I recently attended an event at the World Bank entitled “AIDS in Southern Africa: a socio-cultural interpretation from USAID’s first AIDS anthropologist.” Suzanne Leclerc-Madlala was the speaker, and she primarily discussed the problem of multiple and concurrent partnerships (MCP) of men and women with low consistent condom use.

Her presentation discussed many aspects of sexual relationships that I had not heard about before in the context of HIV in sub-Saharan Africa, including different types of concurrent partnerships (ongoing, occasional or one-off) and exchange of money for sex as a “normative cultural expectation in relationships.”

Now, I am not a doctor or an expert, but in these circumstances, I would think that pushing condom use by education, motivation or non-profit organizations (i.e. giving condoms to sex workers and educating them) would be policy suggestions put forth by the presentation. However, when an audience member asked about condom use, and the idea of giving out condoms, the speaker rejected the idea saying that only 18 percent of people wear condoms, and it is less of a priority than ending this pattern of multiple concurrent partnerships.

With all of the drivers in the presentation explaining the reasons for multiple concurrent partnerships, it seems as though it will take decades for these multiple concurrent partner behaviors to stop. The younger generations seem to be getting the idea that MCP is acceptable, and they are not thinking about the dangers that can come from this type of behavior. The speaker further mentioned that most people are aware of the epidemic, but they practice “active avoidance.” Additionally, Leclerc-Madlala discussed the high rates of hopelessness among young people, characterized by this practice of high risk sex and excessive drinking.  How is the epidemic of HIV ever going to stop if that is the case?

I think that a good short-term solution to this problem is promotion of condom use. If these people used condoms in their MCP relationships, the risk of passing HIV would diminish. I think that in these types of situations, condom use should not be pushed aside as it has proven to be the only way to protect yourself from HIV besides abstaining. Since we know that everyone does not abstain, condom use should be an inevitable suggestion to stopping this problem of the spread of HIV through multiple concurrent partnerships.

Furthermore, the “hopelessness” of youth populations should be addressed by further mental health care through aid organizations in the U.S. since these types of care are generally stigmatized, it would need to be implemented slowly and in a way that does not ostracize those who seek care.

The presentation was otherwise informative and had a lot of interesting information on the problem of MCP and how it affects youth. You can see the PowerPoint slides here: http://siteresources.worldbank.org/INTHIVAIDS/Resources/375798-1118234887771/LeclercMadlalaCultureAIDS2010.pdf.