Abstract
Little is known about the impact of HIV infection on the disruption of families through separation, divorce, and widowhood. Using life tables and multinomial logistic regression, this research examined the influence of HIV status on the risk of separation or divorce and widowhood among women in Rakai, Uganda. The multivariate results revealed that dissolution is more common among HIV-infected women and that infected women in HIV-discordant couples are especially likely to face separation or divorce than women in other HIV-status couples. These results highlight women’s vulnerability to the social impact of HIV infection and the importance of dyadic studies of the disruption of unions.
The text of this article is only available as a PDF.
References
Abbott, R.D. (
1985
). Logistic Regression in Survival Analysis
. American Journal of Epidemiology
, 121
, 465
–71
.Amoto, P.R., & Rogers, S.J. (
1997
). A Longitudinal Study of Marital Problems and Subsequent Divorce
. Journal of Marriage and the Family
, 59
, 612
–24
. 10.2307/353949Bean, F., Berg, R.R., & Van Hook, J.V.W. (
1996
). Socioeconomic and Cultural Incorporation and Marital Disruption Among Mexican Americans
. Social Forces
, 75
, 593
–617
. 10.2307/2580415Bishai, D., E.D. Suliman, H. Brahmbhatt, F. Wabwire-Mangen, G. Kigozi, N.K. Sewankambo, D. Serwadda, M.J. Wawer, and R.H. Gray. 2003. “Does Biological Relatedness Affect Survival? Testing Hamilton’s Rule With Evidence From Uganda.” Demographic Research 8(9). Available on-line at http://www.demographic-research.org
Blanc, A.K., Wolff, B., Gage, A.J., Ezeh, A.C., Neema, S., & Ssekamatte-Ssebuliba, J. (
1996
). Negotiating Reproductive Outcomes in Uganda
. Calverton, MD
: Macro International and Institute of Statistics and Applied Economics (Uganda)
.Bledsoe, C. (
1990
). The Politics of AIDS, Condoms, and Heterosexual Relations in Africa: Recent Evidence From the Local Print Media
. In Handwerker, W.P. (Ed.), Births and Power: Social Change and the Politics of Reproduction
(pp. 197
–223
). Boulder
: Westview Press
.Boerma, J.T., Nunn, A.J., & Whitworth, J.A.G. (
1998
). Mortality Impact of the AIDS Epidemic: Evidence From Community Studies in Less Developed Countries
. AIDS
, 12
(1
), S3
–S14
.Bollen, K.A., Guilkey, D.K., & Mroz, T.A. (
1995
). Binary Outcomes and Endogenous Explanatory Variables: Test and Solutions With an Application to the Demand for Contraceptive Use in Tunisia
. Demography
, 32
, 111
–31
. 10.2307/2061900Caldwell, J.C., Caldwell, P., & Quiggin, P. (
1989
). The Social Context of AIDS in Sub-Saharan Africa
. Population and Development Review
, 15
, 185
–234
. 10.2307/1973703Carael, M., Van de Perre, P.H., Lepage, P.H., Allen, S., Nsenjumuremyi, F., Van Goethem, C., Ntahorutaba, M., Naramba, D., & Clumeck, N. (
1988
). Human Immunodeficiency Virus Transmission Among Heterosexual Couples in Central Africa
. AIDS
, 2
, 201
–205
. 10.1097/00002030-198800001-00030Carpenter, L.M., Kamali, A., Ruberantwari, A., Malamba, S.S., & Whitworth, J.A. (
1999
). Rates of HIV-1 Transmission Within Marriage in Rural Uganda in Relation to the HIV Sero-status of the Partners
. AIDS
, 13
, 1083
–89
. 10.1097/00002030-199906180-00012Cupples, L.A., D’Agostino, R.B., Anderson, K., & Kannel, W.B. (
1988
). Comparison of Baseline and Repeated Measure Covariate Techniques in the Framingham Heart Study
. Statistics in Medicine
, 7
, 205
–18
