AIDS and Behavior

, Volume 19, Issue 7, pp 1317–1326 | Cite as

Partner Age-Disparity and HIV Incidence Risk for Older Women in Rural South Africa

  • Guy Harling
  • Marie-Louise Newell
  • Frank Tanser
  • Till Bärnighausen
Original Paper

Abstract

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.

Keywords

HIV acquisition Age disparities South Africa Women 

Supplementary material

10461_2014_952_MOESM1_ESM.pdf (694 kb)
Supplementary material 1 (PDF 694 kb)

References

  1. 1.
    UNAIDS. 2013 Report on the Global AIDS Epidemic. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS; 2013.Google Scholar
  2. 2.
    Jennings JM, Luo RF, Lloyd LV, Gaydos C, Ellen JM, Rietmeijer CA. Age-bridging among young, urban, heterosexual males with asymptomatic Chlamydia trachomatis. Sex Transm Infect. 2007;83(2):136–41.CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Spicknall IH, Aral SO, Holmes KK, Foxman B. Sexual networks are diverse and complex: prevalence of relationships bridging population subgroups in the Seattle Sex Survey. Sex Transm Dis. 2009;36(8):465–72.CrossRefPubMedGoogle Scholar
  4. 4.
    Hurt CB, Matthews DD, Calabria MS, et al. Sex with older partners is associated with primary HIV infection among men who have sex with men in North Carolina. J Acquir Immune Defic Syndr. 2010;54(2):185–90.PubMedCentralPubMedGoogle Scholar
  5. 5.
    Garnett GP, Anderson RM. Factors controlling the spread of HIV in heterosexual communities in developing countries: patterns of mixing between different age and sexual activity classes. Philos Trans R Soc Lond B Biol Sci. 1993;342(1300):137–59.CrossRefPubMedGoogle Scholar
  6. 6.
    Hope R. Addressing Cross-Generational Sex: a desk review of research and programs. Washington, DC: Population Reference Bureau; 2007.Google Scholar
  7. 7.
    Leclerc-Madlala S. Age-disparate and intergenerational sex in southern Africa: the dynamics of hypervulnerability. AIDS. 2008;22(Suppl 4):S17–25.CrossRefPubMedGoogle Scholar
  8. 8.
    Luke N. Age and economic asymmetries in the sexual relationships of adolescent girls in sub-Saharan Africa. Stud Fam Plann. 2003;34(2):67–86.CrossRefPubMedGoogle Scholar
  9. 9.
    Luke N. Economic status, informal exchange, and sexual risk in Kisumu, Kenya. Econ Dev Cult Change. 2008;56(2):375–96.CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Woolf SE, Maisto SA. Gender differences in condom use behavior? The role of power and partner-type. Sex Roles. 2008;9–10(58):689–701.CrossRefGoogle Scholar
  11. 11.
    Wingood GM, DiClemente RJ. Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Educ Behav. 2000;27(5):539–65.CrossRefPubMedGoogle Scholar
  12. 12.
    Baird SJ, Garfein RS, McIntosh CT, Ozler B. Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial. Lancet. 2012;379(9823):1320–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Dupas P. Do teenagers respond to HIV risk information? Evidence from a field experiment in Kenya. Am Econ J Appl Econ. 2011;3(1):1–34.CrossRefGoogle Scholar
  14. 14.
    Gregson S, Nyamukapa CA, Garnett GP, et al. Sexual mixing patterns and sex-differentials in teenage exposure to HIV infection in rural Zimbabwe. Lancet. 2002;359(9321):1896–903.CrossRefPubMedGoogle Scholar
  15. 15.
    Kelly RJ, Gray RH, Sewankambo NK, et al. Age differences in sexual partners and risk of HIV-1 infection in rural Uganda. J Acquir Immune Defic Syndr. 2003;32(4):446–51.CrossRefPubMedGoogle Scholar
  16. 16.
    Luke N. Confronting the ‘sugar daddy’ stereotype: age and economic asymmetries and risky sexual behavior in urban Kenya. Int Fam Plan Perspect. 2005;31(1):6–14.CrossRefPubMedGoogle Scholar
  17. 17.
    Pettifor AE, Rees HV, Kleinschmidt I, et al. Young people’s sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey. AIDS. 2005;19(14):1525–34.CrossRefPubMedGoogle Scholar
  18. 18.
    Harling G, Newell M-L, Tanser F, Kawachi I, Subramanian SV, Bärnighausen T. Do age-disparate relationships drive HIV incidence in young women? Evidence from a population cohort in rural KwaZulu-Natal, South Africa. J Acquir Immune Defic Syndr. 2014;66(4):443–51.CrossRefPubMedGoogle Scholar
  19. 19.
    KwaZulu-Natal Department of Health. Sugar Daddy Campaign. 2012; http://www.kznhealth.gov.za/sugardaddy.htm. Accessed 2 Sept, 2014.
  20. 20.
    PSI. Cross-Generational Sex. http://www.psi.org/our-work/healthy-lives/interventions/cross-generational-sex. Accessed 2 Sept, 2014.
  21. 21.
