UGANDA - Kampala – New Vision - SULIMAN Byamugisha, a 40-year-old army officer, married to Hellen went for an HIV test at the AIDS Information Centre after his wife suspected that he was cheating on her.
"My wife proposed to go with me to the clinic for an HIV test because she refused to believe the results from the first test which I took without her," Byamugisha says.
The Ministry of Health recently launched the "Go Together Couple HIV Counselling and Testing National Campaign" to encourage couples to discuss HIV together, go for counselling and test together, adopt and maintain positive health practices and know their HIV status.
According to the 2004-2005 Uganda HIV sero behavioural survey, there is a high incidence of HIV among married couples. Married persons account for about 65% of new infections while discordant couples make up 50% of these transmissions.
Dr. Zainab Akol, the programme manager STD/AIDS control programme, says despite the high sensitisation on where to get an HIV test, couple HIV counselling and testing remains a challenge.
Francis Mukasa, a resident of Kisenyi, a Kampala suburb, says he and his wife went for an HIV test when he was told by his wife that the AIDS Information Centre (AIC) was offering free HIV services.
"We had always longed to get this test but my husband always told me he was busy and lacked money to do the test, until AIC offered to counsel and test free of charge," says Namusoke, Mukasa's wife.
Taking an HIV test together helps couples know their status hence better planning for their life and children.
Akol says: "Less than 13% of men and women currently married have tested for HIV and received the results, while 3.3% of married women and 4.3% of married men have done so in the last 12 months."
Grace Namwanje Ssebbanja, a marriage counsellor at AIC, says most women are willing to test but men are reluctant. "When we ask women why they do not come with their spouses, the most cited reason is that men are busy," she says.
Namwanje adds that some couples are tempted to go for testing after reading some suspicious text messages of their partners.
She says because of men's reluctance in testing for HIV, some hospitals write letters to the husbands requesting them to go with their partners during antenatal care.
"For instance Mulago Hospital writes a letter to the man inviting him to the hospital. When he goes there, they counsel him and tell him the advantage of testing as a couple for both partners and the unborn baby," Namwanje says.
Akol says the "Go Together Know Together" campaign test for HIV aims at encouraging couples to discuss HIV together, go for counselling and test together, adopt and maintain positive health practices and encourage HIV status disclosure.
During the national launch of the "Go Together Know Together" campaign, couples had the opportunity to get tested. There was a big turn up at the two testing centres - AIC and Uganda Cares with 151 and 124 couples respectively. Among those tested, 11 people were positive.
She says many couples are afraid of bringing up the issue of going for counselling and testing with their partners because they fear it would lead to accusations of infidelity.
Akol says 31.2% of women and 45.6% of men between the age of 15-49 years argue that they do not need an HIV test or that they have a low risk of being infected with HIV.
"An estimated 21% of women and 23% of men perceive themselves to be at a high risk of getting infected with HIV.
Another 36% of women and 35% of men perceive their risk as moderate, while 18% of women and 17% of men perceive low risk. Twelve percent of women and 13% of men think they have no chance at all of getting HIV," she says
Namwanje says fear of knowing one's status and the consequences is another behavioural barrier. Sixteen percent of women and 9% of men do not want to know if they have the virus.
She adds that individuals are concerned about the health implications of receiving HIV-positive results and the reactions of their partners.
"Some partners, when found positive, are physically abused, blamed, neglected and become the topic of community gossip. In some cases when the man is found HIV-positive and the woman HIV-negative, he tends to force his wife into having unprotected sex," Namwanje says
Akol says lack of knowledge about where to go for counselling and testing, and low capacity of counsellors to deliver effective counselling for couples, have also hindered the campaign since couples require specialised counselling.
A facility assessment conducted in preparation for the campaign revealed that health units are often understaffed, while in some, there are no staff trained in HIV counselling and testing on top of inefficient referral mechanisms.
Dr. Sam Zaramba, the director general of health services, says married and cohabiting couples in Uganda are at a higher risk of HIV infection than the unmarried.
"Over 6% of married and cohabiting couples are estimated to be HIV-positive, compared to less than 2% of those not married," Zaramba says.
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