Trends in Concurrency, Polygyny, and Multiple Sex Partnerships During a Decade of Declining HIV Prevalence in Eastern Zimbabwe
Identifieur interne : 002C78 ( Ncbi/Merge ); précédent : 002C77; suivant : 002C79Trends in Concurrency, Polygyny, and Multiple Sex Partnerships During a Decade of Declining HIV Prevalence in Eastern Zimbabwe
Auteurs : Jeffrey W. Eaton [Royaume-Uni] ; Felicia R. Takavarasha ; Christina M. Schumacher [États-Unis] ; Owen Mugurungi [Zimbabwe] ; Geoffrey P. Garnett [États-Unis] ; Constance Nyamukapa [Royaume-Uni] ; Simon Gregson [Royaume-Uni]Source :
- The Journal of Infectious Diseases [ 0022-1899 ] ; 2014.
Abstract
Url:
DOI: 10.1093/infdis/jiu415
PubMed: 25381376
PubMed Central: 4231639
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Trends in Concurrency, Polygyny, and Multiple Sex Partnerships During a Decade of Declining HIV Prevalence in Eastern Zimbabwe</title><author><name sortKey="Eaton, Jeffrey W" sort="Eaton, Jeffrey W" uniqKey="Eaton J" first="Jeffrey W." last="Eaton">Jeffrey W. Eaton</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Infectious Disease Epidemiology</addr-line>,<institution>Imperial College London</institution>,<country>United Kingdom</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Takavarasha, Felicia R" sort="Takavarasha, Felicia R" uniqKey="Takavarasha F" first="Felicia R." last="Takavarasha">Felicia R. Takavarasha</name><affiliation><nlm:aff id="af2"><institution>Biomedical Research and Training Institute</institution></nlm:aff></affiliation></author><author><name sortKey="Schumacher, Christina M" sort="Schumacher, Christina M" uniqKey="Schumacher C" first="Christina M." last="Schumacher">Christina M. Schumacher</name><affiliation wicri:level="2"><nlm:aff id="af4"><addr-line>Department of Pediatrics</addr-line>,<institution>Johns Hopkins University School of Medicine</institution>,<addr-line>Baltimore, Maryland</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Maryland</region></placeName><wicri:cityArea>Baltimore</wicri:cityArea></affiliation></author><author><name sortKey="Mugurungi, Owen" sort="Mugurungi, Owen" uniqKey="Mugurungi O" first="Owen" last="Mugurungi">Owen Mugurungi</name><affiliation wicri:level="1"><nlm:aff id="af3"><addr-line>AIDS and TB Unit</addr-line>,<institution>Zimbabwe Ministry of Health and Child Welfare</institution>,<addr-line>Harare</addr-line>,<country>Zimbabwe</country></nlm:aff><country xml:lang="fr">Zimbabwe</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Garnett, Geoffrey P" sort="Garnett, Geoffrey P" uniqKey="Garnett G" first="Geoffrey P." last="Garnett">Geoffrey P. Garnett</name><affiliation wicri:level="2"><nlm:aff id="af5"><addr-line>Global Health Program</addr-line>,<institution>Bill and Melinda Gates Foundation</institution>,<addr-line>Seattle, Washington</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Washington (État)</region></placeName><wicri:cityArea>Seattle</wicri:cityArea></affiliation></author><author><name sortKey="Nyamukapa, Constance" sort="Nyamukapa, Constance" uniqKey="Nyamukapa C" first="Constance" last="Nyamukapa">Constance Nyamukapa</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Infectious Disease Epidemiology</addr-line>,<institution>Imperial College London</institution>,<country>United Kingdom</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation><nlm:aff id="af2"><institution>Biomedical Research and Training Institute</institution></nlm:aff></affiliation></author><author><name sortKey="Gregson, Simon" sort="Gregson, Simon" uniqKey="Gregson S" first="Simon" last="Gregson">Simon Gregson</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Infectious Disease Epidemiology</addr-line>,<institution>Imperial College London</institution>,<country>United Kingdom</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation><nlm:aff id="af2"><institution>Biomedical Research and Training Institute</institution></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25381376</idno><idno type="pmc">4231639</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231639</idno><idno type="RBID">PMC:4231639</idno><idno type="doi">10.1093/infdis/jiu415</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000117</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000117</idno><idno type="wicri:Area/Pmc/Curation">000117</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000117</idno><idno type="wicri:Area/Pmc/Checkpoint">001007</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">001007</idno><idno type="wicri:Area/Ncbi/Merge">002C78</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Trends in Concurrency, Polygyny, and Multiple Sex Partnerships During a Decade of Declining HIV Prevalence in Eastern