Uganda / Prevention: Target the married in fight against HIV/AIDS
Men and Women in a marriage are expected to be faithful to each other. But is that the reality on the ground? Being faithful is just a fallacy among many men and women. Reports have shown that 40 to 60% of HIV positive persons have HIV negative spouses and these are at 10 to 12% HIV transmission risk per year (CeSSRA Public Lecture: March 6, 2009).
More than 75% of Ugandans do not know their HIV status and only approximately 30% of couples have tested together. It has also been reported that the median age of HIV infection shifted from 22 years in 1988 to 35 years in 2007, and that more infections now occur in older age groups. In Uganda, 75% percent of HIV positive people are aged 25 years and above.
For many women around the world, marital sex represents their single greatest risk for HIV infection. This is because marital infidelity by men is deeply ingrained across many cultures. Many men do not view sexual fidelity as necessary for achieving a happy marriage, but they view drinking and having multiple sexual partners as important for male friendships, prosperity and true manhood.
Behavioural risk factors associated with HIV include having more than one sexual partner in one’s life time, commercial, transactional and cross generational sex, including sex for survival, inconsistent use or no use of condom, and ignorance about the HIV status of one’s spouse. Other associated factors are alcohol consumption and drug abuse before sex.
According to the UNAIDS report December 2007, the number of people estimated to be living with HIV globally was 33.2 (30.6-36.1) million and to this total Africa accounts for 68% (22.5 out of 33.2m).
In 2005, overall HIV prevalence was 33% among married clients who attended VCT centres in Uganda. About 93% did not know their spouses’ HIV status. Only 14% had one sexual partner in their life time. In 2005 the proportion of adult men reporting multiple sexual partnerships were 37%, compared to 15% among women in the same year (Opio et al 2008). There are also high levels of unprotected sexual intercourse among HIV positive individuals (Bunnell et al 2008).
The number of men reporting two or more sexual partners plummeted from more than 70% in 1989 to 15-20% in 1995. Among women, the figure dropped from 18% in 1989 to 2.5% in the recent past.
Behaviour change is the way to go if HIV is to be wiped out. Sexual fidelity among the married couples is key to this, counselling and testing for persons intending to get married and for the married can both help reduce HIV incidence among the married. The married couples have a great role in prevention of mother to child transmission of HIV.
Uganda has gone down in the annals of history for combating HIV prevalence from an average of 18% to about 6%, according to the Ministry of Health report of 2004. The country’s prevention approach, known as ABC (Abstinence, Being faithful and Condom use) has been credited with changing the sexual behaviour of Ugandans and contributing to a dramatic drop in the number of new HIV cases. The number of men reporting three or more non-regular sexual partners had reduced from 15% to 3% (Bessinger et al 2003; Green et al 2006).
Young Empowered and Healthy (YEAH), an initiative of Uganda AIDS Commission and implemented by Communication for Development Foundation Uganda (CDFU), is carrying out a true manhood campaign to encourage behaviour change among men and women. Communities should encourage men to get rid of anxieties about masculinity and social reputation that exacerbate the risks of HIV/AIDS.
We need to recognise the marriage objectives which include companionship, and support for one another. If married men and women spend time trying to understand one another, they might easily iron out their marital differences as opposed to seeking for solace elsewhere.
The writer is a SPH-CDC HIV/AIDS fellow at Communication for Development Foundation of Uganda