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Demography
Published in: Demography 3/2012

01-08-2012

Polygyny, Partnership Concurrency, and HIV Transmission in Sub-Saharan Africa

Published in: Demography | Issue 3/2012

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Abstract

We study the relationship between polygyny and HIV infection using nationally representative survey data with linked serostatus information from 20 African countries. Our results indicate that junior wives in polygynous unions are more likely to be HIV positive than spouses of monogamous men, but also that HIV prevalence is lower in populations with more polygyny. With these results in mind, we investigate four explanations for the contrasting individual- and ecological-level associations. These relate to (1) the adverse selection of HIV-positive women into polygynous unions, (2) the sexual network structure characteristic of polygyny, (3) the relatively low coital frequency in conjugal dyads of polygynous marriages (coital dilution), and (4) the restricted access to sexual partners for younger men in populations where polygynous men presumably monopolize the women in their community (monopolizing polygynists). We find evidence for some of these mechanisms, and together they support the proposition that polygynous marriage systems impede the spread of HIV. We relate these results to the debate about partnership concurrency as a primary behavioral driver for the fast propagation of HIV in some parts of sub-Saharan Africa.
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Footnotes
1
Women in polygynous unions have lower fertility than women in monogamous unions, but because polygyny maximizes the time that women spend in a union, population-level fertility rates tend to be positively correlated with the prevalence of polygyny (Pison 1986).
 
2
Morris and Kretzschmar (1997) modeled the spread of HIV in a sexual network with gender-symmetric concurrency but acknowledged the gender asymmetry produced by polygyny. In a later paper (2000), they relaxed the assumption of gender symmetry (to match empirical data for Uganda) with the expected dampening effect on component sizes and epidemic potential. The component size distribution is, however, not the only attribute of a polygynous sexual network with repercussions for the diffusion of an STI. Polygynous networks are, for example, characterized by star-shaped network components wherein polygynous men serve as the central nodes, whereas gender-symmetric partnership concurrency tends to produce chainlike network components. See Reniers and Watkins (2010) for an illustration of a simulated sexual network with gender-symmetric and gender-asymmetric concurrency.
 
3
In these cases, it is often understood that the husband retains the paternity rights to the children that might ensue (Delius and Glaser 2004).
 
4
See Delius and Glaser (2004) for a critique.
 
5
There is some discussion as to whether the age effect persists after marital duration is taken into account (Brewis and Meyer 2005).
 
6
See Welch et al. (1998) for a simulation study of gonorrhea transmission.
 
7
A previous assessment revealed no strong correlation between national-level HIV prevalence and the annual rate of change in the prevalence of polygyny (Reniers and Watkins 2010). Ideally, one would need to repeat such an analysis at the subnational level.
 
8
Analyses with measures of the incidence and intensity themselves point in the same direction. These are presented in Reniers and Tfaily (2010).
 
9
See Timæus and Reynar (1998) for a discussion of the correspondence between husbands and wives in the reporting of polygyny status.
 
10
This restriction also requires us to work with a subsample of linked spouses (i.e., the DHS couples-files), and the linkage of spouses is only possible if they co-reside.
 
11
These estimates could be affected by a mortality selection bias because first wives are likely to have been married longer than junior wives, and those who were HIV positive at the time of marriage could have died already. In the DHS, marriage durations are usually known for first marriages only, and this is difficult to account for. To reduce the potential for mortality selection bias, we repeated the analysis but restricted the sample to women under age 30 because AIDS mortality is not as common in young women. The results point in the same direction, but the coefficients are estimated with greater uncertainty: OR = 1.48 (95% CI: 1.01–2.15) for the logit model, and OR = 1.97 (95% CI: 1.11–3.49) for the survey-cluster fixed-effects model. Restricting the analysis to even younger women does not change the odds ratio estimates much, but they gradually lose statistical significance.
 
12
The magnitude of that selection effect may further depend on the distribution of the number of spouses per polygynous husband (i.e., the intensity of polygyny).
 
13
For men and women who married in the year prior to the survey, a nonmarital sexual partnership is not necessarily an extramarital or concurrent partnership because they may have had another partner prior to marrying the current spouse. Unfortunately, these cases cannot be excluded in the analyses because marriage duration is known for first marriages only.
 
14
In the subset of countries with information on the outcome of the previous marriage, widows report a lower frequency of intercourse, and that is particularly the case in Zambia and Zimbabwe, two of the countries with the highest HIV prevalence (not shown).
 
15
Our measures of the age at sexual debut and—in a later analysis— the age at first marriage are survey-cluster values of the median age. For a small number of clusters in which over 50% of respondents are self-reported virgins or single, the values have been imputed at the age of the oldest individual plus 1.
 
16
Widow inheritance, like polygyny, is often presented as an entrenched and harmful cultural practice that promotes the spread of HIV (Nyindo 2005; Okeyo and Allen 1994; UNAIDS 2006). Again, such claims come without much supporting evidence and, considering our results, appear premature.
 
17
Even this turns out to be difficult because changes in concurrency also induce other structural network changes (e.g., the number of isolated nodes or the mean number of partnerships non-isolates) (Boily 2010).
 
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Metadata
Title
Polygyny, Partnership Concurrency, and HIV Transmission in Sub-Saharan Africa
Publication date
01-08-2012
Published in
Demography / Issue 3/2012
Print ISSN: 0070-3370
Electronic ISSN: 1533-7790
DOI
https://doi.org/10.1007/s13524-012-0114-z

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