The Unseen Things: women, secrecy, and HIV in Northern Nigeria by Kathryn A. Rhine (review)

In this compact monograph, Kathryn Rhine explores the emotional, ethical and material dimensions of HIV-positive women's relationships with men in Northern Nigeria. Based on her lengthy acquaintance with HIV-positive women from Kano to Jos, Rhine emphasizes the performance of health that women must undertake to protect themselves and their children. Women counter the perception that to be dirty and unkempt is to be immoral and contagious by attending closely to their bodily appearance–their dress, hair, make-up, cleanliness and even their speech. In order to remain well they must project well-being.

Rhine established contacts in the context of support groups and sustained those relationships sometimes over many years, following the women's health, relationships and aspirations. She quickly discovered that the confessional ethos that dominates American philanthropic thinking runs counter to a central Hausa concern for restraint and discretion. Women did not attend such groups to be transformed by unburdening themselves of their secrets; they came in search of an HIV-positive husband. Self-disclosure entails the disclosure of the HIV status of others. By contrast self-care for women in Nigeria requires securing those relations (particularly in marriage) necessary to remain healthy. Silence is central to self-care.

Sustaining such relationships requires women to enter into a patriarchal bargain; they will remain silent about their male partners' HIV status, extramarital relations, physical abuse, and failure to provide for the family. In exchange, or so women hope, men will continue to support them, remain silent about their HIV status, and safeguard their reputations as respectable wives. However, women 'give far more than they receive in sometimes futile attempts to safeguard their reputations' (p. 57). Women keep secrets and provide care to others in the hope of being cared for themselves. A woman's knowledge of her partner's HIV status may give her some power; nevertheless, he may withhold money for medical care, refuse to pay for the naming ceremony of a newborn, or even divorce her to deflect attention away from his own HIV status (pp. 68–71). By divorcing a wife or refusing to recognize a child, a man implies that she has been promiscuous and that therefore any illness in the household has been caused by her. A woman who protests proves herself to be an uncompliant and disrespectful wife.

This explains to some extent why HIV-positive women who are aware of their status sometimes do not give birth at a medical facility, where the care given to them could reveal their HIV status and that of their partners. It accounts for why they may not follow optimal feeding practices to protect the newborn, since failing to breastfeed would raise questions in the household. Men and women play a game to avoid being the first to be diagnosed in a manner that both must recognize. As long as one or the other can feign unawareness, they can maintain silence regarding their status. However, this game makes it impossible for women to insist upon the use of condoms, request their partners to seek ARVs, or protect their co-wives from infection.

A thread that runs through the text is the contradictory status of HIV-positive children in such couples. While women may be eager to have children as a demonstration of health and womanly virtue, HIV-positive men may be less eager to have children. Rhine does not pursue this pattern specifically. But while a healthy child is a sign of fertility and general well-being for both a woman and her partner, an ill child is not. An HIV-positive child may be seen by men as more of a liability than an asset; physical abuse, refusal to recognize the child and divorce of the mother appear to be ways in which men distance themselves from the social, financial and emotional cost...