Transcript Community Engagement and Recruitment

Gender and Multiple and Concurrent
Sexual Partnerships in Zambia
Preliminary Findings
Uniting the world against AIDS
NAC
ZAMBIA
National AIDS Council
Tropical Diseases
Research Center
Study Contributors
Study Partners
National Aids Council (NAC)
United Nations (UNAIDS,UNICEF, UNFPA,
WHO)
Family Health International (FHI)
International Organization for Migration
(IOM)
Tropical Diseases Research Center (TDRC)
Funders
United Nations (UNAIDS,UNICEF, UNFPA)
International Organization for Migration
(IOM)
United States Agency for International
Development (USAID)
National AIDS Council (NAC)
Concurrency in Zambia 2010
Project Investigator
Shepherd Khondowe, TDRC
NAC Steering Committee
Harold Witola, NAC
Kathleen MacQueen, FHI US
Michael Gboun, UNAIDS
Florence Mulenga, UNFPA
Katy Barwise, IOM
Sansan Myint, UNICEF
Kanyanta Sunkutu, WHO
Steve Sichone, FHI ZA
Technical Monitor
Catalina Ramirez, FHI US
Acknowledgements
NAC
Dr. Ben Chirwa
Dr. Osward Mulenga
MCP Steering Committee Members
FHI
Cathy Thompson
Mark Weaver
Kathryn Lancaster
United Nations
Dr. Amaya Gillespie
TDRC
Dr. Modest Mulenga
Nancy Soko
Research Assistants
IOM
Joseph Ongina
Annie Lane
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Presentation Outline

Introduction
Study Rationale
Research Questions

Methods
Population / Site Selection
Community Engagement
Data Collection Procedures
Analysis

Results
In-depth Interview Calendar Data
Focus Groups

Summary
Limitations and Strengths
Conclusions
Next Steps
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INTRODUCTION
Background: MCP and HIV

UNAIDS Reference Group on Estimates, Modelling, and
Projections meeting, Nairobi 2009



CONCLUSION: Standardized new measure on concurrency (“overlapping
concurrency”).
Emphasized need for research into the methods of measuring concurrent
partnerships and sexual behaviour, the relationship between concurrency
and HIV transmission, and social norms around concurrent partnerships.
Southern African Development Community meeting,
Maseru 2006

CONCLUSION: multiple concurrent sexual partners is one of the key drivers
of the epidemic in the Southern African region
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MCP in Zambia; ZDHS 2007


2 % women and 20% of men between 15-49 reported sex with two or
more partners in the 12 months before the survey.
17% of women and 38% of men reported that they had sex in the
previous 12 months with someone who was not their spouse.
Percentage of Men and Women with Multiple Sexual Partners in Past 12 mos.
Province
Men
Women
Lusaka
25.1 %
1.5%
Northwestern
24.4%
3.1%
Northern
10.1%
0.01%
Southern
31.4%
0.8%
Eastern
25%
1.2%
Copperbelt
14.9%
2.5%
Western
24.3%
4.1%
Source: ZDHS Preliminary Report 2007
Unit
8: Protocol
Overview
Concurrency
in Zambia
2010 Multiple and Concurrent Partnerships in Zambia
Previous Research

Important formative research was conducted by the Health
Communication Partnership (HCP), Society for Family Health (SFH) and
Zambia Center for Communication Programmes (ZCCP).



Informed the OneLove, Kwasila! campaign which rolled-out in May 2009
Focus group results were used by current study to inform cultural model
and perceptions surrounding concurrency.
No contemporary qualitative study is available exploring the practice of
having multiple concurrent sexual partners within the context of stable
relationships in Zambia
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Study Rationale

Little is known about how best to reduce HIV risk among
men and women
In stable relationships AND
In concurrent partnerships

Programmes need to respond to sexual relationships as
they exist
actual gender ideas
social values
cultural meanings
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Study Objectives

OBJECTIVE 1: Generate context-specific information on the practice of
multiple concurrent sexual partnerships in the context of stable
relationships.

OBJECTIVE 2: Highlight community perceptions and understanding of
HIV risk within stable relationships in order to strengthen community
and civil society communication and advocacy for social change.