. 10.1002/sim.4780070122D’Agostino, R.B., Lee, M.L., Belanger, A.J., Cupples, L.A., Anderson, K., & Kannel, W.B. (
1990
). Relation of Pooled Logistic Regression to Time Dependent Cox Regression Analysis: The Framingham Heart Study
. Statistics in Medicine
, 9
, 1501
–15
. 10.1002/sim.4780091214Desgrees du Lou, A., Msellati, P., Ramon, R., Noba, V., Viho, I., Dabis, F., Mandelbrot, L., & Wellfens-Ekra, C. (
1998
). HIV-Infection and Reproductive History: A Retrospective Study Among Pregnant Women, Abidjan, Cote d’Ivoire, 1995–1996
. International Journal of STD and AIDS
, 9
, 452
–56
. 10.1258/0956462981922610Espenshade, T.J., & Braun, R.E. (
1982
). Life Course Analysis and Multistate Demography: An Application to Marriage, Divorce, and Remarriage
. Journal of Marriage and the Family
, 44
, 1035
–36
. 10.2307/351461Foster, G., & Williamson, J. (
2000
). A Review of Current Literature on the Impact of HIV/AIDS on Children in Sub-Saharan Africa
. AIDS
, 14
(3
), 275
–84
.Gray, R.H., Kiwanuka, N., Quinn, T.C., Sewankambo, N.K., Serwadda, D., Wabwire-Mangen, F., Lutalo, T., Nalugoda, F., Kelly, R., Meehan, M., Chen, M.Z., Li, C., & Wawer, M.J. (
2000
). Male Circumcision and HIV Acquisition and Transmission: Cohort Studies in Rakai, Uganda
. AIDS
, 14
, 2371
–81
. 10.1097/00002030-200010200-00019Gray, R.H., Wawer, M.J., Serwadda, D., Sewankambo, N.K., Li, C., Wabwire-Mangen, F., Paxton, L., Kiwamuka, N., Kigozi, G., Konde-Lule, J., Quinn, T.C., Gaydos, C.A., & McNairn, D. (
1998
). Population-Based Study of Fertility in Women With HIV-1 Infection in Uganda
. Lancet
, 351
, 98
–103
. 10.1016/S0140-6736(97)09381-1Gregson, S., Zhuwau, T., Anderson, R.M., & Chadiwana, S.K. (
1999
). Apostle and Zionist: The Influence of Religion on Demographic Change
. Population Studies
, 53
, 179
–93
. 10.1080/00324720308084Grinstead, O.A., Gregorich, S.E., Choi, K.H., & Coates, T.
Voluntary HIV-1 Counselling and Testing Efficacy Study Group
(2001
). Positive and Negative Life Events After Counseling and Testing: The Voluntary HIV-1 Counseling and Testing Efficacy Study
. AIDS
, 15
, 1045
–52
. 10.1097/00002030-200105250-00013Heaton, T.B., & Call, V.R.A. (
1995
). Modeling Family Dynamics With Event History Techniques
. Journal of Marriage and the Family
, 57
, 1078
–90
. 10.2307/353424Huber, P.J. (
1967
). The Behavior of Maximum Likelihood Estimate Under Non-Standard Conditions
Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability
(pp. 221
–33
). Berkeley
: University of California Press
.Kahn, H.A., & Sempos, C.T. (
1989
). Statistical Methods in Epidemiology. Monographs in Epidemiology and Biostatistics, Vol. 12
. New York
: Oxford University Press
.Kamenga, M., Ryder, R.W., Jingu, M., Mbuyi, N., Mbu, L., Behets, F., Brown, C., & Heyward, W.L. (
1991
). Evidence of Marked Sexual Behavior Change Associated With Low HIV-1 Seroconversion in 149 Married Couples with Discordant HIV-1 Serostatus: Experience at an HIV Counseling in Zaire
. AIDS
, 5
, 61
–67
. 10.1097/00002030-199101000-00009Karanja, W.W. (
1994
). The Phenomenon of ‘Outside Wives’: Some Reflections on Its Possible Influence on Fertility
. In Bledsoe, C., & Pison, G. (Eds.), Nuptiality in Sub-Saharan Africa: Contemporary Anthropological and Demographic Perspectives
(pp. 194
–214
). Oxford, England
: Clarendon Press
.Lee, L.M., Wortley, P.M., Fleming, P.L., Eldred, F.J., & Gray, R.H. (
2000
