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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Sociodemographic drivers of multiple sexual partnerships among women in three rural districts of Tanzania</title><author><name sortKey="Exavery, Amon" sort="Exavery, Amon" uniqKey="Exavery A" first="Amon" last="Exavery">Amon Exavery</name><affiliation><nlm:aff id="af1-hiv-7-105">Ifakara Health Institute, Dar es Salaam, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Kante, Almamy Malick" sort="Kante, Almamy Malick" uniqKey="Kante A" first="Almamy Malick" last="Kanté">Almamy Malick Kanté</name><affiliation><nlm:aff id="af1-hiv-7-105">Ifakara Health Institute, Dar es Salaam, Tanzania</nlm:aff></affiliation><affiliation><nlm:aff id="af2-hiv-7-105">Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, new York, NY, USA</nlm:aff></affiliation><affiliation><nlm:aff id="af3-hiv-7-105">Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland</nlm:aff></affiliation></author><author><name sortKey="Tani, Kassimu" sort="Tani, Kassimu" uniqKey="Tani K" first="Kassimu" last="Tani">Kassimu Tani</name><affiliation><nlm:aff id="af1-hiv-7-105">Ifakara Health Institute, Dar es Salaam, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Hingora, Ahmed" sort="Hingora, Ahmed" uniqKey="Hingora A" first="Ahmed" last="Hingora">Ahmed Hingora</name><affiliation><nlm:aff id="af1-hiv-7-105">Ifakara Health Institute, Dar es Salaam, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Phillips, James F" sort="Phillips, James F" uniqKey="Phillips J" first="James F" last="Phillips">James F. Phillips</name><affiliation><nlm:aff id="af2-hiv-7-105">Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, new York, NY, USA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25914557</idno><idno type="pmc">4399694</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4399694</idno><idno type="RBID">PMC:4399694</idno><idno type="doi">10.2147/HIV.S76694</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">002449</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002449</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Sociodemographic drivers of multiple sexual partnerships among women in three rural districts of Tanzania</title><author><name sortKey="Exavery, Amon" sort="Exavery, Amon" uniqKey="Exavery A" first="Amon" last="Exavery">Amon Exavery</name><affiliation><nlm:aff id="af1-hiv-7-105">Ifakara Health Institute, Dar es Salaam, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Kante, Almamy Malick" sort="Kante, Almamy Malick" uniqKey="Kante A" first="Almamy Malick" last="Kanté">Almamy Malick Kanté</name><affiliation><nlm:aff id="af1-hiv-7-105">Ifakara Health Institute, Dar es Salaam, Tanzania</nlm:aff></affiliation><affiliation><nlm:aff id="af2-hiv-7-105">Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, new York, NY, USA</nlm:aff></affiliation><affiliation><nlm:aff id="af3-hiv-7-105">Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland</nlm:aff></affiliation></author><author><name sortKey="Tani, Kassimu" sort="Tani, Kassimu" uniqKey="Tani K" first="Kassimu" last="Tani">Kassimu Tani</name><affiliation><nlm:aff id="af1-hiv-7-105">Ifakara Health Institute, Dar es Salaam, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Hingora, Ahmed" sort="Hingora, Ahmed" uniqKey="Hingora A" first="Ahmed" last="Hingora">Ahmed Hingora</name><affiliation><nlm:aff id="af1-hiv-7-105">Ifakara Health Institute, Dar es Salaam, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Phillips, James F" sort="Phillips, James F" uniqKey="Phillips J" first="James F" last="Phillips">James F. Phillips</name><affiliation><nlm:aff id="af2-hiv-7-105">Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, new York, NY, USA</nlm:aff></affiliation></author></analytic><series><title level="j">HIV/AIDS (Auckland, N.Z.)</title><idno type="eISSN">1179-1373</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>This study examines prevalence and correlates of multiple sexual partnerships (MSP) among women aged 15+ years in Rufiji, Kilombero, and Ulanga districts of Tanzania.</p></sec><sec><title>Materials and methods</title><p>Data were collected in a cross-sectional household survey in Rufiji, Kilombero, and Ulanga districts in Tanzania in 2011. From the survey, a total of 2,643 sexually active women ages 15+ years were selected for this analysis. While the chi-square test was used for testing association between MSP and each of the independent variables, logistic regression was used for multivariate analysis.</p></sec><sec><title>Results</title><p>Number of sexual partners reported ranged from 1 to 7, with 7.8% of the women reporting multiple sexual partners (2+) in the past year. MSP was more likely among both ever married women (adjusted odds ratio [AOR] =3.83, 95% confidence interval [CI] 1.40–10.49) and single women (AOR =6.13, 95% CI 2.45–15.34) than currently married women. There was an interaction between marital status and education, whereby MSP was 85% less likely among single women with secondary or higher education compared to married women with no education (AOR =0.15, 95% CI 0.03–0.61). Furthermore, women aged 40+ years were 56% less likely compared to the youngest women (<20 years) to report MSP (AOR =0.44, 95% CI 0.24–0.80). The odds of MSP among Muslim women was 1.56 times as high as that for Christians women (AOR =1.56, 95% CI 1.11–2.21). Ndengereko women were 67% less likely to report MSP compared to Pogoro women (AOR =0.33, 95% CI 0.18–0.59).</p></sec><sec><title>Conclusion</title><p>Eight percent of the women aged 15+ in Rufiji, Kilombero, and Ulanga districts of Tanzania are engaged in MSP. Encouraging achievement of formal education, especially at secondary level or beyond, may be a viable strategy toward partner reduction among unmarried women. Age, religion, and ethnicity are also important dimensions for partner reduction efforts.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Lema, La" uniqKey="Lema L">LA Lema</name></author><author><name sortKey="Katapa, Rs" uniqKey="Katapa R">RS Katapa</name></author><author><name sortKey="Musa, As" uniqKey="Musa A">AS Musa</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bellan, Se" uniqKey="Bellan S">SE Bellan</name></author><author><name sortKey="Fiorella, Kj" uniqKey="Fiorella K">KJ Fiorella</name></author><author><name sortKey="Melesse, Dy" uniqKey="Melesse D">DY Melesse</name></author><author><name sortKey="Getz, Wm" uniqKey="Getz W">WM Getz</name></author><author><name sortKey="Williams, Bg" uniqKey="Williams B">BG Williams</name></author><author><name sortKey="Dushoff, J" uniqKey="Dushoff J">J Dushoff</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Shipena, J" uniqKey="Shipena J">J Shipena</name></author><author><name sortKey="Khuruses, F" uniqKey="Khuruses F">F Khuruses</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Den Borne, F" uniqKey="Van Den Borne F">F Van den Borne</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chiwaya, W" uniqKey="Chiwaya W">W Chiwaya</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chaima, M" uniqKey="Chaima M">M Chaima</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Forster, Pg" uniqKey="Forster P">PG Forster</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Forster, Pg" uniqKey="Forster P">PG Forster</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chirwa, Wc" uniqKey="Chirwa W">WC Chirwa</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chirwa, Wc" uniqKey="Chirwa W">WC Chirwa</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Msolomba, T" uniqKey="Msolomba T">T Msolomba</name></author><author><name sortKey="Chirwa, Wc" uniqKey="Chirwa W">WC Chirwa</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Chirwa, Wc" uniqKey="Chirwa W">WC Chirwa</name></author><author><name sortKey="Chizimbi, S" uniqKey="Chizimbi S">S Chizimbi</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Exavery, A" uniqKey="Exavery A">A Exavery</name></author><author><name sortKey="Kante, Am" uniqKey="Kante A">AM Kanté</name></author><author><name sortKey="Jackson, E" uniqKey="Jackson E">E Jackson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vittinghoff, E" uniqKey="Vittinghoff E">E Vittinghoff</name></author><author><name sortKey="Glidden, Dv" uniqKey="Glidden D">DV Glidden</name></author><author><name sortKey="Shiboski, Sc" uniqKey="Shiboski S">SC Shiboski</name></author><author><name sortKey="Mcculloch, Ce" uniqKey="Mcculloch C">CE McCulloch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sundas, B" uniqKey="Sundas B">B Sundas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rector, Re" uniqKey="Rector R">RE Rector</name></author><author><name sortKey="Johnson, Ka" uniqKey="Johnson K">KA Johnson</name></author><author><name sortKey="Noyes, Lr" uniqKey="Noyes L">LR Noyes</name></author><author><name sortKey="Martin, S" uniqKey="Martin S">S Martin</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Peltzer, K" uniqKey="Peltzer K">K Peltzer</name></author><author><name sortKey="Mlambo, G" uniqKey="Mlambo G">G Mlambo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Exavery, A" uniqKey="Exavery A">A Exavery</name></author><author><name sortKey="Lutambi, Am" uniqKey="Lutambi A">AM Lutambi</name></author><author><name sortKey="Mubyazi, Gm" uniqKey="Mubyazi G">GM Mubyazi</name></author><author><name sortKey="Kweka, K" uniqKey="Kweka K">K