The likelihood that a man will have multiple sex partners—a key factor promoting the spread of HIV—may be mediated by his financial resources and his exposure to social control mechanisms, such as monitoring by village elders and family members.1 In many of the 15 Sub-Saharan African countries included in a recent study, the odds of having had multiple partners in the previous 12 months were elevated among men with greater household wealth and those with nonagricultural occupations. In addition, the odds of having had multiple partners were frequently elevated among men who were relatively free from social control because they lived alone or traveled away from home; for example, Ethiopian men who had taken six or more long trips in the past year, including at least one that lasted a month, were far more likely than nontravelers to have had multiple partners (odds ratio, 8.1).
The researcher used self-reported data on men aged 15–49 from Demographic and Health Surveys conducted in Burkina Faso, Cameroon, Côte d'Ivoire, Ethiopia, Ghana, Guinea, Kenya, Lesotho, Malawi, Mali, Niger, Rwanda, Senegal, Tanzania and Zambia. He excluded men in polygynous marriages, who accounted for 1% (in Rwanda) to 15% (in Guinea) of men in that age range. Respondents reported their marital status, their age at first sex and the number of sex partners they had had in the 12 months prior to the interview. The key socioeconomic variables included in the study were household wealth (categorized in quintiles), education (none, some primary, completed primary, some secondary or completed secondary) and employment status (student, unemployed or employed in one of seven broad occupational categories). In addition, the researcher used three indicators of social control mechanisms that might affect men's sexual behavior: rural or urban residence (because social control mechanisms are presumably weaker in urban regions), travel away from home in the past 12 months, and social position in the household, determined by whether the man lived alone, headed a two-person household, headed a larger household, was the son or grandson of the head of the household, or was in another position. Logistic regression was used to elucidate any relationships among men's characteristics, social control variables and having had multiple partnerships.
The proportion of respondents who were currently married ranged from 27% in Côte d'Ivoire to 59% in Malawi. Those with no education accounted for between 5% (in Kenya and Zambia) and 64% (in Niger) of respondents; men living in rural areas accounted for 40% (in Cameroon) to 84% (in Ethiopia) of respondents. The proportion of men who reported having had two or more sex partners in the previous 12 months ranged from 1% in Ethiopia to 28% in Cameroon, and exceeded 10% in nine countries.
A relationship between marital status and having had multiple sex partners was evident in 11 of the 15 countries. The odds of having had multiple partners were lower among monogamously married men than among never-married men in five countries (odds ratios, 0.2–0.6 in Burkina Faso, Côte d'Ivoire, Guinea, Mali and Niger)—a finding that runs counter to the common assumption that men's marital authority over their wives facilitates their having multiple partners. Tanzania was the only country in which married men were more likely than never-married men to have had more than one partner in the past 12 months (1.4). The odds of having had multiple partners were elevated among unmarried cohabiting men in Côte d'Ivoire, Rwanda and Senegal (1.5–4.0) and formerly married men in Cameroon, Kenya, Tanzania and Zambia (1.5–3.6).
In about half of the 13 countries for which relevant data were available, wealth was related to having had multiple partners. In three (Cameroon, Côte d'Ivoire and Ghana), the risk of men having had more than one partner in the past year generally increased with greater household wealth. For example, in Cameroon, the odds that men had had multiple partners rose as household wealth increased from the poorest quintile (the reference group) to the second poorest quintile (odds ratio, 1.7), the middle and second-richest quintiles (2.2 each) and the richest quintile (3.1). Multiple partnerships were more prevalent among only the wealthiest men in Burkina Faso, Kenya, Niger and Senegal (1.7–7.5), while in most of the remaining countries wealth was not consistently related to men's partnerships.
In nine countries (Burkina Faso, Côte d'Ivoire, Ghana, Kenya, Lesotho, Mali, Rwanda, Senegal and Zambia), the odds of having had multiple partners were higher among men in one or more nonagricultural occupations than among agricultural workers (odds ratios ranged from 1.5 among unskilled manual laborers in Kenya to 3.6 among professional, technical and managerial workers in Mali). Compared with agricultural workers, men who were unemployed had lower odds of having had multiple partners in Tanzania (0.5), but higher odds in Cameroon, Côte d'Ivoire, Ghana and Mali (1.7–2.2)—possibly because some unemployed men "use sex with multiple partners as a way of reasserting their masculinity," the author suggests. Students were generally less likely than agricultural workers to have had multiple partnerships.
In eight of the 15 countries, men living in urban areas had elevated odds of having had multiple sex partners (odds ratios, 1.6–4.3). In 11, men living alone—who presumably were the most free from familial monitoring—were more likely than heads of large households to have had more than one partner (1.8–4.0). Finally, in all 11 countries for which travel data were available, men who had been away from home in the previous 12 months—and who thus had experienced freedom from social control—were generally more likely than those who had not traveled to have had multiple partners. For example, in Côte d'Ivoire, men who had taken at least one trip lasting a month were more likely than nontravelers to have had more than one partner (3.0–4.0). The odds of having had multiple partners were highest among Ethiopian men who had taken six or more trips, including at least one that had lasted a month (8.1).
The researcher asserts that given the diversity among Sub-Saharan countries in the prevalence of men's multiple sexual partnerships, generalizations about the region should be avoided. Nonetheless, he argues that evidence connecting men's escape from social strictures and their control of financial resources with their increased risk of having multiple partners could help shape strategies for addressing HIV risk. Meanwhile, he points out that there was little evidence that their authority over their wives—commonly thought to facilitate extramarital sex and the spread of HIV—contributes to men's having had multiple sex partners. He concludes that "programs intended to reduce the spread of HIV and other sexually transmitted infections through behavior change may be able to build upon, enhance the effectiveness of, or operate synergistically with" the formal and informal social control mechanisms delineated above.
1. Bingenheimer JB, Men's multiple sexual partnerships in 15 Sub-Saharan African countries: sociodemographic patterns and implications, Studies in Family Planning, 2010, 41(1):1–17.