Late marriage and the HIV epidemic in sub-Saharan Africa.
The causes of large variation in the sizes of HIV epidemics among countries in sub-Saharan Africa are not well understood. Here we assess the potential roles of late age at marriage and a long period of premarital sexual activity as population risk factors, using ecological data from 33 sub-Saharan African countries and with individual-level data from Demographic and Health Surveys (DHS) in Kenya and Ghana in 2003. The ecological analysis finds a significant positive correlation between HIV prevalence and median age at first marriage, and between HIV prevalence and interval between first sexual intercourse and first marriage. The individual-level analysis shows that HIV infection per year of exposure is higher before than after first marriage. These findings support the hypothesis of a link between a high average age at marriage and a long period of premarital intercourse during which partner changes are relatively common and facilitate the spread of HIV.
Bongaarts
John
J
Population Council, New York, NY 10017, USA. jbongaarts@popcouncil.org
D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000367:Age Factors; D002944:Circumcision, Male / Q000706:statistics & numerical data; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008393:Marriage / Q000706:statistics & numerical data*; D008875:Middle Aged; D012725:Sexual Behavior