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Brief Report

Age-Disparate Relationships and HIV Prevalence Among Never Married Women in Rakai, Uganda

Mwinnyaa, George MS*; Gray, Ronald H. MD, MSc*; Grabowski, Mary K. PhD, MSc; Ssekasanvu, Joseph BSc*; Ndyanabo, Anthony MSc; Ssekubugu, Robert MHS; Kagaayi, Joseph MBBS, MPH, PhD; Kigozi, Godfrey MBBS, MPH, PhD; Nakigozi, Gertrude MBBS, MPH, PhD; Serwadda, David M. MBBS, MPH, MMed‡,‖; Laeyendecker, Oliver PhD, MBA, MS§

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 1, 2018 - Volume 79 - Issue 4 - p 430–434
doi: 10.1097/QAI.0000000000001832

Background: Age-disparate relationships are associated with increased HIV prevalence. We determined whether the frequency of age-disparate relationships in never married women changed over time and whether they are associated with HIV prevalence in Rakai, Uganda.

Methods: A total of 10,061 never married women, aged 15–49 years, in the Rakai Community Cohort Study provided information on the age of their male sexual partners from 1997 to 2013. Logistic regression was used to assess trends in age-disparate relationships (≥5 years) between never married women and their male partners. Log-binomial regression was used to estimate adjusted prevalence ratios (adjPR) of HIV prevalence associated with age-disparate relationships.

Results: Two thousand nine hundred ninety-nine women (30%) had a male partner ≥5 years older, which remained stable over time. The prevalence of HIV among women in age-disparate relationships was 14%, 10% for women in relationships with men 0–4 years older (adjPR 1.36, 95% confidence interval: 1.22 to 1.53) not controlling women's age; however, after age adjustment, the impact of age-disparate relationships on HIV prevalence was attenuated. Age-disparate relationships were associated with increased HIV prevalence among women aged 15–17 years (adjPR 1.83, 95% confidence interval: 1.10 to 3.17), but not in other age groups.

Conclusions: The frequency of age-disparate relationships among never married women was unchanged over a 15-year period in Rakai, Uganda. Age-disparate relationships were associated with increased HIV prevalence among adolescents aged 15–17 years, but not older women.

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

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD;

Rakai Health Sciences Program, Kalisizo, Uganda;

§Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD; and

Makerere University, Kampala, Uganda.

Correspondence to: Oliver Laeyendecker, 855 North Wolfe Street, Rangos Building, Room 538A, Baltimore, MD 21205 (e-mail:

Supported by the National Institute of Mental Health (R01MH107275), the National Institute of Allergy and Infectious Diseases (R01AI110324, U01AI100031, U01AI075115, R01AI110324, R01AI102939, K01AI125086-01), the National Institute of Child Health and Development (RO1HD070769, R01HD050180), and Division of Intramural Research of the National Institute for Allergy and Infectious Diseases, the World Bank, the Doris Duke Charitable Foundation, the Bill & Melinda Gates Foundation (#08113, 22006.02), and the Johns Hopkins University Center for AIDS Research (P30AI094189). The findings and conclusions in this report are those of the authors and do not represent the official position of the funding agencies.

Presented at the Conference on Retroviruses and Opportunistic Infections (CROI); March 3–7, 2018; Boston, MA.

The authors have no funding or conflicts of interest to disclose.

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Received March 01, 2018

Accepted July 09, 2018

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