Gender Differences in the Risk of HIV Infection among Persons Reporting Abstinence, Monogamy, and Multiple Sexual Partners in Northern Tanzania

This report examines the association between the number of lifetime sexual partners and the risk of HIV seropositivity among men and women presenting for HIV voluntary counselling and testing (VCT) in northern Tanzania, and further identifies risk factors for seropositivity among monogamous women and men. The findings of the research suggest that programmes built on the ABC (abstinence, be faithful, condomise) strategy may be simplifying a complex issue.

According to the authors, study subjects were recruited at a free-standing VCT centre operated by Kikundi cha Wanawake Kilimanjaro Kupambana na UKIMWI (KIWAKKUKI; Women Against AIDS in Kilimanjaro), a women-led HIV/AIDS advocacy, education, and home care organisation based in Moshi, Tanzania that provides services for men and women. Clients presenting for HIV VCT were surveyed between November 2003 and December 2007. Data on socio-demographic characteristics, reasons for testing, sexual behaviours, and symptoms were collected. Men and women were categorised by number of lifetime sexual partners, and rates of seropositivity were reported by category.

The report states that in a large cohort of VCT clients in Moshi, Tanzania, the risk for HIV infection increased with the numbers of clients' sexual partners. The rate of increase was higher among women than among men, and women reporting lifetime monogamy had a significantly higher risk for HIV infection than monogamous men. The study also found significantly higher rates of HIV infection among women reporting certain or possibly polygamous partners. The authors state that these findings demonstrate limited protection of monogamy among women and highlight the risk of partner concurrency.

The study reports two key limitations. First, the study population was comprised entirely of VCT service users, potentially limiting the ability to generalise the findings to the general population. The second is the study's reliance on self-reporting, which may have resulted in inaccurate measurement of risk factors.

The report states that the observed high rates of HIV infection in monogamous women, and the large effect of monogamous women's partners having other partners on infection rates suggest that efforts to promote abstinence, reduce the number of sexual partners, and to promote mutual monogamy should be coupled with methods that empower women to better control their exposure risk. The authors recommend increased efforts to educate and empower women with respect to condom use, while continuing other efforts to reduce HIV transmission, including the promotion of male circumcision and development of vaginal microbicides.

The study concludes that an overly simple formulation of the ABC prevention strategy, "if not A, then B, and if not B, then C" is misguided. Authors urge that greater means to control the risk of HIV infection should be given to all women, including those who are monogamous.