Characteristics of Age-Discordant Partnerships Associated With HIV Risk Among Young South African Women (HPTN 068)

Abstract

Objective Sexual liaisons between older men and younger women have been linked to greater risk of HIV acquisition. This study aims to: 1) identify psychosocial and behavioral factors associated with age-discordant (partner ≥ 5 years older) versus age-concordant partnerships (−1<partner< 5); and 2) examine the association between partner age discordance and young South African women's sexual behavior. Methods We used generalized estimating equations to analyze responses from 656 sexually-experienced females (aged 13-20 years) from rural Mpumalanga province. Results Partner age discordance was associated with greater odds of reporting both more frequent sex (adjusted odd ratio [aOR] = 1.77, 95% CI 1.20-2.60) and having a partner with concurrent partnerships (aOR = 1.77, 95% CI 1.22-2.57). Age-discordant partnerships were associated with greater odds of: casual partnerships (aOR 1.50, 95% CI 1.06-2.13), having a partner with concurrent partnerships (aOR 1.71, 95% CI 1.19-2.46) and more frequent intercourse (i.e., having sex at least 2 or 3 times per month) (aOR 2.04, 95% CI 1.39-3.00). They were associated with lower odds of reporting condom use at last sex (aOR 0.70, 95% CI 0.50-0.98) and always using condoms (aOR 0.53, 95% CI 0.32-0.88) in age-discordant partnerships. Conclusion Our findings suggest that a history of age-discordant partnerships, and to a lesser extent having an age-discordant partner, is linked to HIV risk among young South African women; however, the link between partner age discordance and HIV risk may be more strongly related to the characteristics of age-discordant partnerships than to characteristics of young women who form such partnerships.

Who are the male partners of adolescent girls and young women in Swaziland? Analysis of survey data from community venues across 19 DREAMS districts

“…Disclosing HIV status to a partner (whether a negative, positive or unknown status) was less likely to happen when that partner was an adolescent girl, ages 15–19 years, versus older (ages 20+ years), as well as when that partner was more than five years younger than the respondent. This concurs with recent findings of attributes of age disparity in relationships that are directly responsible for placing young women at risk—including more frequent sex and less consistent condom use [ 5 , 27 ], and further suggests that conversations about HIV status may be particularly difficult in relationships with adolescent girls specifically. However, few studies report on (or perhaps measure) HIV status disclosure, which the present findings suggest may be an important factor to assess and address.…”

Predictors of contraceptive use among adolescent girls and young women (AGYW) aged 15 to 24 years in South Africa: results from the 2012 national population-based household survey

“…Epidemiologic studies of relationships and contraceptive use have demonstrated a strong association between relationship type, and contraceptive decision-making including condom use [26]. For example, evidence shows that condom use is negotiable when the age range between partners is within 5 years, and this has been linked to gender-power dynamics [26,[29][30][31][32]. The results also showed that contraceptive use was less likely among AGYW who had not given birth as observed in other studies [33].…”

Partner age differences and associated sexual risk behaviours among adolescent girls and young women in a cash transfer programme for schooling in Malawi

“…While similar associations between age-disparate relationships and condom use [ 18 – 22 ] or sex frequency [ 20 , 21 ] have been noted in other studies, the relationship between age differences and duration of relationships has been less studied. We found that the older a man was compared to the girl, the less likely they were to terminate their relationship.…”

“…Second, older male partners are more likely to be in a concurrent relationship [ 7 , 13 , 17 ], which increases the likelihood young women will be sexually active with a man when he experiences acute HIV infection. Finally, age-asymmetric relationships have been reported to result in inconsistent condom use [ 18 – 22 ] and higher frequencies of sex [ 20 , 21 ]. This could be due to the gender-power imbalances that may be more likely in age-disparate relationships, and which result in less ability of younger women to negotiate when and how sex occurs [ 21 , 23 ].…”