AIDS and Behavior

, Volume 14, Issue 1, pp 17–24 | Cite as

Concurrent Partnerships as a Driver of the HIV Epidemic in Sub-Saharan Africa? The Evidence is Limited




The authors would like to thank Brian Williams, Richard White, Jeff Eaton and Monica Bertoia for their valuable input. Support for this work came in part from a KO1 Career Development Grant to Dr. Lurie (MH069113-O1A1).


  1. Aral, S. O. (1999). Sexual network patterns as determinants of STD rates: Paradigm shift in the behavioral epidemiology of STDs made visible. Sexually Transmitted Diseases, 26(5):262–264. doi:10.1097/00007435-199905000-00004.CrossRefPubMedGoogle Scholar
  2. Boily, M. C., Baggaley, R. F., Wang, L., Masse, B., White, R. G., Hayes, R. J., et al. (2009). Heterosexual risk of HIV-1 infection per sexual act: Systematic review and meta-analysis of observational studies. The Lancet Infectious Diseases, 9(2):118–129. doi:10.1016/S1473-3099(09)70021-0.CrossRefPubMedGoogle Scholar
  3. Carter, M. W., Kraft, J. M., Koppenhaver, T., Galavotti, C., Roels, T. H., Kilmarx, P. H., et al. (2007). “A bull cannot be contained in a single kraal”: Concurrent sexual partnerships in Botswana. AIDS and Behavior, 11:822–830. doi:10.1007/s10461-006-9203-6.CrossRefPubMedGoogle Scholar
  4. Cleland, J., Boerma, J. T., Carael, M., & Weir, S. S. (2004). Monitoring sexual behavior in general populations: A synthesis of lessons of the past decade. Sexually Transmitted Infections, 80(Suppl. 2):1–7. doi:10.1136/sti.2004.013151.Google Scholar
  5. Colvin, M., Abdool Karim, S. S., Connolly, C., Hoosen, A. A., & Ntuli, N. (1998). HIV infection and asymptomatic sexually transmitted infections in a rural South African community. International Journal of STD and AIDS, 9:548–550. doi:10.1258/0956462981922683.CrossRefPubMedGoogle Scholar
  6. Deuchert, E., & Brody, S. (2007). Plausible and implausible parameters for mathematical modeling of nominal heterosexual HIV transmission. Annals of Epidemiology, 17:237–244. doi:10.1016/j.annepidem.2006.10.011.CrossRefPubMedGoogle Scholar
  7. Doherty, I. A., Shiboski, S., Ellen, J. M., Adimora, A. A., & Padian, N. S. (2006). Sexual bridging socially and over time: A simulation model exploring the relative effects of mixing and concurrency on viral sexually transmitted infection transmission. Sexually Transmitted Diseases, 33(6):368–373. doi:10.1097/01.olq.0000194586.66409.7a.CrossRefPubMedGoogle Scholar
  8. Epstein, H. (2007). The invisible cure. Why we are losing the fight against AIDS in Africa. New York: Picador.Google Scholar
  9. Epstein, H. (2008). AIDS and the irrational. British Medical Journal, 337:1265–1267. doi:10.1136/bmj.a2638.CrossRefGoogle Scholar
  10. Garnett, G. P., & Johnson, A. M. (1997). Coining a new term in epidemiology: Concurrency and HIV. AIDS (London, England), 11:681–683. doi:10.1097/00002030-199705000-00017.Google Scholar
  11. Ghani, A. C., & Garnett, G. P. (2000). Risks of acquiring and transmitting sexually transmitted diseases in sexual partner networks. Sexually Transmitted Diseases, 27(10):579–587. doi:10.1097/00007435-200011000-00006.CrossRefPubMedGoogle Scholar
  12. Halperin, D., & Epstein, H. (2004). Concurrent sexual partnerships help to explain Africa’s high HIV prevalence: Implications for prevention. Lancet, 364(9428):4–6. doi:10.1016/S0140-6736(04)16606-3.CrossRefPubMedGoogle Scholar
