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Background: Whereas sexual relationships among low-risk individuals account for the majority of HIV infections in sub-Saharan Africa, limited knowledge exists about the structure and characteristics of sexual networks among the general population in sub-Saharan Africa., Objectives: To investigate the population-level structure of sexual networks connecting the young adult population of several villages on Likoma Island (Malawi), and analyse the structural position of HIV-positive individuals within the sexual network., Design and Methods: A cross-sectional sociocentric survey of sexual partnerships and biomarkers of prevalent HIV infections., Results: The study documents the existence of a large and robust sexual network linking a substantial fraction of the island's young adult population: half of all sexually active respondents were connected in a giant network component, and more than a quarter were linked through multiple independent chains of sexual relationships. This high network connectivity emerges within short time frames. The prevalence of HIV also varied significantly across the network, with sparser regions having a higher HIV prevalence than densely connected components. Several risk factors related to sexual mixing patterns help explain differentials in HIV prevalence across network locations., Conclusion: Contrary to claims that sexual networks in rural sub-Saharan Africa are too sparse to sustain generalized HIV epidemics, the structure of the networks observed in Likoma appears compatible with a broad diffusion of HIV among lower-risk groups. The non-homogeneous distribution of HIV infection within the network suggests that network characteristics are an important determinant of the dynamics of HIV spread within a population.

Objective: To examine the acceptance of repeat population-based voluntary counselingand testing (VCT) for HIV in rural Malawi.Methods: Behavioral and biomarker data were collected in 2004 and 2006 fromapproximately 3,000 adult respondents. In 2004, oral swab specimens were collected andanalyzed using enzyme-linked immunosorbent assay (ELISA) and confirmatory Westernblot tests while finger-prick rapid testing was done in 2006. We use cross-tabulationswith chi-square tests and significance tests of proportions to determine the statisticalsignificance of differences in acceptance of VCT by year, individual characteristics andHIV risk.Results: First, over 90% of respondents in each round accepted HIV test, despitevariations in testing protocols. Second, the percentage of individuals who obtained theirtest results significantly increased from 67% in 2004 when the results were provided inrandomly selected locations several weeks after the specimens were collected, to 98% in2006 when they were made available immediately within the home. Third, whereas therewere significant variations in the socio-demographic and behavioral profiles of those whowere successfully contacted for a second HIV test, this was not the case for those whoaccepted repeat VCT. This suggests that variations in the success of repeat testing mightcome from contacting the individuals rather than from accepting the test or knowing theresults.Conclusions: Repeat HIV testing at home by trained health care workers from outsidethe local area, and with either saliva or blood, is almost universally acceptable in ruralMalawi, and thus likely to be acceptable in similar contexts.

Introduction: Starting in late 2019, the coronavirus "SARS-CoV-2", which causes the disease Covid-19, spread rapidly and extensively. Although many have speculated that prior experience with infectious diseases like HIV/AIDS, Ebola, or SARS would better prepare populations in sub-Saharan Africa for COVID-19, this has not been formally tested, primarily due to data limitations. Methods: We use longitudinal panel data from the Malawi Longitudinal Study of Families and Health (MLSFH, waves 2006, 2008, and 2020) to examine the association between exposure to the HIV/AIDS epidemic and perceptions of, and behavioral response to, the COVID-19 pandemic. We measured exposure to HIV infection through perceived prevalence of HIV/AIDS in the community, worry about HIV infection, perceived likelihood of HIV infection, and actual HIV status; and the experience of HIV/AIDS-related mortality through self-reports of knowing members of the community and extended family who died from AIDS (measured in 2006 or 2008). Our outcome measures were perceptions of COVID-19 presence in the community, perceptions of individual vulnerability to COVID-19, and prevention strategies to avoid COVID-19 collected through phone-interviews in 2020. Results: Based on our data analysis using multivariable regression models, we found that the experience of HIV-related mortality was positively associated with perceptions of COVID-19 prevalence in the community and preventive behaviors for COVID-19. However, perceived vulnerability to HIV-AIDS infection and actual HIV positive status 10-years prior to the COVID-19 pandemic are generally not associated with COVID-19 perceptions and behaviors. Conclusions: Our results suggest that COVID-19-related behaviors are impacted more by experience of AIDS mortality instead of HIV/AIDS risk perceptions, and that individuals may be correctly viewing HIV/AIDS and COVID-19 transmission as distinct disease processes. [ABSTRACT FROM AUTHOR]

Over a third of new HIV infections occur in adolescents aged 10–19 globally. Pre-exposure prophylaxis (PrEP) could be a powerful tool for prevention. Understanding more about the drivers of PrEP interest could inform implementation strategies among this age group. Moreover, family dynamics may play a uniquely critical role for this younger age group, thus it is important to gauge whether caregivers would support their children's use of PrEP. We surveyed 2,089 adolescents (aged 10–16) and their caregivers in Malawi during 2017–2018. Data were collected on PrEP interest, factors that may facilitate PrEP use, and preferences for PrEP modality. We used multivariate logistic regression to estimate the association between the above characteristics and PrEP interest. We find that young adolescents are engaging in behaviors that would put them at substantial risk of acquiring HIV, would likely benefit from PrEP, are largely (82%) interested in using such, would prefer to get an injection over taking a daily pill, and are considerably discouraged by the prospect of side effects. Endorsement by caregivers was even greater (87%). Our findings demonstrate initial support for adolescent PrEP, and suggest parents may be a surprising advocate. [ABSTRACT FROM AUTHOR]

