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Concurrent partnerships and HIV: an inconvenient truth

By Helen Epstein and Martina Morris

Abstract

The strength of the evidence linking concurrency to HIV epidemic severity in southern and eastern Africa led the Joint United Nations Programme on HIV/AIDS and the Southern African Development Community in 2006 to conclude that high rates of concurrent sexual partnerships, combined with low rates of male circumcision and infrequent condom use, are major drivers of the AIDS epidemic in southern Africa. In a recent article in the Journal of the International AIDS Society, Larry Sawers and Eileen Stillwaggon attempt to challenge the evidence for the importance of concurrency and call for an end to research on the topic. However, their "systematic review of the evidence" is not an accurate summary of the research on concurrent partnerships and HIV, and it contains factual errors concerning the measurement and mathematical modelling of concurrency

Topics: Commentary
Publisher: BioMed Central
OAI identifier: oai:pubmedcentral.nih.gov:3064618
Provided by: PubMed Central

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Citations

  1. (2000). A Micro-simulation study of the effect of concurrent partnerships on HIV spread in Uganda. Math Pop Studies
  2. (2009). A network-level explanation for the differences in HIV prevalence in South Africa’s racial groups.
  3. (2001). A: HIV seroprevalence and its associations with the other reproductive tract infections in asymptomatic women in Harare, Zimbabwe.
  4. (2001). al: Concurrent sexual partnerships and HIV prevalence in five urban communities of sub-Saharan Africa. Aids
  5. (2007). al: Genetic characterization of HIM strains circulating in Kazakhstan.
  6. (2006). Bajos N: Sexual and reproductive health 2 - Sexual behaviour in context: a global perspective. Lancet
  7. (2010). Barking up the Wrong Evidence Tree. Comment on Lurie & Rosenthal, “Concurrent Partnerships as a Driver of the HIV Epidemic in Sub-Saharan Africa? The Evidence is Limited”. AIDS and Behavior
  8. (2009). Bignami-Van Assche S: Concurrent Sexual Partnerships and HIV Infection: Evidence from National Population-Based Surveys Calverton,
  9. (1991). Borgdorff MW: HIV incidence and HIV-associated mortality in a cohort of factory workers and their spouses in Tanzania,
  10. (2009). C-Change: A Baseline Survey of Multiple and Concurrent Sexual Partnerships Among Basotho Men in Lesotho
  11. (2008). C: HIV-1 transmission, by stage of infection.
  12. (2007). Can we achieve Millennium Development Goal 4? New analysis of country trends and forecasts of under-5 mortality to 2015. Lancet
  13. (2010). Centers for Disease Control: CDC Malaria Map Application
  14. (2007). Central Statistical Office Zambia: HIV Prevalence Rates Decline
  15. (2000). Concurrent and non-concurrent sexual partnerships and risk of prevalent and incident
  16. (2001). Concurrent Partnerships and Syphilis Persistence: New Thoughts on an Old Puzzle. Sex Transm Dis
  17. (1997). Concurrent partnerships and the spread of HIV. Aids
  18. (1995). Concurrent partnerships and transmission dynamics in networks.
  19. (2010). Concurrent Partnerships as a Driver of the HIV Epidemic in Sub-Saharan Africa? The Evidence is Limited. AIDS and Behavior
  20. (1993). Concurrent partnerships could cause AIDS epidemics.
  21. (2010). Concurrent partnerships,
  22. (2010). Concurrent sexual partnerships among youth in urban Kenya: Prevalence and partnership effects.
  23. (2007). Concurrent sexual partnerships amongst young adults in South Africa: Challenges for HIV prevention communication Johannesburg, South Africa: Centre for AIDS Development, Research and Evaluation;
  24. (2010). Concurrent Sexual Partnerships and Primary HIV Infection: A Critical Interaction. AIDS and Behavior
  25. (1999). Condom use and HIV risk behaviors among US adults: Data from a national survey. Family Planning Perspectives
  26. (2007). Connolly C: NAMIBIA: A Midterm Household Analysis of Residents from
  27. (2009). Control of schistosomiasis in sub-Saharan Africa: progress made, new opportunities and remaining challenges. Parasitology
  28. (2008). de Vlas SJ, Habbema JDF: Separation of spouses due to travel and living apart raises HIV risk in Tanzanian couples. Sexually Transmitted Diseases
