Why is HIV prevalence so severe in southern Africa? : the role of multiple concurrent partnerships and lack of male circumcision - implications for HIV prevention : opinion

A Think Tank meeting on AIDS prevention in the high HIV prevalence countries in southern Africa convened in Lesotho in May 2006 by SADC and UNAIDS concluded that high levels of multiple and concurrent sexual partnerships by men and women with insufficient consistent correct condom use combined with low levels of male circumcision are the key drivers of the epidemic in the sub-region. The top two key priority interventions recommended by the HIV-AIDS reproductive health epidemiological and other experts participating in the Think Tank meeting were: (i ) Significantly reduce multiple and concurrent partnerships for both men and women and (ii) Prepare for the potential national roll out of male circumcision ... depending on the outcome of the [now successfully completed] Kenya and Uganda randomized trials. Various other factors in the regions HIV epidemic including a range of gender issues especially the need for greater male involvement in HIV prevention high prevalence of sexual violence low HIV risk perception and pervasiveness of transactional sex among young people especially young women were also discussed and continued promotion of primary abstinence greater access to HIV counselling and testing and access to condoms especially in high-risk situations were also recommended. This paper however focuses on the evidence underlying the Prevention Think Tank Meetings two main conclusions. (excerpt)