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Age-disparate partnerships and HSV-2 among adolescent girls and young women in South Africa: implications for HIV infection risk
  1. Brendan Maughan-Brown1,
  2. Gavin George2,
  3. Sean Beckett2,
  4. Meredith Evans3,
  5. Lara Lewis4,
  6. Cherie Cawood5,
  7. David Khanyile5,
  8. Ayesha B M Kharsany4
  1. 1 Southern Africa Labour and Development Research Unit (SALDRU), Department of Economics, University of Cape Town, Cape Town, South Africa
  2. 2 Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
  3. 3 Department of Anthropology, York University, Toronto, Ontario, Canada
  4. 4 Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
  5. 5 Epicentre AIDS Risk Management (Pty) Limited, Sandton, South Africa
  1. Correspondence to Dr Brendan Maughan-Brown, Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town 7701, South Africa; brendan.maughanbrown{at}


Objective There is an urgent need to understand high HIV-infection rates among young women in sub-Saharan Africa. While age-disparate partnerships have been characterised with high-risk sexual behaviours, the mechanisms through which these partnerships may increase HIV-risk are not fully understood. This study assessed the association between age-disparate partnerships and herpes simplex virus type-2 (HSV-2) infection, a factor known to increase HIV-infection risk.

Methods Cross-sectional face-to-face questionnaire data, and laboratory HSV-2 and HIV antibody data were collected among a representative sample in the 2014/2015 household survey of the HIV Incidence Provincial Surveillance System in KwaZulu-Natal, South Africa. Among 15–24-year-old women who reported having ever had sex (n=1550), the association between age-disparate partnerships (ie, male partner ≥5 years older) and HSV-2 antibody status was assessed using multivariable Poisson regression models with robust variance. Analyses were repeated among HIV-negative women.

Results HSV-2 prevalence was 55% among 15–24-year-old women. Women who reported an age-disparate partnership with their most recent partner were more likely to test HSV-2 positive compared with women with age-similar partners (64% vs 51%; adjusted prevalence ratio (aPR):1.19 (95% CI 1.07 to 1.32, p<0.01)). HSV-2 prevalence was also significantly higher among HIV-negative women who reported age-disparate partnerships (51% vs 40 %; aPR:1.25 (95% CI 1.05 to 1.50, p=0.014)).

Conclusions Results indicate that age-disparate partnerships are associated with a greater risk of HSV-2 among young women. These findings point towards an additional mechanism through which age-disparate partnerships could increase HIV-infection risk. Importantly, by increasing the HSV-2 risk, age-disparate partnerships have the potential to increase the HIV-infection risk within subsequent partnerships, regardless of the partner age-difference in those relationships.

  • intergenerational partnerships
  • age discordant partners
  • herpes simplex virus type 2
  • HIV prevention
  • young women
  • sub-Saharan Africa

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  • Handling editor Catherine H Mercer

  • Author contributions ABMK is the principal investigator of the HIV Incidence Provincial Surveillance System (HIPSS). ABMK, CC and DK were responsible for HIPSS study operations and quality assurance. ABMK, BM-B and GG were responsible for the concept of the analysis for this paper. All authors contributed to the interpretation of the data, and manuscript preparation. All authors approved the final version of the article.

  • Funding The HIV Incidence Provincial Surveillance System (HIPSS) is funded by a cooperative agreement (3U2GGH000372) between Epicentre and the Centers for Disease Control and Prevention (CDC). Support was provided to BMB by the National Research Foundation, South Africa, through the Research Career Advancement Fellowship. ABMK is supported by a joint South Africa–U.S. Program for Collaborative Biomedical Research, National Institutes of Health grant (R01HD083343).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available on request to the HIV Incidence Provincial Surveillance System Steering Committee.