AIDS, Culture, and Africa

12. HIV/AIDS and the Context of Polygyny and Other Marital and Sexual Unions in Africa: Implications for Risk Assessment and Interventions

12 HIV/AIDS and the Context of Polygyny and Other Marital and Sexual Unions in Africa Implications for Risk Assessment and Interventions Teresa Swezey and Michele Teitelbaum Introduction Some attention has been paid to the impact AIDS has had on the African family with respect to widows and orphans. Orphans and vulnerable children have especially been the target of funding and multiple interventions to address their needs. Limited observations have been made about the impact of AIDS on formal marital arrangements, but little has been done to incorporate a realistic view of African marriage into policy, funding, and interventions. Some policies and funding decisions appear to be based on an idealized, prescriptive concept of marriage. Most notably, the “ABC” approach to HIV/AIDS prevention—abstain, be faithful, and condom use— promotes abstinence before marriage, fidelity to one partner within marriage , and targeted use of condoms by high-risk groups. This chapter explores a less idealized concept of marriage, one that shows that African marriage can be a relatively fluid concept that includes polygyny, several other arrangements that can be called “de facto polygyny,” and serial monogamy. This broader concept of marriage, interacting with gender dynamics and current economic reality in Africa, has implications for assessment of risk for HIV/AIDS. Household-level data collected from Basoga Muslims in Uganda also suggest that gender stereotypes of women as either virtuous wives or commercial sex workers have obscured the wider range of roles that women may have in contributing to risk within marriage. 221 HIV/AIDS and the Context of Polygyny and Other Marital and Sexual Unions A broad view of marriage in Uganda and a wide perspective on women’s sexual behavior can be seen as a positive development, in much the same way that many see the “sexual revolution” in Western society, which has led to acceptance of sex without marriage and serial monogamy in many segments of society. Similarly, Western society has frankly acknowledged a wide range of sexual behavior among heterosexuals and gay men and lesbians , and a less prescriptive view of marriage, as prerequisite to effective mitigation of the risk of HIV/AIDS. We argue for comparable frankness in risk mitigation in Africa, which would include a more realistic approach to risk assessment than one focused on monogamous sexual dyads, or “couples.” We also point to the need to address underlying socioeconomic factors that may lead to an increase of risky behavior. For example, in Western society, AIDS programs address sex-for-drugs exchanges; in developing countries of Africa, we may need to address situations of economic vulnerability that lead some women to increase the number of their sexual partners. Marriage Does Not Mitigate Risk Irrespective of the need for a broader approach, for many women in subSaharan Africa, a commitment to monogamy within a marital union or steady partnership is no guarantee against HIV infection. An estimated 60 to 80 percent of women infected with HIV in the region have had only one lifetime sexual partner (Rivers and Aggleton 1999; see also Whelan 1999). Most women living with HIV/AIDS in sub-Saharan Africa, as well as globally , were infected by their “primary partner” (O’Leary 2000).1 The results of a ten-year longitudinal study in the Masaka District in Uganda found, for example, that “in married couples where both partners are not infected, men bring HIV infection into the marriage at twice the rate of women. This is probably owing to extramarital sexual behaviour” (Whitworth 1999: 181).2 The idea that women who remain “faithful” will be at less risk, or that women are in a position to effectively negotiate condom use with their husbands or steady male partners, is belied by gender power differentials within marital relations and other unions. These gender power differentials in control over sexuality within and outside of marriage mean that many women have little control over their husbands’ or steady male partners’ sexual behavior (Blanc 2001; McGrath et al. 1993; Gupta et al. 1996; Schoepf 1998; Simmons et al. 1996; Ulin 1992). Given this, de Bruyn and colleagues (1998: 14) argue that “marriage should be squarely acknowledged as a major risk 222 Teresa Swezey and Michele Teitelbaum factor for women in many societies.” If monogamous marriage has so little impact on risk mitigation, an understanding of the dynamics of a broader range of marital arrangements and sexual unions in sub-Saharan Africa is a critical precursor...