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Marriage and the Risk of Incident HIV Infection in Rakai, Uganda

Nalugoda, Fred BStat, MHS*; Guwatudde, David BStat, MSc, PhD; Bwaninka, John B. BStat, MHS*; Makumbi, Fredrick E. BStat, MHS, PhD*,†; Lutalo, Tom BStat, MSc*,‡; Kagaayi, Joseph MBChB, MPH*; Sewankambo, Nelson K. MBChB, MMED, MSc*,§; Kigozi, Godfrey MBChB, MPH*; Serwadda, David M. MBChB, MMed, MSc, MPH*,†; Kong, Xiangrong PhD; Wawer, Maria J. MHSc, MD, BSc*,‖; Wabwire-Mangen, Fred MBChB, DTM&H, MPH, PhD; Gray, Ronald H. BSc, MBBS, DTM&H, MSc, MFCM*,‖

JAIDS Journal of Acquired Immune Deficiency Syndromes: January 1st, 2014 - Volume 65 - Issue 1 - p 91–98
doi: 10.1097/QAI.0b013e3182a7f08a
Epidemiology and Prevention

Objective: Studies suggest that the prevalence of HIV is higher among long-term marital/consensual relationships than in the unmarried. We assessed the risk of incident HIV infection by marital status in rural Rakai, Uganda.

Design: Longitudinal data from the Rakai Community Cohort Study between 1999 and 2011.

Methods: We estimated HIV incidence per 100 person years (py) in sexually active individuals aged 15–49 years with a total of 44,179.6 py who were never married (women 2929 py and men 4261 py), currently married or in long-term consensual relationships (currently married women 29,823 py and men 21,299 py) and previously married (women 3563 py and men 1475). Poisson multivariable regression was used to estimate the unadjusted and adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of HIV acquisition.

Results: The HIV incidence among currently married persons was 0.93/100 py, which was lower than that for the never-married (1.51/100 py) and previously married (2.85/100 py) persons. The risk of HIV acquisition was significantly lower in the currently married compared with that in the never married among women (Adj IRR = 0.26, 95% CI: 0.16 to 0.42), but not among men (Adj IRR = 0.69, 95% CI: 0.31 to 1.52). HIV incidence was lower among first marriages (0.73/100 py) compared with that among second- or higher-order marriages (1.38/100 py). Multiple sex partners significantly increased the risk of HIV acquisition in both women (Adj IRR = 2.53, 95% CI: 1.6 to 3.97) and men (Adj IRR = 1.77, 95% CI: 1.20 to 2.60).

Conclusions: Current marriage especially first-order marriage was associated with a reduced risk of HIV acquisition in women, but not in men, and multiple sex partnerships increased HIV risk for both sexes.

*Rakai Health Sciences Program, Entebbe, Uganda;

Makerere University School of Public Health, Kampala, Uganda;

Uganda Virus Research Institute, Entebbe, Uganda;

§Makerere University College of Health Sciences, Kampala, Uganda; and

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

Correspondence to: Fred Nalugoda, BStat, MHS, Rakai Health Sciences Program, PO Box 49, Entebbe, Uganda (e-mail:

Supported by the National Institutes of Health, Division of Allergy and Infectious Diseases; Bill and Melinda Gates Foundation; Department of the Army, United States Army Medical Research and Material Command Cooperative Agreement, the Henry M. Jackson Foundation; Fogarty International Center/USNIH-AITRP.

F.N., the lead author, contributed to the design and implementation of the study and was responsible for data management, analysis, interpretation, and article development. R.H.G., J.B.B., X.K., F.E.M., F.W-M., D.G., and T.L., contributed to the analysis, interpretation, and article development. D.M.S., M.J.W., N.K.S., J.K., G.K., and R.H.G., contributed to the design, implementation, and article development.

The authors have no conflicts of interest to disclose.

Received March 20, 2013

Accepted July 23, 2013

© 2014 by Lippincott Williams & Wilkins