Partner Reduction
In a 2003 paper entitled ‘Partner Reduction in HIV Prevention: The Neglected Middle Child of “ABC”, the researchers (Shelton, Halperin et al.) involved stated, “It seems obvious, but were it not for multiple partners, there would be no global AIDS pandemic.”

This points to the fact that multiple sexual partnerships, (especially concurrent partnerships) are a key driver of HIV. The rate at which people change sexual partners- especially concurrent partners is a crucial determinant in the spread of sexually transmitted infections (STIs) and HIV. Moreover, one’s HIV viral load, and therefore infectiousness, is dramatically higher during the early (acute) stages of HIV infection, and transmission would be particularly heightened by partner change among newly infected people.

Debates around partner reduction and HIV transmission

• Partner reduction has been identified as an important component in the ABC (Abstinence; Being Faithful; Condom Use) approach to reducing the risk of HIV transmission. However, some argue that many women are unable to negotiate relationships based on abstinence, faithfulness and condom use.
• Women’s greater vulnerability to HIV and AIDS is explained in part by existing gender roles that often limit women's ability to negotiate safe sexual terms. And although most African women in concurrent partnerships are not sex workers, such relationships often include a powerful element of sexual-economic exchange, related to issues of gender and income inequality, sexual culture, poverty, and the globalisation of consumerism. A recent study from Malawi found that among some 1000 adult villagers, whose sexual relationships were carefully mapped by researchers over a two-year period, some 65% were "connected" in the same sexual network. Unfortunately, the investigators did not enquire whether the sexual relationships were of a concurrent or serial nature; although data from similar populations in southern Africa suggests the likelihood that concurrency also plays a key role in that Malawi population.
• Slowing the spread of HIV and AIDS requires a shift in the way most men in the region men equate manhood with sexual conquest and risk taking. Surveys across the SADC region suggest that when information and education (IEC) campaigns succeed in encouraging men to reduce their number of concurrent partners, incidence and prevalence rates decline. According to Avert website for instance, Uganda adopted the ABC approach in the late 1980s, and between 1989 and 1995, HIV rates fell sharply. Ugandans became less likely to have multiple sex partners and more likely to use condoms, and adolescents also increasingly delayed first sex.
• And contrary to popular misconceptions that men cannot and will not change their sexual behaviours or seek to reduce their risk, numerous studies show that partner reduction campaigns have been effective in a variety of settings across the region. How can the media highlight the importance of such interventions and work to normalise the idea of monogamy and partner reduction?
• At the same time, some argue that it is difficult to ascertain the relative importance of reduction in the number of sexual partners as opposed to other forms of safer sex. But with fewer sexual partners, it appears that HIV transmission is less likely to occur.

Most information that exists on partner reduction is in the form of studies and research findings, and not practical information on how partner reduction can work as an HIV prevention tool. The onus is therefore on media practitioners to highlight the social, cultural and economic factors that often lead to individuals engaging in multiple sexual partnerships, and to challenge such norms, thereby highlighting the importance of partner reduction in mitigating HIV spread.

References:

http://www.bmj.com/cgi/content/full/328/7444/891
http://www.medicalnewstoday.com/articles/57924.php
http://www.genderjustice.org.za/onemancan/images/publications/factsheet/factsheet_eng_lowres.pdf
http://findarticles.com/p/articles/mi_hb264/is_200505/ai_n15081764
http://www.guttmacher.org/media/presskits/2005/06/27/abc.html
http://www.bmj.com/cgi/reprint/328/7444/848.pdf
http://www.healthdev.org/eforums/cms/inv-archives.asp
http://www.avert.org/abc-hiv.htm