Older people’s sexual behaviour and HIV risk in five high prevalence sub-Saharan African populations

Nuala McGrath, London School of Hygiene and Tropical Medicine (LSHTM)
Raphael Isingo, National Institute for Medical Research, Tanzania
Ben Lopman, Imperial College London
Ivan Kasamba, Medical Research Council Programme on AIDS
Milly Marston, London School of Hygiene and Tropical Medicine (LSHTM)
Joseph Sekasanvu, Rakai Health Science Program

HIV prevalence in older people is expected to increase rapidly in sub-Saharan Africa due to declining mortality in HIV infected adults. New research also suggests that sexual activity at older ages may cause secondary peaks in HIV incidence. Research and policy in Africa has largely overlooked high risk sexual behaviour in older people. Using data from five population cohorts (Tanzania, Uganda, Zimbabwe and South Africa), we compare sexual behaviour, marriage, partnerships, and condom use patterns and trends in people aged 40-60 years. The majority of older people are sexually active in each site. Preliminary site-specific findings suggest that HIV prevalence is higher in the marital status categories associated with a higher rate of multiple partner acquisition i.e. polygamous marriage, remarriage and being separated, widowed or divorced; that widows and widowers have exceptionally high HIV prevalence; and that older men are significantly less likely to use condoms than younger men.