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AIDS. 2017 Jun 19;31(10):1461-1470. doi: 10.1097/QAD.0000000000001506.

Age-disparate relationships and HIV incidence in adolescent girls and young women: evidence from Zimbabwe.

Author information

1
aDepartment of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, UK bBiomedical Research and Training Institute cZimbabwe Ministry of Health and Child Care, Harare, Zimbabwe.

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:

A total of 3746 young women aged 15-24 years participated in consecutive surveys and were HIV-negative at the beginning of intersurvey periods. Last sexual partner age difference and age-disparate relationships [intergenerational (≥10 years age difference) and intragenerational (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:

About 126 HIV infections occurred over 8777 person-years (1.43 per 100 person-years; 95% confidence interval = 1.17-1.68). Sixty-five percent of women reported partner age differences of at least 5 years. Increasing partner age differences were associated with higher HIV incidence [adjusted hazard ratio (aHR) = 1.05 (1.01-1.09)]. Intergenerational relationships tended to increase HIV incidence [aHR = 1.78 (0.96-3.29)] but not intragenerational relationships [aHR = 0.91 (0.47-1.76)]. Secondary education was associated with reductions in intergenerational relationships [adjusted odds ratio (aOR) = 0.49 (0.36-0.68)]. Intergenerational 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.

CONCLUSION:

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.

PMID:
28426534
PMCID:
PMC5457819
DOI:
10.1097/QAD.0000000000001506
[Indexed for MEDLINE]
Free PMC Article

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