Prevalence & Social Drivers of HIV among Married & Cohabitating Heterosexual Adults in South-Eastern Tanzania: Analysis of Adult Health Community Cohort Data

In sub-Saharan Africa, the prevalence of HIV among married and cohabiting couples is substantial. Information about the underlying social drivers of HIV transmission in couples is critical for the development of structural approaches to HIV prevention, but not readily available. We explored the association between social drivers, practices, and HIV status among stable couples in Ifakara, Tanzania.

Using a cross-sectional design, we analyzed data from a sample of 3,988 married or cohabiting individuals, aged 15 years and older from the MZIMA adult health community cohort study of 2013. Sociodemographic factors (sex, income, age, and education), gender norms (perceived acceptability for a wife to ask her partner to use a condom when she knows he is HIV positive), marriage characteristics (being in a monogamous or a polygamous marriage, being remarried), sexual behavior practices (lifetime number of sexual partners and concurrent sexual partners), health system factors (ever used voluntary HIV counseling and testing), and lifestyle patterns (alcohol use) were used to explore the odds of being HIV positive, with 95% confidence intervals.

Prevalence of HIV/AIDS was 6.7% (5.9% males and 7.1% females). Gender norms, that is, perception that a woman is not justified to ask her husband to use a condom even when she knows he has a disease, marital characteristics, that is, being remarried, and sexual behavior characteristics, that is, lifetime number of sexual partners were the main independent predictors of HIV prevalence.

Among married or cohabiting individuals, the key social drivers/practices that appeared to make people more vulnerable for HIV are gender norms, marriage characteristics (being remarried), and sexual behavior practices (lifetime number of sexual partners). Married and cohabiting couples are an important target group for HIV prevention efforts in Tanzania. In addition to individual interventions, structural interventions are needed to address the gender norms, remarriage, and sexual practices that shape differential vulnerability to HIV in stable couples.

Table 3.  HIV positive status by background characteristics: multivariate logistic regression (n=3,737)^a

Variable	Odds ratio (OR)	95% Confidence interval (CI)	p
Social demographic characteristics
Sex
Male (ref)	1.00	–	–
Female	1.23	0.90–1.67	0.189
Ever had formal education
Yes (ref)	1.00	–	–
No	1.31	0.90–1.90	0.153
Marital characteristics
Remarried
No (ref)	1.00	–	–
Yes	1.49	1.08–2.04	0.014
Sexual behavior characteristics
Lifetime number of sexual partners
1 (ref)	1.00	–	–
2–4	1.47	1.02–2.11	0.038
5+	1.61	1.05–2.47	0.028
Gender norms
Woman’s status (believing that a woman is justified to ask their husbands to use a condom if she knows he has a disease)
Yes (ref)	1.00	–	–
No	1.51	1.06–2.17	0.024
Health care utilization
Ever had VCT
Yes (ref)	1.00	–	–
No	0.76	0.57–1.01	0.061

Ref=reference/baseline category.
^aCurrently married and cohabitating heterosexuals adults who participated in MZIMA adult health community cohort conducted in Ifakara, Tanzania.

Full article at: http://goo.gl/0WWFDm

By: Mtenga SM1, Pfeiffer C2,3, Merten S2,3, Mamdani M4, Exavery A4, Haafkens J5,6, Tanner M2,3, Geubbels E4.

• 1Ifakara Health Institute, Ifakara, Tanzania; smtenga@ihi.or.tz.
• 2Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.
• 3Department of Epidemiology & Public Health (EPH), University of Basel, Basel, Switzerland.
• 4Ifakara Health Institute, Ifakara, Tanzania.
• 5Centre for Social Science and Global Health, Amsterdam Institute of Advanced Labour Studies, University of Amsterdam, Amsterdam, The Netherlands.
• 6Department of General Practice AMC, University of Amsterdam, Amsterdam, The Netherlands. 

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