Sexual Concurrency among Married Couples in the Fishing Communities along Lake Victoria in Kisumu County, Kenya

HIV remains a global problem accounting for 1.6 million deaths in 2012 alone. With just 12% of the world’s population and bearing 67% of HIV/AIDS burden, SubSaharan Africa is the most affected with large inter-country variations. Although Kenya has declining prevalence, some regions and sub-populations such as Nyanza and fishing communities still have prevalences more than three times the national average of 5.6%. Existence of high risk sexual behaviours such as concurrent sexual partnerships in the fishing communities are postulated to account for the high HIV prevalence of up to 25.6%. Thus, determining prevalence and determinants of sexual concurrency among married couples and the patterns of the resultant sexual networks is crucial in designing appropriate HIV interventions. Thus, this study aimed at establishing the prevalence, determinants, sexual networks, actor-partner effects and interventions to address sexual concurrency among married couples in the fishing communities along Lake Victoria in Kisumu County. This was achieved through a mixed methods cross-sectional study using 1090 gender-matched structured interviews among 545 couples, 12 focus group discussions with 59 couples and, 16 in-depth interviews with eight couples. For the structured interviews, randomly sampled fishermen on each beach were contacted as index participants and asked to enroll into the study with their spouses. Quantitative data was analyzed using both descriptive statistics such as frequencies, percentages, means, medians, interquartile ranges; and inferential statistics utilizing χ tests, logistic regressions and multilevel modeling. For qualitative data, the transcribed and translated transcripts were analyzed inductively based on grounded theory tenets for theme and content. The prevalence of sexual concurrency based on six months reference period was 33.1% among men and 6.2% among women. One third (37.6%) of the couples were sexually concurrent (at least one spouse within the couple was involved in concurrency). Determinants of couple sexual concurrency were: unmet sexual desire, intra-spousal suspicions of infidelity, male dominance sex roles, domestic violence and relatively young unstable families. This study found no association between men’s concurrency status and non-concurrent spouse’s HIV status (p=0.91) or women’s sexual concurrency status and non-concurrent spouse’s HIV status (p=0.20). The largest component in the sexual networks among these married couples had 108 people (nodes). The median component size was 5 (IQR, 4-6). A quarter (23.7%) of the components that had 3 members each had HIV positive couples. Similarly, 35.7% of the size 7 components had HIV positive couples. This study found evidence of actor and partner effects among married couples in respect to relationship and sexual satisfaction, mutuality in relationship and male dominance sex roles. Couples’ suggested interventions for sexual concurrency in this community included: community education and sensitization, improving spousal communications, and instituting marital counseling. Married couples in these fishing communities have a high prevalence of sexual concurrency that may potentially result into formation of sexual networks within the reachable paths of HIV. It is recommended that communities re-introduce pre-marital and start periodic in-marriage counseling to impart marital life and mutual respect skills in couples to help in reducing concurrent sexual partnerships. Future research should focus on designing longitudinal and complete sexual network studies that enable better understanding of network structures and possible intervention options.