"Many divorces and many spinsters": marriage as an invented tradition in southern Malawi 1946-1999

MEASURING UNION FORMALIZATION FOR A NEW GENERATION OF FAMILY DEMOGRAPHY: A CASE STUDY FROM URBAN KENYA

Despite repeated calls for improved measures of marriage as a process in sub‐Saharan Africa, large‐scale surveys continue to rely on static marital status. As a result, there is an incomplete understanding of the effects of marriage on outcomes of interest. We use qualitative and survey data from a longitudinal study of 1,203 young mothers residing in informal settlements of Nairobi, Kenya, to (1) describe the development of an innovative measure of union formalization (UF) defined as the steps through which a union attains social legitimacy; (2) compare UF with a conventional current marital status measure; (3) examine the distribution of UF steps across union history; and (4) examine the sequence and timing of pregnancy and childbearing within the UF process. We find UF steps indicative of both increasing individualization of marriage and the ongoing importance of kin involvement hold meaning. We demonstrate extensive heterogeneity in the sequence and extent of UF steps completed and interrogate the classification of premarital childbearing using sequence analysis. We argue that measuring UF is feasible and necessary for the next generation of family demography in Africa; UF measures facilitate understanding the linkages among family dynamics, health, and social stratification within the context of ongoing socioeconomic change.

Assessing the relationship between reproductive autonomy and contraceptive use in rural Malawi

Reproductive autonomy, or the extent to which people control matters related to their own sexual and reproductive decisions, may help explain why some people who do not intend to become pregnant nevertheless do not use contraception. Using cross-sectional survey data from 695 women aged 16 to 47 enrolled in the Umoyo Wa Thanzi (UTHA) study in Malawi in 2019, we conducted confirmatory factor analysis, descriptive analyses, and multivariable logistic regression to assess the freedom from coercion and communication subscales of the Reproductive Autonomy Scale and to examine relationships between these components of reproductive autonomy and current contraceptive use. The freedom from coercion and communication subscales were valid within this population of partnered women; results from a correlated two-factor confirmatory factor analysis model resulted in good model fit. Women with higher scores on the freedom from coercion subscale had greater odds of current contraceptive use (aOR 1.13, 95% CI: 1.03-1.23) after adjustment for pregnancy intentions, relationship type, parity, education, employment for wages, and household wealth. Scores on the communication subscale were predictive of contraceptive use in some, but not all, models. These findings demonstrate the utility of the Reproductive Autonomy Scale in more holistically understanding contractive use and non-use in a lower-income setting, yet also highlight the need to further explore the multidimensionality of women's reproductive autonomy and its effects on achieving desired fertility.

Household Splitting Process and Food Security in Malawi

Despite the frequent changes in household composition in Sub-Saharan Africa, the literature on the household division process is sparse, with no evidence of its effect on food security. This paper addresses the topic in Malawi, where the fission process is evident and malnutrition is a severe problem. Using the Integrated Household Panel Dataset, this study applies the difference-in-difference model with the propensity score matching technique to compare matched groups of households that did and did not split between 2010 and 2013. The results suggest that coping strategies adopted by poor households and life course events determine household fission in Malawi, a process that benefits household food security in the short term. On average, the food consumption score is 3.74 units higher among households that split between 2010 and 2013 compared to the matched households that did not. However, the household division might have long-run adverse effects on food insecurity, especially for poor households due to the adoption of coping strategies that might compromise their human capital and income-generating activities. Therefore, this process warrants attention for the more accurate understanding, design, and evaluation of food security interventions.

Adverse Selection in the Marriage Market: HIV Testing and Marriage in Rural Malawi

Asymmetric information in the marriage market may cause adverse selection and delay marriage if partner quality is revealed over time. Sexual safety is an important but hidden partner attribute, especially in areas where HIV is endemic. A model of positive assortative matching with both observable (attractiveness) and hidden (sexual safety) attributes predicts that removing the asymmetric information about sexual safety accelerates marriage and pregnancy for safe respondents, and more so if they are also attractive. Frequent HIV testing may enable safe people to signal and screen. Consistent with these predictions, we show that a high-frequency, "opt-out" HIV testing intervention changed beliefs about partner's safety and accelerated marriage and pregnancy, increasing the probabilities of marriage and pregnancy by 26 and 27 percent for baseline-unmarried women over 28 months. Estimates are larger for safe and attractive respondents. Conversely, a single-test intervention lacks these effects, consistent with other HIV testing evaluations in the literature. Our findings suggest that an endogenous response to HIV risk may explain why the HIV/AIDS epidemic has coincided with systematic marriage and pregnancy delays.