Kweka</name></author><author><name sortKey="Mbaruku, G" uniqKey="Mbaruku G">G Mbaruku</name></author><author><name sortKey="Masanja, H" uniqKey="Masanja H">H Masanja</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yan, H" uniqKey="Yan H">H Yan</name></author><author><name sortKey="Chen, W" uniqKey="Chen W">W Chen</name></author><author><name sortKey="Wu, H" uniqKey="Wu H">H Wu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Santelli, Js" uniqKey="Santelli J">JS Santelli</name></author><author><name sortKey="Brener, Nd" uniqKey="Brener N">ND Brener</name></author><author><name sortKey="Lowry, R" uniqKey="Lowry R">R Lowry</name></author><author><name sortKey="Bhatt, A" uniqKey="Bhatt A">A Bhatt</name></author><author><name sortKey="Zabin, Ls" uniqKey="Zabin L">LS Zabin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rotermann, M" uniqKey="Rotermann M">M Rotermann</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Seidman, Sn" uniqKey="Seidman S">SN Seidman</name></author><author><name sortKey="Mosher, Wd" uniqKey="Mosher W">WD Mosher</name></author><author><name sortKey="Aral, So" uniqKey="Aral S">SO 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<front><journal-meta><journal-id journal-id-type="nlm-ta">HIV AIDS (Auckl)</journal-id><journal-id journal-id-type="iso-abbrev">HIV AIDS (Auckl)</journal-id><journal-id journal-id-type="publisher-id">HIV/AIDS – Research and Palliative Care</journal-id><journal-title-group><journal-title>HIV/AIDS (Auckland, N.Z.)</journal-title></journal-title-group><issn pub-type="epub">1179-1373</issn><publisher><publisher-name>Dove Medical Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25914557</article-id><article-id pub-id-type="pmc">4399694</article-id><article-id pub-id-type="doi">10.2147/HIV.S76694</article-id><article-id pub-id-type="publisher-id">hiv-7-105</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Research</subject></subj-group></article-categories><title-group><article-title>Sociodemographic drivers of multiple sexual partnerships among women in three rural districts of Tanzania</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Exavery</surname><given-names>Amon</given-names></name><xref ref-type="aff" rid="af1-hiv-7-105">1</xref><xref ref-type="corresp" rid="c1-hiv-7-105"></xref></contrib><contrib contrib-type="author"><name><surname>Kanté</surname><given-names>Almamy Malick</given-names></name><xref ref-type="aff" rid="af1-hiv-7-105">1</xref><xref ref-type="aff" rid="af2-hiv-7-105">2</xref><xref ref-type="aff" rid="af3-hiv-7-105">3</xref></contrib><contrib contrib-type="author"><name><surname>Tani</surname><given-names>Kassimu</given-names></name><xref ref-type="aff" rid="af1-hiv-7-105">1</xref></contrib><contrib contrib-type="author"><name><surname>Hingora</surname><given-names>Ahmed</given-names></name><xref ref-type="aff" rid="af1-hiv-7-105">1</xref></contrib><contrib contrib-type="author"><name><surname>Phillips</surname><given-names>James F</given-names></name><xref ref-type="aff" rid="af2-hiv-7-105">2</xref></contrib></contrib-group><aff id="af1-hiv-7-105"><label>1</label>Ifakara Health Institute, Dar es Salaam, Tanzania</aff><aff id="af2-hiv-7-105"><label>2</label>Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, new York, NY, USA</aff><aff id="af3-hiv-7-105"><label>3</label>Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland</aff><author-notes><corresp id="c1-hiv-7-105">Correspondence: Amon Exavery, Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania, Tel +255 222 771 714, Fax +255 222 771 714, Email <email>aexavery@ihi.or.tz</email></corresp></author-notes><pub-date pub-type="collection"><year>2015</year></pub-date><pub-date pub-type="epub"><day>09</day><month>4</month><year>2015</year></pub-date><volume>7</volume><fpage>105</fpage><lpage>113</lpage><permissions><copyright-statement>© 2015 Exavery et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0)License</copyright-statement><copyright-year>2015</copyright-year><license><license-p>The full terms of the License are available at <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.</license-p></license></permissions><abstract><sec><title>Background</title><p>This study examines prevalence and correlates of multiple sexual partnerships (MSP) among women aged 15+ years in Rufiji, Kilombero, and Ulanga districts of Tanzania.</p></sec><sec><title>Materials and methods</title><p>Data were collected in a cross-sectional household survey in Rufiji, Kilombero, and Ulanga districts in Tanzania in 2011. From the survey, a total of 2,643 sexually active women ages 15+ years were selected for this analysis. While the chi-square test was used for testing association between MSP and each of the independent variables, logistic regression was used for multivariate analysis.</p></sec><sec><title>Results</title><p>Number of sexual partners reported ranged from 1 to 7, with 7.8% of the women reporting multiple sexual partners (2+) in the past year. MSP was more likely among both ever married women (adjusted odds ratio [AOR] =3.83, 95% confidence interval [CI] 1.40–10.49) and single women (AOR =6.13, 95% CI 2.45–15.34) than currently married women. There was an interaction between marital status and education, whereby MSP was 85% less likely among single women with secondary or higher education compared to married women with no education (AOR =0.15, 95% CI 0.03–0.61). Furthermore, women aged 40+ years were 56% less likely compared to the youngest women (<20 years) to report MSP (AOR =0.44, 95% CI 0.24–0.80). The odds of MSP among Muslim women was 1.56 times as high as that for Christians women (AOR =1.56, 95% CI 1.11–2.21). Ndengereko women were 67% less likely to report MSP compared to Pogoro women (AOR =0.33, 95% CI 0.18–0.59).</p></sec><sec><title>Conclusion</title><p>Eight percent of the women aged 15+ in Rufiji, Kilombero, and Ulanga districts of Tanzania are engaged in MSP. Encouraging achievement of formal education, especially at secondary level or beyond, may be a viable strategy toward partner reduction among unmarried women. Age, religion, and ethnicity are also important dimensions for partner reduction efforts.</p></sec></abstract><kwd-group><title>Keywords</title><kwd>HIV/AIDS</kwd><kwd>transmission</kwd><kwd>Rufiji</kwd><kwd>Kilombero</kwd><kwd>Ulanga</kwd></kwd-group></article-meta></front><body><sec sec-type="intro"><title>Introduction</title><p>While the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) epidemic remains a significant global health concern, sub-Saharan Africa continues to be the most affected region on the globe.<xref rid="b1-hiv-7-105" ref-type="bibr">1</xref> Behavioral patterns in sexual relationships play a significant role in the spread of HIV/AIDS.<xref rid="b2-hiv-7-105" ref-type="bibr">2</xref> A recent publication in the <italic>Lancet</italic> cites extra-couple partnerships as a factor that has, and continues to play, a paramount role in driving new HIV infections among men and women within couples.<xref rid="b3-hiv-7-105" ref-type="bibr">3</xref> According to the same study, while the transmission within couples occurs mostly from men to women, the study indicates that women experience a very high risk period before couple formation. In sub-Saharan Africa, unsafe sex is accountable for the vast majority of HIV infections.<xref rid="b4-hiv-7-105" ref-type="bibr">4</xref> In Tanzania, the epidemic is described as generalized since it affects all sectors of the population.<xref rid="b5-hiv-7-105" ref-type="bibr">5</xref> In 2012, the HIV/AIDS prevalence among Tanzanian adults age 15–49 years was estimated at 5.1% (6.2% women and 3.8% men),<xref rid="b6-hiv-7-105" ref-type="bibr">6</xref> ranging from as low as <2% in Arusha region to as high as 16% in Iringa region.<xref rid="b7-hiv-7-105" ref-type="bibr">7</xref> In 2011, Tanzania recorded more than 80,000 deaths due to HIV/AIDS.<xref rid="b9-hiv-7-105" ref-type="bibr">9</xref> Approximately 1.6 million Tanzanians are living with HIV,<xref rid="b8-hiv-7-105" ref-type="bibr">8</xref> with over 400 new infections occurring every day, spreading predominantly through heterosexual contact.<xref rid="b6-hiv-7-105" ref-type="bibr">6</xref>,<xref rid="b9-hiv-7-105" ref-type="bibr">9</xref></p><p>Previous studies have identified a number of factors associated with multiple sexual partnerships (MSP). In 2006, a think tank of the Southern Africa Development Community reported high levels of multiple and concurrent sexual partnerships among men and women and identified inconsistent and incorrect condom use and low levels of male circumcision as key drivers of the HIV epidemic in the region.<xref rid="b10-hiv-7-105" ref-type="bibr">10</xref> Other factors that fuel the epidemic include male attitudes and behaviors, intergenerational sex, gender-based violence, stigma, lack of openness about the epidemic, and untreated sexually transmitted infections (STIs). Underlying these biological and social drivers are the structural factors of high mobility and inequalities of wealth as well as cultural factors, including gender inequality, with young women rendered particularly vulnerable to HIV infection.<xref rid="b10-hiv-7-105" ref-type="bibr">10</xref></p><p>Van den Borne argues that the major motivational driver for MSP among women in Malawi is the struggle for survival in the fight against poverty, which encourages engagement in transactional sex and MSP to make ends meet.