Zimbabwe</title><author><name sortKey="Eaton, Jeffrey W" sort="Eaton, Jeffrey W" uniqKey="Eaton J" first="Jeffrey W." last="Eaton">Jeffrey W. Eaton</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Infectious Disease Epidemiology</addr-line>,<institution>Imperial College London</institution>,<country>United Kingdom</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Takavarasha, Felicia R" sort="Takavarasha, Felicia R" uniqKey="Takavarasha F" first="Felicia R." last="Takavarasha">Felicia R. Takavarasha</name><affiliation><nlm:aff id="af2"><institution>Biomedical Research and Training Institute</institution></nlm:aff></affiliation></author><author><name sortKey="Schumacher, Christina M" sort="Schumacher, Christina M" uniqKey="Schumacher C" first="Christina M." last="Schumacher">Christina M. Schumacher</name><affiliation wicri:level="2"><nlm:aff id="af4"><addr-line>Department of Pediatrics</addr-line>,<institution>Johns Hopkins University School of Medicine</institution>,<addr-line>Baltimore, Maryland</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Maryland</region></placeName><wicri:cityArea>Baltimore</wicri:cityArea></affiliation></author><author><name sortKey="Mugurungi, Owen" sort="Mugurungi, Owen" uniqKey="Mugurungi O" first="Owen" last="Mugurungi">Owen Mugurungi</name><affiliation wicri:level="1"><nlm:aff id="af3"><addr-line>AIDS and TB Unit</addr-line>,<institution>Zimbabwe Ministry of Health and Child Welfare</institution>,<addr-line>Harare</addr-line>,<country>Zimbabwe</country></nlm:aff><country xml:lang="fr">Zimbabwe</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Garnett, Geoffrey P" sort="Garnett, Geoffrey P" uniqKey="Garnett G" first="Geoffrey P." last="Garnett">Geoffrey P. Garnett</name><affiliation wicri:level="2"><nlm:aff id="af5"><addr-line>Global Health Program</addr-line>,<institution>Bill and Melinda Gates Foundation</institution>,<addr-line>Seattle, Washington</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Washington (État)</region></placeName><wicri:cityArea>Seattle</wicri:cityArea></affiliation></author><author><name sortKey="Nyamukapa, Constance" sort="Nyamukapa, Constance" uniqKey="Nyamukapa C" first="Constance" last="Nyamukapa">Constance Nyamukapa</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Infectious Disease Epidemiology</addr-line>,<institution>Imperial College London</institution>,<country>United Kingdom</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation><nlm:aff id="af2"><institution>Biomedical Research and Training Institute</institution></nlm:aff></affiliation></author><author><name sortKey="Gregson, Simon" sort="Gregson, Simon" uniqKey="Gregson S" first="Simon" last="Gregson">Simon Gregson</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Infectious Disease Epidemiology</addr-line>,<institution>Imperial College London</institution>,<country>United Kingdom</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation><nlm:aff id="af2"><institution>Biomedical Research and Training Institute</institution></nlm:aff></affiliation></author></analytic><series><title level="j">The Journal of Infectious Diseases</title><idno type="ISSN">0022-1899</idno><idno type="eISSN">1537-6613</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><bold><italic>Background.</italic></bold> Observed declines in the prevalence of human immunodeficiency virus (HIV) infection in Zimbabwe have been attributed to population-level reductions in sexual partnership numbers. However, it remains unknown whether certain types of sex partnerships were more important to this decline. Particular debate surrounds the epidemiologic importance of polygyny (the practice of having multiple wives).</p><p><bold><italic>Methods.</italic></bold> We analyze changes in reported multiple partnerships, nonmarital concurrency, and polygyny in eastern Zimbabwe during a period of declining HIV prevalence, from 1998 to 2011. Trends are reported for adult men (age, 17–54 years) and women (age, 15–49 years) from 5 survey rounds of the Manicaland HIV/STD Prevention Project, a general-population open cohort study.</p><p><bold><italic>Results.</italic></bold> At baseline, 34.2% of men reported multiple partnerships, 11.9% reported nonmarital concurrency, and 4.6% reported polygyny. Among women, 4.6% and 1.8% reported multiple partnerships and concurrency, respectively. All 3 partnership indicators declined by similar relative amounts (around 60%–70%) over the period. Polygyny accounted for around 25% of male concurrency. Compared with monogamously married men, polygynous men reported higher levels of subsequent divorce/separation (adjusted relative risk [RR], 2.92; 95% confidence interval [CI], 1.87–4.55) and casual sex partnerships (adjusted RR, 1.63; 95% CI, 1.41–1.88).