Dataset Information

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

SUBMITTER: Maughan-Brown B

PROVIDER: S-EPMC7473385 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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

Maughan-Brown Brendan B Venkataramani Atheendar A Kharsany Ayesha B M ABM Beckett Sean S Govender Kaymarlin K Lewis Lara L Cawood Cherie C Khanyile David D George Gavin G

AIDS (London, England) 20200101 1

<h4>Objective</h4>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.<h4>Desi ...[more]

PMID: 31483373

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Project description:BACKGROUND:Evidence on the role of age-disparate partnerships in high HIV-infection rates among young women in sub-Saharan Africa remains inconclusive. This study examined the HIV-infection risk associated with age-disparate partnerships among 15- to 24-year-old women in a hyperendemic setting in South Africa. METHODS:Face-to-face questionnaire, and laboratory HIV and viral load data were collected during 2014-2015 among a representative sample (15-49 years old) in KwaZulu-Natal. The association between age-disparate partnerships (age difference ≥5 years) and HIV status among 15- to 24-year-old women (N = 1459) was assessed using multiple logistic regression analyses. Data from the male sample on all on-going partnerships (N = 1229) involving 15- to 24-year-old women were used to assess whether young women's age-disparate male partners were more likely to have a viral load ≥1000 copies per milliliter, a marker of HIV-infection risk. RESULTS:Women reporting an age disparity in any of their 3 most recent partnerships were more likely to test HIV positive compared to women with only age-similar partners [adjusted odds ratio (aOR): 1.58, 95% confidence interval (CI): 1.20 to 2.09, P < 0.01]. Among partnerships men reported with 15- to 24-year-old women, the age-disparate male partners were more likely to be HIV positive and have a viral load ≥1000 copies per milliliter (aOR: 2.05, 95% CI: 1.30 to 3.24, P < 0.01) compared with age-similar partners. Results were similar for each category of age disparity: partners 5-9 years older (aOR: 2.01, 95% CI: 1.18 to 3.43, P = 0.010) and those ≥10 years older (aOR: 2.17, 95% CI: 1.01-4.66, P = 0.048). CONCLUSIONS:Results indicate that age-disparate partnerships increase young women's HIV risk, although conclusive evidence was not ascertained. Interventions addressing risk from age-disparate sexual partnering, including expanding antiretroviral treatment among older partners, may help to reduce HIV incidence among young women.

Project description:OBJECTIVE:There is an urgent need to understand high HIV-infection rates among young women in sub-Saharan Africa. While age-disparate partnerships have been characterised with high-risk sexual behaviours, the mechanisms through which these partnerships may increase HIV-risk are not fully understood. This study assessed the association between age-disparate partnerships and herpes simplex virus type-2 (HSV-2) infection, a factor known to increase HIV-infection risk. METHODS:Cross-sectional face-to-face questionnaire data, and laboratory HSV-2 and HIV antibody data were collected among a representative sample in the 2014/2015 household survey of the HIV Incidence Provincial Surveillance System in KwaZulu-Natal, South Africa. Among 15-24-year-old women who reported having ever had sex (n=1550), the association between age-disparate partnerships (ie, male partner ≥5 years older) and HSV-2 antibody status was assessed using multivariable Poisson regression models with robust variance. Analyses were repeated among HIV-negative women. RESULTS:HSV-2 prevalence was 55% among 15-24-year-old women. Women who reported an age-disparate partnership with their most recent partner were more likely to test HSV-2 positive compared with women with age-similar partners (64% vs 51%; adjusted prevalence ratio (aPR):1.19 (95% CI 1.07 to 1.32, p<0.01)). HSV-2 prevalence was also significantly higher among HIV-negative women who reported age-disparate partnerships (51% vs 40 %; aPR:1.25 (95% CI 1.05 to 1.50, p=0.014)). CONCLUSIONS:Results indicate that age-disparate partnerships are associated with a greater risk of HSV-2 among young women. These findings point towards an additional mechanism through which age-disparate partnerships could increase HIV-infection risk. Importantly, by increasing the HSV-2 risk, age-disparate partnerships have the potential to increase the HIV-infection risk within subsequent partnerships, regardless of the partner age-difference in those relationships.