<xref rid="b11-hiv-7-105" ref-type="bibr">11</xref> This was also emphasized by several other studies.<xref rid="b12-hiv-7-105" ref-type="bibr">12</xref>–<xref rid="b15-hiv-7-105" ref-type="bibr">15</xref> However, these were not the only socioeconomically related drivers of MSP according to several studies conducted by Chirwa<xref rid="b16-hiv-7-105" ref-type="bibr">16</xref>,<xref rid="b17-hiv-7-105" ref-type="bibr">17</xref> and Msolomba and Chirwa.<xref rid="b18-hiv-7-105" ref-type="bibr">18</xref> They point out that while men engage in MSP in pursuit of prestige, status, and honor, women are driven by attractiveness, peer pressure, and quest for leisure and entertainment among other motivators. These studies detail further that for both men and women, the pursuit of leisure and entertainment, sexual gratification, experimentation with sexual variety, alcohol abuse, and migrancy result in MSP. History, culture, socialization, and religion are also major determinants of multiple concurrent partners in the country.</p><p>MSP is a risky sexual behavior that substantially contributes to the spread of the HIV/AIDS pandemic.<xref rid="b19-hiv-7-105" ref-type="bibr">19</xref> Forms of MSP include promiscuity, infidelity, prostitution and commercial sexual activities, and rape.<xref rid="b8-hiv-7-105" ref-type="bibr">8</xref> MSP along with inconsistent or absent condom use is associated with increased risk of contracting HIV infection. In countries where HIV infection has declined significantly, such as Uganda, Kenya, Zimbabwe, Zambia, and Thailand, partner reduction reportedly played a major role.<xref rid="b20-hiv-7-105" ref-type="bibr">20</xref> This underscores the need for efforts to promote MSP reduction to combat the HIV pandemic in other countries. Therefore, a strong evidence base concerning both the individual and the sociocultural drivers of MSP is needed to inform the design and scale-up strategies that will effectively promote partner reduction and change the social norms that facilitate MSP.<xref rid="b20-hiv-7-105" ref-type="bibr">20</xref></p><p>Unfortunately, a rigorous assessment of the drivers of MSP among women in rural Tanzania and most developing countries is limited. In response to this gap, this study seeks to establish prevalence of and factors associated with MSP among 15+ year-old women in Rufiji, Kilombero, and Ulanga districts of Tanzania.</p></sec><sec sec-type="materials|methods"><title>Materials and methods</title><sec sec-type="methods"><title>Study area</title><p>This analysis is based on data collected in three rural district of Tanzania – Rufiji, Kilombero, and Ulanga – in 2011. Within these districts, there are two ongoing health and demographic surveillance systems (HDSS) of Rufiji and Ifakara, which are longitudinal, health and vital events registration systems that monitor demographic events, including births, deaths, and migrations. The Rufiji HDSS is located in the Rufiji district in the Pwani region, while the Ifakara HDSS occupies parts of Kilombero and Ulanga districts, both of which are located in the Morogoro region. In 2011, these HDSS altogether covered a population of approximately 370,000 people, 24% of which were women of reproductive ages. Details about these HDSS are available in further publications.<xref rid="b21-hiv-7-105" ref-type="bibr">21</xref>,<xref rid="b22-hiv-7-105" ref-type="bibr">22</xref></p></sec><sec sec-type="methods|subjects"><title>Study design, sampling, and participants</title><p>This study was cross-sectional in design. The HDSS provided a sampling frame of households from which 2,183 households were randomly selected. The households were sampled using probability proportionate to size to ensure that the final sample is representative of each village in the study area. In these households 3,127 women were interviewed, and 2,643 of them who were aged 15+ years were selected for the current analysis because they had at least one sexual partner in the past 12 months preceding the survey. More details about this survey are available elsewhere.<xref rid="b23-hiv-7-105" ref-type="bibr">23</xref></p></sec><sec><title>Variables and definition</title><p>The outcome or dependent variable for the current analysis was MSP in the past 12 months prior to the survey. This was derived from the original question which was “In the last 12 months how many sexual partners have you had (including your husband), if any?” Responses to this question were absolute numbers of the sexual partners reported, with acceptable values being positive integers: 0, 1, 2, 3, etc. Respondents who reported that they did not have any sexual partner (zero partners) (n=477, 15.3 %) within the same period and those who did not answer the question (n=7, 0.2%) were excluded from the analysis because they were considered less pertinent to the research question. The resulting outcome variable was dichotomized into two categories – “no” or “yes,” with codes “0” and “1” used to represent the former and latter category respectively, such that,
<disp-formula id="fd1-hiv-7-105"><mml:math id="mm1"><mml:mrow><mml:mtext>MSP in past 12 months</mml:mtext><mml:mo>=</mml:mo><mml:mrow><mml:mo>{</mml:mo><mml:mrow><mml:msubsup><mml:mrow></mml:mrow><mml:mrow><mml:mn>1</mml:mn><mml:mspace width="0.2em"></mml:mspace><mml:mtext>if the respondent had twoor more sexual partners</mml:mtext></mml:mrow><mml:mrow><mml:mn>0</mml:mn><mml:mspace width="0.2em"></mml:mspace><mml:mtext>if the respondent had only onesexual partner</mml:mtext></mml:mrow></mml:msubsup></mml:mrow></mml:mrow></mml:mrow></mml:math></disp-formula></p><p>Independent variables included in the analysis were age in years (<20, 20–29, 30–39, 40+), marital status (married, ever married, single), ethnicity (Pogoro, Ndengereko, Ngindo, Ndamba, Sukuma, Ngoni, Hehe, Bena, other), place of residence (urban, rural), education (no formal education, primary, secondary/higher), religion (Christian, Muslim, traditional/other), household socioeconomic status (poor, middle, rich), and district of residence (Rufiji, Kilombero, Ulanga). Household socioeconomic status was constructed using principal component analysis of household assets owned. This included toilet, type of toilet, and source of drinking water. Unfortunately, information regarding other household assets such as roofing material, wall material, floor material, etc that are conventionally included in determining household wealth status using principal component analysis were not available. Finally, all women were grouped in three categories of household wealth status as poor, middle, or rich according to their household wealth score.</p></sec><sec sec-type="methods"><title>Statistical analysis</title><p>Descriptive statistics were calculated using frequencies in one-way tabulations. This indicated distributional features of the data across the variables. Bivariate analysis was then conducted by cross-tabulating the outcome variable against each of the independent variables. Bivariate analysis was used to assess the degree of association between each pair of cross-tabulated variables using the Pearson chi-square test. Logistic regression was used to perform both univariate (regression model with one independent variable) and multivariate (regression model with more than one independent variable) analyses. In both cases, missing observations were excluded from the model. Multivariate logistic regression was performed to determine the independent predictors of MSP. Using the log-likelihood ratio test, a variable was selected for inclusion in the multivariate model if it was statistically significant at 5% that its presence improved the overall model.<xref rid="b24-hiv-7-105" ref-type="bibr">24</xref> The model was also checked for statistical interactions and adequacy before being declared final. This was achieved using the Hosmer–Lemeshow goodness-of-fit test.<xref rid="b24-hiv-7-105" ref-type="bibr">24</xref> Crude odds ratios, adjusted odds ratios (AOR), and their corresponding 95% confidence intervals (CIs) and <italic>P</italic>-values were all presented. The entire process of data analysis was conducted using Stata (version 11) statistical software and a significance level of 5% was used.</p></sec><sec><title>Ethical consideration</title><p>The primary survey received ethical approval from the Medical Research Coordinating Committee of the National Institute for Medical Research as well as from the Ifakara Health Institute’s institutional review board in Tanzania and the institutional review board of Columbia University, USA. All respondents participated in the survey voluntarily. Each participant signed an informed consent form prior to being interviewed. Completed questionnaires and consent forms were stored separately to ensure that the data remains anonymous.</p></sec></sec><sec sec-type="results"><title>Results</title><sec><title>Profile of respondents</title><p>Data analysis pertained to 2,643 women who were aged 30.5 years on average (standard deviation =9.3), ranging from 15 to 63 years. Almost three-quarters (74.4%) of the women were married and 69.3% had primary education. Half (50.6%) of the respondents were Muslim while Christians amounted to 46.0% of the total participants. In terms of district of residence, Kilombero held the majority of the respondents (62.9%). Furthermore, 80.9% of the respondents resided in rural settings and the rest resided in urban or suburban areas (<xref ref-type="table" rid="t1-hiv-7-105">Table 1</xref>).