Young widowhood as a predictor of HIV risk behaviors in a high HIV prevalence setting in Siaya County, Kenya

BACKGROUND: Widowed women in sub-Saharan Africa bear a disproportionate burden of HIV/AIDS. OBJECTIVES: We examined the likely period of HIV exposure among widows living with HIV and the patterns and predictors of widowed women's HIV risk behaviors. METHODS: We performed a cross-sectional survey with an age-stratified random sample of widowed women in Siaya County, Kenya. We estimated the period of HIV exposure and the prevalence of HIV-risk behaviors, and used Firth's penalized multivariable logistic regression to determine the association of socio-economic characteristics with HIV risk behaviors since widowhood. RESULTS: Of the 480 widowed women, 178 (37.1%) had HIV. Of the 168 widows with confirmed dates of HIV diagnosis, 51.2% and 36.9% may have been exposed 2 and 5 years after widowhood, respectively. At least one in two widows engaged in condomless sex since widowhood. Widowhood during reproductive age was associated with higher odds of culturally sanctioned sexual behaviours. Specifically, young widowhood (<30 years old) was associated with condomless sex (AOR: 64.5, 95%CI: 15.0-277.1), widow inheritance (AOR: 34.5, 95%CI: 9.0-133.0), sexual cleansing (AOR: 41.5, 95%CI: 10.1-171.0), sex with a 10-year‑older partner (AOR: 227.4, 95%CI: 12.0-4324.5), and sex with an inheritor who had a wife (AOR: 16.8, 95%CI: 2.8-100.8). Living with HIV was associated with condomless sex (AOR: 2.9, 95%CI: 1.5-5.5), widow inheritance (AOR: 3.4, 95%CI: 1.8-6.5) and sexual cleansing (AOR: 3.2, 95%CI: 1.7-6.2). CONCLUSIONS: One in three widows living with HIV may have acquired the virus during widowhood. Young widowhood and living with HIV were associated with higher HIV risk behaviours. HIV testing, pre-exposure prophylaxis, and condom use in culturally sanctioned sexual practices should be studied further.