OBJECTIVE 3: Strengthen evidence-based community dialogue on HIV
prevention within stable relationships, particularly through improved
mechanisms for involvement of men in dialogue and community
response.

OBJECTIVE 4: To add to and strengthen the monitoring systems that
track behavioural trend data which influence the epidemic in Zambia as
a basis for informing HIV/ADS programs.
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OBJECTIVE 1: Generate context-specific information on the practice of
multiple concurrent sexual partnerships in the context of stable
relationships.






RESEARCH Q1: What are the social norms of stable relationships among
men and women?
RESEARCH Q2 What are the values and obligations associated with these
relationships?
RESEARCH Q3: What is the value of sex among men and women?
 What are the structures/systems that promote/sustain these values?
 Are there social benefits or constraints that make MCP relations difficult
to terminate?
RESEARCH Q4: What are the structures/systems that promote/sustain
multiple and concurrent sexual partnerships?
RESEARCH Q5: Are there economic factors that encourage and sustain MCP
in both genders?
RESEARCH Q6: What are the life experiences of men and women with
regard to multiple and concurrent sexual partnerships in the context of
stable relationships?
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OBJECTIVE 2: Highlight community perceptions and understanding of HIV
risk within stable relationships in order to strengthen community and civil
society communication and advocacy for social change.


RESEARCH Q7: How is HIV risk perceived and negotiated within
stable and concurrent relationships?
RESEARCH Q8: What can be done to encourage people to reduce
their risk of HIV infection?
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OBJECTIVE 3: Strengthen evidence-based community dialogue on HIV
prevention within stable relationships, particularly through improved
mechanisms for involvement of men in dialogue and community response.




RESEARCH Q1: What are the social norms of stable relationships
among men and women?
RESEARCH Q3: What is the value of sex among men and women?
RESEARCH Q7: How is HIV risk perceived and negotiated within stable
and concurrent relationships?
RESEARCH Q8: What can be done to encourage people to reduce their
risk of HIV infection?
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Ethics Review & Approval

Tropical Diseases Research
Ethics Committee, TDRC


Ndola, Zambia
Protection of Human Subjects
Committee, FHI

Durham, North Carolina
Tropical Diseases Research Centre, Ndola
Zambia
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METHODS
Methods: Population & Site Selection
Key Factor
Categories
Area of residence
Lusaka (Lusaka Province, urban)
Solwezi (Northwestern Province, periurban/border town)
Nakonde (Northern Province, periurban border town)
Livingston (Southern Province, rural)
Nyimba (Eastern, rural)
Kitwe (Copperbelt Province, urban)
Kaoma (Western Province, rural)
Sex
Male
Female
Age
16-24 (male and female)
25-34 (male and female)
35-49 (male and female)
Marital status
Married
Unmarried
Social and economic
status
High
Medium
Low
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Methods: In- Country Data Team

TDRC





1Principal Investigator
1 Study Coordinator
9 Researcher Assistants
2 Data Entry Staff
FHI

1 Study Manager
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Community Engagement

PURPOSE: Elicit acceptance for the project at each potential site.
 Introduce the study
 Identify stakeholders and how/where they can be located.
 Gain approvals from key stakeholders
 Assess acceptability and viability of the study
 Learn about possible strategies of resolving implementation
challenges
 Identify catchment areas for the target populations

Led by Study Manager and Study Coordinator in partnership with National
AIDS Commission (NAC)
Support and Coordination by : District AIDS Task Force (DATF), Provincial
AIDS Task Force (PATF), Provincial AIDS Coordination Advisor (s) (PACA)
and District AIDS Coordination Advisor(s) (DACA)

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Community Engagement: Methods

Key informant interviews with
Traditional Leaders and other
Community Leader(s)
 4-5 per site
 To elicit recruitment strategy

Stakeholder meetings held at District
level
 2-3 per site
 To inform about study
 To get initial input on perceptions
about HIV in the community

1 FGDs conducted at each site (7 total;
approx.70 participants)
 1 stakeholder, mixed gender and
age
 To supplement previous research
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Community Engagement: Methods

Approvals to go forward obtained from
 MOH
 NAC
 DATF/PATF
 Traditional Leader(s)
 District Health Office
 District Commissioner
 Local Authorities
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Data Collection Overview

