Marital Status

Women living with a partner had 93% lower odds of never testing compared with single women, with similarly large reductions for separated, divorced, married, and widowed women. Marital status produced the largest effect sizes of any variable in the multivariable analysis of never being tested. The adjusted subdistribution hazard ratio for non-partnered women was 1.32, indicating a 32% higher hazard. The testing advantage of non-single women most plausibly reflects exposure to couple and partner testing programmes and mutual motivation to know HIV status within relationships. The article suggests that social and emotional support among partnered women may help explain the association. Non-partnered women may experience stress and social isolation that could contribute to inflammation and impaired immunity. Over half of single women (53.3%) had never been tested for HIV, the highest rate of any marital status subgroup. Non-partnered women had higher breast cancer incidence hazard than partnered women. Single women are identified as the highest-priority underserved group for HIV testing interventions.