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2015 ; 8
(ä): 28941
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Prevalence and social drivers of HIV among married and cohabitating heterosexual
adults in south-eastern Tanzania: analysis of adult health community cohort data
#MMPMID26432785
Mtenga SM
; Pfeiffer C
; Merten S
; Mamdani M
; Exavery A
; Haafkens J
; Tanner M
; Geubbels E
Glob Health Action
2015[]; 8
(ä): 28941
PMID26432785
show ga
BACKGROUND: 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. DESIGN: 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. RESULTS: 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 (adjusted odds
ratio AOR=1.51, 95% CI 1.06-2.17), marital characteristics, that is, being
remarried (AOR=1.49, 95% CI 1.08-2.04), and sexual behavior characteristics, that
is, lifetime number of sexual partners (2-4: AOR=1.47, 95% CI 1.02-2.11; 5+:
AOR=1.61, 95% CI 1.05-2.47) were the main independent predictors of HIV
prevalence. CONCLUSIONS: 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.