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. 2023 Jan 1;37(1):113-123.
doi: 10.1097/QAD.0000000000003388. Epub 2022 Sep 19.

Male partner age, viral load, and HIV infection in adolescent girls and young women: evidence from eight sub-Saharan African countries

Sarah Ayton  1   2   3 , Amee Schwitters  4 , Joanne E Mantell  5 , Harriet Nuwagaba-Biribonwoha  1 , Avi Hakim  6 , Susie Hoffman  2   5 , Sam Biraro  1 , Neena Philip  1 , Lubbe Wiesner  7 , Elizabeth Gummerson  1 , Kristin Brown  6 , Daniel Nyogea  1 , Danielle Barradas  8 , Masauso Nzima  9 , Christa Fischer-Walker  10 , Danielle Payne  11 , Lloyd Mulenga  12 , George Mgomella  13 , Wilford L Kirungi  14 , Limpho Maile  15 , Dorothy Aibo  1 , Godfrey Musuka  1 , Owen Mugurungi  16 , Andrea Low  1   2
Affiliations

Male partner age, viral load, and HIV infection in adolescent girls and young women: evidence from eight sub-Saharan African countries

Sarah Ayton et al. AIDS. .

Abstract

Objective: We aimed to elucidate the role of partnerships with older men in the HIV epidemic among adolescent girls and young women (AGYW) aged 15-24 years in sub-Saharan Africa.

Design: Analysis of Population-based HIV Impact Assessments in Eswatini, Lesotho, Malawi, Namibia, Tanzania, Uganda, Zambia, and Zimbabwe.

Methods: We examined associations between reported partner age and recent HIV infection among AGYW, incorporating male population-level HIV characteristics by age-band. Recent HIV infection was defined using the LAg avidity assay algorithm. Viremia was defined as a viral load of more than 1000 copies/ml, regardless of serostatus. Logistic regression compared recent infection in AGYW with older male partners to those reporting younger partners. Dyadic analysis examined cohabitating male partner age, HIV status, and viremia to assess associations with AGYW infection.

Results: Among 17 813 AGYW, increasing partner age was associated with higher odds of recent infection, peaking for partners aged 35-44 (adjusted odds ratio = 8.94, 95% confidence interval: 2.63-30.37) compared with partners aged 15-24. Population-level viremia was highest in this male age-band. Dyadic analyses of 5432 partnerships confirmed the association between partner age-band and prevalent HIV infection (male spousal age 35-44-adjusted odds ratio = 3.82, 95% confidence interval: 2.17-6.75). Most new infections were in AGYW with partners aged 25-34, as most AGYW had partners in this age-band.

Conclusion: These results provide evidence that men aged 25-34 drive most AGYW infections, but partners over 9 years older than AGYW in the 35-44 age-band confer greater risk. Population-level infectiousness and male age group should be incorporated into identifying high-risk typologies in AGYW.

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Conflict of interest statement

Conflicts of interest

The authors declare that they have no competing interests.

Figures

Fig. 1.
Fig. 1.. HIV prevalence and viremia in sub-Saharan African countries.
Spatial distribution of (a) Population-Based HIV Impact Assessment countries included in analyses, and weighted subnational estimates of (b) HIV prevalence in adolescent girls and young women, and viremia in (c) men aged 25–34, and (d) 35–44 years. Viremia was defined as a viral load of more than 1000 copies/ml/all men in that age band regardless of HIV serostatus.
Fig. 2.
Fig. 2.. HIV and viremia dynamics in men and adolescent girls and young women.
Characteristics of the national breakdown of viremia in men by age group and country (a). Comparison of HIV prevalence in men and women by age across the country (b). HIV prevalence and annual incidence in adolescent girls and young women, and estimated number of new HIV cases in adolescent girls and young women by male partner age (c).
See this image and copyright information in PMC

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