Role of widows in the heterosexual transmission of HIV in Manicaland, Zimbabwe, 1998–2003
- B A Lopman1,
- C Nyamukapa1,2,
- T B Hallett1,
- P Mushati2,3,
- N Spark-du Preez4,
- F Kurwa2,
- M Wambe2,
- S Gregson1,2
- 1Imperial College London, London, UK
- 2Biomedical Research and Training Institute, Harare, Zimbabwe
- 3London School of Economics, London, UK
- 4Loughborough University, Loughborough, UK
- Dr B A Lopman, Department of Infectious Disease Epidemiology, Imperial College London, St Mary’s Campus, Norfolk Place, London W2 1PG, UK;
- Accepted 19 December 2008
Background: AIDS is the main driver of young widowhood in southern Africa.
Methods: The demographic characteristics of widows, their reported risk behaviours and the prevalence of HIV were examined by analysing a longitudinal population-based cohort of men and women aged 15–54 years in Manicaland, eastern Zimbabwe. The results from statistical analyses were used to construct a mathematical simulation model with the aim of estimating the contribution of widow behaviour to heterosexual HIV transmission.
Results: 413 (11.4%) sexually experienced women and 31 (1.2%) sexually experienced men were reported to be widowed at the time of follow-up. The prevalence of HIV was exceptionally high among both widows (61%) and widowers (male widows) (54%). Widows were more likely to have high rates of partner change and engage in a pattern of transactional sex than married women. Widowers took partners who were a median of 10 years younger than themselves. Mathematical model simulations of different scenarios of sexual behaviour of widows suggested that the sexual activity of widow(er)s may underlie 8–17% of new HIV infections over a 20-year period.
Conclusions: This combined statistical analysis and model simulation suggest that widowhood plays an important role in the transmission of HIV in this rural Zimbabwean population. High-risk partnerships may be formed when widowed men and women reconnect to the sexual network.
Contributors: BA led the analysis and drafted the manuscript. CN advised on analyses and interpretation of findings and, along with PM, FK and MW, led the data collection and field work activities. TH designed and led the modelling studies. NSP contributed to the analysis and interpretation of the widowhood data. SG conceived the study and is the senior investigator at the Manicaland HIV/STD Prevention Study.
▸ A description of the mathematical model used in the study is published in the online appendix at http://sti.bmj.com/content/vol85/issueSupplI
Funding: This work was supported by the Wellcome Trust and the Joint United Nations Programme on HIV/AIDS (UNAIDS).
Competing interests: None.
Ethics approval: Ethical approval for the study was granted by the Research Council of Zimbabwe (No 02187) and the Applied and Qualitative Research Ethics Committee in Oxford, UK (N97.039). Written informed consent was obtained from all participants who were offered free HIV counselling and testing.