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A MULTILEVEL ANALYSIS OF THE DETERMINANTS OF HIGH-RISK SEXUAL BEHAVIOUR IN SUB-SAHARAN AFRICA

Published online by Cambridge University Press:  09 November 2011

JOSEPH UCHUDI ,
MONICA MAGADI  and
MOHAMMOD MOSTAZIR
JOSEPH UCHUDI
Affiliation:
Independent Consultant, Silver Spring, Maryland, USA
MONICA MAGADI
Affiliation:
Department of Sociology, City University London, UK
MOHAMMOD MOSTAZIR
Affiliation:
Department of Sociology, City University London, UK
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Summary

A number of authors have identified multiple concurrent sexual partnerships by both men and women to lie at the root of the HIV/AIDS epidemic in sub-Saharan Africa. This study applies multilevel models to Demographic and Health Survey data collected during 2003–2008 in 20 sub-Saharan African countries to examine the influence of social and cultural context on involvement with multiple sexual partnerships in the region, above and beyond the effects of individual characteristics. The findings provide support for the ecological argument that health behaviours are shaped and determined by societal conditions, in addition to the effects of individual and household characteristics. Involvement with multiple sex partners is most prevalent in societies in which sexual norms are widely permissive and where polygyny is common. Individual autonomy is substantial and attitudes towards sexuality are more liberal among men and women who live in communities in which sexual norms are widely permissive. Men and women who are most likely to have multiple sex partners in the sub-Saharan region are those who initiated sexual activity earlier and those who have the individual attributes (e.g. young age, urban residence, education, media exposure and working for cash and away from home) that bring to them more rights and/or decision-making autonomy, but not necessarily more financial resources and economic security (mostly among women). On the other hand, involvement with multiple partners is determined by cultural norms (i.e. permissive sexual norms) and social change (i.e. mass education, expansion of cash employment). The findings suggest a number of opportunities for more effective policy and programmatic responses to curb the prevalence of multiple partnerships in sub-Saharan Africa.

Type
Research Article
Information
Journal of Biosocial Science , Volume 44 , Issue 3 , May 2012 , pp. 289 - 311
Copyright
Copyright © Cambridge University Press 2011

