Volume 25 - Article 28 | Pages 869–902

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

By Michelle Poulin, Adamson S. Muula

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Date received:17 May 2011
Date published:21 Dec 2011
Word count:7060
Keywords:HIV/AIDS, inequality, Malawi, male circumcision, marriage, migration, mortality, population, sub-Saharan Africa


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.

Author's Affiliation

Michelle Poulin - University of North Texas, United States of America [Email]
Adamson S. Muula - University of Malawi, Malawi [Email]

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