By Julian Siddle
Producer, Malawi, HIV and Marriage
Earlier this year the World Health Organisation and the UN published a series of reports looking at reasons why women might be more susceptible to HIV than men.
Traditional practices are resulting in more women being infected
They weren't medical reports, but ones that looked at the structures of society.
One of the areas blamed was marriage. This seemed something of a contradiction, but the idea was that young women, particularly teenage girls, married older infected men.
I travelled with presenter Hassan Arouni to Malawi, one of Africa's poorest countries, where HIV infects around 17% of the population and where infection rates amongst teenage girls are four times higher than boys.
According to Agnes Chimbiri from Malawi University's centre for reproductive health it is not an issue with simple cause and effect.
"There are many factors," she says. "Yes teenage girls have sex with older men, but also with their peers.
"There's also the issue of poverty, exchange of sex for material things and early marriage."
'Shaking the dust'
We travelled to the south east of the country, the Balaka region, below Lake Malawi.
It's a mainly agricultural area, with many poor people subsisting on meagre maize harvests and through fishing the lakes.
Young girls, 10 or 11-years-old, were taken off to a separate hut in a corner of the village, and visited by several men who had sex with them
In appearance, it's very much the stereotype of Africa, small villages, dirt roads, buildings of adobe bricks made from local soil, roofed with thatch or tin. It's an area where traditional practices prevail.
What we found was a far more complex picture of local cultural practice interacting with poverty to produce higher HIV rates.
Many spoke of an initiation ceremony called 'shaking the dust' . Young girls, 10 or 11-years-old, were taken off to a separate hut in a corner of the village, and visited by several men who had sex with them.
Girls were also victims at school, with male teachers putting pressure on them to have sex to pass their exams.
Marriage was also a factor. Polygamous marriages were not uncommon. We visited one village where the local health worker suggested eight out of 10 people had HIV.
Social and practical problems
Janet Karim from the Society of Women living with Aids Malawi chapter says young girls have little choice in any of this.
"What women can insist on even using a condom? These girls have little education. They are powerless."
Many children are left orphaned by the spread of Aids
Later we went to the town of Ulongwe to meet a local youth group involved in trying to change attitudes to HIV amongst young people.
Their efforts were based on teaching abstinence, possibly influenced by the Catholic church, still the dominant religion in Malawi, a hangover from colonial times.
While many young people in the town had joined the group, its blanket approach was not one that seemed to take account of the reality of sexual practices in the villages.
There are many NGOs in Malawi concerned with HIV, many offering advice and even antiretroviral drugs, but the country now has to live with HIV.
There is little to address the social and practical problems faced by people whose lives have been changed forever by HIV.
FOCHTA is a small NGO based in the Thyolo region in the tea growing south. It forms part of the mountainous area bordering Mozambique.
To help the direct and indirect victims of HIV/Aids escape the poverty trap, it offers small business start-up loans to people with HIV and also practical help to the region's many Aids orphans - it is thought there are well over 30,000 in the region alone.
We didn't find an ignorance of HIV. Everyone we spoke to seemed aware of how it was spread and how to avoid it
Just near to one school we visited a woman had set up a business cooking food for orphaned children.
The one meal a day paid for by FOCHTA represented hope, it freed the children from the need to look for food on a daily basis and with the school fees paid gave them a chance to escape the cycle of poverty.
Overall we found a complex picture. But we didn't find an ignorance of HIV. Everyone we spoke to seemed aware of how it was spread and how to avoid it.
It's just that the social pressure to engage in risky sex, the strength of the traditional practices, and the poverty which compounds this is not being addressed.
'Malawi, HIV and marriage' was broadcast on the Discovery programme on BBC World Service at 1005 GMT on Wednesday 1 December.