For Ugandan banker Moses Arinaitwe learning he was HIV positive when his wife Robinah was HIV negative was the beginning of disagreement and conflict in their relationship.
Moses and Robinah had been together for seven years when HIV knocked on their door.
“She wanted more babies, which I could not give her. She decided to leave me and got married to another man. In fact she has already produced,” Moses says.
Arinaitwe says that, even without the need for more children, their relationship was plagued by conflicts, disagreements and even domestic violence as a result of their HIV discordance. He says his wife accused him of bringing the virus into their home and that he was “stigmatized and discriminated against” in his own home.
He says his wife began sending text messages to his friends and relatives telling them about his health condition and HIV status and called him names like “dead walking person, virus man”.
“She started a war against me and told all our friends and relatives about my HIV status – a reason she was giving of for our separation,” Arinaitwe says.
On once occasion Arinaitwe’s wife brought him a coffin to be buried in when he died, a situation which left him devastated.
“It was too much for me to handle and I had no choice but to let her go so that I could have peace of mind. Her revelation of my status to my friends and relatives made me lose my self esteem among my peers and I stopped going home because my parents were now seeing me as useless and a dead person,” he says.
Like Moses and Robinah, many discordant couples – when one partner is HIV positive and the other HIV negative – are faced with many challenges. In particular, the issue of family planning can pose problems, especially if one partner wants to have babies.
Doctors in Uganda have been researching discordance and why married couples may have different HIV status.
Dr Charles Olaro, the medical director of Fort Portal regional hospital , says HIV negative partners are at risk of getting infected yet there is no system of effective counseling for discordant couples.
Discordant couples represent a critical risk group but it is not yet clear how large a risk this is because the number of discordant couples is increasing, something Dr Olaro partly attributes to the increasing number of people on antiretroviral treatment (ART).
“HIV negative partners are at very high risk of HIV infection from their positive partners, yet service providers have not yet developed effective counseling messages for discordant couples to prevent the infection,” he says.
Dr Olaro notes that judgmental attitudes of partners and society has reinforced denial and secrecy on the part of people living with the virus. In turn, this undermines the efforts being made to mitigate the impacts of HIV and to prevent its transmission.
Dr Olaro says discordance is more common in polygamous unions and among urban couples than their rural counterparts.
Annette Kabasambu, a 38-year-old resident of Kiburara in Kabarole district who is HIV positive, says that when she visited a health facility she was advised to undergo female sterilization as a safe, simple and permanent method of family planning.
She did not want to have more children due to her HIV status but her husband wanted to have a baby boy and kept on insisting that she should conceive.
“I did not want to endanger my life by producing more children and did not want to infect my husband but he kept on insisting that I must give him a baby boy so I had no choice but to go for female sterilization,” she says.
Female sterilization is a permanent method of contraception and is advisable for couples who no longer want to have children. It is a single procedure with lifetime effects and does not need repeated clinic visits. But just like the contraceptive pill, female sterilization does not offer protection against sexually transmitted diseases.
Steve Okoboi of TASO Uganda says a cross-sectional survey of 114 HIV discordant couples conducted in Kampala last year found that participants wanting children and those with multiple sexual partners were less likely to use condoms.
“We see many HIV positive women coming up for six times pregnant and we know that there are going to be big problems of mortality rates and an increased number of children being born with HIV,” Okoboi says.
Many discordant couples want to conceive for multiple reasons including to ensure lineage continuity and posterity, to secure a relationships, and due to pressure from relatives to reproduce. However, they face many challenges such as the risk of HIV transmission to partner and child and the failure of health systems to offer safe methods of family planning. Strategies such as condom use and abstinence have been suggested as important for discordant couples.
Despite the fact that many medics are urging discordant couples to use family planning methods to reduce the mortality rate, there is a lack of political will in addressing the issue with prominent politicians including Ugandan president Yoweri Museveni and leading politician Abdul Naduli encouraging couples to produce as many children as possible.