Polygyny and the spread of HIV in Sub Saharan Africa: A case of benign concurrency

Abstract

Objectives
Most of our understanding about the effect of concurrent sexual partnerships on the spread of HIV derives from mathematical models, but the empirical evidence is limited. In this contribution, we focus on polygyny, a common and institutionalized form of concurrency, and study its relationship with HIV prevalence at the ecological level.
Methods
First, we describe country‐level variation in the prevalence of polygyny and HIV. Second, we test the relationship between HIV and polygyny at the sub‐national level using country fixedeffects regression models with data from nineteen Demographic and Health Surveys.
Results
The ecological association between polygyny and HIV prevalence is negative at the country as well as sub‐national level: HIV prevalence is lower in countries where the practice of polygyny is common, and within countries it is lower in areas with higher levels of polygyny. Proposed explanations for the protective effect of polygyny include the distinctive structure of sexual networks produced by polygyny, the disproportionate recruitment of HIV positive women into marriages with a polygynous husband, and the lower coital frequency in conjugal units of polygynous marriages.
Conclusion
Existing models of concurrency are not sufficiently specific to account for the protective effect of polygyny on the spread of HIV, and require refinements before they are to be used for informing HIV prevention policies.