The New York Times - Sunday, February 29, 2004
Lawrence K. Altman

ATLANTA - Teenage brides in some African countries are becoming infected with the AIDS virus at higher rates than sexually active unmarried girls of similar ages in the same areas, the director of Unicef and other United Nations officials said here on Saturday.

The studies are the first to show such differences among married and unmarried young women, the officials said at the closing of a two-day international meeting on women and infectious diseases. The officials said the findings pointed to an inadequacy in programs that focus on abstinence among teenagers as a main means of preventing H.I.V. infection because they failed to take into account fully the risk of transmission in marriage.

The young brides are apparently acquiring H.I.V., the AIDS virus, from their husbands, who tend to be many years older and were infected before marriage, the officials said.

While many people around the world may conclude that being married and faithful protects them from exposure to AIDS, that is not necessarily true, said Dr. Paul DeLay, an official of the United Nations AIDS program. In many parts of the world, a married woman who is faithful runs the highest risk of exposure to the AIDS virus, he said, if she has "a philandering husband."

Dr. Catherine Hankins, chief scientific adviser to United Nations AIDS program, said "it's the first time we have ever seen" differences in H.I.V. infection rates between married women and sexually active single women ages 15 to 19. She commented from the agency's headquarters in Geneva on remarks made at the meeting by Dr. DeLay and Carol Bellamy, the director of Unicef.

Though the findings are from studies in Kisumu, Kenya, and Ndola, Zambia, they may have applicability elsewhere. The studies indicated a greater difference in age between the brides and husbands than among the sexually active teenage women and their boyfriends.

"Consistently around the world, girls who marry at or after age 20 have partners closer in age to them than girls who marry younger than that," Dr. Hankins said.

"We have known for a long time that marriage in and of itself is not protective for women who have partners who have been or continue to be at risk," Dr. Hankins said, referring to the risk of acquiring H.I.V.

"The striking finding here is that among 15-to-19-year-old girls who are sexually active in these two settings, the fact of being married carries significantly higher risk -- in part because of the increased age differential between spouses and in part because condom use in marriage has not been promoted," she said. "Common H.I.V./AIDS protection messages are often inappropriate for married adolescents who seem to have been a forgotten population."

The studies in Africa found that H.I.V. rates in the husbands were higher than in the boyfriends of sexually active single teenage women.

AIDS experts have long known that teenage women are more vulnerable to acquiring H.I.V. infection because cells in the cervixes of girls are biologically more susceptible to the virus than those of older women.

Earlier studies of AIDS from the United Nations have shown that the disease has cut life expectancy to 37 to 40 years from 60 to 62 in many countries in sub-Saharan Africa.

In addressing the broader dimensions of infections among women, Ms. Bellamy said that despite the benefits of globalization, many types of infections were increasingly affecting a disproportionate number of women, compared with men. Nearly half of the world's women live on $2 a day or less, she said.

High illiteracy rates among women in many countries and cuts in government aid for drugs for malaria, H.I.V. and tuberculosis "have led to the rampant spread of infectious diseases that affect the world's poorest communities," she added.

Citing a World Health Organization report, she said less money was spent on health care for women and girls worldwide than for men and boys. She did not provide the figures.

The world needs to open up educational, economic, social and political opportunities for women, she said, to "ensure progress in stabilizing population growth, protecting the environment and improving health, starting with the health of young children."

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