Social Norms, Agency, and Marriage Aspirations in Malawi

OBJECTIVE

We evaluate whether community norms, caregiver beliefs, and adolescents' own beliefs and perceptions, focused on early marriage, predict adolescent marriage aspirations in a low-income context.

BACKGROUND

The processes that contribute to adolescent marriage aspiration formation have received little attention in low-income contexts, particularly sub-Saharan Africa. Understanding how marriage aspirations are formed is important because they are associated with critical education and health outcomes.

METHOD

Using data that links Malawian adolescents (N=2,089) with their caregivers (N=1,452), we analyze gender stratified ordered logistic regression models to examine key relationships.

RESULTS

We show that community norms for youngest acceptable marriage age predict when boys want to marry, but do not find conclusive evidence that they predict when girls want to marry. We also show that adolescents who believe it is acceptable to marry at an early age are more likely to want to marry early themselves.

CONCLUSION

Both community norms and adolescents' own beliefs are central to the formation of their marriage aspirations.

IMPLICATIONS

We recommend that programs incorporate adolescent beliefs and perceptions when designing child marriage interventions and measuring their impact. We also recommend theory-driven measurement of community norms to better evaluate their impact on both marriage aspirations and marriage age.

Marital dissolutions and changes in mental health: Evidence from rural Malawi

BACKGROUND

Advancing efforts to unpack the complex relationship between marital dissolutions and health outcomes increasingly requires assessing the marital histories and health of individuals who have lived long enough to experience divorce or widowhood ‒ or even multiples of each ‒ and measurable changes in health.

OBJECTIVE

To explore this line of inquiry, we chose a sample from rural Malawi where a high prevalence of marital dissolutions and remarrying exists, as an ideal theoretical foil to the predominant literature found in high-income countries (HICs). We examine if changes in having experienced a marital dissolution, one's total number of dissolutions, and the percentage of one's life spent outside of marriage since first becoming married are associated with changes in mental health.

METHODS

Our analyses focus on 1,266 respondents aged 45 years and older who participated in the 2012 Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC), linked back to cohort information from 2008 and 2010 available through the MLSFH. Fixed-effects regressions guide our inferences over the 2008, 2010, and 2012 waves of data.

RESULTS

For men, spending more life outside of marriage is associated with worse mental health, while more marital dissolutions are surprisingly associated with better mental health for women.

CONCLUSIONS

These results could suggest that larger portions of one's life spent unmarried are associated with a type of role strain for men or simply that men are burdened with taking up tasks that their spouses had previously done in order to survive. For women, many may have gotten out of 'bad' marriages that otherwise would have been detrimental to their mental health and/or those in good mental health are the ones able to remarry.

CONTRIBUTIONS

Our research from rural Malawi provides a type of litmus test for many HICs where marriage, remarriage, and dissolution rates are lower but quite consequential for mental health outcomes. Measuring time outside of marriage should be more strongly considered in such settings. These results also inform increasingly important research on the relationship between marital dissolutions and mental health in other African nations as noncommunicable diseases play a continually more important role in people's lives.

Divorce, living arrangements, and material well-being during the transition to adulthood in rural Malawi

In this paper, we use longitudinal data to investigate how parental death and divorce influence young women's own experience of divorce in Malawi, a setting where women marry relatively early and unions are fragile. We find that maternal death and parental divorce are positively associated with divorce for young women but, after controlling for socio-demographic and marital characteristics, only the association with maternal death remains statistically significant. Maternal and paternal death are both strongly associated with women's post-divorce living arrangements, which in turn affects their material well-being. This finding suggests that divorcing at a young age shapes the subsequent life chances of women; although some women return to their parental home and may have the opportunity to reset the transition to adulthood, other women begin their 20s as head of their own household and with considerable material disadvantage.

Marital infidelity, food insecurity, and couple instability: A web of challenges for dyadic coordination around antiretroviral therapy

RATIONALE

Despite the importance of primary partners for health, little is known about factors that constrain the ability of couples to work collaboratively towards HIV care and treatment (dyadic coordination). This study examined the interplay of marital infidelity, food insecurity, and couple instability on dyadic coordination and adherence to antiretroviral therapy (ART) in Malawi.

