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SURPRISING RESULTS: HIV TESTING AND CHANGES IN CONTRACEPTIVE PRACTICES AMONG YOUNG WOMEN IN MALAWI

Published online by Cambridge University Press:  10 July 2015

Christie Sennott  and
Sara Yeatman
Christie Sennott*
Affiliation:
Department of Sociology, Purdue University, West Lafayette, Indiana, USA
Sara Yeatman
Affiliation:
Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, Colorado, USA
*
1Corresponding author. Email: csennott@purdue.edu
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Summary

This study uses eight waves of data from the population-based Tsogolo la Thanzi study (2009–2011) in rural Malawi to examine changes in young women’s contraceptive practices, including the use of condoms, non-barrier contraceptive methods and abstinence, following positive and negative HIV tests. The analysis factors in women’s prior perceptions of their HIV status that may already be shaping their behaviour and separates surprise HIV test results from those that merely confirm what was already believed. Fixed-effects logistic regression models show that HIV testing frequently affects the contraceptive practices of young Malawian women, particularly when the test yields an unexpected result. Specifically, women who are surprised to test HIV positive increase their condom use and are more likely to use condoms consistently. Following an HIV-negative test (whether a surprise or expected), women increase their use of condoms and decrease their use of non-barrier contraceptives; the latter may be due to an increase in abstinence following a surprise negative result. Changes in condom use following HIV testing are robust to the inclusion of potential explanatory mechanisms, including fertility preferences, relationship status and the perception that a partner is HIV positive. The results demonstrate that both positive and negative tests can influence women’s sexual and reproductive behaviours, and emphasize the importance of conceptualizing of HIV testing as offering new information only insofar as results deviate from prior perceptions of HIV status.

Type
Research Article
Information
Journal of Biosocial Science , Volume 48 , Issue 2 , March 2016 , pp. 174 - 191
Copyright
Copyright © Cambridge University Press, 2015 

