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Furthermore, as more people learn about how to protect themselves from HIV, those who remain most vulnerable to infection will likely be those who suffer most from injustice, anger, and abuse. In the voices of women, this chapter provides an insight into the ways in which violence strips women of bodily autonomy, prevents them from safeguarding themselves from exposure to HIV infection, and forces them to go to great lengths to disguise their HIV-positive status. We will not achieve progress against HIV until women gain control of their sexuality.

Human Rights Watch interviewed women who confirmed that, in many instances, Ugandan men have absolute dominion over the terms of sexual relations with their spouses. Where the husband is HIV-positive, this dominion directly threatens women's lives. In one such case, even the fact that he lay dying did not prevent Hadija Namaganda's husband from punishing her.

In , Namaganda's HIV-positive husband forced her to have unprotected sex with him until he became bedridden. He routinely beat her viciously, and, on one occasion, attacked her so violently that he bit off half of her left ear. Then, while he lay dying of AIDS too weak to beat her, he ordered his younger brother to beat her instead.

Namaganda is now HIV-positive. Seggane Musisi, head of psychiatric consultation at Mulago Hospital, who has researched the factors that psychologically influence sexual behavior in Uganda, explained:.

African Women's Unique Vulnerabilities to HIV AIDS: Communication Perspectives and Promises

The control of sexual relations is with men. The determination of marriage rests with the father and brothers. Relations in the family are under the husband. Who the women sleep with is all under the control of men. If things go right, the credit goes to men. If things go wrong, the blame goes to women. The prevention of AIDS always focuses on how to control women's sexuality. As is always the case.

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So when they talk about virginity, they are talking about women. Women have no cultural or legal power to control safe sex. Sixty-six percent of the clients served are female. Almost 90 percent of these women get infected through unprotected heterosexual sex. Sheila Ndyanabangi is in charge of mental health at the Ministry of Health, an office that also addresses general human rights issues.

She highlighted male infidelity within marriage as a principal cause of HIV infection in women: "There is a high incidence of infection amongst faithful wives of errant husbands. The woman most at risk is a woman in a monogamous marriage. For some, rape and battery had literally become part of the fabric of their daily lives.

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Individual women, NGO representatives, and government officials all referred to the prevalence of the belief that wives have no right to deny their husbands sex. A women's rights activist declared, "Men proceed under the common law assumption that saying 'I do,' means that you no longer have the right to say 'I don't. Lydia Mbakile, a thirty-six-year-old HIV-positive widow, explained: "I think women should give their husbands sex. If you say 'that is my husband' you have to finish up [complete] the duties that he has delegated to you. A number of government representatives stressed that married or cohabiting women appeared to be at a far greater risk of HIV infection than single women.

The single woman does not have a contract. The fact that in some cases actual violence did not take place did not alter the coercive nature of these relationships. Women's own belief that they had no authority over sex often made it unnecessary for husbands to rape unwilling wives. Masturah Tibegwya, a Munyankore, is forty-eight and lives in Luwero.

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She is on her second marriage, and first got married in , at about the age of She says that although her first husband was violent, he never had to force her to have sex because she knew her duty:. He never forced me into sex. He would beat me for other things but not sex. There were other times I had sex with him when I didn't want to. I would just do it. What could I do? It's the Banyankore tradition. In our tradition the men don't physically force you but they don't need to.

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It is the honor of your parents. I have never used a condom. It's taboo. I am HIV-positive. I don't know where it came from. My first husband died. He died of AIDS. Joy Kobushingye, forty-five, told a similar story. She continued to have sex with him despite his extramarital affairs. What do you do? Unless you intend to break [up] the marriage. That is not a strong reason to leave a home. I don't know about forcing.

There is no negotiation.

You know that you must. Many of the women were afraid to introduce the subject of prophylactic protection for fear of being beaten either for suspecting their husbands of having extramarital affairs, or because they might be accused of adultery themselves. When they did raise the subject of condom use, violence typically ensued.

Preventing an HIV infection - Infectious diseases - NCLEX-RN - Khan Academy

Margaret Namusisi, twenty-five, moved in with her husband when she was fourteen and he was forty. She explained why she continued to have unprotected sex with him despite her desire to stop having children: "There are times when I don't feel like [sex] and tell him to use a condom, but he doesn't want to. I'm on family planning. That causes disputes. When I tell him to use a condom he refuses. He accuses me of having other men.

African Women's Unique Vulnerabilities to HIV AIDS: Communication Perspectives and Promises

He goes away and doesn't provide. So I have sex with him so that he can look after the children and won't fight. Sara Kisakye's account of her relationship with her ex-husband is a vivid illustration of the powerlessness many women experienced as a result of violence. Kisakye, a thirty-one-year-old Muganda woman, left her husband in January as a result of his violence and extramarital affairs. She described how her husband would refuse to use condoms and how he would often beat her because she refused to have unprotected sex with him. She explained:.