Global IssuesPAKISTAN: When Men Fear Telling Their Wives About HIV
As a peer educator at a local HIV/AIDS organisation, Ahmad (not his real name) has taken care to teach his own wife anything and everything he knows about the disease.
But there is something that Ahmad is hesitating to tell her, and it is a fact that is crucial for her to know: three months after they were wed, Ahmad had tested positive for HIV.
'My worst fear is that if I disclose my status, my wife will leave me,' says Ahmad, 25. 'I can’t bear the thought of that.'
More than two decades after Pakistan had its first recorded case of HIV/AIDS, significant advances have been made in treating and managing the illness. But cultural taboos combined with persistent misconceptions and poor knowledge about HIV/AIDS are helping ensure that a stigma will continue to be attached to the disease and to those who have it.
That, in turn, has led people with HIV/AIDS reluctant to disclose their status even to family members, including their spouses.
'I try my utmost to persuade all such people to share their status with their (spouses) and eventually most do,' says Dr Saleem Azam, who has been working with injecting drug users (IDUs) for the last 25 years. ''But it takes time and continuous counselling for them to brace themselves for the disclosure, given the strong societal pressures they encounter.'
According to the National AIDS Control Programme, Pakistan has a concentrated epidemic, with an HIV prevalence of more than five percent among IDUs. Among the general population, the prevalence rate remains under 0.1 percent.
At present, there are an estimated 97,400 people living with HIV/AIDS across the country, although only 2,917 are registered as having the disease.
That the main modes of transmission of HIV/AIDS in Pakistan and almost elsewhere in the world are injecting drug use and unprotected sex have only made the illness ‘dirty’ in the eyes of many Pakistanis.
IDUs, for one, are often considered as the ‘filth’ of society. Azam, who heads the non-government group Pakistan Society, even says, 'The existing government-run AIDS programme is faulty. IDUs are discriminated (against).'
'They tell them to first get themselves off drugs before they can access (HIV treatment),' he says. 'But the government provides no detox facility. The only two facilities run by the Anti-Narcotics Force in the country that I know of refuse to admit those who have HIV/AIDS.'
A 2008 study on homosexuality and HIV/AIDS in Pakistan, was published by the respected ‘Lancet’ journal, observed that socio-cultural and religious taboos in this predominantly Muslim country 'hamper recognition of HIV/AIDS as a sexually transmitted disease and limit discussion on sexual health'.
It also noted that while the government had 'allowed the use of electronic media to propagate AIDS awareness' since 1993, the words ‘condom’ and ‘sex’ were still banned in advertisements.
Not surprisingly, a 2008 survey cited by a report of the United Nations Office on Drugs and Crime (UNODC) and the Joint U.N. Programme on HIV/AIDS (UNAIDS) revealed a '‘hidden epidemic’ of HIV among the wives of IDUs' and who were themselves not drug users.
The survey indicated HIV prevalence among the wives that ranged from five to 15 percent depending on the area. In addition, it found a 'low level of condom use, with over 70 percent of wives reporting that no condom was used' when they last had sex with their husbands.
Ahmad says he and his wife had agreed not to have children right away, so they were having protected sex. But he says, 'Once I found out my status, I got her blood tested as well, without her knowledge. It was a relief to find I had not infected her.'
In the last two years since, though, Ahmad has been pretending he still does not want children yet and tries to work till late most nights.
Ahmad was once a heroin addict. 'Not only did I share needles,' he recounts, '(I) also visited brothels. I had no clue how risky my entire behaviour was.'
He has no idea when he would be able to tell his wife about his condition, but he thinks that by educating her about HIV/AIDS, she would later be able to make 'an informed decision' to either stay or leave him.
Ahmad’s co-worker Imran (not his real name) was also diagnosed with HIV eight months ago. Imran, too, has yet to tell his wife of five years about his status. He says he has seen people 'cringe and recoil instantly' once someone reveals he or she has HIV/AIDS.
Adds Imran: 'When I take people with AIDS to the hospital, doctors will wear two and sometimes three pairs of gloves (and) will stay as far away from them as possible. If doctors are so uncomfortable around us, what can you expect from those less knowledgeable?'
Azam agrees that 'non-disclosure 'of people with HIV/AIDS about their status to their prospective partners is 'a form of deception'. Yet he says it is not up to medical personnel to tell the family of someone with the disease about his or her condition.
Counselling is key, says Dr Sharaf Ali Shah, former director of the Sindh AIDS Control Programme. He also hints that people with HIV/AIDS have nothing to fear in making their status known to their loved ones.
'In Pakistan,' says Shah, 'there is strong family support after the initial shock, anger, and hurt wear off.'
© Inter Press Service (2010) — All Rights ReservedOriginal source: Inter Press Service