What Works for Women and Girls

among urban male youth aged 15 to 24 from 7.1% in 1998 to 1.9% in 2003 and amongrural men aged 25 to 49 from 17.8% in 1998 to 11.9% in 2003. In addition, reportedcondom use increased during the most recent sexual intercourse both with the spouseand with the latest non-cohabitating partner increased from 1998 to 2003. An importantpredictor of concurrency was early sexual debut and early entry into marriage, aswell as absence from home. (Sandøy et al., 2008). (Gray III) (sexual partners, condomuse, Zambia)A study from 2003 to 2007 of women and men presenting for VCT at a communitybasedAIDS service organization in Moshi, Tanzania found that the number of partnerswas strongly associated with rates of HIV seropositivity for both men and women.However, even women reporting lifetime monogamy had a high risk for HIV infection.Of 6,549 clients, 3,067 were female, with 25% of the women and 10% of the menHIV-positive. Among 1,244 monogamous females, 34% were HIV-positive. Among 423monogamous males, 4% were HIV-positive. A monogamous female with a partner whohad other partners (as is the case for polygamy) or who did not know if the partnerhad other partners was 36% more likely to be HIV-positive than an otherwise identicalfemale who reported no partners with other partners. The risk increased up to 45%for women with five or more partners and 15% for men with five or more partners. Ina multivariate analysis, HIV seropositivity among monogamous women was associatedwith reporting a partner with other partners; among monogamous men, with age.Women having more than one lifetime sexual partner reported fewer total partners,with a median of three, as compared to a median of four among men (Landman et al.,2008). (Gray III) (counseling, HIV testing, sexual partners, Tanzania)Gaps in Programming—Partner Reduction1. Interventions are urgently needed to reduce concurrent partnerships among all—andparticularly for both husbands and wives where perceived HIV risk is low and thewoman is subjected to gender norms of faithfulness while the man is subjected togender norms of having multiple sexual partners.2. Interventions are needed to reduce homophobia, which may fuel MSM havingmultiple partnerships that include women.1. Interventions are urgently needed to reduce concurrent partnerships among all—andparticularly for both men and women where perceived HIV risk is low and the womanis subjected to gender norms of faithfulness while the man is subjected to gender normsof having multiple sexual partners. [See also Chapter 11A. Strengthening the EnablingEnvironment: Transforming Gender Norms] Studies found that married women were at risk66 CHAPTER 3 PREVENTION FOR WOMEN