Gendered sexual risk patterns and polygamy among HIV sero-discordant couples in Uganda
Presented by Sarah Khanakwa (Uganda).
S. Khanakwa1, M. Ngolobe2, S. Anya3, J. Birungi4, R. Mwesigwa4, K. Shannon5
1The AIDS Support Organisation (TASO), Management, Kampala, Uganda, 2The AIDS Support Organisation (TASO), Jinja, Uganda, 3BC Centre for Excellence in HIV/ AIDS, Statistician, Vancouver, Canada, 4The AIDS Support Organization (TASO), Kampala, Uganda, 5University of British Colombia, Vancouver, Canada
Background: Concurrent sexual partnerships and HIV sero-discordant relationships are among the highest risk for HIV transmission in sub-Saharan Africa, with women continuing to experience the burden of new HIV infections.
Methods: This study reports baseline data and sexual risk among men in polygamous relationships (≥ 2 wives) enrolled in a prospective cohort of 246 HIV serodiscordant couples, the HAARP study at TASO Jinja in Uganda. Participants were 18 years or older, in a stable relationship (>6 months), and were sexually active. We conducted descriptive and bivariate analyses to compare sexual risk patterns among men in polygamous as compared to monogamous HIV sero-discordant relationships.
Results: Bivariate analysis compared 56 males who reported being in polygamous relationships with 185 who reported only one primary partner. Men in polygamous relationships were significantly less likely to report male-controlled sexual decision making (34 (34%) Vs 66 (66%), p=0.001), male-controlled condom use (33 (39%) Vs 51 (61%), p< 0.001), providing financial support to their female partner (26% vs. 77%), or condom use at last sex (26% vs. 74% p=0.086). Men in polygamous relationships were significantly more likely to be the HIV-positive partner of the serodiscordant dyad as compared to monogamous couples (83% vs. 17%, p=0.065). There was no statistically significant differences in age, ART use of the HIV+ index; or intergenerational sex by polygamy status.
Conclusions: This study demonstrates continued gendered risks for women in HIV serodiscordant relationships in sub-Saharan Africa. In particular, men with 2 or more wives are more likely to be the HIV+ partner and to not use a condom with their HIV-negative partner, with no differences in ART use by polygamy status. At the same time, men in polygamous relationships are less likely to provide financial support to their female partner, or to report exerting power over sexual decision making.
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