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Correlates of Sexual Concurrency Among Married Couples in Fishing Communities

Explore the factors contributing to sexual concurrency among married couples in fishing communities along Lake Victoria in Kisumu County, Kenya. The study reveals prevalent correlates and suggests interventions to address this issue and its impact on HIV transmission.

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Correlates of Sexual Concurrency Among Married Couples in Fishing Communities

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  1. Correlates of couple sexual concurrency among married couples in fishing communities along Lake Victoria in Kisumu County Z. Kwena1, C. Shisanya2, I. Mwanzo3, E. Bukusi1 1Center for Microbiology Research, Kenya Medical Research Institute; 2Department of Geography, Kenyatta University; 3Department of Community Health, Kenyatta University

  2. Background…1 • HIV/AIDS is still a big problem with enormous impact • 35.4m living with HIV, 2.3m new infections, 1.6m deaths1 • SSA = 12% of world population and 67% of HIV burden • HIV prevalence in Kenya has been declining • Epidemic is generalized at a prevalence of 5.6%2 1UNAIDS (2013). UNAIDS report on the global AIDS epidemic 2013, UNAIDS/WHO 2KAIS (2013), Kenya AIDS indicator survey 2012: Preliminary report

  3. Background…2 • Still large regional and sub-population variations • HIV prevalence in fishing communities in Nyanza 25-40%3 • HIV in Nyanza is attributed to many • including sexual concurrency4 • Sexual concurrency associated with HIV infections • HIV is mostly spread in contexts of heterosexual couples - interventions to focus on couples • Thus, we sought establish the correlates of couple sexual concurrency among married couples 3Ng’ayo et al. (2008). Epidemiology of human papillomavirus infection among fiishermen. Sex Transm Infect.;84(1):62-6 4Agot et al. (2010), Widow inheritance and HIV prevalence in Bondo District, Kenya; PLoS One. 2010 Nov 17;5(11)

  4. Study design • A cross-sectional mixed methods survey targeting married couples in fishing communities along Lake Victoria in Kisumu County Data collection methods • Quantitative • Structured interviews • Qualitative • Focus group discussions (FGDs) • In-depth interviews (IDIs) • Combined to give a clearer picture of sexual concurrency

  5. Results • Overall sexual concurrency was 19.2% in six month preceding the study • By gender • Men 32.1% • Women 6.2% • Couple sexual concurrency (at least one of the partners involved in concurrency) was 37.6%

  6. Types of couples based spouse involved in sexual concurrency

  7. Correlates of couple sexual concurrency • Men being denied sex • Women being younger • Male dominance sex roles • Domestic violence • Lack of sexual satisfaction • Revenge for spouse infidelity

  8. Community • Community education & sensitization • Pessimistic attitude Individual & community confluence Couple & community confluence Couple Individual • Spousal communication & dialogue Individual, couple & community confluence • Self-reassessment and change • Marital counseling and family life training • Reduced eating of certain fish species • Spousal relationships • Supernatural interventions

  9. Conclusion • There is high prevalence of sexual concurrency among married couples that form large sexual networks within reach of HIV (cf 3.5% -- women and 4.0%-- men)5 • Correlates of sexual concurrency in this group goes beyond individual characteristics such as age and income to include couple attributes such as sexual satisfaction, number of children together and domestic violence • Both individual’s own and partners sexual satisfaction affect people’s involvement in sexual concurrency 5Xu et al (2010). Concurrent Sexual Partnerships among Youth in Urban Kenya, Popul Stud

  10. Key recommendations • Need to understand community sexual networks: Targeted community education and sensitization on the role of sexual concurrency in STI including HIV– using existing community institutions such as BMUs • Need for institutions that prepare young people for marital life: Enhance pre-marital and periodic in-marriage counseling and training; emphasizing on values of good marriage such as spousal communication, spousal responsibilities and entitlements, and mutual respect

  11. Output from CNHR-funded PhD research • Published papers • From PhD work -- 3 papers in STI & PLoS One • From other work affiliated with -- more than 6 • Conference/workshop International • CROI in Atlanta (March 2013) – presented a poster • ISSTDR in Vienna (June 2013) – presented 2 posters • ICASA in Cape Town (December 2013)– presented 1 oral and 1 poster Local • UoN collaborative meeting in Nairobi – presented 1 oral • CDC weekly meeting in Kisumu – 2 oral presentations • Community feedback • Ober Kamoth; # attending 30 mixed gender – Kisumu beaches • Kagwel; # attending 30 mixed gender – Seme beaches • Nyamware Pri. Sch. # attending 30 mixed gender Kano beaches

  12. Acknowledgment • NCHR funding – RLG 026 • KEMRI and KU • Study staff • BMU officials • All participants

  13. Correlates of couples’ involvement in sexual concurrency among married couples

  14. Correlates of couple’s involvement in sexual concurrency support by qualitative data Sexual satisfaction “For us to minimize unfaithfulness men should satisfy their women and this should be the same to women because men also need sexual satisfaction. This will make both partners happy in a relationship” FGD#4 with men Unsatisfactory sex “Some [men] just take a minute and leaves you there when you are still ‘hanging’… You cannot even tell if this thing is over or still continuing. Sometimes we aren’t satisfied yet we can’t explain it [to our partners]... We are left wondering and can be very happy if we can get someone who can do it better and makes you feel that your body is satisfied. I can just continue with him because his sex is sweet and your husband can then do it on short time basis” FGD#1 with women

  15. Desired sexual position “… as a woman, you may have passed through many different men. You will therefore come with a new style unknown to him. He may try his best but still finds this style very tough for him. It will force you to go back to a style that he familiarizes with. This will mean that you start again” FGD#5 with women Domestic violence “One can quarrel with the wife and disagree on certain issues. You can have stress but if you go to the other women, you will feel settled. They can cool you and make you feel good again” FGD#2 with men

  16. Role of actor and partner effects of sexual satisfaction in couple sexual concurrency

  17. Effect of sexual satisfaction on extra-marital partnerships Man’s sexual satisfaction Man’s number of extra-marital partners -0.46* -0.17* Woman’s sexual satisfaction Woman’s number of extra-marital partners -0.07 -0.15*

  18. Partner effects were also came out strongly in qualitative data Partner effect “You may have a husband who is unfaithful. There comes a time when you will have to tell him God gave both of us sexual organs. Whatever you do to the woman [outside marriage], that can also be done to me [by another man]. I will also do my part. If that cleanness is what attracts men so be it. I will also try to be clean and have my own man to have a sexual relationship with. People will now start competing in unfaithfulness. Whether death comes in, so be it. I will also do my part in prostitution” (FGD#4 with women)

  19. Community suggested interventions to reduce couple sexual concurrency

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