In-depth interviews (IDI)

Specific sexual partnerships/behavior and
related social, cultural, and behavioral
practices
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In-depth Interviews
People in stable partnerships (self-defined)
 Purposive selection for diversity of gender,
age, marital status, and socioeconomic
status
 Local guidance sought at each site for
how to recruit for diversity
 301 total IDIs conducted at 7 sites

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In-depth Interviews

Key Areas of Interest
Sexual History
 Relationship Status
 Migration/Mobility
 Partners (past 12 mos)
 Perceived closeness of each partner
 HIV Knowledge/ Attitudes

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IDI: Data Collection Tools


Visualize relationships (sociogram)
 How many partners?
 How well do you know each partner?
 How well do your partners know each other?
 Partner characteristics
Sexual activity recall (time-line follow-back)
 Use of memory aids
 1-year recall
 For each month
 First & last day of sex with each partner
 Frequency of sex with each partner
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IDI: Data Collection Tools
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ANALYSIS
Analysis Strategy: Text Data


Capture key ideas, themes and concepts (content coding)
 FHI US data team worked with in-country field team to identify
themes.
 Detailed code definitions developed
Code all text using content code book
 2 FHI coders
 Intercoder agreement checks
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Example of Content Code
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Analysis Strategy: Partner Data
Quantitative Data
 Sociogram
 Calendar
 Partner Characteristics
 Length of Partnership
 Mobility/ Migration
 Other Partnerships
 HIV Risk
 Generate output to describe
 Types of partnerships
 Frequencies of types

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Definitions: Calendar Data
PARTNERSHIP TYPE
MEASUREMENT STRATEGY
UTILITY
Concurrent within
calendar month
Two or more sexual partners in
the same calendar month
during at least one month in
the 12 month recall period.
Easiest measure to calculate;
provides a rough estimate of
concurrency
Concurrent within
21 days
Two or more sexual partners
within at least one 21 day
interval in the 12 month recall
period
Captures critical timeframe
for on-going transmission of
acute infections
Concurrent within
60 days
Two or more sexual partners
within at least one 60 day
interval in the 12 month recall
period
Captures maximal timeframe
for on-going transmission of
acute infections.
Overlapping
Concurrency
Overlapping sexual
partnerships where sexual
intercourse with one partner
occurs between two acts of
intercourse with another
partners.
Distinguishes between
concurrency and rapid serial
monogamy
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Definitions: Calendar Data
PARTNERSHIP TYPE
MEASUREMENT STRATEGY
UTILITY
Sequential
Partnerships
Two or more sexual
partners in the 12 month
recall period with at least
61 days of no sexual
activity between any two
partners
Capture multiple nonconcurrent partnerships
Monogamous
Partnerships
One, and only one, sexual
partner in the 12 month
recall period.
Captures monogamous
partnerships.
No Sex
No sexual partners in the
12 month recall period.
Captures sexual abstinence
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Preliminary Results
Quantitative Data Results
Calendar Data Results
Percentage of partnership types by gender
PARTNERSHIP TYPE
MALE
FEMALE
TOTAL
(N=133)
(N=162)
(N=295)*
Concurrent within
calendar month
53.38%
59.26%
56.61%
Concurrent within 21 days
75.94%
46.30%
59.66%
Concurrent within 60 days
77.44%
48.77%
61.69%
Overlapping Concurrency
81.95%
46.30%
57.29%
*information missing for 6 participants
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Calendar Data Results
Percentage of partnership types by gender
PARTNERSHIP TYPE
MALE
FEMALE
TOTAL
(N=133)
(N=162)
(N=295)
Overlapping Concurrency
79.66%
47.47%
61.23%
Sequential partnerships
5.08%
3.16%
3.99%
Monogamous partnerships
14.41%
48.73%
34.06%
No Sex
0.85%
0.63%
0.72%
TOTAL
100.00%
100.00%
100.00%
*information missing for 6 participants
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Calendar Data Results
Percentage of partnership types by marital status and gender
PARTNERSHIP
TYPE
Married
Unmarried
Divorced or Widowed
Female
Male
Female
Male
Female
Male
(N= 74)
(N=83)
(N=45)
(N=47)
(N= 42)
(N=1)
Overlapping
Concurrency
44.59%
77.11%
42.22%
57.45%
54.76%
100.00%
Monogamous
partnerships
52.70%
16.67%
52.27%
10.81%
36.84%
-
Sequential
Partnerships
2.70%
1.28%
2.27%
13.51%
2.63%
-
No Sex
0.00%
0.00%
2.27%
2.70%
0.00%
-
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
Total
*information missing for 12 participants
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Calendar Data Results
Percentage of partnership types by site
PARTNERSHIP
TYPE
Kaoma
Lusaka
Solwezi
Kitwe
Livingstone
Nakonde
Nyimba
N=35
N=64
N=35
N=49
N=44
N=34
N=34
Overlapping
Concurrency
53.33%
67.80%
71.88%
52.17%
53.49%
72.73%
57.58%
Monogamous
partnerships
43.33%
27.12%
25.00%
43.48%
39.53%
24.24%
36.36%
Sequential
partnerships
3.33%
3.39%
3.13%
4.35%
4.65%
3.03%
6.06%
No Sex
-
1.69%
-
-
2.33%
-
-
TOTAL
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
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Calendar Data Results
Percentage of partnerships types by age and gender
AGE
Overlapping Concurrency
Monogamous
partnerships
Female
Male
Female
Male
(N=75)
(N=94)
(N= 77)
(N=17)
16-19
4.00%
3.19%
5.19%
0.00%
20-24
21.33%
22.34%
23.38%
11.76%
25-29
18.67%
20.21%
15.58%
17.65%
30-34
22.67%
23.40%
14.29%
11.76%
35-39
16.00%
14.89%
10.39%
5.88%
40-44
4.00%
8.51%
14.29%
23.53%
Over 45
10.67%
7.45%
11.69%
23.53%
Total
100.00%
100.00%
100.00%
100.00%
Nine interviews were missing age information
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“Multiple Partners”: Perceptions vs. Actual
Behavior

