----· -·-·--------~-~-----------~ Child L·1arriags in AJnca ln many countries, the legal age for marriage is 18. yet some gO\ernments enforce these laws loosely. For example_ the percentage of girls married before age 18 in Niger is 77°o. in Chad 71~0- in l\lali 63\'o_ in Cameroon 6l':o_ and in J\loz~m1bique 57~ a(1). ln pans of Ethiopia, 50~o of girls are married before the age of 15, and in Mali. 39° o. Some lllclrriages even occur at birth: in such instances, the girl is s..:n110 her husband's home at the age of 7 (11). Incentives for Perpetuating Child Marriages Poveny plays a central role in perpetuating child marriage. Parents ''ant to ensure their daughters' financial security: hO\rever, daughters are considered an economic burden. Feeding, clothing, and educating girls is costly, and girls will eventually leave the household. A family's only way to recover its investment in a daughter may be to ha,·e her married in exchange for a dowry. ln some countries, the dowry decreases as the girl gets older, which may tempt parents to have their daughters married at younger ages. These are not necessarily hezniless parents but, rather, parents who are surviving under heartless conditions. Additionally, child marriages form new alliances between tribes, clans, and villages: reinforce social ties: and st<Jbilize vital social status. Parents \\'orry about ensuring their daughters' virginity rmd chastity. Child marriage is also seen as a protective mechanism against premarital sexual activity, unintended pregnancies, and sexually transmitted diseases (STDs). The btter concern is even greater in this era ofHJV/AlDS. Girls who marry young tend to be from poor families and to have low levels of education. If they marry men outside tl1eir village, they must move away. Coping with the unfamiliar inside and outside the home creates an intensely lonely and isolated life_ As these girls assume their new roles as \Vives and mothers, they also inherit the primary job of domestic worker. Because the husband has paid a hefty dowry, tl1e girl also has immediate pressure to prove her fertility. Girls often em brace their fate and bear children quickly to secure their identity, status, and respect a~ an adult. As a result, these young girls have high toial fertility rates but have missed the opportunities to be children: to play, develop friendships, bond, become educated, and build social skills. Characteristics of tl1e men who marry young girls are also fairly homogenous. Because men have to pay large dowries for girls, many must work for years to generate enough income. As a result, they are older \\'hen they marry. \\'lJich means that they have linle in common to discuss with their young wives except household responsibilities and child rearing. Men also are e:-;pected to have had multiple sex pminers and to be sexually experienced. Because men are aware of. the HlV/AlDS danger, they seek even younger, virginal brides, who are presumably not infected. Risk for HiV and Other Sexually Transmitted Diseases A common belief is th3l child marriage pro1eCis girl~ from promiscuir: and, therefore. di:;ease; the re;dity is quite differem. J\larried girls are mc>re likely lh:m unmarried girls to become infeCled \\'i1h STDs. in ]Xirticular l-ll\' and human papillom:; Yirus (J-JPV). Jn sub-Sah:nan Afric:._ girls ages 15-19 years ure 2--8 times more likely 1han boy>: of the s~1me age to become infected with J-lJV (1:; ). The risk of acquiring 1-ll\' from a single act of unprOlectcd vaginal intercourse is ::::>--3 times grc<:llfr for women than men (13). Globally, the prevalence of 1-ll\' infections among women is highest from ages 15 to 24; the risk for men peaks 5-10 years later (J:l). Marriage by age 20 has become a risk f~1e1or for HI V infection for young and adolescent girls (13 ), as has been shO\m by several studies of African popubtions (1-/- 16). A study in Kenya demonstrated that married girls had 3 50~/o higher likelihood than unmarried girlo of becoming infected with HIV. This risk was even higher (59?(,) in Zambia. In Uganda, the HlV prevalence rate for girls 15-19years of age was higher for married (89%) than single girls (66~[,): for those 15-29 years of age. HIV prevalence was 28% for married and 15% for single girls_ This study noted that the age difference between the men and their wives was a significant 1-llV risk friCtor for the wives (J 6). All of these studies showed that girls were being infected by their husbands. A hypothesis relev;mt to thio finding is that a young girl may be physiologically more prone to HlV infection because her vagina is not yet well lined with protective cells and her cervix may be more easily eroded. Risk for HlV transmission is also heightened because hymenal, vaginal, or cervical lacerations increa~e the transmission rate, and many of these young girls lose their virginity to HlV-infected husbands. A]so, STDs such as herpes simplex \'irus type 2 infection, gonorrhea. or chlamydia enhance girls' vulnerability to J-JIV (1'; -19 ). Another study explored why married girls in kcny3 and Zambia l1ad a higher risk for l-llV infection. This study concluded that because married girls are under intense pressure to pron their fe11ility, they have more unprotected intercourse. The study also found that l1usbands were substaJitially older (5-14 years) than tl1eir wives and were 30% more likely than boyfriends of single girls to be HJV infected. Because of their age alone. the husbands had already had numerous sex partners. Additionally. in these areas of Africa, polygamy is common (]D). One fundamental difficult)' with child marriage is that girls are financially dependent on their husbands and therefore lack the power to make demand' upon them. They cannot ask their husbands to get an HIV test: they cannot abstain from intercourse or demand condom use (20): they cannot insist that their husbands be mc>nogamou5; and Emerging Infectious Diseases • www.cdc.gov/e:id • Vol. 12, No. 11, Nove:mbH 2006 16"E