HIV unknowns nudge Malawians to want kids

PENN STATE (US) — People in Malawi who are uncertain about their HIV status are more eager to start families than those who are certain one way or the other, a new study shows.

Malawi, a landlocked country in southeast Africa, has both a high fertility rate and a high prevalence of HIV. About 12 percent of the population is infected with the virus that causes AIDS.

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More than 30 percent of young Malawians surveyed for the study, published in American Sociological Review, indicated they were uncertain about their HIV status and 70 percent were uncertain about the chance they will be infected with HIV in the future.

“In decision-making, what you know you don’t know can be just as important as what you do know,” says Jenny Trinitapoli, assistant professor of sociology, religious studies, and demography, at Penn State.

“In this context, uncertainty about HIV is even more widespread than the disease itself. Furthermore, testing for HIV does not reduce uncertainty young Malawians experience.”

Those uncertain of their HIV status indicated that they want to have children significantly sooner than both those who were sure they have HIV and those who were certain that they did not have the disease. The pattern was the same for men and women.

The fact that families with many children tend to have a higher status in Malawian culture may be one reason why uncertainty accelerates childbearing in Malawi.

“In Africa, where being a parent is critically important, having children reduces some of life’s uncertainties,” Trinitapoli says. “They may want to take advantage of their current good health.  Another reason is that people believe that having children may prove that they are in good health.”

Many people in Malawi believe that a woman with HIV cannot carry a healthy baby to full-term, so having a baby may be considered a sign that the woman does not have HIV.

Many Malawians may also want to start their families sooner so they can live long enough to raise their children. People experience different levels of uncertainty differently, and this plays a role in decision-making that some may take for granted, Trinitapoli says.

“This type of personal uncertainty is relevant for how people think about their lives and make decisions.”

The study included 1,472 female and 567 male subjects who were between 15 and 25 years old. To measure uncertainty, participants were given 10 beans and asked to place the number of beans on a small plate that corresponded to their likelihood of being HIV positive. For instance, if the participants were certain they were HIV positive, they placed 10 beans on the plate. If they were certain they did not have HIV, they did not put any beans on the plate. People who were uncertain of their HIV status tended to place four, five, and six beans on the plate.

The method avoids embarrassing participants and gives them a chance to better communicate their level of certainty, Trinitapoli says.

“How do you communicate probability? It’s hard to converse about what we know and what we don’t know even in the U.S. We just don’t have the vocabulary for it.”

Researchers from the University of Colorado-Denver contributed to the study.

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