HIV/AIDS cases increasing among our young, married women

KARACHI: Bound by ‘watta satta’, a cultural tradition of exchanged marriage between two families, Nuzhat (not her real name), 22, cannot disclose her HIV status.

“I know well what will happen. I’ll be thrown out of my husband’s home and my own family will never accept me either. It will also mean my brother’s home will be ruined. His wife is my husband’s sister and she too will be sent packing. In any case, where will I go?” she says.

Entrenched age-old social attitudes, practices and stereotyping, coupled with unequal access to economic resources, are hampering progress towards dealing with the spread of HIV/AIDS in women, which, according to the UNAIDS, the joint UN programme on AIDS, make up almost 40 percent of new HIV cases. At the Eighth International Congress on AIDS in Asia and the Pacific, held in August 2007 in Sri Lanka, the worrying trend of a rising rate of HIV among young married women was reported.

Dr Naseem Salahuddin, an infectious disease specialist at the Liaquat National Hospital, Karachi, notes the increasing transmission of the virus from husbands to their wives. “A third of the 200 HIV/AIDS-infected people that I have treated since 1998 are women, mostly wives. It’s not just a health issue and must be looked at as a socio-cultural one.”

Nuzhat’s husband, Taufiq, is a daily wage earner. Not only is he an injecting drug user - including heroin - but he also consumes alcohol and has multiple sexual partners. He knows his HIV-positive status and that he has infected his wife, and possibly even his daughter, but the knowledge has made little difference to his life.

Dr Saleem Azam, who has been working with injecting drug users (IDUs) for the last 25 years, convinced Nuzhat’s husband to have her tested. “When I first saw her six months ago, she was at a breaking point and I had to send her for psychiatric counseling. It’s not the stigma she thinks she will face, it’s the outright rejection from her family that she knows is there.”

Azam agreed that discrimination, unequal power relations between men and women, and economic dependence have exacerbated the issue. “The unequal power makes women more vulnerable, leading to coercive and violent sex. This often puts them at a disadvantage, with little option to either refuse sex or negotiate for safe and protected sex.” Azam has 5,000 IDUs registered with his non-governmental organization and, in the last few years, he has seen a disturbing spread of the virus among IDUs. He fears the impact it will have on others, particularly women.

Keeping the illness secret out of fear and receiving no treatment is putting unbearable pressure on women like Nuzhat. “I can’t keep up a brave face any longer,” she said.

According to a report issued Thursday by the Integrated Regional Information Networks (IRIN), the information unit of the United Nations (UN), Nuzhat is a classic case of the feminisation of HIV and AIDS that seems to have taken a toll on younger women in the Asia-Pacific region, where the epidemic is being fuelled primarily by the gender inequality that prevails.

When there was nothing to eat at home, Nuzhat decided to get a job, though she cannot step out without a male escort. Without proper qualification, she had few options but to work in a local beauty parlour. Taufiq maintains his lifestyle on his meagre and sometimes uncertain income. He often beats up Nuzhat and forces to part with her wages, or otherwise he borrows from his mother.

Nuzhat’s health is deteriorating but her husband takes little notice. “I often get fevers. Boils erupt out of nowhere but I am too scared to seek medical help. I’m always accompanied by some family member. If I go to see a doctor, my mother-in-law will come. What if she suspects something and discloses it?”

This fear not only stops her from seeking help from one of the centres run by the Sindh AIDS Control Programme (SACP), part of the National AIDS Control Programme (NACP), but keeps her from having her two-year-old daughter tested who is also often sick. “I can’t take the risk,” she says.

Nuzhat feels that women in her family are never given the status of human beings. “We are treated like cattle and beaten up regularly on the slightest of pretexts. Our sole reason for existence seems to be to procreate or provide sexual pleasure for men. Even my mother thinks that way, as does my mother-in-law. They both live in the city, but it hasn’t changed their mindset. Sometimes I feel I’ll become like them if I continue living in this suffocating environment.” ppi

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