Abstract
BackgroundCrucial connections between sexual network structure and the distribution of HIV remain inadequately understood, especially in regard to the role of concurrency and age disparity in relationships, and how these network characteristics correlate with each other and other risk factors. Social desirability bias and inaccurate recall are obstacles to obtaining valid, detailed information about sexual behaviour and relationship histories. Therefore, this study aims to use novel research methods in order to determine whether HIV status is associated with age-disparity and sexual connectedness as well as establish the primary behavioural and socio-demographic predictors of the egocentric and community sexual network structures.Method/DesignWe will conduct a cross-sectional survey that uses a questionnaire exploring one-year sexual histories, with a focus on timing and age disparity of relationships, as well as other risk factors such as unprotected intercourse and the use of alcohol and recreational drugs. The questionnaire will be administered in a safe and confidential mobile interview space, using audio computer-assisted self-interview (ACASI) technology on touch screen computers. The ACASI features a choice of languages and visual feedback of temporal information. The survey will be administered in three peri-urban disadvantaged communities in the greater Cape Town area with a high burden of HIV. The study communities participated in a previous TB/HIV study, from which HIV test results will be anonymously linked to the survey dataset. Statistical analyses of the data will include descriptive statistics, linear mixed-effects models for the inter- and intra-subject variability in the age difference between sexual partners, survival analysis for correlated event times to model concurrency patterns, and logistic regression for association of HIV status with age disparity and sexual connectedness.DiscussionThis study design is intended to facilitate more accurate recall of sensitive sexual history data and has the potential to provide substantial insights into the relationship between key sexual network attributes and additional risk factors for HIV infection. This will help to inform the design of context-specific HIV prevention programmes.
Highlights
Crucial connections between sexual network structure and the distribution of HIV remain inadequately understood, especially in regard to the role of concurrency and age disparity in relationships, and how these network characteristics correlate with each other and other risk factors
For young women in South Africa, an older partner is more likely to expose them to the virus, since the HIV prevalence in men increases with age, peaking in their early thirties [6]
This study will describe age-disparity and sexual connectedness in disadvantaged communities around Cape Town, South Africa. These aspects of sexual networks appear to be important for the spread of HIV, yet their complex patterns and the way in which they are driving HIV transmission are insufficiently understood
Summary
Crucial connections between sexual network structure and the distribution of HIV remain inadequately understood, especially in regard to the role of concurrency and age disparity in relationships, and how these network characteristics correlate with each other and other risk factors. The high prevalence of HIV in South Africa can be at least partially attributed to widespread poverty and labour migration from rural areas to urban centres that has subsequently upset family structures and disrupted psychosocial support increase young women’s susceptibility to HIV acquisition, their frequent engagement in age-disparate relationships is assumed to impose additional risk of HIV infection. Recent data suggests that women in sexual relationships with men five or more years older are more likely to be HIV infected [1,7,8]. For young women in South Africa, an older partner is more likely to expose them to the virus, since the HIV prevalence in men increases with age, peaking in their early thirties [6]. Older male partners of young women frequently partake in multiple, concurrent relationships with casual partners while maintaining ‘long-term’ partnerships [11]
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