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Charging HIV-positive husbands and wives with adultry — and lying about it


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Suppose a neighborhood gossip spread rumors a married woman was seeing lovers when her husband was at work, or that a married man had lovers? Suppose the gossip had no evidence, but was well paid to spread such rumors?

This situation threatens many HIV-positive married men and women in Africa. HIV prevention programs pay health care professionals to say most adults — including most HIV-positive married men and women with an HIV-negative partner — got it from lovers, even if there is no evidence they had lovers, and even if they deny it. Most health care professionals seem only too happy to play the role of malicious gossip.

For example, a UNAIDS-funded study in Zimbabwe followed adults to see who got HIV and what were their risks. The authors reported: “Thirteen of 67 individuals seroconverting in this study reported no sexual partners in the inter-survey period… This leads us to suspect that…misreporting of sexual behaviour may explain some of these infections…“[1]

Wife with HIV, husband without

Many women are victimized by such unsupported suspicions. National surveys in 24 African countries during 2010-14 report the percentages of couples with HIV in one or both partners. In 14 of 24 countries, if a married woman was HIV-positive, more than 50% of husbands were HIV-negative (Table 1). This is not explained by women getting HIV before marriage – even among married women aged 30-39 years, an HIV-positive wife was more likely to have an HIV-negative than an HIV-positive husband in 12 of 24 countries (Table 1).

Table 1: Among married HIV-positive women, the % of  husbands HIV-negative

wife+ husband-

Sources: Demographic and Health Surveys and AIDS Information Surveys for each country available at: http://www.dhsprogram.com/Where-We-Work/Country-List.cfm (from this link, click on the country and then the survey, and to the chapter that reports HIV prevalence).

Seeing such data, a World Bank economist, opines: “Sexual intercourse among women outside the marriage (or cohabiting union) may be more common than reported… [T]he contradiction between self-reported female behavior and the proportion of discordant female couples…suggests that self-reported behaviors are likely to be biased…”[2]

Most countries in Africa routinely test pregnant women for HIV. Hence, the wife is often the first partner to know her status. If the husband subsequently goes for a test, he is more likely to test HIV-negative than HIV-positive in most countries across Africa.

What is he to think? Should he believe his wife? Or should he believe health care professionals (behaving like paid gossips) who propose his wife lied about outside lovers? It is relevant, as well, that health care professionals have a conflict of interest – the alternative to blaming the wife for adultery is to acknowledge her infection could well have come from unsafe health care.

Husband with HIV, wife without

Similarly, blaming all HIV on sex encourages wives to blame HIV-positive husbands for having lovers and lying about it. In 15 of 24 countries, when the husband is HIV-positive, at least 50% of wives are HIV-negative (see Table 2).

Table 2: Among married HIV-positive men, the % of wives HIV-negative

husband+ wife-
Sources: Demographic and Health Surveys and AIDS Information Surveys for each country available at: http://www.dhsprogram.com/Where-We-Work/Country-List.cfm (from this link, click on the country and then the survey, and to the chapter that reports HIV prevalence).

References

1. Lopman, Garnett, Mason, Gregson. Individual level injection history: A lack of association with HIV incidence in rural Zimbabwe. PLoS 2008: Med 2(2): e37. Available at: http://www.plosmedicine.org/article/fetchObject.action?uri=info:doi/10.1371/journal.pmed.0020037&representation=PDF

2. http://econ.worldbank.org/external/default/main?theSitePK=469382&contentMDK=21077340&menuPK=574960&pagePK=64165401&piPK=64165026

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