AIDS-proof your marriage

Thirty-four year-old Joan Gray has never led a dissolute life so she felt she had little need to worry about using a condom or being at risk for HIV/AIDS.

She was wrapped up in the security of a Christian marriage anchored on trust. Her husband Paul was also firmly rooted in the faith. "I trusted him because he was a child of God. And I know that if you are a child of God, you wouldn't do nothing to at all to hurt your wife or your husband," she said ruefully as she reflected on her ten-year marriage.

She is now HIV-positive - not as a result of her husband cheating on her but because he had had unprotected sex in a previous relationship.
"Five years after we got married he learned that his ex-girlfriend had died of AIDS. He never went to get tested and he never told me," she said.

But five years later when he was constantly getting sick and a longstanding cough kept worsening, he had his worst fears confirmed.
"Full-blown AIDS," he whispered as pain racked his body after a visit to the hospital. His wife was stupefied.

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The revelation stabbed into her consciousness: she had never demanded an HIV test before they consummated the relationship and condom use was never practised. "Mi neva understand nothing about HIV and AIDS, so we didn't use condoms, so the whole thing was frightening to me," she said.

Her life became a nightmare as her own HIV status was confirmed and news of it leaked. People flocked her home and she was even labelled on the streets as the 'AIDS woman'.

"Sometimes, they will say things mek you hear and sometimes they say it behind yuh back. People treat people who are HIV-positive like aliens. I was like a nobody,'' she shared. But as the community isolated them and her husband's body withered, anger dissipated and left in its place a resignation to death."Me give up everything. It didn't make sense to live on. I knew I was going to die," she said.

She needed a respite from the turbulence, so she embraced a friend who helped her to emerge from the gloom to acknowledge the life- affirming side of her. That friendship evolved into a second marriage. His family and many others decried it; those who knew of her positive HIV status wouldn't show compassion towards her now.

Her story highlights a global trend: the growing vulnerability of married women and housewives to the deadly virus. The Jamaica Aids Report for 2002 confirmed that more housewives (169) than prostitutes (159) were reported with the illness.

Many women feel that they are in mutually monogamous sexual relationships rooted in concrete trust. The institution of marriage is therefore erroneously seen as an insulation against exposure to HIV. Health minister John Junor echoed this point at a special HIV Church Service at Swallowfield Chapel recently. ''Many married women are particularly vulnerable because they often believe they are safe but the realities have proven otherwise."

The UNFPA State of World Population Report for 2004 unveiled this increasingly worrying trend in countries such as Tanzania and Cambodia. In Tanzania the rate of infection among sexually active unmarried women was lower than among 'married, monogamous young women', while in Cambodia new infections among married women more than quadrupled from 11% to 46%, disproportionately higher than among commercial sex workers.

The report advanced a number of reasons for this trend. In some cultures women are expected to subordinate their interest to their husbands' demands. Some therefore feel powerless to negotiate condom use to protect themselves against HIV.

In a relationship where power dynamics are sharply at play, a woman's financial dependence leaves her with very little influence in ensuring condom use. Additionally, some sociocultural norms demand that women be submissive in sexual matters. Broaching condom use can trigger aggressive behaviour from husbands who think such request is imbued with a silent message of distrust.

For thirty year-old Garcia, who has been married for five years, it would be difficult at this stage in her marriage to introduce condom use.
"For those couples getting married then they can start their relationship using condoms. But if you have been married for a while it is difficult to introduce condoms into the relationship as the question will come up 'why after all this time do you want to use it?' she told all woman, while admitting that she had not used a condom with her husband in a long time.

"Part of the problem is that I am allergic to condoms so I have to go to the doctor most times when I use it," she explained. "I can't bother with that. I have never had a problem with an STI or anything like that before. I just hope and pray that things remain that way. I think about HIV but I have had no reason to be alarmed."a
But, said she, if she had any suspicions that her husband was cheating then she would stop sexual relations.

"If I suspect cheating then I lock off because a condom can burst, so until I know for sure, that is it," she said.
She added, however, that at one point they had separated and before they resumed sexual relations they had gotten tested.
"We had to make sure all was well," she said.

A wise move, according to the Ministry of Health's Novia Condell, who strongly recommended that women delay sexual intercourse until a HIV test is done to confirm the status of the couple.
"If women suspect their partners are being unfaithful, a risk assessment must be done - condom use must be firmly initiated," she said.

At the same time, Hilary Nicholson of Women's Media Watch suggested that the issue of trust sometimes underpins the decision of some women not to use condoms. Touching on the topic may load the male partner's mind with doubt that the woman has violated the relationship or that she is distrustful of him.

"There is an assumption that when you ask for condoms, it means that one of the two people is having sex elsewhere. When she asks for condom use it breaks what is supposed to be a theoretical trust or it may suggest that she is having sex outside the marriage which is not acceptable for women," explained Nicholson.

She also explained that financial dependence creates power imbalances in sexual negotiating power.
"Very often there is unequal sexual negotiating power because she may be financially dependent on the partner which creates an imbalance of power relationships when it comes to sex. And this prohibits women from asking for what is rightfully theirs, " she said.

Also in the quest for long-term security, a woman may feel pressured to submit to her partner's demands because she fears he may leave the union. In such a relationship, there isn't a climate for the woman to assert her demands about how she wants the sexual experience to proceed.

"There is a gender ideal that requires women by a certain age to be in a long-term relationship, and that creates an emotional dependence because she may fear he may leave her. (Additionally) when a condom is requested by a female, there is research to show that sometimes the male responds violently," Nicholson stated.

In some cultures, a report by the UNFPA explained, gender-based violence holds a nexus to HIV AIDS. For instance, in Rwanda HIV-positive women with infected partner were likely to report sexual coercion. Similarly, HIV positive married women in Tanzania experienced higher violence in their relationships.

Marriage is now seen as a major risk for women who have lower levels of education as in some regions a high proportion of HIV- positive married women were infected by their husbands, their only sexual partners, the report indicated.

Joan Grey emphasised that women should break the culture of submissiveness.

"Demand a condom and if him don't want to use it, no sex. Fight back. If the husband loves the wife, he will respect her point of view. Tell him we are protecting ourselves," she argued.