</p></sec><sec sec-type="intro"><title>MSP by background characteristics</title><p>Overall, the number of sexual partners reported ranged from 1 to 7, with 7.8% of the women reporting MSP in the past 12 months preceding the survey. This proportion varied significantly by some characteristics of the respondents. The proportion of women reporting MSP was highest at 10.5% among youngest women (<20 years) and declined as age advanced to as low as 4.2% among women who were aged 40+ years (<italic>P</italic><0.001). As such, a test for trend of MSP across ordered age groups showed significant findings (<italic>P</italic><0.001). While 5.8% of married women reported MSP, 14.4% of women who were ever married (currently divorced or widowed) and 13.5% of women who were single reported MSP (<italic>P</italic><0.001). With respect to religion, MSP was 8.8% among Muslims, 7.0% among Christians, and 2.3% among those following traditional or other unspecified beliefs (<italic>P</italic>=0.03) (<xref ref-type="table" rid="t2-hiv-7-105">Table 2</xref>). These observations were also in agreement with those reported in univariate models in <xref ref-type="table" rid="t3-hiv-7-105">Table 3</xref>.</p></sec><sec sec-type="methods"><title>Multivariate analysis</title><p>Results of the multivariate logistic regression analysis of factors associated with MSP are presented in <xref ref-type="table" rid="t3-hiv-7-105">Table 3</xref>. They show that as age increased, the odds of MSP declined generally, but significant differences were observed for women aged 40+ years. These women (age 40+ years) were 56% less likely compared to the youngest women (<20 years) to report MSP (AOR =0.44, 95% CI 0.24–0.80). MSP was significantly associated with marital status. Ever married women were almost three times more likely to have MSP compared to the married women (AOR =3.83, 95% CI 1.40–10.49). Similarly, women who were single were 6.13 times more likely to have MSP compared to the married women (AOR =6.13, 95% CI 2.45–15.34). The data showed further that there was a significant interaction between marital status and education; whereby single women with secondary or higher education were 85% less likely to have MSP compared to married women with no education (AOR =0.15, 95% CI 0.03–0.61). Ethnicity was also important, where the adjusted odds of MSP was generally lower in all ethnic groups compared to the Pogoro ethnic group, and was significantly lower among Ndengereko women compared to the Pogoro women (AOR =0.33, 95% CI 0.18–0.59). With respect to religion, the results showed that Muslim women were 56% more likely to have MSP compared to Christian women (AOR =1.56, 95% CI 1.11–2.21).</p><p>However, MSP was not significantly associated with the socioeconomic status of the household, the place of residence (rural/urban), and district of residence.</p></sec></sec><sec sec-type="discussion"><title>Discussion</title><p>Given the enormous impact of the HIV/AIDS pandemic in Tanzania and the notable role of sexual behaviors in its spread,<xref rid="b2-hiv-7-105" ref-type="bibr">2</xref> this analysis assesses the extent and drivers of MSP among women in Rufiji, Kilombero, and Ulanga districts of Tanzania. It should be borne in mind that sexual relationships with multiple partners are associated with an increased risk of transmission and acquisition of STIs including HIV/AIDS infection among others.<xref rid="b25-hiv-7-105" ref-type="bibr">25</xref>,<xref rid="b26-hiv-7-105" ref-type="bibr">26</xref> This study shows that overall 8% of the women in the study area have had MSP in the past 12 months. This proportion is twice as high as that reported in the 2011 Tanzania Demographic and Health Survey report.<xref rid="b27-hiv-7-105" ref-type="bibr">27</xref> This might have been due to the fact that even within Tanzania, this proportion varies by location, as it was as low as 2.0% in the northern zone and as high as 8.6% in the southern zone of the country.<xref rid="b2-hiv-7-105" ref-type="bibr">2</xref> This observation is fairly similar to the prevalence observed in Lesotho, where MSP among women in the last 12 months is 6% according to the Lesotho Demographic and Health Survey.<xref rid="b28-hiv-7-105" ref-type="bibr">28</xref> However, our observation was very high relative to statistics from other African countries such as Uganda,<xref rid="b29-hiv-7-105" ref-type="bibr">29</xref> Kenya,<xref rid="b30-hiv-7-105" ref-type="bibr">30</xref> Malawi,<xref rid="b31-hiv-7-105" ref-type="bibr">31</xref> Zambia,<xref rid="b32-hiv-7-105" ref-type="bibr">32</xref> and Nigeria.<xref rid="b33-hiv-7-105" ref-type="bibr">33</xref> A study in Mpumalanga, South Africa among pregnant women found that the prevalence of MSP was 20%.<xref rid="b34-hiv-7-105" ref-type="bibr">34</xref> These variations suggest that the magnitude of MSP depends on the context at hand because populations differ in several aspects including locations, cultures, values, beliefs, norms, and practices.</p><p>A number of determinants of MSP among women in the three districts of Tanzania were identified. Marital status was the most pervasive driver of MSP, with ever married and single women showing much higher risk for MSP than those currently married. It may be that currently unmarried women (either single or ever married) feel insecure without a husband or at least a permanent sexual partner or simply a potential husband. Therefore, apart from commercial sex workers, there is an obvious chance that before a woman finds her most preferred partner, she will be particularly susceptible to MSP on the course of finding one. One study confirms that outside marital union, women have a very high-risk period to contract HIV infection,<xref rid="b3-hiv-7-105" ref-type="bibr">3</xref> which could be due to MSP. In marriage, women likely become secure and settled, thus they are better able to avert risky sexual behaviors including MSP. However, further studies are still needed to clearly reveal underlying mechanisms of the observed relationship. Therefore, social and behavioral interventions should particularly target unmarried women with partner reduction strategies. Outside marital union, abstinence remains the most reliable method against transmission or acquisition of STIs including HIV.<xref rid="b35-hiv-7-105" ref-type="bibr">35</xref></p><p>This study found further that the chances of MSP declined as age advanced, particularly 40 years or above. This observation is in agreement with other studies, which have also observed that younger age is a risk factor for multiple partnerships,<xref rid="b36-hiv-7-105" ref-type="bibr">36</xref>–<xref rid="b38-hiv-7-105" ref-type="bibr">38</xref> and has therefore been associated with an inclination toward longer-term, monogamous relationships at older ages.<xref rid="b38-hiv-7-105" ref-type="bibr">38</xref> Additionally, it has been pointed out that adolescents typically engage in fleeting sexual relationships, which consequently make them more likely than their adult counterparts to have sex with multiple partners, thus placing them at a greater risk of contracting HIV/AIDS and other STIs.<xref rid="b39-hiv-7-105" ref-type="bibr">39</xref></p><p>Interestingly, as higher levels of education were achieved, the odds of MSP declined generally, but significant only among single women with secondary or higher education. This suggests the need to promote and support women’s formal education – preferably at secondary level or beyond – to enhance their self-esteem, confidence, capability to make decisions, and freedom of expression<xref rid="b40-hiv-7-105" ref-type="bibr">40</xref> regarding their choices in sexual relationships.<xref rid="b23-hiv-7-105" ref-type="bibr">23</xref> In addition, a recent study in this population reveals that education beyond primary school improves condom use.<xref rid="b23-hiv-7-105" ref-type="bibr">23</xref> Therefore, unmarried women in the study area are likely to change their risky sexual behaviors in favor of protective behaviors such as limiting the number of sexual partners and using condoms if their formal education is enhanced. Education is known to be a catalyst for change in gender relations as well as safer sex options.<xref rid="b40-hiv-7-105" ref-type="bibr">40</xref>,<xref rid="b41-hiv-7-105" ref-type="bibr">41</xref> However, in other places such as Uganda,<xref rid="b29-hiv-7-105" ref-type="bibr">29</xref> it has been noted that MSP among women increases as education enhances.</p><p>Ethnic differences in the odds of MSP were observed, with the Ndengereko ethnic group exhibiting lower risk than Porogo. The risk in other ethnic groups was also lower compared to the one observed among the Pogoro women, but the differences were not statistically significant. Also Muslim women had an elevated risk of MSP over Christian women. Although this points to the possibility of cultural or attitudinal differences in perceptions, beliefs, and practices in sexually-related matters, underlying mechanisms for these observations are less clear. Therefore further investigations, particularly qualitative studies, may be needed to understand contexts fostering this observation. Such research would also reveal knowledge, attitudes, values, beliefs, and practices concerning sexual relationships and partnerships in the study area.