Role of widows in the heterosexual transmission of HIV in Manicaland, Zimbabwe, 1998-2003

Abstract

Background: AIDS is the main driver of young widowhood in southern Africa. Methods: The demographic characteristics of widows, their reported risk behaviours and the prevalence of HIV were examined by analysing a longitudinal populationbased cohort of men and women aged 15-54 years in Manicaland, eastern Zimbabwe. The results from statistical analyses were used to construct a mathematical simulation model with the aim of estimating the contribution of widow behaviour to heterosexual HIV transmission. Results: 413 (11.4%) sexually experienced women and 31 (1.2%) sexually experienced men were reported to be widowed at the time of follow-up. The prevalence of HIV was exceptionally high among both widows (61%) and widowers (male widows) (54%). Widows were more likely to have high rates of partner change and engage in a pattern of transactional sex than married women. Widowers took partners who were a median of 10 years younger than themselves. Mathematical model simulations of different scenarios of sexual behaviour of widows suggested that the sexual activity of widow(er)s may underlie 8-17% of new HIV infections over a 20-year period.Conclusions: This combined statistical analysis and model simulation suggest that widowhood plays an important role in the transmission of HIV in this rural Zimbabwean population. High-risk partnerships may be formed when widowed men and women reconnect to the sexual network.AIDS as the leading cause of death among adults in southern Africa 1 is the major driver of early widowhood, even in areas of low prevalence. [2][3][4][5][6] In Zimbabwe an estimated 25% of men and women aged 15-49 years were infected with HIV in 2003,7 and the resulting mortality in these age groups means that children are orphaned and spouses are widowed, thus eroding family structures.8 9 Owing to the relatively high levels of adult mortality even before the HIV epidemic, family structures were maintained by traditional intra-and intergenerational coping mechanisms such as the levirate, whereby a widow is remarried-often to a member of the deceased husband's family. [10][11][12] As the epidemic progresses and populations become aware of the impact of AIDS mortality, such practices may diminish. 13 14 Remarriage of widows involves people with a sexual history and therefore may account for some of the serodiscordant couples (where one person is HIV positive) observed in cohorts in sub-Saharan Africa.3 15 Serodiscordant couples have a higher risk of widowhood than seroconcordant-negative couples, and seroconcordant-positive couples have the highest risk of widowhood, in which case an HIV-positive widow(er) is always produced. 16Previous findings from the Manicaland HIV/ STD Prevention Study cohort and others in the southern African region, as well as modelling estimates, suggest that men mostly acquire HIV infection from premarital and extramarital relations while, for married women, the strongest determinants of infection are their partner's behaviours.9 17 18 Marriage is a potentially risky form of part...

Prevalence and Incidence of HIV Infection, Trends, and Risk Factors Among Persons Aged 15–64 Years in Kenya

“…Studies have also demonstrated that widowers are more likely to engage in high-risk sexual behavior after the death of their spouse and contribute to new HIV infections in the population. 15 …”

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An inquiry into the uneven distribution of women’s HIV infection in rural Malawi

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