  29. (1995). Desiring difference: risk behavior among young Maasai men. Young People at Risk: Fighting AIDS in Northern Tanzania Copenhagen:
  30. (2010). DT: The Evidence for the Role of Concurrent Partnerships
  31. (2006). Duvvury N: Factors associated with HIV sero-positivity in young, rural South African men.
  32. (2010). E: Concurrent sexual partnerships do not explain the HIV epidemics in Africa: a systematic review of the evidence.
  33. (2008). Economic status, informal exchange, and sexual risk
  34. (2003). et al: Diverse HIV-1 subtypes and clinical, laboratory and behavioral factors in a recently infected US military cohort. Aids
  35. (2005). et al: Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda.
  36. (2004). et al: Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections. Lancet
  37. (2000). EW: Partner type and condom use. Aids
  38. (2005). Extramarital sex among Nigerian men - Polygyny and other risk factors.
  39. (2008). Fact Sheet on HIV and AIDS,
  40. (2010). FM: How to improve the validity of sexual behaviour reporting: systematic review of questionnaire delivery modes in developing countries.
  41. (2009). for The Network Modeling Group: Concurrent partnerships and HIV prevalence disparities by race: Linking science and public health practice.
  42. (2010). Fylkesnes K: Prevalence and Correlates of Concurrent Sexual Partnerships
  43. (2011). G: Co-factors for HIV Incidence during Pregnancy and the Postpartum Period.
  44. (2006). GC: Domestic violence and prevention of mother-to-child transmission of HIV-1. Aids
  45. (2008). Ghys PD: The epidemiology of HIV infection among young people aged 15-24 years in southern Africa. Aids
  46. (2010). Group on Measurement and Modeling: HIV: consensus indicators are needed for concurrency. Lancet
  47. (2008). Halperin DT: “Know your epidemic, know your response": a useful approach, if we get it right. Lancet
  48. (2010). Halperin DT: Concurrent Sexual Partnerships and the HIV Epidemics in Africa: Evidence to Move Forward. AIDS and Behavior
  49. (1998). HIV infection and asymptomatic sexually transmitted infections in a rural South African community.
  50. (2008). HIV transmission risk behavior among HIVinfected adults in Uganda: results of a nationally representative survey. Aids
  51. (1993). HIV Transmission through social and geographical networks
  52. (2006). Human immunodeficiency virus type 1 strains epidemic in Shenzhen
  53. Incidence of HIV infection in stable sexual partnerships: A retrospective cohort study of 1802 couples in Mwanza Region,
  54. (2004). Informal confidential voting interview methods and temporal changes in reported sexual risk behaviour for HIV transmission in sub-Saharan Africa. Sexually Transmitted Infections
  55. (1997). International: Tanzania Demographic and Health Survey 1996: Final Report Calverton,
  56. (1990). JT: Looking for change in response to the AIDS epidemic: Trends in AIDS knowledge and sexual behavior in Zambia,
  57. (1990). KE: The Risk of Transmission of HIV-1 through Nonpercutaneous, Nonsexual Modes - a Review. Aids
  58. (2006). Kublin JG: Dual infection with HIV and malaria fuels the spread of both diseases in sub-Saharan Africa. Science
  59. (2010). Leslie-Cook A: Evaluating concurrent partnership data from the Demographic and Health Surveys (DHS).
  60. (2008). Longini I: No HIV stage is dominant in driving the HIV epidemic in sub-Saharan Africa. Aids
  61. (2003). Makgabaneng Listenership survey in Botswana Botswana: Policy Resource Group;
  62. (1994). Mburu FM: Tanzania Knowledge, Attitudes and Practices Survey,
  63. (1996). Measures of concurrency in networks and the spread of infectious disease.
  64. (1995). Mertens T: Validating population surveys for the measurement of HIV/STD prevention indicators. Aids
  65. (2005). MG: Human immunodeficiency virus type 1 (HIV-1) genotyping in Rio de Janeiro, Brazil: assessing subtype and drug-resistance associated mutations in HIV-1 infected individuals failing highly active antiretroviral therapy. Memorias Do Instituto Oswaldo Cruz
  66. (2009). Milking the cow: Young women’s construction of identity and risk in age-disparate transactional sexual relationships in Maputo, Mozambique. Global Public Health
