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Marriage Is a Risk Factor for HIV Infection in Malawi

April 17, 2013

Researcher Lucy Mkandawire-Valhmu reports that cultural norms in the southeast African country of Malawi result in increased HIV risk for married women. Approximately 12 percent of Malawi adults are HIV-infected; women become infected at a younger age and more often than men in Malawi. The average annual income in Malawi is $200, and women are "substantially poorer" than men, according to Mkandawire-Valhmu.

The study author conducted 12 focus groups comprised of 72 women, most of whom had been diagnosed with HIV during the last two years. The average age of participants was 33. Most participants had some primary education, but none were employed at the time of the focus groups. Although half of the participants were married during the study, almost all had been married—some two or three times. The women cited poverty and companionship as reasons for marriage.

The focus group participants reported several factors contributing to increased HIV risk for married women in Malawi: Polygamy is legal in Malawi; husbands are unfaithful; Malawi cultural norms dictate that couples abstain from sex for a year after childbirth; Malawi men do not disclose their HIV status; and women are vulnerable to "nkhaza" (domestic abuse and violence, frequently with forced, unprotected sex).

Some study participants stated they have chosen poverty over marriage. The focus group participants suggested policy changes, including equal access to land and sustainable income-generating activity, and microfinancing to alleviate poverty among Malawi women.

The full report, "Marriage as a Risk Factor for HIV: Learning from the Experiences of HIV-Infected Women in Malawi," was published online in the journal Global Public Health (2013; doi:10.1080/17441692.2012.761261).

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Excerpted from:
04.08.2013; Roger Pebody

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