Demography

, Volume 48, Issue 4, pp 1401–1428 | Cite as

Marital Shopping and Epidemic AIDS

Article

Abstract

HIV risks decline sharply at age 30 for women in South Africa, long before coital frequencies or pregnancies decrease. I evaluate several prominent behavioral models of HIV, and find that these do not suggest sharply decreasing risks with age. I formulate a model of spousal search and find that “marital shopping” can generate epidemic HIV prevalence despite low transmission rates because search behavior interacts with dynamics of HIV infectiousness. The implied age-infection profile closely mimics that in South Africa, and the suggested behavior matches that reported by South Africans. Condom use in new relationships and transmission rate reductions are both found to be effective policies and, when used together, eliminate the potential of spousal search to spread HIV. In contrast, antiretroviral treatment is found to have only a minimal effect on the epidemic.

Keywords

Behavioral epidemiology HIV/AIDS Spousal search 

Supplementary material

13524_2011_60_MOESM1_ESM.pdf (119 kb)
ESM 1(PDF 118 kb)

References

  1. Actuarial Society of South Africa (ASSA). (2005). ASSA 2002 AIDS and Demographic Model 2002. Retrieved from http://www.assa.org.za
  2. Ali, M. M., Cleland, J., & Shah, I. B. (2004). Condom use within marriage: A neglected HIV intervention. Bulletin of the World Health Organization, 82, 180–186.Google Scholar
  3. Anderson, R. M., May, R. M., Boily, M. C., Garnett, G. P., & Rowley, J. T. (1991). The spread of HIV-1 in Africa: Sexual contact patterns and the predicted demographic impact of AIDS. Nature, 352, 581–589.CrossRefGoogle Scholar
  4. Bongaarts, J. (2006). Late marriage and the HIV epidemic in sub-Saharan Africa (Working Paper No. 216). New York: Population Council.Google Scholar
  5. Castle, P. E., Schiffman, M., Herrero, R., Hildesheim, A., Rodriguez, A. C., Bratti, M. C., . . . Burk, R. D. (2005). A prospective study of age trends in cervical human papillomavirus acquisition and persistence in Guanacaste, Costa Rica. The Journal of Infectious Diseases, 191, 1808–1816.Google Scholar
  6. Centers for Disease Control and Prevention. (2005). STD surveillance 2003. Retrieved from http://www.cdc.gov/std/stats/toc2003.htm
  7. Chen, C. Y., Ballard, R. C., Beck-Sague, C. M., Dangor, Y., Radabe, F., Schmid, S., . . . Morse, S. (2000). Human immunodeficiency virus and genital ulcer disease in South Africa: The herpetic connection. Sexually Transmitted Diseases, 27(1), 21–29.Google Scholar
  8. Clark, S. (2004). Early marriage and HIV risks in sub-Saharan Africa. Studies in Family Planning, 35, 149–160.CrossRefGoogle Scholar
  9. Clark, S., Poulin, M., & Kohler, H.-P. (2009). Marital aspirations, sexual behaviors, and HIV/AIDS in rural Malawi. Journal of Marriage and Family, 71, 396–416.CrossRefGoogle Scholar
  10. Clark, S., Kabiru, C., & Mathur, R. (2010). Relationship transitions among youth in urban Kenya. Journal of Marriage and Family, 72, 73–88.CrossRefGoogle Scholar
  11. Cohen, M. S., Gay, C., Kashuba, A. D. M., Blower, S., & Paxton, L. (2007). Narrative review: Antiretroviral therapy to prevent the sexual transmission of HIV-1. Annals of Internal Medicine, 146, 591–601.Google Scholar
  12. de Walque, D. (2007). Sero-discordant couples in five African countries: Implications for prevention strategies. Population and Development Review, 33, 501–523.CrossRefGoogle Scholar
  13. Dorrington, R., Bourne, D., Bradshaw, D., Laubsher, R., & Timaeus, I. M. (2001). The impact of HIV/AIDS on adult mortality in South Africa (Technical report). South Africa: Medical Research Council. Retrieved from http://www.mrc.ac.za/bod
  14. Downs, A. M., & De Vincenzi, I. (1996). Probability of heterosexual transmission of HIV: Relationship to the number of unprotected sexual contacts. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 11, 388–395.CrossRefGoogle Scholar
  15. Dupas, P. (2011). Do teenagers respond to HIV risk information? Evidence from a field experiment in Kenya. AEJ: Applied Economics, 3, 1–34.CrossRefGoogle Scholar
  16. Fideli, U. S., Allen, S. A., Musonda, R., Trask, S., Hahn, B. H., Weiss, H., . . . Aldrovandi, G. M. (2001). Virologic and immunologic determinants of heterosexual transmission of human immunodeficiency virus type 1 in Africa. AIDS Research and Human Retroviruses, 17, 901–910.Google Scholar
