Age-disparate partnerships and incident HIV infection in adolescent girls and young women in rural South Africa

doi:10.1097/QAD.0000000000002037

. 2019 Jan 27;33(1):83-91.

doi: 10.1097/QAD.0000000000002037.

Age-disparate partnerships and incident HIV infection in adolescent girls and young women in rural South Africa

Marie C D Stoner¹, Nadia Nguyen², Kelly Kilburn¹, F Xavier Gómez-Olivé^{3

4}, Jessie K Edwards⁵, Amanda Selin⁵, James P Hughes^{6

7}, Yaw Agyei⁸, Catherine Macphail^{3

9

10}, Kathleen Kahn^{3

4

11}, Audrey Pettifor^{1

5

3}

Affiliations

¹ Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina.
² HIV Center for Clinical and Behavioral Studies at Columbia University at the New York State Psychiatric Institute, New York.
³ MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁴ INDEPTH Network, Accra, Ghana.
⁵ Department of Epidemiology, University of North Carolina, Chapel Hill, New York, USA.
⁶ Department of Biostatistics, University of Washington.
⁷ Fred Hutchinson Cancer Research Center, Seattle, Washington.
⁸ School of Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA.
⁹ School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia.
¹⁰ Wits Reproductive Health and HIV Research Institute, University of the Witwatersrand, Johannesburg, South Africa.
¹¹ Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.

PMID: 30289813
PMCID: PMC6279556
DOI: 10.1097/QAD.0000000000002037

Age-disparate partnerships and incident HIV infection in adolescent girls and young women in rural South Africa

Marie C D Stoner et al. AIDS. 2019.

. 2019 Jan 27;33(1):83-91.

doi: 10.1097/QAD.0000000000002037.

Authors

Affiliations

¹ Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina.
² HIV Center for Clinical and Behavioral Studies at Columbia University at the New York State Psychiatric Institute, New York.
³ MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁴ INDEPTH Network, Accra, Ghana.
⁵ Department of Epidemiology, University of North Carolina, Chapel Hill, New York, USA.
⁶ Department of Biostatistics, University of Washington.
⁷ Fred Hutchinson Cancer Research Center, Seattle, Washington.
⁸ School of Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA.
⁹ School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia.
¹⁰ Wits Reproductive Health and HIV Research Institute, University of the Witwatersrand, Johannesburg, South Africa.
¹¹ Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.

PMID: 30289813
PMCID: PMC6279556
DOI: 10.1097/QAD.0000000000002037

Abstract

Objective: Adolescent girls and young women (AGYW) have a much higher risk of HIV infection than young men of the same age. One hypothesis for this disparity is AGYW are more likely to be in sexual partnerships with older men with HIV; however, evidence has been inconclusive.

Design: We used longitudinal data from a randomized trial in South Africa (HPTN 068) to determined whether partner age difference is associated with incident HIV infection in AGYW.

Methods: Age difference was examined continuously and dichotomously (≥5 years). We examined inverse probability of exposure weighted survival curves and calculated time-specific risk differences and risk ratios over 5.5 years of follow-up. We also used a marginal structural Cox model to estimate hazard ratios over the entire study period.

Results: Risk of HIV was higher in AGYW with an age-disparate partnership versus not and the risk difference was largest at later time points. At 5.5 years, AGYW with an age-disparate partnership had a 12.6% (95% confidence interval 1.9-23.3) higher risk than AGYW with no age-disparate partnerships. The weighted hazard ratio was 1.91 (95% confidence interval 1.33-2.74), an association that remained after weighting for either transactional or condomless sex, and after examining continuous age-differences.

Conclusion: Age-disparate partnerships increased risk of HIV infection, even after accounting for transactional sex and condomless sex. The relationship between age-disparate partnerships and HIV infection may be explained by increased exposure to infection from men in a higher HIV prevalence pool rather than differences in sexual behaviour within these partnerships.

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Conflict of interest statement

Conflicts of interest

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

We have no conflicts of interest to declare.

