Sunday Times (Johannesburg) - June 10, 2007
Claire Keeton

"Playas" who average six girlfriends in three months, people living with HIV and those with sexually transmitted infections who drink alcohol are among the groups being targeted to stop the spread of HIV.

The need for focused, effective HIV prevention programmes was high on the agenda at the third South African Aids Conference in Durban this week.

Dr Mickey Chopra from the Medical Research Council's Health Systems Research Unit, who presented survey results on men with high-risk sexual habits, said: "There is little information about these men.

"Prevention strategies have not had the impact they should have had and they have been very general.

"Now we need to focus on understanding the key sexual networks that are driving the epidemic."

For this research, Chopra's team recruited men from Khayelitsha who had more than one partner, and had at least one partner three years younger than them.

Some 400 men joined the study last year; their number of partners over three months ranged from two to 39 , with the average being six partners.

When it comes to HIV risk, Chopra said these "playas" tended to be a hidden group; the sugar daddies with the Mercedes-Benz cars were a more visible problem, he said.

"These playas were a bit better off [than most residents], had a better education and were more likely to be employed," he said of the men surveyed.

Their average age was 28 and most were unmarried.

The key findings were that:

²These men tended to have a "steady girlfriend" from Monday to Friday but on weekends had sex with casual girlfriends known as kwapheni or once-off girlfriends;

²The vast majority of their friends thought it was acceptable for them to have multiple partners and their status diminished if they did not;

²They used condoms only about a third of the time with their steady girlfriends, and about 51% of the men had inconsistent condom use with their casual partners;

²They had more than double the incidence of HIV, when compared with the general population (12% versus 5%); and

²They did not think they were at risk of HIV, even though they practised risky sex .

Chopra said: "We found these men had quite distinct rituals in the way they spent their recreational time.

"On Fridays they would often meet up with a small group of friends at somebody's house and always end up at a tavern or shebeen, where they would meet certain women.

"Sometimes they would drive somewhere to find 'fresh fields'."

Chopra said the Western Cape government was looking at what steps it could take to stop these patterns - like targeting recreational venues without alcohol.

He said most shebeen owners were supportive of HIV prevention.

Meanwhile, another study showed that short-term counselling could dramatically decrease the rate of unsafe sex among participants.

This was according to researcher Professor Seth Kalichman of the Human Sciences Research Council and the University of Connecticut.

One-hour counselling sessions were conducted among 143 participants (all drinkers) at a Cape Town clinic for sexually transmitted infections. The results included a 65% reduction in unsafe sex over a follow-up period of six months.

Kalichman said: " Unlike the International Aids Conference in Toronto last year, which was very depressing because it focused on what we wish we had (vaccines and microbicides), the South African conference is clearly asking for behavioural intervention, which does work and is available now.

"But the interventions must also be science based - not just education and condoms."

He highlighted the importance of "positive prevention" directed at people living with HIV. This is one of the priorities of South Africa's New Strategic Plan on HIV/Aids.

"Combining prevention services for the most at-risk HIV-negative groups with universal access to HIV testing and positive prevention offers the best opportunity to control HIV/Aids in Africa," he said, quoting from the Journal of the American Medical Association.

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