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Try out PMC Labs and tell us what you think. Learn More. Extramarital sex is a potential driver of human immunodeficiency virus HIV transmission for long-term couples in sub-Saharan Africa. It is increasingly recognized that preventing sexual risk behaviours requires an understanding and adjustment of sexual relationship factors beyond the individual level. We investigated the association between extramarital affairs and HIV status, factors associated with extramarital affairs, and created insights in the context and pathways for married men and women in rural Tanzania who engage in extramarital affairs.
A cross-sectional sequential explanatory mixed method de was employed. The WHO-Social determinants of health perspective guided the study. Multinomial logistic regression analysis established the relative risk ratio RRR of different social and economic factors with lifetime proxy and recent 12 months prior Married women wanting sexual affairs Switzerland survey extramarital affairs. Logistic regression analysis determined the association between extramarital affairs and HIV status.
Semi-structured interviews and focus group discussions explored the quantitative findings, capturing the experiences and norms regarding extramarital affairs. We found a ificant association between lifetime proxy extramarital affairs and HIV infection among women only. In the case of recent extramarital affairs 12 months prior to surveyassociations were ificant for the same variables except for religion, having an income was also associated with the outcome.
For women, striving for financial autonomy, obligations to pay back debts borrowed from several VICOBA, and limited support from their husbands encouraged their engagement in extramarital affairs. The findings show that the link between extramarital affairs and HIV has a gender dimension in which women are more likely to acquire HIV through extramarital affairs case of recent extramarital affairs 12 months prior to survey.
Microfinance projects e.
Extramarital sex is a potential driver of increased risk of human immune virus HIV transmission among couples in long-term relations in sub-Saharan Africa SSA. An incidence study among stable couples in SSA estimates that Absence of contextually adapted information to address extramarital affairs in marriage, together with an underestimation of the potential risk of this behavior among married partners [ 3 ] are likely to have undermined the effectiveness of proven HIV interventions in the region.
In Tanzania, as elsewhere in sub-Saharan Africa SSA various studies suggest that extramarital sex is common among married and stable couples [ 4 ]. Whether engaging in concomitant sexual relationships involves married or unmarried individuals is making a difference with regards to HIV prevention [ 6 ].
This is because, unlike unmarried partners, married partners may feel protected from sexually transmitted infections, as it is not expected to have other sexual partners outside the union. In some communities in Tanzania, women may not be allowed to suggest safer sex use to their husbands in marriage as this may be considered as against societal expectations about married partners [ 8 ]. A study in Zambia also found that married women are often not given the right to decide on HIV health matters [ 9 ]. This is likely to heighten the risk for HIV transmission since partners perceive themselves at a low risk of HIV infection [ 10 ], do not realize Married women wanting sexual affairs Switzerland a partner may be infected with HIV [ 11 ], and are less likely to use protection during extramarital affairs [ 6 ].
Therefore, being in a marriage with someone who has other partners outside the union subjects both partners to the risk of HIV infection. Various social-behavioral aspects have been associated with extramarital affairs in SSA. In Tanzania, a study among men shows that, higher education, being older, a lower age at first sexual intercourse, and having sex before marriage were ificantly associated with extramarital affairs [ 12 ].
Agnarson in Tanzania also found that concurrent partnerships are sometimes a way to assure financial security for women [ 13 ].
In Nigeria the of sexual partners before marriage, polygamy, wealth, being in a monogamous marriage, the region, and self-perceived risk of HIV infection were linked to extramarital affairs [ 14 ]. Individual behavior-change approaches have been consistently employed to address extramarital affairs and HIV vulnerability in marriage.
In Tanzania couple counseling and testing services are well implemented and accessible in various levels of the health facilities. In SSA, couple counseling and testing services are known to improve adoption of safer sex practices including condom use and reduction of multiple sexual partners among couples [ 1718 ]. Increasing recognition that high-risk sexual behaviors and HIV vulnerability are entrenched within the broader social, cultural, economic and political contexts [ 19 — 21 ], requires a wider understanding of how these aspects Married women wanting sexual affairs Switzerland likely to shape extramarital affairs in a localized context.
