Twenty four-year-old Patricia Mugumya has been married for two years now. However, one year into her marriage, she learnt that her husband had another woman.
“When I told my mother about it, she told me to either abstain from sex with him or use a condom. I have so far managed to insist on using condoms. However, of recent, he has refused to sleep with me when I insist on using condoms.”
The mother of two adds, “While I am afraid of contracting HIV because I am not the only woman he is sleeping with, I do not know if my trick of using a condom will hold, given that his attitude has started changing.”
Mugumya is one of many women in Uganda who do not get to decide whether to use or not to use condoms. According to UNAIDS statistics, 66 per cent of the new HIV infections are of adolescent women aged between 15 and 24 and the lack of the right to negotiate for sex by the women is one of the causes of these increased infections.
Reasons for the high infections
Sarah Nakku, the community mobilisation and networking adviser, UNAIDS, explains: “When it comes to sexual interaction, the men negotiate for sex but if the woman is not interested, it is hard to say no, especially if they are married.”
Jotham Mubangizi, the strategic information adviser, UNAIDS Country Office, says, “We have been talking about the female and male condoms but who determines when and how to use it is an issue that has led to these increased infections.”
Nakku adds that the other challenge is that men have been left behind in the fight against HIV and the focus is on women, “Yet we know that a woman will make a decision in the home but the man will have to determine if it is enforced or not.”
In an earlier interview, Dr Zepher Ranyabokabo from Ministry of Health attributed this trend to cross-generation sex and sex for money relationships. “Go look at those posh vehicles parked at university girls’ hostels, those men are not picking or visiting their daughters but they are picking other people’s daughters,” Dr Ranyabokabo said.
UNAIDS country director Sande Amakobe says, “The UN position is that given those statistics, all countries globally must adapt comprehensive approaches by looking at their context and come up with a comprehensive sexuality education programme that will tackle the statistics that are looking us in the face.”
Amakobe adds that sexual education must be age appropriate and it must be culturally sensitive. We need to tackle this problem in a comprehensive manner that is evidence-based and will get us to the core of the problem. If young people are acquiring HIV at these rates, we need to interrogate as a nation whether we will make the goal of ending Aids by 2030.
Mubangizi says the focus should be to see how to reduce new infections or to sustain them such that they do not increase.
“There is a potential that we can end HIV/Aids but what we need to do is a targeted combination intervention that reaches those that we are not able to reach. There is need to be able to find those that have not known their HIV status and are living with it so that they can be identified and enrolled for care.
Once they have been enrolled we need to ensure that they adhere and are retained on treatment because if we follow this, then the viral load will be reduced,” Mubangizi explains.
One in four teenage girls are either pregnant or they have had a child. Fifty eight per cent of adolescent girls have either experienced physical or sexual violence. UNAIDS country director, Sande Amakobe says most young people start having sex at the age of 12.
“We hope that if we do great work, by 2020, we shall be able to go below the red line of 20,000 infections and by 2030, we shall not be talking about infection but we will be managing other side effects, she says.