The University of Southampton
University of Southampton Institutional Repository

Do age-disparate relationships drive HIV incidence in young women? Evidence from a population cohort in rural KwaZulu-Natal, South Africa

Do age-disparate relationships drive HIV incidence in young women? Evidence from a population cohort in rural KwaZulu-Natal, South Africa
Do age-disparate relationships drive HIV incidence in young women? Evidence from a population cohort in rural KwaZulu-Natal, South Africa
Background: Based on ethnographic investigations and mathematical models, older sexual partners are often considered a major risk factor for HIV for young women in sub-Saharan Africa. Numerous public health campaigns have been conducted to discourage young women from relationships with older men. However, longitudinal evidence relating sex partner age disparity to HIV acquisition in women is limited.

Methods: Using data from a population-based open cohort in rural KwaZulu-Natal, South Africa, we studied 15- to 29-year-old women who were HIV seronegative at first interview between January 2003 and June 2012 (n = 2444). We conducted proportional hazards analysis to establish whether the age disparity of women's most recent sexual partner, updated at each surveillance round, was associated with subsequent HIV acquisition.

Results: A total of 458 HIV seroconversions occurred over 5913 person-years of follow-up (incidence rate: 7.75 per 100 person-years). Age disparate relationships were common in this cohort; 37.7% of women reported a partner 5 or more years older than themselves. The age disparity of women's partners was not associated with HIV acquisition when measured either continuously [hazard ratio (HR) for 1-year increase in partner's age: 1.00, 95% confidence interval (CI): 0.97 to 1.03] or categorically (man ≥5 years older: HR, 0.98; 95% CI: 0.81 to 1.20; man ≥10 years older: HR, 0.98; 95% CI: 0.67 to 1.43). These results were robust to adjustment for known sociodemographic and behavioral HIV risk factors and did not vary significantly by women's age, marital status, education attainment, or household wealth.

Conclusions: HIV incidence in young women was very high in this rural community in KwaZulu-Natal. Partner age disparity did not predict HIV acquisition. Campaigns to reduce age-disparate sexual relationships may not be a cost-effective use of HIV prevention resources in this setting.
1525-4135
443-451
Harling, Guy
0403b83a-0afe-472c-a184-7a6357afe29a
Newell, Marie-Louise
c6ff99dd-c23b-4fef-a846-a221fe2522b3
Tanser, Frank
a7112c48-809b-4f7c-8662-eaef445891f4
Kawachi, Ichiro
d34f230d-b0da-48e4-bbc6-00f58ad5aa59
Subramanian, S.V.
f1de516a-6a32-483f-80cf-ed196fae9567
Bärnighausen, Till
337d5ec4-e26e-40de-aa26-42e5c5c9b61e
Harling, Guy
0403b83a-0afe-472c-a184-7a6357afe29a
Newell, Marie-Louise
c6ff99dd-c23b-4fef-a846-a221fe2522b3
Tanser, Frank
a7112c48-809b-4f7c-8662-eaef445891f4
Kawachi, Ichiro
d34f230d-b0da-48e4-bbc6-00f58ad5aa59
Subramanian, S.V.
f1de516a-6a32-483f-80cf-ed196fae9567
Bärnighausen, Till
337d5ec4-e26e-40de-aa26-42e5c5c9b61e

Harling, Guy, Newell, Marie-Louise, Tanser, Frank, Kawachi, Ichiro, Subramanian, S.V. and Bärnighausen, Till (2014) Do age-disparate relationships drive HIV incidence in young women? Evidence from a population cohort in rural KwaZulu-Natal, South Africa. JAIDS Journal of Acquired Immune Deficiency Syndromes, 66 (4), 443-451. (doi:10.1097/QAI.0000000000000198). (PMID:24815854)

Record type: Article

Abstract

Background: Based on ethnographic investigations and mathematical models, older sexual partners are often considered a major risk factor for HIV for young women in sub-Saharan Africa. Numerous public health campaigns have been conducted to discourage young women from relationships with older men. However, longitudinal evidence relating sex partner age disparity to HIV acquisition in women is limited.

Methods: Using data from a population-based open cohort in rural KwaZulu-Natal, South Africa, we studied 15- to 29-year-old women who were HIV seronegative at first interview between January 2003 and June 2012 (n = 2444). We conducted proportional hazards analysis to establish whether the age disparity of women's most recent sexual partner, updated at each surveillance round, was associated with subsequent HIV acquisition.

Results: A total of 458 HIV seroconversions occurred over 5913 person-years of follow-up (incidence rate: 7.75 per 100 person-years). Age disparate relationships were common in this cohort; 37.7% of women reported a partner 5 or more years older than themselves. The age disparity of women's partners was not associated with HIV acquisition when measured either continuously [hazard ratio (HR) for 1-year increase in partner's age: 1.00, 95% confidence interval (CI): 0.97 to 1.03] or categorically (man ≥5 years older: HR, 0.98; 95% CI: 0.81 to 1.20; man ≥10 years older: HR, 0.98; 95% CI: 0.67 to 1.43). These results were robust to adjustment for known sociodemographic and behavioral HIV risk factors and did not vary significantly by women's age, marital status, education attainment, or household wealth.

Conclusions: HIV incidence in young women was very high in this rural community in KwaZulu-Natal. Partner age disparity did not predict HIV acquisition. Campaigns to reduce age-disparate sexual relationships may not be a cost-effective use of HIV prevention resources in this setting.

This record has no associated files available for download.

More information

Published date: 1 August 2014
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 367913
URI: http://eprints.soton.ac.uk/id/eprint/367913
ISSN: 1525-4135
PURE UUID: 587ae0b8-ea3c-4de5-aefc-8e03ee48617e
ORCID for Marie-Louise Newell: ORCID iD orcid.org/0000-0002-1074-7699

Catalogue record

Date deposited: 20 Aug 2014 13:50
Last modified: 15 Mar 2024 03:47

Export record

Altmetrics

Contributors

Author: Guy Harling
Author: Frank Tanser
Author: Ichiro Kawachi
Author: S.V. Subramanian
Author: Till Bärnighausen

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×