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Coital frequency and condom use in age-disparate partnerships involving women aged 15 to 24: evidence from a cross-sectional study in KwaZulu-Natal, South Africa
  1. Gavin George1,
  2. Brendan Maughan-Brown2,
  3. Sean Beckett3,
  4. Meredith Evans4,
  5. Cherie Cawood5,
  6. David Khanyile5,
  7. Kaymarlin Govender6,
  8. Ayesha BM Kharsany7
  1. 1 Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
  2. 2 Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town, South Africa
  3. 3 Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
  4. 4 Department of Anthropology, York University, Toronto, Canada
  5. 5 AIDS Risk Management (Pty) Limited, Durban, KwaZulu-Natal, South Africa
  6. 6 Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, KwaZulu Natal, South Africa
  7. 7 Centre for the AIDS Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
  1. Correspondence to Dr Gavin George; georgeg{at}


Objective This study examines the role of age-disparate partnerships on young women’s HIV risk by investigating coital frequency and condom use within age-disparate partnerships involving women aged 15 to 24.

Design A community-based, cross-sectional study was conducted.

Setting Participants were randomly selected using a two-stage random sampling method in uMgungundlovu district, KwaZulu-Natal, South Africa, between June 2014 and June 2015.

Participants A total of 1306 15–24-year-old women in an ongoing heterosexual partnership were included in the analysis. Participants had to be a resident in the area for 12 months, and able to provide informed consent and speak one of the local languages (Zulu or English).

Primary and secondary outcome measures Sexual frequency was assessed by asking participants how many times they had sex with each partner in the past 12 months. The degree of condomless sex within partnerships was assessed in the survey by asking participants how often they used a condom with their partners.

Results Age-disparate partnerships were associated with a higher order category (once, 2–5, 6–10, 11–20, >20) of coital frequency (adjusted OR (aOR) 1.32, p<0.05, 95% CI 1.02 to 1.71) and with sex on more than 10 occasions (aOR 1.48, p<0.01, 95% CI 1.12 to 1.96) compared with age-similar partnerships. Age-disparate partnerships were also more likely to involve sex on more than 10 occasions with inconsistent condom use (aOR 1.43, p<0.05, 95% CI 1.04 to 1.96) in the previous 12 months.

Conclusion The finding that increased sexual activity is positively associated with age-disparate partnerships adds to the evidence that age-disparate partnerships pose greater HIV risk for young women. Our study results indicate that interventions to reduce risky sexual behaviour within age-disparate partnerships remain relevant to reducing the high HIV incidence rates among adolescent girls and young women.

  • age-disparate sex
  • coital frequency
  • HIV
  • south africa
  • risky sexual behaviour
  • condoms

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  • Contributors GG, BM-B and ABMK conceptualised the study and GG was responsible for drafting the manuscript. GG, BM-B, ME and SEB analysed and interpreted the data. ABMK is the principal investigator of HIPSS. ABMK, GG, SEB, CC and KG contributed to the design of the survey instruments. ABMK, CC and DK were responsible for the field work and quality assurance. All authors critically reviewed and approved the final version of the manuscript for submission.

  • 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).

  • Disclaimer The contents of this publication are those of the authors and do not necessarily represent the official position of the funding agencies.

  • Competing interests None declared.

  • Ethics approval The study was approved by the Biomedical Research Ethics Committee, University of KwaZulu-Natal, (BF269/13), the Centers for Disease Control and Prevention (CDC) of the Center for Global Health, Centers for Disease Control and Prevention, United States of America (CGH 2014-080) and by the KwaZulu-Natal Provincial Department of Health in South Africa (HRKM 08/14). Eligible participants provided informed written consent prior to study enrolment.

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

  • Data sharing statement The data and supporting documentation can be accessed by contacting the corresponding author.

  • Patient consent for publication Not required.

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