Sexual behavior and HIV risk across the life course in rural South Africa: trends and comparisons

ABSTRACT

There is limited information about sexual behavior among older Africans, which is problematic given high HIV rates among older adults. We use a population-based survey among people aged 15–80+ to examine the prevalence of sexual risk and protective behaviors in the context of a severe HIV epidemic. We focus on variation across the life course, gender and HIV serostatus to compare the similarities and differences of young, middle aged, and older adults. Younger adults continue to be at risk of HIV, with potential partners being more likely to have been diagnosed with an STI and more likely to have HIV, partner change is high, and condom use is low. Middle aged and older adults engage in sexual behavior that makes them vulnerable at older ages, including extramarital sex, low condom use, and cross-generational sex with people in age groups with the highest rates of HIV. We find insignificant differences between HIV positive and negative adults’ reports of recent sexual activity. This study provides new information on sexual behavior and HIV risk across the life course in rural South Africa to inform HIV prevention and treatment programing.

KEYWORDS:

• Sexual behavior
• life course
• South Africa
• HIV/AIDS

Acknowledgments

We thank all the respondents who participated in this study and the Ha Na Kakelela field team. We are also grateful to members of the HIV Survey investigative team for their numerous contributions to the project. We also thank the people of the Agincourt sub-district for their long involvement with the MRC/Wits Rural Public Health and Health Transitions Research Unit. We are grateful to Vusumuzi G. Dlamini for his critical input during the analysis.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

We are grateful for funding support from: National Institutes of Health – R24 AG032112-05 Partnership for Social Science AIDS Research in South Africa's Era of ART Rollout (PI Jane Menken); National Institute on Aging – R01 AG049634-01 HIV after 40 in rural South Africa: Aging in the Context of an HIV epidemic (PI Sanyu Mojola); Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) – K01 HD057246 (PI Samuel Clark); MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt): the Wellcome Trust, UK (grants 058893/Z/99/A, 069683/Z/02/Z, and 085477/Z/08/Z); the Medical Research Council, University of the Witwatersrand, and Anglo-American Chairman's Fund, South Africa; the William and Flora Hewlett Foundation (grant 2008-1840), and the Andrew W. Mellon Foundation. This work has also benefited from research, administrative, and computing support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development–funded University of Colorado Population Center (P2C HD066613).