When asked directly if they ever had more than one partner at a time,
7 men and 23 women, of the 136 preliminary interviews analyzed, said
no.

TLFB method indicated 4 of the 7 men and 8 of the 23 women
identified overlapping concurrent partners in the previous 12 months.

Qualitative data indicated that the phrase “multiple partners” is often
interpreted as partners with whom the participant had sex close in
time (e.g., one week) or had little or no emotional connection, or
partners who lived in a participant’s community or were perceived as
“higher risk.”
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“Multiple Partners”: Perceptions vs. Actual
Behavior
“INTERVIEWER: Have you ever had a relationship with more than one
sexual partner at the same time, like suppose you have a husband and
then you also have a boyfriend as well?
PARTICIPANT: No.
INTERVIEWER: Earlier you had told me that you had a boyfriend, was that
before you got married?
PARTICIPANT: He [husband] had gone away for 8 months.
INTERVIEWER: Were you still married?
PARTICIPANT: Yes. “
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Text Data
IDIs: Sexual Dynamics
CODE
BRIEF DEFINITION
Faithful_NonSex
Being faithful means being supportive, trustworty or reliable as a partner; faithfulness as a
non-sexual quality
Backup
Having additional sexual partnerships in case one of existing partnerships ends
Dissatisfaction
Dissatisfaction with current partner leads a person to have multiple sexual partnerships
Greedy-Sex
Discussion of sexual relationship because of greediness or wanting additional partners
Revenge-Gossip
Discussion of sexual relationship because seeking revenge or heard gossip
Alcohol
Discussion of alcohol and the exchange of alcohol in relationships
Influence
Peer or family influence related to sexual decision-making
Mobile
Role of a mobile workforce in multiple sexual relationships
Money
Money or money-related goods/services in relationships
Struggle
Relationships initiated to overcome hardships (economic, emotional, etc.)
Sexual-Violence
Narratives of sexual violence and uncontrollable sexual desire
Trans- Sex
Participant account of whether money or goods were exchanged as part of sexual
encounter.
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IDI: Major Domains
Proportion of IDIs where a theme was coded as present
Green
A significant number of participants ( 15-20%)
Yellow
About one fifth (21-25%)
Orange
About one third (26-35%)
Pink
More than a third (more than 35%)
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Sexual Dynamics
CODE
ALL
(N= 136)
MALE
(N= 63)
FEMALE
(N= 76)
Faithful_NonSex
47 (35%)
19 (30%)
28 (37%)
Backup
14 (10%)
8 (13%)
6 (8%)
Dissatisfaction
26 (19%)
13 (21%)
13 ( 17%)
Greedy-Sex
29 (21%)
25 (40%)
4 (5%)
Revenge Gossip
19 (14%)
2 (3%)
17 (23%)
Alcohol
26 (19%)
12 (19%)
14 (19%)
Influence
35 (26%)
24 (38%)
11 (15%)
Mobile
42 (39%)
24 (38%)
20 (26%)
Money
70 (52%)
19 (30%)
51 (67%)
Struggle
31 (23%)
3 (5%)
28 (37%)
Sexual-Violence
15 (11%)
3 (5%)
12 (16%)
Trans-Sex
66 (49%)
33 (52%)
35 (46%)
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Sexual Dynamics
“INTERVIEWER: Have you ever had a relationship with more than one sexual
partner at the same time?
PARTICIPANT: Yes.
INTERVIEWER: Why?
PARTICIPANT: Ok, there are a lot of contributing factors. Lets say in a marriage and
then you find that your wife is pushing you away. What do I mean - Firstly you find
that your wife does not want to have sex with you, torturing you mentally, so this
will drive you out of your home. You end up having sex with someone outside. The
