Abstract
Conceptually and theoretically, it is easy to see how short gaps and concurrent partnerships fuel the spread of sexually transmitted infections (STI) and HIV in populations. The consequences of concurrency are bounded by the duration of the infectious period and by the relationships between concurrent partnerships and other dimensions of sexual behavior. Consequently, it is difficult to predict how concurrent partnerships or short gaps may be related to the spread of STI and HIV in a particular epidemiologic context in empirical reality. In recent years, analyses of sexual behavior data collected through nationally representative surveys revealed similar prevalences of concurrent sexual partnerships in Western populations. The association between concurrent sexual partnerships and STI/HIV risk is complicated. At the population level, recent findings suggest that the ecological association between polygyny and HIV prevalence is negative at the country level and at the sub-national level. To address the need for agreed-upon standard definitions and measures of concurrent sexual partnerships, which will facilitate comparisons across time and settings, the Joint United Nations Program on HIV/AIDS (UNAIDS) Reference Group on Estimates, Modelling, and Projections convened a meeting in April 2009. The recommendations developed at this meeting include suggestions for a definition, indicators, and measures of concurrency.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
Aral SO, Padian NS, Holmes KK: Advances in multilevel approaches to understanding the epidemiology and prevention of sexually transmitted infections and HIV: an overview. JID 2005, 191(Suppl 1):S1–S6.
Aral SO, Lipshutz JA, Blanchard J: Drivers of STD/HIV epidemiology and the timing and targets of STD/HIV prevention. Sex Transm Infect 2007, 83(Suppl I):i1–i4.
Aral SO: Understanding racial-ethnic and societal differentials in STI: do we need to move beyond behavioral epidemiology? Sex Transm Infect 2002, 78(Suppl 1):i2–i3.
Aral SO, Hughes JP, Stoner B, et al.: Sexual mixing patterns in the spread of gonococcal and chlamydial infections. Am J Public Health 1999, 89:825–833.
Liljeros F, Edling CR, Amaral LAN, et al.: The web of human sexual contacts. Nature 2001, 411:907–908.
Kretzschmar M, Dietz K: The effect of pair formation and variable infectivity on the spread of an infection without recovery. Math Biosci 1998, 148:83–113.
Foxman B, Newman M, Percha B, et al.: Measures of sexual partnerships: lengths, gaps, overlaps, and sexually transmitted infection. Sex Transm Dis 2006, 33:209–214.
JR Kraut-Becher, SO Aral: Gap length: an important factor in sexually transmitted disease transmission. Sex Transm Dis 2003, 30:221–225.
Morris M, Goodreau S, Moody J: Sexual networks, concurrency, and STD/HIV. In Sexually Transmitted Diseases, edn 4. Edited by Holmes KK, Sparling PF, Stamm WE, et al. New York: McGraw-Hill; 2008:109–125.
Watts CH, May RM: The influence of concurrent partnerships on the dynamics of HIV/AIDS. Math Biosc 1992, 108:89–104.
Morris M, Kretzschmar M: Measuring concurrency. Connections 1994, 17:31–34.
Pilcher CD, Tien HC, Eron JJ Jr, et al.: Brief but efficient: acute HIV infection and the sexual transmission of HIV. J Infect Dis 2004, 189:1785–1792.
•• Kretzschmar M, White RG, Caraël M: Concurrency is more complex than it seems. AIDS 2010, 24:313–315. This article presents a most interesting piece by one of the mathematical modelers (and coauthors) who introduced the concept of concurrency into the STI and HIV field. The authors attempt to reconcile empirical and theoretical approaches to concurrent sexual partnerships and their impact on STI and HIV.
Garnett GP: The geographical and temporal evolution of sexually transmitted disease epidemics. Sex Transm Infect 2002, 78(Suppl 1):i14–i19.
Wasserheit JN, Aral SO: The dynamic topology of sexually transmitted disease epidemics: Implications for prevention strategies. J Infect Dis 1996, 174(Suppl 2):S201–S213.
Helleringer S, Kohler H-P: Sexual network structure and the spread of HIV in Africa: evidence from Likoma Island, Malawi. AIDS 2007, 21:2323–2332.
Garnett GP, Johnson AM: Coining a new term in epidemiology: concurrency and HIV. AIDS 1997, 11:681–683.
Adimora AA, Schoenbach VJ, Bonas DM, et al.: Concurrent sexual partnerships among women in the United States. Epidemiology 2002, 13:320–327.
Adimora AA, Schoenbach VJ, Doherty IA: Concurrent sexual partnerships among men in the United States. Am J Public Health 2007, 97:2230–2237.
Johnson AM, Mercer CH, Erens B, et al.: Sexual behaviour in Britain: partnerships, practices, and HIV risk behaviours. Lancet 2001, 358:1835–1842.
Manhart LE, Aral SO, Holmes KK, Foxman B: Sex partner concurrency measurement, prevalence, and correlates among urban 18–39-year-olds. Sex Transm Dis 2002, 29:133–143.
Doherty IA, Minnis A, Auerswald CL, et al.: Concurrent partnerships among adolescents in a Latino community: the mission district of San Francisco, California. Sex Transm Dis 2007, 34:437–443.
Morris M, Kurth AE, Hamilton DT, et al.: Concurrent partnerships and HIV prevalence disparities by race: linking science and public health practice. Am J Public Health 2009, 99:1023–1031.
Adimora AA, Schoenbach VJ, Martinson FEA, et al.: Concurrent sexual partnerships among African Americans in the rural south. Ann Epidemiol 2004, 14:155–160.