  17. Fleming, D. T., & Wasserheit, J. N. (1999). From epidemiological synergy to public health policy and practice: The contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sexually Transmitted Infections, 75, 3–17.CrossRefGoogle Scholar
  18. Gersovitz, M., Jacoby, H. G., Dedy, F. S., & Tape, A. G. (1998). The balance of self-reported heterosexual activity in KAP surveys and the AIDS epidemic in Africa. Journal of the American Statistical Association, 93, 875–883.CrossRefGoogle Scholar
  19. Ghimire, D. J., Axinn, W. G., Yabiku, S. T., & Thornton, A. (2006). Social change, premarital nonfamily experience, and spouse choice in an arranged marriage society. American Journal of Sociology, 111, 1181–1218.CrossRefGoogle Scholar
  20. Glynn, J., Carael, M., Auvert, B., Kahindo, M., Chege, J., Musonda, R., . . . the Study Group on the Heterogeneity of HIV Epidemics in African Cities. (2001). Why do young women have much higher prevalence of HIV than young men? A study in Kisumu, Kenya and Ndola, Zambia. AIDS, 15(Suppl. 4), S51–S60.Google Scholar
  21. Gray, R. H., Wawer, M. J., Brookmeyer, R., Sewankambo, N. K., Serwadda, D., Wabwire-Mangen, F., . . . the Rakai Project Team (2001). Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda. Lancet, 357, 1149–1153.Google Scholar
  22. Heckathorn, D. (1997). Respondent-driven sampling: A new approach to the study of hidden populations. Social Problems, 44, 174–199.CrossRefGoogle Scholar
  23. HIV-1 Prevention Trials Network (HPTN) (2010). A randomized, placebo-controlled trial to evaluate the effectiveness of antiretroviral therapy to prevent the sexual transmission of HIV-1 in serodiscordant couples (HPTN 052). HIV Prevention Trials Network. Retrieved from http://www.hptn.org/research_studies/hptn052.asp
  24. Jovanovic, B. (1979). Job matching and the theory of turnover. Journal of Political Economy, 87, 972–990.CrossRefGoogle Scholar
  25. Katzenstein, T. L. (2003). Molecular biological assessment methods and understanding the course of HIV infection. APMIS, 111(Suppl. 114), 1–37.Google Scholar
  26. Koopman, J. S., Jacquez, J. A., Welch, G. W., Simon, C. P., Foxman, B., Pollock, S. M., . . . Lange, K. (1997). The role of primary HIV infection in the spread of HIV through populations. Journal of Acquired Immune Deficiency Syndromes and Human Retroviruses, 14, 249–258.Google Scholar
  27. Kremer, M. (1996). Integrating behavioral choice into epidemiological models of AIDS. Quarterly Journal of Economics, 111, 549–573.CrossRefGoogle Scholar
  28. Kristof, N. D. (2005, March 30). When marriage kills. The New York Times. Retrieved from http://www.nytimes.com
  29. Lam, D., Seekings, J., & Sparks, M. (2006, December). The Cape Area Panel Study: Overview and technical documentation for Waves 1-2-3. Cape Town, South Africa: The University of Cape Town.Google Scholar
  30. Morris, M., & Kretzschmar, M. (1997). Concurrent partnerships and the spread of HIV. AIDS, 11, 641–648.CrossRefGoogle Scholar
  31. Mukiza-Gapere, J., & Ntozi, J. P. (1995). Impact of AIDS on marriage patterns, customs, and practices in Uganda. Health Transition Review, 5(Suppl.), 201–208.Google Scholar
  32. National Center for Health Statistics (2002). National Survey of Family Growth, Cycle 6. Retrieved from http://www.cdc.gov/nchs/nsfg.htm
  33. Oster, E. (2005). Sexually transmitted infections, sexual behavior, and the HIV/AIDS epidemic. Quarterly Journal of Economics, 120, 467–515.Google Scholar
  34. Pedraza, M.-A., Del Romero, J., Roldan, F., Garcia, S., Ayerbe, M.-C., Noriega, A. R., & Alcami, J. (1999). Heterosexual transmission of HIV-1 is associated with high plasma viral load levels and a positive viral isolation in the infected partner. Journal of Acquired Immune Deficiency Syndromes, 21, 120–125.Google Scholar
  35. Philipson, T. J., & Posner, R. A. (1993). Private choices and public health: The AIDS epidemic in an economic perspective. Cambridge, MA: Harvard University Press.Google Scholar
  36. Pictet, G., Le Coeur, S., M’Pele, P., Brouard, N., & Lallemant, M. (1998). Contribution of AIDS to the general mortality in central Africa: Evidence from a morgue-based study in Brazzaville, Congo. AIDS, 12, 2217–2223.CrossRefGoogle Scholar