other thing is whenever you go home your wife is always nagging you, so you start
shunning away from home and usually it'll drive you to clubs and in those clubs
finally you will get somebody to talk to, whether it is in your 100% sober state or
partially drunk state somebody will get to you eventually.”
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Sexual Dynamics
“INTERVIEWER: What about being faithful to [your husband] mean?
PARTICIPANT : I can be faithful if he does everything for me, even when I tell him I
do not have lotion, he provides it for me. But if he does not, then another guy
comes along…
INTERVIEWER: How important is it for you to faithful to your husband?
PARTICIPANT : The most important thing is to have a respectable name, that I am
married.”
“INTERVIEWER: How does faithfulness apply to your relationship?
PARTICIPANT : Well he is faithful and so am I, he supports me when I don't have
money, he gives me, and he is the one who pays school fees for my children. So
yeah… he is faithful, though he has a wife, I don't expect him to marry but at least
he can support me. “
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Sexual Dynamics
“I consider women as a gift, which was given to us. It is like something that
you can own at any time you feel like. So it [having multiple partners] was just
a question of wanting to taste this one and that one.”
“INTERVIEWER: Tell me why you had different sexual partners?
PARTICIPANT: Now it's due to current occupation…I 'd leave my wife go very
far maybe to ---- and you are [there] 2to 3 weeks and you feel like having sex
what do you do, you get one .. I'll be told fat women are sweet so I'd go for fat
ones … then another tells me that slim ones are warm then I go for slim ones
and that short ones are tight so these are things that were causing me to have
a long chain of women.”
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Sexual Dynamics
“INTERVIEWER: Does your fiancé know any of these two girls?
PARTICIPANT: Yes she knows about --. They were at the same school. In
fact my fiancé made me fall in love with -- to protect me from other girls.
It was a strategic arrangement among themselves.”
“PARTICIPANT: The truck driver who l came with used to take care of me
in those days. So as the time went by he stopped coming. So like l said, l
came to know a man from --- who started helping me. .he came here and
as time went by the wife came here and that's how it ended. So now l
have this one from ---. But, there times when a friend has two who brings
one to you.
INTERVIEWER: Bringing you what?
PARTICIPANT: May be she has two then she gives you one….a man “
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Sexual Dynamics
“Those years before 2006, I was having stable partners but the past year, I
was just having sex with different men in exchange for money. I was not
even asking them their names or where they came from. What I was only
interested in was to have sex in exchange for money, but throughout last
year, I was having sex nearly every day with a lot of different men. I cannot
remember. “
“INTERVIEWER: On any of these days, did you give GG money, food or a
place to stay in exchange for sex?
PARTICIPANT : On this one my brother as a man, you always feel a need
to give something to someone you have sex with. It's like saying thank
you.“
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Sexual Dynamics: Mobility

Fifty-one percent of males and 26% of female who
reported “overlapping concurrency” reported one or mor e
partners whose primary residence was different that the
participant.

