Multiple sexual partnerships in the context of HIV prevention: alternative methods to overcome the challenge of under-reporting
Presented by Clemens Benedikt (Zimbabwe).
C. Benedikt1, S. Manyenya1, O. Mundida2, L. Langhaug3, F. Cowan4, G. Woelk5, G. Zimbizi6, B. Tambashe1
1UNFPA, Zimbabwe Country Office, Harare, Zimbabwe, 2National AIDS Council, Harare, Zimbabwe, 3Regai Dzive Shiri Project, Harare, Zimbabwe, 4University College London, London, United Kingdom, 5Zimbabwe Community Health Intervention Research Project, Harare, Zimbabwe, 6Consultant, Harare, Zimbabwe
Background: While Zimbabwe's hyper epidemic is mainly driven by heterosexual HIV transmission,. according to the 2005/06 DHS, levels of multiple partnering appeared relatively low. This partially reflects reductions in multiple partnerships as compared to the DHS 1999 and may also reflect under-reporting, because anecdotal and qualitative evidence still pointed to high levels of multiple and concurrent partnerships. To inform programmes innovative and pragmatic approaches were required to establish the prevalence of specific types of multiple partnerships and their underlying reasons.
Methods: In 2007 a bio-behavioural baseline survey (n=4,879) was conducted in 16 districts of Zimbabwe using audio computer-assisted self-interview (ACASI), a method that has shown increased reporting of sensitive behaviours. In parallel, 104 focus group discussions conducted in 26 districts explored community member's perceived reasons for multiple partnerships.
Results: The proportion of multiple partnerships (reporting more than one sexual partner in the past 12 months) was considerably higher in the 2007 baseline survey than in the 2005/06 DHS among married men (28.1% cv. 11.7%) and married women (6.2% cv. 0.4%). 60 % of men and 65 % of women interviewed believed that in their community most married men have other partners. FGD data provided important contextual information. Of 428 statements on perceived reasons for multiple partnerships, 28% were classified as dissatisfaction with an existing relationship, 21% as economic reasons, 18 % as “natural sexual drive”, 16 % as social expectations (peer pressure) and 17 % as various other reasons.
Conclusions: Use of self-admininistered questionnaire delivery mode may provide an increase in reporting of sensitive behaviours. Questionnaire data indicated higher levels of self-reported multiple partnerships. By triangulating the data, we uncovered reasons for multiple partnerships. Modifications to survey techniques, innovations in programme baseline assessments and triangulation of data provide rich data that can inform programme development.
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