  13. Harrison, A., Cleland, J., & Frohlich, J. (2008). Young people’s sexual partnerships in KwaZulu/Natal, South Africa: Patterns, contextual influences, and HIV risk. Studies in Family Planning, 39(4):295–308. doi:10.1111/j.1728-4465.2008.00176.x.CrossRefPubMedGoogle Scholar
  14. Helleringer, S., & Kohler, H.-P. (2007). Sexual network structure and the spread of HIV in Africa: Evidence from Likoma Island, Malawi. AIDS (London, England), 21(17):2323–2332. doi:10.1097/QAD.0b013e328285df98.Google Scholar
  15. Hill, A. B. (1971). Statistical evidence and inference. Principles of medical statistics (9th ed.) (pp. 309–323). New York: Oxford University Press.Google Scholar
  16. Hollingsworth, T. D., Anderson, R. M., & Fraser, C. (2008). HIV-1 transmission, by stage of infection. The Journal of Infectious Diseases, 198(5):687–693. doi:10.1086/590501.CrossRefPubMedGoogle Scholar
  17. Hudson, C. P. (1993). Concurrent partnerships could cause AIDS epidemics. International Journal of STD and AIDS, 4(5):249–253.PubMedGoogle Scholar
  18. Jewkes, R., Dunkle, K., Nduna, M., Levin, J., Jama, N., Khuzwayo, N., et al. (2006). Factors associated with HIV sero-positivity in young, rural South African men. International Journal of Epidemiology, 35(6):1455–1460. doi:10.1093/ije/dyl217.CrossRefPubMedGoogle Scholar
  19. Kalichman, S. C., Ntseane, D., Nthomang, K., Segwabe, M., Phorano, O., & Simbayi, L. C. (2007). Recent multiple sexual partners and HIV transmission risks among people living with HIV/AIDS in Botswana. Sexually Transmitted Infections, 83:371–375. doi:10.1136/sti.2006.023630.CrossRefPubMedGoogle Scholar
  20. Korenromp, E. L., van Vliet, C., Bakker, R., de Vlas, S. J., & Habbema, J. D. F. (2000). HIV spread and partnership reduction for different patterns of sexual behaviour—a study with the microsimulation model STDSIM. Mathematical Population Studies, 8(2):135–173.CrossRefGoogle Scholar
  21. Kretzschmar, M., & Morris, M. (1996). Measures of concurrency in networks and the spread of infectious diseases. Mathematical Biosciences, 133:165–195. doi:10.1016/0025-5564(95)00093-3.CrossRefPubMedGoogle Scholar
  22. Lagarde, E., Auvert, B., et al. (2001). Concurrent sexual partnerships and HIV prevalence in five urban communities of Sub-Saharan Africa. AIDS (London, England), 15(7):877–884. doi:10.1097/00002030-200105040-00008.Google Scholar
  23. Leynaert, B., Downs, A., de Vincenzi, I., et al. (1998). Heterosexual transmission of human immunodeficiency virus: Variability of infectivity throughout the course of infection. American Journal of Epidemiology, 148(1):88–96.PubMedGoogle Scholar
  24. Lurie, M., Williams, B., Zuma, K., et al. (2003). The impact of migration on HIV-1 transmission: A study of migrant and non-migrant men, and their partners. Sexually Transmitted Diseases, 40(2):149–156. doi:10.1097/00007435-200302000-00011.CrossRefGoogle Scholar
  25. Mah, T. L., & Halperin, D. T. (2008). Concurrent sexual partnerships and the HIV epidemics in Africa: Evidence to move forward. AIDS and Behavior, 22. Epub ahead of print.Google Scholar
  26. Mattson, C. L., Bailey, R. C., Agot, K., Ndinya-Achola, J. O., & Moses, S. (2007). A nested case-control study of sexual practices and risk factors for prevalent HIV-1 infection among young men in Kisumu, Kenya. Sexually Transmitted Diseases, 34(10):731–736.PubMedGoogle Scholar
