AIDS and Behavior

, Volume 17, Issue 7, pp 2405–2415 | Cite as

From Coitus to Concurrency: Sexual Partnership Characteristics and Risk Behaviors of 15–19 Year Old Men Recruited from Urban Venues in Tanzania

  • Thespina J. YamanisEmail author
  • Irene A. Doherty
  • Sharon S. Weir
  • James M. Bowling
  • Lusajo J. Kajula
  • Jessie K. Mbwambo
  • Suzanne Maman
Original Research


Understanding the uptake and patterns of sexual partnerships of adolescent males reveals their risky behaviors that could persist into adulthood. Using venue-based sampling, we surveyed 671 male youth ages 15–19 from an urban Tanzanian neighborhood about their sexual partnerships during the past 6 months. The proportion of males who had ever had sex increased with age (21 % at age 15; 70 % at age 17; 94 % at age 19), as did the proportion who engaged in concurrency (5 % at age 15; 28 % at age 17; 44 % at age 19). Attendance at ≥2 social venues per day and meeting a sexual partner at a venue was associated with concurrency. Concurrency was associated with alcohol consumption before sex among 18–19 year olds and with not being in school among 15–17 year olds. We find that concurrency becomes normative over male adolescence. Venue-based sampling may reach youth vulnerable to developing risky sexual partnership patterns.


Youth Men Concurrency HIV Venues 



The Vijana Vijiweni Project was funded through grants from the National Institute of Mental Health (R21MH 080577) and the University of North Carolina at Chapel Hill’s Center for AIDS Research and Injury Prevention Research Center. The first author’s participation in the project was funded by the University of North Carolina at Chapel Hill’s C.V. Starr International Award and Dissertation Travel Award from the Center for Global Initiatives, as well as a National Research Service Award for pre-doctoral training from the University of North Carolina at Chapel Hill’s Center for Infectious Diseases (NRSA-AI 7001-32).


