Partner Age-Disparity and HIV Incidence Risk for Older Women in Rural South Africa
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While sexual partner age disparity is frequently considered as a potential risk factor for HIV among young women in Africa, no research has addressed this question among older women. Our aim was thus to determine whether sex partner age disparity was associated with subsequent HIV acquisition in women over 30 years of age. To achieve this aim we conducted a quantitative analysis of a population-based, open cohort of women in rural KwaZulu-Natal, South Africa (n = 1,737) using Cox proportional hazards models. As partner age rose, HIV acquisition risk fell significantly: compared to a same-aged partner, a 5-year older partner was associated with a one-third reduction [hazard ratio (HR) 0.63, 95 % CI 0.52–0.76] and a 10-year older partner with a one-half reduction (HR 0.48, 95 % CI 0.35–0.67) in acquisition risk. This result was neither confounded nor effect-modified by women’s age or socio-demographic factors. These findings suggest that existing HIV risk-reduction campaigns warning young women about partnering with older men may be inappropriate for older women. HIV prevention strategies interventions specifically tailored to older women are needed.
KeywordsHIV acquisition Age disparities South Africa Women
This analysis is based on data collected by the Africa Centre Demographic Information System and would not have been possible without the kind contributions of all respondents and the support of many staff at the Africa Centre for Health and Population Studies, for which the authors are extremely grateful. GH acknowledges support from the Harvard University Committee on African Studies for travel to the research site for this study. The Wellcome Trust, UK, provides core funding to the Africa Centre, including for the surveillance on which this work is based (Grant 082384/Z/07/Z). TB and FT received financial support through grant 1R01-HD058482-01 from the National Institute of Child Health and Human Development, National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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