This thesis aims at examining vulnerability to HIV/AIDS among adolescents in Malawi. The study uses mixed methods that combine quantitative and qualitative techniques in order to better understand whether there are significant variations in the pattern of sexual behaviour between adolescent orphans and non-orphans. Results of a quantitative analysis (n=1214) revealed that orphans are less likely to undertake voluntary counseling and testing (VCT) for HIV/AIDS, that they tend to experience their first sexual intercourse earlier in life, and that they are generally more likely to engage in high risk sexual behavior than non-orphans. In addition, female orphans in particularly are less likely to abstain from sex or to use a condom. The qualitative analysis (n=82) revealed that female orphans’ high risk sexual behaviour is closely linked to a well-established inter-household casual labour relation locally known as ganyu. While providing an escape from extreme poverty, ganyu is increasingly associated with a practice of sexual exchange between those who offer it and those who perform it.
This study makes important contributions to theory, methodology and policy. Theoretically, the study shows that orphans’ heightened vulnerability to HIV/AIDS in Malawi is in part rooted in their socioeconomic disadvantage and the lack of social support, but in ways that markedly differ between male and female orphans. Building on survey findings in order to examine the role played by the social and spatial environment in shaping vulnerability to HIV/AIDS also demonstrates the value of combining quantitative and qualitative methods. The presence of a large and highly vulnerable orphan population in a country already overburdened with one of the worst HIV/AIDS prevalence rates in the world raises searching questions regarding new fault lines of the epidemic, and unravels complex policy challenges.