Report on the Global HIV/AIDS epidemic

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Report on the global HIV/AIDS epidemic - June 2000
In a recent study in western Kenya, a third of young married men said they had had
more than 10 partners before marriage, and the average number of premarital partners reported was close to 9. Women marry younger and may thus have less opportunity for premarital partnerships, but married women in rural areas in the Kenyan
study nevertheless reported having sex with an average of three men before marriage. And it seems that, in many places, these partnerships overlap. In studies of
young people's sexual behaviour in South Africa and Zambia, over half of the sexually active respondents in some areas said they had more than one sex partner currently or in the past three months.
The number of premarital partners is not the only factor contributing to the risk of
HIV infection. As discussed on pages 46-49, the crucial factors for girls are early
sexual debut - at an age when their biological vulnerability is very high - and sex
with older and more heavily infected men. Studies in African cities where the
prevalence of HIV is high tend to confirm that young women are more likely than
young men to become infected with HIV during premarital sex. In the Kenyan city
of Kisumu, nearly two-fifths of women who had had premarital partners were HIVpositive, while no infections were found in the women who said they were virgins
when they married. Overall, in the high-prevalence heterosexual epidemics of
eastern and southern Africa, HIV infection rates among young women are far
higher than the rates among the men they are apt to marry - men their own age
/ and those up to five years older. The inescapable conclusion is that in some badly
affected countries women are now more likely than men to enter marriage already
infected and may be exposing their new husbands to HIV. In Kisumu, over a quarter of married men aged 20-24 tested HIV-positive, compared with fewer than
10% of single men.
What about fidelity between regular partners?
While some women may be entering marriage infected and putting their husbands
at risk, the reverse still holds true in most countries of the world. Moreover, in most
cases women are far more likely than men to be put at risk of HIV by their partner's
extramarital encounters.
Mutual monogamy is a social ideal in many societies and most religions, but a double standard tends to relax the rules for men. Men are far more likely than women to
report and indeed to have multiple and casual sex partners, even if women underreport this activity where it is socially disapproved. In a study of the general populations of several cities in southern Viet Nam, more than one man in four reported having had a casual sex partner in the previous year, compared with 1 woman in 200,
and two-fifths of the men did not always use a condom for casual sex. In a qualitative study in the Indian state of Gujarat, 33 out of 78 married men interviewed said
they had had extramarital sex, mostly with unmarried women in their immediate
community. The consequences for a spouse who remains faithful to an unfaithful
partner can be devastating. A review of the case histories of 134 women infected

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