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- AN INCONVENIENT TRUTH SUMMARY AND ANALYSIS SERIAL
- AN INCONVENIENT TRUTH SUMMARY AND ANALYSIS DRIVERS
The partners may be spatially separated for defined periods, as in the case of a man who has a wife at home and a girlfriend at a gold mine where he works for months at a time. Long-term concurrencies include cases in which one person has regular sexual intercourse with more than one partner, such as in a formal polygamous marriage involving a man and more than one wife (or a woman with two husbands), and less formal arrangements in which man has two girlfriends, or a wife and a girlfriend, or a woman has two regular boyfriends, etc.
AN INCONVENIENT TRUTH SUMMARY AND ANALYSIS SERIAL
The definition covers every form of multiple partnerships other than serial monogamy.Ĭoncurrency can be long term, in which the overlaps last for months or years, or short term, in which the overlaps last for hours or days. The precise UNAIDS definition is "overlapping sexual partnerships in which sexual intercourse with one partner occurs between two acts of intercourse with another partner". The simple definition of concurrency is when someone begins a new sexual partnership before ending a previous sexual partnership. Here, we address the key specific issues they raise that are new, and demonstrate why they are wrong. Many of the points they raise have already been dealt with in previous exchanges on concurrency and HIV in the journal, AIDS and Behavior, and interested readers should consult these articles. We do not attempt an exhaustive review of Sawers and Stillwaggon's lengthy article here.
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for which there is substantial epidemiological evidence."
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Instead, they recommend that research resources be invested in understanding the role of bed nets, nutrition, other sexually transmitted infections, recreational drug use, homosexuality and "numerous forms of blood exposures." These, Sawers and Stillwaggon claim, are the "drivers of African HIV epidemics. "The continued use of financial and human resources to prove Western preconceptions about African sexuality cannot be justified," they argue. However, Sawers and Stillwaggon's article presents a selective reading of the literature, aimed less at clarification than at advancing the authors' own stated belief that all research on concurrency and AIDS in Africa should be stopped. Despite the claim that their article represents a "systematic review of the evidence", it is not an accurate summary of the research on concurrent partnerships and HIV, and it contains factual errors concerning the measurement and mathematical modelling of concurrency.Ĭritical scrutiny of evidence is a welcome and indeed a necessary part of making progress in science, and all empirical studies have limitations and weaknesses that should be acknowledged. In a recent article in the Journal of the International AIDS Society, Larry Sawers and Eileen Stillwaggon attempt to challenge the evidence for the importance of concurrency.
AN INCONVENIENT TRUTH SUMMARY AND ANALYSIS DRIVERS
In 2006, a Joint United Nations Programme on HIV/AIDS (UNAIDS) and Southern African Development Community (SADC) group of experts concluded that high rates of concurrent - or overlapping - sexual partnerships, combined with low rates of male circumcision and infrequent condom use, are major drivers of the AIDS epidemic in southern Africa. This kind of research is indeed the only way to obtain conclusive evidence on the role of concurrency, the programmes needed for effective prevention, the willingness of people to change behaviour, and the obstacles to change. Determining whether these interventions can help people better assess their own risks and take steps to reduce them remains an important task for research. Most interventions to raise awareness about the risks of concurrency are less than two years old few evaluations and no randomized-controlled trials of these programmes have been conducted. Practical prevention-oriented research on concurrency is only just beginning. However, their "systematic review of the evidence" is not an accurate summary of the research on concurrent partnerships and HIV, and it contains factual errors concerning the measurement and mathematical modelling of concurrency. In a recent article in the Journal of the International AIDS Society, Larry Sawers and Eileen Stillwaggon attempt to challenge the evidence for the importance of concurrency and call for an end to research on the topic. The strength of the evidence linking concurrency to HIV epidemic severity in southern and eastern Africa led the Joint United Nations Programme on HIV/AIDS and the Southern African Development Community in 2006 to conclude that high rates of concurrent sexual partnerships, combined with low rates of male circumcision and infrequent condom use, are major drivers of the AIDS epidemic in southern Africa.