CHAPTER 4: PRESENTATION OF FINDINGS 4.1 Introduction
4.2.5 Experiential theme: Knowledge about AIDS epidemic
According to what this participant said, in practice when a woman gets infected the suspicion that she was infected by her husband is not generally accepted.
The family usually accuses the woman of becoming infected from extramarital relationships even if she does not have them. This unfair situation convinces women not to move to better relationships even if it means getting infected from their husbands.
In this sub-theme married women felt trapped in their unhappy marriages because they could not deceive their children and relatives by leaving their unhappy situations. This would result in rejection from their families and lose respect from their children. Besides, when children needed their family for customs and rituals there would not be anyone to do this if she left her husband.
In this situation they feel it is better to get infected by their abusive husbands than to leave for more caring men.
/; But how do you know if the husband did not infect you as he was having other partners?
P: He only had liver damage he was not infected. I also know that I am not infected because when he died I had already left him 2 years before the divorce. So we had a period of 4 years not sleeping together.
Another employed married participant also gave an account of a woman who had left her husband for another man whose wife had died. When this ishende died later, she went back to her own husband and the family asked him to take her back. The participant was asked about the cause of death of this man and replied that people said he had AIDS and that the woman could have been infected because she had also had sexual partners other than her husband. The same participant further said that perhaps this woman had many partners because she thinks AIDS will go away. When another married participant was asked about the topic, she gave this account:
(I: Interviewer; P: Participant)
/.- Do you think women of migrant men are more at risk than those of non-migrant men?
P: They are equally in danger of getting AIDS either as migrant men's wives with the husband staying away from home or as non-migrant men's wives with their husbands staying with them if the man or the wife is having ishende.
Though the full blown AIDS stage is only reached after a long time of suffering from several illnesses, some participants know that there is a difference between HIV opportunistic infections related to HIV and AIDS. To support this statement during the interview one participant said:
"By the time you get ill people will associate your previous behaviour when you were well and the signs of the illness that you are suffering from and they will know that you have AIDS"
Experience with the local community has shown that people have seen people suffering and even dying from AIDS. Thus in all focus group discussions when the participants were asked what they knew about AIDS, their spontaneous responses were,
"It is this disease which has finished people" (expressed in different phrases).
In traditional Zulu culture, when there is unfamiliar illness, people tend to attribute the cause to witchcraft. This also happens in the case of AIDS as was shown when one participant said:
"Some do not disclose. You just see by the signs they have. Even if they say it is
witchcraft, the signs are obvious. We have seen our relatives and children dying from this disease"
All the participants also seemed to know that transmission occurs mainly through sexual intercourse between people who are infected and those who are not. This was evident in statements like the following:
"Men fall for local widows because they have money, despite the fact that they could be infected with AIDS from their husbands...if they behave like this the disease will attack them".
It was clear that in this rural area there are women who have more than one sexual partner. Participants said of this, "They'll get AIDS as they do not know their new partners' behaviour well" To confirm their knowledge of heterosexual transmission, participants were not biased in their answers as they said:
"Both partners can come with the virus in a relationship and if they behave like this they will get AIDS".
The participants seemed aware that married people have an obligation towards their partners so that even if married women engage in other relations, it is not as easy as they would be if out of wedlock. In an interview, the participant who divorced her husband responded in the following manner:
(I: Interviewer; P: Participant)
/: You are not very old to be on your own. In fact you look younger than your age. Why don't you have another partner?
P: (Laughing,) / decided to have no other man after all the problems I had with my husband.
I: Hm.
P: Besides I do not want to get AIDS.
One of the focus group participants also agreed with the same idea when she said, "When you divorce, you both feel free to have other partners. That is when AIDS spreads" The oldest key informant shared with us her experiences while still a young married woman in the following extract:
"When the husband came home with a girlfriend in our days, the wife slept in the kitchen leaving the husband and his girlfriend to sleep in her hut. Today wives either fight or leave the husband who does this. They seek jobs away from home and have other men.
Men have failed to treat women well. That is why homes have fewer young married women today".
When this participant was asked why is it so easy to do that today she said that cell phones are a menace:
"They phone each other and make appointments to meet and infect each other with this disease".
When a migrant woman who works as a maid was interviewed, she admitted having seen people with AIDS where she works. She said about one of her fellow maids who was among those who were suspected of having AIDS: "One of them
became very thin and went back home with many illnesses". Further probing to capture if she thought that the woman with many illnesses had AIDS, with a far away look she said, "Who hasn't got it? You can never be sure that you do not have it".
Participants also knew that one can find out if a person has AIDS by having a blood test. This could be because of sensitization from Africa Centre which has an HIV Surveillance study that tests women between 15 to 49 years old and men between age 15 and 55. The blood tests are done during home visits in the community and eligible participants are tested in their homes. They are referred to the Counselling Centres existing in their areas for blood results. Vertical Transmission Study (VTS) and the Microbicide Study also test their participants.
The people from this Demographic Surveillance Area have considerable knowledge of the disease. One of the study participants in an interview said:
"I joined the Microbicide Study, did a test and have the results slip, which I showed to my husband. Everyone knows about AIDS".
In this sub-theme all participants showed considerable knowledge about AIDS:
that transmission is from person to person mainly through sexual intercourse.
They verbalized that both male and females, irrespective of whether they are migrants, wives of migrant men or not are all at risk if they are not well behaved.
This made them feel that rather than leaving their unhappy marriages, was better to get infected by their husbands than by new partners who would treat them with care but who could infect them. In addition to this, they admitted that witchcraft
was still often blamed for any unknown disease but signs of AIDS are distinctive and cannot be mistaken with witchcraft. They know that confirmation of HIV infection is by means of HIV test. Their knowledge comes mainly from the media and sensitization from the local population health studies namely: Population Based Testing and Counselling study, Vertical Transmission Study and Microbicide Study. All of the participants (besides key informants) were part of one or all of these programmes.
4.2.5.2 Sub-theme: Prevention and beliefs/myths
When the participants were asked what could be done to help women avoid getting infected with AIDS, they said that women should be taught about AIDS and condoms and how to use them. They also mentioned that, as much as they knew about AIDS (as they have seen people dying from AIDS), they still needed to be taught more about it.
Participants also displayed knowledge of how AIDS should be prevented as they mentioned condoms as the device for prevention:
"Condoms are easy to use but men do not want them" "When you mention condoms to men, they say you do not trust them"
(This was expressed in a second person probably to make the topic less sensitive)
According to what the participants said, their husbands seem to believe that when women initiate the use of condoms it is because women have other
partners with whom they sleep without using condoms. Men also do this out of jealousy as one participant said, "That I was suggesting use of condoms meant
that I had a man who told me to use condoms with my husband."
This discussion shows that participants know how to prevent HIV infection mentioning condoms as means of protection. They stated, however, that they still need more teaching on AIDS and how to use condoms. They also pointed out that attitudes towards condom use is a problem as men accuse women who suggest condom of covering up their infidelity wit other men.