Grace* raised her children in the cramped corridors of Kampala’s slums where proximity and necessity make neighbours de facto family members. But everyone looked the other way when her husband started beating her.

She says the violence began soon after they were married. When she asked to work to raise money for their five children’s school fees, he beat her. When she asked about his HIV status, he beat her. She never denied him sex, but still he beat her.

Grace was trapped by the need to secure the immediate survival of both her and her children. “I needed school fees for our children. I needed food. I wanted to work outside of the home but he refused me to work. I had no choice,” Grace said.

The abuse Grace suffered has been normalised and reinforced through the centuries of global and local traditions of male dominance. But the historical inequality puts women at risk of a modern threat–HIV.

The ABC strategy of the 1980s focused on abstinence and being faithful, but did not address the complex cause and effect relationship between gender-based violence and HIV.

Vulnerability

Grace gave birth to five children and then following the birth of the couple’s last child, Grace took her first HIV test. That was in 1997 and she was positive. In denial and for fear that it too would result in beatings, she kept her status secret.

He came home just before dawn most nights, saying that his shift as a taxi driver ran late. Grace says she always guessed he was out with any one of his multiple girlfriends. Although she shrugged his late nights off at the time, she feels confident that it was through one of these rendezvouses that he contracted HIV. In turn, she contracted the virus from him. “Definitely,” Grace said.

The cultural acceptability for men to take multiple partners outside of the marital home and the expectation for women to engage in unprotected sex, regardless of his actions, puts wives at a particularly dangerous nexus.

Sammuel Lule is a community activist for SASA!, a Swahili word for “now” and an acronym for the organisation’s steps against gender-based violence and HIV–start, awareness, support and action.

“Even if the man goes out of the house for one year or more, the day he comes back, he expects to have sex with his woman,” Lule said. “She loses her voice. She cannot refuse. The husband always decides, even if he left the house for years. When he returns, she is expected to submit fully.”

Afraid of beatings or worse, Grace never asked her husband about his status nor asked him to use a condom.

“He didn’t tell me if he tested but I think he knew. He was always taking medicine. I would ask, ‘Why are you taking so many pills? What could these be?’ He ignored me and did not suggest safe sex. Now I know he knew his status and still forced sex with me,” Grace said.