Abstract
Young women in age-asymmetric relationships may be at an elevated risk for acquisition of HIV, since relationships with older men are also correlated with other risk behaviors like less condom use. Qualitative studies have shown that women are motivated to participate in these relationships for money and emotional support. However, there is a paucity of research on women’s perceived risks of these relationships, particularly in South Africa. To this end, we conducted in-depth interviews with 23 women recruited from three urban communities in Cape Town. A thematic question guide was used to direct the interviews. Thematic content analysis was used to explore women’s perceived risks of age-disparate and non-age-disparate relationships, the benefits of dating older men, and risk perceptions that influence decisions around beginning or ending a relationship. A plurality of women thought that dating an older man does not bring any adverse consequences, although some thought that older men do not use condoms and may be involved in concurrent partnerships. Many women were less inclined to date same-age or younger men, because they were viewed as being disrespectful and abusive. This study points to the need for more awareness raising about the risks of age-disparate relationships. In addition to these initiatives, there is an urgent need to implement holistic approaches to relationship health, in order to curb intimate partner violence, improve gender equity and make non-age-disparate relationships more attractive.
Highlights
Epidemiological evidence is showing that ageasymmetric relationships—younger women engaging in sexual relationships with older men—may be at an elevated risk for sexually transmitted infections (STIs), including Human Immunodeficiency Virus (HIV) infection in sub-Saharan Africa [1,2,3,4,5,6]
According to the 2008 South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, the prevalence of infection is significantly higher among young women, with 21.1% of the 20-24 year-old women infected, compared to 5.1% of men infected in the same age category, [7]
Young women may be more vulnerable to HIV infection as a consequence of cervical ectopy, an elevated inflammatory state of the female reproductive tract, and the HIV-susceptibility enhancing effect of injectable hormonal contraceptives [8], which are popular among young women in many countries in sub-Saharan Africa [9]
Summary
Epidemiological evidence is showing that ageasymmetric relationships—younger women engaging in sexual relationships with older men—may be at an elevated risk for sexually transmitted infections (STIs), including Human Immunodeficiency Virus (HIV) infection in sub-Saharan Africa [1,2,3,4,5,6]. While the precise mechanism behind this gender discrepancy is incompletely understood, it is thought that a complex interplay of biological, socio-behavioral, and epidemiological factors is responsible for the observed differences in age-stratified HIV prevalence between men and women. The main partner of men engaging in concurrency is usually older than their casual partners [12], so these men may act as a bridging population, allowing HIV to spread indirectly from older age groups with a higher burden of HIV infections to younger age groups
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