21 November 2012

Uganda: Men Are Still a Stumbling Block in the HIV Fight

Photo: Patrick Jaramogi/New Vision
Florence Nansubuga, 43, and Nakku Florence, 45, have been living with HIV for 17 years.

ON the muddy veranda of her house, Nalongo peels Irish potatoes. She looks at the small balls with a pensive face, seemingly wondering where things might have gone wrong. No, Nalongo has not had a quarrel with her food. She simply has a lot on her mind.

Nalongo is the second of three HIV-positive wives of Salongo. "I tested for HIV in 2003 and ever since, my life has never been the same," she says.

One of her co-wives died, while the other fled. Today, Nalongo lives in a shack in Kyebando, Wakiso district, together with 11 of her husband's 13 children. Out of these, only six are her biological children. The rest were born by her co-wives.

Salongo lives in Naluvule, a fairly short distance from where Nalongo and the children live. "He only visits once in a while," she says.

Nalongo is a peasant farmer. She earns a paltry income from selling the produce from her garden located down the road from her house. With 11 children to take care of, including two who are HIV-positive, life is hardly a piece of cake for this 48-year-old woman.

Nalongo regularly attends HIV awareness seminars and devotedly takes her medication. She often ensures that her HIV-positive children are well-catered for as well. She also keeps encouraging her husband to go for regular check-ups and take his medication. But he does not seem to care about that.

"Whenever I talk to him about this, he claims to be busy. Even when seminars are organised about HIV, Salongo never attends," she laments.

Instead of buying his own ARVs, Salongo shares the medicine with his wife and HIV-positive daughter. Nalongo knows it is not safe to share HIV drugs, but she cannot restrain her husband from engaging in this dangerous act.

Poor as she is, Nalongo single-handedly looks after all her husband's children, including one in a tertiary institution, "but my husband won't contribute a single shilling," she says.

Nalongo's story is similar to that of Betty Najjemba, an HIV-positive mother whose partner has refused to cooperate in all matters regarding HIV. "He has refused to go for a test, no matter how much I beg him to," she says.

"I don't know whether he has the virus or not."

Even when she was breastfeeding under the Prevention of Mother-to-Child transmission programme, "he could not contribute a shilling to my nutritional needs." This has affected their relationship. Now she is contemplating leaving him.

Problematic situation

Studies have indicated that the HIV infection rate is increasing in Uganda, specifically among married and cohabiting couples. According to the Uganda AIDS Commission, 65% of all new HIV infections occur in married people.

The infection rate, according to the latest data, is over 6% among the married and cohabiting couples in comparison to 1.6%, among single people. Despite this grim picture, only 3-4% of married men and women in Uganda regularly test for HIV and approximately 90% of these individuals do not know the HIV status of their partners.

Experts like Dr. David Tigawalana, the Uganda AIDS Commission coordinator of HIV prevention, attribute this growing trend to what he calls "complacency" of many individuals in marriage. Apathy among some people in relationships and reluctance to seek HIV support services is believed to be one of the leading causes for this situation.

Men are especially at fault here. A 2007 Ministry of Health study revealed that whereas 80% of pregnant mothers test for HIV, only 6% of their spouses go for the test. An informal investigation reveals that male partners are generally indifferent to issues relating to HIV testing, taking anti-retroviral drugs and attending counselling sessions.

Why is this so?

The study by the Ministry of Health indicated that most men shy away from HIV tests because of cultural beliefs.

Swizen Kyomuhendo, a social researcher on HIV issues, offers a sociological explanation.

"As a people whose social role is to protect the family, men consider the prospects of having HIV and, therefore, needing support as a challenge on this," he says.

Many men, Kyomuhendo says, will, therefore, not want to appear to have failed to protect themselves.

Salongo, for instance, says he feels normal and will only go for check-up when his life is in danger. "There is nothing that I have not heard about HIV, therefore, I do not need to frequent the clinic," he told me when I visited him at his Kyebando farm. "I am also too busy tending my farm to find the time to be away for too long."

Salongo considers his wife's effort useless and of little consequence. It is such negative attitudes to testing that have derailed campaigns like "Go Together, Know Together"- an initiative launched to empower couples to assess their risk of HIV infection, test together for HIV and adopt practices that improve their health.

While there is concern about inadequacy of tools and personnel to spread the campaign throughout the country, a holistic approach ought to be adopted to address these issues. One as Kyomuhendo advises, pays more attention to sensitisation of men and their involvement in issues concerning HIV. "We need to understand men, talk to them and work with them."


Get men to test for HIV

By Joyce Nyakato

Mastula Namugenyi used to take her HIV-positive child for treatment at Mildmay Uganda regularly. During one such visit, one of the nurses advised her to take an HIV test, which came back positive. Namugenyi was three months pregnant and she vowed to protect her unborn baby from contracting HIV.

Namugenyi then implored her husband several times to go with her for an HIV test, but he refused. She told him she was HIV-positive, but he still did not go for an HIV test. She left him.

"I feared he would pick different strains of HIV from other women and re-infect me, yet I was taking drugs," she says. Months later, she gave birth to an HIV-negative baby.

Namugenyi's story highlights the unwillingness of many men to test for HIV after marriage.

Interestingly, when men are pursuing women for marriage, they willingly take the HIV test. However, after taking their marriage vows, many men feel their wives are nagging them when they insist on taking more HIV tests together.

Trouble is medics insist that married couples cannot rely on their pre-marital test results to determine their HIV status.

According to Prossy Nabagereka, a counsellor at Mildmay Uganda, when women turn up for HIV tests alone and are tasked to explain where their husbands are, they come up with excuses to cover up for them.

Even the few men who show up for HIV tests complain throughout the process claiming their time is being wasted. Dr. Stephen Watiti, an HIV/AIDS activist, explains this trend, saying men are generally poor at seeking health care services, not just HIV/AIDS testing.

While well-educated women usually stand their ground for their partners to take HIV tests, their rural counterparts are not as fortunate. They fear being abandoned, or being beaten up by their husbands when they mention HIV tests. That explains why when some of these women test HIV-positive, they do not disclose it to their husbands.

Statistics back this up. According a Ministry of Health Uganda AIDS information survey, HIV prevalence is higher among women (8.3%) than men (6.1%). However, according to Nabagereka, this statistic does not put into consideration that men do not want to test.

Namugenyi cites guilt as one reason men do not want to go for HIV tests. Usually, if a man is promiscuous, he is afraid that his wife will find out about his misdeeds if he goes for an HIV test with her. "The fear of the outcome and being blamed is why men don't want to test," she says.

How do we get men to test?

According to Nabagereka, one way could be to engage a third-party. However, she adds that while involving a third party may work for some couples, for others, it may spur violence.

Where communication lines are open, couples can discuss the issue and go for HIV tests together.

Like women are captured by the health systems and take mandatory HIV tests, for instance, when they are pregnant, perhaps the health ministry can come up with a measure that can subject men to mandatory HIV tests.

Measures like HIV/AIDS counselling at the workplaces are being put in place to bring these services closer to the men.

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