Monogamy Less Protective Against AIDS Than Expected

Nathan

Published September 8, 2008, last updated on March 8, 2013 under Research News

Although “being faithful” is one of the three points in the “ABC” strategy of HIV prevention in Africa (abstinence, being faithful to your partner, and use of condoms), monogamy is not as protective against AIDS as one might expect, according to recent research.


In a paper published in the peer-reviewed, open source online journal PLoS ONE, Nathan Thielman, associate professor of medicine at Duke University, and his colleagues at Duke and in Tanzania reported that women who come in to a HIV testing clinic in Tanzania for HIV testing are roughly three times more likely than men to be found seropositive, even when reporting that they are monogamous.

“The ABC prevention strategy has been around for quite some time, and it makes sense, but the “B” part requires thoughtful qualification,” says Thielman. “An overly simple formulation of ‘if not A, then B, and if not B, then C’ is misguided. It is morally disturbing to me that many women who appear to be following this advice become infected with HIV and it highlights the need for researchers, policy makers, and HIV prevention educators to figure out better means to equip women, including those who are monogamous, to control their risk of HIV infection.”

The research team examined the association between the number of sexual partners and the risk of HIV seropositivity among Tanzanians coming for HIV testing at KIWAKKUKI, a community-based AIDS service organization in Moshi, Tanzania between November 2003 and December 2007.  Men and women were categorized by the number of lifetime sexual partners, and rates of seropositivity were reported by category.  The researchers found that 19 percent of females reporting to be monogamous were HIV infected, while only 4 percent of the males reporting to be monogamous carried the virus.  The seropositive rate increased to 45 percent of women and 15 percent of men who reported five or more partners.

“The findings are deep proof about what is happening in sub-Saharan Africa,” says Dafrosa Ikemba, of KIWAKKUKI. “They depict the truth about our culture—that many men have continued to have multiple partners, even in the face of the HIV epidemic, and that one man can infect many women, including his faithful wife.”


“Our research team spent a good bit of time trying to decipher the ‘why’ for monogamous women,” says Thielman. “We highlight some important correlates of HIV infection among monogamous women in the paper: those who were poorer, less educated, and those who suspected or were uncertain if their sexual partner had other partners were more likely to be HIV infected. Women who lack education and wealth may find it difficult to exert control over their risk of acquiring HIV infection by insisting on the use of condoms or refusing sex altogether.”

The complete paper is available online at:
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0003075

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