</p><p><bold><italic>Conclusions.</italic></bold> No indicator clearly dominated declines in partnerships. Polygyny was surprisingly unstable and, in this population, should not be considered a safe form of concurrency.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Halperin, Dt" uniqKey="Halperin D">DT Halperin</name></author><author><name sortKey="Mugurungi, O" uniqKey="Mugurungi O">O Mugurungi</name></author><author><name sortKey="Hallett, Tb" uniqKey="Hallett T">TB Hallett</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gregson, S" uniqKey="Gregson S">S Gregson</name></author><author><name sortKey="Garnett, Gp" uniqKey="Garnett G">GP Garnett</name></author><author><name sortKey="Nyamukapa, Ca" uniqKey="Nyamukapa C">CA Nyamukapa</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gregson, S" uniqKey="Gregson S">S Gregson</name></author><author><name sortKey="Gonese, E" uniqKey="Gonese E">E Gonese</name></author><author><name 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uniqKey="Anderson R">RM Anderson</name></author><author><name sortKey="Chandiwana, Sk" uniqKey="Chandiwana S">SK Chandiwana</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Langhaug, Lf" uniqKey="Langhaug L">LF Langhaug</name></author><author><name sortKey="Sherr, L" uniqKey="Sherr L">L Sherr</name></author><author><name sortKey="Cowan, Fm" uniqKey="Cowan F">FM Cowan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sawers, L" uniqKey="Sawers L">L Sawers</name></author><author><name sortKey="Isaac, Ag" uniqKey="Isaac A">AG Isaac</name></author><author><name sortKey="Stillwaggon, E" uniqKey="Stillwaggon E">E Stillwaggon</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Infect Dis</journal-id><journal-id journal-id-type="iso-abbrev">J. Infect. Dis</journal-id><journal-id journal-id-type="publisher-id">jid</journal-id><journal-id journal-id-type="hwp">jinfdis</journal-id><journal-title-group><journal-title>The Journal of Infectious Diseases</journal-title></journal-title-group><issn pub-type="ppub">0022-1899</issn><issn pub-type="epub">1537-6613</issn><publisher><publisher-name>Oxford University Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25381376</article-id><article-id pub-id-type="pmc">4231639</article-id><article-id pub-id-type="doi">10.1093/infdis/jiu415</article-id><article-id pub-id-type="publisher-id">jiu415</article-id><article-categories><subj-group subj-group-type="heading"><subject>Developing and Applying Theoretical Frameworks in the Epidemiology of Sexually Transmitted Infections</subject></subj-group></article-categories><title-group><article-title>Trends in Concurrency, Polygyny, and Multiple Sex Partnerships During a Decade of Declining HIV Prevalence in Eastern Zimbabwe</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Eaton</surname><given-names>Jeffrey W.</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Takavarasha</surname><given-names>Felicia R.</given-names></name><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Schumacher</surname><given-names>Christina M.</given-names></name><xref ref-type="aff" rid="af4">4</xref></contrib><contrib contrib-type="author"><name><surname>Mugurungi</surname><given-names>Owen</given-names></name><xref ref-type="aff" rid="af3">3</xref></contrib><contrib contrib-type="author"><name><surname>Garnett</surname><given-names>Geoffrey P.</given-names></name><xref ref-type="aff" rid="af5">5</xref></contrib><contrib contrib-type="author"><name><surname>Nyamukapa</surname><given-names>Constance</given-names></name><xref ref-type="aff" rid="af1">1</xref><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Gregson</surname><given-names>Simon</given-names></name><xref ref-type="aff" rid="af1">1</xref><xref ref-type="aff" rid="af2">2</xref></contrib><aff id="af1"><label>1</label><addr-line>Department of Infectious Disease Epidemiology</addr-line>,<institution>Imperial College London</institution>,<country>United Kingdom</country></aff><aff id="af2"><label>2</label><institution>Biomedical Research and Training Institute</institution></aff><aff id="af3"><label>3</label><addr-line>AIDS and TB Unit</addr-line>,<institution>Zimbabwe Ministry of Health and Child Welfare</institution>,<addr-line>Harare</addr-line>,<country>Zimbabwe</country></aff><aff id="af4"><label>4</label><addr-line>Department of Pediatrics</addr-line>,<institution>Johns Hopkins University School of Medicine</institution>,<addr-line>Baltimore, Maryland</addr-line></aff><aff id="af5"><label>5</label><addr-line>Global Health Program</addr-line>,<institution>Bill and Melinda Gates Foundation</institution>,<addr-line>Seattle, Washington</addr-line></aff></contrib-group><author-notes><fn id="AN1"><p>Presented in part: 19th Biennial Conference of the International Society for Sexually Transmitted Diseases Research, Québec City, Canada, July 2011 (abstract O1-S06.06); Workshop on Translational Epidemiology: Using Theoretical Frameworks for HIV and STI Control, London, United Kingdom, January 2014.