The recent national HIV prevalence survey asked participants two questions about their knowledge of HIV prevention. The questions related to whether do condoms and having less sexual partners reduce HIV risk. Overall, the knowledge of HIV prevention has dropped from about 60% from the last survey conducted in 2005 to around 40 ‘€“ 50% on average in 2008 among people aged 15 ‘€“ 49. Although the survey shows an increase in condom use, especially among the youth, it cautions that more South Africans are not aware that having more sexual partners can lead to HIV infection.

‘€œIt’€™s not surprising. It’€™s quite interesting, though. I think as a country we all focused on condom use and we all said, over many years, ‘€˜people are not going to change their behavior; it’€™s too hard to tell people to stick to one partner; sexuality is difficult to control; so let’€™s just tell people to use condoms’€™. What happened is that we all neglected that message’€, says Dr Sue Goldstein, Soul City’€™s Senior Executive for Health Programmes, in response to the finding.

Goldstein says neglecting warning people of the dangers of multiple sexual partners was a ‘€œmistake’€.

‘€œOne of the things that I believe why we made the mistake of not focusing on not having one partner was some of us looked at it from a woman’€™s perspective. If you’€™re a woman in a marriage and you are faithful to your partner, it doesn’€™t mean that you’€™re safe from HIV because if your partner goes out and has sex with other people he can infect you. And so, the issue of ‘€˜stick to one partner’€™ as an individual is not a really safe strategy, always. But at a population level, it’€™s a really important strategy to decrease the number of partners. You’€™re cutting back on those sexual networks and you’€™re making them smaller and more isolated so that HIV can’€™t spread through them’€, she said.

She added that prevention programme designers also assumed that it will be difficult for people to understand the message. As a result, the message that having multiple sexual partnerships, especially established ones that are maintained over a lengthy period can breed HIV infection, was hidden away from the public.    

 ‘€œWhen you have more than one partner at a time, you get linked into their sexual network that people can’€™t see. You don’€™t know that you’€™re having sex with your partner’€™s ex ex’€¦ You’€™re linked in. That you don’€™t know – and certainly when you’€™re having sex – you don’€™t think about it. But the key issue that makes HIV risk so high is that when you have more than one long-term partnership, you trust your partners. And so, after a couple of months you look good, you’€™re happy together and you stop using condoms. And that’€™s where the risk comes in. People don’€™t use condoms in long-term relationships’€, she said.

Although the survey did not go into detail into the types of relationships termed ‘€˜multiple and concurrent partnerships’€™, it shows that the number of people who have had more than one sexual partner in one year hasn’€™t increased dramatically.

However, provincial breakdowns show that in the Free State the number of people who have had more than one sexual partner in the last year has more than doubled from the last survey in 2005. With 14.6% of the respondents admitting to having had more than one sexual partner in one year, the Free State tops all the provinces, followed by the Eastern Cape and the North West province.  

‘€œIf you have lots of partners, every new partner increases your risk of HIV, there’€™s no doubt’€, said Goldstein.

That is particularly true if you don’€™t use condoms consistently.

But just like it’€™s proven that people have started to realise the importance of using condoms, there is hope that South Africans will also understand why it’€™s crucial to stick to one partner.      

‘€œTen years ago, I remember these discussions around condoms and people said: ‘€˜You know what? People are never going to use condoms. It’€™s like eating sweets with a wrapper on. Don’€™t tell us. South Africans will never use them’€™.   And if you look at the stats in the HSRC study, they’€™re absolutely fabulous. People are really using them’€, added Goldstein.