Partner age differences and associated sexual risk behaviours among adolescent girls and young women in a cash transfer programme for schooling in Malawi

Undefined

Abstract
Background:
Age disparities in sexual relationships have been proposed as a key risk factor for HIV transmission in Sub-Saharan Africa, but evidence remains inconclusive. The SIHR study, a cluster randomised trial of a cash transfer programme in Malawi, found that young women in the intervention groups were less likely to have had a sexual partner aged 25 or older, and less likely to test positive for HIV and HSV-2 at follow-up compared to control groups. We examined the hypotheses that girls in the intervention groups had smaller age differences than control groups and that large age differences were associated with relationship-level HIV transmission risk factors: inconsistent condom use, sex frequency, and relationship duration.
Methods:
We conducted an analysis of schoolgirls in the Schooling, Income, and Health Risk (SIHR) study aged 13-22 at baseline (n= 2907). We investigated the effects of study arm, trial stage and participant age on age differences in sexual relationships using a linear mixed-effects model. Cumulative-link mixed-effects models were used to estimate the effect of relationship age difference on condom use and sex frequency, and a Cox proportional hazard model was used to estimate the effect of relationship age difference on relationship duration. We controlled for the girl’s age, number of partners, study group and study round.
Results:
Girls receiving cash transfers, on average, had smaller age differences in relationships compared to controls, though the estimated difference was not statistically significant (−0.43 years; 95% CI: -1.03, 0.17). The older the participant
was, the smaller her age differences (−0.67 per 4-year increase in age; 95% CI: -0.99,−0.35). Among controls, after the
cash transfers had ended the average age difference was 0.82 years larger than during the intervention (95% CI: 0.43, 1.21), suggesting a possible indirect effect of the study on behaviour in the community as a whole. Across treatment groups, larger age differences in relationships were associated with lower levels of condom use, more frequent sex, and longer relationship durations.
Conclusions:
Cash-transfer programmes may prevent HIV transmission in part by encouraging young women to formage-similar relationships, which are characterised by increased condom use and reduced sex frequency. The benefits of these programmes may extend to those who are not directly receiving the cash.
Keywords:
Malawi, Sexual risk behaviour, Age-disparate relationships, Age-mixing, Southern Africa

Authors & affiliation: 
Roxanne Beauclair 1,2* , Jonathan Dushoff 3 and Wim Delva 1,2,4,5 1 International Centre for Reproductive Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium. 2 The South African Department of Science and Technology-National Research Foundation (DST-NRF) Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, 19 Jonkershoek Road, Stellenbosch 7600, South Africa. 3 Department of Biology, McMaster University, 1280 Main St. West, Hamilton, ON L8S 4K1, Canada. 4 Center for Statistics, Hasselt University, Campus Diepenbeek, Agoralaan Building D, 3590 Diepenbeek, Belgium. 5 Rega Institute for Medical Research, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
Ranking: 
Published In: 
Roxanne Beauclair, Jonathan Dushoff and Wim Delva. Partner age differences and associated sexual risk behaviours among adolescent girls and young women in a cash transfer programme for schooling in Malawi. BMC Public Health (2018) 18:403
Publication date: 
Tuesday, March 27, 2018
Downloads: