Extra-Marital Sexual Partnerships and Male Friendships in Rural Malawi
Clark, Shelley, Demographic Research
Extra-marital sexual partnerships (EMSPs) are a major route of HIV/AIDS transmission in sub-Saharan Africa. In this paper, we investigate the roles of two types of male friendships - best friends and friends with whom they talk about AIDS - in determining whether men have EMSPs. Using data from men in rural Malawi, we find that men's current extra-marital sexual behavior is most closely correlated with their best friends', but that the behaviors of both types of friends are associated with men's subsequent EMSPs. These findings suggest that men's friendships could be used to help combat the AIDS epidemic.
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The spread of the AIDS crisis into the general population of married couples in much of sub-Saharan Africa has shone an increasingly intense spotlight on extra-marital sexual partnerships (EMSPs). EMSPs comprise a key group of concurrent partners, which are widely identified as one of the most important factors fuelling generalized epidemics of HIV/AIDS (Garnett and Johnson 1997; Halperin and Epstein 2004; Morris and Kretzschmar 1997, 2000; Wilson and Halperin 2008).2 Almost by definition non-marital sexual partners of married men and women are concurrent partners, as few spouses cease having sexual relations with each other. These extra-marital partnerships can vary in length from one-night stands to decades-long relationships. Individuals who have sexual partners outside of marriage directly increase their own risk of contracting HIV and, consequently, increase the risk that they will pass the virus along to their spouse. Concurrent partnerships may further increase the risk of transmission within marriage, as individuals have higher viral loads and, thus, are more infectious shortly after contracting the virus (Quinn et al. 2000). According to a recent study in urban Zambia and Rwanda, between 55.1% and 92.7% of new heterosexually-acquired HIV infections take place within serodiscordant married or cohabiting couples (Dunkle et al. 2008).
Although both husbands and wives may have EMSPs, men are far more likely to report having sexual relationships outside of the marriage. Married men in rural Malawi, for example, are four times more likely to acknowledge having had an EMSP than married women in Malawi (Schatz 2005). Similarly large differences are reported elsewhere in Africa (Caraël et al. 1995). Part of this self-reported discrepancy may be attributable to under-reporting by women and, potentially, over-reporting by men (Nnko et al. 2004). However, prospective studies of HIV-negative couples in stable unions, which repeatedly test both members of the dyad, have found that men are twice as likely as women to first become infected with HIV and bring it into the union (Carpenter et al. 1999; Lurie et al. 2003). Presumably most of these husbands became infected from their EMSPs. Because of the potential for under-reporting of EMSPs by women, as well as their likely lower rates of having EMSPs, this paper focuses exclusively on men's EMSPs.
Among demographers and sociologists, interest in the determinants of men's extra-marital relations predates the HIV/AIDS epidemic, and the topic received sporadic attention in relation to total fertility, non-marital fertility, marital dissolution, and the transmission of other STIs. Most of the literature on EMSPs has focused on the individual characteristics of men most likely to have EMSPs as well as some aspects of the martial unions, particularly the practice of post-partum abstinence and polygamy. A wide spectrum of men appears to engage in extra-marital sexual relationships with few individual characteristics being consistently correlated with having EMSPs. There are a few notable exceptions. Migrant laborers report having more EMSPs due to their extended residence away from their families (Boerma et al. 2002; Chirwa 1997; Hirsch et al. 2002; Wolffers et al. 2002). Wealthier men are often suspected of having more EMSPs, partly because these men can afford payments and gifts in exchange for sexual favors. …