). Duration of Human Immunodeficiency Virus Infection and Likelihood of Giving Birth in a Medicaid Population in Maryland
. American Journal of Epidemiology
, 151
, 1020
–28
.Locoh, T. (
1994
). Social Change and Marriage Arrangements: New Types of Union in Lome, Togo
. In Bledsoe, C., & Pison, G. (Eds.), Nuptiality in Sub-Saharan Africa: Contemporary Anthropological and Demographic Perspectives
(pp. 215
–29
). Oxford, England
: Clarendon Press
.Mason, K.O. (
1994
). HIV Transmission and the Balance of Power Between Men and Women: A Global View
. Health Transition Review
, 4
, 217
–40
.McGrath, J.W., Rwabukwali, C.B., Schumann, D.A., Pearson-Marks, J., Nkayiwa, S., Namande, B., Nakyobe, L., & Mukasa, R. (
1993
). Anthropology and AIDS: The Cultural Context of Sexual Risk Behavior Among Urban Baganda Women in Kampala, Uganda
. Social Science and Medicine
, 36
, 429
–39
. 10.1016/0277-9536(93)90405-SNabaitu, J., Bachengana, C., & Seeley, J. (
1994
). Marital Instability in a Rural Population in South-West Uganda: Implications for the Spread of HIV-1 Infection
. Africa
, 64
, 243
–51
. 10.2307/1160982Nguyen, R.H.N., S.J. Gange, D. Serwadda, F. Wabwire-Mangen, N.K. Sewankambo, M.J. Wawer, T.C. Quinn, and R.H. Gray. 2001. “Association Between HIV-RNA Viral Load and Subfertility: Rakai, Uganda.” Paper presented at the 39th annual meeting of the Infectious Diseases Society of America, San Francisco, October 25–28.
Obbo, C. (
1980
). African Women. Their Struggle for Economic Independence
. London
: Zed Press
.Obbo, C. (
1993
). HIV Transmission: Men Are the Solution
. Population and Environment
, 14
, 211
–43
. 10.1007/BF01254373Painter, T.M. (
2001
). Voluntary Counseling and Testing for Couples: A High-Leverage Intervention for HIV/AIDS Prevention in Sub-Saharan Africa
. Social Science and Medicine
, 53
, 1397
–411
. 10.1016/S0277-9536(00)00427-5Peters, H.E. (
1986
). Marriage and Divorce: Informational Constraints and Private Contracting
. American Economic Review
, June
, 437
–54
.Pilon, M. (
1994
). Types of Marriage and Marital Stability: The Case of the Moba-Gurma of North Togo
. In Bledsoe, C., & Pison, G. (Eds.), Nuptiality in Sub-Saharan Africa: Contemporary Anthropological and Demographic Perspectives
(pp. 130
–47
). Oxford, England
: Clarendon Press
.Radcliffe-Brown, A.R., & Forde, D. (
1962
). African Systems of Kinship and Marriage
. New York
: Oxford University Press
.Roth, D.L., Stewart, K.E., Clay, O.J., Van Der Straten, A., Karita, E., & Allen, S. (
2001
). Sexual Practices of HIV Discordant and Concordant Couples in Rwanda: Effects of a Testing and Counselling Programme for Men
. International Journal of STD and AIDS
, 12
, 181
–88
. 10.1258/0956462011916992Ryder, R.W., Kamenga, C., Jingu, M., Mbuyi, N., Mbu, L., & Behets, F. (
2000
). Pregnancy and HIV-1 Incidence in 178 Married Couples With Discordant HIV-1 Serostatus: Additional Experience at an HIV-1 Counselling Centre in the Democratic Republic of the Congo
. Tropical Medicine and International Health
, 5
(7
), 482
–87
. 10.1046/j.1365-3156.2000.00582.xSchoen, R. (
1988
). Modeling Multigroup Populations
. New York
: Plenum Press
.Schoen, R. (
1988
). Practical Uses of Multistate Population Models
. Annual Review of Sociology
, 14
, 341
–61
. 10.1146/annurev.so.14.080188.002013Schoen, R., Astone, N.M., Kim, Y.J., Nathanson, C.A., & Fields, J.A. (
1999
). Do Fertility Intentions Affect Fertility Behavior?
