Discordance strains commitment

When they first got married six years ago, Mary and William Simiyu were a typical newly-wed couple - full of love and hope about their future together. Three years into their marriage Mary fell sick and they reluctantly agreed to get tested for HIV. Her result was HIV positive but her husband’s wasn’t. Suddenly, they had become discordant.

"There and then I decided I wasn't going to stay with her because I wouldn't risk my life staying with somebody who is HIV positive while I was not. I wanted her to go so that I could look for another woman. The counsellor told us we could just stay together normally, but that wasn't going to change my mind," William told IRIN/PlusNews.

Mary said her husband couldn't share anything with her, including their bed, and when he disclosed her positive status to his mother, pressure mounted on him to send her away.

"He didn't want to see me and he insisted that all along I knew my HIV status and I wanted to infect him," she said.

After being counselled by community health workers and the church pastor, the couple agreed to stay together, but both said that at times it is difficult.

"At one time we love each other, but… when it dawns on me that she is positive, I feel like marrying another woman so that I can have a normal marriage, one where I won't have to use a condom like a youth. I sit back look at our two children and I decide we are in this together… better the devil you know than an angel you do not know," William said.

His desire to have more children also adds to the tension. "At times I tell myself that two children are not enough and I want more. I don't want more with her because I fear sex without a condom. This at times pushes me to try and look for another woman," he admitted.

Experts say the desire to have children could be fuelling the spread of HIV in marriages. "Many people still view children as the epitome of a successful and fulfilling marriage,” noted Lucy Waweru, a psychology lecturer at the University of Nairobi.

At one time we love each other but ... when it dawns on me that she is positive, I feel like marrying another woman so that I can have a normal marriage

“This phenomenon, while not bad in itself, is pushing many couples, even those that are discordant, to engage in sex without condoms, and it means that the negative partner might sero-convert at some point."

An estimated 6 percent of Kenyan couples - about 344,000 - are HIV discordant, while a further 22 percent of couples know the HIV status of their sexual partners. Although Kenya has national guidelines for promoting prevention among people living with HIV, implementing them has proved to be a challenge.

Dr Charles Okal, the AIDS and Sexually Transmitted Diseases (STD) Coordinator for Nyanza Province says providing services for discordant couples is made difficult by the fact that testing is the only way to find them, yet couples rarely turn out for testing together.

According to the Kenya AIDS Strategic Plan 2009/13, the higher level of HIV testing amongst women (43 percent) compared to men (25 percent) is mainly due to antenatal testing and the uptake of prevention of mother-to-child transmission programmes.

"We are constantly passing the message forward that couples should be tested together so that those that are discordant can be singled out and ways to stop the infection of the negative partner are put in place,” Okal told IRIN/PlusNews.

“Otherwise, marriages continue to be at high risk because people do not know the status of their partners, and at the same time it is in these unions where condom use is lowest."

The Kenya AIDS Indicator Survey 2007 notes that 45 percent of all new HIV infections occur in marriages, but the fear of disclosure remains a major problem. "Even those partners who already know their status would rather keep quiet about it because they don't know how the other partner will react on knowing their sero-positive status,” Okal said.

”If it is a woman, there could be violence or her being sent away by the husband,” he noted. “That could be the moment love ceases to exist for many couples."

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