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. 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 Stoner  1 , Nadia Nguyen  2 , Kelly Kilburn  1 , F Xavier Gómez-Olivé  3   4 , Jessie K Edwards  5 , Amanda Selin  5 , James P Hughes  6   7 , Yaw Agyei  8 , Catherine Macphail  3   9   10 , Kathleen Kahn  3   4   11 , Audrey Pettifor  1   5   3
Affiliations

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

Marie C D Stoner et al. AIDS. .

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.
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.
See this image and copyright information in PMC

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