</p><sec><title>Limitations</title><p>Some variables which have been shown in similar studies to be determinants of MSP such as the extent of sexual satisfaction between partners, sexual networks, substance abuse, and alcohol abuse were not available for inclusion. Also it should be noted that questions related to sexual behavior are sensitive. Therefore reporting bias may have occurred as some respondents might have underreported their actual number of sexual partners in the past 12 months. However, possible biases were minimized by recruiting experienced young (mostly aged 18 to 30 years) male and female enumerators who had at least secondary education and underwent rigorous 2-week training on the questionnaire and later on by conducting a pilot survey among respondents who were similar to those who participated in the main survey. The pilot findings helped refinement of the tool and selection of the best enumerators after which field data collection commenced and lasted for 2 months.</p><p>Causal inferences may not be drawn from these findings due to the “snapshot” nature of cross-sectional studies. In addition, these results are not generalizable nationally or beyond since only three districts within Tanzania were included.</p></sec></sec><sec><title>Conclusion</title><p>Eight percent of women aged at least 15 years in Rufiji, Kilombero, and Ulanga districts of Tanzania are engaged in MSP. While both single and ever married women are more likely than their married counterparts to report MSP, only single women with at least secondary education have significant less chance for MSP compared to married women with no education. This suggests that promoting formal education at secondary level or beyond could be a sound strategy for sexual partner reduction among single women. Furthermore, although the odds of MSP generally decline as age advances, women aged 20 to 39 years are not significantly different from women <20 years of age. Muslim women as well as women belonging to the Pogoro ethnic group are more likely to engage in MSP in the study area. These groups should be targeted by interventions focused on partner reduction.</p></sec></body><back><ack><title>Acknowledgments</title><p>Connect Project which collected these data is funded by the Doris Duke Charitable Foundation (DDCF) and Comic Relief. A version of the abstract of this manuscript was accepted for presentation as a poster at the STI and AIDS World Congress, July 14–17, 2013 in Vienna, Austria. However, for some reasons the abstract was not presented at the congress. The abstract was later published in the journal <italic>Sexually Transmitted Infections</italic>.<xref rid="b42-hiv-7-105" ref-type="bibr">42</xref> It was a requirement that all accepted abstracts for that Congress – even if not presented – would be published in this journal.</p><p>We are greatly thankful to the District councils of Rufiji, Kilombero, and Ulanga and the communities from which the data were collected. Field data collectors, field supervisors, and all the participants are especially acknowledged for the role each one played to make the survey a success. Special appreciations are extended to Anna Larsen of Columbia University for proofreading the manuscript.</p></ack><fn-group><fn><p><bold>Author contributions</bold></p><p>All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.</p></fn><fn><p><bold>Disclosure</bold></p><p>The authors report no conflicts of interests in this work.</p></fn></fn-group><ref-list><title>References</title><ref id="b1-hiv-7-105"><label>1</label><element-citation publication-type="book"><person-group person-group-type="author"><collab>Joint United Nations Programme on HIV/AIDS, World Health Organization</collab></person-group><source>AIDS Epidemic Update</source><publisher-loc>Geneva</publisher-loc><publisher-name>World Health Organization</publisher-name><year>2007</year><comment>Available from: <ext-link ext-link-type="uri" xlink:href="http://data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdf">http://data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdf</ext-link></comment></element-citation></ref><ref id="b2-hiv-7-105"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lema</surname><given-names>LA</given-names></name><name><surname>Katapa</surname><given-names>RS</given-names></name><name><surname>Musa</surname><given-names>AS</given-names></name></person-group><article-title>Knowledge on HIV/AIDS and sexual behaviour among youths in Kibaha District, Tanzania</article-title><source>Tanzan J Health Res</source><year>2008</year><volume>10</volume><issue>2</issue><fpage>79</fpage><lpage>83</lpage><pub-id pub-id-type="pmid">18846784</pub-id></element-citation></ref><ref id="b3-hiv-7-105"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bellan</surname><given-names>SE</given-names></name><name><surname>Fiorella</surname><given-names>KJ</given-names></name><name><surname>Melesse</surname><given-names>DY</given-names></name><name><surname>Getz</surname><given-names>WM</given-names></name><name><surname>Williams</surname><given-names>BG</given-names></name><name><surname>Dushoff</surname><given-names>J</given-names></name></person-group><article-title>Extra-couple HIV transmission in sub-Saharan Africa: a mathematical modelling study of survey data</article-title><source>Lancet</source><year>2013</year><volume>381</volume><issue>9877</issue><fpage>1561</fpage><lpage>1569</lpage><pub-id pub-id-type="pmid">23391466</pub-id></element-citation></ref><ref id="b4-hiv-7-105"><label>4</label><element-citation publication-type="book"><person-group person-group-type="author"><collab>World Health Organization</collab></person-group><source>The World Health Report 2002. 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(%)</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">Total</td><td valign="top" align="left" rowspan="1" colspan="1">2,643</td><td valign="top" align="left" rowspan="1" colspan="1">100.0</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Number of sexual partners in the past 12 months</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> One</td><td valign="top" align="left" rowspan="1" colspan="1">2,437</td><td valign="top" align="left" rowspan="1" colspan="1">92.2</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Multiple (2+)</td><td valign="top" align="left" rowspan="1" colspan="1">206</td><td valign="top" align="left" rowspan="1" colspan="1">7.8</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Min =1, Max =7</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Age (years)</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> <20</td><td valign="top" align="left" rowspan="1" colspan="1">380</td><td valign="top" align="left" rowspan="1" colspan="1">14.4</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> 20–29</td><td valign="top" align="left" rowspan="1" colspan="1">881</td><td valign="top" align="left" rowspan="1" colspan="1">33.3</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> 30–39</td><td valign="top" align="left" rowspan="1" colspan="1">855</td><td valign="top" align="left" rowspan="1" colspan="1">32.4</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> 40+</td><td valign="top" align="left" rowspan="1" colspan="1">527</td><td valign="top" align="left" rowspan="1" colspan="1">19.9</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Mean =30.5, SD =9.3, Min =15, Max =63</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Marital status<xref ref-type="table-fn" rid="tfn1-hiv-7-105">m</xref></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Married</td><td valign="top" align="left" rowspan="1" colspan="1">1,964</td><td valign="top" align="left" rowspan="1" colspan="1">74.4</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Ever married</td><td valign="top" align="left" rowspan="1" colspan="1">181</td><td valign="top" align="left" rowspan="1" colspan="1">6.9</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Single</td><td valign="top" align="left" rowspan="1" colspan="1">495</td><td valign="top" align="left" rowspan="1" colspan="1">18.8</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Ethnicity<xref ref-type="table-fn" rid="tfn1-hiv-7-105">m</xref></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Pogoro</td><td valign="top" align="left" rowspan="1" colspan="1">445</td><td valign="top" align="left" rowspan="1" colspan="1">16.9</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Ndengereko</td><td valign="top" align="left" rowspan="1" colspan="1">374</td><td valign="top" align="left" rowspan="1" colspan="1">14.2</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Ngindo</td><td valign="top" align="left" rowspan="1" colspan="1">352</td><td valign="top" align="left" rowspan="1" colspan="1">13.3</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Ndamba</td><td valign="top" align="left" rowspan="1" colspan="1">238</td><td valign="top" align="left" rowspan="1" colspan="1">9.0</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Sukuma</td><td valign="top" align="left" rowspan="1" colspan="1">207</td><td valign="top" align="left" rowspan="1" colspan="1">7.8</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Ngoni</td><td valign="top" align="left" rowspan="1" colspan="1">205</td><td