Sexual and marital trajectories and HIV infection among ever-married women in rural Malawi
Open Access
- 1 April 2009
- journal article
- other
- Published by BMJ in Sexually Transmitted Infections
- Vol. 85 (uppl 1), i27-i33
- https://doi.org/10.1136/sti.2008.033969
Abstract
Objective: To explore how sexual and marital trajectories are associated with HIV infection among ever-married women in rural Malawi. Methods: Retrospective survey data and HIV biomarker data for 926 ever-married women interviewed in the Malawi Diffusion and Ideational Change Project were used. The associations between HIV infection and four key life course transitions considered individually (age at sexual debut, premarital sexual activity, entry into marriage and marital disruption by divorce or death) were examined. These transitions were then sequenced to construct trajectories that represent the variety of patterns in the data. The association between different trajectories and HIV prevalence was examined, controlling for potentially confounding factors such as age and region. Results: Although each life course transition taken in isolation may be associated with HIV infection, their combined effect appeared to be conditional on the sequence in which they occurred. Although early sexual debut, not marrying one’s first sexual partner and having a disrupted marriage each increased the likelihood of HIV infection, their risk was not additive. Women who both delayed sexual debut and did not marry their first partner are, once married, more likely to experience marital disruption and to be HIV-positive. Women who marry their first partner but who have sex at a young age, however, are also at considerable risk. Conclusions: These findings identify the potential of a life course perspective for understanding why some women become infected with HIV and others do not, as well as the differentials in HIV prevalence that originate from the sequence of sexual and marital transitions in one’s life. The analysis suggests, however, the need for further data collection to permit a better examination of the mechanisms that account for variations in life course trajectories and thus in lifetime probabilities of HIV infection.Keywords
This publication has 20 references indexed in Scilit:
- The Malawi Diffusion and Ideational Change Project 2004–06: Data collection, data quality, and analysis of attrition2009
- Age at First Sex and HIV Infection in Rural ZimbabweStudies in Family Planning, 2007
- The condom is an ‘intruder’ in marriage: Evidence from rural MalawiSocial Science & Medicine, 2007
- Protecting Young Women from HIV/AIDS: The Case Against Child and Adolescent MarriageInternational Family Planning Perspectives, 2006
- Early Marriage and HIV Risks in Sub‐Saharan AfricaStudies in Family Planning, 2004
- HIV status and union dissolution in Sub-saharan Africa: The case of Rakai, UgandaDemography, 2004
- Condom Use Within Marital and Cohabiting Partnerships in KwaZulu‐Natal, South AfricaStudies in Family Planning, 2004
- Sexual partner reductions explain human immunodeficiency virus declines in Uganda: comparative analyses of HIV and behavioural data in Uganda, Kenya, Malawi, and ZambiaInternational Journal of Epidemiology, 2004
- Why do young women have a much higher prevalence of HIV than young men? A study in Kisumu, Kenya and Ndola, ZambiaAIDS, 2001
- Rates of HIV-1 transmission within marriage in rural Uganda in relation to the HIV sero-status of the partnersAIDS, 1999