Contextual Factors, Substance Use and HIV Risk among Young Rural Male Workers in a Malawian Market

Purpose: Substance use and HIV-related risky sexual behaviors are increasing among young men in Malawi. The purpose of this study was to describe substance use and HIV risk behaviors of young men who work as casual workers in a rural Malawi market and contextual risk factors that contribute to these behaviors. Method: Using a qualitative ethnographic research design, three types of data were collected: systematic observations of the marketplace and surrounding establishments; interviews with eighteen key leaders knowledgeable about the marketplace; and in-depth interviews with fifteen young men, aged 18-25. Interviews were conducted in Chichewa, audio-taped, transcribed, and translated into English and analysed using constant comperative method. Results: There were three major findings of this study. First, there were three patterns of risky behaviors among young men working at this rural market. Six young men continued to engage in high risk behavior, six formerly engaged in risky behaviors but discontinued, and three never engaged in risky behaviors. Alcohol and marijuana were the two substances commonly used by young men. Second, substance use was linked to sex with multiple partners without using condoms consistently. Finally, factors at multiple levels influenced young men’s risky behaviors. The market where young men work put young men at high risk for substance use and risky sexual activities. The market offered high availability, accessibility and affordability of resources and services,including ready cash, substances for sale and commercial sex workers. Lack of restraints, such as policies regulating availability of substances, and the presence of norms supporting risky behaviours also supported risky behaviors. At the community and home environment, poverty and lack of resources influenced young men to work at the market. At the interpersonal level, peer influences and lack of parental supervision encouraged risky behaviors. At the individual level, lack of formal education, and earlier initiation of risky behaviors influenced young men’s risky behaviors. Implications: This study identified the market as a risky environment for young men who work there. These young men should be treated as a high-risk group who need intervention. Also, national policies and programs addressing substance use as a disease are needed.