Addressing the Vulnerability Paradigm: Gender-Based Power Dynamics and HIV/AIDS in Malawian Couples

Background: Recent debates around the “vulnerability paradigm” have led HIV researchers to question the usefulness of a prevention approach that favors women over men. This study adds to the dialogue by examining gender-based power in a high-prevalence African setting, Malawi, and asks the questions: how much power do women and men have in their relationships, what are their respective forms of power, and what does power mean for the HIV/AIDS epidemic?

Methods: Semi-structured interviews (n=34) were conducted separately, but simultaneously, with married and dating couples in order to understand theoretically-based dimensions of power. Deductive and inductive coding was used to determine core categories by capturing both predefined and emerging constructs of power. Data matrices were used to identify similarities and differences by gender and marital status.

Results: The main domains of power were decision-making, communication, love, conflict, agency, and freedom. Contrary to the vulnerability paradigm, many women exhibited a substantial amount of decision-making and communication power by using gendered strategies to achieve desired aims, such as protecting themselves from HIV. Often times men and women used cultural scripts (e.g., “husbands are heads of households”) to explain their respective roles, but when interviewers probed deeper, a more nuanced picture of power emerged. Maintaining peace was an important overarching theme that led couples to act in ways that encouraged shared decision-making and open discussion around HIV/AIDS, as opposed to dominance.

Conclusions: Couple-based prevention programs need to be considerate of the culturally-rooted ways men and women use power to navigate the AIDS epidemic.