HIV uncertainty pushes Malawians to want children earlier

"In decision-making, what you know you don't know can be just as important as what you do know," said Jenny Trinitapoli, assistant professor of sociology, religious studies and demography, Penn State.

Malawi, a landlocked country in southeast Africa, has both a high fertility rate and a high prevalence of HIV. About 12 percent of the population is infected with the virus that causes AIDS.

More than 30 percent of young Malawians surveyed by Trinitapoli and Sara Yeatman, assistant professor, health and behavioral sciences, University of Colorado, Denver, indicated they were uncertain about their HIV status and 70 percent were uncertain about the chance they will be infected with HIV in the future.

"In this context, uncertainty about HIV is even more widespread than the disease itself," Trinitapoli said. "Furthermore, testing for HIV does not reduce uncertainty young Malawians experience."

Those uncertain of their HIV status indicated that they want to have children significantly sooner than both those who were sure they have HIV and those who were certain that they did not have the disease.

Trinitapoli said the pattern was the same among both male and female respondents

According to Trinitapoli, there are several reasons why uncertainty accelerates childbearing in Malawi.

"In Africa, where being a parent is critically important, having children reduces some of life's uncertainties," Trinitapoli said.

Families with many children tend to have a higher status in Malawian culture.

"They may want to take advantage of their current good health," Trinitapoli said. "Another reason is that people believe that having children may prove that they are in good health."

Many people in Malawi believe that a woman with HIV cannot carry a healthy baby to full-term. Having a baby, therefore, is considered a sign that the woman does not have HIV.

Many Malawians want to start their families sooner so they can live long enough to raise their children, Trinitapoli said.

According to the researchers, people experience different levels of uncertainty differently, and this plays a role in decision-making that some may take for granted.

"This type of personal uncertainty is relevant for how people think about their lives and make decisions," Trinitapoli said.

The researchers, who reported their findings in the current issue of the American Sociological Review, selected 1,472 female and 567 male subjects who were between 15 and 25 years old.

To measure uncertainty, the researchers gave the participants ten beans and asked them to place the number of beans on a small plate that corresponded to their likelihood of being HIV positive. For instance, if the participants were certain they were HIV positive, they placed 10 beans on the plate. If they were certain they did not have HIV, they did not put any beans on the plate. People who were uncertain of their HIV status tended to place four, five and six beans on the plate.

Trinitapoli said that the method avoids embarrassing participants and gives them a chance to better communicate their level of certainty.

"How do you communicate probability? It's hard to converse about what we know and what we don't know even in the U.S.," said Trinitapoli. "We just don't have the vocabulary for it."