  1. 1.
    UNAIDS. Outlook breaking news: young people are leading the HIV prevention revolution. UNFPA Africa. Report 2012; 2010.Google Scholar
  2. 2.
    Gouws E, Stanecki KA, Lyerla R, Ghys PD. The epidemiology of HIV infection among young people aged 15–24 years in southern Africa. AIDS. 2008;22(Suppl 4):S5–16.PubMedCrossRefGoogle Scholar
  3. 3.
    Pettifor AE, Rees HV, Kleinschmidt I, Steffenson AE, MacPhail C, Hlongwa-Madikizela L, et al. Young people’s sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey. AIDS. 2005;19(14):1525–34.PubMedCrossRefGoogle Scholar
  4. 4.
    Barker G, Ricardo C. Young men and the construction of masculinity in sub-Saharan Africa: implications for HIV/AIDS, conflict, and violence. The world bank social development papers: conflict prevention and reconstruction June, 2005; Paper No. 26: October 25; 2010.Google Scholar
  5. 5.
    Koumans EH, Farley TA, Gibson JJ, Langley C, Ross MW, McFarlane M, et al. Characteristics of persons with syphilis in areas of persisting syphilis in the United States: sustained transmission associated with concurrent partnerships. Sex Transm Dis. 2001;28(9):497.PubMedCrossRefGoogle Scholar
  6. 6.
    Potterat JJ, Zimmerman-Rogers H, Muth SQ, Rothenberg RB, Green DL, Taylor JE, et al. Chlamydia transmission: concurrency, reproduction number, and the epidemic trajectory. Am J Epidemiol. 1999;150(12):1331.PubMedCrossRefGoogle Scholar
  7. 7.
    Guwatudde D, Wabwire-Mangen F, Eller LA, Eller M, McCutchan F, Kibuuka H, et al. Relatively low HIV infection rates in rural uganda, but with high potential for a rise: a cohort study in Kayunga District, Uganda. PLoS ONE. 2009;4(1):e4145.Google Scholar
  8. 8.
    Helleringer S, Kohler HP, Kalilani-Phiri L. The association of HIV serodiscordance and partnership concurrency in Likoma Island (Malawi). AIDS. 2009;23(10):1285–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Morris M, Kretzschmar M. Concurrent partnerships and the spread of HIV. AIDS. 1997;11(5):641–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Pilcher CD, Tien HC, Eron JJ Jr, Vernazza PL, Leu SY, Stewart PW, et al. Brief but efficient: acute HIV infection and the sexual transmission of HIV. J Infect Dis. 2004;189(10):1785–92.PubMedCrossRefGoogle Scholar
  11. 11.
    Morris M. Concurrent partnerships and syphilis persistence: new thoughts on an old puzzle. Sex Transm Dis. 2001;28(9):504–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Lurie MN, Rosenthal S. The concurrency hypothesis in sub-Saharan Africa: convincing empirical evidence is still lacking. Response to Mah and Halperin, Epstein, and Morris. AIDS Behav. 2010;14(1):34.PubMedCrossRefGoogle Scholar
  13. 13.
    Lurie MN, Rosenthal S. Concurrent partnerships as a driver of the HIV epidemic in sub-Saharan Africa? The evidence is limited. AIDS Behav. 2010;14(1):17–24.PubMedCrossRefGoogle Scholar
  14. 14.
    Sawers L, Stillwaggon E. Concurrent sexual partnerships do not explain the HIV epidemics in Africa: a systematic review of the evidence. J Int AIDS Soc. 2010;13:34.Google Scholar
  15. 15.
    Tanser F, Bärnighausen T, Hund L, Garnett GP, McGrath N, Newell M. Effect of concurrent sexual partnerships on rate of new HIV infections in a high-prevalence, rural South African population: a cohort study. Lancet. 2011;378(9787):247–55.Google Scholar
  16. 16.
    Padian NS, Manian S. The concurrency debate: time to put it to rest. Lancet. 2011;378(9787):203–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Enns EA, Brandeau ML, Igeme TK, Bendavid E. Assessing effectiveness and cost-effectiveness of concurrency reduction for HIV prevention. Int J STD AIDS. 2011;22(10):558–67.PubMedCrossRefGoogle Scholar
  18. 18.
    Eaton JW, Case KK, Secretariat of the UNAIDS reference group on estimates, modelling, and projections. Consultation on concurrent sexual partnerships: recommendations from a meeting of the UNAIDS reference group on estimates, modelling, and projections held in Nairobi, Kenya, April 20–21st 2009.Google Scholar
  19. 19.
    Mattson CL, Bailey RC, Agot K, Ndinya-Achola JO, Moses S. A nested case-control study of sexual practices and risk factors for prevalent HIV-1 infection among young men in Kisumu, Kenya. Sex Transm Dis. 2007;34(10):731–6.PubMedGoogle Scholar
  20. 20.
    Harrison A, Cleland J, Frohlich J. Young people’s sexual partnerships in KwaZulu-Natal, South Africa: patterns, contextual influences, and HIV risk. Stud Fam Plann. 2008;39(4):295–308.PubMedCrossRefGoogle Scholar
  21. 21.
