Rural Malawians' perceptions of HIV risk behaviors and their sociocultural context

Prevention remains key in the fight against HIV/AIDS. However, prevention requires understanding the sociocultural and economic context in which HIV-risk behaviors occur. This qualitative, descriptive study was part of the initial phase of a larger project to adapt and test a community-based HIV-prevention intervention. We conducted individual interviews with rural Malawian community leaders and focus groups with adult community residents to elicit perceptions of both sexual and non-sexual HIV-risk behaviors and their sociocultural context. Interviews and focus groups were conducted in Chichewa, audio-taped, transcribed and translated into English by bilingual co-investigators. Content analysis of transcripts was done collaboratively by US-based and Malawian co-investigators to confirm culturally accurate interpretation of data. Participants identified sexual and non-sexual HIV-risk behaviors and contextual factors that influence these behaviors, including gender relations, cultural practices, economic conditions and religion. Community leaders and residents voiced similar perspectives on risk behaviors, except that community leaders were much less likely than residents to discuss sexual transmission through participation in traditional cultural practices. We incorporated these study results in adapting our HIV-prevention intervention to the sociocultural context of rural Malawi. Study participation enhanced the community leader's and resident's interest in the intervention phase of the project.