METHODS

In 2016, we conducted 80 in-depth interviews with 25 couples with at least one partner on ART. Couples were recruited at two HIV clinics in the Zomba district when attending clinic appointments. Participants were asked about their relationship history, relationship dynamics (love, trust, conflict), experiences with HIV care and treatment, and how partners were involved. Using an innovative analysis approach, we analyzed the data at the couple-level by examining patterns within and between couples.

RESULTS

Three patterns emerged. For some couples, ART led to positive changes in their relationships after men terminated their extramarital partnerships in exchange for love and support. For other couples with power imbalances and ongoing conflict, men's infidelity continued after ART and negatively affected dyadic coordination. Finally, some couples agreed to remain "faithful", but could not overcome stressors related to food insecurity, which directly impacted their adherence.

CONCLUSIONS

Couples-based interventions targeting ART adherence should improve relationship quality, while also addressing interpersonal stressors such as marital infidelity and food insecurity. Multi-level interventions that address both dyadic and structural levels may be necessary for couples with severe food insecurity.

Parental Divorce and Children's Schooling in Rural Malawi

A growing body of literature has examined the impact of different types of family structures on children's schooling in sub-Saharan Africa. These studies have investigated how living arrangements, gender of the household head, parental death, and paternal migration are related to schooling. Although many sub-Saharan African countries have high divorce rates, very few studies have explored the impact of parental divorce on children's schooling. The present study uses three waves of data from the Malawi Longitudinal Study of Families and Health (MLSFH) to investigate the effect of parental divorce on children's schooling and the possible mechanisms driving this relationship. Unlike prior studies, this study uses child-level fixed-effects models to control for selection into divorce. Results show that parental divorce is associated with lower grade attainment and a larger schooling gap, defined as the number of years a child is behind in school (among children currently attending school). Although no association exists between parental divorce and current school attendance, girls affected by divorce are significantly less likely to be attending school. Differences in economic resources, maternal coresidence, or maternal psychological well-being do not explain the relationship between parental divorce and children's schooling.

Variation in the link between parental divorce and children's health disadvantage in low and high divorce settings

Like in other world regions, children with divorced parents in sub-Saharan Africa experience significant heath disadvantages relative to their peers with married parents. Preliminary evidence suggests this disadvantage may not be uniform across the subcontinent's diverse settings. Research from other world regions shows that the childhood health consequences of divorce vary across different contexts. Specifically, we hypothesize that the childhood disadvantages associated with divorce are more severe in regions of sub-Saharan Africa where divorce is rare, and less so where divorce is a more common family experience. Using Demographic and Health Survey data from 290 subnational regions within 31 sub-Saharan African countries, multilevel models document the previously shown link between having a divorced mother and child morbidity and mortality. The study results further demonstrate that the childhood health disadvantage is accentuated in subnational African regions where fewer women are divorced and muted in areas where more women are divorced. The findings demonstrate that the broader context can powerfully moderate childhood health inequalities traditionally thought of as operating at the family or individual level.

Integrated agriculture programs to address malnutrition in northern Malawi

BACKGROUND

In countries where the majority of undernourished people are smallholder farmers, there has been interest in agricultural interventions to improve nutritional outcomes. Addressing gender inequality, however, is a key mechanism by which agriculture can improve nutrition, since women often play a crucial role in farming, food processing and child care, but have limited decision-making and control over agricultural resources. This study examines the approaches by which gender equity in agrarian, resource-poor settings can be improved using a case study in Malawi.

METHODS

A quasi-experimental design with qualitative methods was used to examine the effects of a participatory intervention on gender relations. Thirty married couple households in 19 villages with children under the age of 5 years were interviewed before and then after the intervention. An additional 7 interviews were conducted with key informants, and participant observation was carried out before, during the intervention and afterwards in the communities. The interviews were recorded and transcribed, and analysed qualitatively for key themes, concepts and contradictions.

RESULTS

Several barriers were identified that undermine the quality of child care practices, many linked to gender constructions and norms. The dominant concepts of masculinity created shame and embarrassment if men deviated from these norms, by cooking or caring for their children. The study provided evidence that participatory education supported new masculinities through public performances that encouraged men to take on these new roles. Invoking men's family responsibilities, encouraging new social norms alongside providing new information about different healthy recipes were all pathways by which men developed new 'emergent' masculinities in which they were more involved in cooking and child care. The transformational approach, intergenerational and intra-gendered events, a focus on agriculture and food security, alongside involving male leaders were some of the reasons that respondents named for changed gender norms.

