CHAPTER 7: SEXUAL BEHAVIOUR
7.2 Sexual Behaviour
In order to assess the sexual behaviour of men and women in both study settings a selected number of questions, based on the UNAIDS core indicators guidelines, were asked (UNAIDS, 2000; 2008). Respondents were asked to give information about lifetime number of past sexual partners since they became sexually active, the number of partners in the last 12 months prior to the survey, partner type and characteristics. Indicators of sexual behaviour are probably the most valuable of all indicators in monitoring the level of HIV infections (UNAIDS, 2000).
7. 2.1 Lifetime Number of Sexual Partners
Lifetime number of sexual partners refers to the total number of sexual partners since he or she became sexually active (Slaymaker, 2004; Oral, 2004; Wittrock, 2004; Brown and Sinclair, 1999). While one’s sexual history may consist of a range of sexually related events (Murkowski, Croake and Keller, 1978; Holmberg and Blair, 2009; Dixon-Mueller, 1993; Varga, 2001; Higgins and Hirsch, 2007), lifetime number of past sexual partners is related to sexual risk behaviour (Slaymaker, 2004; Clark, 2004; Gregson et al., 2002; Todd et al., 2008). The risk of HIV infection is greater for people who have sex with many sexual partners. According to Slaymaker (2004), this risk depends on the rate at which new partners are acquired and on whether those partners have other sexual partners.
It is generally used by some scholars and researchers as an indicator of sexual risk exposure to sexually transmitted infections including HIV/AIDS, particularly when safe sex practices such as the use of condoms are not observed (Shepard, et al., 2001; Carpenter, et al., 1999; Gregson et al., 2002; UNAIDS, 2008). Thus, in order to obtain information about their lifetime number of sexual partners, respondents were asked: “In total, how many partners have you had sexual intercourse with in your entire life?” The results are shown in Table 7.1
Table 7.1: Percentage of respondents by total lifetime number of past sexual partners
Lifetime number of sexual partners
Men Women n % n %
1 14 6.7 70 32.3 2-4 58 27.7 123 56.6
5 + 137 65.6 24 11.1
Total 209 217
The data indicates that few men and women restrict themselves to one sexual partner. Indeed, while only 6.7 percent of men reported that they had only one sexual partner in their entire lifetime, the corresponding proportion for women was 32 percent. Of interest but not surprising is the fact that men are more likely than women to report a higher number of past sexual partners.
Women were more likely than men to report that they had two to four partners in their lifetime.
Almost 57 percent of all interviewed women admitted that they had between 2 to 4 sexual partners in their lifetime compared with only 28 percent of men. Almost two-thirds of men (66 percent), compared with 11 percent of women, reported having five or more lifetime number of sexual partners.
In order to assess the characteristics of men and women who reported more than five lifetime number of sexual partners a bivariate analysis was performed with some selected socio-economic and demographic characteristics. The socio-economic and demographic characteristics include place of residence, age, level of education and marital status and household socio-economic status.
Table 7.2: Percentage of respondents who reported five or more partners in their lifetime, by selected socio- demographics background
Men Women n % n % Place of residence
Urban 106 64.2 111 17.1*
Rural 103 67.0 106 4.7
Age
Less than 30 108 60.2 121 13.2 30 and more 101 71.3 94 8.5 Level of Education
Less than secondary 127 70.1 157 8.3 Secondary or higher 82 58.5 60 18.3
Marital Status
Married/cohabiting 138 69.6 120 6.7*
Neither 71 57.7 97 16.5 API
Low 44 68.2 67 11.9
Lower medium 59 71.2 50 4.0 Upper medium/high 106 61.3 96 14.0
Total 209 217 Note: * significant P ≤ 0.05 percent.
Table 7.2 shows the percentage of men and women who reported five or more partners in their lifetime by selected socio-economic and demographic characteristics. Table 7.2 shows that place of residence and marital status seems to emerge as the most powerful determinant of lifetime number of sexual partners for women. However, for men, none of the variables were statistically significant.
