Are people aware of their HIV-positive status responsible for driving the epidemic in sub-saharan Africa? The case of Malawi

Many have alleged that those who are now aware that they are HIV-positive are driving the epidemic. This article reports the results of a study in Malawi that provides empirical evidence of differences in knowledge, attitudes and behaviour between HIV-positive people and those unaware of their sero-status. It comes to three conclusions: HIV-positive people report better knowledge and attitudes; there is substantially higher safer-sex practice among those aware of their HIV-positive status; and the assertion that the epidemic is spread by those aware of their positive sero-status is unsubstantiated. The overall message is that there is a need to accelerate both HIV testing and positive-prevention work. © 2007 Blackwell Publishing Ltd.