border areas.Methods The target sample comprised randomly selected people living near the border, aged 15 to 49 years. To gather information, we utilised: (i) a standardised questionnaire (n = 86; 42 men and 44 women) previously used in national household surveys conducted by the Tanzanian government; (ii) focus group discussions (ten male groups, n = 47; ten female groups, n = 51); and (iii) semi-structured interviews with service providers (n = 37).Results The mean number of sexual partners, frequency of multiple concurrent partnerships and engagement in transactional sex were significantly higher in the border community than in the national population. Knowledge about HIV was comparable with that in the general population. Access to SRH services was limited in the border areas.Conclusion Efforts to reduce HIV transmission and to improve SRH in the border areas should focus on gaps in service delivery rather than education and information activities alone. In addition, multi-sectorial efforts spanning the health, social, legal and private sectors addressing gender imbalances and poverty alleviation are imperative for reducing poverty-driven unsafe transactional sex.Chinese 摘要 目的 为评估坦桑尼亚边境地区人群对于HIV的认知度与态度、性医学及性与生殖健康（sexual and reproductive health, SRH）工作的开展，优先支持边境地区的SRH干预。方法随机抽取边境地区15至49岁人群为目标样本。数据采集应用到：(i)标准化调查表（n = 86; 42男性与44女性），该调查表此前被坦桑尼亚政府用于全国家庭调查；(ii) 焦点小组讨论（10组男性，n = 47; 10组女性，n = 51）；(iii) 与医务人员的半结构式访谈（n = 37）。结果 边境地区人群的平均性伴侣数、同时多个性伴侣频率及参与性交易频率显著高于其他地区，对HIV的认知度与其他地区相当。边境地区SRH医疗水平低下。结论 要降低边境地区的HIV传播、提高SRH水平，应着重填补医疗空缺，而非单一进行教育、信息等宣传活动。此外，跨越多部门如卫生、社会、法律、私营部门，共同解决性别失衡与贫困扶持问题，是减少贫困驱使下不安全性交易的必要措施。

Partnership Concurrency and Coital Frequency

National HIV prevalence estimates across sub-Saharan Africa range from less than 1 percent to over 25 percent. Recent research proposes several explanations for the observed variation, including prevalence of male circumcision, levels of condom use, presence of other sexually transmitted infections, and practice of multiple concurrent partnerships. However, the importance of partnership concurrency for HIV transmission may depend on how it affects coital frequency with each partner. The coital dilution hypothesis suggests that coital frequency within a partnership declines with the addition of concurrent partners. Using sexual behavior data from rural Malawi and urban Kenya, we investigate the relationship between partnership concurrency and coital frequency, and find partial support for the coital dilution hypothesis. We conclude the paper with a discussion of our findings in light of the current literature on concurrency.

Sexual Risk Behavior and Symptoms of Historical Loss in American Indian Men

Native Americans in the United States are not typically regarded as a most at-risk population for HIV or other sexually transmitted infections (STIs), despite emerging evidence which suggests otherwise. As a result, Native Americans lack access to key prevention services and programs. In planning prevention programs for this unique population, however, it is important to take into account the cultural factors that may be implicated in health risk behaviors. Historical Loss is a type of historical trauma that has been reported in Native Americans, and which may be related to health behaviors. We examined whether Historical Loss was associated with sexual risk behaviors in a sample of 120 American Indian men living in Fort Peck Reservation in northeastern Montana who completed questions regarding Historical Loss and sexual risk behaviors. Symptoms of Historical Loss that reflected Anxiety/Depression and Anger/Avoidance were associated with an increased likelihood of individuals' having sex with multiple concurrent partners. Health interventions that aim to address HIV/STI prevention should take symptoms of Historical Loss into account, as Historical Loss could be a potential factor that will mitigate HIV, STI, and pregnancy prevention efforts in this population.

