Late marriage and the HIV epidemic in sub-Saharan Africa

A longer interval between first sex and first marriage is correlated with a higher rate of HIV

By: Bongaarts J
Published by: Population Council, USA , 2006
Via: Eldis

One of the most puzzling features of the HIV epidemic in sub-Saharan Africa is the large variation in its size among countries. For example, the proportion of adults infected ranges from 33 percent in Swaziland to less than 1 percent in Mauritania, Madagascar, and Senegal.
This study investigates the possibility that late age at first marriage, and a long period of premarital sexual activity, may be risk factors for HIV infection. The relationship between marital status and the prevalence and incidence of HIV is examined with ecological data from 33 sub- Saharan African countries and with individual-level data from nationally representative Demographic and Health Surveys in Kenya and Ghana in 2003.

The ecological analysis finds a significant positive correlation between HIV prevalence and the median age at first marriage, and between HIV prevalence and the interval between first sex and first marriage. Male circumcision rates also contribute to differences in prevalence. In the individual-level analysis, the risk for HIV infection per year of exposure among sexually active women is higher before than after first marriage. These findings support the hypothesis that a high average age at marriage in a population leads to a long period of premarital sex during which partner changes are relatively common, thus facilitating the spread of HIV. However, the paper also observes that very early marriage also raises the risk of infection for young girls, because they would otherwise not be having sex during those years. For the same reason, while being married is less risky per year of exposure than being sexually active and never married, more women are infected while married than while single.