Through which pathways do cohabiting married couples become HIV serodiscordant? Evidence from a longitudinal study in rural Malawi

Kim Deslandes, Université de Montréal
Simona Bignami, Université de Montréal

In sub-Saharan Africa, transmission of HIV occurs primarily through heterosexual intercourse. HIV discordance among cohabiting couples is widespread. The importance and challenges in preventing HIV transmission within serodiscordant couples are well recognized but poorly understood. Most existing studies mainly rely on cross-sectional data and are thus prone to selection bias. This limits developing effective joint voluntary counseling and testing programs, which have shown promising results for reducing HIV transmission in some countries. We use data from a large-scale longitudinal couple survey in rural Malawi (the Malawi Diffusion and Ideational Change Project) to explore the pathways through which cohabiting married couples become HIV serodiscordant, and their implications for HIV prevention. First, we use sequence analysis to describe and categorize the different marital trajectories of MDICP couples. Second, we use these groups of marital trajectories as the main independent variable to predict couples’ HIV status at the time of the most recent survey to which they participated.