Abstract

PIP: 90% OF Malawi's 9 million inhabitants live in rural areas. Although tradition dictates that young females abstain from engaging in sexual relations until being initiated by a traditional adviser following the initial onset on menses, many preinitiation and premenstrual girls break tradition and say that they receive school fees and gifts in exchange for sex. While these village girls may know that AIDS can kill, most think that they are not at risk. Knowledge, attitude, and behavior were assessed by live-in researchers in a sample of 258 girls aged 10-18 in 2 villages over the period 1991-92. Focus groups were held, in initiations attended and observed, and interviews conducted with girls, mothers, grandmothers, and village leaders. 300 female adolescents were then surveyed in 10 other villages. 70% of the girls had sex before either initiation or menstruation with the average age at first intercourse of 13.6 years. 80% of the girls had heard of AIDS and 14% thought they had a good or moderate chance of contracting it, yet they expressed a far higher perceived risk of contracting other sexually transmitted diseases. These benefits were obtained from radio, church, and word-of-mouth messages that AIDS is transmitted by easy partners, bar girls, and truck drivers, and from someone who looks very ill from AIDS. 55% said they are often forced to have sex; 66% have accepted money or gifts for sex; and 75% would like help in learning how to convince a boy to use a condom. Grandmothers and other elders tell girls about menstruation, hygiene, and illness, while sex education comes largely from peers. Were there widespread motivation to employ condoms, condoms are accessible only in the district hospital which is a 25-mile round trim for many; all surveyed community members favored eventual community-based condom distribution. Study results suggest that disseminating messages through existing communication channels of grandmothers, other elder women, and peers could help correct false perceptions about HIV transmission and personal risk, and condoms need to be more available in villages as well as counseling on their use. It is suggested that a group of interventions could be tested which would build upon the work of the national AIDS program.