Widowed and at risk: Increasing HIV prevalence among Kenyan widows in the last decade
Abstract Authors
Jackline A. Odhiambo1,2,3, Ali Mizarzardeh2, Moses Otieno4, Elizabeth Fair2, Sammy Khagayi4
Author Affiliations
1. School of Public Health and Community Development, Maseno University, Kenya 2. Institute for Global Health Sciences, University of California San Francisco, CA, USA 3. Nyanam Widows Rising, Kisumu, Kenya 4. Kenya Medical Research Institute, Kisumu, Kenya
Background
The majority (66%) of the 1.3 million people living with HIV in Kenya are women. Sexual behaviors increase the risk of HIV transmission; however, little is known about the HIV epidemiology among widowed women. Using 11 years of data, we measured the HIV prevalence and its correlates among widowed women, in comparison to married women in Siaya, Kenya.
Methods
We conducted a cross-sectional analysis of data collected between 2011 and 2022 for widowed and married women enrolled in the health and demographic surveillance system in Siaya, Kenya. Widows were women who reported ever having a deceased husband. The participants’ HIV status was determined either by blood tests or self-report. We reported the HIV prevalence among widowed and married women and assessed the correlates of HIV infection by logistic regression analysis.
Results
Of 14,445 women included in the study, 27.2% (3,930) were ever widows and 72.8% (10,515) were married women. Widows had an overall HIV prevalence of 24.1% (95%CI: 23.5% - 24.6%) compared to 17.5% (95%CI: 17.1% - 17.8%) for married women. In the last decade, the trend in HIV prevalence increased among widows while declined among married women. HIV prevalence was higher in widowed than married women across all characteristics: <45 years (55.8% vs 18.4%), 45-59 years (46.7% vs 18.6%), having a younger sexual partner (69.9% vs 34.0%), ever had transactional sex (62.9% vs 16.6%), and ever experienced forced sex (42.4% vs 21.1%). In the adjusted analysis, widows had 4.12 times higher odds of HIV prevalence than married women (95%CI: 3.62, 4.67). The odds of HIV infection were higher among younger (<45 years) than older women (60+ years) (AOR: 13.2, 95%CI: 10.5, 16.5), women in age-disparate relationships with younger compared to older male sexual partners (AOR: 2.20, 95%CI: 1.75, 2.77), and women who ever experienced forced sex (AOR 1.24, 95%CI: 1.10, 1.40).
Conclusion(s)
From a decade long follow-up, we show a disproportionately high and increasing rate of HIV infection among widowed women in Siaya, Kenya. This is significantly elevated among; the younger women, women with younger sexual partners, and who experienced forced or transactional sex. This calls for policy to prioritize widows in HIV control strategies and develop targeted interventions that address the unique challenges they face.