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The Impact of Married Individuals Learning HIV Status in Malawi: Divorce, Number of Sexual Partners, and Condom Use With Spouses

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Demography

Abstract

This article assesses how married individuals’ knowledge of HIV status gained through HIV testing and counseling (HTC) affects divorce, the number of sexual partners, and the use of condoms within marriage. This study improves upon previous studies on this topic because the randomized incentives affecting the propensity to be tested for HIV permit control for selective testing. Instrumental variable probit and linear models are estimated, using a randomized experiment administered as part of the Malawi Longitudinal Study of Families and Health (MLSFH). The results indicate that knowledge of HIV status (1) does not affect chances of divorce for either HIV-negative or HIV-positive respondents; (2) reduces the number of reported sexual partners among HIV-positive respondents; and (3) increases reported condom use with spouses for both HIV-negative and HIV-positive respondents. These results imply that individuals actively respond to information about their HIV status that they learn during HTC, invoking protective behavior against future risk of HIV/AIDS for themselves and their actual and potential sexual partners. Some limitations of this study are a small sample size for those who are HIV-positive and dependence on self-reported sexual behaviors.

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Notes

  1. Seventy-four percent of attrition between 1998 and 2001 was attributable to migration (total attrition from 1998–2001 was 23 %). Similarly, 54 % of the attrition between 2001 and 2004 was attributable to migration (total attrition from 2001 to 2004 was 26 %).

  2. Eighty-five percent of respondents were not tested from an outside source between 2004 and follow-up, but results are robust to the exclusion of individuals who did report an additional test after 2004.

  3. Seven divorces were dropped because they occurred after 2006.

  4. Less 10 respondents with indeterminate results.

  5. The marriage question is as follows: “I am interested both in marriages that involved your family and ankhoswe, and marriages where you and your husband just started living together without involving ankhoswe.” Therefore, the sample of “married” individuals includes both married and cohabiting couples.

  6. Of those who divorced after 2004, approximately 80 % remarried by follow-up.

  7. The level of condom use was assessed in continuous form and several dichotomous forms: decreased condom use, increased condom use, change in condom use from “never” to “any,” and have ever used a condom.

  8. Age in 2004 was estimated by the interviewer for 33 respondents in 2004 and 7 in 2008 (2.2 % of the total sample).

  9. Age and schooling level are taken from the 2004 data. Missing values in 2004 are imputed from 2006, 2007, and 2008 data (0.4 % of the age variable and 13.5 % of the schooling variable).

  10. Least squares linear regression models are estimated for the number of sexual partners in follow-up year.

  11. The two stages are estimated jointly to ensure accurate standard errors using the ivreg and ivprobit commands in STATA12.

  12. Descriptive statistics for HIV-positive respondents separated by sex are in Table S24 in Online Resource 1.

  13. Marginal effects are evaluated at the mean values of the RHS variables.

  14. Results are the same with a dichotomous variable for zero versus one partner.

  15. Eriksson and Sovero (2013) examined the effect of HIV testing on divorce among HIV-negative couples. We have been unable to replicate these findings, despite our best attempts to duplicate their approach.

  16. The 2004 MLSFH HIV testing was the first test for 85 % of respondents.

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Acknowledgments

We also gratefully acknowledge the generous support by the National Institute of Child Health and Development (Grant Nos. R03 HD058976, R21 HD050652, R01 HD044228, R01 HD053781), the National Institute on Aging (Grant No. P30 AG12836), the Boettner Center for Pensions and Retirement Security at the University of Pennsylvania, and the National Institute of Child Health and Development Population Research Infrastructure Program (Grant No. R24 HD-044964), all at the University of Pennsylvania.

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Authors and Affiliations

  1. University of Pennsylvania, 3718 Locust Walk, 266 McNeil Building, Philadelphia, PA, 19104-6298, USA

    Theresa M. Fedor

  2. University of Pennsylvania, 3718 Locust Walk, 272 McNeil Building, Philadelphia, PA, 19104-6298, USA

    Hans-Peter Kohler

  3. University of Pennsylvania, 3718 Locust Walk, 229 McNeil Building, Philadelphia, PA, 19104-6298, USA

    Jere R. Behrman

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  1. Theresa M. Fedor
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Correspondence to Theresa M. Fedor.

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Fedor, T.M., Kohler, HP. & Behrman, J.R. The Impact of Married Individuals Learning HIV Status in Malawi: Divorce, Number of Sexual Partners, and Condom Use With Spouses. Demography 52, 259–280 (2015). https://doi.org/10.1007/s13524-014-0364-z

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