Helping couples cope with single HIV diagnosis

From TheStar.com:
Program helps Africa’s ‘discordant’ couples stay together and healthy through counseling, communication
Oct 05, 2009 04:30 AM

Global Voices
When Lucy Emmanuel learned her husband had tested positive for HIV, she cried.

After nine years of marriage, the 32-year-old from Arusha, Tanzania attempted to process her fears. Lucy tested as well. It came back negative but she found little relief. She worried about her own health and that of her two young children.

Mostly, she worried about her marriage.

An opportunistic infection brought Lucy’s husband, Emmanuel Ndolimana, to a clinic. It took him three weeks to tell his wife about the positive result. When he broke the news, he made a request – please stay with me, please be okay with it and please help find a way to work through this.

“I put myself in his place,” she says. “I thought, ‘What if it was me?’”

There is no greater test of the vow “in sickness and in health” than a single positive HIV test. Yet, discordant couples – where one partner is HIV-positive and the other negative – are prevalent throughout Africa.

Despite the fear of disclosure and the challenges of the disease, through counseling, couples like Lucy and Emmanuel are staying together, staying healthy and making their marriages work.

“We enforce a positive prevention strategy where we prevent them from infecting their partner,” says Cayus Mrina, project coordinator for the African Medical and Research Foundation’s (AMREF) Counseling Discordant Couples Project in Tanzania. “To be able to have the skills to disclose and bring up the issue of communication with them and other community members, these are the key things.”

Due to the stigma associated with HIV, many fear repercussions for disclosure. There is the risk of transmitting the disease to a loved one. There are also the social challenges. Women especially fear being thrown out of the home and ostracized by the community due to male-dominance in the culture.

For most couples involved, it is the woman who is HIV-positive. Pregnancy means women are more likely to get tested.

“Disclosure is especially low when there is no couple counseling,” says Dr. Florence Temu, AMREF’s Deputy Country Director. “The issue of fear is there.”

Despite their nervousness, Lucy and Emmanuel enrolled in AMREF’s program.

Emmanuel was determined to keep Lucy and their marriage healthy.

In their session, the focus was communication. They discussed prevention methods like sustained and proper condom use. At the same time, they talked about antiretroviral drugs and the importance of a nutritious diet.

From there, they learned how to strengthen their marriage and acceptance of their new marital status.

“Women are linked into peer support clubs,” says Mrina. “For the few men who are HIV-positive, we encourage them to create a forum for discussion at home.”

Through the practices they learned, Lucy has been able to stay HIV-negative. They have found others who share similar challenges. Their community even started a club. Emmanuel serves as its chair and members openly discuss stigma, prevention and health.

Most importantly, the couple says their love for each other has deepened.

“He takes good care of me,” says Lucy. “He loves me very much.”

The couple still faces challenges. The two have come to accept the positive test result, but others outside their marriage are less tolerant. Emmanuel left his job when he became ill. Now, he is concerned he won’t be able to find an employer who will hire an HIV-positive worker.

At the same time, Lucy worries their extended families will start questioning why she hasn’t produced any more children.

But, these are all issues Lucy and Emmanuel are slowly addressing with their counselor. Emmanuel describes his wife as kind and says he appreciates her acceptance of his status. Both say they love each other very much and that their marriage is strong.

Despite the challenges, their vow is to work through them together.

Marc and Craig Kielburger are children’s rights activists and co-founded Free The Children, which is active in the developing world. Their column appears Mondays online at www.thestar.com/globalvoices

Craig and Marc Kielburger


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