New Vision (Kampala)

8 December 2012

Uganda: My HIV - Partner Stuck With Me Despite My Status

"It is a game of chance," Dr Ivan Mambule of Infectious Diseases Institute, describes discordance.

He explains that HIV transmission, especially sexually, is a chance game. When one has sexual intercourse with an infected partner, there is a probability that they will catch it and a probability that they will not. However, if one takes many chances, at some point, they might catch it.

There are a number of circumstances that reduces the probability.

Protected sex with a partner who is HIV positive means there is little or no chance of you catching it.

Wounds or sores around the private parts increase the chances of transmitting the virus from the infected partner.

For men, circumcision reduces the chances of catching HIV

Use of ARVs reduces chances of passing the virus on to the uninfected partner.

People who have just got HIV in the last six months before their immunity has recognised it are infectious. HIV replicates itself fast and their viral copy is very high

CD4 count (the number of immunity cells) the infected person also determines infection. If the immunity is still good (high CD4 count) the risk of transmission is low

Tears and cuts during sex give HIV a highway to enter the bloodstream

Presence of another disease e.g if you have malaria, cough, flue, diabetes, worms etc, your risk of contracting HIV during sex increases

Malnutrition, poor feeding and hunger increase your risk of HIV during sex

Women have a higher risk of catching HIV because of their anatomy. HIV in semen is deposited inside them, where it may stay over a wider surface area for some time

Infectious Diseases Institute Couples' Clinic has 244 registered couples accessing clinical care.

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I am organising a wedding to reward her kindness

Damiano Kyategekera, 50, is a farmer in Masaka district. He is HIV positive, while his wife, a farmer too, Lucy Namuddu, 40, is negative. They have been married for 23 years

Damiano Kyaterekera, 50

How many children do you have?

Between my wife and I are five girls and five boys. However, I had two children with my late second wife.

How did you find out that you were HIV positive?

I was a vendor in Owino Market. Often, I felt unwell, with on and off headaches and fever, which I blamed on malaria and fake treatment. One afternoon, a group of medical personnel called a meeting at the market and at the end of it asked us to have our blood tested. I obliged and found out that I was HIV positive.

I was shocked, despite the fact that two years earlier, before I turned into a Pentecostal, I lived a promiscuous life. However, the counsellor who spoke to me after relaying the bad news calmed me down.

He narrated t stories of people who had lived with HIV for 20 years and more and promised me that if I adhered to my anti-retroviral drugs treatment schedule, I would have a longer life and see my children grow into adults.

How did you break it to your wife?

I simply broke it to her when I got home that evening. She, however, was perplexed because the same week, she had been to the hospital for antenatal visits and had tested HIV negative. She was about eight months pregnant then. At that point, we were hoping that it was not true, that I had the disease.

But then we remembered that my other wife had passed on about a year before and though we never confirmed it, she had exhibited signs of HIV/AIDS.

My wife sunk into a period of depression, but I assured her that all would be well if we took our drugs. However, when we were tested again, I was the only one who was positive.

And she still stayed by your side?

Yes. I convinced her that with condoms and me adhering to the medication, all would be well. Her decision to stay with me is also the reason I am now preparing to wed her.

She cares for me when I feel weak, to the extent of feeding me. She knows exactly when I need to take my medication and keeps reminding me, or waking me up if she thinks I might miss it. Currently, we are farmers and when I am sick, she does the work alone. But she brings back all the money she earns from selling the produce.

How do you handle sexual intercourse?

To be honest, at the start, we did not use condoms as often as we should have. We had teenage children who often found the condoms in our bedroom, which we found embarrassing. Consequently, we had a baby boy. In positive living, people are advised to use condoms, correctly and consistently each time they have sex.

How could you let embarrassment get in the way of protecting your wife?

We messed up, but miracles never cease, because even after the boy was born, my wife and son tested HIV negative. However, we have not taken any after that. She was tested three times and she was negative.

How did you handle disclosure, are your children aware that you are HIV positive?

All my ten children know I am HIV positive, right from my 24-year-old first born son to the youngest, who is four years old.

How about disclosure to friends and relatives?

Our relatives and friends all know my sero status and so do a few close friends. The disclosure was necessary because I call them when I am sick and cannot work yet I need the money.

What advice do you have for couples, regarding HIV?

First of all, all couples should test for HIV. And when one finds out that they are sick, they should tell their partners. Unfortunately, women fear to reveal their status if they discover that they are positive. They should not think it is the end of the world.

However, if your spouse is aware of your condition, like mine is, if you over sleep, she can wake you up and tell you to take your drugs. She tries her best to make sure I am okay.

So, if your spouse does not know your condition, they will not be in position to help you. Also, you will not take your medication well, because you will keep hiding it.

In case you are hiding it from your spouse, you cannot follow the right timetable for taking the drugs, yet these drugs require consistency.

Lucy Namuddu, 40

How long have you lived as a discordant couple?

For three years.

How did you feel like when your husband told you he had contracted HIV?

I was very worried. Our children were very young and I knew that if my husband passed on, there was no way I would comfortably take care of all the nine children by myself.

And weren't you worried that you had it too?

Yes, I was sure that since he had it, I too had it, including the children.

Did you blame your husband?

There was a lot for me to worry about that blaming him was the last thing on my mind. It had already happened and what we needed was a solution, not to play the blame game.

When you discovered that you did not have the virus, what was your reaction?

I was happy, but did not think it was true. It was only after I was tested three more times that I finally believed I was negative.

What prompted you to stay by his side?

First of all, when we agreed to use condoms, I knew there was no way he would pass the virus to me and that made me feel safe. Secondly, he is my husband and the father of my children. By then, we had nine children with one on the way, so it was hard to separate.

