‘Take your mat and go!’: Rural Malawian women's strategies in the HIV/AIDS era

Abstract

In much of HIV/AIDS prevention literature, women are depicted as passive and ill‐equipped to confront the epidemic without external support to enhance their status, autonomy, and negotiation skills. This paper critically evaluates this depiction, using data from in‐depth interviews conducted with married couples in rural Malawi. It focuses on the extent to which married women perceive that they have the ability to protect themselves from infection and on the prevention strategies that they employ. Interview data suggest that women have identified a range of contextually appropriate ways to resist exposure to HIV. These strategies include sitting and discussing the dangers of HIV/AIDS with their husbands; utilizing social networks for advice and as advocates; publicly confronting husbands' girlfriends; and divorcing men who do not adopt safer practices. These locally‐formulated strategies are not likely to be followed consistently, and they may not be the most effective strategies in preventing husbands from straying or protecting women from contracting HIV/AIDS. Their existence, however, demonstrates that rural Malawian women believe that they have some agency to protect themselves; and, they are in fact using locally appropriate strategies to do so.

Résumé

Dans beaucoup de publications sur la prévention du VIH/Sida, les femmes sont représentées comme passives et mal préparées face à l'épidémie, sans soutien extérieur pour améliorer leur statut, leur autonomie, et leurs aptitudes à négocier. Cet article dresse une évaluation critique de ces représentations, en utilisant des données provenant d'entretiens en profondeur menés avec des couples mariés dans le Malawi rural. Il se concentre sur le domaine où les femmes mariées perçoivent qu'elles ont la capacité de se protéger de la contamination et sur les stratégies de prévention qu'elles emploient.

Les données provenant des entretiens suggèrent que les femmes ont identifié une gamme de méthodes contextuelles appropriées pour résister à l'exposition au VIH. Ces stratégies comprennent celles de s'asseoir et de discuter des dangers du VIH/Sida avec leurs maris; d'utiliser des réseaux sociaux pour obtenir des conseils et en tant que défenseurs ; de se confronter publiquement aux petites amies des maris; et de divorcer lorsque les maris n'adoptent pas de pratiques sexuelles sans risques.

Il est probable que ces stratégies, élaborées localement, ne soient pas suivies de manière systématique, et ne soient pas les plus efficaces pour empêcher les maris d'avoir des aventures ou les femmes d'être contaminées par le VIH/Sida. Cependant, leur existence démontre que les femmes du Malawi rural croient avoir les moyens de se protéger; et en fait, elles utilisent des stratégies localement appropriées pour le faire.

Resumen

En gran parte de la literatura sobre prevención del VIH/sida, las mujeres son caracterizadas como pasivas, mal preparadas para defenderse contra la epidemia sin apoyo externo que permita mejorar su estatus, autonomía y habilidades de negociación. En este documento se evalúa críticamente esta representación usando datos de entrevistas exhaustivas llevadas a cabo con parejas casadas en una zona rural de Malawi. Se centra en cómo las mujeres casadas creen que tienen la capacidad para protegerse contra infecciones y sobre las estrategias de prevención que utilizan. Los datos de las entrevistas indican que las mujeres han identificado toda una serie de métodos contextualmente apropiados para luchar contra la exposición a VIH. Algunas de estas estrategias serían sentarse a charlar sobre los peligros de VIH/sida con sus maridos, utilizar redes sociales para asesorarse y ser representadas, enfrentarse públicamente a las amantes de los maridos y divorciarse de los hombres que no quieren usar métodos más seguros. No es muy probable que se vayan a seguir siempre a rajatabla estas estrategias formuladas localmente y es posible que no sean las estrategias más eficaces para impedir que los maridos tengan relaciones extramatrimoniales o de proteger a las mujeres contra VIH/sida. No obstante, el hecho de que existan demuestra que las mujeres rurales de Malawia creen que tienen los medios para protegerse y de hecho usan estrategias apropiadas en su entorno para conseguirlo.

Keywords:

• Gender
• HIV/AIDS
• Malawi
• Africa

Acknowledgements

The author is grateful to Susan Watkins and Eliya Zulu for making her part of the Malawi Diffusion and Ideational Change Project (MDICP). She is also indebted to the qualitative field team in Malawi for their collection of high quality data: McDaphton Bellos, Praise Chatonda, Davie Chitenje, Fanizo George, Hazrat Hassan, Matthews Howard, Bertha Kalua, Jenala Kayira, Harry Mkamanga, Enala Mnthali, Ziveza Nkana, Joseph Nyirenda, Kenneth Nyirenda, Rosemary Sapangwa, Esnat Sanudi, and Jones Shange. This paper has benefited from comments on earlier drafts from Kathryn Edin, Nancy Luke, Amy Kaler, Sangeetha Madhavan, Jane Menken, Herbert Smith, Liz Walker, and Susan Watkins.

Notes

1. Kaler (2003) focuses on men's strategies using data from a separate study in the same study site.

2. The Mellon Center Grant to the University of Pennsylvania for Training and Research in Developing Countries funded a 1999 pilot study. Enid Schatz was principal investigator. The larger study conducted in 2000 was supported by two sources: a Mellon grant extension, and support from NIH RO1 grant HD37276‐01, ‘Social Interactions and Reproductive Health’. Susan Watkins and Jere Behrman were principal investigators.

3. MDICP is a collaboration between the University of Pennsylvania Population Studies Center and the University of Malawi Demographic Research Unit. For more information about MDICP—including study design, sampling, data collection, and map—see Watkins et al., 2003, and http://www.ssc.upenn.edu/Social_Networks.

4. The decision was made to work in the northern and southern sites because of contrasting lineage and residence patterns. The northern site is predominantly patrilineal and patrilocal. The southern site is largely matrilineal and matrilocal. The third site in the central region has more ambiguous patterns. See Schatz (2002) for a discussion of this decision as well as a discussion of the inherent problems in the dichotomy between matrilineal/patrilineal and matrilocal/patrilocal.

5. This study interviewed only the sampled wife and her husband in polygynous unions. Each widowed or divorced woman was counted as a ‘couple’.

6. Local interviewers conducted, recorded, translated and transcribed two interviews with each respondent. The qualitative interviews were coded and analysed using Nvivo.

7. For a discussion of the GCS sample, sample selection and the advantages to nesting the qualitative sample within a larger quantitative study see Schatz (2002) and (2003).

8. In 2000, 12 originally selected respondents had moved or could not be traced with names collected earlier. These women were replaced with others with similar attributes (age, marital status, marriage type, lineage and residence).

9. Respondents are identified with a pseudonym and the region in which each lives (north/south).