What Works for Women and Girls

matic focus on partner reduction, yet this review identified few evaluations of interventionsintended to promote fidelity, “be faithful,” or partner reduction, particularly among adult men.Furthermore, “The needs of the married and cohabitating population have been neglected...despite the fact that more than half of HIV infections in the severe epidemics of Southern andEast Africa are occurring in this group” (Delvaux and Nöstlinger, 2007: 56).Interventions to reduce concurrent partnerships that are gender transformative are urgentlyneeded. Programs need to work with communities to address gender norms that put womenat risk through expectations of fidelity, while encouraging multiple partnerships among men.Programs that do not incorporate a gender perspective are precisely what have placed womenwith only one sexual partner at risk for HIV acquisition. Increasing couple communicationis a promising strategy to begin addressing these risks and raise awareness that marriedwomen are indeed at risk for acquiring HIV. A few areas regarding partner reduction still havemajor gaps that need to be filled, including interventions that address the risks of polygamousmarriage (Sandøy et al., 2008), and the role of homophobia in leading men who have sex withmen to feel they must hide their sexuality through concurrent partnerships with women, thusputting many at risk.What Works—Prevention for Women: Partner ReductionPromising Strategies:1. Partner reduction, particularly concurrent partnerships, can be effective in reducingtransmission of HIV.EVIDENCEPromising Strategies:1. Partner reduction, particularly concurrent partnerships, can be effective in reducing transmissionof HIV.Reduction in concurrent sexual partnerships may have contributed to the recentlyobserved decline in HIV prevalence in Zambia. While the proportion of women engagingin concurrent partnerships was less than 2%, there was a significant decline in concurrentpartnerships for young urban men and older rural men. Men were 7 times morelikely than women to report several ongoing relationships in both 1998 and 2003 inthe young age group and 6 to 17 times more likely in the age group 25 to 49. Polygamywas common among older rural men (12%). The percent of rural men aged 15 to 24who reported concurrent sexual partners declined from 58% in 1998 to 3.5% in 2003;WHAT WORKS FOR WOMEN AND GIRLS65