Project description:IntroductionAge-disparate sex has long been considered a factor that increases HIV risk for young women in South Africa. However, recent studies from specific regions in South Africa have found conflicting evidence. Few studies have assessed the association between age-disparate partnerships (those involving an age gap of 5 years or more) and HIV risk at the national level. This study investigates the relationship between age-disparate sex and HIV status among young women aged 15-24 in South Africa.MethodsNationally representative weighted data from the 2002, 2005, 2008, and 2012 South African National HIV Surveys were analysed for young women aged 15-24 years using bivariate analyses and multiple logistic regressions.ResultsAfter conducting multiple logistic regression analyses and controlling for confounders, young women with age-disparate partners had greater odds of being HIV positive in every survey year: 2002 (aOR = 1.74, 95%CI: 0.81-3.76, p = 0.16); 2005 (aOR = 2.11, 95%CI: 1.22-3.66, p < 0.01); 2008 (aOR = 2.02, 95%CI: 1.24-3.29, p < 0.01); 2012 (aOR = 1.53, 95%CI: 0.92-2.54, p < 0.1). The odds of being HIV positive increased for each year increase in their male partner's age in 2002 (aOR = 1.10, 95%CI: 0.98-1.22, p = 0.11), 2005 (aOR = 1.10, 95%CI: 1.03-1.17, p < 0.01), 2008 (aOR = 1.08, 95%CI: 1.01-1.15, p < 0.05), and 2012 (aOR = 1.08, 95%CI: 1.01-1.16, p < 0.05). Findings were statistically significant (p < 0.1) for the years 2005, 2008, and 2012.ConclusionOur findings suggest that age-disparate sex continues to be a risk factor for young women aged 15-24 in South Africa at a national level. These results may reflect variation in HIV risk at the national level compared to the differing results from recent studies in a demographic surveillance system and trial contexts. In light of recent contradictory study results, further research is required on the relationship between age-disparate sex and HIV for a more nuanced understanding of young women's HIV risk.

Project description:BackgroundAge-mixing (age-disparate [5-9 years difference] and intergenerational [≥ 10 years difference]) partnerships are hypothesized drivers of HIV in adolescent girls and young women (AGYW; 15-24 years). These partnerships are often associated with increased gender inequities which undermine women's agency and assertiveness. We assessed whether age-mixing partnerships were associated with HIV in Malawi and if endorsement of inequitable gender norms modifies this relationship.MethodsWe analyzed data from the Malawi Population-based HIV Impact Assessment, a nationally representative household survey conducted in 2015-2016. Participants underwent HIV testing and completed questionnaires related to actively endorsed gender norms and sexual risk behavior. We used multivariate logistic regression and multiplicative interaction to assess associations among AGYW who reported the age of their primary sex partner from the last year.ResultsThe analysis included 1,958 AGYW (mean age = 19.9 years, SD = 0.1), 459 (23.4%) and 131 (6.7%) of whom reported age-disparate and intergenerational partnerships, respectively. AGYW in age-mixing partnerships accounted for 13% of all AGYW and were older, more likely to reside in urban areas, to be married or cohabitating with a partner, and to have engaged in riskier sexual behavior compared with AGYW in age-concordant partnerships (p < 0.05). HIV prevalence among AGYW in age-disparate and intergenerational partnerships was 6.1% and 11.9%, respectively, compared with 3.2% in age-concordant partnerships (p < 0.001). After adjusting for residence, age, education, employment, wealth quintile, and ever been married or cohabitated as married, AGYW in age-disparate and intergenerational partnerships had 1.9 (95% CI: 1.1-3.5) and 3.4 (95% CI: 1.6-7.2) greater odds of HIV, respectively, compared with AGYW in age-concordant partnerships. Among the 614 (31% of the study group) who endorsed inequitable gender norms, AGYW in age-disparate and intergenerational partnerships had 3.5 (95% CI: 1.1-11.8) and 6.4 (95% CI: 1.5-27.8) greater odds of HIV, respectively, compared with AGYW in age-concordant partnerships.ConclusionsIn this Malawi general population survey, age-mixing partnerships were associated with increased odds of HIV among AGYW. These findings highlight inequitable gender norms as a potential focus for HIV prevention and could inform interventions targeting structural, cultural, and social constraints of this key group.

Dataset Information

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

Objective

Design

Methods

Results

Conclusion

Publications

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

Similar Datasets

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