Estimating HIV Prevalence and HIV-Related Risk Behaviors Among Heterosexual Women Who Have Multiple Sex Partners Using Respondent-Driven Sampling in a High-Risk Community in South Africa

Repeated surveillance surveys are important for monitoring trends in HIV and risk behaviors over time. In countries most adversely affected by HIV and AIDS, community-level HIV biological and behavioral surveillance surveys are needed among subpopulations who engage in high-risk sexual behaviors. To describe the effectiveness of respondent-driven sampling (RDS) to recruit heterosexual women who have multiple concurrent sexual partnerships, to report HIV prevalence and describe key characteristics among them, and to assess whether RDS-accessed women not usually recruited during routine sentinel surveillance surveys. We conducted a HIV biological and behavioral surveillance surveys using RDS among women. Participants completed an audio-computer-assisted survey interview, voluntarily provided dried blood spots for HIV testing, and were offered rapid HIV testing. The analytical sample comprised 845 women whose mean age was 23.9 years. About 6.4% were married, 49.6% lived in informal dwellings, and 31.8% reported not to have enough money for food. HIV prevalence was 28.8% (95% confidence intervals: 24.3 to 33.4). Being between 20 and 29 years was significantly related to HIV infection. Women who had never attended a public health facility (10.1%) compared with those who had were more likely to be 16-19 years (P = 0.008), reported sexual debut at 10-14 years (P = 0.044), were more likely to have experienced a symptom of a sexually transmitted infection (P = 0.031), and to have taken illegal drugs (P = 0.007). RDS effectively recruited women who reported 2 or more male sexual partners in the past 3 months. HIV prevalence and HIV-related risk behaviors were high among women who have multiple concurrent partners.

Measuring change in vulnerable adolescents: Findings from a peer education evaluation in South Africa

Introduction: In the context of poverty and HIV and AIDS, peer education is thought to be capable of providing vulnerable youth with psychosocial support as well as information and decision-making skills otherwise limited by scarce social and material resources. As a preventative education intervention method, peer education is a strategy aimed at norms and peer group influences that affect health behaviours and attitudes. However, too few evaluations of peer-led programmes are available, and they frequently fail to reflect real differences between those who have been recipients of peer education and those who have not. This article reports on an evaluation of a pilot peer-led intervention, entitled Vhutshilo, implemented on principles agreed upon through a collaborative effort in South Africa by the Harvard School of Public Health and the Centre for the Support of Peer Education (the Rutanang collaboration). Vhutshilo targeted vulnerable adolescents aged 14–16 years living in some of South Africa's under-resourced communities. Methodology: The research design was a mixed-method (qualitative and quantitative), longitudinal, quasi-experimental evaluation. Tools used included a quantitative survey questionnaire (n = 183) and semi-structured interviews (n = 32) with beneficiaries of peer education. Surveys were administered twice for beneficiaries of peer education (n = 73), immediately after completion of the programme (post-test) and 4 months later (delayed post-test), and once for control group members (n = 110). The three main methodological limitations in this study were the use of a once-off control group assessment as the baseline for comparison, without a pre-test, due to timing and resource constraints; a small sample size (n = 183), which reduced the statistical power of the evaluation; and the unavailability of existing tested survey questions to measure the impact of peer education and its role in behaviour change. Findings: This article reports on the difficulties of designing a comprehensive evaluation within time and financial constraints, critically evaluates survey design with multi-item indicators, and discusses six statistically significant changes observed in Vhutshilo participants out of a 92-point survey. Youth struggling with poor quality education and living in economically fraught contexts with little social support, nonetheless, showed evidence of having greater knowledge of support networks and an expanded emotional repertoire by the end of the Vhutshilo programme, and 4 months later. At both individual and group level, many with low socio-economic status showed great improvement with regard to programme indicator scores. Conclusion: For the poorest adolescents, especially those living in the rural parts of South Africa, peer education has the potential to change future orientation, attitudes and knowledge regarding HIV and AIDS, including an intolerance for multiple concurrent partnerships. When well organised and properly supported, peer education programmes (and the Vhutshilo curriculum, in particular) provide vulnerable youth with opportunities to develop psychosocial skills and informational resources that contribute to the changing of norms, attitudes and behaviours. However, the article also flags the need for effective peer education evaluations that take into account limited financial resources and that possess tested indicators of programme effectiveness.