valign="top" align="left" rowspan="1" colspan="1">7.8</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Hehe</td><td valign="top" align="left" rowspan="1" colspan="1">177</td><td valign="top" align="left" rowspan="1" colspan="1">6.7</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Bena</td><td valign="top" align="left" rowspan="1" colspan="1">134</td><td valign="top" align="left" rowspan="1" colspan="1">5.1</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Other</td><td valign="top" align="left" rowspan="1" colspan="1">507</td><td valign="top" align="left" rowspan="1" colspan="1">19.2</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Place of residence<xref ref-type="table-fn" rid="tfn1-hiv-7-105">m</xref></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Urban</td><td valign="top" align="left" rowspan="1" colspan="1">503</td><td valign="top" align="left" rowspan="1" colspan="1">19.1</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Rural</td><td valign="top" align="left" rowspan="1" colspan="1">2,130</td><td valign="top" align="left" rowspan="1" colspan="1">80.9</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Education</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> No formal education</td><td valign="top" align="left" rowspan="1" colspan="1">541</td><td valign="top" align="left" rowspan="1" colspan="1">20.5</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Primary</td><td valign="top" align="left" rowspan="1" colspan="1">1,832</td><td valign="top" align="left" rowspan="1" colspan="1">69.3</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Secondary/higher</td><td valign="top" align="left" rowspan="1" colspan="1">270</td><td valign="top" align="left" rowspan="1" colspan="1">10.2</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Religion<xref ref-type="table-fn" rid="tfn1-hiv-7-105">m</xref></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Christian</td><td valign="top" align="left" rowspan="1" colspan="1">1,215</td><td valign="top" align="left" rowspan="1" colspan="1">46.0</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Muslim</td><td valign="top" align="left" rowspan="1" colspan="1">1,338</td><td valign="top" align="left" rowspan="1" colspan="1">50.6</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Traditional/other</td><td valign="top" align="left" rowspan="1" colspan="1">89</td><td valign="top" align="left" rowspan="1" colspan="1">3.4</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Socioeconomic status<xref ref-type="table-fn" rid="tfn1-hiv-7-105">m</xref></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Poor</td><td valign="top" align="left" rowspan="1" colspan="1">861</td><td valign="top" align="left" rowspan="1" colspan="1">34.7</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Middle</td><td valign="top" align="left" rowspan="1" colspan="1">827</td><td valign="top" align="left" rowspan="1" colspan="1">33.3</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Rich</td><td valign="top" align="left" rowspan="1" colspan="1">794</td><td valign="top" align="left" rowspan="1" colspan="1">32.0</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">District of residence</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Kilombero</td><td valign="top" align="left" rowspan="1" colspan="1">1,663</td><td valign="top" align="left" rowspan="1" colspan="1">62.9</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Rufiji</td><td valign="top" align="left" rowspan="1" colspan="1">567</td><td valign="top" align="left" rowspan="1" colspan="1">21.5</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Ulanga</td><td valign="top" align="left" rowspan="1" colspan="1">413</td><td valign="top" align="left" rowspan="1" colspan="1">15.6</td></tr></tbody></table><table-wrap-foot><fn><p><bold>Note:</bold></p></fn><fn id="tfn1-hiv-7-105"><label>m</label><p>Some missing data (n<2,643).</p></fn><fn id="tfn2-hiv-7-105"><p><bold>Abbreviations:</bold> Max, maximum; Min, minimum; SD, standard deviation.</p></fn></table-wrap-foot></table-wrap><table-wrap id="t2-hiv-7-105" position="float"><label>Table 2</label><caption><p>Percent distribution of MSP among women by background characteristics (n=2,643)</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">Variable</th><th valign="top" align="left" rowspan="1" colspan="1">Absolute number of women</th><th valign="top" align="left" rowspan="1" colspan="1">% women with MSP in the past 12 months</th><th valign="top" align="left" rowspan="1" colspan="1">95% confidence interval</th><th valign="top" align="left" rowspan="1" colspan="1"><italic>P</italic>-value</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">Total</td><td valign="top" align="left" rowspan="1" colspan="1">2,643</td><td valign="top" align="left" rowspan="1" colspan="1">7.8</td><td valign="top" align="left" rowspan="1" colspan="1">4.1–11.4</td><td valign="top" align="left" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Age (years)<xref ref-type="table-fn" rid="tfn4-hiv-7-105">*</xref></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> <20</td><td valign="top" align="left" rowspan="1" colspan="1">380</td><td valign="top" align="left" rowspan="1" colspan="1">10.5</td><td valign="top" align="left" rowspan="1" colspan="1">7.4–13.6</td><td valign="top" align="left" rowspan="1" colspan="1"><0.001</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> 20–29</td><td valign="top" align="left" rowspan="1" colspan="1">881</td><td valign="top" align="left" rowspan="1" colspan="1">9.7</td><td valign="top" align="left" rowspan="1" colspan="1">7.7–11.6</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> 30–39</td><td valign="top" align="left" rowspan="1" colspan="1">855</td><td valign="top" align="left" rowspan="1" colspan="1">6.9</td><td valign="top" align="left" rowspan="1" colspan="1">5.2–8.6</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> 40+</td><td valign="top" align="left" rowspan="1" colspan="1">527</td><td valign="top" align="left" rowspan="1" colspan="1">4.2</td><td valign="top" align="left" rowspan="1" colspan="1">2.5–5.9</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Marital status<xref ref-type="table-fn" rid="tfn3-hiv-7-105">m</xref></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Married</td><td valign="top" align="left" rowspan="1" colspan="1">1,964</td><td valign="top" align="left" rowspan="1" colspan="1">5.8</td><td valign="top" align="left" rowspan="1" colspan="1">4.7–6.8</td><td valign="top" align="left" rowspan="1" colspan="1"><0.001</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Ever married</td><td valign="top" align="left" rowspan="1" colspan="1">181</td><td valign="top" align="left" rowspan="1" colspan="1">14.4</td><td valign="top" align="left" rowspan="1" colspan="1">9.3–19.5</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Single</td><td valign="top" align="left" rowspan="1" colspan="1">495</td><td valign="top" align="left" rowspan="1" colspan="1">13.5</td><td valign="top" align="left" rowspan="1" colspan="1">10.5–16.6</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Ethnicity<xref ref-type="table-fn" rid="tfn3-hiv-7-105">m</xref></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Pogoro</td><td valign="top" align="left" rowspan="1" colspan="1">445</td><td valign="top" align="left" rowspan="1" colspan="1">10.6</td><td valign="top" align="left" rowspan="1" colspan="1">7.7–13.4</td><td valign="top" align="left" rowspan="1" colspan="1">0.269</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Ndengereko</td><td valign="top" align="left" rowspan="1" colspan="1">374</td><td valign="top" align="left" rowspan="1" colspan="1">5.6</td><td valign="top" align="left" rowspan="1" colspan="1">3.3–7.9</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Ngindo</td><td valign="top" align="left" rowspan="1" colspan="1">352</td><td valign="top" align="left" rowspan="1" colspan="1">8.5</td><td valign="top" align="left" rowspan="1" colspan="1">5.6–11.4</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Ndamba</td><td valign="top" align="left" rowspan="1" colspan="1">238</td><td valign="top" align="left" rowspan="1" colspan="1">8.0</td><td valign="top" align="left" rowspan="1" colspan="1">4.5–11.4</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Sukuma</td><td valign="top" align="left" rowspan="1" colspan="1">207</td><td valign="top" align="left" rowspan="1" colspan="1">5.8</td><td valign="top" align="left" rowspan="1" colspan="1">2.6–9.0</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Ngoni</td><td valign="top" align="left" rowspan="1" colspan="1">205</td><td valign="top" align="left" rowspan="1" colspan="1">6.3</td><td valign="top" align="left" rowspan="1" colspan="1">3.0–9.7</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Hehe</td><td valign="top" align="left" rowspan="1" colspan="1">177</td><td valign="top" align="left" rowspan="1" colspan="1">6.2</td><td valign="top" align="left" rowspan="1" colspan="1">2.7–9.8</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Bena</td><td valign="top" align="left" rowspan="1" colspan="1">134</td><td valign="top" align="left" rowspan="1" colspan="1">8.2</td><td valign="top" align="left" rowspan="1" colspan="1">3.6–12.9</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Other</td><td valign="top" align="left" rowspan="1" colspan="1">507</td><td