  37. Pilcher, C. D., Tien, H. C., Eron, J. J., Jr., Vernazza, P. L., Stewart, P. W., Goh, L.-E., & Cohen, M. S. (2004). Brief but efficient: Acute HIV infection and the sexual transmission of HIV. The Journal of Infectious Diseases, 189, 1785–1792.CrossRefGoogle Scholar
  38. Potts, M., Haperin, D. T., Kirby, D., Swidler, A., Marseille, E., Klausner, J. D., . . . Walsh, J. (2008). Reassessing HIV prevention. Science, 320, 749–750.Google Scholar
  39. Quinn, T. C., Wawer, M. J., Sewankambo, N., Serwadda, D., Li, C., Wabwire-Mangen, F., . . . the Rakai Project Study Group (2000). Viral load and heterosexual transmission of human immunodeficiency virus type 1. New England Journal of Medicine, 342, 921–929.Google Scholar
  40. Republic of South Africa, Ministry of Health. (2008). Progress report on declaration and commitment on HIV and AIDS: Republic of South Africa. Prepared for the United Nations General Assembly Special Session on HIV and AIDS. Retrieved from http://data.unaids.org/pub/Report/2008/south_africa_2008_country_progress_report_en.pdf
  41. Sewankambo, N. K., Gray, R. H., Ahamad, S., Serwadda, D., Wabwire-Mangen, F., Nalu-goda, F., . . . Wawer, M. J. (2000). Mortality associated with HIV infection in rural Rakai district, Uganda. AIDS, 14, 2391–2400.Google Scholar
  42. Smith, D. J. (2000). “These girls today na war-o”: Premarital sexuality and modern identity in southeastern Nigeria. Africa Today, 47(2), 99–120.CrossRefGoogle Scholar
  43. Smith, J. S., & Robinson, N. J. (2002). Age-specific prevalence of infection with herpes simplex virus types 2 and 1: A global review. The Journal of Infectious Diseases, 186(Suppl. 1), S3–S28.CrossRefGoogle Scholar
  44. South Africa Department of Health and ORC Macro (2001). South African Demographic and Health Survey 1998. Retrieved from http://www.measuredhs.com
  45. Statistics South Africa. (2005). Mortality and causes of death in South Africa, 1997–2003: Findings from death notification (statistical release). Pretoria, South Africa: Statistics South Africa.Google Scholar
  46. Statistics South Africa (Producer) (2002–2004). South Africa Labour Force Survey, September 2001. Pretoria, South Africa: South African Data Archive (distributor). Retrieved from http://www.nrf.ac.za/sada
  47. Te Velde, E. R., & Pearson, P. L. (2002). The variability of female reproductive ageing. Human Reproductive Update, 8, 141–154.CrossRefGoogle Scholar
  48. Templeton, A., Morris, J. K., & Parslow, W. (1996). Factors that affect the outcome of in-vitro fertilization. Lancet, 348, 1402–1406.CrossRefGoogle Scholar
  49. Thornton, A., Chang, J.-S., & Lin, H.-S. (1994). From arranged marriage toward love match. In A. Thornton & H.-S. Lin (Eds.), Social change and the family in Taiwan (pp. 148–177). Chicago, IL: The University of Chicago Press.Google Scholar
  50. UNAIDS (2004). AIDS epidemic update December 2004. Retrieved from http://www.unaids.org
  51. U.S. Census Bureau. (2006, December). HIV/AIDS surveillance data base. Retrieved from http://www.census.gov/ipc/www/hivaidsd.html
  52. van Noord-Zaadstra, B. M., Looman, C. W., Alsbach, H., Habbema, J. D., Te Velde, E. R., & Karbaat, J. (1991). Delaying childbirth: Effect of age on fecundity and outcome of pregnancy. British Medical Journal, 302, 1361–1365.CrossRefGoogle Scholar
  53. Wawer, M. J., Sewankambo, N. K., Serwadda, D., Quinn, T. C., Paxton, L. A., Kiwanuka, N., . . . Gray, R. H. (1999). Control of sexually transmitted diseases in Uganda: A randomized community trial. Lancet, 353, 525–535.Google Scholar
  54. Wawer, M. J., Gray, R. H., Sewankambo, N. K., Serwadda, D., Li, X., Laeyendecker, O., . . . Quinn, T. C. (2005). Rates of HIV-1 infection per coital act by stage of HIV-1 infection, in Rakai, Uganda. The Journal of Infectious Diseases, 191, 1403–1409.Google Scholar
  55. Yerly, S., Vora, S., Rizzardi, P., Chave, J.-P., Vernazzi, P., Flepp, M., . . . the Swiss HIV Cohort Study. (2001). Acute HIV infection: Impact on the spread of HIV and transmission of drug resistance. AIDS, 15, 2287–2292.Google Scholar

Copyright information

© Population Association of America 2011

Authors and Affiliations

  1. 1.University of California, BerkeleyBerkeleyUSA

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