Marital risk factors and HIV infection among women: a comparison between Ghana and Kenya.

Abstract

The purpose of this study is to establish and compare marital risk factors associated with HIV infection among women in Ghana and Kenya, regions representing low and high HIV prevalence, respectively. The study controls for individual demographics, sexual behavior, and socio-cultural contexts. Samples of 2,057 in Ghana and 1,657 in Kenya are drawn from Demographic Health Surveys of 2003. Of married/ cohabiting women, about 3% and 8% are infected with HIV in Ghana and Kenya respectively. These mirror the general population prevalence in both countries. Results of logistic regression analyses indicate that when individual demographics including SES, degree of autonomy to make self-healthcare decisions, religious affiliation, sexual behavior, and socio-cultural factors are controlled for, marital characteristics significantly account for HIV infection. For Ghana, the model accounts for 7% of variance and remarriage is the only significant marital risk, increasing the odds of infection 1.9 times over those who are not remarried. For Kenya, marital factors explain one-half (6%) of the 12% total variability accounted for by the model. Remarriage, polygyny, and traditional marriage are the positive risk factors, with estimated increased risk likelihood of 2.8, 2.4, and 2.2 respectively. Negative predictors include delayed sexual debut and marriage and longer duration of marriage. The latter is a significant predictor in Kenya. Implications for educators are including content stating the life course risk factors, beginning with early sexual debut, delayed marriage, and ending up in a marriage that is likely to be characterized by multiple occurrences of consensual unprotected sex. Such unions include traditional/ cohabitation, polygyny, and/or remarriage. Additionally, public health and social policies that delay sexual debut, marriage, and reduce the risk of infection both before and after marriage should be put in place. Risk-reduction policy is a public health approach that provides options for safe sex for young people who might be engaging in sex. Social policies include laws that govern social life, such as marriage. Both countries need to outlaw early marriage and enforce laws against it. The challenges of multiple partner marriages like polygyny and remarriage, which are protected by human rights laws, can be addressed through continued dialogue in communities to adopt riskreduction strategies in such unions. Other factors that support such practices, like poverty, require long-term plans. These should be relentlessly pursued. Further research with valid measurements for empowerment and socio-cultural factors that are relevant to HIV infection is needed. Similarly, research on long-term marriages that have weathered the HIV era could provide insights for strengthening marriages through education.