Patriarchal Traditions and War Pave Way for Spread of HIV in Northern Uganda

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GULU, UGANDA – Alice Ongom, 45, says when she got married at 18 she thought she would live happily ever after in Gulu, a city in northern Uganda that was home to much of the bloodshed during the country’s civil war.

Ongom says she was happy, at first. But when she was not able to give her husband a male heir, things changed. After giving birth to five daughters but no sons, she says her in-laws advised her husband to chase her away. Instead, he married a second wife, who Ongom says gave her husband HIV.

“I suffered,” Ongom says. “All my in-laws hated me and told my husband to chase me away. He did not chase me away, but instead he brought in another woman.”

His second wife soon became pregnant but gave birth to a baby girl. Soon after, she started falling sick. Ongom says the family accused her of bewitching the second wife.

But Ongom then began to have ailments of her own. After losing three sets of twins, Ongom says she started to suspect that her co-wife was suffering from AIDS and that her husband had transmitted HIV from her co-wife to her. Ongom took an HIV test and found out she was HIV-positive.

Ongom says that her culture’s patriarchal traditions place so much value on boys that they disregard girls. She says that the pursuit of a male child jeopardized her health and controlled her future from an early age.

“That problem started from home,” she says. “I should not have got married at 18 years. I should have been in school. My dad refused to pay school fees for all of my siblings because we were girls.”

She says she dropped out of school in grade seven and that the highest grade any of her sisters reached was the second year of high school.

She says it’s a cycle.

“My mother had been accused of bearing only girls and chased from her matrimonial home,” she says. “We grew up with our stepmother.”

And she’s not alone. It is common in Ugandan culture for men to take up multiple wives if the first can’t bear him a son.

Many say that patriarchal traditions that prioritize the interests of men over the education and health of women have contributed to Uganda’s high population of people living with HIV/AIDS. More than two decades of war have led to especially high HIV rates in northern Uganda, as advocates say sex was used as a tool of war and for entertainment. The government and many nongovernmental organizations, NGOs, have made special efforts to increase care in northern Uganda. But it’s an uphill battle, and some say the real solution is the empowerment of women.

Uganda has one of the highest populations of people living with HIV/AIDS in the world, according to international data. Because of poverty and pregnancy, just 7 percent of girls attend secondary school, according to the Ministry of Education. Just 32 percent of young women and 38 percent of young men in Uganda have comprehensive knowledge of HIV, according to UNICEF.

A 2008 report listed northern Uganda in particular as having the second-highest HIV/AIDS prevalence rate behind central Uganda, according to the Program for Accessible Health, Communication and Education, PACE, an organization that aims to improve health in Uganda. Ugandans in the northern region and in internally displaced person, IDP, camps, set up for people displaced by the war here, demonstrated less comprehensive knowledge of HIV/AIDS compared with other regions in the country, according to the latest Uganda Demographic and Health Survey, UDHS, taken in 2006.

Paula Kyomukama, a women’s rights activist based in Gulu, says that many girls are taught that they can’t achieve anything without a man. She says that many young girls rush into marriage to escape the social stigma associated with being unmarried here. She says this has contributed to the spread of HIV because young women are more concerned with finding a husband, leading to sexual intercourse at young ages, than protecting themselves.

Both women and young women in northern Uganda had the second lowest comprehensive knowledge of HIV/AIDS of any of Uganda’s regions, according to the UDHS. And almost double the percentage of men here had comprehensive knowledge compared with their female counterparts, who do not receive much schooling.

The PACE report attributed the high rate of HIV in the area to the 20-year insurgency in the region by the Lord’s Resistance Army, LRA, a armed group seeking political power. Starting in 1986, the violence caused more than 1.6 millions Ugandans to flee their homes and live in overcrowded IDP camps and led to the abduction of about 30,000 children, according to the United Nations. LRA fighters terrorized anyone perceived to be sympathetic to the government by cutting off their hands, breasts, lips or ears and forcing children to be soldiers or the commanders’ sex slaves, according to Human Rights Watch, an international human rights organization.

“HIV prevalence in northern Uganda is higher than the national average because of the insurgency,” says Dr. Zainabu Akol, manager of the AIDS Control Program, set up by the Ministry of Health in the late 1980s to educate the public about HIV/AIDS. “People were made to live in camps, and sex became the only source of entertainment.”

