Transition to Parenthood and HIV Infection in Rural Zimbabwe

Abstract

Background: The relationship between the risk of acquiring human immunodeficiency virus (HIV) infection and people's choices about life course events describing the transition to parenthood-sexual debut, union (in the form of marriage, cohabitation, or long-term relationship), and parenthood-is still unclear. A crucial role in shaping this relationship may be played by the sequence of these events and by their timing. This suggests the opportunity to focus on the life courses in their entirety rather than on the specific events, thus adopting a holistic approach that regards each individual's life course trajectory as a whole.

Methods: We summarise the individual life courses describing the transition to parenthood using ordered sequences of the three considered events. We aim to (i) investigate the association between the sequences and HIV infection, and (ii) understand how these sequences interact with known mechanisms for HIV transmission, such as the length of sexual exposure and the experience of non-regular sexual partnerships. For this purpose, we use data from a general population cohort study run in Manicaland (Zimbabwe), a Sub-Saharan African area characterised by high HIV prevalence.

Results: For both genders, individuals who experienced either premarital or delayed childbearing have higher HIV risk compared to individuals following more standard transitions. This can be explained by the interplay of the sequences with known HIV proximate determinants, e.g., a longer exposure to sexual activity and higher rates of premarital sex. Moreover, we found that people in the younger birth cohorts experience more normative and safer sequences.

Conclusions: The shift of younger generations towards more normative transitions to parenthood is a sign of behaviour change that might have contributed to the observed reduction in HIV prevalence in the area. On the other hand, for people with less normative transitions, targeted strategies are essential for HIV prevention.

Fig 1. Age at events by sequence and HIV prevalence for women.

Boxplot of the age at sexual debut, age at first union, and age at first child, by sequence, sorted by median age at sexual debut (in ascending order) and coloured according to the HIV prevalence, Manicaland (Zimbabwe), 2000–2011.

Fig 2. Age at events by sequence and HIV prevalence for men.

Boxplot of the age at sexual debut, age at first union, and age at first child, by sequence, sorted by median age at sexual debut (in ascending order) and coloured according to the HIV prevalence, Manicaland (Zimbabwe), 2000–2011.

Fig 3. Relationship between sequences and HIV across birth cohorts.

Change in the distribution across birth cohorts of the sequences and of their HIV prevalence, Manicaland (Zimbabwe), 2000–2011. Top row: bar plot of the distribution of sequences across birth cohorts, for women (left panel) and for men (right panel). Bottom row: bar plot (with 95% confidence interval) of the HIV prevalence associated with each sequence across birth cohorts, for women (left panel) and for men (right panel).