Marital power and decision-making processes regarding voluntary counseling and testing for HIV in rural Malawi

Lauren Gaydosh, Invest in Knowledge Initiative (IKI)

In response to the staggering AIDS pandemic in sub-Saharan Africa, many governments, policy organizations and non-governmental organizations recommend the scaling-up of voluntary counseling and testing (VCT). However, there is limited information on who attends VCT clinics and why people accept or refuse testing. Using qualitative interviews with married couples approached for VCT, this paper explores the sources of women’s marital power, married men’s and women’s decision-making processes, and gender differences in decision making, all in the context of HIV testing in rural Malawi. Finally, I present the implications of these results for couple VCT, and suggest that couple VCT permits a different decision-making process and a different way of sharing information between spouses. This paper is a step forward in the academic and policy debates, demonstrating the benefits of testing and counseling husband and wife together, and supporting couple VCT as a vital next step in HIV/AIDS prevention in Malawi.