For men, the findings suggest that young adult men in their twenties were less likely than men in their thirties and forties to report five or more lifetime partners. Indeed, Table 7.2 shows that 60 percent of men below 30 years reported five or more lifetime sexual partners at the time of the survey compared with 71 percent of men aged 30 years and over. Therefore, these findings
suggest that accumulation of sexual partner’s overtime for men. In this regard, taking into consideration that young men may continue acquiring sexual partners if they do not change their behaviour then, lifetime numbers of sexual partners will increase as their age increases. This is of serious concern in the context of the HIV/AIDS pandemic. The bivariate analysis shows that there is a significant association between place of residence and lifetime number of sexual partners for women. The picture for men is slightly less clear. Indeed, no significant differences among urban and rural men are observed although rural men were more likely than urban men to report five or more lifetime partners. Similarly, level of education seems to play a marginal role in influencing lifetime number of sexual partners for men. Nevertheless, it is worth noting that men with less than secondary education were more likely than men with secondary or higher education to report five or more lifetime sexual partners.
Meanwhile the fact that men with less than secondary education reported having had more than five lifetime sexual partners does not indicate that they are more prone to multiple sexual partnerships than men with secondary or higher education. In other words, for men lifetime number of sexual partners cannot be explained by education attainment only. The number of lifetime sexual partners for men seems to be related to other factors which underlie the propensity of men to collect sexual partners during the course of their life.
Finally, marital status of men (as education) seems to play a marginal role in determining lifetime number of sexual partners. Married and cohabiting men were more likely than men who were neither married nor cohabiting to report five or more partners in their lifetime. This could be due to the fact that single and never married men are still young. Indeed, 56 percent of men aged 20- 29 years reported themselves single or never married (Table not shown). Here, and contrary to what one would expect, the marital or cohabiting status of men does not prevent the men from accumulating sexual partners. This, though not surprising, is a cause of concern since the findings reflect risky sexual behaviour, which is in line with the general worldwide trend (Wellings et al., 2006; Cohen and Trussell, 1996; Cleland et al., 2004). Lifetime number of sexual partners is not significantly associated with the socio-economic household status of men. Nevertheless, it should
be noted that men with an upper medium or high API were more likely than men with a low and lower medium API to report five or more lifetime number of sexual partners.
With regard to women, the findings shown in Table 7.2 indicate that place of residence and marital status seems to have a strong influence on women’s lifetime number of sexual partners.
Thus, Table 7.2 shows that urban women were more likely than rural women to report five or more lifetime sexual partners. The findings regarding place of residence are statistically significant. Of interest regarding age is that women’s lifetime sexual partner tends to peak during their twenties but, generally, declines sharply as they age increase, above thirties. These findings may represent a significant shift in the sexual behaviour of younger women compared with the older generation of women. In addition, the findings seem to be consistent with other studies findings where it has been suggested that although women usually underreport their lifetime sexual partners, young women are more likely than older women to report a higher numbers of sexual partners (Gregson et al., 2002; Todd et al., 2008).
Level of education seems to impact on lifetime number of sexual partners for women. Thus, women who had secondary or higher education were more likely than women with less education to report more lifetime number of sexual partners. This seems to be consistent with what other studies have suggested that while education plays a pivotal role in enhancing women’s sexual health, including delaying marriage it also allows an open window to more premarital sex (Bankole and Singh, 1998). In contrast, marital status seems to play a significant role in women’s lifetime number of sexual partners. In this regard, the findings suggest that married and cohabiting women were less likely than neither married nor cohabiting women to report five or more partners in their lifetime. These results are also statistically significant. For women, lifetime number of sexual partners seems to be associated with the socio-economic status of the household. Thus, women with an upper medium or high API were more likely than women with a low and lower medium API to report five or more lifetime number of sexual partners. However, these findings are not statistically significant.