Academic journal article International Journal of Men's Health

Determinants of Multi-Partner Behaviour of Male Patients with Sexually Transmitted Diseases in South Africa: Implications for Interventions

Academic journal article International Journal of Men's Health

Determinants of Multi-Partner Behaviour of Male Patients with Sexually Transmitted Diseases in South Africa: Implications for Interventions

Article excerpt

Key Words: STDs, HIV/AIDS, risk behaviour, gender

Indicators of South Africans' exposure to high-risk sexual behaviour is present in the estimation that 4.74 million people are HIV infected and that approximately 11 million STD cases are treated annually (Colvin, 1997; National Department of Health, 2002). Improved treatment of sexually transmitted diseases has been found to reduce HIV incidence by about 40% in rural Tanzania (Grosskurth et al., 1995). The comprehensive management of STDs with equal emphasis on early diagnosis, treatment, and prevention, specifically directed at sustained behavioural change, has been widely advocated. Efforts directed at the prevention of STDs remain critical, focusing on achieving sustained behavioural change through reducing the number of sexual partners people have, all the while promoting sustained condom use (Royce, Sena, Cates, & Cohen, 1997).

However, the facilitation of sustained behavioural change remains problematic in South Africa. It has been argued that the AIDS pandemic is about women and inequity and that gender inequality where men are assigned a higher status than women is therefore fatal (Gupta, 2000). Within this context the practice of safer sex behaviours therefore greatly depend on men's commitment to it. While the empowerment of women remains a major HIV/AIDS prevention strategy (Johnston, 2001), it is possible that too few prevention efforts have been directed toward males as sexual partners (Campbell, 1995).

Men's, especially younger men's, relatively high level of multiple sex partner patterns are supported by various studies in general and more specifically in Southern Africa (Brunswick & Flory, 1998; Dolcini, Coates, Catania, Kegeles, & Hauck, 1995; Mnyika Klepp, Kvale, & Ole-King'ori, 1997). Multiple partners have been found to be an independent risk factor in HIV acquisition (Morris, 1997). The traditional gender roles of males and females in South Africa are often blamed for existing gender inequalities that contribute to multi-partner behaviours and thus fuel the spread of HIV/AIDS and other STDs (Strebel, 1995). In men's traditional role, male sexual prowess is valued as an indication of men's ability to ensure the continuation of the lineage (De Villiers, 1992; Harden, 1997; Wessels, 1996), while women's role is defined in terms of motherhood, fidelity, and a subordinate position in male-female relationships (Gupta, 2000; Meyer-Weitz, Reddy, Weijts, Van den Borne, & Kok, 1998; Ulin, 1992). A prevailing opinion is that consensual unions, often between a man and more than one woman, occur relatively frequently and are still accepted as normal cultural practices among South Africans in spite of the effects of modern life on many traditional customs (Harrison, Lurie, & Wilkinson, 1997; Mokhobo, 1989). The role of poverty in multi-partner behaviour with specific reference to sex work or sexual services in exchange for gifts is well documented (Colvin, 2000; Gupta, 2000; Mabitsela, Meyer-Weitz, Bosman, Marais, & Nkau, 2000; Meyer-Weitz et al., 1998; Mitton, 2000; Strebel, 1995; Ulin, 1992). Recent research on multiple partner patterns suggests that the prevalence of sexual and social networks is hampering efforts at reducing HIV transmission (Hankins, 1998).

It appears that men with higher levels of education have an increased risk of having multiple sexual partners because of the association of higher education with higher income that allows for more disposable income for social activities that may include casual sex and being attractive as a potential partner but also because of increased travel opportunities (Mnyika et al., 1997; Somsé, Chapko, & Hawkins, 1993). The "sugar daddy" phenomenon where younger girls offer sexual services to older men in exchange for gifts is facilitated by the older men's higher socio-economic status, which contributes to multi-partner behaviour and an increased risk to contracting STDs and HIV/AIDS (Kelly, 2000; Shell & Zeitlin, 2000; Williams, Gouws, Colvin, Ramgee, & Abdool Karim, 2000). …

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