The HIV risk of saying “I DoÀ

Date: January 1, 1970
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8 March is International Women’s day. In a world with an ever-increasing amount of days and coloured ribbons, representing an ever-increasing number of causes, how much farther has 8 March taken us in understanding the reality of the world’s women? For years, we have heard about abstaining, being faithful, and using a condom. Yet for many women in Sub-saharan Africa these are not options.

The United Nations Population Fund (UNFPA) estimates that more than four-fifths of new HIV infections in women result from sex with their husbands – or primary partners.
What makes marriage dangerous for women? More sex, less condom use and a virtually non-existent ability to abstain among other things. In some instances, married persons may not feel the need to use a condom – convinced of a partner’s fidelity and status,  because of the desire to have children or for the simple reason that the decision to engage in sex – let alone use a condom – may not be up for discussion.
Even in the few countries that have legislation against rape in marriage, forced sex in marriage often remains unspoken.
UNFPA estimates suggest that only 4.9% of married women of reproductive age use protection, with that figure dropping to 1.3% in the African context.
Such statistics challenge current perceptions about what is sacred, what is “safe” and what should be constituting prevention methods.
Marriage, often viewed as a source of protection against HIV, can be especially risky for young women who marry older men.  According to research, 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 younger boyfriends of single girls.
Marriage, whether in Lusaka or Pretoria, may then not be as safe, or as sacred, as once thought. 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) just 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. After all, think of all of the achievements and potential lost.
Laura Lopez Gonzalez in a freelance journalist working in Johannesburg. This article is part of the Gender Links Opinion and Commentary Service that provides fresh views on everyday news

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