in Sub-Saharan Africa, divorced, separated and widowed individuals who have remarried are more likely than those who are single or married for the first time to be HIV-positive, especially if they are female, according to an analysis of nationally representative data for 13 countries.' Compared with those in their first marriage, remarried women had higher odds of being HIV-positive in all but one country (odds ratios, 2.0-8.3). Individuals who were formerly but not currently married were also at risk; for example, in the three countries where HIV prevalence was highest, the odds of being infected were elevated at least twofold among formerly married men (2.4-5.3) and women (3.0-3.9).
Although prior studies have found high rates of HIV infection among divorced and widowed individuals in Africa, most of those studies used nonrepresentative samples or did not focus on the remarried population. To address these issues, investigators analyzed data from Demographic and Health Surveys and AIDS Indicator Surveys in which the majority of respondents (70-97% of women and 63-96% of men) had been tested for WV. Women were eligible for the surveys, which were conducted between 2003 and 2006, if they were aged 15-49; the age range for men varied across countries but was generally 15-54 or 15-59. Data for Ethiopia were available only for women, as male respondents were not tested for HIV. Respondents who had never been married (or in a marriage-like union) were classified as single; those with a history of marriage were categorized as either married for the First time, remarried or formerly married (if they were separated, divorced or widowed but not currently mat tied). To assess the relationship between remarriage and HIV status, the researchers performed descriptive analyses, as well as logistic regression analyses that adjusted for social and demographic characteristics (including the practice of polygyny).
Overall, the prevalence of HIV was relatively low in Senegal, Burkina Faso, Cote d'Ivoire, Guinea and Ethiopia (less than 2% for both sexes); moderate in Ghana, Rwanda, Cameroon, Tanzania and Kenya (3-9% among women and 2-6% among men); and high in Malawi, Zimbabwe and Lesotho (13-26% among women and 10-19% among men). Some 2-9% of men and 1-16% of women had been in a marriage that ended. Among those who were currently married or in union, 6-44% of men and 3-26% of women had previously been married.
In 10 of the 13 countries, the prevalence of HIV was higher among remarried women than among other women. For example, in Cote d'Ivoire, 13% of remarried women were infected, compared with 6% of other women; similar trends were apparent in Kenya (17% vs. 8%) and Lesotho (46% vs. 26%). The pattern was essentially the same for formerly married women, who were more likely than other women to be infected in 10 countries, including Ethiopia (6% vs. 1%), Rwanda (12% vs. 2%) and Zimbabwe (46% vs. 17%).
The relationship between marital history and HIV was less consistent among men. …