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References

Allen, S., Meinzen-Derr, J., Kautzman, M., Zulu, I., Trask, S., Fideli, U. et al. (2003) Sexual behavior of HIV discordant couples after HIV counseling and testing. AIDS 17, 733–740.Google Scholar
Allen, S., Serufilira, A., Gruber, V., Kegeles, S., Van de Perre, P., Carael, M. & Coates, T. J. (1993) Pregnancy and contraception use among urban Rwandan women after HIV testing and counseling. American Journal of Public Health 83, 705–710.Google Scholar
Allen, S., Tice, J., Van de Perre, P., Serufilira, A., Hudes, E., Nsengumuremyi, F. et al. (1992) Effect of serotesting with counselling on condom use and seroconversion among HIV discordant couples in Africa. British Medical Journal 304, 1605–1609.Google Scholar
Allison, P. D. (1994) Using panel data to estimate the effects of events. Sociological Methods & Research 23, 174–199.Google Scholar
Allison, P. D. (2009) Fixed Effects Regression Models. Sage Publications, Thousand Oaks, CA.Google Scholar
Anglewicz, P. & Kohler, H-P. (2009) Overestimating HIV infection: the construction and accuracy of subjective probabilities of HIV infection in rural Malawi. Demographic Research 20, 65–96.Google Scholar
Askew, I. & Berer, M. (2003) The contribution of sexual and reproductive health services to the fight against HIV/AIDS: a review. Reproductive Health Matters 11, 51–73.Google Scholar
Baird, S., Gong, E., McIntosh, C. & Ozler, B. (2014) The heterogeneous effects of HIV testing. Policy Research Working Paper 6823. Development Research Team, Poverty and Inequality Group, The World Bank.Google Scholar
Balkus, J., Bosire, R., John-Stewart, G., Mbori-Ngacha, D., Schiff, M. A., Wamalwa, D. et al. (2007) High uptake of postpartum hormonal contraception among HIV-1-seropositive women in Kenya. Sexually Transmitted Diseases 34, 25–29.Google Scholar
Bassett, I. V., Giddy, J., Nkera, J., Wang, B., Losina, E., Lu, Z. et al. (2007) Routine voluntary HIV testing in Durban, South Africa: the experience from an outpatient department. Journal of Acquired Immune Deficiency Syndromes 46, 181–186.Google Scholar
Chimbiri, A. M. (2007) The condom is an ‘intruder’ in marriage: evidence from rural Malawi. Social Science & Medicine 64, 1102–1115.Google Scholar
Church, K., Wringe, A., Fakudze, P., Kikuvi, J., Nhlabatsi, Z., Masuku, R. et al. (2014) Reliance on condoms for contraceptive protection among HIV care and treatment clients: a mixed methods study on contraceptive choice and motivation within a generalised epidemic. Sexually Transmitted Infections. doi: 10.1136/sextrans-2013-051339.Google Scholar
Cooper, D., Harries, J., Myer, L., Orner, P. & Bracken, H. (2007) ‘Life is still going on’: reproductive intentions among HIV-positive women and men in South Africa. Social Science & Medicine 65, 274–283.Google Scholar
Crankshaw, T. L., Mindry, D., Munthree, C., Letsoalo, T. & Maharaj, P. (2014) Challenges with couples, serodiscordance and HIV disclosure: healthcare provider perspectives on delivering safer conception services for HIV-affected couples, South Africa. Journal of the International AIDS Society 17, 18832.Google Scholar
Delavande, A. & Kohler, H-P. (2009) Subjective expectations in the context of HIV/AIDS in Malawi. Demographic Research 20, 817–874.Google Scholar
Denison, J. A., O’Reilly, K. R., Schmid, G. P., Kennedy, C. E. & Sweat, M. D. (2008) HIV voluntary counseling and testing and behavioral risk reduction in developing countries: a meta-analysis, 1990–2005. AIDS and Behavior 12, 363–373.Google Scholar
Dube, A. L. N., Baschieri, A., Cleland, J., Floyd, S., Molesworth, A., Parrott, F. et al. (2012) Fertility intentions and use of contraception among monogamous couples in northern Malawi in the context of HIV testing: a cross-sectional analysis. PLoS One 7, e51861.Google Scholar
Frye, M. (2012) Bright futures in Malawi’s new dawn: educational aspirations as assertions of identity. American Journal of Sociology 117, 1565–1624.Google Scholar
Gong, E. (2014) HIV testing and risky sexual behavior. Economic Journal. doi: 10.1111/ecoj.12125.Google Scholar
Grabbe, K. L., Menzies, N., Taegtmeyer, M., Emukule, G., Angala, P., Mwega, I. et al. (2010) Increasing access to HIV counseling and testing through mobile services in Kenya: strategies, utilization, and cost-effectiveness. Journal of Acquired Immune Deficiency Syndromes 54, 317–323.Google Scholar
Hausman, J. A. (1978) Specification tests in econometrics. Econometrica 46, 1251–1271.CrossRefGoogle Scholar
Hayford, S. R. & Agadjanian, V. (2010) Providers’ views concerning family planning service delivery to HIV-positive women in Mozambique. Studies in Family Planning 41, 281–300.CrossRefGoogle ScholarPubMed
Hoffman, I. F., Martinson, F. E. A., Powers, K. A., Chilongozi, D. A., Msiska, E. D., Kachipapa, E. I. et al. (2008) The year-long effect of HIV-positive test results on pregnancy intentions, contraceptive use, and pregnancy incidence among Malawian women. Journal of Acquired Immune Deficiency Syndromes 47, 477–483.Google Scholar
Lutalo, T., Kidugavu, M., Wawer, M. J., Serwadda, D., Zabin, L. S. & Gray, R. H. (2000) Trends and determinants of contraceptive use in Rakai District, Uganda, 1995–98. Studies in Family Planning 31, 217–227.Google Scholar
Maheswaran, H., Thulare, H., Stanistreet, D., Tanser, F. & Newell, M-L. (2012) Starting a home and mobile HIV testing service in a rural area of South Africa. Journal of Acquired Immune Deficiency Syndromes 59, e43–e46.Google Scholar
MDHS, NSO & ICF Macro (2011) Malawi Demographic and Health Survey 2010. NSO and ICF Macro, Zomba, Malawi, and Calverton, MD, USA.Google Scholar
Passin, W. F., Kim, A. S., Hutchinson, A. B., Crepaz, N., Herbst, J. H. & Lyles, C. M. & the HIV/AIDS Prevention Research Synthesis Project Team (2006) A systematic review of HIV partner counseling and referral services: client and provider attitudes, preferences, practices, and experiences. Sexually Transmitted Diseases 33, 320–328.Google Scholar
Polis, C. B. & Curtis, K. M. (2013) Use of hormonal contraceptives and HIV acquisition in women: a systematic review of the epidemiological evidence. Lancet Infectious Diseases 13, 797–808.Google Scholar
Reniers, G. (2008) Marital strategies for regulating exposure to HIV. Demography 45, 417–438.Google Scholar
Schatz, E. (2005) ‘Take your mat and go!’: rural Malawian women’s strategies in the HIV/AIDS era. Culture, Health & Sexuality 7, 479–492.Google Scholar
Sherr, L., Lopman, B., Kakowa, M., Dube, S., Chawira, G., Nyamukapa, C. et al. (2007) Voluntary counselling and testing: uptake, impact on sexual behaviour, and HIV incidence in a rural Zimbabwean cohort. AIDS 21, 851–860.Google Scholar
Taulo, F., Berry, M., Tsui, A., Makanani, B., Kafulafula, G., Li, Q. et al. (2009) Fertility intentions of HIV-1 infected and uninfected women in Malawi: a longitudinal study. AIDS and Behavior 13, S20–S27.Google Scholar
Tavory, I. & Swidler, A. (2009) Condom semiotics: meaning and condom use in rural Malawi. American Sociological Review 74, 171–189.Google Scholar
Trinitapoli, J. & Yeatman, S. (2011) Uncertainty and fertility in a generalized AIDS epidemic. American Sociological Review 76, 935–954.Google Scholar
Weinhardt, L. S., Carey, M. P., Johnson, B. T. & Bickham, N. L. (1999) Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985–1997. American Journal of Public Health 89, 1397–1405.Google Scholar
Wettstein, C., Mugglin, C., Egger, M., Blaser, N., Salazar, L., Estill, J. et al. (2012) Missed opportunities to prevent mother-to-child-transmission in sub-Saharan Africa: systematic review and meta-analysis. AIDS 26, 2361–2373.Google Scholar
WHO (2012) Service Delivery Approaches to HIV Testing and Counseling (HTC): A Strategic HTC Policy Framework. WHO, Geneva, Switzerland.Google Scholar
Yeatman, S. (2009a) The impact of HIV status and perceived status on fertility desires in rural Malawi. AIDS and Behavior 13, S12–S19.Google Scholar
Yeatman, S. (2009b) HIV infection and fertility preferences in rural Malawi. Studies in Family Planning 40, 261–276.Google Scholar