Transition to Parenthood and HIV Infection in Rural Zimbabwe.
BACKGROUND
The relationship between the risk of acquiring human immunodeficiency virus (HIV) infection and people's choices about life course events describing the transition to parenthood-sexual debut, union (in the form of marriage, cohabitation, or long-term relationship), and parenthood-is still unclear. A crucial role in shaping this relationship may be played by the sequence of these events and by their timing. This suggests the opportunity to focus on the life courses in their entirety rather than on the specific events, thus adopting a holistic approach that regards each individual's life course trajectory as a whole.


METHODS
We summarise the individual life courses describing the transition to parenthood using ordered sequences of the three considered events. We aim to (i) investigate the association between the sequences and HIV infection, and (ii) understand how these sequences interact with known mechanisms for HIV transmission, such as the length of sexual exposure and the experience of non-regular sexual partnerships. For this purpose, we use data from a general population cohort study run in Manicaland (Zimbabwe), a Sub-Saharan African area characterised by high HIV prevalence.


RESULTS
For both genders, individuals who experienced either premarital or delayed childbearing have higher HIV risk compared to individuals following more standard transitions. This can be explained by the interplay of the sequences with known HIV proximate determinants, e.g., a longer exposure to sexual activity and higher rates of premarital sex. Moreover, we found that people in the younger birth cohorts experience more normative and safer sequences.


CONCLUSIONS
The shift of younger generations towards more normative transitions to parenthood is a sign of behaviour change that might have contributed to the observed reduction in HIV prevalence in the area. On the other hand, for people with less normative transitions, targeted strategies are essential for HIV prevention.
Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy.
Emanuele
http://orcid.org/0000-0001-7352-8525
E
Del Fava
Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy.|Department of Decision Science, Bocconi University, Milan, Italy.
Raffaella
R
Piccarreta
Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.|Biomedical Research and Training Institute, Harare, Zimbabwe.
Simon
S
Gregson
Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy.|Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy.
Alessia
A
Melegaro
Health Transit Rev. 1994;4 Suppl:93-110
10150527
AIDS. 1999 Oct 22;13(15):2133-41
10546867
AIDS. 2000;14 Suppl 3:S85-99
11086852
AIDS. 2000 Oct 20;14(15):2323-31
11089620
AIDS. 2001 Aug;15 Suppl 4:S51-60
11686466
Lancet. 2002 Jun 1;359(9321):1896-903
12057552
Milbank Q. 2002;80(3):433-79, iii
12233246
Sex Transm Dis. 2002 Oct;29(10):568-75
12370523
J Epidemiol Community Health. 2003 Oct;57(10):778-83
14573579
Reprod Health Matters. 2003 Nov;11(22):122-33
14708403
Soc Sci Med. 2004 Jul;59(2):299-310
15110421
Stud Fam Plann. 2004 Sep;35(3):149-60
15511059
Sex Transm Infect. 2004 Dec;80 Suppl 2:ii36-42
15572638
J Infect Dis. 2005 Feb 1;191 Suppl 1:S61-7
15627232
Am J Epidemiol. 2005 Apr 15;161(8):774-80
15800270
Science. 2006 Feb 3;311(5761):664-6
16456081
Bull World Health Organ. 2006 Mar;84(3):189-97
16583077
Int Fam Plan Perspect. 2006 Jun;32(2):79-88
16837388
Cult Health Sex. 2005 Sep-Oct;7(5):479-92
16864217
Sex Transm Infect. 2007 Aug;83 Suppl 1:i61-69
17215273
Stat Med. 2007 Oct 15;26(23):4352-74
17342754
Popul Stud (Camb). 2007 Mar;61(1):73-83
17365874
Stud Fam Plann. 2007 Mar;38(1):1-10
17385378
BMC Public Health. 2007 Apr 23;7:60
17448256
Demography. 1991 Nov;28(4):493-512
1769399
Andrologia. 2008 Apr;40(2):72-5
18336453
Demography. 2008 May;45(2):417-38
18613488
Sex Transm Infect. 2009 Apr;85 Suppl 1:i20-6
19307336
Sex Transm Infect. 2009 Apr;85 Suppl 1:i27-33
19307337
Sex Transm Infect. 2009 Apr;85 Suppl 1:i34-40
19307339
Sex Transm Infect. 2009 Apr;85 Suppl 1:i56-63
19307342
Sex Transm Infect. 2009 Apr;85 Suppl 1:i64-71
19307343
Int Perspect Sex Reprod Health. 2009 Jun;35(2):82-90
19620092
AIDS Behav. 2010 Jun;14(3):708-15
19623481
Demography. 2010 Feb;47(1):1-22
20355681
Afr J Reprod Health. 2008 Aug;12(2):64-74
20695042
Afr J Reprod Health. 2008 Aug;12(2):98-110
20695045
Stud Fam Plann. 2009 Dec;40(4):261-76
21151844
Sex Transm Dis. 2011 Jun;38(6):475-82
21278627
J Urban Health. 2011 Jun;88 Suppl 2:S318-40
21340662
PLoS Med. 2011 Feb 08;8(2):e1000414
21346807
Fertil Steril. 2011 Sep;96(3):546-53
21722892
Int Perspect Sex Reprod Health. 2011 Dec;37(4):181-90
22227625
Am Sociol Rev. 2011 Dec 1;76(6):935-954
22536003
Am J Reprod Immunol. 2013 Feb;69 Suppl 1:27-40
23176109
Stud Fam Plann. 2012 Sep;43(3):191-9
23185862
Sex Transm Infect. 2013 May;89(3):245-50
23241967
BMC Pregnancy Childbirth. 2013 Mar 21;13:72
23517021
J AIDS HIV Res. 2013 Feb;5(2):59-64
23626920
Demography. 2013 Oct;50(5):1521-49
23839100
Health Place. 2014 Jul;28:45-9
24747195
Genus. 2009;65(2):45-77
24948839
Popul Dev Rev. 2013 Jun;39(2):231-256
25067862
PLoS One. 2015 Apr 23;10(4):e0124537
25906185
PLoS One. 2015 Jul 24;10(7):e0129611
26208134
SSM Popul Health. 2016 Feb 23;2:164-174
29349137