HIV risk among currently married couples in rural Malawi: what do spouses know about each other?

In countries with generalized HIV/AIDS epidemics, married couples have a shared risk of acquiring HIV/AIDS. Yet very little research has adopted a couple-level perspective to investigate perceived risk of HIV infection. In this paper, we used population-based data from 768 married monogamous couples in the 2004 Malawi Diffusion and Ideational Change Project (MDICP) to compare respondents' perceptions about their spouses' HIV status to their spouses' actual HIV status. Using chi-squared and Kappa coefficient statistics, we evaluated how accurately respondents assess their spouse's HIV status, and compared the assessment of their spouse's HIV status with their assessment of their own serostatus. We found that individuals tend to overestimate their spouse's as well as their own risk of having HIV. Husbands were generally more accurate in assessing their own risk of HIV infection than that of their wives, but wives were more accurate in assessing the HIV status of their spouses. In our multivariate logistic regression results, we found that marital infidelity is the most important correlate of overestimating individual and spousal HIV risk.