Partner Age Differences and Concurrency in South Africa: Implications for HIV-Infection Risk Among Young Women

Abstract

Partner-age difference is an HIV-risk factor among young women in Africa, but the underlying mechanisms are poorly understood. We used nationally representative data among black South Africans (men: 3530; women: 3946) to examine the proportion of women in partnerships involving male partner concurrency by age of female partners and by age-disparate (≥5 years) partnerships. Of all partners reported by men, 35% of young (16–24) women were in partnerships involving male partner concurrency of four weeks or longer during the past 12 months. Young women in age-disparate partnerships were more likely to be in partnerships with men who had other concurrent partners (9%; OR 1.88 p<0.01) and more likely to be connected to an older sexual network. Our results suggest that the relationship between male concurrency and age-disparate relationships may increase HIV risk for young women by connecting them to larger and older sexual networks.

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

“…Concordance between these findings support previous results indicating that partnerships between young women and significantly older men are associated with greater engagement in sexual risk behaviors. 16, 27-28 …”

Age-disparate Partnerships and Risk of HIV-1 Acquisition among South African Women Participating in the VOICE Trial

“…[5][6][7][8][9][10] Evidence in support of this hypothesis comes from surveillance data showing consistent sex-age disparities in HIV prevalence, 2,3,11,12 where the prevalence of HIV is greater among young women compared to young men, and from epidemiologic studies that report that age-disparate relationships are common among young women. 3,13,14 In South Africa, a country which continues to have the greatest HIV-1 burden globally, 2 population based surveys of women aged [15][16][17][18][19][20][21][22][23][24] reported that 33-39% of respondents had a partner >5 years older. 3,13 Campaigns to reduce or eliminate agedisparate relationships have been a prominent part of HIV-1 prevention strategies in this region and other high incidence settings.…”

“…3,13,14 In South Africa, a country which continues to have the greatest HIV-1 burden globally, 2 population based surveys of women aged [15][16][17][18][19][20][21][22][23][24] reported that 33-39% of respondents had a partner >5 years older. 3,13 Campaigns to reduce or eliminate agedisparate relationships have been a prominent part of HIV-1 prevention strategies in this region and other high incidence settings. [15][16][17] Although cross-sectional studies have reported an association between age-disparate relationships and HIV in women, 7,14,18 data from prospective studies provide limited and conflicting evidence regarding the contribution of age-disparate relationships to HIV-1 acquisition in South Africa and other African countries.…”

Correlates of concurrency among young people in Carletonville, South Africa

“…In addition, we assessed if the respondent had ever had a concurrent relationship -where the dates of two relationships overlapped. The independent variables assessed for inclusion into model A consisted of a range of socio-demographic, individual and relationship characteristics that have been shown in other studies to affect concurrency (Adimora, Schoenbach & Doherty 2007;Adimora, Schoenbach, Taylor, Khan & Schwartz 2011;Carter, Kraft, Koppenhaver, Galavotti, Roels, Kilmarx, et al 2007;Kenyon et al 2010;Mah 2010;Maughan-Brown, Kenyon & Lurie 2014;Mishra & Van Assche 2009;Sandøy, Dzekedzeke & Fylkesnes 2010;Steffenson, Pettifor, Seage, Rees & Cleary 2011;Xu et al 2010). The respondents' individual income was categorized into one of the three categories: monthly income ,R50, R50-R200 or .R200.…”