Polygamy in West Africa: what are the implications for sexual health?

Does polygamy change the pattern of spread of HIV/AIDS and other sexually transmitted diseases (STDs)? Are women in polygamous marriages more likely to contract herpes than other women? The UK's Medical Research Council, together with the London School of Hygiene and Tropical Medicine, looked at the risk of herpes in The Gambia, and what lessons could be learnt for the fight against HIV/AIDS.

As the herpes virus and the AIDS virus can both be transmitted through sexual activity, identifying those who are at greatest risk of contracting herpes can be used to help predict those at higher risk of HIV infection. The report, 'Herpes simplex 2 risk among women in a polygynous setting in rural West Africa', asked what effect might polygamy have on the spread of herpes? Compared with a monogamous marriage (two people), polygamy introduces more people (up to five in total) to the marriage group (which may or may not already be infected with a STD). Once one family member has a STD, more people are exposed to it within the group. Moreover, polygamous societies, where there is frequently a large age gap between husband and wife, have more remarriage due to death and divorce. This can also assist the spread of STDs.

The study found that:

• Women who were, or had been, married were more likely to have herpes than those who were single.
• Women whose husbands had more than one wife, or who had previously been married to someone else, were three times as likely to have herpes as women whose husbands had only ever been married once.
• Women who had a husband who was older when he married for the first time were more at risk.
• Women whose husbands were thinking about remarrying in the next year were also more likely to be infected.

This indicates that for women a lot of exposure to herpes infection is likely to come from within marriage through their husbands' lifetime sexual experiences.

The report warns that:

• Even if programmes aimed at changing sexual behaviour are successful in encouraging abstinence, fidelity and condom use in casual relationships, people will still be at risk of catching the disease within marriage.
• Condom use within marriage will be difficult to promote in a society where there is little communication between men and women, greater sexual freedom for men, and a desire to have many children.
• While behaviour change could prevent a husband and his wives from becoming infected in the first place, once a marriage group is infected, polygamy is a very effective way of transmitting the disease.
• Transmission within polygamous marriages could sustain the epidemic and lessen the effect of behaviour change programmes when compared with other societies.

In this polygamous setting a lot of herpes infection in women occurs within marriage, a situation where it is difficult for partners to protect themselves by using condoms. Health education programmes aimed at changing sexual behaviour and lessening the risk of catching AIDS and herpes are very important, however they may be undermined by transmission within marriages. Polygamy can have particular implications for sexual health, as there are a larger number of partners in each family group.

Source(s):
‘Herpes simplex 2 risk among women in a polygynous setting in rural West Africa’, AIDS 17(1): 97-103, by K. Halton et al., 2003
'Prevalence of herpes simplex type 2 and syphilis serology among young adults in a rural Gambian community', Sexually Transmitted Infections 77(5): 358-365, by M. Shaw et al., 2001
HINARI subscribers can access the full-text article here. Full document.

Funded by: The Medical Research Council (UK); Rockefeller Foundation

id21 Research Highlight: 26 March 2003

Further Information:
Kate Halton
School of Public Health
Faculty of Health
Queensland University of Technology
Victoira Park Road
Kelvin Grove
Queensland 4059
Australia

Tel: +61 (7) 3864 3405
Fax: +61 (7) 3864 3369
Contact the contributor: k.halton@qut.edu.au

Medical Research Council, UK

London School of Hygiene and Tropical Medicine, UK

Other related links:
'Is awareness enough? Practical responses the HIV epidemic in southern Africa'

'Silent suffering: the burden of reproductive health problems in the Gambia'

'Prevention in context: HIV risk behaviour among Zambian sex workers'

See id21's collection of links relevant to sexual and reproductive health.

See id21's collection of links relevant to HIV/AIDS.