Marta Pirzadeh is a technical officer on FHI 360’s Research Utilization Youth Team.

Multiple and concurrent partnerships, “the big house,” “spare tire,” and sugar daddy—these are just a few of the terms used to refer to multiple sexual partners. Even though there are many ways to refer to such partnerships, the risk is the same: within a large sexual network, HIV is spread more quickly and entire communities are being affected. In South Africa and many other countries with generalized epidemics, the high HIV prevalence rates are caused in part by people having unprotected sex with multiple partners, especially when those sex partners are concurrent. But, what causes young people to engage in such risky behavior when they know the consequences? Doesn’t everyone know that if you have unprotected sex with multiple partners, you are putting yourself and others at increased risk of contracting HIV? It seems simple, but I learned on a recent trip to South Africa, that it’s much more complicated than you would think.

“Most youth living in urban areas or townships, they engage in MCP because they think it’s cool…even though they know the risks.”

“Many girls are not ashamed of MCP (having multiple partners), but actually happy that they are beating the boys at their own game.”

The list of reasons why young people have multiple sexual partners is long and multifaceted. Although it varies by individual, community and country, common themes appear when young people are asked about this risky behavior:  the influence of their peers and role models, the desire for emotional or sexual satisfaction, to receive gifts, as a reflection of gender norms, the influence of alcohol or drugs, as a “ticket out” of poverty, the impact of transactional sex (having sex in exchange for something you want or need), cultural expectations, love, lust…and on and on.  How can youth programs even begin to combat this extensive list? What tools are available to help young people understand the increased HIV risks associated with having multiple partners?

Partner reduction has been identified as an important approach to decreasing the risk of HIV transmission at the individual and population levels.  Having fewer lifetime partners is strongly associated with a reduced risk of HIV infection. Yet, even though multiple sexual partnerships are a major driver of the HIV epidemic, this topic is often inadequately covered in HIV prevention curricula for young people. During a recent trip to South Africa to provide training to youth program staff, my primary questions were: “Is your program addressing the importance of partner reduction?” and “What resources do you have to educate young people on this topic?”

Youth program staff from LoveLife, South African Council of Churches (SACC), Family Life Association of Swaziland (FLAS) and AMICALL-Swaziland attended a training that I facilitated on a new educational tool developed by FHI 360 and ETR and funded by USAID. Promoting Partner Reduction: Helping young people understand and avoid HIV risks from multiple partnerships (PPR) was designed to supplement existing YSRH/HIV programs, and I had the incredible experience of introducing this set of activitiesto these four programs. All four programs are already doing the hard work; they are providing support, life skills training, YSRH and HIV education to young people in some of the communities at highest risk for HIV infection in two countries with some of the highest rates of HIV in the world.  Yet, they were not discouraged by these overwhelming circumstances; rather, they were eager to learn new skills and excited about sharing the activities with program participants.   During our training and discussions, they admitted the risks associated with having multiple sexual partnerships are often overlooked. As one Fcover of Promoting Partner ReductionLAS staff person stated, “Prior to the training, we did not have a specific tool that focuses on addressing partner reduction. It was not discussed in detail in our program.” There was general consensus that multiple sexual partnerships are common among young people but they don’t have the information or resources to address it, so the topic is provided very limited coverage. We hope that by introducing this set of activities, they will be able to integrate them into their already successful programs. It’s a lofty goal; sexual partnerships are complicated and the reasons that young people are involved in them are often even more complex, but perhaps by providing simple activities and guidelines to a few programs, we can begin to see a change.

My trip to South Africa was a small part of an ongoing assessment of PPR. Over the next three months, all four programs will pilot select activities to gauge youth response, and facilitators will be interviewed about their experience. From their experiences, we hope to begin to understand program gaps and learn how we can expand the reach of partner reduction activities to other programs. 

It’s a big topic that needs to have its own time. It’s a socialization topic, it’s a sexual topic. You cannot talk about MCP without talking about gender, society, etc. As much as it can be integrated within existing program, there needs to be time that is set aside just to deal with MCP.

Promoting Partner Reduction: Helping young people understand and avoid HIV risks from multiple partnerships will be available through in the late fall of 2012.