Female empowerment and positive attitudes towards women’s rights in sexual relationships have been found to be key elements of successful behaviour-based HIV prevention programmes. However, HIV prevention programmes that do not specifically engage with gender issues may also affect attitudes and beliefs towards women’s rights within sexual relationships. Using data from the Malawi Longitudinal Study of Families and Health we compare measures of female empowerment and changing gender norms between intervention participants and non-participants. Results suggest that female intervention participants were more likely than non-participants to believe that: (1) women have more rights within sexual relationships in general and (2) women have the right to protect themselves against HIV risk (indicating possible increases in female self-efficacy in making HIV prevention decisions). Male intervention participants showed no substantial positive change in attitudes towards women’s rights. These results highlight an important positive effect of HIV prevention programmes on women’s attitudes towards their own rights. [ABSTRACT FROM PUBLISHER]

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. [ABSTRACT FROM AUTHOR]

Background: The objective of these analyses is to document the relationship between biomarker-based indicators of health and socioeconomic status (SES) in a low-income African population where the cumulative effects of exposure to multiple stressors on physiological functions and health in general are expected to be highly detrimental for the well-being of individuals. Methods: Biomarkers were collected subsequent to the 2008 round of the Malawi Longitudinal Study of Families and Health (MLSFH), a population-based study in rural Malawi, including blood lipids (total cholesterol, LDL, HDL, ratio of total cholesterol to HDL), biomarkers of renal and liver organ function (albumin and creatinine) and wide-range C-reactive protein (CRP) as a non-specific biomarker for inflammation. These biomarkers represent widely used indicators of health that are individually or cumulatively recognized as risk factors for age-related diseases among prime-aged and elderly individuals. Quantile regressions are used to estimate the age-gradient and the within-day variation of each biomarker distribution. Differences in biomarker levels by socioeconomic status are investigated using descriptive and multivariate statistics. Results: Overall, the number of significant associations between the biomarkers and socioeconomic measures is very modest. None of the biomarkers significantly varies with schooling. Except for CRP where being married is weakly associated with lower risk of having an elevated CRP level, marriage is not associated with the biomarkers measured in the MLSFH. Similarly, being Muslim is associated with a lower risk of having elevated CRP but otherwise religion does not predict being in the high-risk quartiles of any of the MLSFH biomarkers. Wealth does not predict being in the high-risk quartile of any of the MLSFH biomarkers, with the exception of a weak effect on creatinine. Being overweight or obese is associated with increased likelihood of being in the high-risk quartile for cholesterol, Chol/HDL ratio, and LDL. Conclusions: The results provide only weak evidence for variation of the biomarkers by socioeconomic indicators in a poor Malawian context. Our findings underscore the need for further research to understand the determinants of health outcomes in a poor low-income context such as rural Malawi. [ABSTRACT FROM AUTHOR]

We explore how marital aspirations are related to the sexual behaviors of adolescents and young adults in Malawi, where HIV/AIDS prevalence among adults exceeds 10%. We also consider whether the specter of AIDS is shaping ideals about marriage. By combining survey data (N = 1,087) and in-depth interviews (N = 133) with young Malawians from the Malawi Diffusion and Ideational Change Project, we show that looking for and finding a suitable spouse are linked to sexual behaviors and, thus, HIV risks. Moreover, concerns about contracting HIV are closely tied to the ideal characteristics of a future spouse. Our findings draw long-overdue attention to the importance of marital aspirations in understanding adolescent sexual behaviors and risks in the era of AIDS. [ABSTRACT FROM AUTHOR]

In this paper, a Marginal Structural Model (MSM) with inverse probability of treatment weights was used to estimate the causal effect of HIV positivity awareness on condom use and multiple sexual partners using data from the Malawi Longitudinal Study of Families and Health (MLSFH). Cumulative awareness of HIV positivity was measured as the number of times an individual was aware of their positive HIV status. Awareness of HIV positivity was associated with increased condom use (OR=2.22, 95%: (1.79, 2.75)). Only among women was it associated with multiple sexual partners (OR=1.76, 95%: (1.36, 2.28)). The use of MSM (over standard regression models for repeated measures) should be encouraged as it is more suited for assessing the cumulative treatment effects while controlling for time-varying confounders in longitudinal studies. There is a need to up-scale interventions that promote HIV testing, awareness of HIV status, and prevention of HIV transmission. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) can have lifelong adverse impacts on health and behavior. While this relationship has been extensively documented in high-income countries, evidence from lower-income contexts is largely missing. In order to stimulate greater research on the prevalence and consequences of ACEs in low-income countries, the World Health Organization (WHO) developed the ACE-International Questionnaire (ACE-IQ). In this paper, we explore the factor structure, validity and reliability of the original ACE-IQ, and evaluate whether potential adaptations improve its predictive validity. Four hundred and ten adolescents (age 10–16 years old) from Malawi. The adolescents answered an adapted version of ACE-IQ and Beck Depression Inventory (BDI). Taken together, our results suggest that (a) the ACE-IQ is structured in three dimensions: household disruption, abuse, and neglect; (b) there is support for the validity of the scale evidenced by the correlation between subdimensions (average across 13 correlations, phi =.20, p < 0,01; across subdomains (phi =.10, p < 0,01); partial agreement among children with the same caregiver (ICC =.43, p <.001) and correlation between ACE and depression (predictive validity; r =.35, p <.001); (c) information on the timing of the adversities ("last year" in addition to "ever") modestly improved the predictive value of the ACE-IQ in models of depression (from R 2 =.12 to.15, p <.001); and (d) additional HIV-related questions showed low endorsement and a modest correlation with BDI (r =.25, p < 0,01). Our findings suggest that the ACE-IQ is appropriate for use among adolescents from a low-income context. [ABSTRACT FROM AUTHOR]