Role of widows in the heterosexual transmission of HIV in Manicaland, Zimbabwe, 1998-2003.

Role of widows in the heterosexual transmission of HIV in Manicaland, Zimbabwe, 1998-2003.

AIDS is the main driver of young widowhood in southern Africa. The demographic characteristics of widows, their reported risk behaviours, and the prevalence of HIV were examined by analysing a longitudinal population-based cohort of men and women aged 15-54 years in Manicaland, eastern Zimbabwe. The results from statistical analyses were used to construct a mathematical simulation model with the aim of estimating the contribution of widow behaviour to heterosexual HIV transmission. 413 (11.4%) sexually experienced women and 31 (1.2%) sexually experienced men were reported to be widowed at the time of follow-up. The prevalence of HIV was exceptionally high among both widows (61%) and widowers (male widows) (54%). Widows were more likely to have high rates of partner change and engage in a pattern of transactional sex than married women. Widowers took partners who were a median of 10 years younger than themselves. Mathematical model simulations of different scenarios of sexual behaviour of widows suggested that the sexual activity of widow(er)s may underlie 8-17% of new HIV infections over a 20-year period. This combined statistical analysis and model simulation suggest that widowhood plays an important role in the transmission of HIV in this rural Zimbabwean population. High-risk partnerships may be formed when widowed men and women reconnect to the sexual network.

practice of widows marrying the brother of their deceased spouse, known as the ‘levirate’, appears to have declined in Zimbabwe, along with traditional practices discouraging widows from taking another partner for one year after the death of their spouse. Widows’ rights to inheritance are better protected, although less so for those married under customary law. Nevertheless, this modelling study in a rural area suggests that widows and widowers in this high prevalence setting are more likely to enter into high risk partnerships when they reconnect to the sexual network. Many of them likely need support and knowledge to make safe sexual choices after the death of a spouse. Widows in particular need legal advice and increased financial independence through employment opportunities to reduce their need for economic support from a new partner.