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Sexual and marital trajectories and HIV infection among ever-married women in rural Malawi.

Boileau C, Clark S, Bignami-Van Assche S, Poulin M, Reniers G, Watkins SC, Kohler HP, Heymann SJ - Sex Transm Infect (2009)

Bottom Line: The association between different trajectories and HIV prevalence was examined, controlling for potentially confounding factors such as age and region.Women who both delayed sexual debut and did not marry their first partner are, once married, more likely to experience marital disruption and to be HIV-positive.These findings identify the potential of a life course perspective for understanding why some women become infected with HIV and others do not, as well as the differentials in HIV prevalence that originate from the sequence of sexual and marital transitions in one's life.

View Article: PubMed Central - PubMed

Affiliation: Cartagene, Montreal, Quebec, Canada. Catherine.Boileau@CARTaGENE.qc.ca

ABSTRACT

Objective: To explore how sexual and marital trajectories are associated with HIV infection among ever-married women in rural Malawi.

Methods: Retrospective survey data and HIV biomarker data for 926 ever-married women interviewed in the Malawi Diffusion and Ideational Change Project were used. The associations between HIV infection and four key life course transitions considered individually (age at sexual debut, premarital sexual activity, entry into marriage and marital disruption by divorce or death) were examined. These transitions were then sequenced to construct trajectories that represent the variety of patterns in the data. The association between different trajectories and HIV prevalence was examined, controlling for potentially confounding factors such as age and region.

Results: Although each life course transition taken in isolation may be associated with HIV infection, their combined effect appeared to be conditional on the sequence in which they occurred. Although early sexual debut, not marrying one's first sexual partner and having a disrupted marriage each increased the likelihood of HIV infection, their risk was not additive. Women who both delayed sexual debut and did not marry their first partner are, once married, more likely to experience marital disruption and to be HIV-positive. Women who marry their first partner but who have sex at a young age, however, are also at considerable risk.

Conclusions: These findings identify the potential of a life course perspective for understanding why some women become infected with HIV and others do not, as well as the differentials in HIV prevalence that originate from the sequence of sexual and marital transitions in one's life. The analysis suggests, however, the need for further data collection to permit a better examination of the mechanisms that account for variations in life course trajectories and thus in lifetime probabilities of HIV infection.

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Related in: MedlinePlus

Number of HIV-positive cases and HIV prevalence (in parentheses) by sexual and marital trajectories of the women selected for the study, MDICP 2001 and 2004.
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U9G-85-S1-0027-f02: Number of HIV-positive cases and HIV prevalence (in parentheses) by sexual and marital trajectories of the women selected for the study, MDICP 2001 and 2004.

Mentions: Figure 2 shows the variations in HIV prevalence according to the sexual and marital trajectories described above. Across all trajectories the prevalence of HIV was lowest among women who married their first sexual partner and remained married to that same spouse. As noted above when discussing the results in table 1, women who had an early sexual debut were slightly more likely to be infected than those who delayed it (11.1% and 7.6%, respectively; p<0.10), although the difference was only marginally significant. Among women with a sexual debut after the age of 15, those who did not marry their first sexual partner were much more likely to be HIV-positive than those who married their first sexual partner (p<0.001). Among women with a sexual debut at ⩽15 years, however, women who did not marry their first sexual partner were no more likely to be HIV-positive than women who did. This finding can be partially explained by the relatively high proportion of these young married women who are ever-widowed and that 40% of these widows are HIV-positive. Not surprisingly, widows always exhibit an increased HIV prevalence (trajectories 3, 6, 9 and 12). Ever-divorced women also had a higher HIV prevalence than women who remained in their first marriages.


Sexual and marital trajectories and HIV infection among ever-married women in rural Malawi.

Boileau C, Clark S, Bignami-Van Assche S, Poulin M, Reniers G, Watkins SC, Kohler HP, Heymann SJ - Sex Transm Infect (2009)

Number of HIV-positive cases and HIV prevalence (in parentheses) by sexual and marital trajectories of the women selected for the study, MDICP 2001 and 2004.
© Copyright Policy - openaccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2654116&req=5

U9G-85-S1-0027-f02: Number of HIV-positive cases and HIV prevalence (in parentheses) by sexual and marital trajectories of the women selected for the study, MDICP 2001 and 2004.
Mentions: Figure 2 shows the variations in HIV prevalence according to the sexual and marital trajectories described above. Across all trajectories the prevalence of HIV was lowest among women who married their first sexual partner and remained married to that same spouse. As noted above when discussing the results in table 1, women who had an early sexual debut were slightly more likely to be infected than those who delayed it (11.1% and 7.6%, respectively; p<0.10), although the difference was only marginally significant. Among women with a sexual debut after the age of 15, those who did not marry their first sexual partner were much more likely to be HIV-positive than those who married their first sexual partner (p<0.001). Among women with a sexual debut at ⩽15 years, however, women who did not marry their first sexual partner were no more likely to be HIV-positive than women who did. This finding can be partially explained by the relatively high proportion of these young married women who are ever-widowed and that 40% of these widows are HIV-positive. Not surprisingly, widows always exhibit an increased HIV prevalence (trajectories 3, 6, 9 and 12). Ever-divorced women also had a higher HIV prevalence than women who remained in their first marriages.

Bottom Line: The association between different trajectories and HIV prevalence was examined, controlling for potentially confounding factors such as age and region.Women who both delayed sexual debut and did not marry their first partner are, once married, more likely to experience marital disruption and to be HIV-positive.These findings identify the potential of a life course perspective for understanding why some women become infected with HIV and others do not, as well as the differentials in HIV prevalence that originate from the sequence of sexual and marital transitions in one's life.

View Article: PubMed Central - PubMed

Affiliation: Cartagene, Montreal, Quebec, Canada. Catherine.Boileau@CARTaGENE.qc.ca

ABSTRACT

Objective: To explore how sexual and marital trajectories are associated with HIV infection among ever-married women in rural Malawi.

Methods: Retrospective survey data and HIV biomarker data for 926 ever-married women interviewed in the Malawi Diffusion and Ideational Change Project were used. The associations between HIV infection and four key life course transitions considered individually (age at sexual debut, premarital sexual activity, entry into marriage and marital disruption by divorce or death) were examined. These transitions were then sequenced to construct trajectories that represent the variety of patterns in the data. The association between different trajectories and HIV prevalence was examined, controlling for potentially confounding factors such as age and region.

Results: Although each life course transition taken in isolation may be associated with HIV infection, their combined effect appeared to be conditional on the sequence in which they occurred. Although early sexual debut, not marrying one's first sexual partner and having a disrupted marriage each increased the likelihood of HIV infection, their risk was not additive. Women who both delayed sexual debut and did not marry their first partner are, once married, more likely to experience marital disruption and to be HIV-positive. Women who marry their first partner but who have sex at a young age, however, are also at considerable risk.

Conclusions: These findings identify the potential of a life course perspective for understanding why some women become infected with HIV and others do not, as well as the differentials in HIV prevalence that originate from the sequence of sexual and marital transitions in one's life. The analysis suggests, however, the need for further data collection to permit a better examination of the mechanisms that account for variations in life course trajectories and thus in lifetime probabilities of HIV infection.

Show MeSH
Related in: MedlinePlus