valign="top" align="left" rowspan="1" colspan="1">7.9</td><td valign="top" align="left" rowspan="1" colspan="1">5.5–10.2</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Place of residence<xref ref-type="table-fn" rid="tfn3-hiv-7-105">m</xref></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Urban (ref)</td><td valign="top" align="left" rowspan="1" colspan="1">503</td><td valign="top" align="left" rowspan="1" colspan="1">9.5</td><td valign="top" align="left" rowspan="1" colspan="1">7.0–12.1</td><td valign="top" align="left" rowspan="1" colspan="1">0.110</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Rural</td><td valign="top" align="left" rowspan="1" colspan="1">2,130</td><td valign="top" align="left" rowspan="1" colspan="1">7.4</td><td valign="top" align="left" rowspan="1" colspan="1">6.3–8.5</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Education</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> No formal education</td><td valign="top" align="left" rowspan="1" colspan="1">541</td><td valign="top" align="left" rowspan="1" colspan="1">8.7</td><td valign="top" align="left" rowspan="1" colspan="1">6.3–11.1</td><td valign="top" align="left" rowspan="1" colspan="1">0.485</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Primary</td><td valign="top" align="left" rowspan="1" colspan="1">1,832</td><td valign="top" align="left" rowspan="1" colspan="1">7.8</td><td valign="top" align="left" rowspan="1" colspan="1">6.5–9.0</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Secondary/higher</td><td valign="top" align="left" rowspan="1" colspan="1">270</td><td valign="top" align="left" rowspan="1" colspan="1">6.3</td><td valign="top" align="left" rowspan="1" colspan="1">3.4–9.2</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Religion<xref ref-type="table-fn" rid="tfn3-hiv-7-105">m</xref></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Christian</td><td valign="top" align="left" rowspan="1" colspan="1">1,215</td><td valign="top" align="left" rowspan="1" colspan="1">7.0</td><td valign="top" align="left" rowspan="1" colspan="1">5.6–8.4</td><td valign="top" align="left" rowspan="1" colspan="1">0.032</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Muslim</td><td valign="top" align="left" rowspan="1" colspan="1">1,338</td><td valign="top" align="left" rowspan="1" colspan="1">8.8</td><td valign="top" align="left" rowspan="1" colspan="1">7.3–10.3</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Traditional/other</td><td valign="top" align="left" rowspan="1" colspan="1">89</td><td valign="top" align="left" rowspan="1" colspan="1">2.3</td><td valign="top" align="left" rowspan="1" colspan="1">0.8–5.3</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Socioeconomic status<xref ref-type="table-fn" rid="tfn3-hiv-7-105">m</xref></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Poor</td><td valign="top" align="left" rowspan="1" colspan="1">861</td><td valign="top" align="left" rowspan="1" colspan="1">7.1</td><td valign="top" align="left" rowspan="1" colspan="1">5.4–8.8</td><td valign="top" align="left" rowspan="1" colspan="1">0.753</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Middle</td><td valign="top" align="left" rowspan="1" colspan="1">827</td><td valign="top" align="left" rowspan="1" colspan="1">7.5</td><td valign="top" align="left" rowspan="1" colspan="1">5.7–9.3</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Rich</td><td valign="top" align="left" rowspan="1" colspan="1">794</td><td valign="top" align="left" rowspan="1" colspan="1">8.1</td><td valign="top" align="left" rowspan="1" colspan="1">6.2–10.0</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">District of residence</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Kilombero</td><td valign="top" align="left" rowspan="1" colspan="1">1,663</td><td valign="top" align="left" rowspan="1" colspan="1">8.2</td><td valign="top" align="left" rowspan="1" colspan="1">6.9–9.5</td><td valign="top" align="left" rowspan="1" colspan="1">0.526</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Rufiji</td><td valign="top" align="left" rowspan="1" colspan="1">567</td><td valign="top" align="left" rowspan="1" colspan="1">6.7</td><td valign="top" align="left" rowspan="1" colspan="1">4.6–8.8</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Ulanga</td><td valign="top" align="left" rowspan="1" colspan="1">413</td><td valign="top" align="left" rowspan="1" colspan="1">7.8</td><td valign="top" align="left" rowspan="1" colspan="1">5.2–10.3</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr></tbody></table><table-wrap-foot><fn><p><bold>Note:</bold></p></fn><fn id="tfn3-hiv-7-105"><label>m</label><p>Some missing data (n<2,643);</p></fn><fn id="tfn4-hiv-7-105"><label>*</label><p>significant trend test of MSP across age group (z=−4.26, <italic>P</italic><0.001).</p></fn><fn id="tfn5-hiv-7-105"><p><bold>Abbreviations:</bold> MSP, multiple sexual partnerships; ref, reference category.</p></fn></table-wrap-foot></table-wrap><table-wrap id="t3-hiv-7-105" position="float"><label>Table 3</label><caption><p>Univariate and multivariate logistic regression analysis of factors associated with multiple sexual partnerships among women in three rural districts of Tanzania, 2011</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2" valign="top" align="left" colspan="1">Variable</th><th colspan="3" valign="top" align="left" rowspan="1">Univariate models
<hr></hr></th><th colspan="3" valign="top" align="left" rowspan="1">Multivariate model (n=2,625)
<hr></hr></th></tr><tr><th valign="top" align="left" rowspan="1" colspan="1">Crude odds ratio</th><th valign="top" align="left" rowspan="1" colspan="1">95% confidence interval</th><th valign="top" align="left" rowspan="1" colspan="1"><italic>P</italic>-value</th><th valign="top" align="left" rowspan="1" colspan="1">Adjusted odds ratio</th><th valign="top" align="left" rowspan="1" colspan="1">95% confidence interval</th><th valign="top" align="left" rowspan="1" colspan="1"><italic>P</italic>-value</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">Age (years)</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> <20</td><td valign="top" align="left" rowspan="1" colspan="1">1.00</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">1.00</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> 20–29</td><td valign="top" align="left" rowspan="1" colspan="1">0.91</td><td valign="top" align="left" rowspan="1" colspan="1">0.61–1.35</td><td valign="top" align="left" rowspan="1" colspan="1">0.632</td><td rowspan="2" valign="top" align="left" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">0.64–1.54</td><td valign="top" align="left" rowspan="1" colspan="1">0.972</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> 30–39</td><td valign="top" align="left" rowspan="1" colspan="1">0.63</td><td valign="top" align="left" rowspan="1" colspan="1">0.41–0.96</td><td valign="top" align="left" rowspan="1" colspan="1">0.032</td><td valign="top" align="left" rowspan="1" colspan="1">0.44–1.20</td><td valign="top" align="left" rowspan="1" colspan="1">0.210</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> 40+</td><td valign="top" align="left" rowspan="1" colspan="1">0.37</td><td valign="top" align="left" rowspan="1" colspan="1">0.22–0.63</td><td valign="top" align="left" rowspan="1" colspan="1"><0.001</td><td valign="top" align="left" rowspan="1" colspan="1">0.44</td><td valign="top" align="left" rowspan="1" colspan="1">0.24–0.80</td><td valign="top" align="left" rowspan="1" colspan="1">0.008</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Marital status</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Married (ref)</td><td valign="top" align="left" rowspan="1" colspan="1">1.00</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">1.00</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Ever married</td><td valign="top" align="left" rowspan="1" colspan="1">2.75</td><td valign="top" align="left" rowspan="1" colspan="1">1.74–4.34</td><td valign="top" align="left" rowspan="1" colspan="1"><0.001</td><td valign="top" align="left" rowspan="1" colspan="1">3.83</td><td valign="top" align="left" rowspan="1" colspan="1">1.40–10.49</td><td valign="top" align="left" rowspan="1" colspan="1">0.009</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Single</td><td valign="top" align="left" rowspan="1" colspan="1">2.56</td><td valign="top" align="left" rowspan="1" colspan="1">1.86–3.53</td><td valign="top" align="left" rowspan="1" colspan="1"><0.001</td><td valign="top" align="left" rowspan="1" colspan="1">6.13</td><td valign="top" align="left" rowspan="1" colspan="1">2.45–15.34</td><td valign="top" align="left" rowspan="1" colspan="1"><0.001</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Education</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> No formal education (ref)</td><td valign="top" align="left" rowspan="1" colspan="1">1.00</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">1.00</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Primary</td><td valign="top" align="left" rowspan="1" colspan="1">0.88</td><td valign="top" align="left" rowspan="1" colspan="1">0.63–1.25</td><td valign="top" align="left" rowspan="1" colspan="1">0.480</td><td valign="top" align="left" rowspan="1" colspan="1">0.73</td><td valign="top" align="left" rowspan="1" colspan="1">0.46–1.14</td><td