Beyond monogamy: opportunities to further reduce risk for HIV infection among married Zimbabwean women with only one lifetime partner.

The main objective of this paper was to identify HIV risk factors at the individual, partner, and partnership levels among married, lifetime monogamous women in a nationally representative sample of Zimbabweans aged 15-29 years. Cross-sectional data were collected through individual survey interviews among 1,286 women who provided blood for HIV testing. The HIV prevalence among these women was high (21.8%). HIV risk increased with female age, within-couple age difference of more than 5 years, the husband having children with other women, and the respondent being 'extremely likely' to discuss monogamy in the next 3 months with her husband. The latter suggests that women were attempting to communicate their concerns while unaware that they were already HIV positive. HIV risk largely appears related to the partner's past and present sexual behavior, resulting in limited ability for married women to protect themselves from infection. Overall, lifetime monogamy offers insufficient protection for women.

Response rates for providing a blood specimen for HIV testing in a population-based survey of young adults in Zimbabwe.

BACKGROUND: To determine differences among persons who provided blood specimens for HIV testing compared with those who did not among those interviewed for the population-based Zimbabwe Young Adult Survey (YAS). METHODS: Chi-square analysis of weighted data to compare demographic and behavioral data of persons interviewed who provided specimens for anonymous testing with those who did not. Prevalence estimation to determine the impact if persons not providing specimens had higher prevalence rates than those who did. RESULTS: Comparing those who provided specimens with those who did not, there was no significant difference by age, residence, education, marital status, perceived risk, sexual experience or number of sex partners for women. A significant difference by sexual experience was found for men. Prevalence estimates did not change substantially when prevalence was assumed to be two times higher for persons not providing specimens. CONCLUSION: When comparing persons who provided specimens for HIV testing with those who did not, few significant differences were found. If those who did not provide specimens had prevalence rates twice that of those who did, overall prevalence would not be substantially affected. Refusal to provide blood specimens does not appear to have contributed to an underestimation of HIV prevalence.

Factors associated with HIV infection in adolescent females in Zimbabwe.

PURPOSE: To identify factors associated with human immunodeficiency virus (HIV) infection among adolescent females in Zimbabwe and appropriate prevention strategies for this vulnerable population. METHODS: A total of 1807 females aged 15-19 years completed a questionnaire and provided a blood sample for HIV testing as part of a nationally representative survey. Associations between HIV infection and factors operating at the individual, household, partner and community levels, as well as sexual behavior, were explored through bivariate and multivariate logistic regression analyses. Two multivariate models were fitted: the first model considered sexual risk behaviors and contextual variables, whereas the second model considered only contextual variables. RESULTS: Of 1807 adolescent females, 192 (10.6%) were HIV positive, and 41% of HIV-positive adolescent females reported no sexual risk behaviors. In the first multivariate model, the risk associated with number of lifetime sexual partners was increased for 1 partner (odds ratio [OR] = 2.4, 95% confidence interval [CI] = 1.57-3.6), 2 partners (OR = 4.4, 95% CI = 2.22-8.55), and 3 or more partners (OR = 6.3, 95% CI = 2.56-15.7) as compared with having 0 partners. Believing that people with HIV have many sexual partners (OR = 1.71, 95% CI = 1.14-2.57) and that the man should take the initiative to have sex (OR = 1.55, 95% CI = 1.03-2.32) were also risk factors. In the second model, increased risk was associated with having ever married or lived with a man (OR = 1.99, 95% CI = 1.18-3.35) as well as the attitudes above. Decreased risk of HIV infection was associated with having a job (OR = .39, 95% CI = .18-.88), main activity in past 12 months was as a student (OR = .39, 95% CI = .19-.80), participation in school-based lectures on sexual health (OR = .49, 95% CI = .27-.87), and perceiving that AIDS is a somewhat serious problem in the community (OR = .55, 95% CI = .33-.92). CONCLUSIONS: Adolescent females in Zimbabwe who are married, not attending school and/or are unemployed, are at heightened risk for HIV infection. Interventions that improve their educational and employment opportunities, strengthen school-based prevention services, foster more equitable gender attitudes, and make marriage safer by, for example, promoting knowledge of partners' serostatus before marriage, may reduce their risk. Future research priorities are proposed.