Impact of marital status on risk of HIV in South Africa (2002–2017)

ABSTRACT

After decades of research, South African women continue to have the highest burden of HIV in the world. The aim of the study is to investigate the impact of marital status on HIV using population and community-level data sources. We included data 13,469 and 5682 South African women who participated to South African HIV behavioural surveys in 2002–2012 and 2017, respectively. HIV prevalence and incidence rates were significantly higher among single/not-cohabiting women compared to those married/cohabiting with a partner in all survey participants (adjusted odds ratio (aOR): 1.60 and 1.58 in 2002–2012 and 2017, respectively). A quarter of the HIV diagnoses were attributed to those who were single/not-cohabiting women (population attributable risk (PAR%): 25% and 24%, respectively). More than 40% of the HIV infections were exclusively associated with single women (PAR%: 42%, 95% CI: 33%, 51%). Our results provided strong evidence for the profound impact of marital status on excess HIV infection rates. Targeting and reaching single/not-cohabiting women with multiple risk factors can potentially play a crucial role in the trajectories of the epidemic.

KEYWORDS:

• HIV
• South Africa
• women
• marital status
• population and clinic-based data

Acknowledgements

The current study used the secondary sub-group data from a study supported by the President's Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of 3U2GGH000570 and the South African National AIDS Council (SANAC). All the views in this study are solely the responsibility of the authors and do not necessarily represent the official views of CDC or SANAC. The authors did not receive any funding for the current study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

HW, TR, JM, SN and NM participated in the design of the study; HW and TR extracted and merged the data and performed the statistical analysis. HW drafted the manuscript. HW, TR, JM, SN and NM interpreted the results. All authors read and approved the final manuscript.

Ethical considerations

Ethical approvals were received from the Research Ethics Committee of the Human Sciences Research Council, South Africa (REC: 5/17/11/10); the Associate Director of Science of the National Centre for HIV and AIDS, Viral Hepatitis, STD and TB Prevention at the U.S.A.’s (CDC) in Atlanta, Georgia, U.S.A. In addition, the principle investigators of the study has received additional approval from the SABSSM data curation team on 5 June 2018 and 22 August 2021.

Informed consent

Study participants who enrolled in these trials provided either written or verbal consent. Participants confirmed their consent by signature or witnessed thumbprint.