Figures

Fig. 1.. Cumulative incidence curves for the association between age-disparate partnership and incident HIV infection for 1626 sexually active young women with no prevalent HIV infection from HPTN 068 conducted in 2011–2017.
(a) Unweighted; (b) weighted. Exposure weighted curves accounted for the following covariates: age at baseline, time-varying school enrolment or completion, time-varying alcohol use, intervention assignment at baseline.

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References

1. Gómez-Olivé FX, Angotti N, Houle B, Klipstein-Grobusch K, Kabudula C, Menken J, et al. Prevalence of HIV among those 15 and older in rural South Africa. AIDS Care 2013; 25:1122–1128. - PMC - PubMed
1. Luke N. Age and economic asymmetries in the sexual relationships of adolescent girls in sub-Saharan Africa. Stud Fam Plann 2003; 34:67–86. - PubMed
1. Luke N Confronting the ‘sugar daddy’ stereotype: age and economic asymmetries and risky sexual behavior in urban Kenya. Int Fam Plan Perspect 2005; 31:6–14. - PubMed
1. Maughan-Brown B, Kenyon C, Lurie MN. Partner age differences and concurrency in South Africa: implications for HIV-infection risk among young women. AIDS Behav 2014; 18:2469–2476. - PMC - PubMed
1. Jewkes RK, Levin JB, Penn-Kekana LA. Gender inequalities, intimate partner violence and HIV preventive practices: findings of a South African cross-sectional study. Soc Sci Med 2003; 56:125–134. - PubMed

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[1] Gómez-Olivé FX, Angotti N, Houle B, Klipstein-Grobusch K, Kabudula C, Menken J, et al. Prevalence of HIV among those 15 and older in rural South Africa. AIDS Care 2013; 25:1122–1128. - PMC - PubMed

[2] Gómez-Olivé FX, Angotti N, Houle B, Klipstein-Grobusch K, Kabudula C, Menken J, et al. Prevalence of HIV among those 15 and older in rural South Africa. AIDS Care 2013; 25:1122–1128. - PMC - PubMed

[3] Luke N. Age and economic asymmetries in the sexual relationships of adolescent girls in sub-Saharan Africa. Stud Fam Plann 2003; 34:67–86. - PubMed

[4] Luke N. Age and economic asymmetries in the sexual relationships of adolescent girls in sub-Saharan Africa. Stud Fam Plann 2003; 34:67–86. - PubMed

[5] Luke N Confronting the ‘sugar daddy’ stereotype: age and economic asymmetries and risky sexual behavior in urban Kenya. Int Fam Plan Perspect 2005; 31:6–14. - PubMed

[6] Luke N Confronting the ‘sugar daddy’ stereotype: age and economic asymmetries and risky sexual behavior in urban Kenya. Int Fam Plan Perspect 2005; 31:6–14. - PubMed

[7] Maughan-Brown B, Kenyon C, Lurie MN. Partner age differences and concurrency in South Africa: implications for HIV-infection risk among young women. AIDS Behav 2014; 18:2469–2476. - PMC - PubMed

[8] Maughan-Brown B, Kenyon C, Lurie MN. Partner age differences and concurrency in South Africa: implications for HIV-infection risk among young women. AIDS Behav 2014; 18:2469–2476. - PMC - PubMed

[9] Jewkes RK, Levin JB, Penn-Kekana LA. Gender inequalities, intimate partner violence and HIV preventive practices: findings of a South African cross-sectional study. Soc Sci Med 2003; 56:125–134. - PubMed

[10] Jewkes RK, Levin JB, Penn-Kekana LA. Gender inequalities, intimate partner violence and HIV preventive practices: findings of a South African cross-sectional study. Soc Sci Med 2003; 56:125–134. - PubMed

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Age-disparate partnerships and incident HIV infection in adolescent girls and young women in rural South Africa

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Age-disparate partnerships and incident HIV infection in adolescent girls and young women in rural South Africa

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Abstract

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