CONCLUSIONS

Participatory education that explicitly addresses hegemonic masculinities related to child nutrition, such as women's roles in child care, can begin to change dominant gender norms. Involving male leaders, participatory methods and integrating agriculture and food security concerns with nutrition appear to be key components in the context of agrarian communities.

The Relationship between Partners' Family-Size Preferences in Southern Malawi

Studies of the relative influence of partners' fertility preferences on behaviors tend to treat preferences as fixed, largely independent traits despite existing theoretical arguments and empirical evidence suggesting that they are moving targets that may be jointly developed within relationships. In this study, we use couple-level panel data from married and unmarried young adults in southern Malawi to examine the relationship between partners' family-size preferences. We find evidence of assortative mating: young Malawians are more likely to partner with individuals who have similar family-size goals. Additionally, although partners' family-size preferences do not perfectly converge, changes among men's and women's preferences are significantly more likely to be "toward" than "away from" those of their partner. Our findings point to a need for studies regarding the relative influence of partners on reproductive outcomes to consider the interdependence of partners' preferences and the varied ways in which partners can influence shared reproductive behaviors.

"Dying is dying, that's all": Structural violence and cultural projects in Malawian AIDS proverbs

This paper examines three Malawian proverbs about AIDS: "AIDS came for people", "Dying is dying, that's all" and "It's in the flour". Proverbs permit Malawians to discuss the otherwise taboo topic of AIDS because they offer a special register and perform a footing shift, a rhetorical manoeuvre that allows the speaker to attribute problematic speech to someone else. The proverbs under consideration convey a sense of powerless in the face of the AIDS epidemic, which is an indicator of the effects of structural violence on the everyday lives of most Malawians. Despite the aura of timeless tradition generally conveyed by proverbs, the author argues that individual Malawians are actually using AIDS proverbs to align themselves with the pursuit of gendered cultural projects, such as multiple concurrent partner sex and transactional sex, which are not traditional at all.

Sexual experiences of married HIV positive women in Osogbo, southwest Nigeria: role of inappropriate status disclosure

Background

Worldwide heterosexual sex is the most common mode of HIV transmission, with the marital heterosexual route becoming a major contributor in sub-Sahara Africa. This study examined the role of inappropriate HIV status disclosure, after diagnosis, on marital sexual experiences of HIV positive women.

Methods

The study employed a descriptive cross-sectional design. An interviewer administered questionnaire that elicited information about HIV status disclosure to partners, sexual experiences, condom use and parity was administered to 122 married women living with HIV/AIDS. Participants were referred from peripheral health centres to receive comprehensive HIV care at the State Specialist Hospital, Osogbo, Nigeria.

Results

Mean age (SD) of respondents was 33.8 (8.9) years. Only 23.8% of partners had HIV screening, with 3.3% being HIV positive. A majority (62%) of respondents reported experiencing marital sex deprivation since their partners became aware of their HIV status. There was a reported rejection (74.3%) of condom use by partners during sexual intercourse. Fear of becoming infected (85.7%) and blaming the women for their positive status (85.7%) were the main reasons the respondents gave for being sexually deprived by their partners.

Conclusion

Inappropriate status disclosure due to poor HIV counseling and testing (HCT) practices resulted in sexual deprivation of married HIV positive women. Adequate training and retraining of health care workers on HCT and HIV status disclosure will reduce experience of sexual deprivation among married HIV positive women.

The impact of family transitions on child fostering in rural Malawi

Despite the frequency of divorce and remarriage across much of sub-Saharan Africa, little is known about what these events mean for the living arrangements of children. We use longitudinal data from rural Malawi to examine the effects of family transitions on the prevalence and incidence of child fostering, or children residing apart from their living parents. We find that between 7 % and 15 % of children aged 3-14 are out-fostered over the two-year intersurvey period. Although divorce appears to be a significant driver of child fostering in the cross-sectional analysis, it is not significantly associated with the incidence of out-fostering. In contrast, maternal remarriage has both a lagged and an immediate effect on the incidence of out-fostering. Furthermore, the likelihood of out-fostering is even higher among children whose mother remarried and had a new child during the intersurvey period. Using longitudinal data collected from living mothers rather than from children's current foster homes offers new insights into the reasons children are sent to live with others besides their parents.

