Multiple Concurrent Partnerships in a Sub-Saharan Setting: Biases in Self-Reported Measures and Their Implications for HIV/AIDS Prevention

Stephane Helleringer, Columbia University
Linda Kalilani-Phiri, University of Malawi
Jemima A. Frimpong, University of Pennsylvania
James Mkandawire, Montfort Hospital, Malawi

Multiple concurrent partnerships (MCP) have been described as the “key driver”' of generalized HIV epidemics, but comparative studies show that MCP are not more common in regions of Africa with high HIV prevalence than in concentrated epidemics. This might be due to systematic under-reporting of MCP during sexual behavior surveys. We use sexual network data from a small island on Lake Malawi, in conjunction with a simple model of HIV transmission, to assess whether self-reports of partnership concurrency possibly underestimate the contribution of MCP to HIV epidemics. We find that the prevalence of MCP was significantly higher in this population according to estimates derived from network data. Self-reported data underestimated the proportion of incident infections attributable to MCP by more than 50%. Our results emphasize the need for interventions addressing patterns of sexual networking at the population level rather than focusing on the transmission of HIV within stable cohabiting couples.