Researchers assumed that people are usually diagnosed two to five years after they actually get infected.Experts are challenging the long-held belief that widows living with HIV mostly contracted the virus from their husbands before they died.
A new study suggests at least a third, and possibly more than half, of widows living with HIV in one high-prevalence area may have acquired the virus after becoming widows.
The study, conducted in Gem subcounty, Siaya county, examined 480 widows. Of these, 178, or 37.1 per cent, were living with HIV.
Researchers led by Dr Jackline Odhiambo, founder and executive director of Nyanam Widows Rising, found 168 HIV-positive widows had medical records showing when they were diagnosed.
Of these, 67.9 per cent were diagnosed after they became widows.
Because it is difficult to establish the exact date when a person acquires HIV, the researchers used a method commonly applied in HIV studies. They assumed diagnosis generally occurs between two and five years after infection.
Using this approach, they estimated that between 36.9 per cent and 51.2 per cent of the widows living with HIV may have acquired the virus during widowhood.
The researchers said the findings are among the first attempts to measure when HIV infection may have occurred among widows, rather than assuming it was acquired from a deceased husband.
“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.
They cautioned the evidence was not conclusive, describing the study as one of the first to examine HIV exposure during widowhood.
Dr Odhiambo, who is also affiliated with Maseno University, said the findings should change how health workers understand HIV risk among widows.
The study found some widows continued to face HIV exposure through cultural practices, including widow inheritance and sexual cleansing.
Widow inheritance involves a widow being taken up by a male relative of her deceased husband, while sexual cleansing involves ritual sex believed to free a widow from the spirit of death.
About 60.2 per cent of the women interviewed had undergone widow inheritance, while 60 per cent had undergone sexual cleansing.
The researchers found both practices were closely associated with condomless sex. Nearly six in 10 widows, or 59.8 per cent, reported having had sex without a condom since becoming widowed.
The researchers described the cultural expectation of condomless sex in an area with high HIV prevalence as a serious health risk.
Young widows below 30 were found to be particularly vulnerable. They were more likely than older widows to undergo widow inheritance and sexual cleansing and to have condomless sex.
They were also more likely to have sexual relationships with considerably older men.
The researchers said younger widows may have less freedom to reject cultural practices and may also be seeking remarriage, more children or a father figure for their children.
They are calling for wider access to HIV testing, condoms and PrEP, an HIV prevention medicine, particularly soon after women are widowed. They also want safer pathways to remarriage that do not expose women to risky cultural practices.
Kenya’s national HIV prevalence was about three per cent in 2025, with an estimated 1.33 million people living with the virus, according to figures from the National Syndemic Diseases Control Council.
However, the burden remains considerably higher in the Lake Region.
Siaya recorded HIV prevalence of 12.18 per cent among women and 7.13 per cent among men, placing it among counties with the highest rates alongside Homa Bay, Kisumu and Migori.
The researchers cautioned that the study was conducted in one subcounty, meaning the findings may not apply to widows across Kenya.
They also lacked access to modern HIV recency tests that can establish more precisely when infection occurred and relied on estimates based on the two-to-five-year period between infection and diagnosis.
The study also depended on participants reporting sensitive information about their sexual lives, meaning some behaviour may have gone unreported.
The study was co-authored by Prof Elizabeth Bukusi of Kemri and Maseno University, Louisa Ndunyu of Nyanam Widows Rising and Maseno University, as well as researchers from Maseno University, the University of California, San Francisco, and Kemri’s Centre for Global Health Research in Kisumu.
