Late marriage and the HIV epidemic in sub-Saharan Africa

Popul Stud (Camb). 2007 Mar;61(1):73-83. doi: 10.1080/00324720601048343.


The causes of large variation in the sizes of HIV epidemics among countries in sub-Saharan Africa are not well understood. Here we assess the potential roles of late age at marriage and a long period of premarital sexual activity as population risk factors, using ecological data from 33 sub-Saharan African countries and with individual-level data from Demographic and Health Surveys (DHS) in Kenya and Ghana in 2003. The ecological analysis finds a significant positive correlation between HIV prevalence and median age at first marriage, and between HIV prevalence and interval between first sexual intercourse and first marriage. The individual-level analysis shows that HIV infection per year of exposure is higher before than after first marriage. These findings support the hypothesis of a link between a high average age at marriage and a long period of premarital intercourse during which partner changes are relatively common and facilitate the spread of HIV.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Africa South of the Sahara / epidemiology
  • Age Factors
  • Circumcision, Male / statistics & numerical data
  • Disease Outbreaks / statistics & numerical data*
  • Female
  • HIV Infections / epidemiology*
  • Humans
  • Male
  • Marriage / statistics & numerical data*
  • Middle Aged
  • Sexual Behavior