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References

Adler, N. E., Boyce, W. T., Chesney, M., Cohen, S., Folkman, S., Kahn, R. & Syme, S. L. (1994) Socioeconomic status and health: the challenge of the gradient. American Psychologist 49(1), 15–24.CrossRefGoogle ScholarPubMed
Ashley, M. F. (2010) The social determinants of HIV serostatus in sub-Saharan Africa: an inverse relationship between poverty and HIV? Public Health Reports 125 (Supplement 4), 16–24.Google Scholar
Awusabo-Asare, K. & Annim, S. K. (2008) Wealth status and risky sexual behaviour in Ghana and Kenya. Applied Health Economics and Health Policy 6(1), 27–39.CrossRefGoogle ScholarPubMed
Bagnol, B. & Chamo, E. (2004) Intergenerational relationships in Mozambique: what is driving young women and older men? Sexual Health Exchange 3, 10–11.Google Scholar
Benefo, K. D. (1995) The determinants of the duration of postpartum sexual abstinence in West Africa: a multilevel analysis. Demography 32(2), 139–158.CrossRefGoogle ScholarPubMed
Benefo, K. D. (2010) Determinants of condom use in Zambia: a multilevel analysis. Studies in Family Planning 41(1), 19–30.CrossRefGoogle ScholarPubMed
Brockerhoff, M. & DeRose, L. F. (1996) Child survival in East Africa: the impact of preventive health care. World Development 24(12), 1841–1857.CrossRefGoogle Scholar
Caldwell, J. C. (1980) Mass education as a determinant of the timing of fertility decline. Population and Development Review 6(2), 225–255.CrossRefGoogle Scholar
Caldwell, J. C. (1982) Theory of Fertility Decline. Academic Press, New York, London.Google Scholar
Caldwell, J. C. & Caldwell, P. (1987) The cultural context of high fertility in sub-Saharan Africa. Population and Development Review 13(3), 409–437.CrossRefGoogle Scholar
Caldwell, J. C. & Caldwell, P. (1993) Women's position and child mortality and morbidity in less developed countries. In Federici, N., Mason, K. O. & Sogner, S. (eds) Women's Position and Demographic Change. Clarendon Press, Oxford, pp. 122–139.Google Scholar
Caldwell, J. & Caldwell, P. (1996) The African AIDS epidemic. Scientific American 274(3), 620–668.CrossRefGoogle ScholarPubMed
Caldwell, J., Caldwell, P. & Quiggin, P. (1989) The social context of AIDS in sub-Saharan Africa. Population and Development Review 15(2), 185–234.CrossRefGoogle Scholar
Cain, M. T. (1993) Patriarchal structure and demographic change. In Federici, N., Mason, K. O. & Sogner, S. (eds) Women's Position and Demographic Change. Clarendon Press, Oxford.Google Scholar
Cain, M. T. (1984) Women's Status and Fertility in Developing Countries: Son Preference and Economic Security. Working Paper No. 110, Population Council Center for Policy Studies, New York.Google Scholar
Coleman, J. S. (1988) Social capital in the creation of human capital. American Journal of Sociology 94, S95–120.CrossRefGoogle Scholar
Edström, J. & Khan, N. (2009) Perspectives on intergenerational vulnerability for adolescents affected by HIV: an argument for voice and visibility. IDS Bulletin 40(1), 41–50.CrossRefGoogle Scholar
Ezeh, A. C. (1997) Polygyny and reproductive behavior in sub-Saharan Africa: a contextual analysis. Demography 34(2), 355–368.CrossRefGoogle ScholarPubMed
Goldstein, H. (2003) Multilevel Statistical Models (3rd edition). Arnold, London.Google Scholar
Halperin, D. T. & Epstein, H. (2004) Concurrent sexual partnerships help explain Africa's high HIV prevalence: implications for prevention. Lancet 364, 4–6.CrossRefGoogle ScholarPubMed
Hargreaves, J. R., Morrison, L. A., Chege, J., Rutenburg, N., Kahindo, M., Weiss, H. A. et al. (2002) Socioeconomic status and risk of HIV infection in an urban population in Kenya. Tropical Medicine and International Health 7(9), 793–802.CrossRefGoogle Scholar
Hedeker, D. & Gibbsons, R. D. (1996) MIXOR: a computer programme for mixed effects ordinal regression analysis. Computer Methods and Programs in Biometrics 49, 157–176.CrossRefGoogle ScholarPubMed
Jones, L. (2006) Sexual decision-making by urban youth in AIDS-afflicted Swaziland. African Journal of AIDS Research 5, 145–157.CrossRefGoogle ScholarPubMed
Kasarda, J. D., Billy, J. & West, K. (1986) Status Enhancement and Fertility: Reproductive Responses to Social Mobility and Educational Opportunity. Academic Press, New York.CrossRefGoogle Scholar
Kimuna, S. R. & Djamba, Y. K. (2005) Wealth and extramarital sex among men in Zambia. International Family Planning Perspectives 31(2), 83–89.CrossRefGoogle ScholarPubMed
