AIDS and Behavior

, Volume 21, Issue 8, pp 2533–2542 | Cite as

HIV Prevalence and ART Use Among Men in Partnerships with 15–29 Year Old Women in South Africa: HIV Risk Implications for Young Women in Age-Disparate Partnerships

  • Meredith EvansEmail author
  • Brendan Maughan-Brown
  • Nompumelelo Zungu
  • Gavin George
Original Paper


This study assesses whether men’s ART use mitigates HIV-risk within age-disparate partnerships. Using data from the 2012 South African National HIV survey, we analyzed differences in HIV prevalence and ART use between men in age-disparate and age-similar partnerships with young women aged 15–29 using multiple logistic regression analyses. Within partnerships involving women 15–24 years old, men in age-disparate partnerships were more likely to be HIV-positive (5–9 year age-gap: aOR 2.8, 95%CI 1.4–5.2; p < 0.01; 10+ year age-gap: aOR 2.2, 95%CI 1.0–4.6; p < 0.05). Men in age-disparate partnerships who were 5–9 years older were significantly more likely to be HIV-positive and ART-naïve (aOR 2.4, 95%CI 1.2–4.8; p < 0.05), while this was not the case for men 10+ years older (aOR 1.5, 95%CI 0.7–3.6; p = 0.32). No evidence was found that 25–29 year old women were at greater HIV-risk in age-disparate partnerships. Our results indicate that young women aged 15–24 have a greater likelihood of exposure to HIV through age-disparate partnerships, but ART use among men 10+ years older could mitigate risk.


HIV South Africa Sexual behaviour Age-disparate partnerships Intergenerational partnerships 



The authors acknowledge the dedication of fieldworkers and research staff of the Human Sciences Research Council and partners, as well as through the contributions of study participants, who made the 2012 South African National HIV Survey possible. The authors thank Atheendar Venkataramani and David Maughan Brown for helpful comments and suggestions on previous versions of this manuscript.


This study is based on data collected as part of the 2012 South African National HIV Survey, supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of 5U2GGH000570. The contents of this study are solely the responsibility of the authors and do not necessarily represent the official views of CDC. Brendan Maughan-Brown acknowledges support from the National Research Foundation, South Africa, through the Research Career Advancement Fellowship.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

Ethical approval for the study was obtained from the Ethics Committee of the Human Sciences Research Council (HSRC), South Africa and Centers for Disease Control (CDC), United States. All procedures performed in the study were in accordance with the ethical standards of the HSRC and CDC.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10461_2017_1741_MOESM1_ESM.docx (663 kb)
Supplementary material 1 (DOCX 663 kb)


