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. 2017 Jul 31;31(12):1755-1764.
doi: 10.1097/QAD.0000000000001553.

Sexual Partnership Age Pairings and Risk of HIV Acquisition in Rural South Africa

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Free PMC article

Sexual Partnership Age Pairings and Risk of HIV Acquisition in Rural South Africa

Adam Akullian et al. AIDS. .
Free PMC article

Abstract

Objective: To quantify the contribution of specific sexual partner age groups to the risk of HIV acquisition in men and women in a hyperendemic region of South Africa.

Design: We conducted a population-based cohort study among women (15-49 years of age) and men (15-55 years of age) between 2004 and 2015 in KwaZulu-Natal, South Africa.

Methods: Generalized additive models were used to estimate smoothed HIV incidence rates across partnership age pairings in men and women. Cox proportional hazards regression was used to estimate the relative risk of HIV acquisition by partner age group.

Results: A total of 882 HIV seroconversions were observed in 15 935 person-years for women, incidence rate = 5.5 per 100 person-years [95% confidence interval (CI), 5.2-5.9] and 270 HIV seroconversions were observed in 9372 person-years for men, incidence rate = 2.9 per 100 person-years (95% CI, 2.6-3.2). HIV incidence was highest among 15-24-year-old women reporting partnerships with 30-34-year-old men, incidence rate = 9.7 per 100 person-years (95% CI, 7.2-13.1). Risk of HIV acquisition in women was associated with male partners aged 25-29 years (adjusted hazard ratio; aHR = 1.44, 95% CI, 1.02-2.04) and 30-34 years (aHR = 1.50, 95% CI, 1.08-2.09) relative to male partners aged 35 and above. Risk of HIV acquisition in men was associated with 25-29-year-old (aHR = 1.72, 95% CI, 1.02-2.90) and 30-34-year-old women (aHR = 2.12, 95% CI, 1.03-4.39) compared to partnerships with women aged 15-19 years.

Conclusion: Age of sexual partner is a major risk factor for HIV acquisition in both men and women, independent of one's own age. Partner age pairings play a critical role in driving the cycle of HIV transmission.

Figures

Fig. 1
Fig. 1
Person-time between study entry (first HIV-negative test) and exit (seroconversion or lost to follow-up) is broken into exposure periods that span from study entry to midway between survey dates (for the first exposure period) and from midway between survey dates to study exit (for the last exposure period).
Fig. 2
Fig. 2
Age-specific HIV incidence with 95% confidence intervals for men and women between 2004 and 2015 for the full dataset (including individuals who had not initiated sex) (a); restricted to those who reported the age of their most recent sexual partner (b) and age-specific HIV prevalence with 95% confidence interval for men and women between 2004 and 2015 (c).
Fig. 3
Fig. 3
(Top panel) scatterplot displaying all reported relationship age pairings and associated incident HIV infections for men and women.

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References

    1. Harling G, Newell ML, Tanser F, Kawachi I, Subramanian SV, Barnighausen T. Do age-disparate relationships drive HIV incidence in young women? Evidence from a population cohort in rural KwaZulu-Natal, South Africa. J Acquir Immune Defic Syndr 2014; 66:443–451. - PMC - PubMed
    1. Balkus JE, Nair G, Montgomery ET, Mishra A, Palanee-Phillips T, Ramjee G, et al. Age-disparate partnerships and risk of HIV-1 acquisition among south african women participating in the VOICE trial. J Acquir Immune Defic Syndr 2015; 70:212–217. - PMC - PubMed
    1. Street RA, Reddy T, Ramjee G. The generational effect on age disparate partnerships and the risk for human immunodeficiency virus and sexually transmitted infections acquisition. Int J STD AIDS 2016; 27:746–752. - PubMed
    1. Biraro S, Ruzagira E, Kamali A, Whitworth J, Grosskurth H, Weiss HA. HIV-1 transmission within marriage in rural Uganda: a longitudinal study. PLoS One 2013; 8:e55060. - PMC - PubMed
    1. Kelly RJ, Gray RH, Sewankambo NK, Serwadda D, Wabwire-Mangen F, Lutalo T, Wawer MJ. Age differences in sexual partners and risk of HIV-1 infection in rural Uganda. J Acquir Immune Defic Syndr 2003; 32:446–451. - PubMed

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