Forgotten marriages? Measuring the reliability of marriage histories

BACKGROUND

Marriage histories are a valuable data source for investigating nuptiality. While researchers typically acknowledge the problems associated with their use, it is unknown to what extent these problems occur and how marriage analyses are affected.

OBJECTIVE

This paper seeks to investigate the quality of marriage histories by measuring levels of misreporting, examining the characteristics associated with misreporting, and assessing whether misreporting biases marriage indicators.

METHODS

Using data from the Malawi Longitudinal Study of Families and Health (MLSFH), I compare marriage histories reported by the same respondents at two different points in time. I investigate whether respondents consistently report their spouses (by name), status of marriage, and dates of marriage. I use multivariate regression models to investigate the characteristics associated with misreporting. Finally, I examine whether misreporting marriages and marriage dates affects marriage indicators.

RESULTS

Results indicate that 28.3% of men and 17.9% of women omitted at least one marriage in one of the survey waves. Multivariate regression models show that misreporting is not random: marriage, individual, interviewer, and survey characteristics are associated with marriage omission and marriage date inconsistencies. Misreporting also affects marriage indicators.

CONCLUSIONS

This is the first study of its kind to examine the reliability of marriage histories collected in the context of Sub-Saharan Africa. Although marriage histories are frequently used to study marriage dynamics, until now no knowledge has existed on the degree of misreporting. Misreporting in marriage histories is shown to be non-negligent and could potentially affect analyses.

Descriptive and injunctive norms related to concurrent sexual partnerships in Malawi: implications for HIV prevention research and programming

Concurrent sexual partnerships are hypothesized to be a contributing factor to Malawi's HIV epidemic. As social norms influence health behavior and have been found to influence sexual behavior, the purpose of this study was to explore two types of norms, descriptive and injunctive norms, toward concurrent sexual partnerships in Malawi. Data from 40 focus group discussions and 20 in-depth interviews conducted in five districts in Malawi, which included 318 participants aged 18-55 years, were analyzed. Participants perceived that concurrent sexual partnerships were extremely common, and believed that very few individuals in their communities were not in concurrent sexual partnerships. However, participants perceived that others in their communities heavily disapproved of concurrent sexual partnerships outside of polygamy, as polygamy was viewed as an acceptable type of partnership because it was conducted in the open. Participants asserted that there were no traditional practices that promoted concurrent sexual partnerships, and perceived that those that engaged in the behavior were for the most part stigmatized by community members. Further research is needed to obtain a thorough understanding of the way in which the perceived actions and beliefs of peers influence the beliefs, feelings and actions of individuals to strengthen HIV programming efforts in the region.

Sex in older age in rural Malawi

This paper examines how older adults living in rural Malawi explain and understand their sex lives. We present sex in this setting as a field in which broader understandings of ageing, aged identities, and conceptions of person- or adulthood in older age are played out and constructed. Qualitative data were collected from men (N=20) and women (N=23) aged 50 to around 90 using in-depth multiple dependent interviews (N=135) between 2008 and 2010. The giving and receipt of sexual pleasure was considered natural and God-given. Primarily understood as a matter of ‘power’, sex was on the one hand, beneficial to older bodies, but on the other, not accessible to such bodies. Declining sexual frequency was associated with declining desire for sex, or frustration stemming from continued desire for sex. These discourses emerged from the way the ageing body was constructed as a weakened body, incompatible with understandings of adulthood based on physical productivity. Older men and women used sex to discursively respond to these challenges to their adulthood in two ways. Firstly, sex was used to confirm strength, physical productivity, and therefore, identity as an ‘adult’. Secondly, adulthood itself was redefined as being based on moral, rather than physical productivity, and refraining from sex was used to demonstrate wisdom, self-control and therefore their ‘adult’ identity. Our results provide in-depth understanding of the ways constructions of ageing and sex can influence complex experiences of marital and non-marital sex in older age. We contribute to debates on sexuality in the gerontological literature by moving discussion beyond the presentation of continued sexuality as somehow exceptional or an indicator of successful ageing. Finally, in a setting of considerable HIV prevalence at older ages, our results challenge a preoccupation with fertility and chronological age in the collection of sexual health data in Africa.

