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Discordant couples : HIV infection among couples in Burkina Faso, Cameroon, Ghana, Kenya, and Tanzania

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  • de Walque, Damien

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 studying HIV infection at the level of the cohabiting couple. The paper exploits this feature of the data for Burkina Faso, Cameroon, Ghana, Kenya, and Tanzania. The analysis yields two surprising findings about the dynamics of the HIV/AIDS epidemic which have important implications for policy. First, at least two-thirds of the infected couples are discordant couples, that is, couples where only one of the two partners is infected. This implies that there is scope for prevention efforts among couples. Second, between 30 and 40 percent of the infected couples are couples where the female partner only is infected. This is at odds with levels of self-reported marital infidelity by females and with the common perception that unfaithful males are the main link between high risk groups and the general population. This study investigates and confirms the robustness of these findings. For example, even among couples where the woman has been in only one union for 10 years or more, the fraction of couples where only the female partner is infected remains high. These results suggest that extramarital sexual activity among cohabiting women, whatever its causes, is a substantial source of vulnerability to HIV that should be, as much as male infidelity, targeted by prevention efforts. Moreover, this paper uncovers several inconsistencies between the sexual behaviors reported by male and female partners, suggesting that as much as possible, prevention policies should rely on evidence including objectively measured HIV status.

Suggested Citation

  • de Walque, Damien, 2006. "Discordant couples : HIV infection among couples in Burkina Faso, Cameroon, Ghana, Kenya, and Tanzania," Policy Research Working Paper Series 3956, The World Bank.
  • Handle: RePEc:wbk:wbrwps:3956
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    References listed on IDEAS

    as
    1. Emily Oster, 2005. "Sexually Transmitted Infections, Sexual Behavior, and the HIV/AIDS Epidemic," The Quarterly Journal of Economics, Oxford University Press, vol. 120(2), pages 467-515.
    2. de Walque, Damien, 2007. "How does the impact of an HIV/AIDS information campaign vary with educational attainment? Evidence from rural Uganda," Journal of Development Economics, Elsevier, vol. 84(2), pages 686-714, November.
    3. Lachaud, Jean-Pierre, 2007. "HIV prevalence and poverty in Africa: Micro- and macro-econometric evidences applied to Burkina Faso," Journal of Health Economics, Elsevier, vol. 26(3), pages 483-504, May.
    4. 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. Robert J. Brent, 2010. "A social cost-benefit criterion for evaluating Voluntary Counseling and Testing with an application to Tanzania," Health Economics, John Wiley & Sons, Ltd., vol. 19(2), pages 154-172.

    More about this item

    Keywords

    HIV AIDS; HIV AIDS and Business; Health Monitoring&Evaluation; Health Service Management and Delivery; Poverty and Health;

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