Among married couples, an individual’s perceived and actual risks of being infected with HIV are closely intertwined with his or her spouse’s. As the HIV/AIDS epidemic spreads to the general population, a large and increasing proportion of HIV transmissions occur within marriage (Bongaarts 1996). Indeed, discordant couples (i. e. couples where only one partner is infected with HIV) represent the majority of HIV-infected couples in sub-Saharan Africa (de Walque 2007), and a large proportion of new HIV infections in this region occurs within discordant couples in longterm stable partnerships (Dunkle et al. 008; Hudson 1996;) Robinson et al. 1999). Although both husbands and wives are at risk of contracting HIV from their spouse, cultural, social and biological gender inequalities render women particularly vulnerable to transmission from their husbands (Gilbert and Walker 2002; Heise and Elias 1995). First, gender-based norms in which it is more permissible for men than for women to have extramarital sexual partners make it more likely that men will bring HIV into the union after marriage.
According to Asunta Wagura, Executive Director Kenya Network of Women Living with AIDS, There are several reasons married women and girls are at increased risk of HIV/AIDS, including; They often are powerless in decisions to have sex or use a condom, Women who are married and faithful to their husbands are at risk of HIV infection because their husband move on with other women who may be infected with HIV. In Uganda, the highest rates of increase of HIV transmission occur among married women.
Though marriage may appear to offer sexual health benefits for women, research in Kenya and Zambia revealed that this is not always the case. Married women are particularly at risk if their husbands have extramarital affairs or inject drugs and neglect to use condoms. ( Asunta Wagura,2008) More than 50 million married girls are 17 years of age or younger. Because married girls more frequently have unprotected sex with their husbands, who are older and more sexually experienced, their risk of HIV infection is high. They may experience violence in their relationships with men that result in unwanted or coerced sexual intercourse.
In Zambia, Kenya and South Africa, 20 to 25 percent of women reported that their first sexual experience involved physical force. Women and girls have greater biological susceptibility to HIV infection. Male-to-female transmission of the virus is twice as likely as female-to-male. Tears and lesions, resulting from forced sexual encounters, increase the likelihood of HIV transmission, especially among younger married women and girls. They face social and economic inequities that reduce access to education, prevention and treatment services, and increase the likelihood that they will marry at a young age.
Poor girls are often unable to access education, which decreases their access to productive employment. They are often denied the protection of property and inheritance rights. A young woman’s HIV infection or the death of her husband from AIDS may leave her without a home, unable to support herself and her children. Without job skills – or the opportunity to acquire skills – women and girls may resort to transactional or commercial sex to provide for themselves and their families, greatly heightening the risk of contracting HIV.
More than 85 percent of pregnant women with HIV live in sub-Saharan Africa. Life-saving drugs to prevent mother-to-child transmission of HIV have not been available, resulting in about half a million newborns that have become infected. They may lack knowledge of HIV, In Burkina Faso, Haiti, Mozambique and Nigeria; four in five women lack a basic understanding of HIV/AIDS. Only two-thirds of young women in West and East Africa and Central Asia knew that a person infected with HIV can appear to be healthy.
The reason for concern is the increased mobility of the productive people, particularly married men within and outside the country. Most of these migrants lived alone, keeping their spouses at village homes. These married people who remained away from families are among the high risk groups who go for unsafe sex leading to infections like STIs and HIV. The majority of married men reported unprotected sex with a sex worker, street girl, Or another man in the past month, and several also reported injecting drugs.
Almost all of these men had sex with their wives in the previous week. Even if none of the women had any risk behavior besides having sex with their husbands, a total of two thirds would have been exposed to the risk of STIs, Commercial sex is still widespread. Women work in brothels, in hotels and in their own homes they meet clients on the streets or at massage parlors, beauty parlors, or over the telephone. The clients are equally diverse. They range from the unemployed, laborers and transportation workers to students, civil servants and businessmen.
Some are married and many have large numbers of sex partners, both paid and unpaid. Sex workers have a higher client turn-over, and consistent condom use during paid sex is rare (depending on the region, 0-12% of sex workers said they used condoms with new clients). In 2005, there were over 105,000 sex workers, both female and male in the country Brothel-based female sex workers reportedly see around 18 clients per week, while street-based and hotel-based workers see an average of 17 and 44 clients per week, respectively.
Syphilis was observed in 9. 7 percent and 12 percent of female sex workers in Central and South-eastern Bangladesh, respectively. The high rates of syphilis and other STIs confirm the low level of condom use and the presence of other risky sexual behaviors that facilitate the spread of HIV infection. According to tradition, in many parts of Uganda when a man dies, his widow is inherited by his brothers or near male relatives. Wife-inheritance is closely linked to the bride wealth paid by the man upon marrying a woman.
The bride price effectively signals that a woman becomes the property of her husband and his clan. Wife inheritance greatly facilitates the spread of HIV/AIDS and has the potential of infecting several families very rapidly: When widows are inherited by their late husband's brother, they risk infecting them as well as their co-wives. If any of the wives has children, they may also be infected with HIV. In some cases, widows whose husbands have died of causes unrelated to HIV/AIDS may become infected with HIV if the brother-in-law is already infected (Bracher et al. 2003; Kelly et al. , 2003) Women find it difficult to control their sexuality. This social reality is affected by the fact that most husbands own property and are engaged in wage labor, whilst a significant proportion of married women depend on material support from husbands (UNDP, 1995). The socialization of women conditions them to be submissive to their husbands even without the corresponding reciprocity of love and respect from their husbands. This affects the ability of wives and husbands to live safer lives in order to deal with the risk of HIV/AIDS.
In Uganda, a study identified polygamous marriage, practiced by about a third of respondents, as one of three risk factors prevalent among Uganda’s Muslim minority (Kagimu et al. 1995). Ntozi and Lubega (1992) also draw attention to the potential link between polygamy and the spread of HIV since it provided another avenue for sexual networking, that is, apart from premarital sex and a high level of extramarital sexual contacts. Another study draws attention to the unequal sexual mores for males and females which makes the marital or sexual contacts of males such adominant factor of the risk of infection within unions (McGrath et al. 993). The fact that women have very weak bargaining positions in matters of sex, inheritance and continued residence in the marital home after the death of a spouse further restricts their freedom of action (AIDS Health 1992), that is, outside the institution of marriage. In this connection the practice of the levirate and the access of brothers-in-law to the females among the Ankole must be a further complication of the analysis of the link between form of marriage and disease transmission (Ntozi and Kabera 1988) omen’s relatively weak negotiating power within marriage as well as their limited ability to find social and economic support outside of marriage makes it difficult for wives to curtail their spouses’ extramarital sexual activities or to insist on protective measures like condoms with their spouses (Turmen 2003). Other factors may play an indirect role in the HIV status of a married couple by influencing sexual behavior within marriage, such as pregnancy, polygamy or religion [30. Factors such as age, early sexual debut, frequent travel, and extramarital partners may influence HIV concordance by increasing exposure outside marriage
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