MCP Remains “Uncomfortable Territory”

By Kristin Palitza

Multiple concurrent partnerships (MCP) were identified as a key driver of HIV in South Africa several years ago. But efforts to integrate MCP into national prevention campaigns remain sparse.

“One wonders why there hasn’t been more hype about the subject of MCP,” says Soul City media coordinator Bongani Ndlovu. “It’s a real challenge, probably because it’s an uncomfortable territory.”

Although the South African Department of Health (DoH) has included MCP as a priority area in its National Strategic Plan for HIV/AIDS and Sexually Transmitted Infections 2007-2011, AIDS activists complain that little MCP-related theory has been put into practice.

“The NSP is well written, but it’s very unclear what the health department is planning to do to achieve its goals,” observes Dean Peacock, co-director of Sonke Gender Justice Network, a non-governmental organisation (NGO) working with boys and men towards gender equality.

Peacock points out, though, that it is not only the DoH’s obligation to challenge MCP, but that of other government departments as well. “The departments of education, sports and recreation, arts and culture and so on also need to make their mark. MCP needs to be a focus everywhere where manhood is created and performed,” he explains.

Peacock believes the South African government needs to be united, frank and outspoken about sexuality to improve HIV prevention efforts. “It is incumbent for our political leadership to engage in this conversation. We need to have a public discussion on HIV and MCP.”

Other health experts agree that the silence around MCP needs to be broken. “The South African government is quite conservative when it comes to addressing sexuality,” says Health4Men psychosocial director Glenn de Swardt. “Nobody wants to touch MCP because it means they will also have to talk about other sensitive topics, such as culture, polygamy and transactional sex.”

More than a third of South African men admit they are unfaithful, according to a 2008 Human Science Research Council (HSRC) report “Why is MCP Important in HIV Prevention?”.

“In South Africa, 32 percent of men said they had more than one sexual partner in the last year, most citing sexual dissatisfaction. This shows that MCP is a key driver in the HIV epidemic, especially in the age range between 15 and 29 years,” confirms HSRC research director Geoffrey Setswe.

Although studies have focused on MCP in men, it is important to note that there are also many women who have multiple concurrent sexual partners and that this contributes to the spread of HIV infection as well.

“In traditional African culture, sex is not spoken about. This becomes a particular problem if sexual dissatisfaction is cited as a key reason for MCP,” he warns.

Like other health experts, Setswe believes the South African government needs to roll out a national HIV campaign that addresses MCP and works in close collaboration with the few civil society organisations that have implemented such programmes: “MCP is a complex problem. We can’t solve it with a one-size-fits-all approach.”

So far, most efforts to involve men – and women – in responding to HIV and AIDS have been limited in scale and impact. To change this, government together with NGOs, should initiate countrywide community dialogues on the topic, suggests Ndlovu: “MCP needs to become a public debate. It needs to be demystified, so that everyone is aware of the risks involved in MCP.”

He believes MCP has become normative behaviour in South African society: “It’s very entrenched and acceptable to have more than one partner and nobody dares to question it. As a result, the environment for behaviour change is not conducive. There is little social support.”

Soul City has been one of the few NGOs in the country brave enough to tackle the issue. The organisation recently produced a twelve-part radio and television drama on MCP, aired on the country’s public broadcaster.

“We developed a character, a married man who has an affair with a woman who also has multiple partners,” explains Ndlovu. “Through this, we wanted to show how HIV is transmitted quickly between people within a social network,” he adds, referring to the way in which the virus is spread rapidly within a group of people who have numerous sexual concurrent relationships.

HIV-positive persons are most infectious three to four weeks after they have been infected with the virus. Those who have sexual contact with multiple partners during this time place all of them at increased risk of HIV infection. In turn, the newly infected people place at risk their other sexual partners, and so the spread of HIV quickly escalates.

The focus on MCP in HIV prevention campaigns brings out the realisation that it’s impossible to reduce HIV infection rates without speaking publicly about sexual behaviour.

“In Southern Africa, the number of people having multiple partners is high, combined with inconsistent condom use and patriarchal norms that disadvantage women,” says Ndlovu. “There is also lots of peer pressure to have many partners, especially for men.”

He notes that poverty is another reason that perpetuates MCP. “High unemployment rates increase financial dependency on a partner. So even if you know that your partner is unfaithful, you can’t confront him,” explains Ndlovu.   

“Often, people tell us they don’t have the agency to change their private lives. They feel they are victims of their circumstances,” he adds.

A further campaign, Brothers for Life, is another recent attempt at confronting MCP. The five-year initiative – launched in late August by Johns Hopkins Health and Education in South Africa (JHHESA), the Sonke Gender Justice Network, the DoH and the South African National AIDS Council (SANAC) – encourages men to stand up and show others how to make the right choices.

“Instead of focusing on irresponsible male behaviour and thereby enforcing it, the campaign wants to affirm positive social norms,” explains Peacock. “We have to address and challenge notions of masculinities.”

But until the national prevention campaigns integrate MCP in their preventions programmes, South Africans will have to continue living with a high risk of HIV infection aggravated by MCP.