Understanding the relationships between HIV and child marriage: Conclusions from an expert consultation

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Research on child marriage from the first decade of the 2000s was largely, and we now know, often mistakenly, interpreted to suggest that child brides—girls who marry under the age of 18 years—faced a higher vulnerability to and higher rates of HIV acquisition than girls and women who married later. In one of the starkest statements on the perceived connection, a paper stemming from a December 2003 global consultation stated that “married adolescent girls tend to have higher rates of HIV infection than their sexually active, unmarried peers.” Indeed, some advocates, academics, and practitioners understood these limited, early publications as evidence of a positive correlation, and even a causal relationship, between child marriage and HIV, asserting, for example, that HIV prevalence rates would decline in tandem with rates of child marriage. More recent studies have, however, produced contrary findings, including one that suggests that unmarried young women have a higher vulnerability to HIV than those who marry early, and another, which reviewed data from 97 countries across the world and found no association between child marriage and HIV. Indeed, although we have gained over the years a more nuanced understanding of the factors that may make some child brides more vulnerable to HIV than women who marry later, there is a dearth of evidence regarding the relationships between child marriage and HIV. Stimulated by careful reviews of the literature undertaken by the World Health Organization and Girls Not Brides, in November 2018, the United Nations International Children's Emergency Fund (UNICEF) and Girls Not Brides convened experts from academia, civil society, and bilateral and multilateral institutions for a consultation that aimed to better understand what is and what is not known about this relationship, as well as to identify priorities for policies and programs. We summarize some key conclusions and recommendations from that convening.