valign="top" align="left" rowspan="1" colspan="1">0.167</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Secondary/higher</td><td valign="top" align="left" rowspan="1" colspan="1">0.71</td><td valign="top" align="left" rowspan="1" colspan="1">0.40–1.26</td><td valign="top" align="left" rowspan="1" colspan="1">0.236</td><td valign="top" align="left" rowspan="1" colspan="1">0.67</td><td valign="top" align="left" rowspan="1" colspan="1">0.25–1.82</td><td valign="top" align="left" rowspan="1" colspan="1">0.433</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Marital status and education</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Married and no formal education (ref)</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">1.00</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Ever married and primary education</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">0.69</td><td valign="top" align="left" rowspan="1" colspan="1">0.22–2.16</td><td valign="top" align="left" rowspan="1" colspan="1">0.521</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Ever married and secondary/higher education</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">2.76</td><td valign="top" align="left" rowspan="1" colspan="1">0.17–45.7</td><td valign="top" align="left" rowspan="1" colspan="1">0.428</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Single and primary education</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">0.42</td><td valign="top" align="left" rowspan="1" colspan="1">0.15–1.13</td><td valign="top" align="left" rowspan="1" colspan="1">0.086</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Single and secondary/higher education</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">0.15</td><td valign="top" align="left" rowspan="1" colspan="1">0.03–0.61</td><td valign="top" align="left" rowspan="1" colspan="1">0.009</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Ethnicity</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Pogoro</td><td valign="top" align="left" rowspan="1" colspan="1">1.00</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">1.00</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Ndengereko</td><td valign="top" align="left" rowspan="1" colspan="1">0.50</td><td valign="top" align="left" rowspan="1" colspan="1">0.30–0.86</td><td valign="top" align="left" rowspan="1" colspan="1">0.012</td><td valign="top" align="left" rowspan="1" colspan="1">0.33</td><td valign="top" align="left" rowspan="1" colspan="1">0.18–0.59</td><td valign="top" align="left" rowspan="1" colspan="1"><0.001</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Ngindo</td><td valign="top" align="left" rowspan="1" colspan="1">0.79</td><td valign="top" align="left" rowspan="1" colspan="1">0.49–1.28</td><td valign="top" align="left" rowspan="1" colspan="1">0.334</td><td valign="top" align="left" rowspan="1" colspan="1">0.66</td><td valign="top" align="left" rowspan="1" colspan="1">0.39–1.10</td><td valign="top" align="left" rowspan="1" colspan="1">0.113</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Ndamba</td><td valign="top" align="left" rowspan="1" colspan="1">0.73</td><td valign="top" align="left" rowspan="1" colspan="1">0.42–1.28</td><td valign="top" align="left" rowspan="1" colspan="1">0.279</td><td valign="top" align="left" rowspan="1" colspan="1">0.88</td><td valign="top" align="left" rowspan="1" colspan="1">0.49–1.57</td><td valign="top" align="left" rowspan="1" colspan="1">0.655</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Sukuma</td><td valign="top" align="left" rowspan="1" colspan="1">0.52</td><td valign="top" align="left" rowspan="1" colspan="1">0.27–1.01</td><td valign="top" align="left" rowspan="1" colspan="1">0.052</td><td valign="top" align="left" rowspan="1" colspan="1">0.96</td><td valign="top" align="left" rowspan="1" colspan="1">0.46–2.01</td><td valign="top" align="left" rowspan="1" colspan="1">0.919</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Ngoni</td><td valign="top" align="left" rowspan="1" colspan="1">0.57</td><td valign="top" align="left" rowspan="1" colspan="1">0.30–1.09</td><td valign="top" align="left" rowspan="1" colspan="1">0.087</td><td valign="top" align="left" rowspan="1" colspan="1">0.56</td><td valign="top" align="left" rowspan="1" colspan="1">0.29–1.08</td><td valign="top" align="left" rowspan="1" colspan="1">0.083</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Hehe</td><td valign="top" align="left" rowspan="1" colspan="1">0.56</td><td valign="top" align="left" rowspan="1" colspan="1">0.28–1.11</td><td valign="top" align="left" rowspan="1" colspan="1">0.096</td><td valign="top" align="left" rowspan="1" colspan="1">0.71</td><td valign="top" align="left" rowspan="1" colspan="1">0.35–1.43</td><td valign="top" align="left" rowspan="1" colspan="1">0.335</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Bena</td><td valign="top" align="left" rowspan="1" colspan="1">0.76</td><td valign="top" align="left" rowspan="1" colspan="1">0.38–1.51</td><td valign="top" align="left" rowspan="1" colspan="1">0.428</td><td valign="top" align="left" rowspan="1" colspan="1">0.95</td><td valign="top" align="left" rowspan="1" colspan="1">0.47–1.92</td><td valign="top" align="left" rowspan="1" colspan="1">0.882</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Other</td><td valign="top" align="left" rowspan="1" colspan="1">0.73</td><td valign="top" align="left" rowspan="1" colspan="1">0.47–1.13</td><td valign="top" align="left" rowspan="1" colspan="1">0.155</td><td valign="top" align="left" rowspan="1" colspan="1">0.78</td><td valign="top" align="left" rowspan="1" colspan="1">0.49–1.23</td><td valign="top" align="left" rowspan="1" colspan="1">0.286</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Place of residence</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Urban (ref)</td><td valign="top" align="left" rowspan="1" colspan="1">1.00</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">1.00</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Rural</td><td valign="top" align="left" rowspan="1" colspan="1">0.76</td><td valign="top" align="left" rowspan="1" colspan="1">0.54–1.07</td><td valign="top" align="left" rowspan="1" colspan="1">0.111</td><td valign="top" align="left" rowspan="1" colspan="1">0.77</td><td valign="top" align="left" rowspan="1" colspan="1">0.54–1.10</td><td valign="top" align="left" rowspan="1" colspan="1">0.152</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Religion</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Christian (ref)</td><td valign="top" align="left" rowspan="1" colspan="1">1.00</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">1.00</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Muslim</td><td valign="top" align="left" rowspan="1" colspan="1">1.29</td><td valign="top" align="left" rowspan="1" colspan="1">0.96–1.72</td><td valign="top" align="left" rowspan="1" colspan="1">0.090</td><td valign="top" align="left" rowspan="1" colspan="1">1.56</td><td valign="top" align="left" rowspan="1" colspan="1">1.11–2.21</td><td valign="top" align="left" rowspan="1" colspan="1">0.012</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Traditional/other</td><td valign="top" align="left" rowspan="1" colspan="1">0.31</td><td valign="top" align="left" rowspan="1" colspan="1">0.07–1.26</td><td valign="top" align="left" rowspan="1" colspan="1">0.102</td><td valign="top" align="left" rowspan="1" colspan="1">0.27</td><td valign="top" align="left" rowspan="1" colspan="1">0.06–1.29</td><td valign="top" align="left" rowspan="1" colspan="1">0.101</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Socio-economic status</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Poor (ref)</td><td valign="top" align="left" rowspan="1" colspan="1">1.00</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Middle</td><td valign="top" align="left" rowspan="1" colspan="1">1.06</td><td valign="top" align="left" rowspan="1" colspan="1">0.74–1.53</td><td valign="top" align="left" rowspan="1" colspan="1">0.747</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Rich</td><td valign="top" align="left" rowspan="1" colspan="1">1.15</td><td valign="top" align="left" rowspan="1" colspan="1">0.80–1.66</td><td valign="top" align="left" rowspan="1" colspan="1">0.453</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">District of residence</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Kilombero (ref)</td><td valign="top" align="left" rowspan="1" colspan="1">1.00</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Rufiji</td><td valign="top" align="left" rowspan="1" colspan="1">0.81</td><td valign="top" align="left" rowspan="1" colspan="1">0.56–1.17</td><td valign="top" align="left" rowspan="1" colspan="1">0.259</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Ulanga</td><td valign="top" align="left" rowspan="1" colspan="1">0.94</td><td valign="top" align="left" rowspan="1" colspan="1">0.63–1.41</td><td valign="top" align="left" rowspan="1" colspan="1">0.774</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1">–</td></tr></tbody></table><table-wrap-foot><fn><p><bold>Note:</bold></p></fn><fn id="tfn6-hiv-7-105"><p>Goodness-of-fit test <italic>P</italic>=0.620.</p></fn><fn id="tfn7-hiv-7-105"><p><bold>Abbreviation:</bold> ref, reference category.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce 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