Patterns of Marital Concurrency and HIV Risk in Africa

Ashley Fox, Mount Sinai School of Medicine

Sexual concurrency is believed to be common in Africa and a leading cause of high prevalence rates, but few studies have measured concurrency within marriage. Utilizing a multi-level model of DHS surveys with HIV-biomarkers for sixteen countries, this study assessed the relationship between individual HIV-infection and formal marital concurrency (polygamous unions) and informal marital concurrency (extramarital partner(s)) among married men and women controlling for covariates and national fixed effects. Regional-level variables (% polygamous unions, % extramarital partner) were constructed and modelled to test the contextual risk posed by living in a region with higher levels of formal and informal marital concurrency. Both formal and informal marital concurrency were positively associated with HIV infection at the individual-level controlling for covariates. However, the odds of having HIV were higher among individuals living in regions with more informal marital concurrency, but lower in regions with more polygamy, even accounting for individual-level concurrency.