Eighteen percent of women and 12% of men who reported
monogamous relationships reported that their partner had
a different primary residence.
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Condom Attitudes & Behavior
Condom use pattern by overlapping concurrency and monogamous
partnerships
Condom Use
Participants with
overlapping partnerships
Participants in monogamous
relationships
Male (N=94)
Female (N=75)
Male (N=17)
Female (N=77)
Consistent (all partners
and all events)
9.68%
8.00%
17.65%
28.77%
Inconsistent (some
partners and/or some
events)
76.34%
77.33%
29.41%
26.03%
No use with any partners
or any events
13.98%
14.67%
52.94%
45.21%
Total
100.00%
100.00%
100.00%
100.00%
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Condom Attitudes
“INTERVIEWER: If someone is attracted to you but you do not want to
have sex with them, what do you do?
PARTICIPANT: I will tell her about the dangers of sex… but I was made to
believe.. I don't trust condoms. I like live sex, no condoms..”
“PARTICIPANT: I have started [using condoms] but he refuse… so with him when
you give him a condom, he says, no, why, you don't trust me? He refuses. But me I
use, but there is always a fight…and he says are [you] a prostitute? I say I'm not a
prostitute. I have been tested, after three months, I go for testing. I want to
protect myself.”
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HIV Knowledge & Risk Behavior
CODE
DEFINITION
Fear-Testing
Participant discussion surrounding fear of HIV testing results
HIV_Appearance
Belief that HIV status is reflected in physical appearance
Misinformation
Misinformation related to HIV risk, testing, prevention or transmission
PX-HIV
Participant identifies themselves as HIV+
PART-HIV
Participant identifies partner as HIV+
NOTE: Participants were not explicitly asked to disclose HIV status. Participants were
asked whether they though TFB partners “could be” HIV positive but were not directly
asked for partner HIV status.
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HIV Knowledge & Risk Behavior
“INTERVIEWER: Why do you have sex with him if you think he has HIV?
PARTICIPANT: He is very kind, he treats me well ad we discuss a lot about
different things, including education, but my husband is closed up that I
cannot ask him anything apart from food or relations.”
“INTERVIEWER: Do you think -- may have HIV and AIDS?
PARTICIPANT: He has, for him to be having sex with me. I am HIV positive,
so he should have. For two years he has been with me, even if his blood is
strong, I think he should have.
INTERVIEWER: Why do you think so?
PARTICIPANT: I always have sex with him live [without a condom], and
even at his home also live.”
Concurrency in Zambia 2010
HIV Knowledge & Risk Behavior
“You know sometimes as human beings we are afraid of going for VCT, reason
being, that we don't trust the people who carry out these tests. After she
discovers that you are positive, then she will go round telling people about your
status which is not good.”
“INTERVIEWER: Please tell me, do you think this person can have HIV?
PARTICIPANT: On that one I don't know but she likes putting on that yellow band
INTERVIEWER: Showing what?
PARTICIPANT: For those if you had gone for V C T, they usually give those yellow
bands when you go through HIV test.
INTERVIEWER: Now do you think that when someone is given that band, does it
mean that person is negative or what?
PARTICIPANT: They do give those who are negative. “
Concurrency in Zambia 2010
HIV Knowledge & Risk Behavior: Participant X
NOTE: Participant disclosed positive HIV status
“INTERVIEWER: Please tell me if you think this person [partner 1] may have HIV or
AIDS?
PARTICIPANT: Yes, she has, she is positive.
INTERVIEWER: Why do you think so?
PARTICIPANT: Because she is taking the medicine ARVs from where I am working.
…
INTERVIEWER: Please tell me if you think this person [partner 2] may have HIV or AIDS?
PARTICIPANT: [partner 2] is also HIV positive, in fact all my partners are positive.
INTERVIEWER: Ok, why do you think [partner 2] is positive?
PARTICIPANT: She has also show me the drug she is taking. “
…..
“INTERVIEWER: Did you or your partner use condoms when you had sex on each of
these occasions?
PARTICIPANT: No.
INTERVIEWER: Why were you not using condoms?
PARTICIPANT: Ugh.. condoms are difficult to use… Yaa, when you are using condoms,
you don't release (ejaculate) fast. There is satisfaction. Satisfaction may be there, but
the problem is you don't release (ejaculate).”
Concurrency in Zambia 2010
HIV Knowledge & Risk Behavior
CODE
ALL
(N= 136)
MALE
(N= 63)
FEMALE
(N= 76)
Fear-Testing
18 (13%)
5 (8%)
13 (17%)
HIV_Appearance
16 (12%)
7 (11%)
9 (12%)
Misinformation
19 (14%)
9 (14%)
10 (13%)
PX-HIV
14 (10%)*
4 (5%)*
10 (13%)
PART-HIV
10 (7%)*
3 (5%)*
6 (8%)*
Several participant had two or more partners that were identified as HIV+
Concurrency in Zambia 2010
SUMMARY
Limitations and strengths



