Limaye, R.J., Babalola, S., Kennedy, C.E., et al. Health Education Research, (June 2013), e-publication ahead of print.
The authors of this qualitative study conducted 40 focus group discussions and 20 in-depth interviews with men and women of reproductive age in five districts of Malawi, seeking to understand perceptions of and attitudes towards concurrent sexual partnerships, particularly to inform HIV prevention interventions. Malawian men and women largely view concurrent sexual partnerships (except polygamy) as unacceptable and stigmatize or have negative opinions of those who engage in this behavior. However, the behavior is considered widespread. This finding suggests inconsistency between the descriptive norm (perceived widespread engagement in the behavior) and the injunctive norm (belief that others disapprove of the behavior).Thematic analysis revealed additional themes. Participants perceived not only that multiple concurrent partnerships are common, but that men and women, as well as religious leaders, engage in this behavior. Concurrency was associated with disease and other negative consequences, such as family or community conflict. Interestingly, women who engaged in this behavior were reportedly very stigmatized, while men were both stigmatized and admired. There is a need to enhance the validity of self-reported behavior to ensure accuracy and assess whether HIV messaging on mitigating multiple concurrent partnerships has inadvertently influenced the behavior. The authors called for further research on perceived norms and sexual behavior, and stressed the need for improved education on concurrent sexual partnerships.