Current: Vol. 5, Issue 2 April - June, 2008

HIV/AIDS IN MARRIAGE – THE PARADOX

Lillian Mutengu

In 2006 when Uganda launched “The year of Accelerated HIV Prevention”, emerging data from the National HIV/AIDS Sero - Behavioral Survey
2004/05, indicated that HIV transmission was highest among married people. The term “married” in this survey refers to both formal and informal
unions such as living together intending to have a lasting relationship but have not had a civil or religious ceremony.

Today, the National HIV/AIDS Strategic Plan 2007/08 – 2011/12 puts HIV transmission among married people at 42% compared with Commercial
Sex Workers (22%) and casual sex (14%). These findings raised a lot of controversy among different sections of society, particularly religious leaders who questioned the validity of this data component. They raised issues such as whether those categorized as “married” were truly married and living in holy matrimony or just cohabiting. Marriage has always been viewed as sacred and a “safe haven” of sorts; a place where two people staying together as husband and wife, are supposed to be protected
from the dangers of HIV/AIDS. To therefore turn around and say that it is the very institution under “attack” by this deadly virus is to question its sanctity.

Hard as it is to hear, the reality still remains that the marriage institution is threatened. Blame has even been cast upon couples who cohabit without formalizing their union. However, irrespective of whether a marriage was sanctified in church or not, the couple living together as husband and wife in all earnest consider themselves married and ought to pay allegiance
to one another.

So where did we go wrong?

It is a known fact that 76% of new HIV infections are through sexual transmission. If HIV therefore entered a marriage, the first alarm signal to go off will be of unfaithfulness.
But what leads a person into extra marital relationships? There has been a lot of dialogue and discourse on this issue ranging from socio– cultural to economic and political schools of thought. But that’s a story for another day.

Our primary concern in light of this rude awakening is how best we can use existing HIV prevention strategies to address this new challenge. The Uganda road map towards universal access to HIV prevention highlights priority intervention areas and targets among which is breaking the cycle of HIV transmission through extra marital sex. This focuses on activities
for married and cohabiting partners aimed at reducing extra marital sexual partners and using existing cultural structures to strengthen the
institution of marriage. But how different will these activities be conducted from what has been in existence? We know, for instance, that efforts
to promote virginity till marriage in a lot of cases haven’t yielded the desired results. We also know that messages discouraging multiple sexual
relationships currently at the forefront of most HIV behavioral change campaigns have had minimal impact in changing such existing risky
behavior. So one wonders what new ideas we will need to implement to turn the tables round on what is going on in the marriage institution.

For the optimists, the struggle against HIV has to go on with or without new strategies. The pessimists however believe that unless new innovative approaches are sought and implemented, the challenge of addressing HIV
in marriage, where protection against infection such as abstinence is near to impractical, remains a distant dream.