Double-talk about multiple concurrent sexual relationships

It has become a shibboleth that the HIV/AIDS epidemic resulted from large networks, or overlapping sets of networks, of people engaged in multiple concurrent sexual partnerships. The basic reasons are that (1) the rate of observed apparent transmission of “HIV” is only a fraction of a percent per act of unprotected intercourse, hundreds of times lower than for common sexually transmitted infections like gonorrhea or syphilis or chlamydia or herpes (p. 46 in The Origin, Persistence and Failings of HIV/AIDS Theory), and (2) an epidemic means spreading to ever-increasing numbers of individuals, the inescapable criterion being that every person who gets infected must infect on average more than one other person within a rather short time.

James Chin, former epidemiologist for the World Health Organization and earlier for the State of California, has published calculations showing that the extent and rapid spread of the sub-Saharan epidemic can be explained only by postulating that 20-40% of the adult population there have been and are engaged in multiple concurrent sexual relationships with changes of partners weekly or monthly to the tune of as many as 100 in a given year (Table 5-1, pp. 64-5, The AIDS Pandemic).

The latest issue of AIDS and Behavior has 9 articles about this central issue of concurrent sexual relationships as a factor in spreading “HIV”, and a healthy diversity of views is represented. From the most outspoken skeptics:

“We would like to thank the authors for their comments on our article that questioned the amount and quality of the evidence to support the hypothesis that concurrent partnerships are a key driver of the HIV epidemics in Africa [8]. All three letters agree with us that we “raise some valid concerns” that the “evidence for this link is still somewhat limited” [10] and that further research is needed [3, 11]. We note further that the three letters were from the most vocal concurrency advocates, and do not necessarily represent mainstream opinion about the current state of knowledge on this important topic [7]. . . . In the end, the burden is on the advocates of concurrency to use empirical data to prove that concurrency is a driving force of the African HIV epidemics; thus far they have been unable to do so. Association and causation are very different levels of evidence, and our colleagues provide no convincing empirical evidence of causation” — Mark N. Lurie and Samantha Rosenthal “The concurrency hypothesis in Sub-Saharan Africa: Convincing empirical evidence is still lacking. Response to Mah and Halperin, Epstein, and Morris”, AIDS and Behavior, 14 #1 (2010) 34-7.

Another article reports that in Zambia “Thirteen percent of rural and 8% of urban men reported more than one ongoing relationship in 1998, and these proportions declined to 8% and 6%, respectively in 2003. The proportion of women reporting concurrent relationships was 0-2%” — Ingvild F. Sandøy, Kumbutso Dzekedzeke1, and Knut Fylkesnes “Prevalence and correlates of concurrent sexual partnerships in Zambia”, ibid.,  pp 59-71.

“HIV” prevalence in Zambia, at 16.5% a few years ago, is about midway between the lowest in sub-Saharan Africa (SSA) and the highest, the range being ~5% to >35% — “Deconstructing HIV/AIDS in ‘Sub-Saharan Africa’ and ‘The Caribbean’”, 21 April 2008.  That 16.5%  rate requires the sort of “fast-lane” multiple concurrency postulated by Chin, 20-40% of the adult population with up to 100 partners in any given year; yet the actual rate of multiple concurrency is far below that; <13% of men and <2% of women reported any concurrent relationship, let alone dozens or scores.

Altogether, the articles that postulate high rates of “concurrency” offer evidence only that people have had more than one sexual partner during a given period (which could mean serially, not necessarily concurrently) or at a given time; but even if half of a population had two partners simultaneously all the time, that would not begin to satisfy the criteria established by Chin’s calculations, which call for weekly or monthly exchange of partners to the tune of dozens or scores per year.

Again, the assertion that Africans do it differently than others is supported only by such weak claims as that, for example, “55% of men and 39% of women in Lesotho . . . reported having more than one regular partner in the previous year, as compared to 3 and 2% of men and 0.2 and 1% of women in Thailand and Sri Lanka, respectively” (Timothy L. Mah and Daniel T. Halperin, “The evidence for the role of concurrent partnerships in Africa’s HIV epidemics: A response to Lurie and Rosenthal”, pp. 25-8) — more than one in year, not excluding serially, is negligible in terms of Chin’s criteria; scores per year would be needed, not “more than one”.

On the other hand, a thoroughgoing survey of 59 countries had found “that the number of lifetime partners is lower in Africa than in industrialized countries, and that the prevalence of multiple partnerships is generally higher in industrialized countries. In addition, more men and women in Africa are sexually abstinent, with two-thirds of the population reporting recent sexual activity compared to three-quarters of the population in industrialized countries. . . . on average, African adults are less sexually active and have fewer lifetime partners than their counterparts in industrialized countries” —  Mark N. Lurie and Samantha Rosenthal, “Concurrent partnerships as a driver of the HIV epidemic in Sub-Saharan Africa? The evidence is limited”, pp. 17-24, citing Wellings et al., “Sexual behavior in context: A global perspective”, Lancet 368 [2006] 1706-28; 369 [2007] 557. Several more references to that same effect are
Brewer et al., “Mounting anomalies in the epidemiology of HIV in Africa: cry the beloved paradigm”, International Journal of STD & AIDS 14 [2003] 144-7;
Gisselquist et al., “HIV infections in sub–Saharan Africa not explained by sexual or vertical transmission”, International Journal of STD & AIDS 13 [2002] 657-66;
McCulloch, “The management of venereal disease in a settler society: colonial Zimbabwe, 1900-30”, Chapter 9, 195-216 in Histories of Sexually Transmitted Diseases and HIV/AIDS in Sub–Saharan Africa, ed. Setel et al., Greenwood 1999.

The mere fact that there is such a healthy to-and-fro between these articles demonstrates that, after more than two decades of intensive study, it remains controversial whether multiple concurrent sexual relationships can account for the purported level of HIV/AIDS in Africa — or elsewhere, because the shibboleth has been used also to rationalize the higher rate of “HIV-positive” among African Americans.

It is interesting to note that none of the 9 articles arguing over concurrency and published in 2010 so much as mention Chin’s book, which had been published 3 years earlier and which quantifies the level of concurrency and multiplicity required to account for an epidemic of African proportions. That omission makes it possible to overlook that all the asserted evidence for concurrency falls very far short of what would be necessary to explain the prevalence of “HIV” in Africa and among African Americans.

Not having to deal with numbers makes it easier also to offer hand-waving “explanations” whose plausibility rests on subterranean racist stereotypes about African sexual behavior — “Racist stereotypes are inherent in HIV/AIDS theory”, 2010/02/08.

AIDS and Behavior, like other mainstream journals, is of course peer-reviewed. How well peer review can work is illustrated by this total ignoring of perhaps the most central publication on this topic, written by an experienced epidemiologist who has held high office in HIV/AIDS-related organizations.