Marriage as a risk factor for HIV: learning from the experiences of HIV-infected women in Malawi

The gender inequalities that characterise intimate partner relationships in Malawi, a country with one of the highest HIV prevalence rates in the world, arguably place marriage as an important risk factor for HIV infection among women, yet few studies detail the complex interactions of marriage and risk. In order to develop HIV-prevention interventions that have lasting impacts in such communities, we need a deeper understanding of the intricacies of women's lives, how and why they are involved in marital relationships, and the implications of these relationships for HIV transmission or prevention. This article describes how women understand marriage's effects on their lives and their HIV risks. Drawing from focus group discussions with 72 women attending antiretroviral clinics in Malawi, we explore why women enter marriage, what women's experiences are within marriage and how they leave spouses for other relationships. Based on their narratives, we describe women's lives after separation, abandonment or widowhood, and report their reflections on marriage after being married two or three times. We then review women's narratives in light of published work on HIV, and provide recommendations that would minimise the risks of HIV attendant on marriage.

An inquiry into the uneven distribution of women's HIV infection in rural Malawi

Ecological comparisons in sub-Saharan Africa show that HIV prevalence is lower where men are generally circumcised than where they are not. Randomized controlled trials have found a 50-60% reduction in HIV acquisition for newly circumcised men. Yet in Malawi, HIV prevalence is highest in several districts in the Southern Region, where men are commonly circumcised. We draw upon a population-based sample of ever-married women to explore this unexpected finding. Our data show that in the southern district of Balaka, women with circumcised spouses have a lower probability of HIV infection compared to those with uncircumcised spouses. However, the strength of this effect is conditioned by specific marital histories: among women with circumcised spouses, those with multiple marriages and an absence of spousal co-residence have a higher probability of HIV infection than do those married once and those who have never lived apart from their spouses. The history of marital turnover and female-headed households among the ethnic groups of Balaka offer insight into the district's elevated HIV levels.

Girls' schooling and the perceived threat of adolescent sexual activity in rural Malawi

Despite its relative infrequency, pregnancy is perceived by parents in rural Malawi as a leading cause of school dropout among female students. This paper explores parents' beliefs about adolescent sexual activity and schoolgirl pregnancy and how these perceptions frame parents' aspirations and expectations about girls' schooling. In-depth interviews were collected in rural Malawi from 60 adults aged 25-50 who were the parent of at least one school-aged child. Four themes emerged from the data: how expectations about sexual activity frame parental expectations about schooling duration and dropout, the loss of parental control, the negative influence of classmates and schools as unsafe environments. These concerns frame how parents consider a daughter's schooling prospects and are active even for parents whose daughters are not sexually active or who are not yet old enough to have gone through puberty. Although all parents aspire for their children to attend secondary school, these perceptions of daughters' relative risk weaken parents' motivation to encourage daughters to remain in school.

Community-level gender equity and extramarital sexual risk-taking among married men in eight African countries

CONTEXT

In many parts of Africa, women are most likely to become infected with HIV by having unprotected sex with their husbands, who may have acquired the virus through extramarital sex. However, the ways in which aspects of community environments-particularly those related to gender equity-shape men's extramarital sexual risk-taking are not well understood.

METHODS

Demographic and Health Survey data from eight African countries (Chad, Ghana, Malawi, Nigeria, Tanzania, Uganda, Zambia and Zimbabwe) were used to examine associations between married men's engaging in risky extramarital sex (i.e., having had both unprotected sex and extramarital sex) and indicators of gender equity and other community characteristics. Separate multilevel logistic regression models that incorporated individual, household and community measures were created for each country.

RESULTS

In five countries, men who lived in communities with more equal ratios of women to men with at least a primary education were less likely to report risky extramarital sexual activity (odds ratios, 0.4-0.6). A similar relationship was found in four countries for the ratio of women to men who were employed (0.4-0.5). In three countries, men who lived in communities with more conservative attitudes toward wife-beating or male decision making had elevated odds of extramarital sexual risk-taking (1.1-1.5).

CONCLUSIONS

While HIV prevention programs should focus on reducing gender inequities, they also need to recognize the conservative cultural factors that influence the formation of men's masculine identities and, in turn, affect their sexual behavior.