Adimora AA, Schoenbach VJ, Martinson FE, et al.: Concurrent partnerships among rural African Americans with recently reported heterosexually transmitted HIV infection. J Acquir Immune Defic Syndr 2003, 34:423–429.
•• Doherty IA, Schoenbach VJ, Adimora AA: Condom use and duration of concurrent partnerships among men in the United States. Sex Transm Dis 2009, 36:265–272. This article provides an empirical analysis of American men’s concurrent sexual partnerships based on data from a nationally representative sample that focuses on characteristics of concurrent partnerships as important determinants of the effect of concurrency on STI and HIV.
Potterat J, Zimmerman-Rogers H, Muth SQ, et al.: Chlamydia transmission: concurrency, reproduction number, and the epidemic trajectory. Am J Epidemiol 1999, 150:1331–1339.
Koumans E, Farley T, Gibson JJ, 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, 28:497–503.
Lagarde E, Auvert B, Carael M, et al.: Concurrent sexual partnerships and HIV prevalence in five urban communities of sub-Saharan Africa. AIDS 2001, 15:877–884.
Mishra V, Bignami-Van Assche S: Concurrent Sexual Partnerships and HIV Infection: Evidence from National Population-Based Surveys. Demographic and Health Surveys Working Papers No. 62. Calverton, MD: Macro International. Available at http://www.measuredhs.com/pubs/pdf/WP62/WP62.pdf. Accessed December 2009.
Mah TL, Halperin DT: Concurrent sexual partnerships and the HIV epidemics in Africa: evidence to move forward. AIDS and Behavior 2008 (Epub ahead of print).
Shelton JD: Why multiple sexual partners? Lancet 2009, 374:367–369.
Halperin DT, Epstein H: Concurrent sexual partnerships help to explain Africa’s high HIV prevalence: implications for prevention. Lancet 2004, 364:4–6.
Potts M, Halperin DT, Kirby D, et al.: Public health: reassessing HIV prevention. Science 2008, 320:749–750.
Lurie MN, Rosenthal S: Concurrent partnerships as a driver of the HIV epidemic in Sub-Saharan Africa? The evidence is limited. AIDS Behav 2009 (Epub ahead of print).
Lurie M, Rosenthal S, Williams B: Concurrency driving the African HIV epidemics: where is the evidence? Lancet 2009, 374:1420.
•• Javanbakht M, Gorbach PM, Amani B, et al.: Concurrency, sex partner risk, and high-risk human Papillomavirus infection among African American, Asian, and Hispanic women. Sex Transm Dis 2009, 36:1–7. This article provides an empirical analysis of the relationship between concurrent sexual partnerships and high-risk human Papillomavirus infection, the results of which show that the effects of concurrency on STI and HIV risk may vary by race-ethnicity.
•• Reniers G, Watkins S: Polygyny and the spread of HIV in sub-Saharan Africa: a case of benign concurrency. AIDS 2010 24:299–307. This article provides an interesting ecological analysis of polygyny and HIV in sub-Saharan Africa which shows that this particular form of concurrency is associated with reduced HIV prevalence at both the country and sub-country level.
Kenyon C, Dlamini S, Boulle A, et al.: A network-level explanation for the differences in HIV prevalence in South Africa’s racial groups. Afr J AIDS Res 2009, 8:243–254.
UNAIDS: Recommended definition, measures, and research on concurrent sexual partnerships and HIV transmission in Sub-Saharan Africa. UNAIDS Reference Group on Estimates, Modelling, and Projections: Working Group on Measuring Concurrent Sexual Partnerships.
Cleland J, Boerma TJ, Carael M, Weir SS: Monitoring sexual behaviour in general populations: a synthesis of lessons of the past decade. Sex Transm Infect, 2004, 80(Suppl 2):ii1–ii7.
Nelson SJ, Manhart LE, Gorbach PM, et al.: Measuring sex partner concurrency: it’s what’s missing that counts. Sex Transm Dis 2007, 34:801–807.
Ghani, AC, Garnett GP: Measuring sexual partner networks for transmission of sexually transmitted diseases. J Royal Stat Soc Series A: Statistics in Society 1998, 161:227–238.
Ghani, AC, Swinton J, Garnett GP: The role of sexual partnership networks in the epidemiology of gonorrhea. Sex Transm Dis 1997, 24:45–56.
•• UNAIDS: HIV: Consensus indicators are needed for concurrency. UNAIDS Reference Group on Estimates, Modelling, and Projections: Working Group on Measuring Concurrent Sexual Partnerships. Lancet 2009 (Epub ahead of print]. This article is a very important piece that reports on the recommendations for the definition, indicators, and measures of concurrency developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections; Working Group on Measuring Concurrent Sexual Partnerships.
Aral SO: Non-monogamy: risk factor for STI transmission and acquisition, and determinant of STI spread in populations. Presented at the 18th International Society for STD Research (ISSTDR) in conjunction with the British Association for Sexual Health and HIV (BASHH) meeting. London, UK; June 28–July 1, 2009.
Aral SO, Leichliter JS: Non-monogamy: risk factor for STI transmission and acquisition; and determinant of STI spread in populations. Sex Transm Infect 2009, in press.
Acknowledgment
The author thanks Patricia Jackson for her outstanding support in the preparation of this article.
Disclosure
The findings and conclusions in this paper are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention. No potential conflict of interest relevant to this article was reported.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Aral, S.O. Partner Concurrency and the STD/HIV Epidemic. Curr Infect Dis Rep 12, 134–139 (2010). https://doi.org/10.1007/s11908-010-0087-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11908-010-0087-2