Imperial College London

Jeff Eaton

Faculty of MedicineSchool of Public Health

Senior Lecturer in HIV Epidemiology







Norfolk PlaceSt Mary's Campus






BibTex format

author = {Schaefer, R and Gregson, S and Eaton, JW and Mugurungi, O and Rhead, R and Takaruza, A and Maswera, R and Nyamukapa, C},
doi = {10.1097/QAD.0000000000001506},
journal = {AIDS},
pages = {1461--1470},
title = {Age-disparate relationships and HIV incidence in adolescent girls and young women: evidence from a general-population cohort in Zimbabwe},
url = {},
volume = {31},
year = {2017}

RIS format (EndNote, RefMan)

AB - Objective: Age-disparate sexual relationships with older men may drive high rates of HIV acquisition in young women in sub-Saharan Africa but evidence is limited. We investigate the association between age-disparate relationships and HIV incidence in Manicaland, Zimbabwe.Design: A general-population open-cohort study (six surveys) (1998-2013).Methods: 3746 young women aged 15-24 years participated in consecutive surveys and were HIV-negative at the beginning of inter-survey periods. Last sexual partner age difference and age-disparate relationships (inter-generational [≥10 years age difference] and intra-generational [5-9 years] versus age-homogeneous [0-4 years]) were tested for associations with HIV incidence in Cox regressions. A proximate determinants framework was used to explore factors possibly explaining variations in the contribution of age-disparate relationships to HIV incidence between populations and over time.Results: 126 HIV infections occurred over 8777 person-years (1.43 per 100 person-years; 95% confidence interval=1.17-1.68). 65% of women reported partner age differences of ≥5 years. Increasing partner age differences were associated with higher HIV incidence (adjusted hazard ratio [aHR]=1.05 [1.01-1.09]). Inter-generational relationships tended to increase HIV incidence (aHR=1.78 [0.96-3.29]) but not intra-generational relationships (aHR=0.91 [0.47-1.76]). Secondary education was associated with reductions in inter-generational relationships (adjusted odds ratio [aOR]=0.49 [0.36-0.68]). Inter-generational relationships were associated with partners having concurrent relationships (aOR=2.59 [1.81-3.70]) which tended to increase HIV incidence (aHR=1.74 [0.96-3.17]). Associations between age-disparity and HIV incidence did not change over time.Conclusions: Sexual relationships with older men expose young women to increased risk of HIV acquisition in Manicaland, which did not change over time, even with introduction of antiretroviral therapy.
AU - Schaefer,R
AU - Gregson,S
AU - Eaton,JW
AU - Mugurungi,O
AU - Rhead,R
AU - Takaruza,A
AU - Maswera,R
AU - Nyamukapa,C
DO - 10.1097/QAD.0000000000001506
EP - 1470
PY - 2017///
SN - 0269-9370
SP - 1461
TI - Age-disparate relationships and HIV incidence in adolescent girls and young women: evidence from a general-population cohort in Zimbabwe
UR -
UR -
VL - 31
ER -