Survey finds surprising attitudes to HIV

HIV-negative. Among the singles, 10% said they had never tested. In gender, 3% female and 7% males have never tested. Those who said they did not know their HIV status were only males. This reflects men’s poor health-seeking behaviour, which is also an epidemic driver.

HIV infection

Respondents were asked: How are you protecting yourself and partners from HIV infection? Half of them said they were faithful to their partners, 19% test regularly with all their sexual partners, 15% said they were abstaining, 18% use condoms all the time, 17% got circumcised, 15% use condoms only when they cheat and 2% have used Pre Exposure Prophylaxis (PrEP). However, the talking point is on the 9%, who said they were doing nothing and leaving it all to God.

It may seem an act of faith, but the responsibility of staying HIV-negative is yours as an individual. People should take advantage of the known, proven preventive tools science has given us. Living a risky sexual life in the hope that God will protect you is vain and a risky way of contracting HIV. Respondents whose topmost education was O’level said they had never abstained, used a condom or PrEP.

Most leave it all to God. 8% of postgraduates also do nothing. Among females, the preferred strategy was faithfulness, followed by abstaining, condoms all the time, testing regularly, leaving it to God, condoms when cheating and lastly, PrEP. But among men, faithfulness led too, followed by circumcision, then condoms when cheating, testing regularly, condoms always, abstinence and leaving it all to God, PrEP, too, came last.

PrEP is the HIV medication you take when you are negative to protect yourself from HIV infection. It is available for free but, just as the survey shows, its uptake is still low. People who are exposed like sex workers, discordant couples, travellers and anybody who perceives risk in the next sexual opportunity, should be able to use PrEP.

The top three protection priorities for People living with HIV in the study were faithful, condoms always and leaving it all to God. For negative people, the three were faithfulness, testing regularly and using Condoms always.

Protection preference

Respondents were given options of HIV protection and those below 20 tend to prefer abstinence (75%) and faithfulness (50%).

From the 20s, faithfulness takes over and remains the most popular throughout the age groups. But among the 20s, it is followed by condoms all the time and, in second position, abstinence and circumcision. In the 30s, faithfulness is followed by use of condoms whenever there is infidelity, and then, testing for HIV regularly. The 40 agers prefer testing for HIV regularly second, followed by circumcision.

And from the 50s and above, testing regularly gets followed by leaving it all to God, which is unfortunate. Experts explain this resignation to fate as resulting from the perceived threat of HIV. The elderly often make a mistake of imagining that HIV is for the young. Secondly, men start having problems achieving and maintaining erections due to old age, diseases like diabetes and reduced libido. So use of condoms becomes an inconvenience. Women find that their choice of sex partners is limited and the motivation to reject the one who has come dies. The elderly also have emotional needs to bond sexually often ignored by their spouses.

If a partner tests positive

The survey question was: What would you do if you are negative and the person you love has just tested HIVpositive? The options were taking off, staying but to use protection, staying a good friend but stopping all sexual contact, continuing with the sexual relationship and I don’t know. The majority (77%) chose not to abandon the partner, which shows what a long way we have come from in terms of stigma.

A 2013 stigma index study by the National Forum of People Living with HIV Networks in Uganda (NAFOPHANU), showed a 23% prevalence in 2012. Six years later, this tolerance is commendable. Of this majority, 50% said they would remain good friends but stop all sexual contact, 24% said they would stay but use protection and that is commendable. Protection in sex with a person living with HIV includes condoms and Pre Exposure Prophylaxis (PrEP).

According to research, even circumcision, treatment of STDs and ARV microbicides can give you an additional backing of protection. 3% said they would continue with the sexual relationship, nevertheless and that is either a misunderstanding or irresponsibility. Discordance does not mean you are resistant. It is a matter of time for transmission to occur after repeated exposure.

The 11%, who said they did not know and the 12%, who would close the relationship and take off, show irresponsibility of an uninformed character. A person who has just tested positive needs care and understanding. No one wants to get HIV. It does not mean immorality, or death and they can live a normal life with adherence and positive living.

Unfortunately, 19% Muslims, 14% Born-Again, 11% Catholics and 11 Anglicans in the study said they would take off. Among the married, 11% of monogamous people and 4% of polygamous couples would take off. 4% of polygamous respondents would continue the sexual relationship. Among the cohabiting, 55% would keep the relationship but stop the sex, 21% would start protection, 9% would take off and 2% would continue with the sex anyway.

62% of singles would stop sex, 12% would take off, 12% would use protection and 3% would continue nevertheless.

Stigma falling

One of the most welcome finding was that majority of the respondents would support their partners who test HIV-positive.

This indicates that the fight against stigma is progressing well. A 2013 study had revealed that stigma still reigned as the most common impediment to the HIV fight. The People Living with HIV Stigma Index Report, 2013 gave the commonest form of stigma against people living with HIV as gossip, verbal insults and threats. Out of 1,000 HIV-positive people surveyed in 18 districts in Uganda by NAFOPHANU, 23% reported losing jobs and being discriminated at work in 2012.

The Vision study, five years later, shows that 77% of the respondents said they would never abandon a partner who has tested HIV-positive even when they are negative. 51% said they would remain good friends, but stop all sexual contact. 24% said they would stay in the relationship and use protection. 2% even said they would continue with the sexual relationship.

While sexual relationships, where one partner is HIVpositive and the other is negative (discordance), are common (with almost 43% of all new HIV infections being discovered in adult couples), having unprotected sex with an HIV-positive partner is risky, unless Pre Exposure Prophylaxis is used.

Surprises in the survey

• There are people who are not bothered by protecting themselves against HIV. 9% of the respondents said they leave it all to God.
• 15 of the 303 respondents who answered the testing question said they had never tested for HIV. 21 respondents skipped the question and of these, 4% were married and 2% cohabiting.
• 12% of the people said they would take off once their partner tests positive for HIV when they are not. 2% said they would continue with sex nevertheless.
• 39% of Catholic respondents said they use condoms for protection against HIV. 24% said they use them all the time, while 15% said they use condoms only when they cheat on their main partners. Yet use of condoms is prohibited in the Catholic Church, which emphasizes that fidelity rather than condoms should be the primary prevention of HIV transmission.
• 3% of the respondents said they would look for and beat up the partner they think was responsible for their HIV acquisition. These included Catholics (5%), Anglicans (3%) and Born-Again (1%), whose religious norms emphasize forgiveness.
• There is low PrEP uptake among the respondents. Only 2% (6 people out of 298) said they had tried PrEP. 12 respondents skipped the question.
• l 45% of the respondents said they were satisfied with the way the Government is handling the HIV response against 33%. Dissatisfaction raged especially among respondents of lower than university education. But the majority, who were of university degree and above, said they were satisfied.
• 15% said HIV is no longer a big problem. l 6% of university and post-graduates would leave their protection from HIV to God.