Solidarity Against HIV in a Polygamous Marriage

Yusuf is a 62-year-old Ugandan restaurant owner, the father of 30 children, and the husband to three wives. He is also living with HIV, as is his first wife, Safina. His other wives, Aisha and Nuriat, are HIV-free. Theirs is a serodiscordant polygamous marriage, meaning that at least one partner is living with HIV, while one or more is HIV-negative. The situation of this family is not unusual in Uganda — and it highlights the importance of disclosing HIV status to prevent transmission of the virus.

A Diagnosis

Yusuf — a 62-year-old Ugandan restaurant owner, father of 30 children, and husband to three wives — discovered his HIV status in September 2013 when he was tested in response to lingering health problems following dental surgery.

Yusef was immediatley referred to counseling and treatment services supported by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), through its Strengthening TB and HIV/AIDS Response in Southwestern Uganda (STAR-SW) project. Through these services, Yusuf acquired education on HIV and its treatment, and on the importance of disclosure to his partners. Disclosure, particularly in serodiscordant relationships, is essential to the health of both HIV-negative and HIV–positive partners; it is associated with both prevention of infection in the uninfected partner and improved retention on lifesaving drugs in the HIV-positive individual. Disclosure, however, can be traumatic for the newly-diagnosed individual due to fears of stigma, partner violence, and rejection.

Courage to Disclose to Multiple Partners

The support Yusuf received from health workers created a comfortable and safe environment for him to disclose his HIV status to his wives. “I told my elder son my status first,” says Yusuf. “He and the health worker encouraged me to tell my wives, so I called all my wives the next morning and told them together that I am HIV-positive. I pleaded with them to test that same day.” 

Safina tested positive for HIV, while Aisha and Nuriat, tested negative. Like Yusef, Safina immediately enrolled in antiretroviral therapy (ART), and her CD4 cell count has steadily improved. She is grateful for her husband’s early disclosure. “When I tested HIV-positive and my co-wives were negative, I could not believe it,” Safina says. “I am now glad my husband told us about his status immediately; that is what I like most about him, he does not hide anything from us.”

Yusuf, Aisha, and Nuriat collectively agreed to reduce sexual activity and use condoms consistently to ensure that Aisha and Nuriat remain HIV-free. “We are proud of our husband’s and co-wife’s courage and deliberate effort to keep us safe from HIV,” says Nuriat.

While stigma continues to be a problem for many Ugandans living with HIV, Yusuf and Safina do not fear disclosing their HIV-positive status to others. Aisha and Nuriat are, likewise resolute. All partners in the marriage support and care for each other. “Everyone here knows about HIV,” says Safina. “We are not treated differently at the health center and do not feel ashamed of being sick. My husband has a restaurant and is running a business like any other person.”

A Unified Front Prevents Transmission

In Yusuf’s case, early disclosure and enrollment in care resulted in prompt diagnosis and better health outcomes for his entire family. These proactive steps, coupled with the availability of a strong primary health care system supported by the STAR-SW project have helped ensure the good health of this family.

“Though the news of having HIV was heavy for me,” says Yusuf. “I am now glad [my dentist] tested me and referred me to HIV treatment.” Yusuf hopes that his story of honesty and care in the face of disclosure — and the response of support and good health — will encourage others to do the same.

This article has been supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID) under the terms of funding provided to the Elizabeth Glaser Pediatric AIDS Foundation in the implementation of the USAID Strengthening TB and HIV AIDS response in the South Western Region of Uganda (STAR-SW project). The contents are the responsibility of the Elizabeth Glaser Pediatric AIDS Foundation and do not necessarily reflect the views of USAID or the United States government.