A female friend of mine, 30-years-old and a mother of two, confided in me that ever since she got married she and her husband have stayed 230 kilometres apart. The husband works in the western part of Uganda while she works in central Uganda. Ever since they wed they have not lived for more than two weeks together as husband and wife. But their on and off encounters have produced two children, and unfortunately one miscarriage.
She has since established that her husband has fathered a child with another woman. This friend of mine says her husband is domineering, and uses every opportunity to subjugate her and make her submissive to everything that he does and says. She says he wants her to be the typical African woman, one who does not question her husband’s authority on the things he does and commands.
I talked her into going back to school for a start and she was accepted at Uganda’s most prestigious university. She started getting happier and looking on the brighter side of life. I then told this woman to look up to the future and make her life better. I also tried to talk her into going for an HIV test; to know her sero-status so that she can live in a state of knowing while planning for her two children and herself post graduation.
After labouring to talk to her for almost a month, we finally agreed that she would go and have counselling and then take an HIV test. I told her that the choice was hers, and the counselling would help her gain the strength. I laboured to explain to her that, there was a great chance she would be found HIV negative but in the unlikely case that she was positive the facilities for handling that situation were available.
But she hesitantly confided in me: “I fear to take an HIV test, because I may not have the energy to move back home when I am found to be HIV positive. I don’t know my status and I rather not know.”
Personally, I observed that the counselling would help her take a good decision. And I felt she needed to look on the brighter side of life – her life after university, the future of her two children and their happiness, and hopefully some certainty in her marriage after that.
But when we reached the HTC [HIV testing and counselling] laboratory my friend turned away.
She later told me that: “James, I am ashamed of what I have done. I feared to test because I do not have the courage. I am so sorry. Hopefully I will be able to test some other time.”
My reply was: “You know friend, the decision to test or not to test is yours. But you need to live your life from an informed position, which is if you need to have major decisions for your life, children and family. Take your time and see whether you can gain the courage to test any time you are ready.”
Considering that this lady had been tested earlier two times, when she delivered her first and second child, I was worried about how she continues to live in such uncertainty about her health. With uncertainty about one’s sero status there is confusion and mistakes are likely to be made.
The Uganda Demographic Health Survey 2011 indicates that there is a bigger percentage of women and men age 15-49 who believe that a woman is justified in refusing to have sexual intercourse with her husband if she knows that he has sexual intercourse with other women, and a higher percentage also believe that a woman is justified in asking that they use a condom if she knows that her husband has a sexually transmitted infection.
It can be observed there are still issues of testing for HIV on an individual level as the case of my friend clearly shows but there are also systemic issues within the health sector. Together this brings up a number of questions about the bigger challenges of tackling HIV among married couples and women who have attended ANC in health facilities.
As for my friend, how long is she going to live in their relationship in fear of her HIV status? How many other women does her husband have unprotected sex? Does she have the authority to determine that they use a condom in a matrimonial bed? Does he use condoms with other women? And how many children has he fathered outside wedlock? Are these children safe? Assuming my friend went for an HIV test and shared the test results with her husband, how would he treat her?
Based on my friend’s fear for an HIV test, is it possible that most women tested during ANC represent a generation of women who are being forced to take the HIV test? How voluntary are these ANC based tests? Can human rights issues be raised in respect to these tests? How best can men be ‘captured’ by health systems to have as many tests as those done on women? Should youths be encouraged to delay marriages or marry early in light of the increasing incidence of HIV among married couples?
These and many more questions need further research in order to get a clear picture of what ought to be done.
- Testing in Nakaseke, Uganda