Sexual Partner Concurrency and HIV Summary of Literature Review - PowerPoint

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					Sexual Partner Concurrency
   and HIV: Summary of
    Literature Review

   Judith D. Auerbach, Ph.D.
    San Francisco AIDS Foundation


       Gender, Sexuality, and HIV
           Research Network
     International AIDS Conference
      Mexico City, August 3, 2008
 Concurrency Lit Review
• Prepared by Sarah Gluckstern, SFAF
  Intern
• With input from
  – Steering Committee members
  – Technical Advisors:
    •   Ada Adimora, University of North Carolina
    •   Pamina Gorbach, UCLA
    •   Martina Morris, University of Washington
    •   Kyle Bernstein, SF Dept. of Health
    •   Navendu Shekhar, PSI
    •   Sue Goldstein, Soul City
      Defining & Measuring
          Concurrency
• No standard definition; multiple
  definitions including:
  – Ongoing relationships with 2+ partners
  – In a polygamous marriage
  – One “regular” and one “casual” partner
  – One regular partner and visits to sex
    worker
  – One regular partner and some “one-night-
    stands” with others
  – Multiple, sequential partners in very short
    timeframe (e.g. a week)
    Defining & Measuring
        Concurrency
• Measurement issues include:
 – Accurate recall
 – Respondents’ own definitions
 – Lack of agreement between partners
   about sexual encounter dates, times,
   exposure, etc.
 – Different methods elicit different
   information
   • Social acceptability issues
   Modeling Concurrency
• Mathematical models comparing
  multiple scenarios of partnerships
  demonstrate significance of
  concurrency, as compared with
  sequential monogamy, for HIV
  transmission.
• With ½ of partnerships concurrent,
  after 5 years, epidemic is 10 times as
  large as with serial monogamy (Morris
  1997).
 Concurrency and Other STI
• Concurrency found to increase
  gonorrhea transmission (Daker-
  White 1997).
• Concurrency associated with both
  individual and partner-level STI
  (Gorbach 2005).
• People diagnosed with STI >2.5
  times as likely to be in concurrent
  partnerships (Manhart 2002).
   Descriptive Research:
  Prevalence and Patterns
• Africa
  – Heterosexual concurrency common
    in many settings, but at variable
    rates and practices
  – Dynamics related to concurrency
    include:
    • Wealth
    • Alcohol use
    • Condom use
    • Marriage
    Descriptive Research:
   Prevalence and Patterns
• United States
  – Low levels of heterosexual concurrency
    reported by men and women (11%-12%)
  – Higher rates reported among adolescents
    (20% for Latinos in Doherty 2007)
  – Higher rates among African Americans in
    North Carolina (ranging from 31% to 63% in
    studies by Adimora, 2004 and 2003)
  – Qualitative studies reveal gender norms at
    play in beliefs about concurrency
   Descriptive Research:
  Prevalence and Patterns
• Gay and Other MSM
  – Little research
  – Concurrency related to:
     •partner selection
     •sero-sorting
     •sero-positioning
     •negotiated safety
 Concurrency and “ABC”
• “Be Faithful”

• Uganda’s “Zero Grazing”
  Campaign

• Few evaluated interventions
  targeting concurrency
     Gender, Sexuality &
        Concurrency
• Qualitative research shows:
  – Males & females report different
    motivations
  – Double-standard in many
    cultures
  – Some practices are normative
    (e.g., polygamy)
      Conclusion: Gaps
• Different Definitions
• Research with gay and MSM
• Research outside Africa and USA
• Evaluated interventions
• Dynamics and risks inherent in
  different forms of concurrency
• Partner reduction vs. harm reduction
• Context of sexuality, sexual rights,
  sexual cultures