The Observer

Avoiding side dish will save you trouble Wednesday, 02 December 2009 22:04
By Joseph Waninda
The findings of the modes of transmission study conducted last year indicates that the
incidence of HIV is rising especially among married couples aged 30-40.
The study indicates that 44% of new infections were among persons involved in multiple
sexual partnerships (that is, those reporting two or more partners), including their regular
partners, and about 11% were related to sex work.
Multiple partnerships, which is regarded as a common phenomenon in Uganda, is one
of the reasons HIV prevalence is now highest in the older, married populations, a group
that is currently not the target of prevention programmes.
Multiple Concurrent Partner (MCP) means that a man or woman has more than one
sexual partner at the same time. The partners can overlap for weeks, months or
years.These relationships have many names, including; away games, balanced diet,
side dish, pre-testing, spare tyre, left hand, suitcase, side mirror, extra
time, panadol, and take-away. This is regarded as a common practice in Africa
where a man can have as many women, besides his marital wife.
The problem with multiple concurrent partners is that they result in sexual networks,
where many people are connected through their sexual partners. This thus gives room for
rapid dissemination of HIV the moment a new infection is introduced in the network.
The combined effect of sexual networks and the spike in amount of virus in the blood
when someone is first infected means that as soon as one person in a network of
concurrent relationships contracts HIV, everyone else is put at risk. This includes persons
who are just starting a sexual relationship and those who are monogamous with a partner
who is not.
Moreover, consistent condom use is much more challenging for people in on-going,
longer-term relationships in which there is a sense of commitment and trust. These
longer-term relationships are typically the ones in which HIV transmission takes place.
Another part of the problem is that most married or cohabiting couples many of whom
are HIV discordant, whereby one partner is infected with HIV and the other is not do
not know their own or their partners HIV status, and thus take no steps for prevention.
In the 1990s, the massive awareness efforts paid off as the HIV/AIDS prevalence rate
reduced from 15% to 6-7% by 2000, thanks largely to the combination of the prevention
strategies of Abstinence, Be faithful and Condom use (ABC).

Recent research however shows that Ugandas HIV/AIDS seroprevalence rate, which has
stagnated at 6.4% since 2005, may be rising again.
This thus calls for a new way of thinking as regards to the fight against HIV/AIDS. That
new school of thought needs to focus prevention efforts at people in marriages or longterm relationships, and those involved in multiple concurrent sexual partnerships.
And such prevention strategies would include promoting couples HIV counseling and
testing (CHCT), in which both couple members learn their HIV status together. There is
also need to emphasise consistent condom use for couples that are discordant along with
access to HIV treatment for the positive partner.
However, key among those should be the need to reduce on the number of sexual
partners, as it is currently one of the main drivers of the epidemic in a country where over
1 million people are infected with HIV. The challenge for Uganda now is to prevent new
HIV infections and again curb the rise in HIV prevalence in the country.
The author is attached to Health Communication Partnership, Johns Hopkins
Bloomberg School of Public Health
josephw@hcpuganda.org