Partner age differences and associated sexual risk behaviours among adolescent girls and young women in a cash transfer programme for schooling in Malawi
Date
2018-03-27
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
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 form
age-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.
Description
CITATION: Beauclair, R., Dushoff, J. & Delva, W. 2018. 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, 18:403, doi:10.1186/s12889-018-5327-7.
The original publication is available at https://bmcpublichealth.biomedcentral.com
The original publication is available at https://bmcpublichealth.biomedcentral.com
Keywords
HIV infected persons -- Malawi, HIV infections -- Age factors, HIV infected persons -- Sexual behavior, Condom use -- Malawi, Teenage girls -- Sexual behavior -- Sub-Saharan Africa, Young women -- Sexual behavior -- Sub-Saharan Africa
Citation
Beauclair, R., Dushoff, J. & Delva, W. 2018. 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, 18:403, doi:10.1186/s12889-018-5327-7