Does marital status matter in an HIV hyperendemic country? Findings from the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey

ABSTRACT

South Africa has experienced declining marriage rates and the increasing practice of cohabitation without marriage. This study aims to improve the understanding of the relationship between marital status and HIV in South Africa, an HIV hyperendemic country, through an analysis of findings from the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey. The nationally representative population-based cross-sectional survey collected data on HIV and socio-demographic and behavioural determinants in South Africa. This analysis considered respondents aged 16 years and older who consented to participate in the survey and provided dried blood spot specimens for HIV testing (N = 17,356). After controlling for age, race, having multiple sexual partners, condom use at last sex, urban/rural dwelling and level of household income, those who were married living with their spouse had significantly reduced odds of being HIV-positive compared to all other marital spouses groups. HIV incidence was 0.27% among respondents who were married living with their spouses; the highest HIV incidence was found in the cohabiting group (2.91%). Later marriage (after age 24) was associated with increased odds of HIV prevalence. Our analysis suggests an association between marital status and HIV prevalence and incidence in contemporary South Africa, where odds of being HIV-positive were found to be lower among married individuals who lived with their spouses compared to all other marital status groups. HIV prevention messages therefore need to be targeted to unmarried populations, especially cohabitating populations. As low socio-economic status, low social cohesion and the resulting destabilization of sexual relationships may explain the increased risk of HIV among unmarried populations, it is necessary to address structural issues including poverty that create an environment unfavourable to stable sexual relationships.

KEYWORDS:

• HIV risk
• HIV prevalence
• HIV incidence
• marital status
• South Africa

Acknowledgements

This study is an original in-depth analysis of findings related to marital status and HIV prevalence first presented in the overall study report (Shisana et al., 2014) The authors would like to acknowledge the contributors to the study report, as well as the study participants.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. Customary marriages in this paper refer to relationships formalized according to indigenous African rites. Although customary marriage in South Africa can, in some instances, include polygyny, it is no longer widespread (South African Law Commission, 1999) and thus not included in this analysis of national-level data.

Additional information

Funding

This work was supported by the President's Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of Cooperative Agreement Numbers [5UGPS000570-05], [3U2GGH00357-02] and [U2GPS001328]. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC. This work was also supported by the Johns Hopkins University Center for AIDS Research [grant number1P30AI094189]; and the National Institutes of Health [grant number T32AI102623].