</p></fn><corresp>Correspondence: Jeffrey W. Eaton, PhD, Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Hospital Campus, Norfolk Pl, London W2 1PG, UK (<email>jeffrey.eaton@imperial.ac.uk</email>).</corresp></author-notes><pub-date pub-type="ppub"><day>01</day><month>12</month><year>2014</year></pub-date><pub-date pub-type="pmc-release"><day>01</day><month>12</month><year>2014</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on the
<volume>210</volume><issue>Suppl 2</issue><issue-title>Developing and Applying Theoretical Frameworks in the Epidemiology of Sexually Transmitted Infections</issue-title><fpage>S562</fpage><lpage>S568</lpage><permissions><copyright-statement>© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.</copyright-statement><copyright-year>2014</copyright-year><license license-type="creative-commons" xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><self-uri content-type="pdf" xlink:type="simple" xlink:href="jiu415.pdf"></self-uri><abstract><p><bold><italic>Background.</italic></bold> Observed declines in the prevalence of human immunodeficiency virus (HIV) infection in Zimbabwe have been attributed to population-level reductions in sexual partnership numbers. However, it remains unknown whether certain types of sex partnerships were more important to this decline. Particular debate surrounds the epidemiologic importance of polygyny (the practice of having multiple wives).</p><p><bold><italic>Methods.</italic></bold> We analyze changes in reported multiple partnerships, nonmarital concurrency, and polygyny in eastern Zimbabwe during a period of declining HIV prevalence, from 1998 to 2011. Trends are reported for adult men (age, 17–54 years) and women (age, 15–49 years) from 5 survey rounds of the Manicaland HIV/STD Prevention Project, a general-population open cohort study.</p><p><bold><italic>Results.</italic></bold> At baseline, 34.2% of men reported multiple partnerships, 11.9% reported nonmarital concurrency, and 4.6% reported polygyny. Among women, 4.6% and 1.8% reported multiple partnerships and concurrency, respectively. All 3 partnership indicators declined by similar relative amounts (around 60%–70%) over the period. Polygyny accounted for around 25% of male concurrency. Compared with monogamously married men, polygynous men reported higher levels of subsequent divorce/separation (adjusted relative risk [RR], 2.92; 95% confidence interval [CI], 1.87–4.55) and casual sex partnerships (adjusted RR, 1.63; 95% CI, 1.41–1.88).</p><p><bold><italic>Conclusions.</italic></bold> No indicator clearly dominated declines in partnerships. Polygyny was surprisingly unstable and, in this population, should not be considered a safe form of concurrency.</p></abstract><kwd-group><kwd>HIV</kwd><kwd>Zimbabwe</kwd><kwd>behavior change</kwd><kwd>multiple partnerships</kwd><kwd>polygyny</kwd><kwd>concurrency</kwd><kwd>divorce</kwd></kwd-group></article-meta></front></pmc><affiliations><list><country><li>Royaume-Uni</li><li>Zimbabwe</li><li>États-Unis</li></country><region><li>Maryland</li><li>Washington (État)</li></region></list><tree><noCountry><name sortKey="Takavarasha, Felicia R" sort="Takavarasha, Felicia R" uniqKey="Takavarasha F" first="Felicia R." last="Takavarasha">Felicia R. Takavarasha</name></noCountry><country name="Royaume-Uni"><noRegion><name sortKey="Eaton, Jeffrey W" sort="Eaton, Jeffrey W" uniqKey="Eaton J" first="Jeffrey W." last="Eaton">Jeffrey W. Eaton</name></noRegion><name sortKey="Gregson, Simon" sort="Gregson, Simon" uniqKey="Gregson S" first="Simon" last="Gregson">Simon Gregson</name><name sortKey="Nyamukapa, Constance" sort="Nyamukapa, Constance" uniqKey="Nyamukapa C" first="Constance" last="Nyamukapa">Constance Nyamukapa</name></country><country name="États-Unis"><region name="Maryland"><name sortKey="Schumacher, Christina M" sort="Schumacher, Christina M" uniqKey="Schumacher C" first="Christina M." last="Schumacher">Christina M. Schumacher</name></region><name sortKey="Garnett, Geoffrey P" sort="Garnett, Geoffrey P" uniqKey="Garnett G" first="Geoffrey P." last="Garnett">Geoffrey P. Garnett</name></country><country name="Zimbabwe"><noRegion><name sortKey="Mugurungi, Owen" sort="Mugurungi, Owen" uniqKey="Mugurungi O" first="Owen" last="Mugurungi">Owen Mugurungi</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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