Trends in marriage and time spent single in sub-Saharan Africa: a comparative analysis of six population-based cohort studies and nine Demographic and Health Surveys

Abstract

Objectives: To describe trends in age at first sex (AFS), age at first marriage (AFM) and time spent single between events and to compare age-specific trends in marital status in six cohort studies. Methods: Cohort data from Uganda, Tanzania, South Africa, Zimbabwe and Malawi and Demographic and Health Survey (DHS) data from Uganda, Tanzania and Zimbabwe were analysed. Life table methods were used to calculate median AFS, AFM and time spent single. In each study, two surveys were chosen to compare marital status by age and identify changes over time. Results: Median AFM was much higher in South Africa than in the other sites. Between the other populations there were considerable differences in median AFS and AFM (AFS 17-19 years for men and 16-19 years for women, AFM 21-24 years and 18-19 years, respectively, for the 1970-9 birth cohort). In all surveys, men reported a longer time spent single than women (median 4-7 years for men and 0-2 years for women). Median years spent single for women has increased, apart from in Manicaland. For men in Rakai it has decreased slightly over time but increased in Kisesa and Masaka. The DHS data showed similar trends to those in the cohort data. The age-specific proportion of married individuals has changed little over time. Conclusions: Median AFS, AFM and time spent single vary considerably among these populations. These three measures are underlying determinants of sexual risk and HIV infection, and they may partially explain the variation in HIV prevalence levels between these populations.Timing of sexual debut and subsequent marriage dynamics are considered important factors in the spread of HIV. The timing of marriage has been shown to be important as, at an individual level, early marriage for women has been associated with an increased risk of infection.1 Conversely, late marriage has been linked to the spread of HIV as an increase in the time between sexual debut and first marriage allows for the acquisition of more premarital sexual partners and thus a higher risk of acquiring HIV before first marriage, 2 and a long time spent single and sexually active has been associated with a higher number of partners later in life. 4 5 For example, in Manicaland, Zimbabwe, an exceptionally high prevalence of HIV was observed among widows and widowers (54% and 61%, respectively, in the 2001/3 survey). 6 In the absence of discordancy, HIV is introduced to a marriage via extramarital partners.7 Furthermore, women in polygamous marriages have been shown to have a higher risk of acquiring HIV than those in monogamous marriages. 8Boerma et al 9 found that the time spent sexually active and single was longer in Kisesa, Tanzania than in Manicaland, Zimbabwe, particularly for women. In both populations, men reported a longer time spent single than women. Subsequent analyses found that the average number of person-years spent sexually active before first marriage has not changed over time in Manicaland 10 whereas, in Kisesa, an increase in time spent single has been observed, 3 9...

The contribution of HIV-discordant relationships to new HIV infections in Rakai, Uganda

“…In much of Southern Africa where age of first marriage is delayed, an even smaller proportion of people are in stable partnerships than in Eastern Africa. 6,7 Moreover, viral sequencing showed that 29% of new infections in the previously negative partner in a discordant relationship, came from a partner outside the primary relationship. 8 Thus, in addition to the question of the efficacy of a CVCT intervention with couples, universal VCT targeted on HIV-discordant couples is unlikely to have a major impact on the epidemic.…”

Recent trends in the timing of first sex and marriage among young women in Ethiopia

“…This trend is also present in sub-Saharan Africa, albeit at varying levels (Bongaarts, 2007) with teenage premarital sexual activity becoming a common phenomenon in many countries (Marston et al, 2009). The research literature identifies several factors behind the trend towards increased first sex outside of marriage and delayed marriage.…”

“…Worldwide, there has been a general trend of declining age at first sex and an increasing age at first marriage (Marston et al, 2009, Harwood-Lejeune, 2001, Kirk and Pillet, 1998, Morgan SP, 2003, Wilson, 2001, Demeny and McNicoll, 2006, Mensh BS et al, 2005). This trend is also present in sub-Saharan Africa, albeit at varying levels (Bongaarts, 2007) with teenage premarital sexual activity becoming a common phenomenon in many countries (Marston et al, 2009).…”

Premarital sexual activity among unmarried adolescents in northern Ethiopia: a cross-sectional study

“…Reports indicate that young women initiate sexual activity at an earlier age compared with boys due to factors such as cultural norms, peer pressure and economic pressure [14,15] or a combination thereof. In Ethiopia, only few studies have documented the sexual behavior of rural girls.…”