Abstract #90  -  What has happened to multiple sexual partnerships in Swaziland between 2002 and 2008?
Authors:   Presenting Author:   Dr Anne Cockcroft - CIET Trust
Additional Authors:  Dr Neil Andersson, Mr Ari Ho-Foster, Ms Nobantu Marokoane, Mr Bheka Mziyako,
Aim: Multiple sexual partnerships, particularly if concurrent, increase the risk of HIV transmission and are an important driver of the AIDS epidemic in Southern Africa. Data are rarely available to allow direct comparisons over time; this study examines changes in rates of multiple partnerships between 2002 and 2008, using data from five similar surveys in Swaziland.
Method / Issue: We conducted five surveys in communities across Swaziland: in 2002, 2005, 2006, 2007, and 2008. In 2002, we drew a stratified random sample of enumeration areas (EA) from capital, urban and rural strata. In 2005 and 2006 we revisited a random sub-sample of the EA; in 2007 and 2008 we revisited them all. For this study, we restricted our analysis to people aged 18-29 years interviewed in communities included in all five surveys. We applied weights to adjust for any urban/rural sample imbalance. We examined, among males and females separately, multiple concurrent partnerships (MCP - those who had more than one sexual partner in the last one month, among those who had any) and multiple partnerships (MP - those who had more than one sexual partner in the last 12 months, among those who had any) in each survey. In 2005 and 2006, the MP figure was over the last six months.
Results / Comments: Over the five surveys, we interviewed a total of 2896 males and 4311 females aged 18-29 years. As expected, males reported much higher rates of MCP and MP than females in all years. Changes in MCP: We did not ask about MCP in 2002. Among males, reported MCP rates fell from 35% in 2005 to 16% in 2006 (OR 0.50, 95% CI 0.38-0.66), then rose to 24% in 2007 and 25% in 2008 (2006-2008, OR 1.57, 95% CI 1.08-2.29). The much lower female rates fell slightly and then rose: 5% in 2005, 4% in 2006, 3% in 2007, 6% in 2008 (2007-2008, OR 3.31, 95% CI 1.71-6.41) Changes in MP: Among males, reported MP rates fell from 61% in 2002 to 46% in 2007 (OR 0.43, 95% CI 0,32-0,57), then rose to 49% in 2008 (OR 1.67, (95% CI 1.03-2.70). Female rates fell from 22% in 2002 to 9% in 2007 (OR 0.30, 95% CI 0.20-0.45) and then rose to 15% in 2008 (OR 2.77, 95% CI 1.67-4.60)
Discussion: The falling rates of MCP and MP to 2006/7 are expected, given the intensive efforts to reduce multiple partnerships in Swaziland, especially in 2005-2006. The more recent increases are worrying. We do not know how much of the reduction was actual change in practice and how much was reduced reporting, as multiple partnerships became less socially unacceptable. Rates were clearly falling before the 2005-2006 campaigns. The recent increases could reflect reversal of a real behaviour change or just that the intense pressure not to admit to multiple partners has decreased recently.
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