However, there is limited contextual information of what contributes to extramarital affairs particularly in Tanzania. This gap is likely to limit appropriate strategies to address the behavior and mitigate risk of HIV transmission among married couples in the country. Therefore, this study aims at investigating the association between extramarital affairs and HIV status, factors associated with extramarital affairs, as well as understanding the contextual aspects and the pathways by which men and women come to engage in extramarital affairs.
We further investigated the association between extramarital affairs and HIV status among married men and women in the respective local context. The emphasis on contextual determinants distinguishes the WHO-CSDH framework from other psychological and behavioral theories, which focus mostly on attitudes, perceptions, and other individual level determinants.
To guide the examination of the social determinants of extramarital affairs as a driver for HIV infection, we used the WHO-CSDH constructs highlighted in yellowbut we also added constructs highlighted in red as illustrated in Fig. The additional constructs highlighted Married women wanting sexual affairs Switzerland red were based on insights from an earlier study conducted in the same project and context which highlighted their relevance in explaining safer sex communication practices in marriage [ 8 ].
A cross-sectional sequential explanatory mixed-method study was employed [ 23 Married women wanting sexual affairs Switzerland to understand the contextual determinants of extramarital affairs. Both studies were carried on in Ifakara town, Kilombero district in southeastern, Tanzania.
Ifakara town is heterogeneous, comprising of more than nine ethnic groups coming from various parts of the country [ 24 ]. Kiswahili is the main language spoken in the area. Islam and Christianity are the predominant religions. The town comprises a hierarchy of health facilities ranging from the referral hospital to health centers and dispensaries.
A detailed description of the quantitative method for this study is published elsewhere [ 24 ]. We provide a brief description here. The study comprised of married and cohabiting partners who were enrolled in the MZIMA community health closed cohort study implemented between April and April in Ifakara town, Kilombero district, Tanzania.
MZIMA, which means being healthy in Kiswahili, aimed to establish the prevalence of communicable and non-communicable diseases and their associated social-economic determinants. This cross-sectional study uses data from the first round of MZIMA cohort study which was captured through a questionnaire that was taken orally in a face-to-face during house visits in which the HIV tests were also performed. All households located within the Ifakara town health and demographic surveillance system were selected.
Because we aimed to investigate factors that determine extramarital affairs in stable relationships, in the present study we restricted the sample to participants who said they were officially married or cohabiting Participants were interviewed in a private place within the premises of the household. The of persons with extramarital affairs in the past 12 months and of the proxy for extramarital affairs before that was sufficient to perform multivariable multinomial statistical analysis.
VICOBA membership was measured by requesting participants to report on whether they were members of a microfinance program in their community. The study had two outcome variables: HIV status as main, and extramarital affairs as intermediate outcome. First, we establish associations of extramarital affairs with HIV infection stratified by sex of the respondent; second, associations of the independent variables with extramarital affairs were determined. Due to the sensitive nature of the topic, participants were not directly asked whether they engaged in extramarital affairs.
As all participants in this study were in a monogamous marriage, participants with more than one sexual partner in the past 12 months were coded as having had extramarital affairs in the 12 months prior to the survey.
Because the of persons who reported extramarital affairs in the last 12 months was low, and with the given HIV incidence less than 1 new HIV infection would be expected in this group, associations of extramarital affairs in the MZIMA sample could not be measured with this variable. The overall of partners of a respondent was available for the respondents, as well as their age at marriage. Based on these variables we estimated the occurrence of lifetime extramarital affairs based on the median age at marriage and the of partners. At the age of 25 years half of the men were married, whereas among women half of the women were married already at the age of In our sample men who were 25 years old had in average 4.
First, descriptive statistics were conducted to list outcomes Married women wanting sexual affairs Switzerland all variables. The ificance of the associations between the dependent and independent categorical variables were tested using the Pearson Chi square test.
