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. Design Longitudinal data from the Rakai Community Cohort Study (RCCS) between 1999 - 2011 Methods We estimated HIV incidence per 100 person years (py) in sexually active individuals aged 15-49 with a total of 44,179.6 person years (py) who were never married (females 2,929py, males 4,261py), currently married or in long-term consensual relationships (“currently married females 29,823py, males 21,299py) and previously married (females 3,563py, males 1,475). Poisson multivariable regression was used to estimate the unadjusted and adjusted incident rate ratios (IRRs) and 95% confidence intervals (95% CI) of HIV acquisition. Results HIV incidence among currently married persons was 0.93/100py, which was lower than the never married (1.51/100py) and previously married (2.85/100py). The risk of HIV acquisition was significantly lower in the currently married compared to the never married among women (Adj IRR=0.26, 95% CI: 0.16-0.42), but not men (Adj IRR=0.69, 95% CI: 0.31-1.52). HIV incidence was lower among first marriages (0.73/100py) compared to second or higher order marriages (1.38/100py). Multiple sex partners significantly increased the risk of HIV acquisition in both women (Adj IRR=2.53, 95% CI: 1.6, 3.97) and men (Adj IRR=1.77, 95% CI: 1.20-2.60). Conclusion Current marriage especially first order marriage was associated with reduced risk of HIV acquisition in women, but not in men, and multiple sex partnerships increased HIV risk for both sexes.

Factors associated with incident HIV infection versus prevalent infection among youth in Rakai, Uganda

“…Also, as a cumulative measure, prevalence does not account for duration of exposure to risk. This period is relatively short in Rakai for never married, sexually experienced women (~2.1 years) and thus, compared with the longer married state, cumulative prevalence will likely be lower [9]. This helps explain the discrepancy seen wherein current marriage is associated with a reduced risk of incident HIV, but increased likelihood of prevalent HIV shown here and elsewhere [3,9–11].…”

Does marital status matter in an HIV hyperendemic country? Findings from the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey

“…In Uganda, a large cohort study found low incidence of HIV in married or cohabitating persons compared to unmarried persons and that having MSPs increased HIV risk (Nalugoda et al, 2014). Low HIV prevalence was also found among married individuals in Cameroon (Reither & Mumah, 2009).…”

Antiretroviral Therapy to Prevent HIV Acquisition in Serodiscordant Couples in a Hyperendemic Community in Rural South Africa

“…Higher HIV incidence among women in serodiscordant relationships may be related to higher per-act probability of HIV transmission among women than among men [ 5 ]. In some studies from SSA, marriage has been implicated as a risk factor for HIV acquisition among women [ 6 , 7 ], perhaps owing to greater vulnerability to HIV within marriage (eg, due to difficulty negotiating condom use) [ 8 – 11 ].…”