HIV infections: Why brothel is safer than your marital bed

By Gatonye Gathura

New HIV infection rates indicate that a married person has twice as much chance of contracting the virus with the spouse than with a prostitute, says study

The matrimonial bed is no longer laid with roses but the leading source of HIV infections and other venereal disease way ahead of brothels and even in the country’s prisons where sodomy is prevalent.

Almost half  of new HIV infections today are occurring among married or steady partners compared to 14 per cent among prostitutes and 15 per cent among homosexuals and prisoners.

Last week at a conference in Nairobi,  the head of the National Aids STDs Control Programme (Nascop), Dr William Maina, said  that while the rate of new HIV infections had declined by 40 per cent in the last five years, infections among steady partners is today the greatest concern and currently stands at 44.1 per cent.

The biggest reason for the high rate of HIV in married and steady partners is the low use of condoms among this group.

Nascop estimates at least one partner out of every ten married couples is living with HIV. Among married people who are living with HIV, 45 per cent have a partner who is not infected.

Condom use is infrequent among married couples for multiple of reasons, including the desire for children and the widespread association of condoms with infidelity and lack of trust.

UNAIDS says 97 per cent of people in married or cohabiting  relationships in Kenya  reported that they did not use a condom the last time they had sex.

This is different among prostitutes with more than 60 per cent saying, in a 2012 study, that they had used a condom in the past 30 days with a paying customer. But only 37 per cent had used a condom with a non-paying client who most likely is a regular boyfriend and who is in a steady or married relationship elsewhere.

A recent survey by the group, Population Action International, says the matrimonial bed is being messed by both men and women having other sexual partners outside their relationship otherwise called ‘Mpango Wa Kando’.

But as the survey shows, men are more likely to bring the virus home and even spread it to their other partners. In the survey, 11 per cent of married men reported having an extramarital partner in the past year, as opposed to just over two per cent of women.

Polygamy is also associated with increased risk of HIV. Among married people, seven per cent of those in monogamous relationships are HIV-positive, but the rate reaches 11 per cent among those in polygamous relationships.

According to the Kenya Demographic and Health Survey, 13 per cent of married Kenyan women have co-wives. This means they are married to men who have at least two or more wives.

Realising how dangerous marriage and steady relationships have become, researchers have since downgraded these institutions from ‘low risk groups’ to ‘steady partner heterosexual’.

“One category that has caused confusion is “low risk”, which implies that couples do not fit  into any of the “high risk” categories, but the label is today a misnomer, and people need to be told of the grave HIV risk in marriage and steady relationships,” says the Kenya HIV Prevention Response, a document of the Ministry of Health.

So with all this knowledge why are couples  not using condoms in marriage?

“Several reasons,” says Dr Nicholas Muraguri, the executive director of UN initiative on eliminating HIV among children.

“Reasons for not using condoms are multiple, including the desire in a couple to have children.” There is also widespread association of condoms with infidelity and lack of trust.

Violence against women in marriage or intimate relationships also acts as a disincentive for women to demand the use of condoms, particularly with a husband who may view the request as an admission or accusation of infidelity.

Although in 2006 Kenya passed the Sexual Offences Act, before its passage, MPs removed a clause criminalising marital rape.

About, 43 per cent of women who are married or have been married report physical or sexual violence from their husband and 28 per cent experienced violence within the past year.

While men have greatly been blamed for much of the infidelity and consequently bringing HIV into the home, women are fast catching up in the game.

In January the Kenya Medical Research Institutes, Kisumu centre published the first study ever showing the fisher folk women to be equally to blame for bringing HIV to the home.

In the study published in the PLoS One online journal,  Dr Zachary Kwena and his team of researchers    from the universities of Kenyatta,   Alabama and California, both of the US, found that women whose jobs entailed travel  but have non-mobile spouses have  2:1 times the likelihood of HIV infection compared to individuals in couples where both partners were non-mobile.

“The mobility of fishermen’s spouses is associated with HIV infection that is not evident among fishermen themselves,” concluded the study.

Before this study, poverty among fisher folk women had been blamed for their involvement in the fish for sex  exchange business but Dr Kwena and his team demonstrate  that the high HIV rates among these travelling women is a pure case of lifestyle choice and infidelity.

Much more recently, medical doctors at the Aga Khan University Hospital published a paper on the high levels of venereal diseases among married, well-to-do and educated women in Nairobi.

The medical study involved 300 women,  each half attending one of two hospital sites in Nairobi, and found majority of the patients were married, were not using condoms and many had more than two sexual partners.

The results of the study published online in the journal BioMed diagnosed six per cent of the women with chlamydia. The most infected were women coming from the higher economic class, many of whom had no knowledge about the disease.

Chlamydia is a common sexually transmitted disease caused by a bacterium. It can infect both men and women and can cause serious, permanent damage to a woman’s reproductive organs.

The study,  carried out at  Aga Khan University Hospital and St Mary’s Mission Hospital in Nairobi, concluded that patients of a higher socio-economic standing, with a higher prevalence of genital chlamydia infection, had more than two partners.

The researchers say the fact that most of these women are not using condoms, have multiple partners or are involved in casual sex is the cause of the high rates of the venereal disease among this group.

Previous studies on venereal diseases have been focused on vulnerable groups such as prostitutes but these findings suggest the need for screening all women for venereal diseases, especially those living in highly urbanised areas.

“This new information provides evidence for the need to implement active opportunistic screening in young sexually active women in our population in patients of all socio-economic groups irrespective of marital status.”