Perfect day? How dreams of marriage can lead to HIV in Malawi

Grace discovered that she was HIV positive after going for antenatal services
© UNICEF Malawi/2017/Eldson Chagara

By Joseph Scott, UNICEF Malawi

Grace (not her real name) is a shy 19-year-old adolescent. She sits under the shade of a tree, with a baby boy sleeping in a chitenge on her back. Grace lives in Luwinga, one of the biggest towns in Mzuzu, where a lot of working people stay. She is the third born in a family of four. Her father died in 2010, leaving her mother to fend for the family.

Once a promising student, Grace’s education came to an end when she got pregnant in Form 1. “I had a boyfriend when I was in school who promised to marry me,” she says. “I started sleeping with him, despite people warning me that he had HIV. I didn’t listen to their advice because I thought they were just being jealous.”

A few months into the relationship, Grace got pregnant. She was only 17, so she ran away from home to marry her boyfriend. Then she went to register for antenatal services at her local health centre.

“I tested positive for HIV but I didn’t believe the results,” she continues. “I thought the health staff had made a mistake so I went to St Johns Mission Hospital for a second opinion. I also tested positive there.”

Grace was devastated and felt like the world was falling in on her. Fortunately, on the day of her HIV test, she met counsellors from Mothers2Mothers, an organization providing psychosocial support to pregnant and breastfeeding women living with HIV, who guided her through the treatment process.

Staff at the health centre told her to bring her husband for HIV testing. At first, he refused but later turned up. He also tested positive. “I accepted that I had made a mistake and now had to focus on the future,” Grace says. “I was immediately put on treatment. At present, I’m focusing on living a healthy life as advised by the health staff.”

The good news is that Grace’s child, a baby boy, tested negative for HIV on his first test. “They got some blood samples again and I am waiting for his second results,” she adds.

Marriage as a risk factor

In Malawi, the problems of child marriage, teenage pregnancy and HIV are all interlinked. While HIV is in retreat globally, in Malawi one in ten adults are still HIV positive. In most countries, the adolescents most at risk of HIV are young gay men, intravenous drug users and people selling sex. However, the picture in Malawi is strikingly different.

“In Malawi, child marriage is a key risk factor for HIV, affecting teenage girls in particular,” UNICEF Malawi’s Chief of HIV Judith Sherman says. “According to recent surveys, most new HIV infections occur in young women. We also know that unprotected heterosexual sex between married and co-habiting partners accounts for most new HIV infections.”

Judith says that there are many factors that make married adolescents more vulnerable to HIV. “These include their physical immaturity; limited power to negotiate safer sex, especially in the face of partner violence; the pressure to demonstrate fertility; and the frequency of unprotected sex, when their partner may already be HIV positive or may contract HIV after they get married,” she explains.

UNICEF is working to bring an end to child marriage throughout Malawi. According to the 2015–16 Malawi demographic and Health Survey, 47 per cent of girls in Malawi were married before the age of 18. In early 2017, a coalition of UN agencies and NGOs was instrumental in supporting the Government to change the Constitution to raise the minimum age of marriage from 15 to 18 years of age, for both girls and boys.

Since then, UNICEF’s work has focused on ensuring that this political change is implemented on the ground. This includes working with religious groups to identify and annul child marriages, and with local leaders and communities to equip girls and boys with knowledge and skills to reduce the risk of child marriage, teenage pregnancy and HIV.

Sigele’s partner refused to use protection, claiming he was HIV-negative
© UNICEF Malawi/2017/Eldson Chagara

Sigele’s story

Another adolescent in a similar situation is 17-year-old Sigele (not her real name). More confident and outgoing than Grace, she is already a mother to Esime, a tiny two-month-old baby girl wrapped in blankets and wearing a pink hat. Sigele’s mood becomes somber as she narrates how she became a mother.

After a fight with a fellow student, Sigele was suspended from school. Fearing her mother’s reaction, she decided to go and stay with her aunt in Lilongwe. While there, she fell in love with an older man who lived in the same neighbourhood.

“We met several times and he tried to sleep with me without protection,” she says. “But I kept on refusing and insisting that we go for an HIV test. To encourage him, I went for testing and my results came back negative. However, he wouldn’t budge and said that he knew he was fine and therefore didn’t need an HIV test.”

Trusting her partner, Sigele eventually had unprotected sex with him. When she was preparing to go back to school, she found out that she was pregnant.

“When I told him, he proposed marriage and said that he could take care of the baby when it was born,” she says. “I couldn’t stay with my aunt, so I went back home to Mzuzu. My mother was disappointed but she accepted my situation.”

Back in Mzuzu, Sigele went to register for antenatal services. As a standard procedure, she was tested for HIV. “I couldn’t believe it when the nurse told me that I was HIV positive,” she says. “I was certain that this man I was in love with was the one who infected me. It pained me so much because I could have seen the signs when he refused to go for testing.”

Sigele also broke the news of her HIV results to her fiancé but he said nothing: “I knew from his silence that he was aware of his status,” she says. “This made me mad but had to keep calm, as I still needed him to take care of the baby. I had to move on and focus on the new challenge that I faced.”

Lignet is now a soldier with the Malawian Defence Force
© UNICEF Malawi/2017/Eldson Chagara

A better future

Happily, some adolescent girls are avoiding the fate of Grace and Sigele. Lignet Chamboko, 24, is one of the lucky ones. Now a soldier with the Malawian Defence Force, based in Salima, Lignet smiles broadly and looks comfortable in her immaculate uniform.

Lignet is from Kalolo village, the second born in a family of four children. Her father died while she was in Standard 3, and her mother remarried. Lignet and her siblings were sent to stay with her grandmother, while her mother made a fresh start with her new husband.

Life was tough for Lignet at her grandmother’s house. The children would sometimes go for days without food. A local NGO heard about their situation and started providing them with support, including paying school fees.

At 16 years old, while in Form 2, Lignet got pregnant and faced pressure from her family to get married. She refused and asked to be allowed to continue her education after giving birth.

“I wrote my Junior Certificate examinations while eight months pregnant and passed,” she says. “After giving birth, I left the baby with my grandmother and went back to school. The NGO continued providing support to me and my child.”

In 2010, Lignet sat for Malawi School Certificate of Education and again passed. “In 2011, I applied to the army for military training. I was selected and successfully completed my course. I am now a qualified soldier,” she says proudly.

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