Objectives. We examine patterns of multiple sexual partnerships and partner faithfulness among men, women, and cohabiting couples in four countries in sub-Saharan Africa and assess the association between these behaviors and the risk of HIV infection.
Methods. Our data are from nationally-representative surveys conducted during 2004-2006 in Cameroon, Rwanda, Uganda, and Zimbabwe that included HIV testing of adult men and women, using blood specimens analyzed with standard laboratory and quality control procedures. Men and women in a marital/cohabiting union who reported never having had sex with any person other than their current partner(s) are defined as lifetime faithful. Men and women in a marital/cohabiting union who ever had sex with a person other than current their partner(s) but not in the previous 12 months are defined as recently faithful. Lifetime and recent mutual faithfulness among cohabiting couples are similarly defined. Data are analyzed using descriptive and multivariate statistical methods after adjusting for potential confounding factors.
Results. Multiple sexual partnerships are common in sub-Saharan Africa. In all four countries considered, the adjusted odds of being HIV-infected increase with the number of lifetime sexual partners and decrease with the level of spousal faithfulness. Similarly, in couples where the partners are not mutually faithful, either or both partners are more likely to be HIV-infected than in couples where both partners are lifetime faithful. Our study finds that men report having more lifetime partners and being less faithful to their spouse(s) than women report.
Conclusions. Having fewer lifetime sexual partners and being faithful to spousal partner(s) are strongly associated with reduced risk of HIV infection. Thus, in addition to promoting abstinence until marriage and condom use, especially in higher-risk sex, HIV prevention programs should focus more on promoting partner reduction and partner faithfulness, especially for men.
KEYWORDS: faithfulness, multiple sexual partnerships, partner reduction, HIV, AIDS, sub-Saharan Africa