Michelle Poulin

Acceptance of repeat population-based voluntary counselling and testing for HIV in rural Malawi.

Objective: To examine the acceptance of repeat population-based voluntary counselling and testing (VCT) for HIV in rural Malawi. Methods: Behavioural and biomarker data were collected in 2004 and 2006 from approximately 3000 adult respondents. In 2004, oral swab specimens were collected and analysed using ELISA and confirmatory Western blot tests, while finger-prick rapid testing was done in 2006. We used cross-tabulations with χ2 tests and significance tests of proportions to determine the statistical significance of differences in acceptance of VCT by year, individual characteristics and HIV risk. Results: First, over 90% of respondents in each round accepted the HIV test, despite variations in testing protocols. Second, the percentage of individuals who obtained their test results significantly increased from 67% in 2004, when the results were provided in randomly selected locations several weeks after the specimens were collected, to 98% in 2006 when they were made available immediately within the home. Third, whereas there were significant variations in the sociodemographic and behavioural profiles of those who were successfully contacted for a second HIV test, this was not the case for those who accepted repeat VCT. This suggests that variations in the success of repeat testing might come from contacting the individuals rather than from accepting the test or knowing the results. Conclusions: Repeat HIV testing at home by trained healthcare workers from outside the local area, and with either saliva or blood, is almost universally acceptable in rural Malawi and, thus, likely to be acceptable in similar contexts.

Sexual and marital trajectories and HIV infection among ever-married women in rural Malawi

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.

Men's heightened risk of AIDS-related death: the legacy of gendered HIV testing and treatment strategies.

Women are frequently depicted as the face of AIDS in sub-Saharan Africa (SAA) [1–3] where they comprise nearly 58% of all reported HIV infections [4]. Donor dollars, policies, and HIV programs have followed suit, resulting in a near-exclusive focus on women [e.g. 5]. Although African women are represented as particularly vulnerable to HIV infection [6], it is men, not women, who are more likely to die of AIDS [7–9]. AIDS prevalence may have the face of a woman, but AIDS mortality has the face of a man.

Migration and the Transition to Adulthood in Contemporary Malawi

This article investigates the relationship among major life events, household characteristics, and migration among adolescents and young adults in contemporary Malawi. Two main questions are investigated: What are the socioeconomic and demographic determinants of migration? and How do schooling, first marriage, and work relate to migration patterns? The study uses panel data collected from a survey designed specifically to explore socioeconomic and demographic aspects of youths’ transitions to adulthood. Respondents were tracked when they moved. Moves are not uncommon, and the predominant reasons for moves are noneconomic. Although historically ethnic traditions in this area have held that girls and women usually do not move upon marrying, young women are now more likely to move than young men, with marriage being a main reason for doing so. Closer ties to the head of the household are associated with less movement for both women and men.

Public Libraries and Democratization in Three Developing Countries: Exploring the Role of Social Capital

This article explores the role of social capital. The authors develop a theoretical framework intended to facilitate systematic investigation of the contributions public libraries may make to democratization.

HIV Testing, Behavior Change, and the Transition to Adulthood in Malawi

For young adults living in countries with AIDS epidemics, getting an HIV test may influence near-term decisions, such as when to leave school, when to marry, and when to have a first child. These behaviors, which define the transition from adolescence to adulthood, have long-term implications for well-being and directly affect a person’s risk of contracting HIV. Using an experimental design embedded in a panel survey from Malawi, this study assesses how HIV voluntary counseling and testing of young adults affects these decisions. The results show a negligible intent-to-treat effect of HIV testing on behaviors. There is some suggestive evidence, however, of a differential response by wealth and by prior beliefs about one’s HIV status.