Marriage in the era of antiretroviral therapy: HIV status and marital change in rural Uganda

Elizabeth A. Sully, Guttmacher Institute
Georges Reniers, London School of Hygiene and Tropical Medicine (LSHTM)
Ivan Kasamba, Medical Research Council, Uganda
Gershim Asiki, Medical Research Council, Uganda
Noreen Goldman, Princeton University
Janet Seeley, MRC/UVRI Uganda Research Unit on AIDS and London School of Hygiene and Tropical Medicine (LSHTM)

Growing awareness about HIV and increasing access to antiretroviral therapy (ART) may be profoundly changing the social implications of HIV in generalized epidemics. This paper describes the relationship between HIV and marriage transitions before and after the availability of ART. Our data contain linked marital partnerships and marital histories over 13 years (1999-2011) from a sero-surveillance site in southwestern Uganda. Historically, unions with an HIV-positive partner had higher rates of widowhood and divorce, and HIV-positive men and women were less likely to remarry. Since the introduction of ART, seroconcordant positive unions have stabilized and the remarriage rates of HIV-positive men have increased. The availability of treatment does not seem to have affected the divorce rates in serodiscordant couples, or the remarriage rates of HIV-positive women. These HIV- and gender-based differences in marital change have important implications for the onward transmission of the virus and the socioeconomic wellbeing of HIV-affected households.