Barriers to condom use cause women in ‘stable’ relationships to be more at risk for HIV

May 29, 2016 News

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By Jeanna Pearson
Carmen [not her real name] has been married to her husband for over a decade. She has children with him.

She loved him and trusted him to the extent that she would have unprotected sex with him—besides why would she not? Although there were times she was suspicious that he had other sexual partners. But this did not bother her, after all he married her. He went home to her not the others.
However, one day she became ill and had to do a blood test. The results floored her: she was HIV positive. Not only had he cheated on her; he knowingly gave her the disease. Carmen’s husband knew that he was infected, but was afraid to share his status because he believed that she would leave him if he told her.
Carmen was one of the women interviewed by a group of researchers conducting a HIV study in Guyana. Her story was told at the 60th Caribbean Public Health Agency Research Conference in Grenada, when the researchers made their presentation on HIV/AIDS in Guyana.
The growing trend of women infected with the disease through sexual transmission is not only alarming, but is disturbingly unnerving – the fact that so many women in intimate or marital relationship are at risk.

CHANGING TREND
The Pan American Health Organization’s Health@50 in Guyana: Progress Health Report 1966-2016 stated that in the early stage of the HIV/AIDS epidemic in Guyana, males were predominantly more affected than females with ratios as high as 4:1. However, the trend changed in the late1990s, when females started to be infected at a higher rate than their male counterparts and by 2004, HIV and AIDS cases were equally distributed in both sexes.
Based on the report, statistics indicated that women were slightly more infected than males in Guyana for 2015.
One of the main issues that popped out in the researchers’ study was the failure of men and women to use condoms. Upon closer perusal, it was found that condom use was not the definitive problem, instead, it was the barriers to condom use which posed the greatest threat.
According to the Guyana Responsible Parenthood Association Youth Coordinator, and former National Aids Programme Secretariat Assistant VCT Coordinator, Delon Brathwaite, there are two main barriers to condom use in women at risk for HIV/AIDS: personal and socio-environmental.
Brathwaite stated that the major personal barriers included lack of perceived threat, absence of protective motivation and lack of trust, while unsupportive communities and cultural norms were the common socio-environmental barriers.
He stated that it is these precise barriers that need to be addressed in order for the effective implementation of HIV/AIDS prevention programmes.
So far, the central thrust of HIV prevention campaigns has been the promotion of male condoms. Condom use has been promoted by the World Heath Organisation as a major preventive strategy—besides abstinence, which is 100% effective.
It has been elevated to a point where it can be deemed as the greatest hope in reducing the spread of the virus.

TRUST AND INTIMACY
However, as a strategy for women in stable or intimate relationships, such as marriage, condom promotion has ceased to be realistic. Brathwaite stated that this is the point where male control over sexual activities stands as the norm, and where women have become voiceless to protect themselves. In other cases, women would choose not to use the contraceptive, because they feel their partner would believe they are questioning their fidelity, and it would be an insult them.
Braithwaite explained that gender discourses where women are unable to negotiate protection in stable or marriage relationships has a significant impact on women’s risk of contracting the virus. However, he stated that it is vital to study the underlying factors which prohibit condom use.
He stated that Guyanese women live in a society where it is “acceptable” for males to cheat. He noted that there is also heavy religious influence, where women are made to believe that it is wrong to ask to use a condom, since it blocks procreation.
“But in truth it all boils down to women living in a man’s world. If the man says it does not feel the same way as skin to skin, then they would want to please them and give in. What they need to understand is that women are 10 % more likely to contract HIV than men,” he said.
Brathwaite said that women have been placed on the front lines of the HIV pandemic, not only because of their greater biological vulnerability, but essentially because of barriers to condom use.
He explained that because condoms are associated with infidelity, it emerged as a key barrier to condom use in marriages and stable relationships.
Braithwaite stated that studies have revealed that higher levels of love and commitment as well as longer and serious relationships are linked with lower levels of condom use. He said people usually use condoms in casual relationships.
“Condoms are used at the beginning of a sexual relationship, but the second it becomes serious, the condom is gone, while in a marriage, contraceptive is used, but only as a birth control measure. Seldom are condoms used in a marriage. Thus the introduction of condoms into long-term relationships has become extremely complicated and in most cases, is seen as an undermining factor to intimacy,” he asserted, adding that women trust easily.

LACK OF PERCEIVED THREAT
Meanwhile, Brathwaite explained that in most of these cases persons do not see the threat. He stated that despite the presence of high risk behaviour and unprotected sex, they for some reason are unable to perceive the risk. He asserted that misguided trust and loyalty, and bad judgment based on appearance, tend to generate a feeling of safety and an absence of sensing the risk.
Braithwaite, who counsels women who have contracted the disease on a daily basis, stated that it has always been heart-rending to watch the emotional phases these women go through upon finding out their status, especially in cases where they were faithful and their partner cheated.
He stated that at first they would go through denial, though the fact is before them, followed by anger, hurt and tears.
“Some of these women have been in stable long-term relationships with their partners. So the reality would hit them hard,” he said.
Then, he said, it is the jobs of counselors to sit with these women and comfort them; let them see beyond the situation and think about their friends, their family, their children…anyone who is dear to them.
“I would normalize it. I would tell them that they can live for many years; that they would not die because treatment is available. I would ask about their children. I would tell them that they wouldn’t want to live without their mom. But the most important part would be educating them on how not to infect anyone else and to protect themselves.”
“The body you have belongs to you so it is your responsibility to care it. So if your husband or partner is reckless, you can rest easily that you have safeguarded yourself,” he said.
Braithwaite opined that for condom programmes to be successful, women must be able to discuss issues of sex and protection with their partners.

REVIEWING THE PROGRAMMEs
According to the Health@50 in Guyana: Progress Health Report 1966-2016, PAHO highlighted that when Guyana started to report on all persons infected with HIV, there was an increase in reported data.
It stated that unlike AIDS cases which peaked in 2001, HIV infections (combination of HIV and AIDS) peaked 5 years later in 2006 with 1,614 cases. An examination of the data before and after the peak of the epidemic in 2006, demonstrated that the average annual number of cases (1,036) did not vary in the five years before and after the peak.
A similar study covering 10 years prior to and after the peak of the epidemic, revealed an average annual increase in cases in the latter 10 years of the epidemic, from 818 to 966.
Initially, AIDS cases or advanced HIV infections were outstripping HIV infections, up to the year 2000 and after that, a divergence initiated.
Chief Medical Officer Dr Shamdeo Persaud stated that there is a need to review the National AIDS programme, since people have become complacent because they know there is treatment and that they can live with the virus.

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