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Women who disclose face violence
Gloria Ganyani, HealthDev.org
January 24, 2008

http://www.healthdev.org/viewmsg.aspx?msgid=0956d773-82fa-4077-8d8d-2aa94777bf5a

Twenty four-year-old Ruth Sibanda (not her real name) is pregnant and cannot wait to have her first baby.

On one of her visits to the antenatal clinic she is made to undergo an HIV test. No one really explains to Ruth what the test is all about. There is no pre-test counselling to psychologically prepare her for the action she is about to take.

All they say is that she must get the test done so that if she is found positive she can get the assistance she needs to avoid infecting her unborn child. Ruth tests positive and her world will never be the same.

When she gets home and breaks the news to her husband, she is met with blows and insults. Despite having only ever slept with her husband, she is accused of infidelity and of infecting him with HIV.

More than 25 years after the start of the HIV pandemic, Ruth is just one among many women who have been subjected to violent abuse after disclosing their HIV status to their partners.

"We receive a number of complaints from women who are abused by their partners after disclosing their status," says Sara Murera, a programme assistant on gender violence and HIV at the Musasa Project in Zimbabwe.

"It's women who usually get to know their HIV status first and if they discuss the results with their partners, they are blamed, shamed, threatened and in some cases this can lead to divorce, stigma and discrimination," she said.

Some women who disclose their status are not only shunned by their partners but by their families and relatives too. According to the World Health Organization (WHO), 3-15% of women who disclose their HIV status to their families in sub-Saharan Africa, report negative reactions including blame, abandonment and violence.

Even in instances where there was no form of violence in the home before, disclosure can ignite violent acts by a woman's partner, says Murera. "The husband can refuse to share a bed with the wife, even if he does not know who infected who. The blame is always heaped on the wife."

The encouraging thing is that to every problem there is always a solution and there are mechanisms in place that aim to end gender-based violence. Murera's organization runs support groups for women and since there are many who have experienced such violence, it is easy to find some who are willing to share their experiences with others.

"They try to show them that their problem is not unique. They have survived it and have moved on with life," Murera said.

Abuse of women who disclose their HIV-positive status encourages people to keep their status a secret and promotes a fear of testing. The consequence of both of these trends is an increase in the spread of HIV.

According to WHO, fear of violence prevents many women from accessing information on HIV, being tested, disclosing their status, accessing services for the prevention of HIV transmission to infants and receiving treatment, care and support.

The main reason health service providers test women for HIV during pregnancy, is to prevent any possible infection from being passed to their unborn child. But while pursuing this cause, as we have seen in Ruth's case, few measures have been put in place to help the women deal with their newfound knowledge and to ensure that they return for follow up tests or treatment.

"If an HIV-positive woman becomes pregnant, there is a 35% chance that she will transmit the virus to her child, if no preventative action is taken. Some 15-20% of children are infected during pregnancy, while 50% are infected during delivery and 33% through breastfeeding," according to the United Nations Children's Fund UNICEF.

Men who have tested positive for HIV also fear disclosing their HIV status. PlusNews has published an article about a man from Ethiopia who discovered that he was HIV positive and started taking antiretroviral drugs (ARVs) but kept it a secret from his wife.

The man told his wife that his ARVs were vitamin tablets that the doctor had prescribed him to boost his energy levels because he was always overloaded with work. He told his wife that the tablets were not good for women's health.

"My husband confessed that he knew his status for three years and did not tell me, fearing that our family and neighbours would discriminate against us. The fact that the virus is sexually transmitted shamed him," his 35-year-old wife told the news service shortly after he died.

Couples should be encouraged to go for testing and counselling together and to be supportive of each other whatever the results of their HIV tests. They should also try and avoid the blame game and instead focus on the way forward and living positively.

Even if they test for HIV separately, it is important that they disclose their status to one another so that they can practice positive prevention to avoid re-infecting each other.

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