30 November 2012

Uganda: Discordance - the Wrecker of Marriages

Until World Aids Day on December 1, New Vision will publish daily HIV-related stories. Today, Stephen Ssenkaaa brings you the story of two women, who have borne the brunt of this epidemic for the past decade amid biting poverty

JOHN Ssali and Grace Namata have been living together as man and wife for the last 12 years. When I met them in Nakawa, they both looked jovial; playfully exchanging glances and once in a while giggling. But deep down something is troubling them. In 2008, Ssali tested positive for HIV.

His wife tested negative. The two are referred to as a discordant couple. Discordance is where one partner is HIV-positive, while the other is negative. Some decades ago, discordance was uncommon in Uganda. However, over the last couple of years, it has increased.

According to the World Health Organisation (WHO), generally up to 50% of people living with HIV are in a discordant relationship.

An incidence modelling by Makerere University Infectious Disease Institute in 2008 revealed that of all new HIV infections in adults (15-49yrs), 43% were among people in discordant monogamous relationships, while 46% were among persons reporting multiple partnerships.

Many of these are not even aware about their status, partly because of reluctance by many couples to test together.

Grappling with discordance

For all the time they lived together, Ssali and Namata never tested regularly for HIV. They never even thought about testing together as a couple.

Ssali learnt about his positive status when he secretly tested. He had had an affair with an infected woman. Fearing a backlash from his wife, he kept the results from her. Later, when he thought about the damage all this could do to his family; he broke the news to her.

"The prospect of living my three children without a mother and a father to care for them struck me hard. "I did not want to infect her as that would put our children in danger if we both fell sick and died," he says.

Namata took the news in her stride. "I was disappointed, but I accepted the situation. I was glad that he had told me the truth," she says.

Fortunately she tested negative. This marked the beginning of a new chapter in Ssali and Namata's lives. "We have since made a conscious decision to be faithful to one another and to protect each other," says Ssali.

He and his partner decided to have protected sex. They have also decided not to have any more children. "We would like to work hard to give the best future possible to our children," he said.

Ssali is a boda boda rider, while Namata is food vendor in Nansana. With barely enough income to pay for their children's education and meet the family's other needs, the couple worries about Ssali's health. "We can hardly afford enough food for all of us.

This affects my health, especially now that I take drugs." Ssali keeps falling sick, which makes it difficult for him to work regularly.

"The family then suffers because I earn far too little to support them," says Namata. Gerald and Allen Baliira have been married for over 30 years. Allen tested positive in 1998, while Gerald was negative.

That news shocked Gerald. "I trusted my wife. Neither had I been unfaithful to her." Allen expected to be thrown out of the house. Her husband instead counselled her. It was later discovered that she had acquired HIV during child-birth. Life became hard. "It was difficult to tell our seven children that one of us had HIV," says Gerald.

They were devastated; they thought she was going to die."We stopped sharing sharp objects and we carefully disposed of razors." Like many discordant couples the Baliiras resorted to having protected sex "only once or twice a week". The family income has been shaken, as Allen, now suffering from TB, diabetes and high blood pressure gets weaker.

The Baliiras, have stuck together through this condition. Some couples are not that fortunate. Cissy Namuddu left her husband after discovering that he was HIVpositive, while she was negative.

"I tested three times," she recalls. Namuddu says she feared to get infected, so she left her partner. Today, she lives in Wakiso with her son.

In worse cases, discordance has resulted in domestic violence and painful separation of partners. For instance, Prossy Mutesi was abandoned by her partner.

Her crime? "I tested positive, while he was negative." Mutesi narrates how her husband walked out of their home and accused her of attempting to kill him with HIV. "He beat me up and humiliated me before our children and neighbours."

He left her with their three children. She is now expecting their fourth child. "He withdrew financial support from me. I cannot pay rent and feed the children." Jobless, Mutesi lives with her children in a small house in Bwaise worried about being thrown out by the landlord for non-payment of rent. "We have not eaten any food for the last two days," she said amid sobs.

Despite the growing number of discordant partners, there seems to be little interventions to assist people like Mutesi. Many negative couples in discordant relationships do not know about the pre-exposure prophylaxis, which involves administering a pill to a negative partner in the relationship to prevent him or her from contracting the virus.

Neria Rugarama, an HIV counsellor, says more effort needs to be put into facilitating awareness and counselling. All this has only further complicated the fight against HIV. A lot of work remains to be done.

HIV discordance continues to baffle many people. Dr. Lydia Mungherera, an HIV activist, says discordance is brought about by differences in immune systems.

"Some people's immune systems are more resistant to the virus than others," she says.

Such people, according to some researchers, have cells that do not allow the virus to mutate in them.

However, Prof. Peter Mugyenyi of the Joint Clinical Research Centre says that there is more to discordance. He offers three main causes for discordance.

"We have found that when the infected partner in a relationship is taking anti-retroviral therapy properly, the chances of passing the virus on to the uninfected partner is greatly minimised, although not completely eliminated," he says.

Prof. Mugyenyi adds that discordance also happens because people get infected at different times.

There are also factors which increase some people's infectivity than others.

For instance, people with sexually transmitted diseases around the genital areas would be more susceptible to infection than those without.

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