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husband). The marriage attributes certain characteristics as forming or making a good wife.
These include:
…she who always attends to her man regardless of when he came/returned home or where he has been; she who always prepares food for him; washes his clothes and works hard to develop their household. The only time she is allowed to lodge a complaint about his sexual affairs with other women is when the husband neglects her or their children. On the contrary, societal perceptions of a good husband is: he who may have sexual affairs outside of his home, as long as he does not ill-treat, neglect or fail to support his family;
he who does not leave his wife or live apart from her without cause; and he who does not use her household property to support another woman (Arnfred, 2011, p. 140).
These factors that support male infidelity outside the home have a negative impact on the economic and social conditions of women as well as their ability to make informed decisions about their lives as well as their health. The section below looks at the literature on HIV prevention as an entry point towards an effective fight against HIV and AIDS.
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Government of Lesotho has adopted called “the test and treat” approach. This treatment as a prevention initiative or approach is believed to be an effective tool that has a 93 percent reduction of HIV transmission among sero discordant couples when the HIV positive partner was on antiretroviral treatment (Lesotho Government Report, 2016). Preventing new HIV infections is critical to controlling the HIV epidemic. Providing HIV testing services in health facilities and communities is essential for identifying people who are HIV negative and providing them with the appropriate education, counselling and prevention strategies to help them stay negative. Treating people living with HIV with life-long ART to prevent new HIV infections, has emerged as a powerful additional prevention tool benefiting people of all ages. Through this treatment-as-prevention approach, it is believed that a 100 percent prevention of new HIV infections is possible when the viral load of the HIV positive partner is fully suppressed by ART. This was explained as follows:
…this intervention is effective regardless of the route of HIV exposure (vaginal, rectal, or percutaneous) and patient group (heterosexual men and women, homosexual men and women, transgender persons, commercial sex workers and people who inject drugs)…
(Lesotho Government Report 2016, p. 3).
The approach carries similar prevention components to what Harrison, (2014) terms “state of the art” approach to HIV prevention which touches on a broad spectrum of social, behavioural and bi-medical matters.
In the social context, Harrison suggests male involvement in HIV and AIDS prevention interventions. She argues that males constitute the “forgotten fifty percent” of the population (Harrison, 2014, p.19) and are often neglected in discussion of gender and sexual and reproductive health. She stresses the importance of these areas as she sees them as not only improving men’s individual health, but also as bettering health outcomes for women. She terms this a gender-transformative approach. Her view is supported by Gqola, (2008) who argues that the reduction of gender-based violence should form part of HIV prevention
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programmes. Gender-based violence is directly relevant to the HIV risk of young women who often experience trauma of forced sex of any kind – rape, dry sex or lack of readiness – with an infected partner. The fear and power differentials associated with gender-based violence, increase gender inequalities and are important causes of the inability of those affected by gender-based violence to make and implement prevention decisions.
Uganda on the one hand uses creative art as an HIV prevention strategy. As a social practice in the African context, creative art has a transformative potential because of its ability to enable marginalised people to express their opinion and thus generate their capacities for their concerns to be heard and addressed. Eze, (2008) does allude to the fact that in the majority of cases HIV and AIDS affects people who are hardest to reach, therefore she advices on the use of print, broadcast medium channels, music, drama, horns, village criers and story tellers as effective channels for disseminating messages in rural societies, where the communication by the population tends to be predominantly oral.
Malawi on the other hand, uses grandmothers (Agogos) as a strategy for HIV prevention among adolescent girls, who they prepare for motherhood. The Agogos are being capacitated by the health professionals and serve as additional health education agents to communicate HIV prevention messages to the adolescent girls to prevent unintended pregnancies (Osha, 2008).
Within the behavioural context, the interventions include use of family planning by women living with HIV and AIDS as it prevents transmission of HIV to the unborn babies and a the same time being used as a protection among uninfected women to prevent both HIV and pregnancy. Harrison, (2014) also highlights the importance of adolescent HIV prevention and sexuality education at both schools and non-school settings.
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The biomedical HIV prevention includes interventions such as treatment-as-prevention e.g.
pre-exposure prophylaxis2 (PrEP), post-exposure prophylaxis (PEP) and microbicides. As alluded to above, PrEP provides maximum benefits at both individual and population levels.
For these benefits to be realised PrEP needs to be combined with other effective prevention interventions. Chin-Chi and Benaya, (2008) and Harrison, (2014) assert that effectiveness of this intervention needs to incorporate the women’s daily lives which may include a desire for pregnancy or, even a desire to prevent pregnancy. This tallies with what the Government of Lesotho proposes for PrEP effectiveness, where the focus is on preventing HIV infection in women, preventing unintended pregnancies among women with HIV, preventing vertical transmission of HIV from mothers to their infants during pregnancy, delivery and breastfeeding, and providing care, treatment, and support for mothers with HIV and their children (Lesotho Government Report, 2016). Harrison, (2014) suggests multi-purpose prevention technologies (MPT) which includes vaginal gels with HIV prevention and contraceptive properties, as well as the need to situate women’s HIV prevention in a broader reproductive health context.
General HIV prevention methods include knowing one’s HIV status, condom and lubricant education and provision, risk reduction counselling and diagnosis and treatment of sexually transmitted infections. Risk reduction messages need to focus on encouraging abstinence, avoiding having multiple concurrent sexual partners for individuals who are sexually active, as well as correct and regular use of condoms for sexual intercourse whether vaginal, anal and oral (Lesotho Government Report, 2016).
2Antiretroviral medication in which HIV uninfected persons with on-going HIV risk use to reduce their risk of acquiring HIV infection
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The next section now looks at what scholars say about HIV testing.