    Mah TL. Prevalence and correlates of concurrent sexual partnerships among young people in South Africa. Sex Transm Dis. 2010;37(2):105–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Carter MW, Kraft JM, Koppenhaver T, Galavotti C, Roels TH, Kilmarx PH, et al. A bull cannot be contained in a single kraal: concurrent sexual partnerships in Botswana. AIDS Behav. 2007;11(6):822–30.PubMedCrossRefGoogle Scholar
  23. 23.
    Steffenson AE, Pettifor AE, Seage GR 3rd, Rees HV, Cleary PD. Concurrent sexual partnerships and human immunodeficiency virus risk among South African youth. Sex Transm Dis. 2011;38(6):459–66.Google Scholar
  24. 24.
    Rothenberg R, Potterat J, Gisselquist D. Concurrency and sexual transmission. AIDS. 2002;16(4):678–9; author reply, 679–80.Google Scholar
  25. 25.
    Nelson SJ, Manhart LE, Gorbach PM, Martin DH, Stoner BP, Aral SO, et al. Measuring sex partner concurrency: it’s what’s missing that counts. Sex Transm Dis. 2007;34(10):801–7.PubMedGoogle Scholar
  26. 26.
    Mah TL, Halperin DT. Concurrent sexual partnerships and the HIV epidemics in Africa: evidence to move forward. AIDS Behav. 2010;14(1):11–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Modelling, and Projections: Working Group on Measuring Concurrent Sexual Partnerships. UNAIDS reference group on estimates. HIV: consensus indicators are needed for concurrency. Lancet. 2010;375(9715):621–22.Google Scholar
  28. 28.
    Landman KZ, Ostermann J, Crump JA, Mgonja A, Mayhood MK, Itemba DK, et al. Gender differences in the risk of HIV infection among persons reporting abstinence, monogamy, and multiple sexual partners in northern Tanzania. PLoS ONE. 2008;3(8):e3075.PubMedCrossRefGoogle Scholar
  29. 29.
    Gorgens M, Kalinga R. The HIV epidemic in Tanzania Mainland: where have we come from, where is it going, and how are we responding? 6 November 2008.Google Scholar
  30. 30.
    National Bureau of Statistics (NBS) [Tanzania], ORC Macro. Tanzania demographic and health survey 2010; 2010.Google Scholar
  31. 31.
    Tanzania Commission for AIDS (TACAIDS), Zanzibar AIDS Commission (ZAC), National Bureau of Statistics (NBS), Office of the Chief Government Statistician (OCGS), Macro International Inc. Tanzania HIV/AIDS and malaria indicator survey 2007–2008; 2008.Google Scholar
  32. 32.
    Boerma JT, Weir SS. Integrating demographic and epidemiological approaches to research on HIV/AIDS: the proximate-determinants framework. J Infect Dis. 2005;191(Suppl 1):S61–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Royce RA, Sena A, Cates W Jr, Cohen MS. Sexual transmission of HIV. N Engl J Med. 1997;336(15):1072–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Yamanis T, Maman S, Mbwambo J, Earp JA, Kajula L. Social venues that protect against and promote HIV risk for young men in Dar es Salaam, Tanzania. Soc Sci Med. 2010;71(9):1601–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Bourdieu P, Nice R. Distinction: a social critique of the judgement of taste. Cambridge, MA: Harvard University Press; 1987.Google Scholar
  36. 36.
    Poland B, Greene L, Rootman I. Settings for health promotion: linking theory and practice. Newbury Park, CA: Sage Publications; 2001.Google Scholar
  37. 37.
    Latkin C, Knowlton A. Micro-social approaches to HIV prevention: a social ecological perspective. AIDS Care. 2005;17(Suppl 1):S102–13.PubMedCrossRefGoogle Scholar
  38. 38.
    Fichtenberg CM, Ellen JM. Moving from core groups to risk spaces. Sex Transm Dis. 2003;30(11):825.PubMedCrossRefGoogle Scholar
  39. 39.
    Weir SS, Morroni C, Coetzee N, Spencer J, Boerma JT. A pilot study of a rapid assessment method to identify places for AIDS prevention in Cape Town, South Africa. Sex Transm Infect. 2002;78(Suppl 1):i106–13.PubMedCrossRefGoogle Scholar
  40. 40.
    Ao TT, Sam NE, Masenga EJ, Seage GR 3rd, Kapiga SH. Human immunodeficiency virus type 1 among bar and hotel workers in northern Tanzania: the role of alcohol, sexual behavior, and herpes simplex virus type 2. Sex Transm Dis. 2006;33(3):163–9.Google Scholar
  41. 41.
    Mziray JC. Boys’ views on sexuality, girls, and pregnancies. In: Rwebangira M, Liljestrom R, editors. Haraka, Haraka…look before you leap. Stockholm, Sweden: Nordiska Afrikainstitutet; 1998. p. 144–63.Google Scholar
  42. 42.
    Setel PW. A plague of paradoxes: AIDS, culture and demography in Northern Tanzania. Chicago: The University of Chicago Press; 1999.Google Scholar
  43. 43.
    Stroeken K, Remes P, De Koker P, Michielsen K, Van Vossole A, Temmerman M. HIV among out-of-school youth in Eastern and Southern Africa: a review. AIDS Care. 2011;24(2):186–94.PubMedGoogle Scholar
  44. 44.
    Tanzania Research on Poverty Alleviation. Tanzania poverty and human development report; 2005.Google Scholar
  45. 45.