    Mossong J, Grapsa E, Tanser FC, Bärnighausen T, Newell M-L. Modelling HIV incidence and survival from age-specific seroprevalence after antiretroviral treatment scale-up in rural South Africa. AIDS. 2013;27(15):2471–9.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Gomez-Olive FX, Angotti N, Houle B, et al. Prevalence of HIV among those 15 and older in rural South Africa. AIDS Care. 2013;25(9):1122–8.CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Bor J, Herbst AJ, Newell M-L, Bärnighausen T. Increases in adult life expectancy in rural South Africa: valuing the scale-up of HIV treatment. Science. 2013;339(6122):961–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Helleringer S, Kohler HP. Sexual network structure and the spread of HIV in Africa: evidence from Likoma Island, Malawi. AIDS. 2007;21(17):2323–32.CrossRefPubMedGoogle Scholar
  25. 25.
    Hosegood V, McGrath N, Moultrie T. Dispensing with marriage: marital and partnership trends in rural KwaZulu-Natal, South Africa 2000–2006. Demogr Res. 2009;20:279–312.CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Hunter M. The changing political economy of sex in South Africa: the significance of unemployment and inequalities to the scale of the AIDS pandemic. Soc Sci Med. 2007;64(3):689–700.CrossRefPubMedGoogle Scholar
  27. 27.
    Seekings J. Race, Class, and Inequality in the South African City. In: Bridge G, Watson S, editors. The New Blackwell Companion to the City. Oxford, UK: Wiley-Blackwell; 2011.Google Scholar
  28. 28.
    Camlin CS, Snow RC, Hosegood V. Gendered patterns of migration in rural South Africa. Popul, Space Place. 2013;20(6):528–51.CrossRefGoogle Scholar
  29. 29.
    Russell MC. Are urban Black families nuclear? A comparative study of Black and White South African family norms. Soc Dyn. 2003;29(2):153–76.CrossRefGoogle Scholar
  30. 30.
    Posel D, Rudwick S, Casale D. Is marriage a dying institution in South Africa? Exploring changes in marriage in the context of ilobolo payments. Agenda. 2011;25(1):102–11.Google Scholar
  31. 31.
    Shisana OR, Simbayi LC, Thomas, Zuma K, et al. South African national HIV prevalence, incidence, behaviour and communication survey 2008: a turning tide among teenagers? Cape Town: HSRC Press; 2009.Google Scholar
  32. 32.
    Macro ICF. HIV Prevalence Estimates from the Demographic and Health Surveys. Calverton, MD: ICF Macro; 2010.Google Scholar
  33. 33.
    Ardington C, Case A, Hosegood V. Labor supply responses to large social transfers: longitudinal evidence from South Africa. Am Econ J Appl Econ. 2009;1:22–48.CrossRefPubMedCentralPubMedGoogle Scholar
  34. 34.
    Tanser F, Hosegood V, Bärnighausen T, et al. Cohort profile: Africa Centre Demographic Information System (ACDIS) and population-based HIV survey. Int J Epidemiol. 2008;37(5):956–62.CrossRefPubMedCentralPubMedGoogle Scholar
  35. 35.
    Bärnighausen T, Tanser F, Newell M-L. Lack of a decline in HIV incidence in a rural community with high HIV prevalence in South Africa, 2003–2007. AIDS Res Hum Retrovir. 2009;25(4):405–9.CrossRefPubMedCentralPubMedGoogle Scholar
  36. 36.
    World Health Organization, UNAIDS. Guidelines for using HIV testing technologies in surveillance: selection, evaluation and implementation—2009 update. Geneva: World Health Organization; 2009.Google Scholar
  37. 37.
    Harling G, Tanser F, Mutevedzi T, Bärnighausen T. Assessing the validity of respondents’ reports of their partners’ ages in a rural South African population. BMJ Open. 2014. doi:10.1136/bmjopen-2014-005638.
  38. 38.
    Boily MC, Baggaley RF, Wang L, et al. Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. Lancet Infect Dis. 2009;9(2):118–29.CrossRefPubMedCentralPubMedGoogle Scholar
  39. 39.
    Ott MQ, Bärnighausen T, Tanser F, Lurie MN, Newell M-L. Age-gaps in sexual partnerships: seeing beyond ‘sugar daddies’. AIDS. 2011;25(6):861–3.CrossRefPubMedCentralPubMedGoogle Scholar
  40. 40.
    Zaidi J, Grapsa E, Tanser F, Newell M-L, Bärnighausen T. Dramatic increase in HIV prevalence after scale-up of antiretroviral treatment. AIDS. 2013;27(10):2301–5.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Guy Harling
    • 1
  • Marie-Louise Newell
    • 2
    • 3
  • Frank Tanser
    • 2
  • Till Bärnighausen
    • 1
    • 2
  1. 1.Department of Global Health and PopulationHarvard School of Public HealthBostonUSA
  2. 2.Africa Centre for Health and Population StudiesUniversity of KwaZulu-NatalMtubatubaSouth Africa
  3. 3.Faculty of MedicineUniversity of SouthamptonSouthamptonUK

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