Married Couples are hard hit by HIV/AIDS

HIV / AIDS is spreading faster in marriages than in any other group of people in the country, two new reports on HIV Prevention Response and Modes of transmission and Assessing the Macroeconomic Impact of HIV/AIDS in Uganda report, launched by Dr. Beatrice Wabudeya, Minister In Charge of Presidency shows.

“Approximately 46 percent (6,022,317) of the population aged 15 to 49 are mutually monogamous heterosexuals; 14percent (1,808,919) are in the multiple partnerships risk group and their partners were 11percent of the population (1,417,881). The number of sex workers was estimated to be 32,652 (0.3percent) and that of their clients was 189,381 (1.5percent). It is estimated that there was a total of 3,949 men who have sex with men, based on self-reports by survey respondents,” States the report on Modes of Transmission.
The report further states that the marital status showed a significant relationship with HIV prevalence. Those who are widowed had by far the highest HIV prevalence. Almost one-third of women and men who have been widowed are HIV positive, compared with around 6 percent of those who are currently married.
According to the report, Widow Inheritance was reported as a frequent socio-cultural practice in rural Uganda where more than 70 percent of respondents reported that it occurred in their communities. Inheritance is linked to bride price, but this cultural practice may have to be discouraged or at least stripped of its sexual component. Those who are divorced or separated have an intermediate level of HIV infection
Of 14 percent, while those who have never been in a marital union have a relatively low prevalence of 2 percent.
Overall,In Uganda in the year 2008, a total of 91,546 new infections were estimated to occur among them were more than 13 million people between the ages of 15to49 year old of adult population, the report stated. This figure is practically the same as the Spectrum estimate of new infections among adults of 91,551, excluding infections due to mother-to child transmission, which was calculated by the Ministry of Health and the Futures Institute.
The mutually monogamous heterosexual sex category, which includes almost half the population, contained the largest proportion of new infections with 43percent. Individuals engaged in multiple partnerships contributed only 24 percent of new infections while the partners of individuals reporting multiple partnerships accounted for 22 percent.
Sex workers accounted for 11percent of new infections, of which clients of sex workers contribute 8percent.
The report states that a small number of infections occurred as a result of medical injections, blood transfusions, injecting drugs and through homosexuality and lesbianism.

On what could have lead to this change there are various means that could have acted as catalysts. Using the UNAIDS document the study identified the risk factors and drivers fuelling the HIV epidemic in Uganda. They include;having Multiple partners, discordance and non-disclosure, Lack of condom use especially married people, transactional sex, cross-generational sex, Presence of STIs especially. HSV-2, Intact foreskin, Alcohol and drug use, behavioural disinhibition due to ART, Socio-cultural factors, Wealth and Poverty, low status of women and girls, Human rights, Stigma and discrimination, Inequity and access to prevention, care and Treatment.
The report further states that for couples in mutually monogamous sexual relationships, the key factor that influences the rate of new infections is discordance. All couples where at least one partner was infected, about half were HIV discordant. Moreover, most of these discordant married or cohabiting couples are not aware of their own HIV status and of their partner’s and therefore are not motivated to take action towards prevention such as using condoms consistently.
“Studies show that couples who tested individually are more likely to disclose to persons other than their spouses and even when they do disclose to their partners they may take as long as two years…Moreover, females may not disclose to their spouses for fear of domestic violence and marital disruption,” states the report. Central region and Kampala lead in HIV occurrences with 8.5 percent while North Central regions followed with 8.2 percent making it third in the regions with highest HIV prevalence rates. The lowest prevalence rates were in Northeast and Northwest regions with 3.5and 2.3percent respectively.


HIV prevalence among residents in urban locations was significantly higher (10 percent) than among residents in rural locations (6 percent).
In terms of age and sex the reports shows; Women are more highly affected than men at younger ages - prevalence in women is considerably higher at ages 15-34; from age 35 and up the age specific prevalence rates are fairly similar.
Mai Harper, UNAIDS country coordinator said that there is need to change national response in order to target population in monogamous relationships.“The reports is confirmation of earlier studies that epidemic has shifted to married couples where 46 percent are for multiple partnership, and 43 percent for discordant monogamous; where either the partner had HIV before marriage or he/she was infected after marriage,” said Mai.Dr. Beatrice Wabudeya, Minister In Charge of Presidency said that the content in the report will form a guided opinion since we now have the evidence on mode of transmission and therefore the need to change this challenge into opportunities.
“I propose in the following three areas; increase the informational knowledge to Ugandans…by setting an ambitious target by ensuring we include the senior citizen. Include all leaders at all levels and strengthening the decentralized structure to fight HIV and AIDS,” said Dr. Wabudeya.Dr. Chris Baryomunsi, Kanungu Member of Parliament, said that he was worried by the stabilization of prevalence which stands between 6.1 and 6.5 percents. He questions what might have happened to lead to this stabilization.
“These days you hardly hear powerful people coming up and declaring their status publicly that there are positive,” Dr. Baryomunsi said.He added that marriage is now risky institution and require appropriate strategies’ to change the trend.
He said that more lodges are being setup which is a clear indication that people no longer care.
He called for translation of the finding into action and need for a new campaign led by the president.
Dr Keith Jafferis who was team leader in the Assessing the Macroeconomic Impact of HIV and AIDS in Uganda said, “We need to package the information to our policy makers …and ensure couple counseling.”