NDLI: Do age-disparate relationships drive HIV incidence in young women? Evidence from a population cohort in rural KwaZulu-Natal, South Africa.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Harling, Guy Newell, Marie-Louise Tanser, Frank Kawachi, Ichiro Subramanian, S. V. Bärnighausen, Till
Spatial Coverage	South Africa
Description	Country affiliation: Morocco Author Affiliation: Harling G ( *Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA)
Abstract	BACKGROUND: Based on ethnographic investigations and mathematical models, older sexual partners are often considered a major risk factor for HIV for young women in sub-Saharan Africa. Numerous public health campaigns have been conducted to discourage young women from relationships with older men. However, longitudinal evidence relating sex partner age disparity to HIV acquisition in women is limited. METHODS: Using data from a population-based open cohort in rural KwaZulu-Natal, South Africa, we studied 15- to 29-year-old women who were HIV seronegative at first interview between January 2003 and June 2012 (n = 2444). We conducted proportional hazards analysis to establish whether the age disparity of women's most recent sexual partner, updated at each surveillance round, was associated with subsequent HIV acquisition. RESULTS: A total of 458 HIV seroconversions occurred over 5913 person-years of follow-up (incidence rate: 7.75 per 100 person-years). Age disparate relationships were common in this cohort; 37.7% of women reported a partner 5 or more years older than themselves. The age disparity of women's partners was not associated with HIV acquisition when measured either continuously [hazard ratio (HR) for 1-year increase in partner's age: 1.00, 95% confidence interval (CI): 0.97 to 1.03] or categorically (man ≥5 years older: HR, 0.98; 95% CI: 0.81 to 1.20; man ≥10 years older: HR, 0.98; 95% CI: 0.67 to 1.43). These results were robust to adjustment for known sociodemographic and behavioral HIV risk factors and did not vary significantly by women's age, marital status, education attainment, or household wealth. CONCLUSIONS: HIV incidence in young women was very high in this rural community in KwaZulu-Natal. Partner age disparity did not predict HIV acquistion. Campaigns to reduce age-disparate sexual relationships may not be a cost-effective use of HIV prevention resources in this setting.
File Format	HTM / HTML
ISSN	15254135
e-ISSN	10779450
DOI	10.1097/QAI.0000000000000198
Journal	JAIDS Journal of Acquired Immune Deficiency Syndromes
Issue Number	4
Volume Number	66
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2014-08-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline AIDS Hiv Infections Epidemiology Transmission Adolescent Aging Cohort Studies Risk Factors Sexual Partners Research Support, N.i.h., Extramural Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Infectious Diseases Pharmacology (medical)

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