Sexual Union Status and HIV Viral Load Suppression Among Older Adults in Rural South Africa: A Population-Based Study

The success of HIV treatment is primarily measured through viral load suppression. However, little is known regarding the association between sexual union status and viral suppression among older adults. This study aimed to assess the association between sexual union status and HIV viral load suppression among adults aged 40 years and older living with HIV in rural Mpumalanga, South Africa. An observational analytical study design was followed, utilising data from the HIV After 40 study in Mpumalanga. The study focused on 4637 older men and women aged 40 years and above, living with HIV. Four nested unadjusted and adjusted binary logistic regression models assessed the association between sexual union status and HIV viral load suppression. All statistical analyses were done using SPSS Version 29.0; the significance level was set at p < 0.05. Viral suppression rates significantly differed by sexual union status (p = 0.003), with married/cohabiting participants showing lower suppression (40.6%) than single (45.1%) and divorced/widowed participants (45.9%). The fully adjusted logistic regression model showed a non-significant association between viral load suppression and sexual union status (p = 0.066); however, a significant association was found in the unadjusted (p = 0.020) and partially adjusted models. Having a primary education (p < 0.001), South African citizenship (p < 0.001), being aged ≥66 years (p < 0.001), and being female (p = 0.003) were independently associated with lower odds of being virally suppressed. Sexual union status was not significantly associated with viral suppression in the fully adjusted regression model. This underscores the need for gender-responsive, age-sensitive HIV treatment interventions in rural South Africa.