Bivariate logistic regression analysis was then performed to determine the association between extramarital affairs and HIV status, stratified by sex. The model used sex, age and level of education as fixed a priori covariates.
Selection of variables for the multinomial analyses was based on their ability to improve the overall model using log likelihood ratio test. Statistical interactions of sex and other independent variables were assessed, and consequently the model was stratified for sex of the participant.
Predictive margins were calculated for men and women separately. Study participants. We targeted sexually active married men and women of age between 18 and 60 years who participated in Married women wanting sexual affairs Switzerland in-depth interviews IDIs and 6 focus group discussions FGDs.
The study was implemented between May and August in two villages where the quantitative participants were recruited in Ifakara town Viwanja sitini and Mlabani villages. A more description of the recruitment procedure is published elsewhere [ 8 ].
Both tools consisted of a series of themes constructed from the quantitative study. However, to gain deeper insights into extramarital practice, the IDIs elicited marital relationship quality and personal experiences regarding extramarital affairs, while the FGDs explored social norms regarding extramarital affairs. A married female social scientist SM with extensive experience in conducting HIV-related qualitative research conducted most of the interviews. One married male research assistant RA —a university graduate in sociology with experience in qualitative studies assisted in some interviews and discussion sessions with Married women wanting sexual affairs Switzerland participants.
Prior to formal interviews, the social scientist conducted the informal discussions with some members of the community to gain insights about the topic and the general marital lifestyle. The formal interviews and discussions were conducted in Kiswahili, recorded verbatim and subsequently transcribed by the social scientist SM assisted with a trained research assistant.
This couple used to be very much in love.
They stayed in this way for a very long time. But it reached a time when the man started realizing that his wife was having some affairs with another man. In the vignette, we chose to portray a woman as the first to perform extramarital affairs since unlike men, women may not easily disclose their behaviors regarding engaging in multiple sexual partnership.
Privacy and confidentiality of information were ensured. The social scientist SM independently coded and analyzed the transcribed data thematically [ 28 ]. Pre-determined themes drawn from the topic guides i. Through open coding, emerging themes were subsequently added.
To enhance validity, another social scientist assisted in conducting independent coding, the codes were compared, and the discrepancies were resolved. Also, themes developed by the social scientist were cross-checked within the research team. In addition, member checking Fig. N-VIVO program version 12 for qualitative data analysis was used to support rigorous data coding. All data were analyzed in Kiswahili, and relevant quotes were translated into English for this study.
Characteristics of survey respondents are summarized in Table 1. There were married and cohabiting participants of which the majorities Seventeen percent of participants were not living with the person they had married first. Table 2 shows the association between extramarital affairs and HIV infection. We did not find any statistical ificant association between extramarital affairs and HIV among men. We looked at the association between age and HIV but did not find a ificant association. The Logistic regression of the association between extramarital affairs and HIV status of men and women in Ifakara town, Tanzania Table 3 presents the of the multinomial logistic regression analysis.
The majority of the independent predictors of the proxy lifetime extramarital affairs were consistent with those in recent 12 months prior to survey extramarital affairs. The relative risk ratio RRR of having extramarital affairs versus non-extramarital affairs in the proxy-lifetime ificantly decreased as age increased RRR: 0. Likewise, the relative risk ratio RRR of having recent extramarital affairs 12 months prior to survey versus non-extramarital affairs, ificantly decreased with increasing age RRR: 0.
When Married women wanting sexual affairs Switzerland predictive margins for men and women separately; we found that most associations with extramarital affairs were similar for men and women. Only a few differences can be noted, in the youngest age-category men were less likely to have had extramarital affairs in contrast to women; women from the southern region, were more likely to have extramarital affairs than men; religion played a role mainly Married women wanting sexual affairs Switzerland women. Twenty-four participants 13 females and 11 males took part in the IDIs Table 4.Married women wanting sexual affairs Switzerland
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Linking gender, extramarital affairs, and HIV: a mixed methods study on contextual determinants of extramarital affairs in rural Tanzania