Africa's AIDS Fight: Fresh Focus on Issue of Multiple Partners

HIV/AIDS prevention in South Africa is moving beyond a focus on condoms, using new research that identifies the epidemic's driving force as multiple concurrent partnerships. Many experts now believe prevention messages did not fail, condom use did increase, but they missed targeting the right behaviors.

Prevention messages presume that people who understand the risk of HIV/AIDS will take measures to protect themselves. Indeed, research shows condom use has markedly increased in Africa, especially with casual partners.

Among South Africans ages 20-30, 65 percent reported condom use in their last sexual encounter, according to a study conducted by the Center for AIDS Research, Development and Evaluation (CADRE). Further, 86 percent said they feared having a one-night stand without using a condom.

However, numerous studies found many people stopped using condoms with long-term partners, and they indicated that Africans were more apt to have multiple concurrent partnerships, including long-term relationships. More than half of CADRE participants said it was acceptable to stop using a condom with regular partners, and more than one-third had had more than one partner in the previous year.

"We found we had been successful on condom use, but it wasn't enough," said Richard Delate, country program director of the Johns Hopkins Health and Education in South Africa (JHHESA) program. "Almost nothing was being done around concurrency and multiple partnerships."

One educational cartoon JHHESA produced uses slang and illustrates sexual networks by showing people standing at a taxi stand. One man has "a big house" -- his wife -- and three "small houses," his mistresses, a narrator explains. A woman has a "minister of housing, transport, and culture" -- references to the benefits she derives from transactional sex with different men. The cartoon then shows how HIV travels along these partnership networks.

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