Widowed and at risk: increasing HIV prevalence among widowed women in Siaya county, Kenya in the last decade, 2011-2022.

Abstract

Background: The majority (66%) of the 1.3 million people living with HIV in Kenya are women. Identification of factors associated with living with HIV, and trends in the burden of HIV among widowed women over time could inform health strategies for this group.

Methods: We used serial cross-sectional data collected between 2011 and 2022 among widowed and married women aged 15 + years enrolled in any of five periodic HIV serological and behavioural surveys conducted in Siaya County, Kenya. HIV status was determined either by blood test or evidence of a previous diagnosis. We estimated the weighted HIV prevalence stratified by marital status and age, and assessed factors associated with living with HIV for both married and widowed women using logistic regression.

Results: Of 14,445 women, 27.2% (3,930) were ever widowed and 72.8% (10,515) were currently married. Median age among widowed women was 64 years (interquartile range [IQR] 49-76) vs. 32 years (IQR 24-44) among married women. Overall weighted HIV prevalence was 26.2% (95% Confidence Interval [CI]: 25.3-27.0%) among widows and 17.1% (CI:16.6-17.6%) among married women. In 2011-2022, HIV prevalence increased among widowed (21.5-26.2%) and married (15.0-17.1%) women. In the adjusted analysis, the odds of HIV was six-fold higher among widowed than married women (AOR: 5.93, CI: 4.90-7.18). The odds of HIV were higher among younger (< 45 years) than older (60 + years) widowed women (AOR: 5.74, CI:1.94-17.0); among women with younger versus older male sexual partners (AOR 2.19, CI:1.03-4.64 [widowed] and AOR 2.11, CI:1.52-2.95 [married]); and among those who had ever experienced forced sex (AOR 1.75, CI:1.01-3.01 [widowed] and AOR 1.23, CI:1.08-1.41 [married]).

Conclusion: From a decade long follow-up, we show a disproportionately high and increasing prevalence of HIV among widowed women in Siaya, Kenya. Among both widowed and married women, there was an association between living with HIV and younger age, 10-year younger sexual partners and experiencing forced sex. Policies that prioritize widowed women could assist in the development of targeted interventions that address the unique challenges of this important subpopulation.