What Works for Women and Girls

3B. Prevention for Women: Partner ReductionRecent evidence links multiple, concurrent partnerships as strongly associated with HIV transmission(Epstein, 2007). “Concurrency can be defined as having sexual relations with morethan one person within a specified period i.e., a new sexual relationship is initiated before thepreceding one has ended…irrespective of whether those relationships were spousal or nonspousal”(Sandøy et al., 2008: para 2). Focusing on concurrent or simultaneous partnershipsin an HIV prevention response is more important than focusing on all multiple partnerships,as concurrency is more efficient at raising HIV prevalence. Viral load and infectivity are higherin the early, acute stage of infection, so recently infected individuals with concurrent partnersare more likely to transmit HIV to others than recently infected individuals that have one or nopartners (Pilcher et al., 2004; Morris and Kretzchmar, 1997 cited in Carter et al., 2007).Multiple Partnerships Are Common and Place Women at Risk of HIV AcquisitionConcurrent sexual partners are a common practice in many parts of the world where theepidemic has proliferated: A meta-analysis of 68 epidemiological studies from 1986 to 2006with 17,000 HIV-positive people and 73,000 HIV-negative people found that women whoreported three or more sex partners had three times as much likelihood of HIV acquisitionversus women with up to two partners (Chen et al., 2007 cited in Vergidis et al., 2009). Studiesshowing that concurrent sexual partners are common were also found for Zimbabwe (Kasprzyket al., 2008); Cameroon and Zimbabwe (Mishra and Assche, 2008); Botswana, with one of thehighest prevalence rates in the world Carter et al., 2007; UNAIDS, 2008); Mali (Levandowskiet al., 2008b); and South Africa (Mah, 2008).When designing prevention interventions it is important to understand women’s variouspartnership patterns. A woman may be married with only one sexual partner. Or a youngwoman may be in a cross-generational sexual relationship, with an older male partner uponwhom she relies for school fees. [See Chapter 5. Prevention for Young People] A woman may alsohave multiple partners to enable her to survive financially. Women may work as sex workers,an occupation that requires multiple sexual partners. [See Chapter 4. Prevention for Key AffectedPopulations] Men may also have multiple partnerships, which may place women at risk forHIV acquisition. In some societies, polygamy, where a man has multiple spouses, may placewomen at risk of HIV acquisition. Other factors, such as gender norms, violence, and income,may result in men having numerous sexual partners. [See Chapter 11. Strengthening the EnablingEnvironment]Married Women Are Still at Risk for HIV AcquisitionMarriage is often portrayed to women and girls as a haven from the risk of HIV infection. Infact, the risk of HIV transmission between sexual partners is nonexistent when both partnersare uninfected at the time of marriage and subsequently engage in sexual activity exclusivelywith each other. However, these conditions are often not met. In some countries, marriedWHAT WORKS FOR WOMEN AND GIRLS63