Profiles of Risk for HIV/AIDS Among Malawian Emerging Adults: Implications for Universal and Targeted Interventions

Purpose:  Despite reductions in HIV infections globally, 2.5 million people continue to be infected annually (UNAIDS, 2012), with Sub-Saharan Africa bearing the brunt of this pandemic.  In Sub-Saharan Africa, emerging adults are particularly affected.  Indeed, about 80% of individuals infected in Malawi are in their twenties (Onokerhoraye, 2012). To decrease these rates, it is necessary to identify who is most at risk for infection (Bertozzi, Laga, Bautista-Arredondo, & Coutinho, 2008), and then match them to interventions that address relevant risk factors.  The purpose of this study was to identify a typology of risk using constructs from AIDS behavioral theories (Noar, 2009).  Specifically, three questions were addressed: 1) Do patterns of HIV/AIDS risk exist among Malawian emerging adults?  (2) Do the patterns differ by emerging adults’ perceptions of their HIV/AIDS status?  (3) Are the patterns associated with changes in sexual behaviors?

Method: This study analyzed data collected in 2004 by the Malawi Diffusion and Ideation Project.  During in-person interviews, participants completed the Role of Informal Conversations on Health and AIDS Behavior survey.  The sample for this study was restricted to males and females between the ages of 19 and 24 who reported never having been married and were not missing data on the dependent variable (N = 139).  The analyzed sample included 82.8% males; 25.5%, 42.5%, and 42% from Balaka, Mchinji, and Rumphi, respectively.

Latent Class Analysis (LCA) was used to address questions one and two, and it was conducted using Mplus 6.1.  This software was selected because it can include covariates and sampling weights, which is important for this study because the sample was disproportionate by site, gender, and age.  To answer question three, a chi-square test was used. 

Results: The study results indicate that two classes of risk exist among Malawian emerging adults:  High Risk class and At Risk class.  Of the sample, the High Risk class comprise 37% and At Risk class comprise 63%.  Individuals in the High Risk class are significantly more likely than the At Risk class to perceive themselves as currently infected with HIV/AIDS.  Among individuals in the At High Risk Class, 87% reported at least some likelihood of HIV.  Last, class membership did not predict whether emerging adults reported changing their sexual behavior.  In spite of not finding significant results, we found that of the 72.7% of young adults who reported changing their sexual behaviors, 38.6% were members of the At High Risk Class, and 61.4% were in the At Risk Class. 

Conclusions and Implications:   Because results indicate that, in this sample, two classes of risk exist and each class reports at least some risk for contracting HIV/AIDS, universal programs most likely are needed in Malawi.  Further, results indicate that for a subset of emerging adults, targeted interventions may be necessary.  For example, emerging adults in the High Risk class may benefit from interventions using cell phone applications – an intervention method that has been found to help decrease risk factors for HIV/AIDS in adolescents.