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

Lopman BA, Nyamukapa C, Hallett TB, Mushati P, Spark-du Preez N, Kurwa F, Wambe M, Gregson S - Sex Transm Infect (2009)

Bottom Line: 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.High-risk partnerships may be formed when widowed men and women reconnect to the sexual network.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Disease Epidemiology, Imperial College London, London, UK. b.lopman@imperial.ac.uk

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 population-based 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.

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Related in: MedlinePlus

Total number of partnerships in 3-year follow-up period based on marital status at baseline: 0 (light grey), 1 (dark grey), >1 (black).
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U9G-85-S1-0041-f02: Total number of partnerships in 3-year follow-up period based on marital status at baseline: 0 (light grey), 1 (dark grey), >1 (black).

Mentions: The majority (modal number) of women widowed at baseline reported no (0) total sexual partnerships in the 3 years of follow-up compared with (1) for women who were separated, divorced, married or unmarried but sexually experienced. However, the mode masks the increased likelihood of extreme levels of sexual activity (⩾10 partners in 3 years) of widows compared with those married at baseline (OR 7.1, 95% CI 2.4 to 20.8; p<0.001, adjusted for age). Only 13 men who were widowed at baseline were found at follow-up, so no comparison could be made. However, separated and divorced men were much more likely to have high sexual activity (⩾10 partners in 3 years) than those married at baseline (OR 4.1, 95% CI 1.4 to 11.6; p = 0.009, adjusted for age). A summary of the partnership history in the follow-up period is shown in fig 2.


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

Lopman BA, Nyamukapa C, Hallett TB, Mushati P, Spark-du Preez N, Kurwa F, Wambe M, Gregson S - Sex Transm Infect (2009)

Total number of partnerships in 3-year follow-up period based on marital status at baseline: 0 (light grey), 1 (dark grey), >1 (black).
© Copyright Policy - openaccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2654148&req=5

U9G-85-S1-0041-f02: Total number of partnerships in 3-year follow-up period based on marital status at baseline: 0 (light grey), 1 (dark grey), >1 (black).
Mentions: The majority (modal number) of women widowed at baseline reported no (0) total sexual partnerships in the 3 years of follow-up compared with (1) for women who were separated, divorced, married or unmarried but sexually experienced. However, the mode masks the increased likelihood of extreme levels of sexual activity (⩾10 partners in 3 years) of widows compared with those married at baseline (OR 7.1, 95% CI 2.4 to 20.8; p<0.001, adjusted for age). Only 13 men who were widowed at baseline were found at follow-up, so no comparison could be made. However, separated and divorced men were much more likely to have high sexual activity (⩾10 partners in 3 years) than those married at baseline (OR 4.1, 95% CI 1.4 to 11.6; p = 0.009, adjusted for age). A summary of the partnership history in the follow-up period is shown in fig 2.

Bottom Line: 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.High-risk partnerships may be formed when widowed men and women reconnect to the sexual network.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Disease Epidemiology, Imperial College London, London, UK. b.lopman@imperial.ac.uk

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 population-based 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.

Show MeSH
Related in: MedlinePlus