HIV and multiple (concurrent) partnerships

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There’s a big to-and-fro in the latest issue of the Lancet about role of “multiple concurrent partnerships” versus “multiple partnerships” in the spread of HIV: four comments on an article published last week which argues (to simplify horribly) that there is no evidence that *concurrent* multiple sexual partnerships play more of a role than *sequential* multiple ones.  The four comments and the response from the authors of the original study response are here (scroll down).

It’s all quite interesting methodologically and epidemiologically speaking… in fact it is a debate that has been going on for some time.  But what strikes me most about the debate is the conclusions that a lot of the protagonists draw about what their findings mean for programmes.  Again, to simplify rather a lot, some of them (the ones that believe concurrency is a major factor) are saying “therefore we need messaging on limiting numbers of partners including concurrent partners”, whereas the others (the ones who dismiss concurrency) are saying “therefore we need messaging on limiting numbers of partners”.

And here’s the issue: there’s actually not a whole lot of evidence for the effects of either of these interventions. There’s certainly no evidence to show that either intervention is particularly more effective or more harmful or more costly than the other.  So the whole debate seems somewhat theoretical.

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