Results are NOT based on a random sample
 Need to be very cautious about generalizing from numeric trends
 Should focus on pattern and range of responses for interpretation
Results are confirmatory of quantitative studies with regard to
importance of multiple and concurrent sexual partnerships
Results provide missing detail on the context and pattern of
concurrency
Concurrency in Zambia 2010
Conclusions

Use of crude measures of concurrency can result
in misleading estimates of concurrency by
gender.
 Calendar-month measures were least accurate.
 Measures that look at overlaps in time (21 or 60
days) were better at identifying gender
distinctions.
 Measure that looked at overlaps in sexual
events by partners identified greatest
differences in concurrency between men and
women.
Concurrency in Zambia 2010
Conclusions (cont.)

Overlapping concurrency is prevalent
 About half of the people we talked to in the one
on one interviews had overlapping concurrent
relationships in the past 12 months
 Higher for men than women

People who had more than one sexual partner in
the past 12 months tended to have concurrent,
rather than sequential, partners
Concurrency in Zambia 2010
Conclusions (cont.)
Women as well as men, who indicated overlapping
concurrency, expressed inconsistent condom use.
 Viewed as contrary trust in stable relationship.
 Stigma associated for women in stable
relationships (e.g., promiscuity, prostitution)
 Women and men in monogamous partnerships
indicated inconsistent condom used with
approximately half reporting “no condom use”.

Concurrency in Zambia 2010
Conclusions (cont.)

People perceived “being faithful” to mean
being supportive and respectful
 A person can have other sex partners and
still behave in a faithful way toward each
partner
 Importance of maintaining respect and
household
Concurrency in Zambia 2010
Conclusions (cont.)


Money was described as a factor in people having more
than one sex partner.
 “struggle” (difficulty in satisfying basic needs)
 desires for material goods
 transactional sex
Alcohol consumption was a cited as a contributing factor to
multiple partnership and higher risk sexual activity (e.g., no
condom usage)
Concurrency in Zambia 2010
Conclusions (cont.)

Mobility

Participants indicate mobility/migration as a factor for engaging in
concurrent partnerships.



Partner is away
Participant is away from partner
More than half of male participants and over a third of females
who reported overlapping concurrency indicated one of their
partner had a different primary residence.
Concurrency in Zambia 2010
Next Steps





Community Dissemination (April- May 2010)
 Community stakeholders
 Community member
 Will include validation of preliminary results
Final Analysis and Development of Draft Report (April -June
2010)
Consolidation of partner/funder feedback from initial
report (~ July 2010)
Final report (~July 2010)
 To include measurement recommendations for NAC
Manuscript submitted for peer review journal (~June 2010)
Concurrency in Zambia 2010
Questions?
Contacts
Harold C. Witola
Research Specialist
National AIDS Council
315 Independence Avenue
P.O Box 38718, Lusaka- Zambia
Tel: 260 211 255 044
e-mails: [email protected]
Shepherd Khondowe, MPH
Tropical Diseases Research Centre
P.O. Box 71769, Ndola – Zambia
Tel: +26-021-2-612837
email: [email protected]
Kathleen M. MacQueen, PhD, MPH
Senior Social Scientist, Behavioral & Biomedical Research
Family Health International
PO Box 23950, Research Triangle Park, NC 27709 USA
Tel: +1-919-544-7040 ext 11587
email:[email protected]
Concurrency in Zambia 2010