So I am to write about the nuances of living with HIV as a woman in Nigeria. My first thought was ‘ do you have time’? The issues leading up to and concerning the HIV + Nigerian women are many and multi-dimensional but they all point to one thing: culture. I will look at it from different angles, peppering it with true-life stories as we go along.
People I have told about my illness always ask the same question initially: How did you get it? My answer is always I do not know. I was not particularly cautious about not sharing blades or clippers, etc., so it could have been contracted through those means. But if truth were to be told, I was not particularly careful about my sexual dalliances either. And this is my first ‘port of call’ on this topic: Prevention.
I had sex with various people for several reasons ranging from fear to confusion. But the underlying reason was that I was clueless as to how to say NO. I have spoken extensively on this in my blog so I shall just rush through it here. Sexual abuse when i was 13/14 and the absence of sexual education in any form from my family provided excellent foundation for my vulnerability to sexual overtures from the opposite sex. Bereft of self-esteem and direction, it would be sex as they pleased, how they pleased. It is pertinent to point this out because the cultural and societal nuances at play in my life at that time are very prominent even today.The patriarchal nature of the Nigerian society and taboo around (the discussion of) women’s sexuality creates a very conducive environment for unhealthy relationships and high-risk behaviour on the part of women. Women are not taught to (or used to) negotiating the process of sex, not encouraged to purchase or carry condoms. Nigerian boys and men can be promiscuous and ‘sow their wild oats’ but girls and women are forbidden to speak about sexuality and are thrown into the world without any education whatsoever about their bodies or sexual health. Add to that a society that continuously emphasizes that a woman is nothing without a man by her side and you have a scene set for dangerous/fatal liaisons. To wit, if we are ever to prevent HIV in Nigeria, we need to critically assess our cultures’ sublime messages.
I discovered my status when I was pregnant- I was/ am one of the lucky ones. A lot of women do not discover their status until it becomes very late, usually when they are very sick and/or dying. However, because it has become mandatory for pregnant women to be tested for HIV immediately they begin antenatal attendance, a few are lucky enough to catch it relatively early, and begin treatment. There is another side to this issue of Nigerian women discovering their status, the side that involves sex and partners. I found a common story thread among quite a number of women in my treatment centre. They had a partner-usually a husband- who was infected but hid it from them. While some began receiving treatment privately, a number of them (the husbands) did not until it was too late, and died of the disease, whereupon the wives would finally discover the HIV infection is the legacy the husband leaves for them and in some cases their offspring. Usually the method of transmission is sex, from an unfaithful husband, to his wife. Were a woman to suspect her husband of promiscuity and even suggest the use of a condom, it is very likely that the tables would turn and she would be either beaten into submission, be accused of infidelity and thrown out, be raped or all of these. This is usually for the lower class/ low income families that comprise the bulk of the patients at the treatment centre, and there is a slightly different reality for women in higher income families which I will attempt to define.
Divorce is still considered a taboo in the Nigerian society, and a failure on the part of the woman. Of course for women who have married into wealth or are originally from wealthy families, the scandal and resultant loss of income is more than they can bear. The solution therefore is to keep up the appearance of marriage but cultivate and maintain illicit relationships outside the home. Unfortunately both partners have other partners and when HIV is introduced, it is spread.
I should have been one of the lucky women who discovered and treated her illness early, but I was not; a victim of an unscrupulous doctor who under the guise of providing me convenient HIV treatment gave me drugs contraindicated in pregnancy, I never actually received care until 3 years later.
In Nigeria, HIV treatment for women and men is basically the same: a swarm of people, converge on a centre on their designated day and endure 4-7 hours of waiting, rudeness and impatience from clinic workers. There is no respite for those who miss their designated days and there is no quick fix for those in a hurry. In some ways it is easier for men to make appointments than women. The reason is that a married woman living with HIV may have a difficult time explaining to her spouse and/or employer why she has to drop everything at a specific time every particular month or couple of months. A man may not face such difficulty.
Another factor is wealth. In all my years of going to the centre I have not seen any patient who sounded as educated as I did, or who seemed to come from a higher income bracket than low-income earners. It therefore stands to reason, that despite the best efforts of the international donors, proper HIV treatment is more available for the rich than for the poor. Again, the odds are against the women who usually earn less than their male counterparts or are in control of less resources. Unfortunately, this also accounts for the increased rate of infection Nigeria is experiencing.
This article will be incomplete without touching on love and relationships. I personally have avoided relationships ever since I was diagnosed- 5 years – for fear of rejection and stigmatization. I do not know that there will be many men who will hang on after you utter the dreaded letters.I know many things people will accept before they accept a Person Living With HIV/AIDS (PLWHA). But I recently heard about someone, another PLWHA who is dating successfully even though he is upfront about his status on the first date. My centre has begun a sort of matchmaking service for people who want to get married but I have zero interest in that. Apart from the fact that I stick out like a sore thumb, I do not want a disease to be my reason for choosing a partner.