title: Marriage and the risk of incident HIV infection in Rakai, Uganda.
abstract: OBJECTIVE
  Studies suggest that the prevalence of HIV is higher among long-term marital/consensual relationships than in the unmarried. We assessed the risk of incident HIV infection by marital status in rural Rakai, Uganda.
  
  
  METHODS
  Longitudinal data from the Rakai Community Cohort Study between 1999 and 2011.
  
  
  METHODS
  We estimated HIV incidence per 100 person years (py) in sexually active individuals aged 15-49 years with a total of 44,179.6 py who were never married (women 2929 py and men 4261 py), currently married or in long-term consensual relationships (currently married women 29,823 py and men 21,299 py) and previously married (women 3563 py and men 1475). Poisson multivariable regression was used to estimate the unadjusted and adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of HIV acquisition.
  
  
  RESULTS
  The HIV incidence among currently married persons was 0.93/100 py, which was lower than that for the never-married (1.51/100 py) and previously married (2.85/100 py) persons. The risk of HIV acquisition was significantly lower in the currently married compared with that in the never married among women (Adj IRR = 0.26, 95% CI: 0.16 to 0.42), but not among men (Adj IRR = 0.69, 95% CI: 0.31 to 1.52). HIV incidence was lower among first marriages (0.73/100 py) compared with that among second- or higher-order marriages (1.38/100 py). Multiple sex partners significantly increased the risk of HIV acquisition in both women (Adj IRR = 2.53, 95% CI: 1.6 to 3.97) and men (Adj IRR = 1.77, 95% CI: 1.20 to 2.60).
  
  
  CONCLUSIONS
  Current marriage especially first-order marriage was associated with a reduced risk of HIV acquisition in women, but not in men, and multiple sex partnerships increased HIV risk for both sexes.
authors.affiliation: *Rakai Health Sciences Program, Entebbe, Uganda; †Makerere University School of Public Health, Kampala, Uganda; ‡Uganda Virus Research Institute, Entebbe, Uganda; §Makerere University College of Health Sciences, Kampala, Uganda; and ‖Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: David
authors.initials: D
authors.lastname: Guwatudde
authors.forename: John B
authors.initials: JB
authors.lastname: Bwaninka
authors.forename: Fredrick E
authors.initials: FE
authors.lastname: Makumbi
authors.forename: Tom
authors.initials: T
authors.lastname: Lutalo
authors.forename: Joseph
authors.initials: J
authors.lastname: Kagaayi
authors.forename: Nelson K
authors.initials: NK
authors.lastname: Sewankambo
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.forename: David M
authors.initials: DM
authors.lastname: Serwadda
authors.forename: Xiangrong
authors.initials: X
authors.lastname: Kong
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
authors.forename: Fred
authors.initials: F
authors.lastname: Wabwire-Mangen
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008393:Marriage / Q000706:statistics & numerical data*; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012747:Sexual Partners; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult