I feared to tell my wife I had HIV

Nov 25, 2019

“Too much love, too much history. The love we have shown each other for all those years is what I hold onto. There was no way I was going to leave him to go through it by himself. I had to stay with him and give him all the support,” she adds.

In the month-long build-up to the World AIDS Day on December 1, Vision Group is covering the subject of HIV daily. The theme this year is, Communities Make the Difference, in recognition of the essential role they play in the AIDS response at local, national and international levels.

Today, Elvis Basudde explores the issue of disclosing to a spouse your HIV status Thirty-year-old Prossy Nakalema is HIV-negative, while her husband, Luke Ssemwogerere, 39, is HIVpositive. This condition is called discordance.

Ssemwogerere and Nakalema are a discordant couple. They are now 10 years into their marriage, but six years after they were married, Ssemwogerere started falling sick regularly. He had a persistent cough and developed TB.

He was later diagnosed with HIV, which terrified him. His major problem was how to tell his wife. There was no right time and no easy way to say it. However, one day, he picked courage and told his wife that he had been infected.

After crying for two months, Nakalema also took up the test. She was negative. After six months, she went for another confirmatory test, which also turned out negative. After a year, she did another test, which confirmed she was still negative. "How come my husband is positive and I am negative?" she wondered.

Nakalema subsequently had a number of HIV tests and all of them turned out negative. According to Dr Anthony Sematimba from Njeru Health Centre in Buikwe district, discordance is real, though there are many theories for its cause.

HIV discordance is related to a combination of factors that include genetics, HIV type, extent to which the infection has progressed in the positive partner, presence of other sexually transmitted diseases, use of antiretroviral drugs, as well as tears (scratches) that occur during sex, as well as circumcision, which research indicates may reduce the risk of HIV infection.

WHO FINDINGS
According to the World Health Organisation (WHO), many HIV transmissions in serodiscordant couples occur when the HIV-infected partner has a high CD4 and is not on antiretroviral therapy (ART). The research also showed that a significant proportion of transmissions in couples were not genetically linked, indicating the infections were acquired through sex with someone other than the HIV infected regular partner.

It reveals that close to the time of transmission, more than 50% of transmitting partners have a CD4 count of less than 350 cells/mm and approximately a third have a CD4 count of more than 500 cells/mm. These findings have implications for expanded use of ART for prevention, called "test and treat."

There is overwhelming evidence that patients taking ART, who have an undetectable viral load, are extremely unlikely to infect their sexual partners. Guidelines issued by the WHO in 2013 recommend ART for all patients with a CD4 count below 500 cells/ mm, patients in a relationship with an HIV-negative partner are also recommended to initiate treatment, regardless of the CD4 count.

WHY THEY HAVE STUCK TOGETHER
So, what if you are in a discordant relationship? Robinah Nanyonga, a counsellor at the AIDS Information Centre (AIC), says there is a tendency of the HIV-negative partner separating from the HIV-positive partner in discordant couples.

This is common, probably because of stigma, among other reasons. However, what surprised Ssemwogerere was his wife's decision to stand by him even after establishing that she was free from the virus. She has always been with him even when he was clinically sick with AIDS, which almost claimed his life last year.

"I always believed in love. That is the reason I did not think of abandoning my husband even after testing negative. The thought did not cross my mind," Nakalema reveals.

"Too much love, too much history. The love we have shown each other for all those years is what I hold onto. There was no way I was going to leave him to go through it by himself. I had to stay with him and give him all the support," she adds.

The couple has three healthy children, aged five, seven and nine, who needed both parents. The couple's love is truly unprecedented. They decided to abstain from sex from the time they discovered their status. Nakalema says they sought psychosocial counselling to cope with the realisation and the obligation to protect themselves.

DISCORDANCE COUPLES
Nanyonga says several theories have been advanced to explain the causes of the discordance condition. She says before couples receive such discordant results, to them discordance is an abstract. They may believe that it cannot happen to them since they have been in a sexual relationship for some time.

They may be tempted to believe that the results were inaccurate. The need to protect the negative partner may not occur to them immediately because they may ask, "is it today that the infection will occur?" There are a number of challenges and concerns in a discordant relationship.

Nanyonga says in discordance, you cannot rule out blame, regret and wishful thinking and, in extreme cases, threats of violence. In most cases, the cause of discordance looms on, haunting the mind. Protection of the negative partner, having more children, supporting of the HIV-positive partner and possible separation are inevitable.

It was due to such challenges that AIC in 2012 established a club for discordant couples, called Couple Club, to offer support. Nanyonga says they embarked on a study to develop interventions that could serve such couples better.

Through constant counselling, reminders and the encouragement of running confirmatory repeat tests, whose results remain negative, bells of reality start ringing," says a counsellor at the centre. Couples have now understood that discordance is not due to the partner being immune to HIV infection, but a temporary condition, hence seriously understanding protecting the HIV-negative partner, says Nanyonga.

She adds that if it wasn't for the constant counselling and encouragement from fellow club members, many discordant couples would be separated by now. "Adopting strategies to protect the negative partner, learning that the negative partner has a role to play in supporting and caring for the positive partner has encouraged couples to remain in steady relationships. Some have even legalised their marriages," Nanyonga says.

Ssemwogerere says love is most paramount in a discordant relationship, coupled with spiritual support.

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