The insurgency also led to brutal killings, displacement and the breakdown of social services, according to The AIDS Support Organization, TASO, an NGO that provides HIV/AIDS services in Uganda and Africa.

“The 20 years of war in northern Uganda aggravated poverty, and many children born during the war did not go to school,” says Muzaaya Geofrey, manager of TASO’s Gulu center. “They are now adolescents. Parents are marrying them off to get favors or money.”

Geofrey says the lack of education and push toward early marriages have contributed to high rates of teen pregnancy and HIV/AIDS.

“We have a high rate of teenage pregnancy,” he says. “By October last year, we had 763 mothers on PMTCT [Prevention of Mother-To-Child-Transmission of HIV], but about 63 percent were youths between the ages of 15 [and] 22 years.”

He says the war displaced many families, forcing them to live in camps where water was scanty. About 100 families shared each borehole, or well, leading to long lines and trips at night.

“The more time they spend at the borehole, the more they get exposed to acts that expose them to HIV,” he says.

He also says that during the war, women wanted to be married or in a relationship to protect themselves, which may have led to a higher frequency of HIV transmission.

TASO is one of many organizations that have set up branches here to offer HIV/AIDS prevention, treatment and counseling services.

Ongom says she joined TASO in 2004, when its Gulu branch opened.

“Before I joined TASO, I had contemplated suicide,” she says. “I wanted to kill myself and poison my children because I had lost hope.”

She says TASO provided her counseling, and that it has helped her to stop hating herself.

“I am shown so much love and have met people who are like me,” she says. “I feel consoled.”

She says TASO also provides people living with HIV with free antiretrovirals, ARVs, which cost about 250,000 Ugandan shillings, $105 USD.

“It was burdensome to raise that money,” she says. “We had a group in which we would contribute for each other money to buy ARVs.”

She says she then joined TASO’s post-test club, a club for people who have ever taken an HIV test.

“It carries out sensitization in the community on HIV/AIDS by delivering care and prevention messages using music, dance and songs,” she says.

Acaye Dominic, 42, a TASO client living with HIV, is also a member of the post-test club. He says that the war took his wife from him. He was working far from home when the war broke out and when he returned, he found his wife living in a barracks where she had sex with soldiers to earn money.

“This she did because she would be able to then get money to feed her children back home,” he says.

He says he had to marry a new wife, but she infected him with HIV and later died. They had a son, who is 1 and still HIV-negative.

Akol says that the number of organizations that work with HIV/AIDS in northern Uganda are too many too enumerate and that many have branches in Gulu. The Joint Clinical Research Center, Uganda’s leading center for AIDS care, treatment, research and training and its largest ARV provider, has a laboratory in Gulu. The AIDS Information Centre, set up by a group of NGOs and the Ministry of Health, offers HIV testing and counseling. And Straight Talk Foundation focuses specifically on young people here, emphasizing delaying sex or practicing safe sex.

She says that many other organizations, such as UNICEF and the Uganda Red Cross Society, also operate in northern Uganda. And some organizations focus on specific areas, such as CUAMM, an Italian organization that works in Pader, Kitgum and Karamoja, districts to the north and east of Gulu.

Akol says that the government has also been working to tackle the high rate of HIV/AIDS here. In addition to national initiatives such as the AIDS Control Program and the Uganda AIDS Commission, established in 1992 to ensure a focused and harmonized response to AIDS, Akol says that the government requested that a special project be set up in northern Uganda. In response, the U.S. Agency for International Development, USAID, a U.S. government agency, set up the Northern Uganda Malaria, AIDS and Tuberculosis program, NUMAT, in 2006.

NUMAT is a five-year program funded by USAID and designed with help from the Ministry of Health and various local and international agencies and organizations. It aims to expand access to prevention, treatment, care and support services in northern Uganda.

NUMAT provides antiretroviral treatment, ART, in more than 30 clinics and supports more than 100 sites offering PMTCT. In the first three months of 2010, NUMAT enrolled 1,000 new ART clients, reached more than 800 babies with its Early Infant Diagnosis intervention, offered more than 5,000 tests, opened three new ART clinics and began refurbishing 10 new laboratories, according to JSI Research and Training Institute, a partner organization based in Boston.

“We thank USAID and NUMAT for doing an excellent job meant to bring hope,” Akol says.

Still, women’s rights activists say more needs to be done to deconstruct patriarchal traditions and educate and empower women in northern Uganda and nationwide.