Skip to main content

Advertisement

SpringerLink
Log in

Marital Concurrency and HIV Risk in 16 African Countries

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Research has identified sexual concurrency as a potential underlying driver of high HIV infection levels in sub-Saharan Africa, though few studies have explicitly examined the contribution of marital concurrency. Utilizing a multi-level model of Demographic and Health Surveys with HIV-biomarkers for sixteen African countries, this study assessed the relationship between an individual’s HIV serostatus and rates of formal and informal marital concurrency (% polygamous unions, % extramarital partner past year) among married men and women. Mutually exclusive regional-level variables were constructed and modeled to test the contextual risk posed by living in a region with higher levels of formal and informal marital concurrency controlling for individual sexual partnerships and other covariates. Compared with regions where monogamous unions were more prevalent, the odds of having HIV were higher among individuals living in regions with more informal marital concurrency, but lower in regions with more polygamy, even accounting for individual-level sexual behavior. These results can help inform prevention policy and practice in sub-Saharan Africa.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Morris M, Kretzschmar M. Concurrent partnerships and the spread of HIV. AIDS. 1997;11:641–8.

    Article  CAS  PubMed  Google Scholar 

  2. Halperin DT, Epstein H. Concurrent sexual partnerships help to explain Africa’s high HIV prevalence: implications for prevention. Lancet. 2004;364(9428):4–6.

    Article  PubMed  Google Scholar 

  3. Mah TL, Halperin DT. Concurrent sexual partnerships and the HIV epidemics in Africa: evidence to move forward. AIDS Behav. 2010;14(1):25–8.

    Article  Google Scholar 

  4. Mah TL, Shelton JD. Concurrency revisited: increasing and compelling epidemiological evidence. JIAS. 2011;14:33–41.

    Article  Google Scholar 

  5. Eaton JW, Hallett TB, Garnett GP. Concurrent sexual partnerships and primary HIV infection: a critical interaction. AIDS Behav. 2011;15(4):687–92.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Sawers L, Stillwaggon E. Concurrent sexual partnerships do not explain the HIV epidemics in Africa: a systematic review of the evidence. JIAS. 2010;13:34–57.

    Article  Google Scholar 

  7. Lurie MN, Rosenthal S. Concurrent partnerships as a driver of the HIV epidemic in sub-Saharan Africa? The evidence is limited. AIDS Behav. 2010;14(1):17–24.

    Article  PubMed  Google Scholar 

  8. Garnett GP, Røttingen JA. Measuring the risk of HIV transmission. AIDS. 2001;15:641–3.

    Article  CAS  PubMed  Google Scholar 

  9. Kretzschmar M, White RG, Caraël M. Concurrency is more complex than it seems. AIDS. 2010;24(2):313–5. doi:10.1097/QAD.0b013e328333eb9d.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Epstein H. The invisible cure: Africa, the West, and the fight against AIDS. New York: Farrar, Strauss, Giroux; 2007.

    Google Scholar 

  11. Thornton RJ. Unimagined community: sex, networks and AIDS in Uganda and South Africa. Los Angeles: University of California Press; 2008.

    Google Scholar 

  12. Sawers L, Isaac A, Stillwaggon E. HIV and concurrency: modelling the role of coital dilution. J Int AIDS Soc. 2011;14:1–9.

    Article  Google Scholar 

  13. Goodreau S. A decade of modelling research yields considerable evidence for the importance of concurrency: a response to Sawers and Stillwaggon. J Int AIDS Soc. 2011;14:1–7.

    Article  Google Scholar 

  14. Glynn JR, Caraël M, Buvé A, Musonda RM, Kahindo M. HIV risk in relation to marriage in areas with high prevalence of HIV infection. JAIDS. 2003;33:526–35.

    PubMed  Google Scholar 

  15. Bongaarts J. Late marriage and the HIV epidemic in sub-Saharan Africa. Popul Stud J Demogr. 2007;61(1):73–83.

    Article  Google Scholar 

  16. Clark S. Early marriage and HIV risks in Sub-Saharan Africa. Study Fam Plan. 2004;35(3):149–60.

    Article  Google Scholar 

  17. Lurie MN, William BG, Zuma K, Mkaya-Mwamburi D, Garnett GP, Swet MD, et al. Who infects whom? HIV-1 concordance and discordance among migrant and non-migrant couples in South Africa. AIDS. 2003;17:2245–52.

