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


  • Michelle Poulin

    (University of North Texas)

  • Adamson S. Muula

    (University of 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.

Suggested Citation

  • Michelle Poulin & Adamson S. Muula, 2011. "An inquiry into the uneven distribution of women’s HIV infection in rural Malawi," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 25(28), pages 869-902, December.
  • Handle: RePEc:dem:demres:v:25:y:2011:i:28

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    References listed on IDEAS

    1. Hunter, Mark, 2007. "The changing political economy of sex in South Africa: The significance of unemployment and inequalities to the scale of the AIDS pandemic," Social Science & Medicine, Elsevier, vol. 64(3), pages 689-700, February.
    2. Kirsten P. Smith & Susan Cotts Watkins, 2005. "Perceptions of Risk and Strategies for Prevention: Responses to HIV/AIDS in Rural Malawi," PGDA Working Papers 0305, Program on the Global Demography of Aging.
    3. FFF1Georges NNN1Reniers, 2003. "Divorce and Remarriage in Rural Malawi," Demographic Research Special Collections, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 1(6), pages 175-206, September.
    4. Damien de Walque, 2007. "Sero-Discordant Couples in Five African Countries: Implications for Prevention Strategies," Population and Development Review, The Population Council, Inc., vol. 33(3), pages 501-523.
    5. Smith, Kirsten P. & Watkins, Susan Cotts, 2005. "Perceptions of risk and strategies for prevention: responses to HIV/AIDS in rural Malawi," Social Science & Medicine, Elsevier, vol. 60(3), pages 649-660, February.
    6. repec:aph:ajpbhl:10.2105/ajph.2006.088682_6 is not listed on IDEAS
    7. Jonathan Crush & Brian Williams & Eleanor Gouws & Mark Lurie, 2005. "Migration and HIV/AIDS in South Africa," Development Southern Africa, Taylor & Francis Journals, vol. 22(3), pages 293-318.
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    Cited by:

    1. Kaler, Amy & Angotti, Nicole & Ramaiya, Astha, 2016. "“They are looking just the same”: Antiretroviral treatment as social danger in rural Malawi," Social Science & Medicine, Elsevier, vol. 167(C), pages 71-78.
    2. Parkhurst, Justin O. & Chilongozi, David & Hutchinson, Eleanor, 2015. "Doubt, defiance, and identity: Understanding resistance to male circumcision for HIV prevention in Malawi," Social Science & Medicine, Elsevier, vol. 135(C), pages 15-22.
    3. Nicole Angotti & Margaret Frye & Amy Kaler & Michelle Poulin & Susan Cotts Watkins & Sara Yeatman, 2014. "Popular Moralities and Institutional Rationalities in Malawi's Struggle Against AIDS," Population and Development Review, The Population Council, Inc., vol. 40(3), pages 447-473, September.
    4. Poulin, Michelle & Dovel, Kathryn & Watkins, Susan Cotts, 2016. "Men with Money and the “Vulnerable Women” Client Category in an AIDS Epidemic," World Development, Elsevier, vol. 85(C), pages 16-30.

    More about this item


    HIV/AIDS; inequality; Malawi; male circumcision; marriage; migration; mortality; population; sub-Saharan Africa;

    JEL classification:

    • J1 - Labor and Demographic Economics - - Demographic Economics
    • Z0 - Other Special Topics - - General


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