Association between extra-spousal partnerships and HIV prevalence among married individuals in Rakai, Uganda

Abstract Introduction: The association between extra-spousal partnerships and HIV in married or cohabiting individuals remains controversial. We established the association between extra-spousal partnerships and HIV prevalence among married or cohabiting individuals in Rakai, Uganda.Methods: This secondary analysis uses data from a large cross-sectional study conducted among 2,135 married or cohabiting individuals aged 15-49 years in Rakai, Uganda, between November 2013 and February 2014. Data were collected on socio-demographic and behavioral characteristics, including extra-spousal partnerships. We used a modified Poisson regression model to assess the association between extra-spousal partnerships and HIV prevalence among married or cohabiting individuals living in three study communities with differing HIV prevalence. Stata version 14.0 was used for data analysis. Results: Of 2,103 respondents included in the analysis, 13.4% (282/2103) reported extra-spousal partnerships; 4.5% (n=49) among females and 22.9% (n=233) among males. Of those reporting extra-spousal partnerships, 48.6% (n=137) were in their second or higher order marriage while 74.1% (n=209) reported a marital duration of six or more years. HIV prevalence was higher among those reporting extra-spousal partnerships (14.6%, 36/247) than in those who did not (7.6%, 120/1575; P<0.0001). In multivariable analyses, we found that engaging in extra-spousal relationships increased the risk of HIV infection by 67% (adjusted Prevalence Ratio [adj. PR] = 1.67; 95%CI: 1.16, 2.39), after adjusting for potential and suspected confounders. Conclusion: We found that engaging in extra-spousal partnerships increased the risk of HIV infection by more than two-thirds. These findings suggest a need for targeted HIV prevention interventions for married or cohabiting individuals who report extra-spousal partnerships.