    Article  PubMed  Google Scholar 

  18. Mishra V, Bignami-Van Assche S, Hong R, Vaessen M. Why do so many HIV discordant couples in sub-Saharan Africa have female partners infected, not male partners? Paper presented at the HIV/AIDS Implementers’ Meeting, Kigali, 20–22 June 2007.

  19. Epstein H, Stanton D. Is polygamy really benign? AIDS. 2010;24(11):1791–2.

    Article  PubMed  Google Scholar 

  20. Reniers G, Watkins S. Polygyny and the spread of HIV in sub-Saharan Africa: a case of benign concurrency. AIDS. 2010;24(2):299–307.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Reniers G, Tfaily R. Polygyny, partnership concurrency, and HIV transmission in Sub-Saharan Africa. Demography. 2012;49(3):1075–101. doi:10.1007/s13524-012-0114-z.

    Article  PubMed  Google Scholar 

  22. Mishra V, Hong R, Bignami-Van Assche S, Barrere B. The role of partner reduction and faithfulness in HIV prevention in sub-Saharan Africa: evidence from Cameroon, Rwanda, Uganda, and Zimbabwe. DHS working paper No. 61, 2009: http://measuredhs.com/publications/publication-wp61-working-papers.cfm.

  23. Helleringer S, Kohler H-P. Sexual network structure and the spread of HIV in Africa: evidence from Likoma Island, Malawi. AIDS. 2007;21:2323–32.

    Article  PubMed  Google Scholar 

  24. Tanser F, Bärnighausen T, Hund L, Garnett GP, McGrath N, Newell ML. Effect of concurrent sexual partnerships on rate of new HIV infections in a high-prevalence, rural South African population: a cohort study. Lancet. 2011;378:247–55.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Shelton JD. A tale of two-component generalised HIV epidemics. Lancet. 2010;375:964–6.

    Article  PubMed  Google Scholar 

  26. Chemaitelly H, Abu-Raddad LJ. External infections contribute minimally to HIV incidence among HIV sero-discordant couples in sub-Saharan Africa. Sex Transm Infect. 2013;89:138–41. doi:10.1136/sextrans-2012-050651.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Chemaitellya H, Shelton JD, Hallett TB, Abu-Raddad LJ. Only a fraction of new HIV infections occur within identifiable stable discordant couples in sub-Saharan Africa. AIDS. 2013;27:251–60.

    Article  Google Scholar 

  28. Bellan SE, Fiorella KJ, Melesse DY, Getz WM, Williams BG, Dushoff J. Extra-couple HIV transmission in sub-Saharan Africa: a mathematical modelling study of survey data. Lancet. 2013;381(9877):1561–9.

    Article  PubMed  Google Scholar 

  29. Morris M, Epstein H, Wawer M. Timing is everything: international variations in historical sexual partnership concurrency and HIV prevalence. PLoS ONE. 2010;5(11):e14092.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Stoneburner RL, Low-Beer D. Population-level HIV declines and behavioral risk avoidance in Uganda. Science. 2004;304:714–8.

    Article  CAS  PubMed  Google Scholar 

  31. Halperin DT, Mugurungi O, Hallett TB, Muchini B, Campbell B, Magure T, Benedikt C, Gregson S. A surprising prevention success: why did the HIV epidemic decline in Zimbabwe? PLoS Med. 2011;8(2):e1000414.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Mishra MK, Vaessen M, Boerma T, Arnold F, Way A, Barrere B, et al. HIV testing in national population based surveys: experience from the demographic and health surveys. Bull World Health Organ. 2006;84(7):537–45.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Auvert B, et al. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial. PLoS Med. 2005;2(11):1112–22.

    Article  Google Scholar 

  34. Bailey RC, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007;369:643–56.

    Article  PubMed  Google Scholar 

  35. Gray RH, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007;369:657–66.

    Article  PubMed  Google Scholar 

  36. Hunter M. Love in the time of AIDS: inequality, gender, and rights in South Africa. Bloomington: Indiana University Press; 2010.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Health Evidence and Policy, Mount Sinai School of Medicine, 1 Gustave Levy Place, New York, NY, 10029, USA

    Ashley M. Fox

Authors
  1. Ashley M. Fox
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ashley M. Fox.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fox, A.M. Marital Concurrency and HIV Risk in 16 African Countries. AIDS Behav 18, 791–800 (2014). https://doi.org/10.1007/s10461-013-0684-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-013-0684-9

Keywords

Search

Navigation