Age-disparate and intergenerational sex partnerships and HIV: the role of gender norms among adolescent girls and young women in Malawi.
Outcomes: Human Immunodeficiency Virus
View SourceKey Social Norms Take-aways Inequitable gender norms—such as male control over women’s healthcare decisions, tolerance of violence, and stigmatization of sexually active women—greatly magnify HIV risks for AGYW in age-mixing relationships. Programs must challenge these harmful norms while promoting girls’ autonomy, education, and economic opportunities to effectively reduce HIV vulnerability.
Objectives This study examined how age-disparate (≥5 years older) and intergenerational (≥10 years older) sexual partnerships impact HIV risk among adolescent girls and young women (AGYW) in Malawi. It specifically assessed whether endorsement of inequitable gender norms modified the relationship between partner age difference and HIV status.
Methods Researchers analyzed nationally representative data from the 2015–2016 Malawi Population-based HIV Impact Assessment (MPHIA). The sample included 1,958 AGYW aged 15–24 who reported the age of their primary sexual partner within the past 12 months. HIV status was confirmed through biological testing. Endorsement of inequitable gender norms was measured through a modified Gender Equitable Men (GEM) Scale. Multivariate logistic regression models with interaction terms were used to explore associations and effect modification.
Results AGYW engaged in age-disparate and intergenerational partnerships had 1.9 and 3.4 times higher odds of HIV infection, respectively, compared to those in age-concordant partnerships. Among AGYW who endorsed inequitable gender norms, the odds of HIV infection were even higher: 3.5 times for age-disparate and 6.4 times for intergenerational partnerships. Endorsing norms that tolerate male dominance, violence, and stigma around female sexuality was widespread and intensified the relationship between partner age gaps and HIV risk.
Conclusions Age-disparate and intergenerational partnerships significantly increase HIV risk for AGYW, especially when harmful gender norms are present. Interventions should not only address age-mixing relationships but must also confront the inequitable gender norms that exacerbate AGYW’s vulnerability.
Norms Addressed
Decision-Making/Agency
Gender
Gender-Based Violence
Human Immunodeficiency Virus
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