Age-disparate relationships and HIV incidence in adolescent girls and young women: evidence from a general-population cohort in Zimbabwe
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Objective:
Age-disparate sexual relationships with older men may drive high rates of HIV acquisition in young women in sub-Saharan Africa but evidence is limited. We investigate the association between age-disparate relationships and HIV incidence in Manicaland, Zimbabwe.
Design: A general-population open-cohort study (six surveys) (1998-2013).
Methods:
3746 young women aged 15-24 years participated in consecutive surveys and were HIV-negative at the beginning of inter-survey periods. Last sexual partner age difference and age-disparate relationships (inter-generational [≥10 years age difference] and intra-generational [5-9 years] versus age-homogeneous [0-4 years]) were tested for associations with HIV incidence in Cox regressions. A proximate determinants framework was used to explore factors possibly explaining variations in the contribution of age-disparate relationships to HIV incidence between populations and over time.
Results:
126 HIV infections occurred over 8777 person-years (1.43 per 100 person-years; 95% confidence interval=1.17-1.68). 65% of women reported partner age differences of ≥5 years. Increasing partner age differences were associated with higher HIV incidence (adjusted hazard ratio [aHR]=1.05 [1.01-1.09]). Inter-generational relationships tended to increase HIV incidence (aHR=1.78 [0.96-3.29]) but not intra-generational relationships (aHR=0.91 [0.47-1.76]). Secondary education was associated with reductions in inter-generational relationships (adjusted odds ratio [aOR]=0.49 [0.36-0.68]). Inter-generational relationships were associated with partners having concurrent relationships (aOR=2.59 [1.81-3.70]) which tended to increase HIV incidence (aHR=1.74 [0.96-3.17]). Associations between age-disparity and HIV incidence did not change over time.
Conclusions:
Sexual relationships with older men expose young women to increased risk of HIV acquisition in Manicaland, which did not change over time, even with introduction of antiretroviral therapy.
Age-disparate sexual relationships with older men may drive high rates of HIV acquisition in young women in sub-Saharan Africa but evidence is limited. We investigate the association between age-disparate relationships and HIV incidence in Manicaland, Zimbabwe.
Design: A general-population open-cohort study (six surveys) (1998-2013).
Methods:
3746 young women aged 15-24 years participated in consecutive surveys and were HIV-negative at the beginning of inter-survey periods. Last sexual partner age difference and age-disparate relationships (inter-generational [≥10 years age difference] and intra-generational [5-9 years] versus age-homogeneous [0-4 years]) were tested for associations with HIV incidence in Cox regressions. A proximate determinants framework was used to explore factors possibly explaining variations in the contribution of age-disparate relationships to HIV incidence between populations and over time.
Results:
126 HIV infections occurred over 8777 person-years (1.43 per 100 person-years; 95% confidence interval=1.17-1.68). 65% of women reported partner age differences of ≥5 years. Increasing partner age differences were associated with higher HIV incidence (adjusted hazard ratio [aHR]=1.05 [1.01-1.09]). Inter-generational relationships tended to increase HIV incidence (aHR=1.78 [0.96-3.29]) but not intra-generational relationships (aHR=0.91 [0.47-1.76]). Secondary education was associated with reductions in inter-generational relationships (adjusted odds ratio [aOR]=0.49 [0.36-0.68]). Inter-generational relationships were associated with partners having concurrent relationships (aOR=2.59 [1.81-3.70]) which tended to increase HIV incidence (aHR=1.74 [0.96-3.17]). Associations between age-disparity and HIV incidence did not change over time.
Conclusions:
Sexual relationships with older men expose young women to increased risk of HIV acquisition in Manicaland, which did not change over time, even with introduction of antiretroviral therapy.
Date Issued
2017-06-19
Date Acceptance
2017-04-10
Citation
AIDS, 2017, 31 (10), pp.1461-1470
ISSN
0269-9370
Start Page
1461
End Page
1470
Journal / Book Title
AIDS
Volume
31
Issue
10
Copyright Statement
© 2017 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the
Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
License URL
Sponsor
Wellcome Trust
Wellcome Trust
UNAIDS
Bill & Melinda Gates Foundation
Grant Number
084401/Z/07/Z
090285/Z/09/Z
PO201153562
OPP1161471
Subjects
Science & Technology
Life Sciences & Biomedicine
Immunology
Infectious Diseases
Virology
adolescent girls
age-disparate relationships
HIV incidence
HIV prevention
older men
young women
SOUTH-AFRICA
RISK-FACTORS
HEALTH
INFECTION
PARTNERSHIPS
ACQUISITION
MARRIAGE
TRENDS
COHORT
06 Biological Sciences
11 Medical And Health Sciences
17 Psychology And Cognitive Sciences
Publication Status
Published