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Sero‐Discordant Couples in Five African Countries: Implications for Prevention Strategies

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  • Damien De Walque

Abstract

Most analyses of the determinants of HIV infection are performed at the individual level. The recent Demographic and Health Surveys, which include results from HIV tests, allow the study of HIV infection at the level of the cohabiting couple. This article exploits this feature of the data for Burkina Faso, Cameroon, Ghana, Kenya, and Tanzania. The analysis yields two findings about the dynamics of the HIV/AIDS epidemic that have important implications for policy. First, at least two‐thirds of the infected couples are sero‐discordant, that is, only one of the two partners is infected. This implies scope for prevention efforts among infected couples. Second, among 30–40 percent of the infected couples only the woman is infected. This is at odds with levels of self‐reported extramarital sex by women and with the common perception that unfaithful men are the main link between high‐risk groups and the general population. These findings are confirmed by tests of robustness. These results indicate that extramarital sexual activity among women in union is a substantial source of vulnerability to HIV that should be, as much as male extramarital activity, targeted by prevention efforts.

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  • Damien De Walque, 2007. "Sero‐Discordant Couples in Five African Countries: Implications for Prevention Strategies," Population and Development Review, The Population Council, Inc., vol. 33(3), pages 501-523, September.
    • Handle: RePEc:bla:popdev:v:33:y:2007:i:3:p:501-523
    DOI: 10.1111/j.1728-4457.2007.00182.x
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    1. de Walque, Damien, 2006. "Who gets AIDS and how ? The determinants of HIV infection and sexual behaviors in Burkina Faso, Cameroon, Ghana, Kenya, and Tanzania," Policy Research Working Paper Series 3844, The World Bank.
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    Cited by:

    1. Mark Gersovitz, 2011. "Infectious Diseases: Responses to the Security Threat Without Borders," Chapters, in: George Mavrotas (ed.), Security and Development, chapter 9, Edward Elgar Publishing.
    2. Wilson, Nicholas, 2021. "Why is ageing associated with lower adoption of new technologies? Evidence from voluntary medical male circumcision and a structural model," The Journal of the Economics of Ageing, Elsevier, vol. 19(C).
    3. Ibrahim Kasirye, 2016. "HIV/AIDS Sero-prevalence and Socio-economic Status: Evidence from Uganda," African Development Review, African Development Bank, vol. 28(3), pages 304-318, September.
    4. Lucia Corno & Damien de Walque, 2012. "Mines, Migration and HIV/AIDS in Southern Africa," Journal of African Economies, Centre for the Study of African Economies, vol. 21(3), pages 465-498, June.
    5. Anglewicz, Philip & Clark, Shelley, 2013. "The effect of marriage and HIV risks on condom use acceptability in rural Malawi," Social Science & Medicine, Elsevier, vol. 97(C), pages 29-40.
    6. Eva Deuchert, 2011. "The Virgin HIV Puzzle: Can Misreporting Account for the High Proportion of HIV Cases in Self-reported Virgins?," Journal of African Economies, Centre for the Study of African Economies (CSAE), vol. 20(1), pages 60-89, January.
    7. Georges Reniers & Benjamin Armbruster, 2012. "HIV Status Awareness, Partnership Dissolution and HIV Transmission in Generalized Epidemics," PLOS ONE, Public Library of Science, vol. 7(12), pages 1-7, December.
    8. Godswill N. Osuafor & Sonto Maputle & Natal Ayiga & Akim J. Mturi, 2018. "Condom use among married and cohabiting women and its implications for HIV infection in Mahikeng, South Africa," Journal of Population Research, Springer, vol. 35(1), pages 41-65, March.
    9. Philip Anglewicz & Hans-Peter Kohler, 2009. "Overestimating HIV infection:," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 20(6), pages 65-96.
    10. Beegle, Kathleen & de Walque, Damien, 2009. "Demographic and socioeconomic patterns of HIV/AIDS prevalence in Africa," Policy Research Working Paper Series 5076, The World Bank.
    11. Jeremy Magruder, 2011. "Marital Shopping and Epidemic AIDS," Demography, Springer;Population Association of America (PAA), vol. 48(4), pages 1401-1428, November.
    12. Judith Lammers & Sweder van Wijnbergen & Daan Willebrands, 2011. "Gender Differences, HIV Risk Perception and Condom Use," Tinbergen Institute Discussion Papers 11-051/2, Tinbergen Institute.
    13. Philip Anglewicz, 2012. "Migration, Marital Change, and HIV Infection in Malawi," Demography, Springer;Population Association of America (PAA), vol. 49(1), pages 239-265, February.
    14. Desgrées-du-Loû, Annabel & Brou, Hermann & Traore, Annick Tijou & Djohan, Gerard & Becquet, Renaud & Leroy, Valeriane, 2009. "From prenatal HIV testing of the mother to prevention of sexual HIV transmission within the couple," Social Science & Medicine, Elsevier, vol. 69(6), pages 892-899, September.
    15. Michelle Poulin & Adamson S. Muula, 2011. "An inquiry into the uneven distribution of women’s HIV infection in rural Malawi," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 25(28), pages 869-902.

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