This paper studies the dynamics between intra-household bargaining power and HIV prevention from a systemic perspective, using a panel data set of 500 married couples in rural Malawi from 2004-2008. All information has been matched at the couple level, which allows to directly assess the effect of a relative increase in bargaining power, as measured by economic, social and relationship variables, on both spouses' attitudes towards HIV prevention, while controlling for HIV status. I employ a fixed effects linear probability model with national and region-specific time trends in order to capture both unobserved heterogeneity at the individual level as well as differences in HIV prevalence and intensity of HIV campaigns in the three regions that are studied. The results show that factors that are associated with a relative increase in female bargaining power, such as own earnings and attendance of women at local political meetings, are related to improved acceptance of HIV prevention.