Late marriage and the HIV epidemic in sub-Saharan Africa

This Population Council working paper assesses the potential roles of late age at marriage and a long period of premarital sexual activity as population risk factors for HIV infection in sub-Saharan Africa. The relationship between marital status and the prevalence and incidence of HIV is examined with ecological data from 33 countries in the region and with individual-level data from nationally representative Demographic and Health Surveys in Kenya and Ghana in 2003. The ecological analysis finds a significant positive correlation between HIV prevalence and the median age at first marriage, and between HIV prevalence and the interval between first sex and first marriage. In the individual-level analysis, the risk for HIV infection per year of exposure among sexually active women is higher before than after first marriage. These findings support the hypothesis that a high average age at marriage in a population leads to a long period of premarital sex during which partner changes are relatively common, thus facilitating the spread of HIV