Explaining both reported and 'true' condom use within marriage in rural Malawi. A couple-level analysis

Julia Cordero, Consejo Superior de Investigaciones Científicas (CSIC)
Richard Breen, Yale University

In populations where extramarital sex is common and condoms are not generally used, married people, even when sexually faithful, are at high risk of becoming infected with HIV/AIDS. Some preventive practices, such as the use of condoms in marital sexual relations, may be in conflict with specific social norms that regulate marriage. In this paper we examine the influence that the fidelity norm and the traditional association between marriage and reproduction have on condom use within marriage. To do this we apply latent class analysis to estimate a 'true' or latent measure of condom use within marriage based on the individual, and sometimes discrepant, reports of husbands and wives. Moreover, we also explore the reasons why individuals tend to misreport their preventive sexual behavior. In order to test the robustness of our results, two different samples of monogamous couples are taken from the Malawi Diffusion and Ideational Change Project (MDICP), 2004 and 2006. The analysis supports the hypotheses that, on the one hand, the suspicion of unfaithfulness and the number of living children increase the 'true' use of condoms by married couples, and on the other hand, that having been informed by experts about AIDS prevention at home induces men and women to over-report condom use within marriage in a survey but does not necessarily increase the extent to which condoms are used.