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Multiple and concurrent partners

Written by Health-e News

Years of working as a professional nurse have convinced Seobi Matube that having more than one sexual partner is a sure way of getting HIV.

Matube works in the heart of the Free State mines in Welkom for Lesedi Lechabile, an organisation that specialises in dealing with sexually transmitted infections and HIV testing.

‘€œDefinitely, working for Lesedi Lechabile has opened my eyes to what can happen with HIV,’€ says the 43-year-old husband and father.

‘€œMany men sit around the table and tell false stories about how, to be men, we have to be promiscuous. But this is just an excuse to have many partners. Somebody has to say ‘€˜guys, what we are doing is not right; not for ourselves, our wives and not for our own dignity’€™.’€

Matube has decided to be this somebody, and has joined ‘€˜Brothers for Life’€, a campaign aimed at encouraging men to ‘€œchoose a single partner over multiple chances with HIV’€.

Part of his motivation is to be a good role model to his 17-year-old son.

‘€œI am not saying I think I am better. I have made mistakes but I have learnt from the past. I don’€™t want my son to have the idea that, when I go out at night, I may have other women,’€ says Matube, adding that his relationship with his wife had improved after taking the ‘€œBrothers for Life’€ pledge.

Like Matube, 38-year-old Nhlanhla Vesi has a son and his wife is pregnant with their second child.

Vesi has worked with men and HIV/AIDS for the past six years for an organisation called the Valley Trust, and is particularly concerned about protecting rural isiZulu men from HIV.

‘€œThere is a tendency for men to have multiple partners and this increases the chances of them spreading HIV, especially in men over the age of 30,’€ says Vesi. ‘€œSleeping around can destroy your whole family by bringing in HIV.’€

But Vesi faces a complication as a number of the men he works with have more than one wife ‘€“ so the message of choosing a single partner would alienate them.

‘€œSome people say having more than one partner is part of our culture. But with them, I say this can be controlled,’€ says Vesi. ‘€œI talk about a circle that has two or three houses inside it and it is protected. But once the gate is opened, this brings HIV inside. We are not against polygamy but we are talking about taking responsibility; reducing the partners outside the gate so that the wives and children inside the circle are protected.’€

Brothers for Life was launched in late August with the main aim of encouraging men to take responsibility for their sexual behaviour and build supportive relationships with their partners and children.

About a quarter of South African men in their thirties are HIV positive and experts say one of the factors driving HIV/AIDS in southern Africa is that people have more than one partner at the same time ‘€“ concurrent partners.

Although surveys have shown that men from a number of other countries have more sexual partners in a year than men from southern Africa, they tend to have one-night stands rather than longer relationships with more than one person.

But scientists and epidemiologists have determined that having ongoing relationships with more than one partner greatly increases the risk of HIV transmission. Concurrent relationships create open sexual networks where a number of people are connected sexually at the same time.

When a person is newly infected with HIV, they are most infectious as their viral load is very high. If they are part of an open sexual ‘€œnetwork’€, their HIV can be transmitted relatively easily.

In contrast, the risk of HIV infection from one sexual encounter is not that great, unless the person has a high viral load.

Plus, the chances of people using condoms during one-night stands is very much higher than condom use during more long-term relationships, even when people have more than one partner. This makes concurrent relationships more risky.

Until a few years back, few organisations in dared to try to change the pattern of ‘€œmultiple and concurrent partners’€ in South Africa.

This was unlike Uganda, which dramatically reduced the spread of HIV by, among other things, running a campaign called ‘€œZero grazing’€ in the 1990s aimed at encouraging people to cut back on their partners. Large WHO surveys conducted in Uganda between 1989 and 1995 found a 60% reduction in men and women reporting multiple partners.

In 2006, an expert ‘€œthink tank’€ meeting organised by the South African Development Community (SADC) identified MCP, with low condom use, and low levels of male circumcision as key drivers of HIV in southern Africa.

This spurred Soul City’€™s ‘€œOne Love’€ campaign, launched in 2008, which aims to discourage multiple and concurrent partners by raising awareness of the risk that sexual networks posed to the spread of HIV/AIDS.

Soul City research in 10 southern African countries found that people did not understand the risk of MCP, and pursued them because they were sexually dissatisfied, were influenced by social and cultural norms and beliefs, including that men cannot control sexual desire; pursuit of money and   were under the influence of alcohol.

Brothers for Life is a new addition to the campaign against MCP, and is focusing specifically on men.

However, changing people’€™s behaviour is a slow and complicated process that requires huge effort and considerable resources to change pervasive social norms.

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Health-e News

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