Academic journal article International Family Planning Perspectives

Protecting Young Women from HIV/AIDS: The Case against Child and Adolescent Marriage

Academic journal article International Family Planning Perspectives

Protecting Young Women from HIV/AIDS: The Case against Child and Adolescent Marriage

Article excerpt

CONTEXT: In most developing countries, the majority of sexually active female adolescents are married. Although married adolescents are often assumed to be at low risk for HIV infection, little is known about the actual HIV risks these adolescents face or about ways to minimize these risks.

METHODS: Demographic and Health Survey data from 29 countries in Africa and Latin America were used to examine the frequency of factors that may increase HIV risk in married women aged 15-19.

RESULTS: Several behavioral and social factors may increase the vulnerability of married female adolescents to HIV infection. First, these young women engage in frequent unprotected sex: In most countries, more than 80% of adolescents who had had unprotected sex during the previous week were married. Second, women who marry young tend to have much older husbands (mean age difference, 5-14 years) and, in polygamous societies, are frequently junior wives, factors that may increase the probability that their husbands are infected and weaken their bargaining power within the marriage. Third, married adolescents have relatively little access to educational and media sources of information about HIV. Finally, the most common AIDS prevention strategies (abstinence, condom use) are not realistic options for many married adolescents.

CONCLUSION: New policies and interventions, tailored to the sexual and behavioral profiles of women in each country, are needed to address the vulnerabilities of adolescent wives. In some countries, delaying age at marriage may be an important strategy; in others, making intercourse within marriage safer may be more valuable.

International Family Planning Perspectives, 2006, 32(2):79-88

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During the past decade, two demographic trends in developing countries have received considerable attention: the unprecedented size of the current cohort of adolescents and the steadily increasing percentage of women infected with HIV. (1) Much of the acceleration in the spread of HIV among women has occurred among adolescents. In some parts of the world, notably Sub-Saharan Africa, the prevalence of HIV among women aged 15-24 is two to eight times that among men in the same age-group. (2) In response, policymakers have increasingly sought to address the reproductive and sexual health needs of adolescents, particularly female adolescents. Most of the resulting policies and programs, however, pay surprisingly little attention to the large proportion of female adolescents who are married.

Child and adolescent marriage remains common in many parts of the developing world. (3) Almost a third of the more than 330 million girls and young women aged 10-19 who currently live in developing countries (excluding China) were or will be married by their 18th birthday. (4) In the majority of these countries, most of the sexual intercourse involving female adolescents occurs within marriage. (5)

Although the risk of HIV transmission between spouses is extremely low under certain conditions--specifically, when both partners are uninfected at the time of marriage and subsequently engage in sexual activity exclusively with each other--these conditions are often not met. When they are violated, as is frequently the case for women who marry at a very young age, sexual intercourse with a spouse is risky. Indeed, in some settings, married adolescents have higher rates of HIV infection than their sexually active unmarried peers. (6) Thus, married female adolescents not only represent a sizable fraction of adolescents at risk of contracting HIV via heterosexual intercourse, but also a group with high rates of HIV infection.

Nonetheless, many policymakers and parents, and even young women themselves, continue to perceive marriage as a haven from the risk of HIV infection. Parents in Malawi, for example, encourage their daughters to marry early to protect them from HIV. (7) Moreover, many international and national AIDS prevention messages encourage abstinence until marriage; these messages imply that sex within marriage is not only more socially sanctioned than premarital sex, but also somehow provides complete protection against HIV. …

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