HIV and gender

There are four Einstein medical students here for the summer. They travel to villages each day to do health worker training. They have the privilege of walking that delicate line between medical necessity and cultural acceptability. As a result, they end up in long conversations about cultural norms and behaviors, and they learn things about this society that I would never find out from my lonely hospital post.

Michal, one of the med students, recently told me a few things about gender relations in Uganda that left an impression. If a woman says she has HIV, that's taken as an implication against the husband. The assumption (usually correct) is that he has been sleeping around, he gave it to her, and that he has HIV too. So if a wife is publicly known to have HIV, the husband's response will be to condemn her. He will say that she is one sleeping around, and kick her out of the house.

So fine. Your husband's been cheating on you, and he gave you HIV. Maybe you’re better off without him right? Except that when a wife is kicked out she leaves with nothing. She takes no money, no property, no children. Let me repeat that last one: she can't take her children with her. She knows her husband will do nothing to care for the children, and his other wives certainly won’t. It's basically a death sentence for her children.

A woman who reveals she has HIV destroys not only her own life but that of all her children. Any wonder no one is willing to admit it?

(p.s. maybe I shouldn't be so angry at that patient last week who didn't disclose her diagnosis.)