Supporting discordant couples to stay together

Ibrahim Umoru enjoyed a harmonious relationship with his wife in Lagos, Nigeria's most populous city, until he tested positive for HIV in 2001. Despite initially showing some understanding of his situation, his wife, who was HIV negative, eventually left him. "She managed to endure with me for about a year," Umoru told IRIN/Plusnews. He later found out that his former wife had been influenced by advice she received from her pastor.

His marriage is one of many in Nigeria that have broken down due to the sero-discordant status of couples, in which one individual is HIV positive and the other HIV negative.

Based on his unhappy experience, Umoru established a care and support group in 2003, called Good Health Educators Initiatives, to help and advise discordant couples on how to stay together.

"The fact that one person in a marriage is positive is not an excuse for the marriage to break down. With the various developments on how to live positively with the virus, couples can have a fulfilling marriage irrespective of the status of either of them," said Umoru, whose group now has about 30 couples as members.

"At our meetings we constantly build the capacity of discordant couples with necessary information. We are also working hard at educating religious leaders, who many rely on for counselling. If only the pastor that counselled my wife had sufficient information he would not have advised her to abandon me," said Umoru, who has since married an HIV-positive woman.

The fact that one person in a marriage is positive is not an excuse for the marriage to break down.

Other support groups for discordant couples have also been established since Umoru started his group. "I can confirm that more discordant couples are now living together," he said.

Maryam Tamakloe, of the Treatment Action Movement (TAM), a treatment lobby group comprising several local non-governmental organisations, said it took some time before her husband accepted her HIV-positive status. "Initially he was supportive, but suddenly changed and started keeping late nights and became very difficult. Later he started supporting me, and is now the nicest man."

Dr Ebun Adejuyigbe, a consultant paediatrician at the Obafemi Awolowo University in Ile Ife, in southwestern Nigeria, recalled that arguments between infected individuals and their uninfected partners had often flared up in hospital wards.

At a media round-table in Lagos, organised by Journalists Against AIDS (JAAIDS) a local NGO, with support from the US-based Henry J. Kaiser Family Foundation, she cited the case of an HIV-positive woman whose husband accused her of being promiscuous before divorcing her. Stigmatised by her in-laws, she eventually committed suicide.

Dr Sulaimon Akanmu, of the College of Medicine at the University of Lagos, said that with a better understanding of how HIV was transmitted, discordant couples should have no fears about living together.

The degree of risk related to passing the virus to an uninfected partner depended on the amount of HIV the infected partner was carrying in their blood stream or bodily fluids. "If the viral load of the infected partner is low, the uninfected partner is not likely to get infected," he said, and with medical support the chances of having HIV-infected children were also very low.

Kingsley Obom-Egbulem, head of research and communication at JAAIDS, stressed the need for creating more awareness about the opportunities for care and support available to discordant couples. "We want couples in such situations to understand that it is possible for them to have babies that are not infected with the virus, without the uninfected partner ... [contracting HIV]."

The fact that women were more likely to be tested for HIV than men because of routine screening at antenatal clinics also needed to be addressed, he said. "The idea of the man saying the woman alone should be the one undergoing antenatal HIV testing is not appropriate. It is when couples know their status that they can manage the infection to ensure HIV does not break the bonds of their marital vows."

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