How come you had a child with your husband even after confirming he was positive?

I was not yet convinced that it was so; I thought the machines had simply failed to detect the virus in my blood, but I was wrong.

I thought my wife would run away

A 40-year-old HIV positive man who prefers to remain anonymous is in a discordant marriage with his 40 year-old-wife. The couple lives in Kyebando and have been married for 20 years. He is a businessman and his wife a stay-at-home mother

When did you get married?

In 1992.

How many children do you have?

Five

How did you discover that you were a discordant couple?

I discovered that in 2006. Prior to 2006, I often suffered from fever, so much that my wife asked me to test for HIV.

We both went to Mulago Hospital, where the tests revealed she was HIV negative and I was positive. I thought she would abandon me because she cried uncontrollably when the counsellor broke the news to us.

I, too, was shocked at the news and thought my days on earth had come to an end. But on our way back home, I thought about friends who are HIV positive and living a good life. Also, the counsellor who revealed the results did a great job conselling us. She said with adherence to medication, I would live a normal life.

How long did it take your wife to calm down?

She cried for about an hour. When we got home, the crying continued for two days. She blamed me for cheating on her and bringing the virus into our home.

I counselled her and I told her it was not the end of the world. I told her we had children to stay strong for, and that if she agreed, we would continue living together.

After playing counsellor, I asked her the question I had wanted to ask since the counsellor broke the news, "Will you leave me?" And added: "If you do, I will die. Do you want that for me?"

After a long pause, she agreed to stay with me. I had to apologise for cheating on her.

How do you handle intimacy?

We were advised to always use condoms when having sex. However, during the first year, it was not so easy for my wife. She kept telling me that perhaps the condom would burst, or slip off as we had sex.

I promised her I would be careful, after which she agreed and later, got used to it. I was glad because I have friends whose wives react to condoms. Otherwise, it would have meant we could not have sex, and what kind of marriage would that be.

Do you know who you contracted the virus from?

I do not know where I got it from. I slept with many girls, even after I was married.

Did you change your ways after discovering your status?

The side dishes cannot miss out, they are there, but I have to protect them and also protect myself from other strains of HIV. I still go for the same girls, but not as frequently as I used to.

What if she found out that even after staying by your side, you cheat on her?

I cannot let her know. I do not want her to leave me. I need her to look after me because she is my wife and we have come a long way. She once told me that when I cheat on her, I am not having unprotected sex with her, so she is safe. "Once you protect me, no problem," she said.

Are your children aware of your status?

No, we chose to keep them in the dark. Why worry them? I am not about to die after all.

How about your friends and relatives?

It is just my wife and I who are aware of my status. I cannot tell my mother. She would collapse if she found out.

Any advice to couples regarding HIV?

It is better to know your status because if you are positive and do not know, you will die faster, compared to if you had known and taken medication. Discordant couples should stick with each other; no one intentionally seeks the virus.

Do you ever wonder or ask her why she stayed with you?

When I asked she told me she could not start all over again and besides, she was not so sure she did not have the virus too.

But even after she confirmed that she was negative, she stayed. Do you ever ask her why?

I don't want to bring that history back. We are happy. Such a question would only make her sad.

The prevalence of HIV is rising, what is the Government not doing right?

It is not up to the Government, it is about us. The Government is not the one sending us to go out and get men and women. We have to be faithful; the Government cannot do anything.

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My husband's compassion shocked me

24-year-old anonymous HIV positive female is in a discordant relationship with her husband. They have been married for three years. She owns a retail shop in Mbuya.

From whom did you contract HIV?

I think I contracted the virus from my ex-boyfriend because later, I was told he was HIV positive.

How did you find out your status?

I was pregnant with my current husband's child. On attending antenatal care at Mengo Hospital, I was told that I was HIV positive. I have a maternal aunt who is HIV positive. She has always confided in me about her condition and I have seen her live a healthy life. After receiving the results, I ran to her. She was shocked, just like I was, but because of her comfort, I was not so depressed. She advised me not to tell my husband until after giving birth, so that he would take care of all the bills in the hospital.

What was your husband's reaction when you told him your status?

I did exactly as my aunt had advised. However, when the baby was three months, I told him that I was HIV positive and he instantly collapsed on our bed. After about five minutes, he opened his eyes and looked at me. I told him that I did not know about my status when I started dating him. I told him it was okay if he wanted to leave me. The two of us would go separate ways.

He was looking at his baby all evening and weeping. We went to bed and by the time I got up, he was gone.

After how long did you hear from him?

That very morning, he called me from the hospital and said he was HIV negative. When he returned home, I was almost done packing my bags. However, he said he wanted me to stay. I thought he was making fun of me, but soon found out he was serious.

I insisted on leaving, but he would not have any of it and whenever the subject came up, he silenced me.

After three months he went back and was still negative. Interestingly, even when he was found negative, he begged me to stay. To show his seriousness, he suggested that we start planning for our introduction ceremony, financed by him.

How do you handle intimacy?

We were having protected sex. However, a month after the introduction, he shocked me when he said I had to give him a baby boy. I got pregnant and after three months, he still tested negative. But that is it. We are not taking any more risks. We now always use protection.

Are the children negative?

Yes, they are all negative.

How do you handle disclosure?

It's only my mother and aunt who know about our status.

Three years down the road, has his attitude towards you changed?

He really supports me and always reminds me to take my medicine. My time is 8:30am and 8:30pm. Even when we are out, he tells me to take my medicine. The code we use is bag; he calls me and asks, do you have your bag? When I say yes, he knows I have my medicine.

What makes a discordant relationship work?

It requires a mature man who knows what he wants. I am 24 and he is 34, so maybe the age difference works for us.

Interviews conducted by Vicky Wandawa

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