Moving and Marrying: HIV Infection among Newlyweds in Malawi

Michael D. Bracher, Royal Netherlands Academy of Arts and Sciences
Gigi Santow, Royal Netherlands Academy of Arts and Sciences
Susan Watkins, University of Pennsylvania

The HIV pandemic is now well-established in eastern and southern Africa in general, and Malawi in particular. Malawians perceive marriage as a strategy to prevent AIDS: parents urge their daughters and sons to marry rather than "move around," the common phrase for promiscuity. But what if they are already infected? We employ a microsimulation model to estimate the proportions of new marriages in which the bride, the groom, or both are already infected with HIV/AIDS. The model incorporates biological processes such as those of the transmission and natural histories of HIV and other STDs, and behavioral processes such as sexual initiation and marriage. Behavioral data are drawn from a household survey and ethnographic interviews conducted in rural Malawi. We find that only a minority of newly-weds are HIV-positive. However, since such couples are overwhelmingly sero-discordant, further HIV transmission may occur subsequently even if partners are sexually faithful after marriage.