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Francis Mwelwa (left to right) and his wife Astridah Mwenya advise Gertrude Mutambo and her husband Steven Mutambo about navigating life as a so-called “discordant couple,” where one partner is HIV positive and the other is not. Mwenya was diagnosed HIV positive in 2000; her husband’s violent reaction almost ended the marriage. Counseling helped them unite, and now they counsel other couples. Prudence Phiri, GPJ Zambia
Autonomy

HIV-Positive Zambians Combat Domestic Abuse Tied to Diagnosis

Zambia

Women in Zambia risk violence and limitations to healthcare when telling their partners they’re HIV positive. A group of couples with the disease aims to make that practice stop.

LUSAKA, ZAMBIA — As Gertrude Mutambo and her husband Steven sit in a courtyard with Astridah Mwenya and Francis Mwelwa, the mood is peaceful.

The Mutambos, 23 and 27 respectively, have been married since 2017, while Mwenya and Mwelwa have been together for 40 years. As the couples converse, an observer might find it hard to believe what has brought them to this relaxed setting.

A year ago, Gertrude Mutambo was enduring regular verbal abuse and beatings from her husband. She had tested HIV positive during a routine pregnancy test, part of a global maternal and child health strategy known as Prevention of Mother to Child Transmission (PMTCT). The strategy includes a set of interventions to prevent transmission of HIV from an HIV-positive mother to her infant during pregnancy, labor, delivery, or breastfeeding.

Mutambo’s world was further shattered when Steven tested negative, and the news enraged him.

“He started beating me right at the clinic, accusing me of infidelity,” Mutambo says. “The violence continued at home, and I had to seek refuge at my parents’ house.”

Ten months of counseling with Mwenya, 72, and Mwelwa, 69, led to a reconciliation.

The older couple could speak from experience. Twenty years ago, Mwenya learned that she was HIV positive. When Mwelwa learned he was not, he almost killed her.

“That day I was badly beaten. I even passed out,” Mwenya says.

People in relationships where one partner is HIV positive and the other is not are referred to as “discordant couples.”

Globally, women in relationships are at risk of intimate-partner violence following an HIV-positive diagnosis. That Mutambo and Mwelwa were each able to accept their wives’ HIV status and remain in the relationship suggests the value of male education and involvement in HIV prevention efforts.

Mental health experts say this kind of counseling can lower the risk of physical violence and rejections and make it easier for women to seek the treatment they need.

That’s why a group of discordant couples in Chipata Compound, an unplanned settlement in Lusaka, began offering counseling services to help couples cope with the challenges of different HIV statuses.

About 11 percent of HIV-positive married or cohabitating couples are discordant in Zambia, according to a 2014 report from the Joint United Nations Programme on HIV/AIDS. The UNAIDS report also indicates that in the initial stages of the PMTCT health strategy in Zambia, participation by mothers was low because of gender-based violence.

There is no documented evidence of violence among discordant couples in Lusaka, but Mwenya says it’s prevalent. She was totally unprepared for her husband’s response, after a lingering illness turned out to be symptoms of HIV infection.

“That was the beginning of war in our home,” she says.

Mwenya says her husband accused her of infidelity and beat her to the extent of breaking her leg.

“When the violence persisted, I sought for help at the clinic and that is how we started counseling together,” Mwenya says.

She says it took two years of counseling before her husband could accept her.

Mwenya says the involvement of men like her husband in PMTCT efforts has led to more couples getting tested together.

Midwife Chowa Kasengele says counseling is a key part of PMTCT regimens. Couples learn how the virus is transmitted, and how to take care of their health in case of either a positive or negative outcome.

“Before any test is done, there is pre-counseling so that the couple easily accepts any results that comes out,” Kasengele says.

She says male involvement in PMTCT is key in helping women make informed decisions regarding their health. But some women need prior permission from their husbands before testing.

“Men are generally decision-makers and, if men are not involved, some women become skeptical to test for HIV,” Kasengele says.

Fear of stigma and violence also are big barriers.

A woman named Veronica, who asked that only her first name be used for this story for fear of undue stigma, says what happened to one of her friends keeps her from asking her husband to join her on clinic visits.

“I saw how my friend was almost killed by the husband when they were found discordant, and I fear that could happen to me in that situation. I have never gone with my spouse for antenatal [appointments],” she says.

Men must be more involved for the fight against HIV/AIDS to be effective, says Dr. Kennedy Malama, a permanent secretary with Zambia’s Ministry of Health.

“For a long time now, we have encouraged men to get involved in PMTCT. But the campaign has become vigorous now with the campaign of ending AIDS in 2030,” Malama says.

The World Health Organization’s Framework for Action in the WHO African Region aims to stop HIV transmission by 2030. Zambia adopted a similar strategy.

Malama says the benefit of a couple knowing their status together outweighs any other outcome of that process.

“It might be disturbing on an individual level if one discovers that their partner is HIV positive and they are negative. But health workers are there to make them understand that HIV is not a death sentence and one must not be stigmatized based on their status,” Malama says.

Prudence Phiri, GPJ, translated some interviews from Nyanja and Bemba.