Association between types of sexual partnerships and condom use in Botswana

Abstract

The practice of multiple concurrent sexual partners, inconsistent condom use and low levels of male circumcision are key drivers of the HIV epidemic in Sub-Saharan Africa. The percentage of people with multiple concurrent partnerships in Botswana are amongst the highest in the world with, 17.5% of men and women practicing having multiple and concurrent partners. Long term concurrent relationships, like serial monogamous relationships are often characterised by strong emotional, social and economic ties, numerous studies suggest that condom use in such relationships tends to be much lower. Although trends in risky sexual behaviours in high HIV prevalence countries have generally declined over the past decade, several countries in sub-Saharan Africa have experienced declines in condom use and an increase in the number of sexual partners. At 22%, Botswana has the third highest HIV prevalence in the world, after Lesotho and Swaziland. Data from the 2013 Botswana AIDS Impacts Survey (BIAS IV) was used to investigate the association between types of sexual relationships and condom use among men and women in Botswana. Only respondents who had had sexual intercourse during the past 12 months leading to the survey and were aged between 15 and 54 were included in analysis. Data was analysed using both bivariate and multivariate (binary regression) analysis techniques. The logistic regression results show high prevalence of MCP, for instance those individuals with secondary education and tertiary education were associated with a decrease in the likelihood of having had multiple concurrent partners during the year leading to the survey, compared to those with non-formal education. Furthermore, statistically significant relationship was observed between types of sexual relationships, consistent condom use and socio demographic characteristics. The association between condom use consistency and MCP diminished with the introduction of control variables. However, after controlling for sexual behaviour variables the odds of having had reported using condoms consistently of individuals who were males increased. A positive association was observed between consistent condom use, age of respondents and marital status. Individuals who were once married were associated with a decline in the odds of having always used condoms with their partners compared to those who were never married. However, after controlling for sexual behaviour variables the odds of having had reported using condoms consistently of individuals who were once married increased. Information generated from this study will serve as a basis for further research in the HIV prevention strategies aimed at reducing concurrent sexual partners. It will also provide information to other organizations that are currently implementing MCP programs, to assist them develop communication strategies to reduce MCP. The results indicate that risky behaviours such as MCP, inconsistence condom use leading to HIV/AIDS prevalence are still practiced. Therefore, there is an urgent need for effective HIV prevention programming that educate people on the importance of reducing one’s sexual partnerships, regardless of their HIV status for HIV prevention. Programs and policies on HIV/AIDS should also target cultural norms and beliefs that promotes practice of risky sexual behaviours.