Marriage, the new frontier in HIV prevention

In Uganda you have a higher risk of contracting HIV if you are married and over 30 than if you are single and in your twenties, according to the UNAIDS 2008 global epidemic report.

The report notes that although HIV prevalence in Uganda has stabilised at 5.4 percent, "there are signs of a possible resurgence in sexual risk-taking that could cause the epidemic to grow again."

Between 1995 and 2006, the proportion of men and women who reported having had sex with someone other than their spouse increased from 12 percent to 16 percent of women, and from 29 percent to 36 percent of men.

Uganda's reliance on the ABC - Abstinence, Be faithful and use a Condom - model of HIV prevention, saw prevalence decline from over 20 percent in the early 1990s, but a slight upward trend in recent years has alerted policymakers to the need to modify prevention strategies to fit the changing face of the epidemic.

The UNAIDS report draws on a study conducted by Uganda's Ministry of Health in 2006. Elaborating on the findings, Dr David Apuuli Kihumuro, head of the Uganda AIDS Commission, said: "In our studies four or five years ago, the main new infections were among [people aged] 20 to 25; but now there is a shift upwards and the most new infections are among people between 30 and 34 years, and 40 and 45 years.

"Most countries, including Uganda, have targeted young people in prevention strategies," he added. "So now we need to change the emphasis because the demographics of the epidemic have changed."

Various surveys have also shown that condom use during sex with non-marital, non-cohabiting partners is inconsistent, indicating a lack of progress in the adoption of safer sexual behaviour in recent years.

Uganda also has a high rate of HIV discordance within marriages, where one partner is HIV-positive and the other negative, with about 48 percent of married individuals with HIV having uninfected spouses.

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"We want to expand voluntary counselling and testing to combat the spread [of HIV] within marriage," Kihumuro said. "Once someone knows his [or her] sero-status he is less likely to be careless with his own life."

The UNAIDS report cites a community-based study in Uganda that showed an estimated 8 percent annual chance of uninfected partners in discordant heterosexual couples contracting HIV.

Kihumuro said the UAC planned to aim informational and outreach campaigns at married and co-habiting couples as part of an effort to counter Uganda's evolving epidemic.