Second, researchers infer concurrency based on information collected about respondents' involvement in multiple sexual relationships that are ongoing or occurred in brief periods before the survey Harrison et al. The analysis began at the start of the calendar, when respondents were ages , and continues up to the time of the survey. Third, geographic distance from a partner could increase the risk of concurrency because of loneliness or reduced access to sexual activity encourages individuals to seek new partnerships Harrison et al.
Like other life history calendars, the RHC gathered information on changes in residence, employment, and schooling. HIV prevalence in Nyanza Province was estimated at The characteristics of and behaviors within the initial partnership could be key drivers in the decision to enter into a second concurrent sexual relationship. The results of the RHC methodological experiment suggest that the RHC decreased social desirability bias and improved reporting of multiple measures of sexual behavior in comparison to the standard instrument Luke et al. Methods Data and sample Kisumu, the third largest city in Kenya and capital of Nyanza Province, provided an important context to explore concurrency among youth. Table 1 Individual characteristics of urban Kenyan youth ages in in the month of first sex in the last 9. Results Sample characteristics Table 1 presents characteristics of respondents during the month of first sexual intercourse in the last 9. In particular, young females, who have been found to underreport their sexual activities in survey interviews Mensch et al. In addition, for all measures of point and cumulative prevalence, we report conservative estimates for comparison purposes. If a concurrency episode began at least one month after first sexual intercourse in an ongoing partnership, we designated the ongoing partnership as the initial partnership or When one concurrency episode ended, the ongoing relationship was treated as a new initial partnership that was at risk of concurrency. Studies have found that calendar interviews, including the RHC, are interesting and enjoyable experiences, which increases respondent motivation Belli and Callegaro ; Freedman et al. Second, several studies report an association between non-monogamy of partners and individuals' likelihood of engaging in concurrency Adimora et al. Given that concurrency is a relatively infrequent event for young women in particular, the regression results should be interpreted with caution. Males had more concurrencies and of shorter duration than females. Over one half of females and almost three quarters of males were in school, and a much smaller proportion approximately 15 per cent was employed. The calendar method aids respondents to accurately recall the occurrence, sequence, and timing of past events Caspi et al. We experimented with lagging initial partnership variables by six months, which produced generally similar results in terms of coefficient sizes and significance levels. Life history calendars could be beneficial for gathering such information. Older age and younger age at first sexual intercourse not only increase exposure time to concurrency but could also proxy for individuals more likely to engage in risky sexual behaviors Manhart et al. The analysis began at the start of the calendar, when respondents were ages , and continues up to the time of the survey. Concurrency has been associated with the spread of HIV and other sexual transmitted infections in simulation and observational studies Morris and Kretzschmar ; Helleringer et al. Surveys have generally gathered information to construct concurrency measures in three ways. Our study has two specific aims. In contrast to sequential monogamy, concurrent partnerships can transmit infection across multiple partnerships simultaneously, where earlier partners can be exposed when the subject becomes infected by a later partner Morris and Kretzschmar Because we do not know the order of events within a particular month and to rule out the possibility of serial monogamy UNAIDS , we also calculated conservative estimates of concurrency by dropping those episodes where last sexual intercourse in one partnership and first sexual intercourse in another partnership overlapped by one month only. The RHC interview procedure was flexible and conversational in nature, with the order of questions left up to a trained interviewer.
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