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Marriage may be putting Sub-Saharan Africa’s women in a risky situation when it comes to HIV/AIDS, challenging perceptions about what is sacred, what is “safe” and what should be constituting prevention methods.
What makes marriage dangerous for these women? Among other things: more sex, less condom use and a virtually non-existent ability to abstain. Being faithful as a means to prevent HIV only works if both partners are HIV negative when they begin the relationship, and both partners in the relationship do not have sex outside of it.
The bond of marriage is not the protection against HIV infection that many assume it to be. Many of the same risk factors continue to apply. Marriage - whether in Lusaka or Pretoria - may then not be as safe, or as sacred, as once thought.
This is especially true for younger married women. According to research done in recent years, married adolescent girls in both Kenya and Zambia demonstrate higher rates of HIV infection than their stereotypically more “at-risk” single, sexually active female counterparts. The same studies also point out these young girls’ often have much older husbands who are about three times as likely to be HIV-positive than the boyfriends of single girls.
A 2003 study found that married adolescent girls in Southern and Eastern Africa had much more unprotected sex than single girls their age. There are obvious reasons for this.
In some instances, married persons may not feel the need to use a condom - convinced of a partner’s fidelity and status, or with the goal of having children. In other cases, women lack the negotiating power in a relationship to insist on condom use, even when they know that their partner is unfaithful. All over the continent, multiple sexual partners for men is often viewed as a testament to one’s masculinity.
However, certain prevention strategies continue to promote marriage as protection enough against the virus. If we are to help protect the health of married women, we must take their needs and situation into consideration.
“Married people are at risk like anyone else,” said Luyanda Ngonyama, Gauteng coordinator for the Treatment Action Campaign. “Although we claim to have broad and comprehensive strategies, our strategies tend to target the youth because we want them to be the future of the country. We aren’t targeting specific groups like married people.”
“Even if both partners know their status at the beginning to be negative, there is no guarantee that they will stay negative. There is this idea that once I am married, I’m safe,” Ngonyama added.
Certain faith-based and governmental bodies continue to propagate the myth of marriage as safe. George W Bush’s President’ s Emergency Plan for AIDS Relief (PEPFAR) is among one of the most influential initiatives still preaching abstinence.
In 2006, PEPFAR’s budget allocated 22 percent of its 3, 263 million USD funding to treatment. Of this 22 percent, 7 percent went to abstinence/”be faithful” activities.
Condom distribution received 6 percent of allocated prevention funding, while prevention of Mother-to-Child Transmission (PMTCT) was allocated 5 percent.
A story told in percentage points, the misconceptions and values underlying Bush’s prevention push have very real and very visible effects.
At the country-specific level, PEPFAR officials in the field are required to spend half of prevention funds on sexual transmission prevention and two-thirds of those funds on abstinence/faithfulness activities. Struggling to meet such requirements, country officials are forced to reduce or cut funding for other prevention programmes such as condom education, according to a 2006 report issued by the U.S. Government Accountability Office.
The same report ultimately advocates PEPFAR re-evaluate its abstinence focus. Meanwhile, HIV/AIDS continues to pose a threat to the lives of individuals and stability of states in Sub-Saharan Africa.
The life expectancy in Zimbabwe has dropped by more than 20 years since the start of the HIV/AIDS epidemic, according to figures from the World Health Organisation. In South Africa, life expectancy is below 50 years in three provinces—the Eastern Cape, Free State and KwaZulu-Natal, according to the latest UNAIDS report.
Re-thinking the epidemic, what is safe, who is vulnerable and what real prevention means, cannot wait.
Laura Lopez Gonzalez
(It should be noted efforts were made to contact PEPFAR representatives for comment. Laura Lopez Gonzalez in a freelance journalist working in Johannesburg and has covered HIV/AIDS throughout Southern Africa.)
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