Challenges HIV positive married persons attending Kanyama Clinic face in using Condoms
Résumé
The ideal situation is that HIV positive married individuals ought to use condoms throughout their sexual life in view of preventing themselves from HIV reinfection except when the couple opts to have a child. However, from the time the ART program was scaled up in various health centers in Zambia almost five years ago, the rate of condom use among concordant HIV positive couples has not been studied and there are many issues that remain unknown. This study was designed to answer four research questions which are: (i) what is the condom use rate like among HIV positive married couples? (ii) Regarding their status of being HIV positive and married, what challenges do they experience sexually? (iii) In what ways do they cope? and (iv) noting the rate of condom use, why do they sexually behave in the manner they do ?
The study was specifically carried out at Kanyama ART clinic in one of the consulting rooms and a qualitative research rooted in the abductive research was used. The data for this study were drawn only from HIV positive married patients on ARV’s attending the ART clinic. Theoretical sampling of HIV positive married patients was the main stay for the study. Each respondent was interviewed in-depth and data was analyzed using content analysis informed by grounded theory.
The findings were that 14 (25 per cent) of the couples were consistent in using condoms when having sexual intercourse, 27 (47 per cent) were inconsistent and 16 (28 per cent) did not use any condoms at all. Respondents in this study experienced nine challenges which ranged from : (i) experiencing adverse effects due to condom use (ii) violence when denied sex without a condom, (iii) failure to convince partner to use a condom, (iv) desiring to have children and stopping to use a condom (v) quarrels on account of refusing to use a condom,(vi) desire for maximum pleasure (vii) lack of availability of condoms at the facility and cost of condoms which seemed to be high , (viii) refusal of advice and (ix) no problems at all with using the condom. On account of these challenges, the respondents used cognitive strategies and behavioral strategies to cope. Cognitive strategies included attempts to change the way one thinks about sex with condom use or not and behavioral strategies included one taking an attempt to reduce the impact of sexual stress. Specifically respondents coped in the following six ways (i) saying no to sex (ii) abstaining from sex if no condoms were not to be used (iii), rarely having sex , (iv) sought an alternative sexual partner because condoms were demanded in marriage (,iv) negotiating sex proved difficult and (vi) others did nothing at all. The reasons for selecting various coping strategies and whether to use or not use a condom were varied and the following stood out: (i) gender and the influence of patriarchy or (ii) one resigned and agreed to have sex with a condom in order for peace to prevail or (iii) one had to have sex because culture prescribed so, or (iv) one had experienced adverse effects warranting to use condoms or not to use condoms at all, or (vi) sex without a condom was pleasurable , or one had a number of fears and (viii) the fact that both were of the same status, sex with a condom was of no consequence.
The conclusion is that there are marked challenges of adhering to the condom prescription in marriage among people living with HIV and AIDS and on HAART as observed by the low rates of condom use. The challenges that women mostly face than men with condom use within marital partnerships are extremely immutable. It is recommended that Kanyama clinic considers the following measures to fortify HIV and AIDs health promotion and prevention programs within the ART Clinic:
1. The government with its collaborating partners concern, should consider coming up with economic empowerment programmes for women, such as micro credit loans, in order to empower the disadvantaged women and in the long run, alleviate themselves from the economic dependence they have on their husbands, so that they would be able to mitigate their failures the perpetually encounter with their husbands, in deciding to use a condom as it is often outside of their control due to poverty they face.
2. Adherence counseling ought to be holistic in the sense that it encompasses messages that include effective pleasure-based safer sex information and emphasize: on the benefits of treatment adherence and also to deliberately draw appointments that enables couples to be counseled together rather than have separate appointments in order to enable the disadvantaged women to bring up issues/matters their husbands hold off using condoms in the midst of the adherence counselor to address.
3. Introducing during regular screening or adherence assessments checking for biological markers such as sperm on vaginal smears, screening for pregnancy at random visits and evidence of sexually transmitted infection, so that the verb consent HIV positive married individuals indicate for condom use when they are asked during adherence counseling is clinically backed up or supported and also in order not to overestimated condom use basing on the manner condoms are collected from the clinic, but be estimated basing on the use.
4. The results of this study confirm that some married men are unwilling to use condoms at least some of the times and others all of the times. The promotion of condoms within such relationships needs to be strengthened in all HIV prevention programs, largely because resistance against condom use is difficult to overcome.