Running head: MARRIED PERSONS AND HIV/AIDS IN SUB-SAHARAN AFRICA 1

Married Persons and Human Immunodeficiency Virus/

Acquired Immunodeficiency Syndrome in Sub-Saharan Africa

Johanna A. Mosquera

Public Health Research

University of North Florida

Running head: MARRIED PERSONS AND HIV/AIDS IN SUB-SAHARAN AFRICA 2

Introduction

Sexual behaviors play an essential role in the transmission of Human Immunodeficiency

Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) and all other Sexually Transmitted

Diseases. Sub-Saharan Africa holds about 12% of the worlds population, however, it is reported

that it is accountable for 71% of HIV/AIDS infections (Kharsany & Karim, 2016). It is also

important to address the fact that women have higher prevalence rates than men in 27 of 29

countries in Sub-Saharan Africa according to the World Health Organization (WHO, 2017).

Some researchers believe that the disparity comes from the concurrency of sexual relationships

by men.

Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome transmission

can be controlled by regular use of latex condoms. About two-thirds of new HIV infections in

Sub-Saharan Africa occur in married or cohabiting couples. Of these two-thirds, half are

attributed to infected partner to uninfected partner transmissions. The remaining half is acquired

from extra-partner sexual relations (Chemaitelly, Awad, Shelton & Abu-Raddad, 2014). Thus,

married people and cohabiting couples are a priority population for safe sex education.

Although there is substantial evidence of the prevalence of HIV/AIDS in Sub-Saharan

Africa, there is little research focused on the married women of this area that have high incident

rates. Therefore, this article will attempt to fill this gap and determine whether there is an

association between married women and HIV prevalence in Sub-Saharan Africa and and the

driving factors. I hypothesize that if married women of Sub-Saharan Africa are having

unprotected sex with their husbands or extra-partner, then they have a higher risk of contracting

HIV/AIDS.
Running head: MARRIED PERSONS AND HIV/AIDS IN SUB-SAHARAN AFRICA 3

Research has proven sexual concurrency as a potential driving force behind new HIV

infections in Sub-Saharan Africa. Few studies have examined marital concurrency as a form of

sexual concurrency that affects the rates of HIV transmission. The study by Fox at the Mount

Sinai School of Medicine hones in on this relationship. The researcher examined both polygamy

and extramarital sexual relationships as forms of marital concurrency. After analyzing the

different prevalence rates across Sub-Saharan Africa, the researcher concluded that there was a

confluent association between having additional sexual partners and HIV rates in married

persons. She also concluded that living in an area where marital concurrency is more common

increased the risk of HIV infections than those who lived in areas where the behavior was less

common (Fox, 2014).

The researchers in the following study examined polygamy further as a possibLe risk

factor for HIV infections. As stated in the previous paragraph, Polygamy is a formal version of

sexual partner concurrency and is largely absent from systematic literature about HIV infections.

Even though monogamous relationships have several protective factors such as disease

entrapment and reduction of the spread of disease because of lower viral loads, HIV prevalence

were lower in areas that the behavior was common than areas where it was not. Distinctly, the

researchers, Georges Reniers and Rania Tfaily, also found that the secondary wives of

polygamous men were more likely to get infected by HIV than the wives of men in monogamous

relationships. They believe both results are to due to the gender-asymmetric partnership

concurrency. Additionally, Reniers and Tfaily addressed the other factors that could play a part

of the relationship, like different attributes of sexual network that could possibly correlate with

polygamy (Reniers and Tfaily, 2012).

Analogously, the literature has concluded that many other factors contribute to the
Running head: MARRIED PERSONS AND HIV/AIDS IN SUB-SAHARAN AFRICA 4

HIV situation in married persons of Sub-Saharan Africa. The literatures by Stephenson (2010)

and Smith (2007) both identify additional factors that play roles in analyzing HIV in marriages.

Stephensons literature examines the community environment and its role, while Smith focuses

on the social organization of infidelity. Both studies concluded that HIV transmission within

marriages is a systemic problem in the culture and traditions. Previous literature have established

the role of gender inequalities in HIV transmission in all relationships, but these literatures

establish the association between economic, moral, and cultural factors and marital HIV

infections. They also encourage viewing gender in a holistic manner in prevention strategies to

truly address the issue.

All of the literature reviewed, accounted for men bringing the infection into the marriage.

Contrarily, this final article by a group of researchers assessed the HIV risk in relation to

marriage in areas with high prevalence through a different perespective. Glynn, Caral, Buv,

Musonda, and Kahindo based their study on the assumption that since young women have the

highest incidence rates, they are bringing the disease into the marriage and are infecting their

husbands. They concluded that the less than one half of cases of HIV infection were acquired

from their spouses for both men and women. (Glynn, Caral, Buv, Musonda, and Kahindo,

2003)
Running head: MARRIED PERSONS AND HIV/AIDS IN SUB-SAHARAN AFRICA 5

Conclusion

There was a wide variability in the prevalence of different types of marital concurrency

across different countries in sub-Saharan Africa. There was an established association between

formal and informal marital concurrency and HIV infections in areas that these behaviors were

common. The literatures also established that, contrarily to popular opinion, there was no

association between polygamous relationships and prevalence of HIV infections in marriages.

There were also numerous contributing factors to the disease rates. The list of factors

reviewed was not exhaustive, but rather fairly general factors that played major roles in the

transmission of HIV in married persons. The gender inequalities that are common in almost all of

Sub- Saharan Africa contribute significantly into the dynamics of heterosexual relationships in

these countries therefore affecting the rates in which HIV is transmitted in marriages.

As concluded by the literature, to effectively implant risky sexual behavior changes in the

population, public health officials will need to address the issue on a cultural and moral level. By

changing the reasons why people have extramarital relationships or agree to be sister wives in

polygamous marriages, there will be a decrease in the HIV rates.

Running head: MARRIED PERSONS AND HIV/AIDS IN SUB-SAHARAN AFRICA 6

Revised References

Chemaitelly, H., Awad, S. F., Shelton, J. D., & Abu-Raddad, L. J. (2014). Sources of

HIV incidence among stable couples in sub-Saharan Africa. Journal of the International AIDS

Society, 17(1), 18765. http://doi.org/10.7448/IAS.17.1.18765

Fox, A.M. AIDS Behav (2014) 18: 791.

https://doi.org/10.1007/s10461-013-0684-9

Glynn JR, Caral M, Buv A, Musonda RM, Kahindo M (2003). HIV risk in relation

to marriage in areas with high prevalence of HIV infection. HIV risk in relation to marriage in

areas with high prevalence of HIV infection. Journal of Acquired Immune Deficiency

Syndromes, 33(4):526-535.

Kharsany, A. B. M., & Karim, Q. A. (2016). HIV Infection and AIDS in Sub-Saharan

Africa: Current Status, Challenges and Opportunities. The Open AIDS Journal, 10, 3448.

http://doi.org/10.2174/1874613601610010034

Reniers, G. & Tfaily, R. Demography (2012) 49: 1075 https://doi.org/10.1007/s13524-

012-0114-z

Smith, D. J. (2007). Modern Marriage, Mens Extramarital Sex, and HIV Risk in

Southeastern Nigeria. American Journal of Public Health, 97(6), 9971005.

http://doi.org/10.2105/AJPH.2006.088583

Stephenson, R. (2010). Community-Level Gender Equity and Extramarital Sexual Risk-

Taking Among Married Men in Eight African Countries. International Perspectives on Sexual

and Reproductive Health, 36(4), 178188. http://doi.org/10.1363/3617810