Africa’s AIDS fight: Fresh focus on issue of multiple partners

Condom use has grown dramatically

Research shows that condom use in Africa has grown dramatically, especially in casual sexual encounters.

One study, by the Center for AIDS Research, Development and Evaluation (CADRE), showed that 65 percent of South Africans ages 20 to 30 reported using a condom in their last sexual encounter and that 86 percent were afraid to have a one-night-stand without using protection.

But studies have also found that many people stopped using condoms with long-term partners – and that Africans were more likely than people in other parts of the world to have a number of long-term partners at the same time.

More than half of CADRE's respondents said it was okay to stop using a condom with a long-term sexual partner. But more than a third reported having more than one partner in the past year.

HIV, many experts now believe, is spreading through interlinked sexual networks. And what's needed is a concerted effort to educate people about the dangers of multiple partnerships.

"We found we had been successful on condom use, but it wasn't enough," says Richard Delate, country program director of the Johns Hopkins Health and Education in South Africa program (JHHESA). "Almost nothing was being done around concurrency and multiple partnerships."

Research has also shown that some AIDS prevention programs may also even have unintentionally sent the wrong message.

For example, the CADRE study found that many people thought "faithfulness" meant making sure your partner didn't find out about your other sexual partners.

Targeted messages

The new prevention messages are more complex and more targeted than those from a few years ago, and are backed by detailed research into the drivers of the epidemic.

South African organizations, which are pioneering the new approach, are also marshaling the kind of market research and focus grouping long used in the advertising industry.

A new animated commercial produced by JHHESA uses local slang to explain the sexual networks that link patrons of a taxi stand.

One man, the narrator explains, has "a big house" – his wife – and three "small houses," his mistresses. A woman has a "minister of housing, transport, and culture" – a reference to the different men she relies on to support different aspects of her lifestyle.

The cartoon shows how HIV, represented as a ninja, can work his way through those networks.

The television spot reflects research about the dangers of multiple partnerships and the social factors driving them, in this case the reliance of poor women on sexual relationships to survive, often called transactional sex. But it also puts to use better knowledge about how these issues are talked about and understood by ordinary people.

The new approach is boosting enthusiasm for HIV/AIDS prevention efforts.

"There was a feeling for a while that prevention was depressing, that it didn't work," says Mr. Delate. "But prevention is coming back on the public agenda again."

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