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Abstract
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.
Notes
1. John Bongaarts is at The Population Council, 1 Dag Hammarskjold Plaza, New York, NY 10017, USA. E-mail: [email protected]
2. This research was funded in part through grants from the William and Flora Hewlett Foundation and the Andrew W. Mellon Foundation. The author thanks Paul Hewett and Monica Grant for assistance in the analysis of DHS data.