Women wake up to HIV/AIDS

As the 10-year Burundian civil war winds down, Kinama township, set against the hills of the capital, Bujumbura, is once more becoming the bustling place it was. A rutted dirt path just off the tarmac leads to a hardened mud courtyard and Gloriosa Bamboneyeho's house. In 1994, one year into the fighting between the Tutsi and Hutu ethnic groups, she fled her village in central Burundi to rejoin her husband, a security guard, in Bujumbura. Unknown to her, he had acquired a new wife and small child. As a legally married wife, Gloriosa exercised her rights, and said: "You are my husband, this is my house, I stay." She went to court and obtained the right to stay in the sitting room while the couple shared a room across the courtyard. Three years ago Gloriosa fell sick - she was HIV-positive. "I didn't know that HIV existed until I came to Bujumbura," she told PlusNews. When the second wife was also diagnosed with HIV, the couple blamed Gloriosa and she was physical abused. After the death of the other woman, the husband and three-year-old daughter moved in with Gloriosa. Although initially reluctant to accept them, she realised they all needed each other. "Burundian women are faithful to their husbands. It's in our culture, so it is a shock to find ourselves HIV-positive," said Seconde Nsabimana, a counsellor at the Society of Women Against AIDS (SWAA) and president of the Burundi Network of People with HIV/AIDS, who has been living with HIV since 1988. Burundian women are twice as likely to be infected with the HI virus than men. In urban areas infection rates for women reach up to 13 percent, while only 5.5 percent of men are estimated to be living with the disease. An estimated 11.3 percent of adults in Burundi are believed to be HIV-positive. But an increase in HIV infections among girls aged 16-20 is a cause for concern. An early sexual debut and sexual relationships between older men and teenage girls were high-risk factors for urban and semi-urban girls, studies on social behaviour have found. "The extreme precocity of girls' sexual relations is a serious problem," Nsabimana commented. HIV rates continue to rise among women in their twenties, suggesting they are infected either by marrying an infected older partner or through their husband having extra-marital sex. Another reason was that despite their HIV-positive status, men refused to use a condom with a spouse. Gloriosa's husband refused to do so until Nsabimana convinced him to get tested, be counselled and use a condom to avoid re-infection. "Men alone have the decision and responsibility of using a condom," said Josephine Nyonkuru, SWAA national coordinator. The female condom is becoming popular among women living with the virus. SWAA began promoting it last year, after a survey found that 87 percent of women who had tried the femidom said it was useful, 63 percent preferred it to the male condom and 76 percent felt it empowered them to prevent HIV infection and unwanted pregnancy. Although HIV rates are stabilising in urban areas, they have been rising quickly in the countryside, where nine out of 10 Burundians live. "War, with its retinue of displacement, rape, misery, family turmoil and lack of prevention work explains this rise," a report by the National Council for the Fight against AIDS (CNLS) noted. Up to one million people have been displaced since 1993. Despite the signing of the Arusha peace agreement in 2000, armed attacks continue. Women have inevitably borne the brunt of the conflict and are often forced into prostitution to stay alive. Isabelle-Lise Barema, SWAA coordinator in Bujumbura said: "Displaced women are very vulnerable to HIV, they need food for their children and end up with HIV." SWAA provides medical, economic and psychological support to 2,500 people living with HIV/AIDS in Bujumbura and another 2,000 in six provinces. Most are war-affected women with infections dating from the first years of the conflict. Rape by soldiers, rebels and bandits during attacks or after kidnapping, has placed women at even greater risk. To make matters worse, traditional practices like "gutera intobo" (sex between the father and the daughter-in-law), "gusobanya" (sex between a man and his sister-in-law) and "guru" (inheriting the wife of a deceased son or brother) may also be contributing to the spread of the disease. Now that the war is drawing to a close and the country is opening up, Burundi has stepped up its response to the pandemic with the implementation of its US $233 million National Action Plan 2002-2006. The government, NGOs and the Catholic church run 80 testing and counselling centres nationwide. About 1,200 people are currently receiving antiretrovirals (ARVs). Funding from the World Bank and the Global AIDS Fund would enable 10,000 more to start free treatment by 2005, Joseph Wakana, CNLS executive secretary, said. The community-based National Association of Support for People with HIV/AIDS (ANSS), which offers comprehensive medical, psychosocial and economic support to over 1,000 HIV-positive people, has 550 members on ARVs, of whom half are very poor. However, ARVs did not solve everything, warned ANSS coordinator Dr Marie-Josee Mbuzenakamwe. "Stigma, psychological needs, rent, food, and school fees must be sorted out as well." The staff at ANSS are now faced with the challenge of helping unemployed, uneducated women taking ARVs become productive members of the community. Back in Kinama, Gloriosa cooks a meal of peanuts, peas, cassava and maize, which she grows for sale and her own use on a nearby plot through a SWAA income-generating project. She also regularly conducts AIDS awareness sessions with neighbours. In spite of the hardship, Gloriosa has learned to live positively with the disease. "She has become a respected community leader, open to change," said counsellor Nsabimana.