Multiple & Concurrent Sexual Partnerships among Men Who Have Sex with Men in Viet Nam

Men who have sex with men (MSM) are one of the largest HIV risk groups in Viet Nam and have been understudied. Sexual concurrency and multiple sex partnerships may contribute to high HIV incidence among MSM in Viet Nam. Limited information is available on concurrency and multiple sexual partnerships among MSM in Viet Nam or on the extent to which this population engages in concurrent and multiple unprotected anal intercourse. 

Data are from a self-administered Internet-based survey of Vietnamese MSM aged 18 years or older, having sex with male partner(s) in the last 12 months and recruited from social networking MSM-specific websites in Viet Nam. Multiple partnerships and concurrency were measured using the UNAIDS-recommended sexual partner matrix, a key component in the questionnaire. Concurrent and multiple sexual partnerships were analyzed at the individual level. Logistic regression analyses were conducted to assess the demographic characteristics and behaviors associated with multiple sexual partnerships. 

A total of 1695 MSM reported on multiple sexual partnerships; 69.5% indicated multiple sexual partnerships in the last 6 months. A total of 257 MSM reported on concurrent sexual partnerships, with 51.0% reporting penetrative sex with concurrent partners in the last 6 months. Respondents were more likely to engage in multiple sexual partnerships if they were no longer a student, consumed alcohol before and/or during sex, used the Internet to meet casual sex partners and had never participated in a behavioral HIV intervention. Multiple sexual partnerships in the previous 6 months were common among MSM surveyed, as was sexual concurrency. High levels of multiple and concurrent sexual partnerships may be catalyzing the transmission of HIV among MSM in Viet Nam. 

Given the high prevalence of this high-risk sexual behavior, our findings underscore the urgent need for targeted prevention efforts, focusing on the reduction of multiple and concurrent sexual partners among this key population.

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By:  García MC1, Duong QL2, Meyer SB3, Ward PR1.

• 1Discipline of Public Health, Flinders University, Adelaide, Australia.
• 2Independent Consultant, Hanoi, Vietnam.
• 3School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada. 
• Health Promot Int. 2016 Mar;31(1):133-43. doi: 10.1093/heapro/dau097. Epub 2014 Nov 7.

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Estimating the Prevalence and Predictors of Incorrect Condom Use among Sexually Active Adults in Kenya: Results From a Nationally Representative Survey

BACKGROUND:

Condom use continues to be an important primary prevention tool to reduce the acquisition and transmission of HIV and other sexually transmitted infections. However, incorrect use of condoms can reduce their effectiveness.

METHODS:

Using data from a 2012 nationally representative cross-sectional household survey conducted in Kenya, we analyzed a subpopulation ofsexually active adults and estimated the percent that used condoms incorrectly during sex, and the type of condom errors. We used multivariable logistic regression to determine variables to be independently associated with incorrect condom use.

RESULTS:

Among 13,720 adolescents and adults, 8014 were sexually active in the previous 3 months (60.3%). Among those who used a condom with a sex partner, 20% experienced at least one instance of incorrect condom use in the previous 3 months. Of incorrect condom users, condom breakage or leakage was the most common error. Factors found to be associated with incorrect condom use were multiple sexual partnerships in the past 12 months and reporting symptoms of a sexually transmitted infection.

CONCLUSIONS:

Incorrect condom use is frequent among sexually active Kenyans and this may translate into substantial HIV transmission. Further understanding of the dynamics of condom use and misuse, in the broader context of other prevention strategies, will aid program planners in the delivery of appropriate interventions aimed at limiting such errors.

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By:  Grasso MA1, Schwarcz S, Galbraith JS, Musyoki H, Kambona C, Kellogg TA; KAIS Study Group.

• 1From the *Global Health Sciences (http://globalhealthsciences.ucsf.edu/), University of California, San Francisco, San Francisco, CA; †Prevention Branch, DGHA, CDC-Kenya, Nairobi,Kenya; ‡National AIDS and STI Control Program, Nairobi, Kenya; and §Kenya Medical Research Institution, Nairobi, Kenya.
• Sex Transm Dis. 2016 Feb;43(2):87-93. doi: 10.1097/OLQ.0000000000000393. 