  67. (2010). Mugurungi O: HIV decline in Zimbabwe due to reductions in risky sex? Evidence from a comprehensive epidemiological review.
  68. (2008). Mushayi W: Multiple Concurrent Partnerships in Zimbabwe: Determinants and monitoring indicators Harare, Zimbabwe: Population Services International;
  69. (2001). Nanchahal K: Sexual behaviour in Britain: partnerships, practices, and HIV risk behaviours. Lancet
  70. (2001). Nuptiality and risk behaviour in Lusaka and Kampala. Afr J Reprod Health
  71. (2009). of Health and Social Welfare: Lesotho Demographic and Health Survey
  72. (2004). Organization: The global burden of disease:
  73. (2004). Pokrovskiĭ V: Variants of human immunodeficiency virus type 1, detected in Russia among those infected by the sexual route. Vopr Virusol
  74. (2009). Polygyny and the spread of HIV in sub-Saharan Africa: a case of benign concurrency. Aids
  75. (2008). Probability of HIV transmission during acute infection
  76. (2008). Public health - Reassessing HIV prevention. Science
  77. (1999). Rates of HIV-1 transmission within marriage in rural Uganda in relation to the HIV sero-status of the partners. Aids
  78. (2010). RC: Determinants of Consistent Condom Use Vary by Partner Type among Young Men in Kisumu, Kenya: A Multi-level Data Analysis. AIDS and Behavior
  79. (2008). Reducing Child Malnutrition in Sub-Saharan Africa: Surveys Find Mixed Progress Population Reference Bureau;
  80. (2009). Rehle TM: Sexual behaviour patterns in South Africa and their association with the spread of HIV: Insights from a mathematical model. Demographic Research
  81. (2009). Relationship Dynamics and Consistency of Condom Use Among Adolescents. Perspectives on Sexual and Reproductive Health
  82. (2010). report: UNAIDS report on the global AIDS epidemic 2010 Geneva;
  83. (2010). Reporting on first sexual experience: The importance of interviewer-respondent interaction. Demographic Research
  84. (2004). RJ: “A bit more truthful": the validity of adolescent sexual behaviour data collected in rural northern Tanzania using five methods. Sexually Transmitted Infections
  85. RM: The Influence of Concurrent Partnerships on the Dynamics of HIV/AIDS.
  86. Rutstein S: A study of the association of HIV infection with wealth in sub-Saharan Africa Calverton,
  87. (1994). S: The Social Organization of Sexuality Chicago:
  88. (1998). Sandstrom A: Decline in the prevalence of HIV-1 infection in young women in the Kagera region of Tanzania. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology
  89. Serial monogamy and the spread of HIV: how explosive can it get?
  90. (1989). Sexual behavior and AIDS in Sub-Saharan Africa–An annotated bibliography ODA (UK);
  91. (2009). SJ: Sexual and marital trajectories and HIV infection among ever-married women in rural Malawi. Sexually Transmitted Infections
  92. (2003). SSA: Who infects whom? HIV-1 concordance and discordance among migrant and non-migrant couples in South Africa. Aids
  93. (2010). The Concurrency Hypothesis in Sub-Saharan Africa: Convincing Empirical Evidence is Still Lacking. Response to Mah
  94. (2002). The Materiality of Everyday Sex: Thinking Beyond ‘Prostitution’. East African Studies
  95. (2010). The mathematics of concurrent partnerships and HIV: a commentary on Lurie and Rosenthal. AIDS and Behavior
  96. (2010). The prevalence, incidence and risk factors of herpes simplex virus type 2 infection among pregnant Zimbabwean women followed up nine months after childbirth. BMC Women’s Health
  97. (1995). The Social Dynamics of HIV Transmission as Reflected through Discordant Couples in Rural Uganda. Aids
  98. (2006). Think Tank Meeting on
  99. (2010). Timing is everything: International variations in historical sexual partnership concurrency and HIV prevalence. PLoS One
  100. (2008). Wawer MJ: Reassessing the hypothesis on STI control for HIV prevention. Lancet
  101. (2011). Wawer MJ: The contribution of HIV-discordant relationships to new HIV infections in
  102. (2007). Why is HIV prevalence so severe in Southern Africa?
  103. (2010). You Still Need to Give Her a Token of Appreciation’’: The Meaning of the Exchange of Money in the Sexual Relationships of Out-of-School Adolescents in Rural Southwest Uganda.