Risk factors for HIV infection among married couples in Rakai, Uganda: a cross-sectional study

Abstract

Background: Although married couples can be at an elevated risk of HIV infection, few studies have explored the risk factors for HIV infection at the couple-level. We explored the risk factors for HIV infection among married couples in settings with differing HIV prevalence levels in Rakai, Uganda. Methods: This was a cross-sectional study conducted among 664 heterosexual couples living in three HIV prevalence strata (low: 9-11.2%; medium: 11.4-20% or high HIV prevalence: 21-43%) in Rakai District, south-western Uganda, between November 2013 and February 2014. Data were collected on socio-demographic and behavioural characteristics from all consenting adults and aggregated to allow for couple-level analyses. We conducted bivariate and multivariable Logistic regression to assess the factors that were independently associated with HIV infection among married couples. Data were analysed using STATA statistical software (version 14.1). Results: Of the 664 couples, 6.4% (n = 42) were in HIV-discordant relationships; 5.8% (n = 39) were in concordant HIV-positive relationships while 87.8% (n = 583) were in concordant HIV-negative relationships. At the bivariate analysis, we found that residing in a high HIV prevalence stratum, reporting extra-marital relations, age difference between partners and number of previous marriages were significantly associated with being part of an HIV infected couple. After adjusting for potential cofounders, living in a high HIV prevalence stratum (Adjusted OR [AOR] =2.31, 95% CI: 1.52, 3.52), being in a third or higher order relationship (AOR = 3.80, 95% CI: 2.30, 6.28), and engagement in extra-marital relations (AOR = 1.75; 95% CI: 1.19, 2.59) were associated with couple HIV infection. Individuals that had stayed together for six or more years had 28% odds of being part of an HIV infected couple (AOR = 0.28; 95%CI: 0.18, 0.43). Conclusion: Living in a high HIV prevalence stratum, engagement in extra-marital relations and having a higher number of previous marriages were significant risk factors for HIV infection among married couples. Long marital duration was associated with reduced risk of HIV infection. Interventions that increase marital stability and those that promote pre-marital couples' HIV testing before marital formation can reduce HIV transmission risk among married couples in this setting.

Correlates of HIV Status Nondisclosure by Pregnant Women Living With HIV to Their Male Partners in Uganda: A Cross-Sectional Study

“…24 Approximately 30% of our study population of PWLHIV reported being in a polygamous relationship (over triple the national average of 8%) 25 , polygamy should be studied as a potential contributing factor for HIV transmission in addition to concurrent or extra-marital relations. 26 Limitations of this study include the cross-sectional analysis of baseline data, which limits causal inferences and assessment of temporality between HIV status disclosure and explanatory variables. In addition, women in this sample were recruited from a clinical trial and may not be fully representative of the general population of PWLHIV.…”

HIV Exposure through Heterosexual Contacts: Analysis of Demographic, Behavioral and Structural Risk Factors among Black Men in Ottawa and Windsor, Ontario

“…Similarly, another study found that the odds of HIV infection was lower among married individuals who were still living with their spouse compared to all other marital status groups [46]. In terms of marriage duration, a study found that HIV Risk reduced with number of years spent in a marriage relationship [47].…”

Association between extra-spousal partnerships and HIV prevalence among married individuals in Rakai, Uganda

“…This secondary analysis uses data from a large cross-sectional study conducted among married or cohabiting individuals in Rakai district, southwestern Uganda, between November 2013 and February 2014. The methods for the large study have been described previously (Matovu et al, 2015, Matovu et al, 2016, Nabukenya et al, 2020. In brief, data were collected from married or cohabiting individuals aged 15-49 years, residents in three study regions of differing HIV prevalence within the Rakai Community Cohort Study (RCCS) enumeration area.…”

“…Factors such as early marriage, Condomless sex, living in a high prevalence area, history of remarriage, and extra-spousal or concurrent sexual partnerships among others have been reported to shape the HIV epidemic among married or cohabiting individuals (Nabukenya et al, 2020, Kasamba et al, 2011, Carpenter et al, 1999, Guthrie et al, 2007. Literature also has it that married women's greatest risk for HIV infection is their husbands' extra-marital sexual activities (Parikh, 2007), though of late, women have picked up on such partnerships as well.…”