Evidence that age-disparate relationships (ADR) between young women and older men are an important route of transmission of HIV infection is limited. The results from recent studies indicate that heterosexual relationships between young women and older men may help sustain the epidemic within some populations of South Africa and Malawi. However, the way in which age differences serve to sustain the epidemic of HIV may be different than what has been previously described in observational studies. This article proposes several public health intervention recommendations in relation to ADR and the epidemic of HIV.
Interventions to curb age-disparate relationships (ADR) are ongoing in spite of conflicting evidence that ADR are a risk factor for HIV transmission. There is a real need to explore the prevalence of ADR and understand what they mean for HIV transmission. We must first understand and describe these relationships; second, establish a causal relationship with HIV. We recently published a paper that explores those objectives in a population of 1,922 adult men and women living in Likoma Island, Malawi.
Young women in relationships with older men are typically at an elevated risk for acquisition of HIV in sub-Saharan Africa. Most qualitative studies have tended to focus on why women are motivated to participate in these relationships, offering little insight into perceived risks of these relationships. Therefore we conducted a qualitative study in three urban communities in Cape Town using thematic content analysis to explore women’s perceived risks of (non-)age-disparate relationships, the benefits of dating older men, and risk perceptions that influence decisions around these relationships.