Age is Nothing but a Number (or So They Say): Age-Discordant Heterosexual Relationships and Their Influence on HIV Transmission in Ghana Open Access

Abstract

In Sub-Saharan Africa (SSA), age-discordant relationships in which the male partner is older than the female have been suggested to increase the risk of human immunodeficiency virus (HIV) infection for women. We investigated these patterns of sex-asymmetric age mixing and its relationship with prevalent HIV infection in Ghana. Using a sample of 590 participants from a cross-sectional study Accra, Ghana, we asked about demographic information and sexual history with the three most recent partners within the previous 12 months. Bivariate and multivariate linear regression was performed to estimate the relationship between reported partner age as a function of participant age and sex. We then used logistic regression to quantify the association between male-relative age within partnerships and prevalent HIV status, and history of diagnosis with a sexually transmitted infection. Men were on average 4.8 years older than female partners. Factors associated with greater male-relative age difference were entering the relationship for money, gifts, or assistance and having a partner who was wealthy. There does not appear to be a strong relationship between male-relative age with HIV status; however, there does appear to be a relationship between female participants receiving money, gifts, or assistance and HIV status. Many studies performed in this field have shown a relationship between age-discordance and HIV status across SSA. By performing more research on factors that may lead to age-discordant relationships as well as providing women more options for HIV prevention methods, the transmission of HIV may begin to decrease.

Table of Contents

Introduction............................................................................................................................................................ 1

Methods................................................................................................................................................................. 3

Study Population..................................................................................................................................................... 3

Sample and Study Design.......................................................................................................................................... 3

Measurement Methods.............................................................................................................................................. 4

Statistical Analysis................................................................................................................................................... 5

Results.................................................................................................................................................................... 6

Discussion................................................................................................................................................................ 9

Appendix.................................................................................................................................................................. i

Table 1: Demographics of Study Participants.................................................................................................................. i

Table 2: Summary of Participants' Partners.................................................................................................................... iii

Table 3: Linear Regression for Age Difference Between Partnerships and Predictors............................................................... v

Table 4.1: Logistic Regression for HIV Status and Predictors............................................................................................. vii

Table 4.2: Logistic Regression for Ever Having a STD and Predictors................................................................................... vii

Figure 1. Age Differentials by Sex................................................................................................................................ viii

Figure 2. Prediction of Partner's Age by Participant Gender............................................................................................... ix

References.............................................................................................................................................................. x

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	sub-Saharan Africa HIV Ghana age-discordance age mixing heterosexual partnerships
Committee Chair / Thesis Advisor	Jenness, Samuel M, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs University, college or educational institution (other than Emory)

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