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Association of Sexual Risk Behavior with Previous HIV Testing among VCT Clients in Kigali, Rwanda

With increased coverage of voluntary HIV counselling and testing (VCT) in Rwanda and a greater focus on repeat testing of key populations, it is important to understand whether the right clients are returning for repeat testing and if repeat testing is effective at reducing risk. 

We assessed the association between repeat testing and recent sexual risk behaviours among 1852 first time or repeat HIV testing clients in Kigali who had had sex, using data from a cross-sectional survey. Repeat testing was associated with being female, older and type of occupation. Multivariable analyses indicate that individuals who tested for HIV 1-2 times and 3+ times previously were more likely to have recent unprotected sex. Those with 3+ previous tests were more likely to have recently had multiple sexual partners. However, a significant decrease in HIV prevalence is shown as individuals receive more HIV tests in their lifetime (p < 0.001). 

These findings show that individuals who report high-risk behaviours are returning for repeat tests. However, VCT may not be successful at addressing certain sexual risk behaviours. Therefore more intensive counselling or additional HIV prevention services may be needed.

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By:  Stalter R1, Chen M2, Uwizeye G3, Mutunge E4, Ahayo A4, Mugwaneza P4, Shumbusho F5, Wesson J6.

• 1FHI 360, Durham, North Carolina, USA rstalter@fhi360.org.
• 2FHI 360, Durham, North Carolina, USA.
• 3FHI 360, Kigali, Rwanda Human Resources for Health (HRH) Program, Ministry of Health, Kigali, Rwanda.
• 4Institute of HIV/AIDS, Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda.
• 5FHI 360, Kigali, Rwanda Rwanda Healthcare Federation (RHF), Kigali, Rwanda.
• 6FHI 360, Kigali, Rwanda IntraHealth International, Chapel Hill, North Carolina, USA. 

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Intimate Partner Violence, Relationship Power Inequity and the Role of Sexual and Social Risk Factors in the Production of Violence among Young Women Who Have Multiple Sexual Partners in a Peri-Urban Setting in South Africa

Introduction

This paper aims to assess the extent and correlates of intimate partner violence (IPV), explore relationship power inequity and the role of sexual and social risk factors in the production of violence among young women aged 16–24 reporting more than one partner in the past three months in a peri-urban setting in the Western Cape, South Africa. Recent estimates suggest that every six hours a woman is killed by an intimate partner in South Africa, making IPV a leading public health problem in the country. While there is mounting evidence that levels of IPV are high in peri-urban settings in South Africa, not much is known about how it manifests among women who engage in concomitantly high HIV risk behaviours such as multiple sexual partnering, transactional sex and age mixing. We know even less about how such women negotiate power and control if exposed to violence in such sexual networks.

Methods

Two hundred and fifty nine women with multiple sexual partners, residing in a predominantly Black peri-urban community in the Western Cape, South Africa, were recruited into a bio-behavioural survey using Respondent Driven Sampling (RDS). After the survey, focus group discussions and individual interviews were conducted among young women and men to understand the underlying factors informing their risk behaviours and experiences of violence.

Findings

86% of the young women experienced IPV in the past 12 months. Sexual IPV was significantly correlated with sex with a man who was 5 years or older than the index female partner (OR 1.7, 95% CI 1.0–3.2) and transactional sex with most recent casual partner (OR 2.1, 95% CI 1.1–3.8). Predictably, women experienced high levels of relationship power inequity. However, they also identified areas in their controlling relationships where they shared decision making power.

Discussion

Levels of IPV among young women with multiple sexual partners were much higher than what is reported among women in the general population and shown to be associated with sexual risk taking. Interventions targeting IPV need to address sexual risk taking as it heightens vulnerability to violence.

Below:  x axis: Types of intimate partner violence; y axis: Prevalence of each type of intimate partner violence.

Table 2

Intimate partner violence and associated sexual risk behaviours among women who have multiple sexual partners.

Explanatory Variables	Sexual IPV OR (95% CI)	Physical IPV OR (95% CI)	Physical & Sexual IPVOR (95% CI)
Age
20–24 years	1.00	1.00	1.00
16–19 years	0.9 (0.4–1.9)	1.0 (0.4–2.7)	0.5 (0.2–1.6)
Poverty status
Non-poor	1.00	1.00	1.00
Poor	1.1 (0.5–2.1)	0.7 (0.3–1.9)	1.00
Abjectly poor	1.0 (0.4–2.3)	0.5 (0.1–1.5)	1.2 (0.3–3.6)
School Status
Out of School	1.00	1.00	1.00
In School	0.5 (0.2–1.2)	0.6 (0.2–1.8)	0.7 (0.2–2.3)
Age mixing in the past 3 months
No	1.00	***	***
Yes	1.7 (1.00–3.1)
Transactional sex for money with the most recent casual partner
No	1.00	***	1.00
Yes	2.1 (1.1–3.8)		1.8 (1.0–3.2)
Sexual Debut
≥15 years	***	1.00	***
<15 years		1.2 (0.5–2.9)
Relationship power inequity
Low	***	1.00	***
High		0.9 (0.4–2.1)
Number of casual partners in the past 3 months
≤4 casual partners	***	***	1.00
≥5 casual partners			0.4 (0.2–0.9)
Condom use with casual partners in the past 3 months
Consistent	***	1.00	1.00
Inconsistent		0.4 (0.2–1.1)	0.4 (0.2–0.9)
Condom use with main partner in the past 3 months
Consistent	***	***	1.00
Inconsistent			4.0 (0.4–34.1)
Condom use with one night stand at last sex
No	***	1.00	***
Yes		1.1 (0.5–2.7)
Male Partner fidelity
No	***	1.00	1.00
Yes		0.9 (0.4–2.1)	0.6 (0.2–1.7)

*** Predictor variables where p >0.25 in the bivariate analyses were excluded from the final multivariate logistic regression models

Full article at:  http://goo.gl/xqHPPr

By:  Yanga Z. Zembe,1,2,* Loraine Townsend,1 Anna Thorson,2 Margrethe Silberschmidt,3 and Anna Mia Ekstrom2

Paula Braitstein, Editor

¹Health Systems Research Unit, Medical Research Council of South Africa, Cape Town, South Africa

²Department of Public Health Sciences /Global health, Karolinska Institutet, and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden

³Department of Public Health, University of Copenhagen, Copenhagen, Denmark

University of Toronto Dalla Lana School of Public Health, CANADA

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: YZ LT AT AME. Performed the experiments: YZ. Analyzed the data: YZ LT MS. Contributed reagents/materials/analysis tools: YZ LT AT MS AME. Wrote the paper: YZ LT AT MS AME.

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Father Involvement and Young, Rural African American Men's Engagement in Substance Misuse and Multiple Sexual Partnerships

This study was designed to examine the associations of biological father and social father involvement during childhood with African American young men's development and engagement in risk behaviors. 

With a sample of 505 young men living in the rural South of the United States, a dual mediation model was tested in which retrospective reports of involvement from biological fathers and social fathers were linked to young men's substance misuse and multiple sexual partnerships through men's relational schemas and future expectations. 

Results from structural equation modeling indicated that levels of involvement from biological fathers and social fathers predicted young men's relational schemas; only biological fathers' involvement predicted future expectations. 

In turn, future expectations predicted levels of substance misuse, and negative relational schemas predicted multiple sexual partnerships. Biological fathers' involvement evinced significant indirect associations with young men's substance misuse and multiple sexual partnerships through both schemas and expectations; social fathers' involvement exhibited an indirect association with multiple sexual partnerships through relational schemas. 

Findings highlight the unique influences of biological fathers and social fathers on multiple domains of African American young men's psychosocial development that subsequently render young men more or less likely to engage in risk behaviors.

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By:  Barton AW1, Kogan SM2,3, Cho J2, Brown GL3.

• 1Center for Family Research, University of Georgia (http://www.cfr.uga.edu/), 1095 College Station Road, Athens, GA, 30605, USA. awbarton@uga.edu.
• 2Center for Family Research, University of Georgia, 1095 College Station Road, Athens, GA, 30605, USA.
• 3Human Development and Family Science, University of Georgia, Athens, GA, USA. 

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