Exploring the complex paradigms regarding concurrent sexual partnerships, condom use, and HIV among youth in Malawi: Lessons learned from qualitative formative research

Background: In Malawi, as in other parts of Sub-Saharan Africa, concurrent sexual partnerships (CP) play a central role in HIV risk among youth. Less is known, however, about the paradigms through which Malawian youth view condom use and CP and assess their personal risk. The current study—conducted as formative research for an HIV prevention program—explores these concepts. Methods: Malawian youth (ages 18 to 22) were interviewed about their sexual relationships and behavior, as well as their perceptions and knowledge regarding condom use and CP. In order to ensure that youth engaged in CP were oversampled, the recruitment process asked potential respondents to self-identify whether they currently participated n CP. Of the total sample (N=19), 13 self-identified as engaging in CP. Data was analyzed using a Grounded Theory approach.

Results: Findings revealed discordance between respondents' personal HIV risk assessment and their knowledge and attitudes regarding condom use and CP. For example, although respondents engaged in CP knew that condoms can reduce one's HIV risk, the majority reported inconsistent condom use. As respondents rationalized their behavior, factors such as partner trust and communication influence their decision-making more than did CP or condom use knowledge.

Conclusions: The current study suggests that youth may not personalize their HIV risk and may rationalize their behavior in spite of their safer sex knowledge. Furthermore, HIV prevention programs in Malawi, and elsewhere in Sub-Saharan Africa, should stress factors such as evaluating partner trust and personalizing risk in order to reach youth with more credible and persuasive messages.