  27. Mishra, V., & Assche, S. B.-V. (2009). Concurrent sexual partnerships and HIV infection: Evidence from national population-based surveys. DHS Working Paper 62. Accessed at on May 5, 2009.
  28. Mitsunaga, T. M., Powell, A. M., Heardm, N. J., & Larsen, U. M. (2005). Extramarital sex among Nigerian men” polygyny and other risk factors. Journal of Acquired Immune Deficiency Syndromes, 39(4):478–488. doi:10.1097/01.qai.0000152396.60014.69.CrossRefPubMedGoogle Scholar
  29. Morris, M., & Kretzschmar, M. (1997). Concurrent partnerships and the spread of HIV. AIDS (London, England), 11:641–648. doi:10.1097/00002030-199705000-00012.Google Scholar
  30. Morris, M., & Kretzschmar, M. (2000). A microsimulation study of the effect of concurrent partnerships on the spread of HIV in Uganda. Mathematical Population Studies, 8(2):109–133.CrossRefGoogle Scholar
  31. Nelson, S. J., Manhart, L. E., Gorbach, P. M., et al. (2007). Measuring sex partner concurrency: It’s what’s missing that counts. Sexually Transmitted Diseases, 34(10):801–807. doi:10.1007/978-1-59745-040-9.PubMedGoogle Scholar
  32. Pettifor, A. E., Rees, H. V., Kleinschmidt, I., et al. (2005). Young people’s sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey. AIDS (London, England), 19:1525–1534. doi:10.1097/01.aids.0000183129.16830.06.Google Scholar
  33. Piot, P., Greener, R., & Russell, S. (2007). Squaring the circle: AIDS, poverty and human development. PLoS Medicine, 4(10):1571–1575. doi:10.1371/journal.pmed.0040314.CrossRefPubMedGoogle Scholar
  34. Sandoy, I. F., Dzekedzeke, K., & Fylkesnes, K. (2008). Prevalence and correlates of concurrent sexual partnerships in Zambia. AIDS and Behavior, 8. Epub ahead of print.Google Scholar
  35. UNAIDS. (2003). AIDS epidemic update: December 2003. Geneva: UNAIDS.Google Scholar
  36. UNAIDS. (2007). AIDS epidemic update: December 2007. Geneva: UNAIDS.Google Scholar
  37. van der Ploeg, C. P. B., van Vliet, D., de Vlas, S. J., Ndinya-Achola, J. O., Fransen, L., et al. (1988). STDSIM: A microsimulation model for decision support on STD control. Interfaces, 28:84–100. doi:10.1287/inte.28.3.84.CrossRefGoogle Scholar
  38. Wasserheit, J. N. (1992). Epidemiological synergy: Interrelationships Between Human Immunodeficiency Virus Infection and other Sexually Transmitted Diseases. Sexually Transmitted Diseases, 19(2):61–77. doi:10.1097/00007435-199219020-00001.PubMedGoogle Scholar
  39. Watts, C. H., & May, R. M. (1992). The influence of concurrent partnerships on the dynamics of HIV/AIDS. Mathematical Biosciences, 108(1):89–104. doi:10.1016/0025-5564(92)90006-I.CrossRefPubMedGoogle Scholar
  40. Wellings, K., Collumbien, M., Slaymaker, E., et al. (2006). Sexual behavior in context: A global perspective. Lancet, 368:1706–1728. doi:10.1016/S0140-6736(06)69479-8.CrossRefPubMedGoogle Scholar
  41. Wellings, K., Slaymaker, E., Bajos, N., Collumbien, M., & Singh, S. (2007). Global sexual behavior. Lancet, 369(9561):557. doi:10.1016/S0140-6736(07)60270-0. author reply 557.CrossRefGoogle Scholar
  42. Williams, B. G., Lloyd-Smith, J. O., Gouws, E., Hankins, C., & Getz, W. M. (2006). The potential impact of male circumcision on HIV in Sub-Saharan Africa. PLoS Medicine, 3(7):e262. doi:10.1371/journal.pmed.0030262.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Department of Community Health, International Health InstituteWarren Alpert Medical School of Brown UniversityProvidenceUSA

Personalised recommendations