  1. 1.
    Dellar RC, Dlamini S, Karim QA. Adolescent girls and young women: key populations for HIV epidemic control. J Int AIDS Soc. 2015;18(Suppl 1):19408.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Joint United Nations Programme on HIV/AIDS (UNAIDS). Global report: UNAIDS report on the global AIDS epidemic 2013. Geneva: UNAIDS; 2013.Google Scholar
  3. 3.
    Shisana O, Rehle T, Simbayi L, et al. South African national HIV prevalence, incidence and behaviour survey, 2012. Cape Town: HSRC Press; 2014.Google Scholar
  4. 4.
    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
  5. 5.
    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
  6. 6.
    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
  7. 7.
    Chapman R, White RG, Shafer LA, et al. Do behavioural differences help to explain variations in HIV prevalence in adolescents in sub-Saharan Africa? Trop Med Int Health. 2010;15(5):554–66.CrossRefPubMedGoogle Scholar
  8. 8.
    de Oliveira T, Kharsany AB, Gräf T, et al. Transmission networks and risk of HIV infection in KwaZulu-Natal, South Africa: a community-wide phylogenetic study. Lancet HIV. 2016;. doi: 10.1016/S2352-3018(16)30186-2.PubMedGoogle Scholar
  9. 9.
    Evans M, Risher K, Zungu N, et al. Age-disparate sex and HIV risk for young women from 2002 to 2012 in South Africa. J Int AIDS Soc. 2016;19(1):21310.PubMedCentralGoogle Scholar
  10. 10.
    Shisana O, Rehle T, Simbayi L, 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
  11. 11.
    Leclerc-Madlala S. Age-disparate and intergenerational sex in southern Africa: the dynamics of hypervulnerability. AIDS. 2008;22(Suppl 4):S17–25.CrossRefPubMedGoogle Scholar
  12. 12.
    Maughan-Brown B, Kenyon C, Lurie MN. Partner age differences and concurrency in South Africa: implications for HIV-infection risk among young women. AIDS Behav. 2014;18(12):2469–76.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Bankole A, Ahmed FH, Neema S, et al. Knowledge of correct condom use and consistency of use among adolescents in four countries in sub-Saharan Africa. Afr J Reprod Health. 2007;11:197–220.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Longfield K, Glick A, Waithaka M, et al. Relationships between older men and younger women: implications for STIs/HIV in Kenya. Stud Fam Plann. 2004;35:125–34.CrossRefPubMedGoogle Scholar
  15. 15.
    Glynn JR, Caraël M, Auvert B, et al. Why do young women have a much higher prevalence of HIV than young men? A study in Kisumu, Kenya and Ndola. Zambia AIDS. 2001;15:S51–60.PubMedGoogle Scholar
  16. 16.
    Harling G, Newell ML, Tanser F, et al. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Balkus JE, Nair G, Montgomery ET, et al. Age-disparate partnerships and risk of HIV-1 acquisition among South African women participating in the VOICE Trial. J Acquir Immune Defic Syndr. 2015;70(2):212–7.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Baird SJ, Garfein RS, McIntosh CT, et al. 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;379:1320–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Dupas P. Do teenagers respond to HIV risk information? Evidence from a field experiment in Kenya. Am Econ J Appl Econ. 2009;3:1–34.CrossRefGoogle Scholar
  20. 20.
    Luke N. Age and economic asymmetries in the sexual relationships of adolescent girls in sub-Saharan Africa. Stud Fam Plann. 2003;34:67–86.CrossRefPubMedGoogle Scholar
  21. 21.
    Luke N. Confronting the “sugar daddy” stereotype: age and economic asymmetries and risky sexual behavior in urban Kenya. Int Fam Plan Perspect. 2005;31:6–14.CrossRefPubMedGoogle Scholar
  22. 22.
    Maughan-Brown B, Evans M, George G. Sexual behaviour of men and women within age-disparate partnerships in South Africa: implications for young women’s HIV risk. PLoS ONE. 2016;11(8):e0159162.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Lamb MR, Fayorsey R, Nuwagaba-Biribonwoha H, et al. High attrition before and after ART initiation among youth (15–24 years of age) enrolled in HIV care. AIDS. 2014;28(4):559.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Kenyon C, Dlamini S, Boulle A, et al. A network-level explanation for the differences in HIV prevalence in South Africa’s racial groups. Afr J AIDS Res. 2009;8(3):243–54.CrossRefPubMedGoogle Scholar
  26. 26.
    UNAIDS. Terminology guidelines. Geneva: UNAIDS; 2011.Google Scholar
  27. 27.
    Bagnol B, Chamo E. Intergenerational relationship in Mozambique: what is driving young women and older men. Sex Health Exch. 2004;3:10–1.Google Scholar
  28. 28.
    Cameron AC, Miller DL. A practitioner’s guide to Cluster-Robust inference. J Hum Resour. 2015;50(2):317–72.CrossRefGoogle Scholar
  29. 29.
    Maughan-Brown B, Lloyd N, Bor J, et al. Increasing access to HIV testing: Impacts on equity of coverage and uptake from a national campaign in South Africa. Working paper 145, Southern Africa Labour and Development Research Unit (SALDRU); 2015.Google Scholar
  30. 30.
    Eisele TP, Mathews C, Chopra M, et al. Changes in risk behavior among HIV-positive patients during their first year of antiretroviral therapy in Cape Town South Africa. AIDS Behav. 2009;13(6):1097–105.CrossRefPubMedGoogle Scholar
  31. 31.
    Maughan-Brown B, Venkataramani A. Measuring concurrent partnerships: potential for underestimation in UNAIDS recommended method. AIDS. 2011;25:1549–51. doi: 10.1097/QAD.0b013e32834905c4.CrossRefPubMedGoogle Scholar
  32. 32.
    Harling G, Tanser F, Mutevedzi T, et al. Assessing the validity of respondents’ reports of their partners’ ages in a rural South African population-based cohort. BMJ Open. 2015;5(3):e005638.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Beauclair R, Delva W. Is younger really safer? A qualitative study of perceived risks and benefits of age-disparate relationships among women in Cape Town, South Africa. PLoS ONE. 2013;8(11):e81748.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Brouard P, Crewe M. Sweetening the deal? Sugar daddies, sugar mummies, sugar babies and HIV in contemporary South Africa. Agenda. 2012;26(4):48–56.Google Scholar
  35. 35.
    Leclerc-Madlala S. Transactional sex and the pursuit of modernity. Social Dynamics. 2003;29:213–33.CrossRefGoogle Scholar
  36. 36.
    Wamoyi J, Fenwick A, Urassa M, et al. “Women’s bodies are shops”: beliefs about transactional sex and implications for understanding gender power and HIV prevention in Tanzania. Arch Sex Behav. 2011;40:5–15.CrossRefPubMedGoogle Scholar
  37. 37.
    Zembe Y, Townsend L, Thorson A, et al. “Money talks, bullshit walks” interrogating notions of consumption and survival sex among young women engaging in transactional sex in post-apartheid South Africa: a qualitative enquiry. Global Health. 2013;9:28.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Cluver L, Boyes M, Orkin M, et al. Child-focused state cash transfers and adolescent risk of HIV infection in South Africa: a propensity-score-matched case-control study. Lancet Glob Health. 2013;1(6):e362–70.CrossRefPubMedGoogle Scholar
  39. 39.
    Bekker LG, Gill K, Wallace M. Pre-exposure prophylaxis for South African adolescents: what evidence? S Afr Med J. 2015;105(11):907–11.CrossRefPubMedGoogle Scholar
  40. 40.
    Celum CL, Delany-Moretlwe S, McConnell M, et al. Rethinking HIV prevention to prepare for oral PrEP implementation for young African women. J Int AIDS Soc. 2015;18(4 Suppl 3):20227.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Walensky RP, Park JE, Wood R, et al. The cost-effectiveness of pre-exposure prophylaxis for HIV infection in South African women. Clin Infect Dis. 2012;54:1504–13.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Mills EJ, Beyrer C, Birungi J, et al. Engaging men in prevention and care for HIV/AIDS in Africa. PLoS Med. 2012;9(2):e1001167.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Van Rooyen H, McGrath N, Chirowodza A, et al. Mobile VCT: reaching men and young people in urban and rural South African pilot studies (NIMH Project Accept, HPTN 043). AIDS Behav. 2013;17(9):2946–53.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of AnthropologyYork UniversityTorontoCanada
  2. 2.Southern Africa Labour and Development Research Unit (SALDRU)University of Cape TownCape TownSouth Africa
  3. 3.HIV/AIDS, STIs and TB (HAST) and Office of the CEOHuman Sciences Research CouncilPretoriaSouth Africa
  4. 4.Health Economics and HIV and AIDS Research Division (HEARD)University of KwaZulu-NatalDurbanSouth Africa

Personalised recommendations