Kirk, D. (1996) Demographic transition theory. Population Studies 50(3), 361–387.CrossRefGoogle ScholarPubMed
Leclerc-Madlala, S. (2003) Transactional sex and the pursuit of modernity. Social Dynamics 29(2), 213–233.CrossRefGoogle Scholar
Leclerc-Madlala, S. (2008) Age-disparate and intergenerational sex in southern Africa: the dynamics of hyper vulnerability. AIDS 22 (Supplement 4), S17–25.CrossRefGoogle Scholar
Leclerc-Madlala, S. (2009) Cultural scripts for multiple and concurrent partnerships in southern Africa: why HIV prevention needs anthropology. Sexual Health 6(2), 103–110.CrossRefGoogle ScholarPubMed
Lesthaeghe, R. J. (1989) Introduction and production and reproduction in sub-Saharan Africa: an overview of organizing principles. In Lesthaeghe, R. J. (ed.) Reproduction and Social Organization in Sub-Saharan Africa. University of California Press, Berkeley, London.CrossRefGoogle Scholar
Mishra, V., Assche, S. B., Greener, R., Vaessen, M., Hong, R., Ghys, P. D. et al. (2007) HIV infection does not disproportionately affect the poorer in sub-Saharan Africa. AIDS 7 (Supplementyes), S17–28.CrossRefGoogle Scholar
Motemekoane, I. & Malope, M. (2008) HIV Prevention: Multiple and Concurrent Sexual Partnerships among Youth and Adults in Lesotho. A target audience research report. Phela Health and Development Communications, Maseru, Lesotho. URL: http://www.comminit.com/en/node/285735/38Google Scholar
Nkosana, J. & Rosenthal, D. (2007) The dynamics of intergenerational sexual relationships: the experience of schoolgirls in Botswana. Sexual Health 4(3), 181–187.CrossRefGoogle ScholarPubMed
Montgomery, M. R., Gragnolati, M., Burke, K. A. & Paredes, E. (2000) Measuring living standards with proxy variables. Demography 37(2), 155–174.CrossRefGoogle ScholarPubMed
Morgan, S. P. & Niraula, B. B. (1995) Gender inequality and fertility in two Nepali villages. Population and Development Review 21(3), 541–561.CrossRefGoogle Scholar
Mott, F. L., Fondell, M. M., Hu, P. N., Kowaleski-Jones, L. & Menaghan, E. G. (1996) The determinants of first sex by age 14 in a high-risk adolescent population. Family Planning Perspectives 28, 13–18.CrossRefGoogle Scholar
O'Brien, D., Wilkes, J., de Haan, A. & Maxwell, S. (1997) Poverty and Social Exclusion in North and South. IDS Working Paper No. 55. Institute of Development Studies and Poverty Research Unit, University of Sussex, UK.Google Scholar
Pebley, A. R., Goldman, N. & Rodriguez, G. (1996) Prenatal and delivery care and childhood immunization in Guatemala: do family and community matter? Demography 33(2), 231–247.CrossRefGoogle ScholarPubMed
Rasbash, J., Steele, F., Browne, W. & Prosser, B. (2005) A Users Guide to MLwiN, Version 2.0. Centre for Multilevel Modelling, University of Bristol, UK.Google Scholar
Riley, N. E. (1997) Gender, power, and population change. Population Bulletin 52(1), 1–48.Google ScholarPubMed
Romaniuk, A. (1968a) La fécondité des populations congolaises. Mouton, Paris.Google Scholar
Romaniuk, A. (1968b) Infertility in tropical Africa. In Caldwell, C. & Okongo, C. (eds) The Population of Tropical Africa. Longmans.Google Scholar
Rwenge, M. J-P. (2004) Les différences ethniques des comportements sexuels au Cameroun: l'exemple des Bamiléké et Bëti. African Population Studies 19(2), 159–190.Google Scholar
Sallis, J. F., Owen, N. & Fisher, E. B. (2002) Ecological models of health behavior. In Glanz, K., Rimer, B. K. & Viswanath, K. (eds) Health Behavior and Health Education: Theory, Research, and Practice (4th edition). Jossey-Bass, San Francisco, CA.Google Scholar
Shelton, J. D., Cassell, M. M. & Adetunji, J. (2005) Is poverty or wealth at the root of HIV? Lancet 366(9491), 1057–1058.CrossRefGoogle ScholarPubMed
Shisana, O. et al. (2009) South African National HIV Prevalence, Incidence, Behavior and Communication Survey 2008: Turning the Tide among Teenagers?HSRC, Johannesburg, South Africa. URL: http://www.hsrc.ac.za/Document-3238.phtmlGoogle Scholar
Smith, D. J. (2007) Modern marriage, men's extramarital sex and HIV risk in southeastern Nigeria. American Journal of Public Health 97, 997–1005.CrossRefGoogle ScholarPubMed
Smith, H. L. (1989) Integrating theory and research on the institutional determinants of fertility. Demography 26(2), 171–184.CrossRefGoogle ScholarPubMed
UNAIDS & WHO (2009) AIDS Epidemic Update. UNAIDS, Geneva.Google Scholar
Veenstra, G. (2000) Social capital, SES and health: an individual-level analysis. Social Science & Medicine 50(5), 619–629.CrossRefGoogle ScholarPubMed