Study challenges belief that widows contract HIV from deceased husbands

A new study has challenged a long-held assumption that widows living with HIV mostly acquired the virus from their husbands before their deaths, suggesting that a significant proportion may have been infected after becoming widowed.

Researchers studying widows in Gem Sub-county, Siaya County, found that at least one in three HIV-positive widows may have acquired the virus during widowhood, with the proportion potentially exceeding half.

The study examined 480 widows, of whom 178, or 37.1 per cent, were living with HIV.

Researchers led by Dr Jackline Odhiambo, Founder and Executive Director of Nyanam Widows Rising and affiliated with Maseno University, were able to establish the date of HIV diagnosis for 168 of the women living with the virus.

Of these, 67.9 per cent had been diagnosed after they became widows.

While the timing of HIV infection cannot ordinarily be established simply from the date of diagnosis, the researchers used an approach commonly applied in HIV studies to estimate when infection may have occurred.

They assumed that, in general, diagnosis occurs between two and five years after infection.

Based on this approach, they estimated that between 36.9 per cent and 51.2 per cent of the HIV-positive widows in the study may have acquired the virus after their husbands had died.

“Yet at least a third of the widowed women with HIV in our study may have been infected after widowhood,” the researchers said in the report published in the journal Global Health Action.

The researchers described the findings as among the first attempts to examine the timing of HIV exposure among widows instead of automatically assuming that infection had been acquired from a deceased husband.

However, they cautioned that the evidence is not conclusive and said the study should be viewed as an early attempt to understand HIV exposure during widowhood.

Dr Odhiambo said the findings should prompt health workers to rethink how they assess HIV risks facing widows.

The study points to cultural practices surrounding widowhood as one potential source of continued exposure to HIV after the death of a husband.

Researchers found that many women had undergone widow inheritance and sexual cleansing—practices that can involve unprotected sexual intercourse.

Widow inheritance involves a widow being taken up by a male relative of her deceased husband, while sexual cleansing is a traditional practice involving ritual sex intended to free a widow from the spirit of death.

Among the women interviewed, 60.2 per cent reported having undergone widow inheritance, while 60 per cent had undergone sexual cleansing.

Both practices were closely associated with condomless sex, according to the researchers.

Overall, 59.8 per cent of the widows reported that they had had sex without a condom since becoming widowed.

The researchers warned that the expectation of condomless sex in a community with a high HIV burden represents a serious public health risk.

Young widows were identified as particularly vulnerable. Women below the age of 30 were more likely than older widows to undergo widow inheritance and sexual cleansing and to report condomless sex.

The younger women were also more likely to have sexual relationships with considerably older men.

Researchers said the vulnerability of younger widows could be linked to several factors, including limited power to reject culturally prescribed practices, the desire to remarry, the need to have more children and the search for a father figure for their children.

The findings have prompted calls for targeted HIV prevention and testing services for women immediately after widowhood.

The researchers recommend wider access to HIV testing, condoms and pre-exposure prophylaxis (PrEP), an HIV prevention medicine, particularly during the period soon after a woman loses her husband.

They also want health and social programmes to create safer pathways to remarriage that do not expose widows to potentially risky cultural practices.

The findings are significant against the backdrop of Kenya’s wider HIV burden. National HIV prevalence was estimated at about three per cent in 2025, with approximately 1.33 million people living with the virus, according to figures from the National Syndemic Diseases Control Council.

However, the burden is substantially higher in parts of the Lake Region.

In Siaya, HIV prevalence was recorded at 12.18 per cent among women and 7.13 per cent among men, placing the county among those with the highest HIV rates in the country, alongside Homa Bay, Kisumu and Migori.

Despite the striking findings, the researchers stressed that the study has important limitations.

It was conducted in only one sub-county, meaning its findings cannot automatically be generalised to widows elsewhere in Kenya or to other populations.

The researchers also did not have access to modern HIV recency tests, which can provide a more precise indication of how recently an individual acquired the virus.

Instead, they relied on the estimated two-to-five-year interval between infection and diagnosis. This means the estimates of infections occurring during widowhood should be interpreted cautiously.

The study also relied on participants disclosing sensitive information about their sexual lives and experiences. The researchers acknowledged that some forms of sexual behaviour may have been under-reported.

The researchers argue that recognising widowhood as a potential period of HIV vulnerability could help health workers identify women who need testing, prevention and counselling services—and potentially prevent new infections linked to cultural practices and unprotected sexual relationships.