Protecting Young Women from HIV/AIDS: The Case against Child and Adolescent Marriage

This research, from the International Family Planning Perspectives, Volume 32, Number 2, June 2006 (also available in Spanish), used demographic and health survey data from 29 countries in Africa and Latin America to examine the frequency of factors that may increase HIV risk in married women aged 15-19.

Because child and adolescent marriage remains common in many parts of the developing world - almost a third of the more than 330 million girls and young women aged 10-19 who currently live in developing countries (excluding China) were or will be married by their 18th birthday - married adolescents may have higher rates of HIV infection than their sexually active unmarried peers. "[M]any policymakers and parents, and even young women themselves, continue to perceive marriage as a haven from the risk of HIV infection. Parents in Malawi, for example, encourage their daughters to marry early to protect them from HIV. Moreover, many international and national AIDS prevention messages encourage abstinence until marriage; these messages imply that sex within marriage is not only more socially sanctioned than premarital sex, but also somehow provides complete protection against HIV."

This article presents evidence from a series of international surveys about four aspects of young women's lives that can increase their vulnerability to the HIV virus:

1. For many adolescents, marriage results in a transition from virginity to frequent unprotected sex, especially when pregnancy is desired.
   
2. The partners of married female adolescents are typically older and, by virtue of their age, more likely to be HIV-positive.
   
3. Women who marry as adolescents receive less formal education and have less exposure to the media than their unmarried peers, greatly reducing their opportunities to receive information about HIV/AIDS via these channels and potentially undermining their ability to negotiate safer sexual practices.
   
4. HIV outreach programmes, often not accessible to married adolescents, are often geared toward unmarried adolescents and other groups that are considered to be high-risk. According to the authors, these programmes often promote protection strategies that are either inappropriate for married adolescents or difficult for them to implement, such as using condoms or abstaining from sexual activity.

The authors suggest policy changes that include a focus on married female adolescents, in order to limit mother-to-child HIV transmission and reduce the likelihood of this group as a vector group furthering infection. They point out that specific policy interventions must be tailored to sexual and behavioural profiles of young women in individual countries because in some countries with low rates of multiple concurrent partners (MCP) married adolescents may be at a lower risk of infection.

As stated here, policymakers may fear that delaying marriage will result in girls becoming more sexually active outside marriage. "However, data from Latin America and Africa show that although the context in which adolescent sexual relationships occur has changed over time (from within marriage to before marriage), the overall percentage of sexually active young women has remained constant, or even declined slightly, as the age of marriage has risen." Where premarital sexual activity is strongly curtailed, delayed marriage might give young women the opportunity to extend their education, "develop livelihood skills and strengthen their self-esteem, all of which may help them create healthier and more stable marital unions when they wed.”

“In other countries, making sexual intercourse within marriage safer may be a more important strategy. The process of getting married can itself be used as an opportunity to reach both brides and grooms with information about HIV/AIDS and to provide HIV testing. Both religious and state institutions could incorporate these elements into the marriage process." In addition, targeted outreach programmes for the recently married could be developed and include strategies to encourage the use of condoms within marriage as a contraceptive and protective strategy for newlywed couples seeking to delay childbearing. The article concludes that "[t]he combination of policies designed to delay marriage until at least age 18 and of policies that recognize and lower HIV risks within marriage could be instrumental in making marriage safer.... Policymakers have long sought to reduce adolescent HIV risks by discouraging risky premarital and extramarital sexual activity; it is time to also promote concurrent and complementary strategies to reduce adolescent marital sex and foster safer marital sex practices."