    National Bureau of Statistics, Tanzania. 2002 population and housing census; 2002.Google Scholar
  46. 46.
    McCurdy SA, Ross MW, Kilonzo GP, Leshabari MT, Williams ML. HIV/AIDS and injection drug use in the neighborhoods of Dar es Salaam, Tanzania. Drug Alcohol Depend. 2006;82(Suppl 1):S23–7.PubMedCrossRefGoogle Scholar
  47. 47.
    Dar es Salaam City Council. City Profile for Dar Es Salaam, United Republic of Tanzania. November 2004.Google Scholar
  48. 48.
    Weir SS, Pailman C, Mahlalela X, Coetzee N, Meidany F, Boerma JT. From people to places: focusing AIDS prevention efforts where it matters most. AIDS. 2003;17(6):895–903.PubMedCrossRefGoogle Scholar
  49. 49.
    MEASURE Evaluation Project. PLACE: priorities for local AIDS control efforts. A manual for implementing the PLACE method. October 2005; MS-05-13.Google Scholar
  50. 50.
    Doherty IA, Minnis A, Auerswald CL, Adimora AA, Padian NS. Concurrent partnerships among adolescents in a Latino community: The Mission District of San Francisco, California. Sex Transm Dis. 34:437–43.Google Scholar
  51. 51.
    Kelley SS, Borawski EA, Flocke SA, Keen KJ. The role of sequential and concurrent sexual relationships in the risk of sexually transmitted diseases among adolescents. J Adolesc Health. 2003;32(4):296–305.PubMedCrossRefGoogle Scholar
  52. 52.
    Reynolds HW, Luseno WK, Speizer IS. The measurement of condom use in four countries in East and Southern Africa. AIDS Behav. 2012;16(4):1044–53.PubMedCrossRefGoogle Scholar
  53. 53.
    The American Association for Public Opinion Research. standard definitions: final dispositions of case codes and outcome rates for surveys, 2008.Google Scholar
  54. 54.
    Kaplan D, Ferguson AJ. On the utilization of sample weights in latent variable models. Struct Equ Model. 1999;6(4):305.CrossRefGoogle Scholar
  55. 55.
    National Bureau of Statistics (NBS) [Tanzania], ORC Macro. Tanzania demographic and health survey 2004-05; 2005.Google Scholar
  56. 56.
    Gardner M, Steinberg L. peer influence on risk taking, risk preference, and risky decision making in adolescence and adulthood: an experimental study. Dev Psychol. 2005;41(4):625–35.Google Scholar
  57. 57.
    MacPhail C, Campbell C. ‘I think condoms are good but, aai, I hate those things’: condom use among adolescents and young people in a Southern African township. Soc Sci Med. 2001;52(11):1613–27.PubMedCrossRefGoogle Scholar
  58. 58.
    Agadjanian V. Men’s talk about “women’s matters”: gender, communication, and contraception in urban Mozambique. Gender Soc. 2002;16(2):194–215.Google Scholar
  59. 59.
    Harrison A, Newell ML, Imrie J, Hoddinott G. HIV prevention for South African youth: which interventions work? A systematic review of current evidence. BMC Public Health. 2010;26(10):102.CrossRefGoogle Scholar
  60. 60.
    Cowan FM, Pascoe SJ, Langhaug LF, Mavhu W, Chidiya S, Jaffar S, et al. The Regai Dzive Shiri project: results of a randomized trial of an HIV prevention intervention for youth. AIDS. 2010;24(16):2541–52.PubMedCrossRefGoogle Scholar
  61. 61.
    Fisher JC, Cook PA, Kapiga SH. Alcohol use before sex and HIV risk: situational characteristics of protected and unprotected encounters among high-risk African women. Sex Transm Dis. 2010;37(9):571–8.PubMedCrossRefGoogle Scholar
  62. 62.
    Kalichman S, Simbayi L, Kaufman M, Cain D, Jooste S. Alcohol use and sexual risks for HIV/AIDS in Sub-Saharan Africa: systematic review of empirical findings. Prev Sci. 2007;8(2):141–51.Google Scholar
  63. 63.
    Noar SM, Cole C, Carlyle K. Condom use measurement in 56 studies of sexual risk behavior: review and recommendations. Arch Sex Behav. 2006;35(3):327–45.PubMedCrossRefGoogle Scholar
  64. 64.
    Nnko S, Boerma JT, Urassa M, Mwaluko G, Zaba B. Secretive females or swaggering males? An assessment of the quality of sexual partnership reporting in rural Tanzania. Soc Sci Med. 2004;59(2):299–310.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Thespina J. Yamanis
    • 1
    Email author
  • Irene A. Doherty
    • 2
  • Sharon S. Weir
    • 3
  • James M. Bowling
    • 4
  • Lusajo J. Kajula
    • 5
  • Jessie K. Mbwambo
    • 5
  • Suzanne Maman
    • 4
  1. 1.School of International ServiceAmerican UniversityWashingtonUSA
  2. 2.Division of Infectious Diseases, School of MedicineUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillUSA
  4. 4.Department of Health BehaviorUniversity of North Carolina at Chapel HillChapel HillUSA
  5. 5.Department of Psychiatry and Mental HealthMuhimbili University of Health and Allied SciencesDar es SalaamTanzania

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