Marital strategies for regulating exposure to HIV

In a setting where the transmission of HIV occurs primarily through heterosexual contact and where no cure or vaccine is available, behavioral change is imperative for containing the epidemic. Abstinence, faithfulness, and condom use most often receive attention in this regard. In contrast, this article treats marriage as a resource for HIV risk management via mechanisms of positive selection (partner choice) and negative selection (divorce of an adulterous spouse). Retrospective marriage histories and panel data provide the evidence for this study and results indicate that men and women in Malawi increasingly turned to union-based risk-avoidance strategies during the period that the threat of HIV/AIDS materialized. Although both sexes strategize in a similar fashion, men are better equipped than women to deploy these strategies to their advantage. The article concludes with reflections on the long-term and population-level implications of these coping mechanisms.

Sex in Geneva, sex in Lilongwe, and sex in Balaka

This paper compares three interpretations of women and the transmission of HIV in rural Malawi. One is disseminated world-wide by institutions with a global reach such as the World Health Organization in Geneva and United States Agency for International Development (USAID); the second is provided by urban Malawians situated in the capital of Lilongwe, the seat of government and the site of the many international and national non-governmental agencies; the third is articulated by rural women and men in Balaka District, Malawi. We focus on women's motivations for extramarital sex, using qualitative interview data. We find that whereas in Geneva and Lilongwe women from rural Malawi are said to engage in sexual relationships outside of marriage because they need money for survival, in Balaka they are said to be motivated not only by money for survival but also for attractive consumer goods as well as by passion and by revenge for a husband's infidelity. We also find that data collection procedures influence explanations for women's affairs, as does the respondent's gender. An implication of this study is that AIDS-prevention policies based on the view from Geneva and Lilongwe need modification for Balaka, and by implication for rural Africa more generally.

The condom is an 'intruder' in marriage: evidence from rural Malawi

This paper assesses the condom situation within marriage in Malawi with particular attention to people's perceptions about the compatibility of condoms and marriage by analyzing the Malawi Demographic and Health Surveys 1992 and 2000, and via semi-structured interviews with married men and women from three districts in rural Malawi. There are four striking findings. First, condom use is negligible inside marriage. Second, there is considerable talk about condoms, especially among male social network partners. Third, virtually all the discussion of condoms, by both men and women, is in the context of preventing STI/HIV-AIDS infection in extramarital partnerships. Lastly, and critical for this paper, is that initiating a discussion of condom use for preventing infection in marriage is like bringing an intruder into the domestic space. Thus, there is evidence that change in attitudes about condom use may be occurring, but only outside marriage. This evidence concurs with Malawian government policy that advocates for condom use in marriage only if either spouse has more than one sexual partner. The AIDS epidemic is therefore bringing sexual behavior change outside marriage and not within.

'Take your mat and go!': rural Malawian women's strategies in the HIV/AIDS era

In much of HIV/AIDS prevention literature, women are depicted as passive and ill-equipped to confront the epidemic without external support to enhance their status, autonomy, and negotiation skills. This paper critically evaluates this depiction, using data from in-depth interviews conducted with married couples in rural Malawi. It focuses on the extent to which married women perceive that they have the ability to protect themselves from infection and on the prevention strategies that they employ. Interview data suggest that women have identified a range of contextually appropriate ways to resist exposure to HIV. These strategies include sitting and discussing the dangers of HIV/AIDS with their husbands; utilizing social networks for advice and as advocates; publicly confronting husbands' girlfriends; and divorcing men who do not adopt safer practices. These locally-formulated strategies are not likely to be followed consistently, and they may not be the most effective strategies in preventing husbands from straying or protecting women from contracting HIV/AIDS. Their existence, however, demonstrates that rural Malawian women believe that they have some agency to protect themselves; and, they are in fact using locally appropriate strategies to do so.

Perceptions of risk and strategies for prevention: responses to HIV/AIDS in rural Malawi

This paper combines quantitative and qualitative data to investigate changes in perceived risk of contracting HIV/AIDS in rural Malawi. Using longitudinal survey data, we find that Malawians worried less about contracting HIV/AIDS in 2001 than in 1998. According to qualitative interviews and observational journal accounts, HIV/AIDS and strategies to prevent it are a frequent topic of conversation amongst married Malawians. Women report worrying most about their husbands as a possible source of infection, discussing with them the importance of avoiding infection, and, increasingly, using divorce to reduce their risk. Men report worrying most about their extramarital partners and adopting preventive strategies such as fewer partners and more careful partner selection. We show that the decline in perceived risk is significantly associated with declines in the behaviors that Malawians worry most about and perceptions of risk in individuals' social networks. We interpret these findings as evidence that Malawians are changing their behavior in ways that may reduce the spread of HIV/AIDS.