title: Protecting young women from HIV/AIDS: the case against child and adolescent marriage.
abstract: BACKGROUND
  In most developing countries, the majority of sexually active female adolescents are married. Although married adolescents are often assumed to be at low risk for HIV infection, little is known about the actual HIV risks these adolescents face or about ways to minimize these risks.
  
  
  METHODS
  Demographic and Health Survey data from 29 countries in Africa and Latin America were used to examine the frequency of factors that may increase HIV risk in married women aged 15-19.
  
  
  RESULTS
  Several behavioral and social factors may increase the vulnerability of married female adolescents to HIV infection. First, these young women engage in frequent unprotected sex: In most countries, more than 80% of adolescents who had had unprotected sex during the previous week were married. Second, women who marry young tend to have much older husbands (mean age difference, 5-14 years) and, in polygamous societies, are frequently junior wives, factors that may increase the probability that their husbands are infected and weaken their bargaining power within the marriage. Third, married adolescents have relatively little access to educational and media sources of information about HIV. Finally, the most common AIDS prevention strategies (abstinence, condom use) are not realistic options for many married adolescents.
  
  
  CONCLUSIONS
  New policies and interventions, tailored to the sexual and behavioral profiles of women in each country, are needed to address the vulnerabilities of adolescent wives. In some countries, delaying age at marriage may be an important strategy; in others, making intercourse within marriage safer may be more valuable.
authors.affiliation: Harris Graduate School of Public Policy, University of Chicago, IL, USA. shelley.clark@mcgill.ca
authors.forename: Shelley
authors.initials: S
authors.lastname: Clark
authors.forename: Judith
authors.initials: J
authors.lastname: Bruce
authors.forename: Annie
authors.initials: A
authors.lastname: Dude
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000517:prevention & control; D000293:Adolescent; D000328:Adult; D000349:Africa; D000367:Age Factors; D002648:Child; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007843:Latin America; D008393:Marriage; D012725:Sexual Behavior