Bread and Cake: Behaviors Relating to Multiple and Concurrent Partnerships

This 20-page research document shares findings from a qualitative study conducted by Population Services International (PSI) in Chibuto and Manjacaze Districts of Gaza Province, Mozambique, to deepen understanding of the factors which motivate men and women to engage or not engage in multiple and concurrent partnerships (MCP) and to identify the barriers that might prevent people from changing their behaviour and reducing the number of partners. The study was designed to provide information that could be used to develop community-based projects and media campaigns seeking to improve risk perception around MCP and partner reduction.

The study outlines several key findings:

• People are generally concerned with improving their living conditions and "building a family." This applies to both men and women and to those engaged and not engaged in MCP. The data further suggest that women get involved in additional sexual relationships as a means to obtain financial benefits that will reduce the economic problems they face. Men, on the other hand, clearly associate how much money they have with their number of sexual partners and are conscious of the economic benefits of having only one partner.
• Although fidelity is seen as the best option, the community tolerates men engaging in MCP. For women, MCP is not well regarded but may be tolerated for those women whose primary partners do not fulfil their responsibilities to their partner and family. The expression "kulhaissa" (well-being) was referred to repeatedly as an important aspect of relationships with primary partners.
• For men, the data suggests that friends and financial considerations influence involvement in MCP. Also, men with MCP reported spending their spare time drinking with friends, watching football, and playing pool, whereas those without MCP said that they spent most of their free time with their family.
• Involvement with secondary partners does not mean the end of the relationship with the primary partner, and fidelity is seen as realistic for adults, but not necessarily youth. Women involved in MCP are very concerned with keeping their relationships with “amigos” hidden from the community and especially from their primary partners for fear of physical reprisals from their husbands and also the scandal that would ensue if they were discovered by their "amigo's" partners. For men, the disadvantage of MCP, apart from financial expenses as mentioned earlier, is the "trouble" or conflict that can arise between their partners.
• The perceived risk of HIV infection inherent in MCP is high, especially among women who know or suspect that their husbands have other partners. Women, whether involved or not in MCP, reported not using condoms with their primary partner, even if they knew he was engaged in MCP. In relationships with secondary partners, some women reported that they used condoms because they had suggested it and the partner accepted, and others used condoms because the partner insisted. However, many women reported not using condoms because they had never spoken about it, and others had suggested condom use, but their partners refused.
• Knowledge about HIV is high among the interviewees, who believe that anybody can get infected, but they have a fatalistic view and a perception of low control over their ability to prevent HIV. Others still do not make the link between their sexual behaviour and risk of HIV infection or are unable to negotiate safe sexual practices with their partners.
• The study showed that some interviewees linked getting tested for HIV with not using condoms. When asked about their motive for not using condoms, they reported that they did not use condoms because they had been tested for HIV, and because they trusted their partner, or because their partner had tested. Others said they had not tested, but were interested in getting tested.
• Radio, television, interpersonal communications activities in the community and hospitals and community health workers are the sources of information about HIV/AIDS that were most frequently mentioned. In the opinion of the interviewees, talks given at hospitals and in the community, theatre, radio, television, leaflets, and films are the most effective ways of transmitting messages about HIV. Counselling and testing centres were also cited as good places to obtain information and assistance on health-related issues.

As stated in the study, the findings provide valuable insight for the design of community-level and mass media communications on MCP. Many positive beliefs, norms, and values relating to fidelity and partner reduction have been identified. Similarly, the study has identified beliefs, norms, and values that contribute to the practice of MCP and thus to HIV transmission. Potential ways in which the study findings could be applied programmatically include:

• MCP communications designed for men can leverage men's concern with immediate and long-term financial costs and material aspirations. One of the most complex aspects of MCP to address through communications is women's engagement in MCP as a survival strategy.
• MCP interventions can leverage the many positive associations that arose from this study of men and women who stick to one partner and the value that is placed on long-term relationships.
• Kulhaissa is a strong concept that stresses primary partners’ obligations to each other, which could be a vehicle for debating gender and relationship norms at the community level.
• The stereotype of the "matreco" (dork or nerd) who can only manage one partner can be challenged, and the positive associations that are already held of men who are faithful can be promoted as aspirational (he is responsible, trustworthy, respected, and has a less complicated life). This can happen through all-male activities at the community or workplace level and through mass media portrayals. Male role models who spend more time with their family and less time drinking with friends could also be promoted.
• MCP communications could help men to resolve problems at home rather than looking outside for 'solutions' through role-playing discussion between couples; this could be achieved through community theatre or mass media. Similar strategies could be used to challenge existing norms about which issues are appropriate for women to raise with their husbands.
• This study suggests that there are three key challenges relating to increasing perception of the risks inherent in MCP: (1) bridging the gap between "theoretical" and personal risk; (ii) related to this, overcoming men’s reluctance to accept that their partners (at least their secondary partners) may have other partners; and (iii) addressing fatalistic attitudes towards infection prevention. Simple communications devices that show how MCP puts one at risk not only from one's partners, but also from their partners, their partners’ partners, and so on are, and should continue to be, central to PSI’s existing MCP interventions.
• For many people involved in MCP, exiting existing secondary relationships is not an option (or is a very tough option), at least in the short term. Although the primary goal of MCP communications is partner reduction, for some audiences promoting consistent condom use will be a more viable short-term risk-reduction strategy. A dual approach is needed, therefore, and promoting condom use without diluting key MCP messages will be a key challenge for community-level behaviour change communications interventions.

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