Social and cultural contexts of concurrency in a township in Cape Town, South Africa

Understanding the social and cultural context in which concurrent sexual partnerships exist is important, given recent interventions to reduce their prevalence. This qualitative study seeks to improve the understanding of concurrent partnerships and perceptions of the link between concurrency and HIV risk in a South African township in Cape Town. Small-group discussion and focus-group participants reported that concurrency was a common phenomenon in their township. The most commonly cited reasons for participating in concurrent partnerships were material and financial exchange or gain and sexual dissatisfaction with partners. Although participants believed that being in a concurrent relationship increases the risk of acquiring HIV, they did not believe this discourages many people from engaging in these behaviours. This study highlights that concurrency in this context may be a social norm that is resistant to change. The efficacy of current programmes aimed at reducing concurrency needs to be examined in this context. Our findings suggest that improving economic independence at the individual level and improving sexual satisfaction within partnerships may have some leverage for concurrency reduction. An alternative approach to strengthen combination HIV-prevention strategies could be to increase condom use with the additional/side partners, whose predominant role is often perceived in terms of sex, with messages centred on the notion that sex with additional partner(s) should not endanger the main partner