. Journal of Marriage and the Family
, 61
, 790
–99
. 10.2307/353578Schoepf, B.G., Engundu, W., Nkera, R.W., Ntsomo, P., & Schoepf, C. (
1991
). Gender, Power, and Risk of AIDS in Zaire
. In Turshen, M. (Ed.), Women and Health in Africa
(pp. 187
–203
). Trenton, NJ
: Africa World Press
.Serwadda, D., Gray, R.H., Wawer, M.J., Stallings, R.Y., Sewankambo, N.K., Konde-Lule, J.K., Lainjo, B., & Kelly, R. (
1995
). The Social Dynamics of HIV Transmission as Reflected Through Discordant Couples in Rural Uganda
. AIDS
, 9
, 745
–50
. 10.1097/00002030-199507000-00012Sewankambo, N.K., Gray, R.H., Ahmed, S., Serwadda, D., Wabwire-Mangen, F., Nalugoda, F., Kiwanuka, N., Lutalo, T., Kigozi, G., Li, C., Meehan, M.P., Brahmbhatt, H., & Wawer, M.J. (
2000
). Mortality Associated With HIV Infection in Rural Rakai District, Uganda
. AIDS
, 14
, 2391
–400
. 10.1097/00002030-200010200-00021South, S.J., & Lloyd, K.M. (
1995
). Spousal Alternative and Marital Dissolution
. American Sociological Review
, 60
, 21
–35
. 10.2307/2096343Staiger, D., & Stock, J.H. (
1994
). Instrumental Variables Regression With Weak Instruments
. Econometrica
, 65
, 557
–86
. 10.2307/2171753Uganda Demographic and Health Survey, 1995
. (1996
). Calverton, MD
: Statistics Department (Uganda) and Macro International
.Tangmunkongvorakul, A., Celentano, D.D., Burke, J.G., de Boer, M.A., Wongpan, P., & Suriyanon, V. (
1999
). Factors Influencing Marital Stability Among HIV Discordant Couples in Northern Thailand
. AIDS Care
, 11
, 511
–24
. 10.1080/09540129947677Timaeus, I.M. (
1998
). Impact of the HIV Epidemic on Mortality in Sub-Saharan Africa: Evidence From National Surveys and Censuses
. AIDS
, 12
(1
), S15
–S27
.Uganda Demographic and Health Survey 2000–2001
. (2001
). Calverton, MD
: UBOS and ORC Macro
.Wawer, M.J., Gray, R.H., Sewankambo, N., Serwadda, D., Paxton, L., Berkley, S., McNairn, D., Wabwire-Mangen, F., Li, C., Nalugoda, F., Kiwanuka, N., Lutalo, T., Brookmeyer, R., Kelly, R., & Quinn, T.C. (
1998
). A Randomized, Community Trial of Intensive Sexually Transmitted Disease Control for AIDS Prevention, Rakai, Uganda
. AIDS
, 12
, 1211
–25
. 10.1097/00002030-199810000-00014World Health Organization (WHO)
(1985
). Acquired Immunodeficiency Syndrome (AIDS).” Workshop on AIDS in Central Africa, Bangui, October 22–25
. Weekly Epidemiological Record
, 60
, 342
–342
.WHO International Collaborating Group for the Study of the WHO Staging System
(1993
). Proposed World Health Organization Staging System for HIV Infection and Disease: Preliminary Testing by an International Collaborative Cross-Sectional Study
. AIDS
, 7
, 711
–18
.© Population Association of America 2004
2004
Issue Section:
Articles
