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AIDS. 2020 Jan 1;34(1):149-154. doi: 10.1097/QAD.0000000000002362.

Recently formed age-disparate partnerships are associated with elevated HIV-incidence among young women in South Africa.

Author information

1
Southern Africa Labour and Development Research Unit (SALDRU), School of Economics, University of Cape Town, Middle Campus, Cape Town, South Africa.
2
Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
3
Centre for the AIDS Programme of Research in South Africa (CAPRISA).
4
Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban.
5
Epicentre AIDS Risk Management (Pty) Limited, Sandton, South Africa.

Abstract

OBJECTIVE:

Cross-sectional and cohort studies draw different conclusions on whether age-disparate partnerships increase HIV-acquisition risk for young women. We investigated whether age-disparities were associated with HIV-infection risk early in relationships. This could result in the exclusion of women who seroconverted during high-risk age-disparate partnerships from cohort studies of HIV incidence - which exclude HIV-positive women - and explain null findings in these studies.

DESIGN:

Prospective cohort study.

METHODS:

We used data on 15-24-year-old, HIV-negative women in heterosexual partnerships (N = 830) in KwaZulu-Natal, South Africa. The association between age-disparate partnering (i.e., male partner ≥5 years older) and subsequent HIV seroconversion was assessed using Cox hazard models. We examined heterogeneity in HIV-acquisition risk by duration of partnership (defined by quartiles) at cohort enrolment.

RESULTS:

During 1139 person-years (mean: 1.4 years) of follow-up, 54 (6.5%) women seroconverted, a weighted HIV-incidence estimate of 4.41/100 person-years [95% confidence interval (CI): 3.30-6.06]. HIV-acquisition risk did not differ significantly between women in age-disparate vs. age-similar partnerships (adjusted hazard ratios: 1.10, 95% CI: 0.55-2.21). However, for women in the shortest partnership quartile (<1.09 years) at baseline, risk of HIV seroconversion was higher for women in age-disparate partnerships (adjusted hazard ratios: 3.13, 95% CI: 1.02-9.65, P = 0.047). HIV acquisition was not statistically different by partnership type among women in longer partnerships.

CONCLUSION:

The association between age-disparate partnerships and HIV-acquisition risk is evident early in young women's relationships. Results provide a potential explanation for null findings in cohort studies, whose research designs may exclude women in such partnerships, and affirms the elevated risk of HIV acquisition for young women in age-disparate relationships.

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